Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: FemaleReason for Study: Reason: ptx History: s/p left lung biopsy Stable cardiomediastinal silhouette.Volume loss in left lung compatible with prior wedge resections.Left mid lung subpleural peripheral opacity.Although chronic loculated left-sided pneumothorax was identified on recent CT, no obvious post procedure pneumothorax identified.

Output: No significant postprocedure pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 47 M. POD1, assess for ETT position. Endotracheal tube tip is approximately 6 cm above the carina.Enteric tube is coiled within the stomach with its tip projecting over the gastric fundus. Probable asymmetric nodular calcification of the first left costal cartilage.Persistent moderate bilateral pleural effusions.Calcified granuloma in the right midlung, compatible with healed granulomatous disease.

Output: Endotracheal tube tip is approximately 6 cm above the carina. Probable asymmetric nodular calcification of the first left costal cartilage; PA/lateral views are recommended for confirmation and to exclude underlying pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: PA catheter. Right jugular Swan-Ganz catheter tip at the level of the right interlobar pulmonary artery. Low lung volumes. No signs of pulmonary edema. No pneumothorax. Left subclavian ICD unchanged.

Output: Right jugular Swan-Ganz catheter tip at the level of the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old. Reason: fever History: fever Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: MVC r/o fx History: L chest pain No acute cardiopulmonary abnormality. No evidence of pneumothorax. No evidence of rib fracture given limits of technique.

Output: No evidence of posttraumatic injury.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: cardiopulmonary process, aspiration History: productive cough, vomiting Changes suggestive of COPD, similar to the prior exam.Cardiomediastinal silhouette is unremarkable. No pleural effusion, focal airspace opacity, or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: eval for evidence of esophageal rupture History: food impaction s/p EGD Endotracheal tube tip is approximately 4 cm above the level of the carina. Cardiomediastinal silhouette is within normal limits, unchanged. There is minimal left basilar subsegmental atelectasis/scarring, appearing similar to the prior radiograph. Small hiatal hernia. Surgical clips project over the left upper quadrant and epigastric region. No evidence of pneumomediastinum on this single radiographic view. Thoracic scoliosis incompletely evaluated.

Output: Small hiatal hernia. No evidence of pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of GBM now with thrombocytopenia and decreased hematocrit. Please evaluate for bleeding. CHEST:LUNGS AND PLEURA: Bilateral small pleural effusions. Bibasilar atelectasis.MEDIASTINUM AND HILA: Small pericardial effusion. The left lobe the thyroid is enlarged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large fluid attenuating lesion in the liver measuring 12 x 10 cm likely representing a simple cyst. Other smaller lesions in both lobes of the liver. Lack of IV contrast precludes further characterization of these lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.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: Bilateral small pleural effusions and pericardial effusion.Large hepatic simple cyst. Smaller hepatic lesions which cannot be further characterized due to lack of IV contrast.Enlarged left lobe of the thyroid.No evidence of intrathoracic or intra-abdominal bleeding.


Instruction: Generate impression based on medical findings.

Input: Reason: Central line placement History: post central line placement Unremarkable cardiac and mediastinal silhouette. Small lung volumes with streaky perihilar opacities suggestive of subsegmental atelectasis and bronchial thickening, unchanged.Catheter tip in the SVC.

Output: Perihilar bronchial thickening and subsegmental atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: effusion History: effusion Large right pleural effusion, larger than before now occupying over three quarters of the right hemithorax, compressing the majority of the right lung.Small left pleural effusion.

Output: Enlarging right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: evaluate lung fields post op History: s/p LVAD Support devices unchanged.Stable cardiac enlargement.Basilar opacities are compatible with atelectasis and small effusions similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Chest pain worse with movement. No trauma. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax. No displaced rib fracture.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.AML, ETT, line. Right jugular catheter and visualized portion of the enteric tube unchanged in position. Endotracheal tube tip about 5 cm above the expected level of the carina.Lung volumes remain low. Decreased pleural fluid and atelectasis on the left. Multifocal airspace opacities bilaterally appear slightly worse.

Output: Worsening airspace opacities bilaterally. Decreased pleural fluid and atelectasis on the left.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of chest pain. The cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: evaluate swan position History: see above Small moderate bilateral pleural effusions with overlying atelectasis, unchanged.Left jugular Swan-Ganz catheter tip directed towards the right interlobar pulmonary artery.

