Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: 63M s/p left VATS, chest tube History: left chest tube Single left apically directed chest tube terminates at the posterior left fifth rib.There is a small left hydropneumothorax with a small amount of subcutaneous emphysema at the left infralateral chest wall. Diffuse mid to lower zone interstitial opacities may represent a combination of subsegmental atelectasis and aspirated secretions. There is a nodular opacity projecting over the posterior right eighth rib which may be a granuloma. Recommend further evaluation with a dedicated PA and lateral chest when the patient can tolerate.

Output: Small left hydropneumothorax in the setting of a chest tube.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval lung fields History: s/p MVR Lines and tubes are unchanged. Left basilar pleural-parenchymal opacity, increased from last study. Right lung remains clear. No significant pneumothorax. Unchanged heart size.

Output: Increase in left basilar opacification, likely atelectasis with some degree of pleural effusion. This can be reevaluated on imaging follow-up.


Instruction: Generate impression based on medical findings.

Input: Visualization of the thorax is limited by the field of view and length of scan, which excludes substantial areas of the lungs.CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant extra cardiovascular abnormalities in the visualized portion of the thorax.


Instruction: Generate impression based on medical findings.

Input: ETT check Persistent pulmonary opacities and edema-like pattern with large layered effusions and mild cardiomegalyBilateral jugular catheters, ETT and NGT are all otherwise unchanged

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: repositioned ETT/swan History: repositioned ETT/swan Swan-Ganz catheter has been pulled back slightly. Endotracheal tube may have been advanced slightly. Iatrogenic devices are unchanged otherwise. Patchy bibasilar opacities again noted. Unchanged cardiomegaly. No pneumothorax. Mild left-sided subcutaneous emphysema.

Output: Swan-Ganz catheter has been pulled back slightly.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: MaleReason for Study: Reason: eval for PNA History: cough, fever There is borderline cardiac enlargement.Retrocardiac consolidation is compatible with left lower lobe pneumonia.The right lung is clear.No pleural effusions.

Output: Left lower lobe consolidation compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: patient with slight desaturation this AM, 2L, r/o PNA vs. volume overload History: desaturation Small lung volumes with foci of subsegmental atelectasis, improved.A Dobbhoff tube terminates in the stomach.Right subclavian catheter, tip at right atrial level.Right jugular catheter removed.

Output: Nonspecific basilar subsegmental atelectasis, but improved since the prior study.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath question volume. Normal heart size. Low normal lung volumes. No signs of pulmonary edema or pleural fluid. No focal airspace opacities or pneumothorax.

Output: No acute cardiopulmonary abnormality. No signs of volume overload.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval new left subclavian catheter tip position History: left subclavian catheter exchanged through existing cordis Known right lower lobe nodule.Unchanged basilar interstitial opacities suggestive of edema with subsegmental atelectasis.Tracheostomy tube tip approximately 6 above the carina.Left subclavian catheter, tip just short of the SVC, terminating in the left innominate vein near the midline.Enteric tube identified.

Output: Left subclavian catheter, tip in left innominate vein near the midline.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lines/tubes/devices History: eval lines/tubes/devices Interval removal of Swan-Ganz catheter with a catheter sheath in the area of the right brachiocephalic vein.Left lower lobe opacity compatible with atelectasis and consolidation.Mild atelectasis at the right base and probable moderate pleural effusions.

Output: Interval removal of Swan-Ganz catheter and no other acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: heart failure History: - Normal cardiac and mediastinal contours.Swan-Ganz catheter tip in the right main pulmonary artery. Small right pleural effusion, not significantly changed allowing for projection.

Output: Small right pleural effusion and no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Dyspnea - evaluate for pulmonary edema or infection History: DOE Large right anterior hemidiaphragmatic eventration again noted. No focal lung consolidation. Normal heart size. No large pleural effusion or pneumothorax.

Output: Large right anterior hemidiaphragmatic eventration again noted. No focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Hypoxia and concern for pulmonary edema. Sepsis Persistent retrocardiac nonspecific opacity again incompletely evaluated with a semiupright portable technique. Decreased lung volumes with patchy densities in both bases likely atelectasis yet additional new bilateral haziness suggest possible layered effusions. Serial imaging is needed

Output: Nonspecific basilar changes suggesting edema with effusions, additional suspected left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval for chest pain History: CHF Basilar interstitial opacities appear chronic and the volumes are large.Ill-defined left upper lobe ill-defined opacity which has been waxing and waning since 1/7/2014.No specific evidence of infection or edema.Heart size normal.

Output: Chronic basilar interstitial disease. Ill-defined left upper lobe opacity, more recent CT performed and reference should be made to this report.


Instruction: Generate impression based on medical findings.

Input: Aortic valve replacement Interval removal of Swan-Ganz catheter without additional underlying cardiopulmonary change. Persistent decreased lung volumes and incompletely visualized mediastinal chest tubes.

Output: Swan-Ganz removed


Instruction: Generate impression based on medical findings.

Input: Reason: F/u effusions History: ADHF The heart size but upper normal.Interval decrease in bilateral pleural effusions with moderate residual effusions.No new findings.

Output: Decreasing pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: resp failure History: same Iatrogenic devices are unchanged. Bibasilar opacities and pleural effusions again noted. Unchanged heart size. No pneumothorax.

Output: Unchanged bibasilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: FemaleReason for Study: Reason: pneumo History: pneumo Motion limits sensitivity.Left sided chest tube with its tip at the apex. Persistent small left apical pneumothorax and decreased in size from the prior exam.Left pleural thickening/small effusion unchanged.Stable cardiomediastinal silhouette.

Output: Left apical pneumothorax decreased in size since the prior exam.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: FemaleReason for Study: Reason: copd, sputum production History: see above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.SOB. Loop recorder device has changed in position, now projecting over the left upper lobe near the hilum.The lung volumes remain low, with elevation of the right hemidiaphragm and chronic basal compressive atelectasis. No pneumothorax or visible signs of pneumonia. Unable to entirely exclude a layering left pleural fluid collection.Soft tissue artifact from abdominal pannus projects over the lower lungs.

Output: No conclusive acute pulmonary abnormality. Apparent change in position of the loop recorder device within the soft tissues due to change in patient position.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old, status post stem cell transplant with history of RSV status-post ribavirin therapy. LUNGS AND PLEURA: Diffuse bronchiolitis pattern with centrilobular and tree-in-bud nodules, particularly at the bases, as well as a few areas of air space opacity have improved when compared to the prior examination. Mild bronchial wall thickening persists.MEDIASTINUM AND HILA: Cardiac size is normal. Small pericardial effusion is new. Right IJ catheter, tip in the SVC.CHEST WALL: Old fractures of the left clavicle and multiple left sided ribs resulting in left chest wall deformity. UPPER ABDOMEN: The spleen is enlarged. Nonspecific focal hypodensity in the posterior aspect of the spleen is not significantly changed.

Output: Interval improvement in diffuse pulmonary opacities. These findings are compatible with, although not completely typical of, a viral infectious process as suggested by the clinical history. Other etiologies, including mycobacterial and fungal infection, may produce similar findings.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for fluid overload and other causes of tachypnea History: labored breathing Interval extubation.Right jugular catheter tip in the right atrium and NG tube tip in the gastric antrum.Moderate cardiomegaly with pulmonary opacity compatible with edema and pleural effusions, greater on the right.

Output: Findings compatible with fluid overload.


Instruction: Generate impression based on medical findings.

Input: 87-year-old female presents with altered mental status and confusion. Evaluate for pneumonia. The cardiomediastinal silhouette is normal. The aorta is mildly tortuous. No focal pulmonary opacity, pleural effusion, or pneumothorax..

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval ETT, lung fields History: s/p CABG Endotracheal tube terminates about 4 cm above the carina. Mediastinal drains. Swan-Ganz catheter terminates in the right main or proximal right interlobar artery.Low lung volumes with large left pleural effusion. Septal thickening indicative of edema.