Output: Unchanged Swan-Ganz catheter position, and stable pleural effusions with overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB r/o pna History: sob Increased perihilar airspace and interstitial opacity on the left, mainly in the superior segment of the left lower lobe, which may be due to aspiration and/or infection.Port catheter with its tip in the SVC.

Output: Increased left lower lobe opacity compatible with aspiration and/or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Patient with cystic fibrosis, cirrhosis, esophageal varices status post banding; 4 bands were stacked on top of each other near the GE junction. C/o chest pain after procedure. Radiopaque object vertically oriented over the lower mediastinum likely represents the stacked variceal band. Cardiomediastinal silhouette is unremarkable. Perihilar bronchial wall thickening and endobronchial debris consistent with cystic fibrosis. Left lower lobe subsegmental atelectasis. Left lung base and right upper lobe peripheral opacities suspicious for aspiration, less likely active infection. No pneumothorax or pneumomediastinum

Output: Signs of aspiration. No pneumothorax or pneumomediastinum. Findings discussed with Dr. Konda.


Instruction: Generate impression based on medical findings.

Input: Female 84 years old Reason: 84 F partial SBO, eval progression/improvement History: NG, no BM Enteric tube seen with side-port at gastroesophageal junction, further advancing by approximately 8 cm recommended. Nonobstructive bowel gas pattern. Right hemidiaphragm elevation. Severe bilateral hip and spinal degenerative disease, sacroiliac sclerotic changes seen, diffusely decreased osseous mineralization. Pelvic calcifications may be vascular in etiology or related to underlying calcified fibroid uterus.

Output: Further advancing of enteric tube suggested as sideport located at gastroesophageal junction.However, there has been interval resolution of previously visualized small bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: assess for new acute lung processes, trach placement History: respiratory failure requiring tracheostomy ET tube removed and tracheostomy placed. Remaining support devices stable.The cardiac silhouette is enlarged but stable.Bilateral, moderate-sized pleural effusions have increased compared to the prior examination. Underlying atelectasis is again noted.

Output: Increasing bilateral pleural effusions and stable support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Preop CABG. Severe emphysema. Architectural distortion and volume loss in the lingula nonspecific by plain film. Loculated left pleural fluid collection not significantly changed. Postsurgical changes in the left lung, incompletely evaluated.

Output: Loculated appearing left moderate pleural fluid collection. Severe emphysema and extensive scarring/postsurgical changes.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: 69 yo IPF s/p lung transplant w/ bronch today-- please eval for pneumothorax or other interval changes History: see above Unchanged interstitial and airspace opacities are unchanged suggestive of edema or ARDS.Stable pleural effusions.No pneumothorax following today's procedure.Tracheostomy tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach, the side port above the GE junction.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary opacities with no pneumothorax following today's bronchoscopy.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old. SOB. Evaluate for pulmonary congestion. Stable severe cardiomegaly with vascular redistribution. No evidence of edema or infection.ICD and LVAD are unchanged.Interval extubation and removal of NGT.

Output: No evidence of pulmonary edema. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: r/o pna, patient CANNOT sit up or move has radiation hardward in place in perineum History: fever Tracheostomy in place. Mild subsegmental atelectasis or scarring at the left lung base. Normal heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: pneumothorax History: pneumothorax Cardiomediastinal silhouette is unchanged. Large right pleural effusion with adjacent atelectasis/consolidation with aeration of the right upper lobe.No pneumothorax.

Output: Unchanged large right pleural effusion with adjacent atelectasis/consolidation. Resolution of pneumothorax. See recent CT.


Instruction: Generate impression based on medical findings.

Input: Brain metastatic disease. Breast cancer aspiration No cardiopulmonary abnormality. Unchanged right jugular single port, tip extends into the mid SVC

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: s/p fall on left chest with severe brusing and rales in left lower half of lung with clear lungs on right. History: rales in left lung after trauma to chest Biapical pleural parenchymal scarring again noted. Bilateral basilar pleural thickening with focal areas of extra pulmonary left basilar calcification again noted. No focal lung consolidation. No displaced fractures are noted. Heart size at the upper limit of normal.

Output: No displaced rib fractures are noted though radiography may miss up to half of rib fractures. No evidence of new left hemothorax/pleural effusion or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for ptx, pleural effusion History: fall, etoh intox Chronic appearing rib fracture deformities on the lower right. No sign of pneumothorax or visible pleural effusion.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Chest pain. Ectatic calcified and tortuous aorta. Mild cardiomegaly, increased from the prior exam.No focal airspace opacity, pleural effusions or pneumothorax.