Output: Signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: eval left rib protuberance History: left rib, painful protuberance Mild eventration of the right hemidiaphragm. No displaced rib fracture. The lungs and pleural spaces are clear. Heart size is normal. If there is continued question of abnormality of rib protuberance, consider coned-down radiographic views of that location.

Output: Eventration of the right hemidiaphragm. Otherwise, no significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old. H/o vaginal cancer, incompletely treated, presents with abd pain, n,v, tenderness. Low lung volumes. Mild basilar subsegmental atelectasis. No new focal airspace opacity. No pleural effusions or pneumothorax. Cardiomediastinal silhouette is unchanged.Surgical clips in the right upper quadrant. IVC filter in place.Nonobstructive bowel gas pattern. Gas and stool seen within the colon.No pneumatosis or portal venous gas. No free air seen on upright imaging.

Output: No evidence of obstruction.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Palpitations and syncope. No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Dysphasia COPD and mild scattered fibrotic interstitial changes without superimposed acute air space abnormality. Specifically no findings to support concern for metastatic diseaseThe cardiac psoas within limits. Mildly tortuous aorta with more moderate atherosclerotic disease changes of the aortic arch

Output: Degenerative end age related changes without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Intubated, assess for infiltrates. Endotracheal tube tip 6 cm above the level of the carina. Enteric tube has been advanced with tip in the caudal margin of the radiograph.Large superior right lower lobe mass with a small loculated pleural fluid collection or pleural thickening about the same. Diffuse interstitial opacities bilaterally, right greater than left, without acute change.

Output: Diffuse interstitial opacities suggestive of edema. Large right lower lobe mass.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Line evaluation. Lung transplant status. Bilateral pleural effusions, right greater than left with underlying atelectasis stable. Cardiomegaly with possible pericardial effusion is also unchanged. No pneumothorax. Dobbhoff tube at least within the stomach below the level of the image.

Output: Stable bilateral pleural effusions and atelectasis. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: 72 year-old female with breast cancer known right pectoral recurrence. Evaluate disease status CHEST:LUNGS AND PLEURA: Fibrotic changes and volume loss right upper lobe, unchanged. No lung nodules or effusions.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 1.9 x 1.5 cm. More properly measured on the prior exam as 2 x 1.5 cm on series 4 image 37 and therefore I believe it is unchanged. Other small superior paratracheal nodes are unchanged. Coronary artery calcifications.CHEST WALL: No previously seen right pectoral noted is not visible on measurable on the scan.Status post right mastectomy. Breast implant on the right.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst unchanged. Mild dilatation common hepatic duct to 1.2 cm as seen on coronal image 68, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Multifocal cysts in the head body and tail of the pancreas redemonstrated. I PMNs cannot be excluded. This is probably causing compression of the common bile duct. There is no evidence of pancreatic ductal dilatation. A few pancreatic calcifications is seen enhancement process lateral aspect of the head. There are calcifications throughout the splenic artery however.ADRENAL GLANDS: 1.9 x 1.5 cm right adrenal nodule series 3 image 82 previously measured 1.8 x 1.2 cm.KIDNEYS, URETERS: Bilateral renal cysts stable.RETROPERITONEUM, LYMPH NODES: No atherosclerotic changes aorta no evidence of focal aneurysm. No pathologic sized retroperitoneal nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osteoporosis, scoliosis and degenerative changes. No lytic or blastic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable pancreatic cyst or cystic lesions and stable mediastinal adenopathy. Right adrenal nodule. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.ACS sickle cell. Right jugular dual-lumen chest port distal tip at the SVC. Normal heart size. No focal airspace opacities, visible pleural fluid or pneumothorax. A portion of the right upper lobe is obscured by the port and cannot be assessed.

Output: No acute pulmonary abnormality. No radiographic signs of acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Male; 64 years. Reason: mets esophageal cancer, on chemo, pls c/w previous study and evaluate tx response. CHEST:LUNGS AND PLEURA: Emphysema. Tree-in-bud opacities in the right base, overall similar to priorMEDIASTINUM AND HILA: Postsurgical appearance esophagectomy and gastric pull-up, similar to prior. No gastrohepatic lymphadenopathy. Reference right hilar lymphadenopathy (series 3 image 51) measures 1.9 x 1.8 cm, unchanged. Severe coronary calcifications.CHEST WALL: Right-sided Port-A-Cath with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts with a minimally complex cyst with peripheral calcification on the left.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm with aorto bi-iliac graft measures 4.4 x 3.9 cm, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable small fat containing hernia in the anterolateral left upper quadrant (series 3 image 146). Post surgical changes of the anterior abdominal wall.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: Stable exam. Persistent right basilar tree-in-bud opacities may suggest chronic mild aspiration.


Instruction: Generate impression based on medical findings.

Input: 47 year old male with history of lung cancer. Evaluate response to chemo and radiotherapy. CHEST:LUNGS AND PLEURA: Centrally necrotic and peripherally enhancing left upper lobe mass without significant change, measuring 88 mm by 74 mm; previously measuring 83 mm x 73 mm (note prior report incorrectly states the lesion's dimensions). Increasing surrounding opacity most likely represents post radiation changes.Small left effusion and associated subpleural atelectasis, both decreased on comparison to prior study.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. The mediastinal fat adjacent to the pulmonary artery appears to be invaded by tumor (unchanged). Tumor thrombus is again noted in the left superior pulmonary vein (unchanged). Small pericardial effusion, slightly increased. Thickening of the esophageal wall, likely post radiation in etiology.CHEST WALL: No significant abnormality noted. No specific evidence of rib destruction to suggest invasion.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left parapelvic cyst. Normal right kidney.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable disease. Decreased pleural effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Retained foreign body fragments. Missing needle. Endotracheal tube terminates 4 cm from the carina. Right IJ sheath in place. Bilateral chest tubes. Question of small basilar left-sided pneumothorax which has subsequently resolved. Mild left-sided subcutaneous emphysema. Diffuse pulmonary opacities most consistent with pulmonary edema. Unchanged cardiomegaly.

Output: Question small left-sided basilar pneumothorax which has subsequently resolved.


Instruction: Generate impression based on medical findings.

Input: Pleural effusion worsening or stable? Decreased breath sounds over LLL Right jugular dialysis catheter remains unchanged terminating in the upper SVC. The underlying loculated pleural fluid and/or mass appears similar with associated pleural changes suggesting superimposed free fluid. Superimposed atelectasis with near complete compression of the left lower lobe again observed unchanged. Overall appearance correlates with recent CT.Right lung remains clear.The cardiac and mediastinal contours are grossly within limits

Output: Moderate to large left pleural effusion, suspected marked loculation and underlying atelectasis or less likely consolidationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Reason: eval for pneumonia History: AMS No focal pulmonary opacity, pleural effusion, or pneumothorax.Tortuous thoracic aorta, consistent with age.Normal cardiac silhouette size.

Output: No evidence of pneumonia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: post op cardiac surgery History: post op cardiac surgery Support devices unchanged.Stable cardiac enlargement.Left retrocardiac consolidation/atelectasis, pulmonary edema, and small effusions similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, edema, atelectasis, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: et History: et Endotracheal tube terminates 5-6 cm from the carina. New enteric tube terminates within the proximal aspect of the stomach. Focal nodular opacity again noted at the right lung base. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged cardiomegaly. Prominent loops of bowel again noted within the upper abdomen. IVC filter, incompletely visualized.

Output: Endotracheal tube terminates 5-6 cm from the carina. New enteric tube terminates within the proximal aspect of the stomach


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: pneumonia History: new thick sputum production Borderline cardiomegaly. Lungs clear. No effusions. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: eval for infection History: leukocytosis Right Port-A-Cath with its tip in the SVC.Decreased lung volumes a stable cardiomediastinal silhouette.Mild bilateral basilar subsegmental atelectasis increased from the prior exam.No new focal areas of consolidation.

Output: Mild interval increase in bibasilar subsegmental atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 39 yearsGender: MaleReason for Study: Reason: hypoxia, likely ohs/osa but assess for infiltrate History: as above There are decreased lung volumes.The cardiomediastinal silhouette is unremarkable.Mild basilar subsegmental atelectasis.No focal areas of consolidation.No large pleural effusions.

Output: Mild basilar atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Status post AVR. Mild pulmonary edema without pleural effusions. No pneumothorax.Interval widening of cardiomediastinal silhouette, likely postsurgical.Interval median sternotomy, mediastinal drains, right IJ Swan-Ganz with tip in the main pulmonary artery. Unchanged left chest wall pacemaker.

Output: Mild pulmonary edema without pleural effusions. Right IJ Swan-Ganz with tip in the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Evaluate pneumothorax on the right compared to 4/6/15. Patient with "atrium" in place. Right chest tube unchanged in position. Moderate right pneumothorax decreased in size.Elevation of the right hemidiaphragm with adjacent atelectasis. Architectural distortion of the right hilum unchanged.

Output: Slight improvement in size of right pneumothorax, now moderate.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Chest pain rule out pneumonia, pneumothorax, acute process, evaluate fluid status. Has hypertension, smoking history, known CAD. Low normal lung volumes. Moderate multichamber cardiomegaly. No pneumothorax, pleural fluid or signs of pulmonary edema. No focal airspace opacities. The central pulmonary vasculature is at least upper normal in caliber.

Output: Cardiomegaly and possible signs of pulmonary hypertension. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: respiratory insufficiency History: see Lines and tubes, unchanged.Right pleural effusion and overlying atelectasis, not significantly changed allowing for differences in positioning.Patchy left greater than right air space opacities, better seen on recent CT.No new pulmonary findings.

Output: Persistent right pleural effusion overlying atelectasis. Patchy left greater than right air space opacities better seen on recent CT.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with chest pain and lymphadenopathy concern for sarcoid. CHEST:LUNGS AND PLEURA: Multiple, small, bilateral nodules in both lungs along the fissures and in the lung parenchyma.MEDIASTINUM AND HILA: Fracture axial, bilateral paratracheal, precarinal, subcarinal and bilateral hilar adenopathy. Reference subcarinal adenopathy measures 2.1 x 2.1-cm image number 38, series number 4. Right hilar adenopathy measures 3.6 x 2.4 cm in image number 37, series number 4. Enlarged left paracardiac adenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver is enlarged measuring 22 cm. no focal lesions in the liver.SPLEEN: Spleen is enlarged measuring 14 cm. Subtle up with dense small foci in the liver spleen.PANCREAS: 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: Mediastinal and hilar adenopathy with bilateral small lung nodules as described above. These findings most likely represent sarcoidosis, however, lymphoma cannot be excluded.Hepato- splenomegaly and small hypodense lesions in the spleen which may be compatible with lymphoma or sarcoidosis.No evidence of enlarged lymph nodes in the abdomen or pelvis


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with head and neck cancer status post chemotherapy and radiation LUNGS AND PLEURA: Micronodule on the right major fissure likely represent intrapulmonary lymph node, unchanged (image 71/105). No new suspicious nodules or pleural effusions. MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No significantly enlarged mediastinal adenopathy. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: eval for pneumonia History: shortness of breath The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 70 years old Male. Reason: eval for pulm edema History: sob, out of medications, hx chf, Afib, copd, dm. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse mild bilateral interstitial edema and patchy airspace opacities, slightly improved as compared with prior study.

Output: The above findings are consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: 75 year old female intubated. ET tube 4 cm above the carina. NG tube tip in stomach, sideport is at GE junction. Left and right IJ venous catheters with tips in SVC. Cardiomegaly with bilateral pleural effusion, left greater than right with adjacent compressive atelectasis not significantly changed. No pneumothorax.

Output: ET tube 4 cm above the carina. NG tube tip in stomach, sideport is at GE junction


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Evaluate for pneumonia. Hypoxia. Right internal jugular catheter tip is now directed upwards into the internal jugular vein. Unchanged enlarged cardiomediastinal silhouette. Mitral annulus calcifications. New right lower lobe segmental atelectasis. Increased left retrocardiac opacity. Interval placement of gastrostomy tube. New nonspecific abnormal air collection within the left chest wall, may represent pneumothorax. Degenerative changes of the thoracic spine.

Output: 1.Malpositioned right internal jugular catheter. 2.New right lower lobe segmental atelectasis and increased retrocardiac opacity, probably atelectasis.3.New nonspecific abnormal air collection within the left chest wall, may represent loculated pneumothorax and/or soft tissue air collection. Recommend follow-up radiograph.Findings discussed Dr. Couri at 11:20 AM on 8/29/2016.


Instruction: Generate impression based on medical findings.

Input: The scout film demonstrates no focal pulmonary opacity, pleural effusion, or pneumothorax. There is increased lucency overlying the mediastinum which likely represent air within the colonic interposition.The cervical esophagus is unremarkable. There is an end to side anastomosis at the thoracic inlet adjoining the cervical esophagus and colonic interposition. The anastomosis is widely patent and measures 1.0 centimeters. The colonic interposition is present in the medial mediastinum. There is retained solid debris within the colonic interposition and stomach which is nonspecific (The patient verified NPO status since 10 p.m. last night). The colon traverses the diaphragm inferiorly. The distal anastomosis adjoining the lesser curvature of the stomach along the gastric body and the colon is widely patent and measures 2.5 centimeters. The gastric antrum is located more cephalad than typical which is likely postsurgical in etiology. No evidence of contrast extravasation.The duodenal bulb and sweep are unremarkable. Contrast readily passes into the jejunum and ileum within 10 minutes. The visualized small bowel is grossly unremarkable.

Output: 1. Colonic interposition located within the medial mediastinum is intact with widely patent proximal and distal anastomoses as above.2. Retained solid debris within the colonic interposition and stomach despite being NPO overnight, which is nonspecific. 3. Gastric antrum is located more cephalad than typical which is likely postsurgical in etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Malignant neoplasm of pleura. Right-sided chest tubes probably similar in position. Perhaps a very small focal air lucency at the right apex, but no significant sized pneumothorax. Right basal consolidation unchanged. Right hemithorax volume loss, postsurgical and unchanged. Small right pleural fluid collection, about the same. Minimal atelectasis on the left.

Output: No significant change in postoperative appearance of the chest since the prior examination. No significant pneumothorax. Right basal consolidation.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: RML and RLL collapse from metastatic HCC, eval progression History: as above Stable cardiomediastinal silhouette.No change in right middle and lower lobe collapse.Calcified bilateral pulmonary nodules are unchanged. The left lower lobe nodule seen on CT is not significantly changed. No new pulmonary opacities.No large pleural effusion or pneumothorax.

Output: Right middle and lower lobe collapse. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old. Shortness of breath. Heart size is top normal.Mild perihilar bronchial wall thickening suggestive of asthma or bronchitis.Bibasilar linear atelectasis/scarring. No evidence of infection or edema. No pleural effusion.

Output: Possible asthma or bronchitis. Basilar scarring/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female 11 days old Reason: Concern for pneumo History: HypoxemiaVIEW: Abdomen and chest AP (2 views) 5/10/2016 at 2129 hours. ET tube tip is below thoracic inlet and above the carina. NG tube terminates at the stomach. UVC tip is at the right atrium. UAC terminates at T9.Cardiac silhouette size is normal. Persistent over expansion of left lung with interval worsening in left lung base pneumatoceles. No change in bilateral diffuse lung haziness, right greater than left with pattern of PIE.Gasless, nonspecific abdominal gas pattern.