Output: Ectatic calcified aorta without acute pulmonary 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: Metastatic breast cancer. CHEST:LUNGS AND PLEURA: Subpleural radiation fibrosis in the right upper lobe. Scattered subpleural nodules stable. No new nodules.MEDIASTINUM AND HILA: Reference right paratracheal lymph node is unchanged measuring 11 x 11 mm.CHEST WALL: Interval increase in the nodule in the right breast. Nodule on image number 31/202 now measures 7 mm, previously closed measuring 3-mm. Previously measured referenced nodule is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Fat infiltration, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal mass unchanged.KIDNEYS, URETERS: UnremarkableRETROPERITONEUM, LYMPH NODES: The retroperitoneal and mesenteric adenopathy is overall stable. Mesenteric soft tissue mass measures .4.2 x 3.2 cm. reference right common iliac lymph node measures 2.3 x 2.1 cm. other para-aortic lymph nodes are also unchanged.BOWEL, MESENTERY: Concentric wall thickening involving the cecum and terminal ileum. Correlation with colonoscopy is recommended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left obturator adenopathy is unchanged measuring 2.3 x 1.4 cm image number 170.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Overall stable disease with slight increase in the size of the right breast nodule.Wall thickening of the cecum and terminal ileum. Correlation with colonoscopy is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: s/p TECAB , chest tube removal History: left pleural and medial CT removal Chest tubes removed with no pneumothorax.Basilar opacities and pleural effusions are stable.

Output: No pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of endometrial cancer and lung metastases, status post resection CHEST:LUNGS AND PLEURA: Postsurgical changes involving the right upper lobe. Small loculated pleural effusions are noted around the right upper lobe and lower lobe.MEDIASTINUM AND HILA: Small mediastinal nodes are redemonstrated. Previously measured cluster of mediastinal lymph nodes are smaller measuring 1.6 x 0.7 centimeter image number 36 on series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval resection of right upper lobe nodules. Postsurgical changes and small loculated pleural effusions on the right side. Mediastinal lymph nodes are smaller.


Instruction: Generate impression based on medical findings.

Input: 45 years, Female. Reason: Evaluate for obstruction History: Constipation No specific evidence of infection or edema within the chest. The cardiomediastinal silhouette is within normal limits. No evidence of free air.Nonobstructive bowel gas pattern. Average stool burden.

Output: Nonobstructive bowel gas pattern with an average stool burden. No free air.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: evaluate left lung expansion History: post-op VATS Left apical chest tube with a very small pneumothorax not seen on the prior study.Left mid and lower lung zone airspace opacity unchanged with a left effusion.Right lung unremarkable.

Output: Small left pneumothorax with unchanged left mid to lower lung zone opacity and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p sternal wound exploration ET tube tip approximately 3 cm above the carina.Right jugular catheter tip in the area of the jugular vein.Drains projected over the mediastinum.Small lung volumes with interstitial opacity compatible with edema, and partial atelectasis and consolidation in both lower lobes.Small pleural effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with unknown primary cancer evaluate left pelvic lesion CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left fissure is unchanged and may represent an intrapulmonary lymph node. No other new nodules in the lungs.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mild intra-and extrahepatic biliary dilatation is unchanged. Common bile duct measures 11 mm. Mildly dilated pancreatic duct in the head of the pancreas is unchanged. Pneumobilia is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Mildly dilated pancreatic duct and atrophic pancreas.ADRENAL GLANDS: Right adrenal adenoma is unchanged.KIDNEYS, URETERS: Atrophic left kidney with mild hydronephrosis. A double-J stent extends from the left collecting system into the bladder. Significant stranding and fluid along the left ureter is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Previously noted left pelvic hypodense lesion is significantly enlarged now measuring 4.8 x 4.3 cm image number 149, series number 3 encasing the distal left ureter and causing the left-sided hydronephrosis. The mass has ill-defined borders and cannot be clearly differentiated from the left iliac vessels. Left common iliac and external and internal iliac veins are not well visualized and may be thrombosed. Collateral vessels in the anterior abdominal wall.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 large pelvic mass causing left-sided hydronephrosis.Subcentimeter left lung nodule is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: assess lungs History: none. pre liver transplant evaluation Surgical staples occupy the mediastinum. Sternal wires are no longer visualized. Mild cephalization of blood flow with stable cardiomegaly. Basilar opacities appear chronic, possibly from recurrent edema. Small right pleural effusion. No pneumothorax. Mild enlargement of the central pulmonary arteries.

Output: Small right pleural effusion with cephalization of blood flow and stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: extubated 11/2 Swan-Ganz catheter tip in the area of the right ventricular outflow tract or main pulmonary artery but not clearly visible due to motion artifact.Nonspecific perihilar airspace opacities compatible with aspirated secretions and atelectasis, slightly increased in the right upper lobe.No other new findings.

Output: Perihilar airspace opacities compatible with aspirated secretions and atelectasis, slightly increased in the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: afib with RVR History: same Cardiomegaly and mediastinal clips.Low lung volumes.Bilateral pleural effusions right greater than left and basilar opacities, suggestive of atelectasis and pulmonary edema.Partially imaged dilated loops of bowel in the upper abdomen.

Output: Cardiomegaly, bilateral pleural effusions, and basilar opacities suggestive of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male presents for evaluation of chest tubes after an aortic valve replacement. Right internal jugular vascular sheath tip overlies the brachiocephalic and internal jugular vein junction. Bilateral chest tubes have been slightly repositioned over. Surgical changes of prior sternotomy noted. There is been interval removal of a Swan-Ganz catheter. Lower extremity PICC has tip in the superior vena cava.Cardiomediastinal silhouette is stable. Small left-sided pleural effusion. Probable right sided pleural effusion. Low lung volumes. No pneumothoraces.

Output: Line and tube placement as above.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: screening for clinical trial History: none Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: MaleReason for Study: Reason: CT clamp trial History: CT clamp trial Stable cardiomediastinal silhouette.Right-sided chest tube unchanged. Extensive chest wall subcutaneous emphysema without evidence of a significant pneumothorax.Redemonstration of severe emphysema and fibrotic changes.

Output: No significant pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with shortness of breath for 6 months and CXR concerning for interstitial lung disease or cancer. LUNGS AND PLEURA: Dense foci of airspace disease and multiple nodular opacities bilaterally likely superimposed on chronic lung disease given the presence of bronchiectasis. The appearance is suggestive of multifocal pneumonia, but given the patient's age, bronchoalveolar carcinoma must be considered. Significant consolidation and volume loss noted on the left. No pleural effusions.MEDIASTINUM AND HILA: Multiple hypoattenuating lesions in the thyroid. Cardiac size is normal. No pericardial effusion. No evidence of significant mediastinal or hilar lymphadenopathy. Vascular calcifications noted. The pulmonary artery is large suggesting pulmonary artery hypertension.CHEST WALL: Degenerative changes affect the spine.UPPER ABDOMEN: Limited exam of the upper abdomen shows no gross abnormality.

Output: Dense, multifocal air space disease superimposed on chronic lung disease suggestive of multifocal pneumonia versus bronchoalveolar carcinoma.


Instruction: Generate impression based on medical findings.

Input: 77 years old Female. Reason: cough History: cough. Prominence of the upper right paratracheal stripe. Cardiac silhouette is normal. There is no evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: Prominence of the upper right paratracheal stripe, which can be due to summation artifact or pathology. Suggest follow-up or further evaluation with chest CT.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Dyspnea. Mild basilar opacities slightly improved. Cardiomegaly is stable. Right jugular line tip over the RA. Left jugular line over the innominate. No pneumothorax. Other devices are stable.

Output: Improved bibasilar opacities. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Status post extubation. Cardiomegaly with severe diffuse interstitial and airspace abnormalities with pleural effusions which may reflect pulmonary edema and/or infection half progressed from previous. Dobbhoff tube is at least within the stomach. Right subclavian catheter tip over the SVC/RA junction. No pneumothorax.

Output: Severe bilateral pulmonary opacities suggesting CHF and/or infection, progressed from previous.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Cough and malaise rule out pneumonia No focal airspace opacity, pleural fluid or pneumothorax. Linear atelectasis or scarring in the right lung along the minor fissure. Normal heart size. Lower cervical spine noted to have spina bifida occulta. Right upper quadrant surgical clips.

Output: No signs of pneumonia or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: RIJ trialysis History: Trialysis placement Bilateral pleural effusions and basilar opacities suggestive of edema and aspiration.Right jugular catheter, tip in SVC.

Output: Basilar opacities and pleural effusion suggestive of edema and left lower lobe aspiration or even infection.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Evaluate PICC line before use History: as above Median sternotomy and valve repairs.Mild cardiomegaly.Right pleural effusion and possible minimal basilar opacities which could be edema or artifact.Left subclavian catheter, tip in SVC.Right PICC, difficult to visualize but likely terminates in the SVC.Right subclavian dual-chamber pacemaker placed since the prior study, leads in appropriate position.