Output: Interval worsening in left lung base pneumatoceles.Gasless, nonspecific abdominal gas pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: PICC line History: PICC line Right sided PICC terminates at the cavoatrial junction. No pneumothorax. Enteric tube extends inferiorly off the field-of-view. Mild bibasilar subsegmental atelectasis or scarring. No new focal lung consolidation. Unchanged heart size. No pneumothorax.

Output: Right-sided PICC terminates at the cavaoatrial junction. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: eval for mediastinal or sub diaphragmatic air History: chest discomfort, post EGD with banding The cardiac mediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.No evidence of a pneumothorax, pneumomediastinum, or free peritoneal air.

Output: No acute cardiopulmonary abnormalities are identified. No evidence of free peritoneal air.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pain Nonspecific focal right lower lung opacity, possibly right middle lobe concerning for aspiration or infection. Minimal atelectasis otherwise observe the left lung base and scarring.Mild cardiomegaly with moderate tortuosity of the aorta and atherosclerotic disease similar to prior exam. Mediastinal contours are accentuated by mild scoliosis

Output: New right lower lung focal opacity concerning for probable right middle lobe infection such as pneumonia and/or aspiration. Pager 4094 contact


Instruction: Generate impression based on medical findings.

Input: Chest pain and shortness of breath past week. Rule-out PE. PULMONARY ARTERY: No evidence of pulmonary embolus.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Dextroscoliosis of the thoracic spine.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of pulmonary embolus or other pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: sob History: sob Focal nodular opacities in the mid aspect the left lung have increased in size from 4/2016, worrisome for metastatic disease. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged cardiomegaly. Aortic atherosclerosis again noted.

Output: Focal nodular opacities in the mid aspect the left lung have increased in size from 4/2016, worrisome for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: hx of epilepsy p/w seizures; eval for PNA History: seizure No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left chest AICD lead positions are unchanged.Basilar predominant opacities likely representing a combination of atelectasis, edema, and small effusions are unchanged. Heart size is stable.

Output: Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: FemaleReason for Study: Reason: r/o PNA History: pleuritic CP, SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of prostate cancer complains of left shoulder pain CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Reference right hilar lymph node measures 15 x 7 mm image number 49, series number 21, stable. Other small mediastinal lymph nodes are also unchanged.CHEST WALL: Left scapular metastatic focus is unchanged possibly explaining patient's left shoulder pain.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortocaval referenced lymph node is stable measuring 7 x 5 mm image number 121, series number 21. This lymph node is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic foci involving multiple vertebral bodies, stable.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable multifocal sclerotic foci in the pelvic bones consistent with metastatic disease.OTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: eval sob History: eval sob Unremarkable cardiac and mediastinal silhouette.Surgical clips in the area of the thyroid gland.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with shortness of breath, productive cough, and recent upper respiratory infection. Evaluate for pneumonia. New patchy nodular opacities in the right perihilar area may be due to atypical infection. Unchanged left suprahilar fibrosis.

Output: New patchy nodular opacities in the right perihilar area may be due to atypical infection. Follow up to resolution is recommended given history of lung CA.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: Assess for pneumonia History: Fever No evidence of pneumonia. PICC tip in SVC. GJ tube partially visualized

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Hypoxemia. Change in Swan-Ganz position. Cardiomegaly with right greater than left interstitial airspace opacities are stable. Right jugular Swan-Ganz catheter stable with tip over the right main pulmonary artery. Mediastinal drains again noted.

Output: Stable predominantly right-sided pulmonary opacities may reflect edema or infection. Swan catheter tip over the right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval swan History: see above Severe cardiomegaly with persistent left lower lobe consolidation and pleural effusions left larger than right.Right PICC, tip in the SVC.IVC Swan-Ganz catheter tip in main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: IVC Swan-Ganz catheter unchanged. Stable cardiomegaly and left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: eval NGT placement History: s/p NGT placement Mild right hemidiaphragm elevation.Small lung volumes, but no acute edema or pneumonia.Bullet fragments project over the right chest and upper abdomen.An NG tube is in place the tip above the diaphragm level.

Output: High NG tube.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Evaluate for pneumonia. Hypotension, altered mental status, NH patient. Low lung volumes, unchanged. Chronic eventration of the left hemidiaphragm. Coarse interstitial markings likely reflect underlying emphysema and scarring. No signs of aspiration or visible signs of pneumonia, though the lung bases are partially obscured.Normal heart size. Calcified mitral annulus. Heavily calcified thoracic aorta.

Output: No visible signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old. Left PICC line with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormality. Left PICC line with its tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Chest pain and shortness of breath, rule out pneumonia/edema. Markedly increased right pleural effusion with associated compressive atelectasis.Known right hilar mass not well seen secondary to adjacent effusion/atelectasis.The visualized cardiomediastinal silhouette unchanged.

Output: Markedly increased right pleural effusion and associated compressive atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: swan placement History: n/a Swan-Ganz catheter tip in the distal right descending pulmonary artery.ICD lead unchanged.Mild cardiomegaly and no significant pulmonary abnormalities.

Output: Swan-Ganz catheter tip in the right descending pulmonary artery, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Syncope and collapse. Evaluate pacer leads. A right cardiac pacer lead terminates in the right ventricle/IVC, with tip pointing downward. An introducer sheath is present. Low lung volumes. Left lower lobe opacity, probably small effusions and atelectasis. Interstitial opacities, unchanged. No pneumothorax.

Output: Right pacer lead terminates in the right ventricle/IVC, with tip pointing downward (not in the right ventricular apex). Unchanged mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Normal heart size with a moderately tortuous aorta.Mild basilar scarring, unchanged from previous.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old. Feeding tube tip projected in the area of the GE junction.PICC line tip in the area of the right axillary vein and pacemaker lead in the area of the right ventricular apex.Diffuse interstitial disease, compatible with edema with underlying emphysema and fibrosis.

Output: Interval advancement of feeding tube with the tip in the area of the GE junction.


Instruction: Generate impression based on medical findings.

Input: Acute SOB while sleeping, likely asthma exacerbation. Unchanged bronchial wall thickening suggestive of reactive airways disease. There is some mild peribronchial opacity in the lower lobes bilaterally new from prior study along with atelectasis. No pneumothorax or pneumomediastinum.

Output: Minimal basilar peribronchial opacity and atelectasis in the lower lobes bilaterally, favored to represent atelectasis, possibly due to mild aspiration given distribution. Bronchial wall thickening unchanged and may be due to reactive airways disease.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Chest pain question pneumonia or pneumothorax. Normal heart size. Atherosclerotic calcification of the thoracic aorta. Minimal subsegmental atelectasis or scarring at the lung bases. Small focal airspace opacity at the medial aspect of the right lung base.

Output: Small focal airspace opacity at the medial aspect of the right lung base may reflect aspiration or infection the appropriate clinical context, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: r/o pna, effusion, edema History: right chest pain Cardiomediastinal silhouette is within normal limits. Lungs clear of airspace and interstitial opacities. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: pna, pleural effusions History: sob, cp Cardiomegaly with interstitial edema, right pleural effusion and right basilar subsegmental atelectasis are all unchanged.Overlie defibrillator device.

Output: CHF with pulmonary edema, right pleural effusion and right basilar atelectasis, less likely a right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: MaleReason for Study: Reason: Worsening right basilar airspace disease and small pleural effusion observed on cxr on 2/28 History: sob Stable cardiac mediastinal silhouette.Minimal right basilar atelectasis/scarring.No new pulmonary opacities identified.No large pleural effusions.Osseous changes related to sickle cell disease.

Output: Mild right basilar atelectasis/scarring. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: 59 yo male, s/p lung transplant, concern for aspiration History: concern for aspiration Unchanged basilar opacities suggestive of infection or aspiration. Support devices unchanged.

Output: Basilar opacities are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p IABP replacement History: as above The intra-aortic balloon pump tip is in appropriate position, at the proximal descending thoracic aorta. The remaining support devices are unchanged in position.Stable cardiomegaly. No pulmonary edema. Gaseous distention of the stomach.

Output: Intra-aortic balloon pump tip is positioned in the proximal descending thoracic aorta. Gaseous distention of the stomach.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: evaluate for pna History: fever No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: dyspnea, pulmonary edema on previous study, improving with diuresis? History: dyspnea Dense opacity in the left lower lung consistent with consolidation, atelectasis and overlying pleural effusion. Focal nodular airspace opacity at the right base also compatible with infection. A more recent radiograph has been interpreted.

Output: Patchy bilateral airspace opacity suggestive of infection and/or aspiration. No specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: ARDS ETT terminates 2 cm above the carina. NG coiled in the proximal stomach.Mild cardiomegaly with decreased lung volumes and mixed interstitial airspace changes greater both bases and on the left. Air bronchograms are observed left over the right lobes. Serial imaging will be important to exclude a superimposed process

Output: Appearance consistent with suspected moderate ARDS, however serial imaging will be needed to confirm


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Status post Pleurx catheter drain. Stable cardiomediastinal silhouette. No pneumothorax. Right pleural effusion is not significantly changed compared to prior examination given differences in technique. Pleurx catheter again noted in the right lung base. Linear opacity in the medial right middle lobe appears similar compared to prior exam. Basilar predominant interstitial thickening suggestive of pulmonary edema.

Output: 1.Right pleural effusion is not significantly changed compared to prior examination given differences in technique. Pleurx catheter is unchanged.2.Linear opacity in the right middle lobe appears similar compared to prior examination.3.Findings suggestive of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Fatigue without fever or cough. Stable cardiomediastinal silhouette. Improved basilar opacities with persistent right greater than left basilar bronchial wall thickening suggestive of aspiration. Probable layering right pleural effusion.

Output: Basilar bronchial wall thickening suggestive of aspiration. Probable layering right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Status post IABP and AVR scheduled 2/25 History: as above Intra-aortic balloon pump terminates approximately 5.3 cm from the top of the aortic arch. Swan-Ganz catheter terminates within the right pulmonary artery. No focal lung consolidation. Moderate cardiomegaly again noted.

Output: Lines and tubes, as above. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: routine health maintenance History: v70.0 No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Heart failure. Chest pain and reflux. Assess NG tube.VIEWS: Chest AP/lateral (two views) 1/25/2016 at 0905 hours. NG tube tip is not visualized but it may be at the stomach. A second tube is crossing over the right side of the chest in AP view.Cardiac silhouette size is normal. Bilateral apical fibrosis or loculated effusions along with perihilar, left lingular and left retrocardiac opacities on a background of chronic lung disease are unchanged.

Output: Unchanged multifocal opacities as described.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Shortness breath. Evaluate. Right chest port with catheter tip in the right atrium. Cardiomediastinal silhouette is normal. No pulmonary opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Infiltrates History: fever Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: recent pneumothorax, worsening L sided infiltrate, NGT History: above No change position of left-sided chest tube. Pneumothorax is not identified clearly on this film.No change in left basilar opacity and effusion.Right lung remains clear.

Output: No significant pneumothorax visualized.No change in left pleural effusion and basilar opacity.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female Small cell lung cancer. CHEST:LUNGS AND PLEURA: Subcentimeter ill-defined nodular density left upper lobe measuring 3 mm in diameter image number 20, series number 5 is unchanged. Emphysema is unchanged. Several other micronodules unchanged. Scarring and postop changes in the left lower lobe are stable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Punctate calcification is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable study.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: Pt is a 28 yo male w/ hx of dlbcl; pre-sct eval History: evaluate Left pleural effusion seen on today's PET/CT.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.Right jugular and left subclavian catheters terminate in the SVC.Upper abdominal embolization coils noted.

Output: Left pleural effusion, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female 74 years old Reason: 74 year-old female with dysphagia, history of fundoplication History: as above. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, spontaneous gastroesophageal reflux was observed to the level of the aortic arch. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.TOTAL FLUOROSCOPY TIME: 5:12 minutes.

Output: Gastroesophageal reflux to the level of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: shortness of breath, cough, eval for infection History: SOB, cough, Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p MVC evaluate for fractures, abnormalities History: back pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: pre-op CABG History: NA Mild bibasilar subsegmental atelectasis or scarring. Moderate cardiomegaly. Tortuous thoracic aorta. Aortic and splenic arterial atherosclerosis. No pleural effusion or pneumothorax. Mild disc degeneration and mid thoracic kyphosis.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Patient with hyperparathyroidism and right axillary lymphadenopathy, please evaluate for intrathoracic lymphadenopathy. Multiple healed left rib fractures and suture anchors from left rotator cuff repair are noted.The cardiomediastinal silhouette is normal and unchanged. No evidence of hilar lymphadenopathy.No focal pulmonary opacities or pleural effusions.

Output: No evidence of hilar lymphadenopathy or acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Chest pressure History: chest pressure Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: cp History: cp Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: ETT check Right chest tube remains unchanged, projected towards apex along the peripheral lateral margin. No significant pneumothorax. Underlying moderate CHF and edema-like changes observed in both bases associated with small effusions. Borderline cardiomegaly and questionable retrocardiac partial atelectasis. Serial imaging may be needed to exclude partial consolidation.Left PICC line extends into the mid SVC, ETT terminates 2 cm above the carina.

Output: ETT well positioned and right chest tube unchanged.


Instruction: Generate impression based on medical findings.

Input: Postop respiratory failure. Low endotracheal tube. The carina is not visualized tube is probably within 1 cm of the carina. Right jugular Swan-Ganz catheter, mediastinal and pericardial drains unchanged. Tiny left apical pneumothorax. Small pleural effusions, left greater than right. Retrocardiac atelectasis slightly improved. IABP marker or a surgical clip projects over the top of the aortic arch.

Output: Improved aeration of the left lower lobe with residual small to moderate pleural effusions and basal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old with endometrial cancer s/p cycle 5 Everolimus/Letrozole with chronic shortness of breath and cough since starting treatment, evaluate for possible pneumonitis Previously described opacity within the superior segment of the left lower lobe demonstrates complete resolution on this exam. Right lung mass along the superior aspect of the major fissure as well as left lung nodular opacities within the apicoposterior segment of the upper lobe are better characterized on recent CT dated 1/19/16. No evidence of pleural effusions.

Output: Bilateral lung nodules/masses consistent with metastatic disease, which are better characterized on recent CT dated 1/19/16. No evidence of infection or acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: sob, hx esrd History: above Mild to moderate interstitial opacities with small pleural effusions suggestive of CHF with edema.No specific evidence of infection.

Output: Mild to moderate interstitial edema. Findings are consistent with CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: 51F wiht CHF and COPD p/w SOB History: SOB, mild CP The decreased lung volumes with mild cardiac enlargement.Mild perihilar/basilar interstitial opacities are suggestive of edema.No focal areas of consolidation.No pleural effusions.

Output: Mild nonspecific interstitial opacities without definite evidence of CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: fluid status History: stroke Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p CABG Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with bilateral pulmonary opacities compatible with subsegmental atelectasis with probable small effusions.No pneumothorax.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: 6-year-old female with metastatic lung cancer CHEST:LUNGS AND PLEURA: Previous described necrotic left lower lobe mass now measures 4.5 x 4.1 cm on image number 52, series number 3, slightly smaller compared to previous study. Now the lesion contains air and an air fluid level. This may be secondary to communication with a bronchus or secondary infection. Left-sided pleural effusion is increased. Subsegmental atelectasis in the left lower lobe.Right upper lobe micronodular image number 83, series number 4 is unchanged in size.MEDIASTINUM AND HILA: Index left paraesophageal lymph node is unchanged and measures 8-mm in diameter image number 52, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small hypodense lesion the spleen is unchanged.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: New 2.3 x 2.2 cm soft tissue mass in the lower anterior abdominal wall on image number 144, series number 3. There are multiple other soft tissue densities in the lower anterior abdominal wall. These may represent metastatic nodules versus secondary to injections. Clinical correlation is recommended.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the left-sided pleural effusion. Left lower lobe necrotic mass has slightly decreased in size and now has an air-fluid level. Secondary infection cannot be excluded.New soft tissue densities in the lower anterior abdominal wall which may represent changes secondary to injections versus less likely metastatic disease. Clinical correlation is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: evaluate for effusion, infection, aspiration History: stupor New lower lung zone air space opacities with pleural effusions.Mild cardiomegaly.

Output: New basilar opacities suggestive of edema or pneumonia. Aspiration is another consideration.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Status post PICC placement. Interval placement of left PICC with tip in the left brachiocephalic vein. Otherwise support devices are unchanged. Persistent cardiomegaly with bilateral small pleural effusions and pulmonary edema.

Output: Interval placement of left with tip in the left brachiocephalic vein. Persistent cardiomegaly with bilateral pleural effusions and edema.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: previous history of head and neck cancer and known metastasis to lungs s/p radiation to multiple lung nodules 2013. RLL wedge for metastatic squamous cell carcinoma. Recent CT demonstrates growing RLL lung nodule, Here for 2 month post operatory follow History: none COPD with unchanged right basilar opacity and right pleural effusion probably postsurgical or post radiation.No nodules identified.

Output: COPD, and basilar opacities and right pleural effusion unchanged. CT is recommended for assessment of metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: potential stem cell donor Mild left basilar scarring/atelectasis. The heart size is normal. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: HX chf. eval for PNA vs. CHF History: see above ICD lead and generator noted and unchanged.Stable cardiomediastinal silhouette.Mildly prominent pulmonary vasculature with blunting of costophrenic angles. Early edema cannot be excluded and follow-up recommended.No specific evidence of infection.

Output: 1. Mildly prominent pulmonary vasculature with possible small effusions. Suggest early edema.2. Stable appearance of ICD lead and generator


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: swan placement History: swan placement Moderate to severe cardiomegaly.Small right pleural effusion but no evidence of edema.Right jugular Swan-Ganz catheter tip in proximal right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.Left PICC, tip in the SVC.

Output: Swan-Ganz catheter, tip in proximal right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: s/p pneumothorax History: s/p pneumothorax Two left chest tubes with a moderate edema pattern but no pneumothorax.Status post right thoracoplasty.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: No pneumothorax. Moderate pulmonary edema pattern, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: confirm dht placement History: same Feeding tube extends to the body of the stomach. Clear lungs. No pleural effusion or pneumothorax. Normal heart size. Incidental note made of azygous lobe.

Output: Feeding tube extends to the body the stomach.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: r/o pneumonia History: confusion Heart size is upper limits of normal.No focal consolidation, pleural effusion, or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: 74 y/o man w/ acute desat History: 74 y/o man w/ acute desat Study again limited by leftward patient rotation. Probable skinfold overlie the right hemithorax. However, there is relative lack of lung markings at the right apex which may represent a pneumothorax. Increase in diffuse left lung opacities. Increased right pleural effusion.

Output: Worsening diffuse left lung opacity. Worsening right basilar pleural effusion. Probable skinfold overlie the right hemithorax. However, there is relative lack of lung markings at the right apex which may represent a pneumothorax. Repeat radiograph is suggested without rotation to reassess the lung parenchyma.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna History: fever Left lower lobe nonspecific opacity compatible with consolidation and atelectasis, possibly with infection.No new findings.

Output: Persistent nonspecific consolidation and atelectasis in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Male 81 years old with history of respiratory failure requiring emergent intubation, low respiratory rate, hypoxia to 50s Interval intubation with endotracheal tube tip approximately 3 to 4 cm above the carina. Pacemaker unchanged in position.Stable cardiomediastinal silhouette. Bibasilar atelectasis with small left pleural effusion/thickening.

Output: Interval intubation with endotracheal tube tip approximately 3 to 4 cm above the carina. New/increased left basilar opacity likely due to atelectasis or small effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: 67 yo M with IPF and icnreased sob. Evaluate for infiltrate, effusion, nwe proces. History: SOB The cardiac mediastinal silhouette is unremarkable.Decreased lung volumes with extensive additional opacities, left greater than right, demonstrating some interval progression since the prior CT dated 11/17/2014.No focal areas of consolidation.No pleural effusions.

Output: Interval progression of interstitial pulmonary fibrosis since the prior CT. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: mvc History: mvc The cardiac contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities.The pleural spaces are within normal limits.No evidence of displaced fractures. Assessment of the sternum is very limited and there is mild rotation of the lateral projection obtained, which limits assessment for fractures.

Output: No evidence of traumatic lesions in the chest, considering severe limitation for the assessment of the sternum. Irregularity of the sternal contours may be secondary to rotation of the lateral projection obtained. Close correlation with physical exam is recommended.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with recent cough. Evaluate for bibasilar scarring, effusions. CHEST:LUNGS AND PLEURA: Clustered centrilobular nodules with some tree-in-bud opacities in the left lung base are compatible with aspiration. There is mild adjacent pleural thickening as well. Mild linear scarring in the left lung base is also noted. Few scattered other micronodules are identified. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Punctate sclerotic focus in the right seventh rib posteriorly is compatible with a benign bone island. UPPER ABDOMEN: No significant abnormality noted.

Output: Findings compatible with mild aspiration. No pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain for two weeks ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructive right renal calculus. Small hypodense lesions in both kidneys likely representing a benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Widemouth ventral abdominal hernia containing nonobstructed transverse colon segment is unchanged. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: 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: Nonobstructing ventral hernia. Nonobstructing right renal calculus.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: ET tube position History: intubated The endotracheal tube terminates 2.5 cm from the carina. Cardiac lead terminates in expected location of the RV.Right IJ line is terminating within the SVC or superior aspect of the right atrium. Enteric tube extends inferiorly off the field-of-view. Diffuse pulmonary opacities with small pleural effusions and dense left lower lobe opacity again noted. Moderate cardiomegaly, unchanged. No pneumothorax. Bilateral pleural effusions.

Output: Endotracheal tube terminates 2.5 cm from the carina. No substantial difference in diffuse pulmonary opacities consistent with pulmonary edema, multifocal pneumonia, and/or diffuse alveolar damage. No substantial change in dense left lower lobe opacity consistent with consolidated lung and/or atelectasis. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p intubation History: none ET tube tip approximately 4 cm above the carina.ICD leads and right jugular catheter unchanged.Cardiomegaly with bilateral predominantly right-sided airspace opacity, not significantly changed over the past 4 hours, compatible with acute pulmonary edema or aspiration.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: intubated, evaluate ETT History: intubated Mild basilar subsegmental atelectasis which may be from aspirated secretions.Heart size normal.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.

Output: Nonspecific basilar subsegmental atelectasis. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: pulled back 1 cm History: pulled back 1 cm Endotracheal tube terminates approximately 2 cm from the carina. Enteric tube extends to the body of the stomach. Diffuse pulmonary opacities, unchanged. No pneumothorax. Likely unchanged heart size.

Output: Endotracheal tube, as above. Diffuse pulmonary opacities, unchanged consistent with edema, diffuse alveolar damage, and/or multifocal pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: s/p intubation History: intubation Complete right upper lobe atelectasis probably from mucous plugging.Previously seen basilar subsegmental atelectasis has resolved.Chronic elevation right hemidiaphragm.ET tube tip approximately 3 cm above the carina.

Output: New complete right upper lobe atelectasis likely from mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Productive cough and shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with fever and history of congestive heart failure. Evaluate for pneumonia. Cardiac silhouette is within normal limits.No focal airspace opacity.No pneumothorax or pleural effusions.

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: Female, 62 years old.COPD exacerbation. Hazy opacity in the right upper lobe above the fissure. Bronchial wall thickening and reticulonodular opacities in the right lung base suggestive of bronchiolitis and mucous plugging, possibly due to aspiration or retained secretions.

Output: Hazy right upper lobe opacity may reflect infection. Faint bronchiolitis and retained secretions in the right lower lobe, possibly related to aspiration but nonspecific by this technique.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with the upper tract urothelial cell carcinoma. The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made.CHEST:LUNGS AND PLEURA: The right upper lobe mass has a large cavitary component, which is new compared to prior examination. The mass measures 5.2 x 3.8cm (series 5, image 36), previously measuring 5.2 x 4.6 cm. There is surrounding focal lung consolidation, which has improved from prior examination.A left lower lobe nodule (series 5, image 50) is changed in character and become more cavitary in nature. A left upper lobe nodule (series 5, image 47) has not changed.No pleural effusions are present.MEDIASTINUM AND HILA: Small precarinal and pretracheal lymph nodes are unchanged. The Port-A-Cath tip is at the SVC/RA junction. The heart size is normal. No pericardial effusion is present.CHEST WALL: Right chest wall port. No significant abnormality is noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis appears unchanged. No biliary dilatation. No focal hepatic lesions, given limitation of lack of intravenous contrast.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A large left renal mass that is heterogeneous with some areas of high density compatible calcification measures 12.0 x 9.6 cm (series 3, image 15), previously measuring 12.5 x 9.8 cm. The calcification at the lower pole the left kidney is unchanged.The right kidney is normal.RETROPERITONEUM, LYMPH NODES: Left periaortic lymph nodes are unchanged. Abdominal aortic atherosclerotic calcifications are visualized.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcifications are present within the uterus, likely representing fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A soft tissue nodule is present in the left inguinal canal (series 3, image 170), and this finding appears smaller compared to prior examination.OTHER: No significant abnormality noted.

Output: 1. Right upper lobe pulmonary mass with cavitation.2. Large left renal mass.3. No new sites of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Peritoneal abscess. Line placement. Tubes and lines unchanged in position. No pneumothorax or focal airspace opacities. Left upper thorax skeletal deformity.

Output: Right jugular catheter tip at SVC level, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Left lower lobe nodule better characterized on recent CT. No evidence of pneumothorax

Output: No evidence of pneumothorax


Instruction: Generate impression based on medical findings.

Input: Chest tube removed Improving overall lung volumes, however lungs remain diminished with basilar atelectasis greater on the right with small effusion no postprocedural complication, specifically no pneumothorax on the left following chest tube removalThe cardiac and mediastinal contours are within limits

Output: No postprocedural compilations following chest tube removal


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Cough rule out pneumonia Upper normal heart size. Calcification of the thoracic aorta, mild to moderate.Mild bronchial wall thickening but no focal airspace opacities. Blunting of the posterior costophrenic angles of unknown chronicity. No pneumothorax.

Output: Mild bronchial wall thickening which could be related to URI/bronchitis or aspirated secretions, but no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Chest pain and shortness of breath. Streaky left basilar opacities most consistent with subsegmental atelectasis. No new focal opacity to suggest acute infection. No large pleural effusion or pneumothorax. No significant interval change in size of the cardiac silhouette. Interval removal of right jugular catheter.

Output: Left basilar atelectasis. Otherwise no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: surveillance History: h/o lung cancer Left hemithorax postsurgical volume loss.Right lung unremarkable.Heart size normal.No specific evidence of infection or edema.

Output: Left hemithorax postsurgical volume loss but no evidence of recurrent lung cancer or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: patient desatting, with new O2 requirement, bibasilar crackles on exam History: patient desatting, with new O2 requirement, bibasilar crackles on exam Minimal basilar interstitial opacities could be developing edema.Mild/moderate cardiomegaly.No specific evidence of infection.

Output: Nonspecific basilar interstitial opacities could be developing edema in this patient with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Left-sided endobronchial valves appear to have been removed since the prior study, with no pneumothorax.Unchanged left hemithorax volume loss.Stable interstitial opacities.

Output: No pneumothorax following endobronchial valve removal.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.History of cough and fever following orthopedic surgery. The cardiomediastinal silhouette is normal.There is mild left costophrenic angle scarring. There are no focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: ett ok? History: ett ET tube tip approximately 3 cm above the carina.PICC tip in the left axillary vein.Bilateral patchy airspace opacities which may be due to infection or aspiration, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: 51M s/p nephrectomy for RCC. Surveillance imaging History: history of RCC Unremarkable cardiomediastinal silhouette.Stable scarring at the left lung, the lungs are otherwise clear. No pleural effusion.

Output: No acute cardiopulmonary abnormalities. No evidence of metastatic disease.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: Age: 67 yearsGender: FemaleReason for Study: Reason: goiter and left upper lobe lung mass History: lung mass Deviation of the trachea from left to right compatible with known goiter.Left upper lobe atelectasis appears to be significantly improved from the prior exam.Left basilar interstitial opacities and possible small effusion.Right lung is clear.

Output: Large left-sided goiter. Apparent interval improvement in the left upper lobe atelectasis which presumably was secondary to bronchial obstruction. However, CT can better evaluate this.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with smoking history and new lung mass in the right upper lobe. CHEST:LUNGS AND PLEURA: A spiculated mass is noted in the right upper lobe, measuring 3.9 x 2.9 cm (series 4; image 17 is present. An adjacent 2-mm nodule is seen in the right upper lobe (series 4; image 27). A subcentimeter right lower lobe nodule is seen (series 4; image 49). Other small nodular opacities are noted in the lung bases (series 4; image is 64 and 70).MEDIASTINUM AND HILA: Borderline enlarged prevascular and paratracheal lymph nodes are seen. For reference, a right paratracheal lymph node measures 14 x 14 mm (series 3; image 30).Small pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: A 15 x 15 mm left adrenal nodule is identified.KIDNEYS, URETERS: Small hypodensities are seen within both kidneys, the largest of which are definitely simple cysts. However, most are too small to definitively characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A diverticulum affects the third portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild to moderate atherosclerotic diseasePELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the lumbar spine and right hipOTHER: Atherosclerotic disease.

Output: Spiculated right upper lobe lung mass, compatible with carcinoma. Scattered pulmonary nodules and mild mediastinal adenopathy.1.5-cm left adrenal nodule, which cannot be further characterized on this single phase study. Consider CT/MRI with adrenal protocol for definitive characterization.


Instruction: Generate impression based on medical findings.

Input: Reason: 40 y/o with ALL undergoing treatment, rhinovirus/enterovirus +, eval for infection, effusion History: rhinovirus/enterovirus + Cardiomediastinal silhouette is unremarkable.Low lung volumes. No consolidation, pneumothorax, or pleural effusion.Right chest port tip in the SVC.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: r/o cardiopulm abnormality History: chest pain The lungs and pleural spaces are clear. The heart size is normal. Multiple compression deformities of the thoracic spine. Known pulmonary micronodules are not well-visualized, better characterized on previous one CT thorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 75 year-old female with collagenous colitis. R/O perforation. No contrast, ARF. Hypotension. CHEST:LUNGS AND PLEURA: Fibrotic changes particularly peripherally apices and bases with no discrete nodules or effusions.MEDIASTINUM AND HILA: Atherosclerotic changes. Coronary artery calcification. Small right paratracheal node. Mildly dilated esophagus correlate for motility abnormality. Probable hiatal hernia.CHEST WALL: Right shoulder prosthesis. ABDOMEN: The exam is not sensitive for detecting lesions in the bowel or solid organs due to the lack of oral or intravenous contrast.LIVER, BILIARY TRACT: No significant abnormality noted. Assuming no prior surgery hypoplastic left lobe of the liver. The appearance is unchanged from CT of June 2004.SPLEEN: No significant abnormality noted.PANCREAS: Somewhat atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical thinning with focal scarring left lower pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ileostomy right lower quadrant. No evidence of bowel obstruction. No ascites. No intramural air or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Foley catheterLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the region of the cecum. Ileostomy right lower quadrant. No ascites. No intramural air or free air.BONES, SOFT TISSUES: Midline surgical scar. Degenerative changes and discogenic disease diffusely lumbar spine. No lytic or blastic disease.OTHER: No significant abnormality noted.

Output: No evidence of perforation.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: assess pulm opacities History: as above Complete right hemithoracic opacification. Patchy opacities on the left unchanged.

Output: Complete right hemithoracic opacification, a combination of right pleural thickening and fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: hypoxia, on bipap History: hypoxia Diffuse pulmonary opacities. Intra-aortic balloon pump terminates approximately 6 cm from the top the aortic arch. No large pleural effusion or pneumothorax. Moderate cardiomegaly. Large patient body habitus.

Output: Diffuse pulmonary opacities certainly consistent with pulmonary edema. Intra-aortic balloon pump, as above.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with diffuse large cell B lymphoma status post 4 cycles CHOP/R CHEST:LUNGS AND PLEURA: Diffuse small foci of tree in bud opacities are seen bilaterally, likely inflammatory. At least one of these in the right lower lobe is secondary to mucous pluggingMEDIASTINUM 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: Small nonobstructive calculus in the midpole of the left kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Several thoracic vertebral bodies demonstrate lytic changes as well as compression deformities, compatible with lymphomatous infiltration. Several thoracic ribs bilaterally also demonstrate lytic changes.Lytic foci in the humeral head most likely represent lymphomatous involvement given lack of degenerative changes in this region.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.BONES, SOFT TISSUES: The pelvic bones demonstrate nonspecific patchy bone density. Orthopedic hardware in the left proximal femur.OTHER: No significant abnormality noted

Output: Numerous lytic osseous lesions, described above, compatible with current or prior tumor involvement.Small foci of tree in bud opacities in the lung, likely inflammatory.Nonobstructive left nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: pneumothorax History: s/p pleurodesis Interval right chest tube removal. Slight decrease in small right apex pneumothorax. Pleural effusions have improved. Subcutaneous emphysema has resolved. Calcified nodes.

Output: Slight decrease in small right apex pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: pulmonary edema? pleural effusion History: chest pain, shortness of breath No change in ICD. No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Infiltrates History: fever No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Status post PICC line placement. Left upper extremity PICC terminates in the SVC. No acute cardiopulmonary abnormality.

Output: Left upper extremity PICC terminates in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: interval eval of parapneumonic effusion History: known effusion and pneumonia Low lung volumes.No change in right pleural effusion and bilateral basilar opacities.

Output: No change in large right pleural effusion and bilateral basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: MaleReason for Study: Reason: effusion following thoracentesis History: s/p procedure Right central venous catheter with its tip in the SVC. Right pleural effusion and right basilar consolidation/atelectasis similar to the prior exam.Stable cardiomediastinal silhouette.No evidence of pneumothorax.

Output: No evidence of a pneumothorax post thoracentesis. Large right pleural effusion and right basilar consolidation/atelectasis similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Extensive emphysema with bilateral apical bulla. There is a nodule at the medial right apex. The heart size is normal. No pulmonary edema

Output: Extensive emphysema with right upper lobe nodule.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Central line placement. Ulcer of other part of the foot. Right jugular catheter tip at the SVC, no pneumothorax.Cardiomegaly with pericardial calcifications.

Output: Appropriate position of right jugular catheter without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: assess swan placement History: s/p swan Swan-Ganz catheter tip in the right main pulmonary artery.Left jugular catheter and ICD lead unchanged.Severe cardiomegaly with bilateral interstitial opacity compatible with edema, with retrocardiac consolidation and atelectasis.

Output: CHF with slightly increased retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: 79 y/o F with CHF History: chf Moderate elevation the right hemidiaphragm again noted. Patchy left basilar opacity noted. Question of cephalization on this semiupright radiograph. Improvement in right basilar opacity. Unchanged cardiomegaly. No pneumothorax. Cardiac leads, similar to previous study.

Output: Question of cephalization on this semiupright radiograph suggestive of elevated left-sided cardiac pressures. Improvement in patchy right basilar opacity. Stable patchy left basilar opacity which may represent atelectasis or scar. Unchanged cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Erythema and swelling right anterior axilla/chest wall 7.2 x 3.9 cm mixed echogenicity mass lesion within the subcutaneous tissues of the right axilla/chest wall. This mass lesion demonstrates no significant vascularity.

Output: Mixed echogenicity mass lesion within the subcutaneous tissues of the right axilla/chest wall. Findings are best considered nonspecific; however, the differential diagnosis would include metastatic focus, hematoma, or chronic complex inflammatory process. This lesion is amenable to ultrasound-guided percutaneous biopsy.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: eval for infiltrate History: DKA The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality or specifically evidence of infection, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of mesothelioma. Evaluate for extent of disease. CHEST:LUNGS AND PLEURA: Scattered calcified pleural plaques at the left lung base (axial image 58/105) compatible with asbestos exposure. Micronodules in the right upper lobe (axial image 54/105) and the right middle lobe (axial image 80/105) are nonspecific. Basilar atelectasis and/or pleural thickening on the left. Mesothelioma reference measurements as follows:Level of the aortic arch (axial image 25/159): 1.4 cm at 9 o'clock; 0 mm at 3 o'clock.Level of the carina (axial image 36/159): 0.8 cm at 7 o'clock; 0 mm at 3 o'clock.Level of the left mainstem bronchus (axial image 43/159): 1.6 cm at 8 o'clock; 0 mm at 3 o'clock.MEDIASTINUM AND HILA: An ectatic ascending aorta measures 4.2 cm on axial image 44/159. The cardiac size is otherwise within normal limits. No pericardial fluid. Scattered small superior mediastinal and prevascular lymph nodes. Scattered nodules are also noted in the epicardial fat.CHEST WALL: Likely surgical resection of the left seventh rib. Evaluation of the chest wall on the source images demonstrates loss of the expected fat planes adjacent to the site of rib resection which may reflect postoperative change but is also suspicious for chest wall neoplastic involvement.ABDOMEN:LIVER, BILIARY TRACT: Punctate scattered liver hypodensities are too small to characterize.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Tumor extends posterior to the diaphragm at the level of T12. Several prominent gastrohepatic lymph nodes are evident. A reference node on axial image 78/159 measures 1.6 x 1.9 cm. Several subcentimeter, but mildly prominent left retroperitoneal lymph nodes are evident (axial image 116/159).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Pleural thickening with reference measurements as described above compatible with stated history of mesothelioma.2.Intra-abdominal lymphadenopathy as described above.3.Ectatic ascending aorta.4.Postoperative findings as described above suggestive of scarring versus left chest wall neoplastic involvement. Follow-up CT examination is recommended. Recommend correlation with surgical history.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Bilateral innumerable pulmonary metastases. Reference nodule in the right middle lobe measures 8 x 6 mm image number 62, series number 4, unchanged. Left lower lobe referenced nodule measures 12 x 10 mm image number 84, series number 4, no significant change. Other numerous pulmonary metastases are also not significant change.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality noted. Lytic lesion involving the left scapula is unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Two soft tissue nodules in the nephrectomy are unchanged. Larger one measures 21 x 15 mm image number one, series number 3.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion L3 vertebral body is unchanged.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: Age: 36 yearsGender: FemaleReason for Study: Reason: cp History: cp The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.