Output: Cardiomegaly with a right pleural effusion, and a question of edema . Devices described above.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: cough History: cough Improvement in bibasilar atelectasis. No new focal lung consolidation. No evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Mild cardiomegaly again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: s/p R VATS mediastinal mass resection History: post op Right-sided chest tube is unchanged. Stable cardiomediastinal silhouette.Low lung volumes with bibasilar atelectasis. No pneumothorax.

Output: Postoperative bibasilar atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Heart failure History: As above Balloon pump no longer visualized. Stable borderline heart size with no evidence of significant pulmonary edema.

Output: Balloon pump no longer visualized. Stable borderline heart size with no evidence of significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Respiratory failure Motion degrades sensitivity. Persistent decreased lung volumes with improved aeration of the left lower lobe. No definite new focal air space process in this limited evaluation.ETT, NG and right jugular catheters similar to prior

Output: ETT unchanged and improved reaeration left lower lobe


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: is there an infiltrate History: cough, cold symptoms, persistent, no travel Cardiomediastinal silhouette is within normal limits.Left basilar opacity is improved from the prior. No new focal air space abnormality. No pleural effusions.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: 56Yrs male with refractory DLBCL, s/p EPOCH-R x 6, RICE x 4, now with refractory right upper lobe chest mass. Evaluate size of mass. History: cough Right Port-A-Cath with its tip in the right subclavian vein.Stable cardiomediastinal silhouette.Right perihilar mass unchanged from the prior exam.No new pulmonary opacities identified.No pleural effusions.

Output: No interval change in the right perihilar mass. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: febrile, tachy History: fever tachy No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 20 years old with a history of rhabdomyosarcoma now with new right sided breast mass. Port adjacent to mass. Evaluate port placement.VIEWS: Chest PA/lateral (two views) 4/4/2016 Left chest port catheter tip is in the SVC. The catheter tubing is continuous with no evidence of kinking or fraying.The cardiomediastinal silhouette is normal. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: Left chest port with intact tubing is unchanged in location.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: SOB, inc O2 requirements with pulmonary disease History: SOB, inc O2 requirements Moderate cardiomegaly.Mild basilar interstitial opacities with pleural effusions, suggestive of edema and/or aspirated secretions.

Output: Cardiomegaly with mild basilar opacities and pleural effusions, suggestive of edema or aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval for CHF History: bilateral leg edema The heart is normal in size. Mild tortuosity of the thoracic aorta.Right upper lobe discoid atelectasis. No signs of pulmonary edema or additional abnormal lung parenchymal opacities.Blunting of the right costophrenic angle may be secondary to small pleural effusion. No pneumothorax.Healed left rib fractures are noted.

Output: No radiographic findings to suggest fluid overload or pulmonary edema, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 65-year-old man coronary disease, shortness of breath, ILD/PTE LUNGS AND PLEURA: Mild upper lobe predominant centrilobular emphysema. Mild basilar predominant subpleural reticulation and septal thickening.No evidence of honeycombing or significant air trapping.No suspicious pulmonary nodules.No evidence of a pleural effusion.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Minimal enlargement of the pulmonary artery.Severe coronary artery calcifications.Common origin of the innominate and left carotid arteries from the aorta.CHEST WALL: Degenerative changes within the thoracic spine.UPPER ABDOMEN: Multiple large cysts in partially visualized non-infused kidneys raises the question of polycystic kidney disease. Small hepatic hypodensities can not be completely evaluated.

Output: 1.Mild nonspecific basilar predominant fibrosis.2.Upper lobe mild centrilobular emphysema.3.Appearance of the partially visualized and incompletely evaluated kidneys is concerning for polycystic kidney disease.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Sepsis, presumed urinary source. Evaluate for pulmonary edema or pneumonia. History of RCC with possible skeletal metastases on prior PET scans. Focal opacity projecting over the right fifth anterior rib tip and scapular tip. Blunting of the lateral right costophrenic angle appears more pronounced, but was present some extent previously. Unfolding of the thoracic aorta.

Output: Focal opacity projecting over the right chest wall and middle lobe could potentially reflect a progression of one of the patient's known osseous lesions however an intraparenchymal pulmonary abnormality cannot be excluded. Further correlation with erect PA and lateral chest radiographs is recommended for localization. Chronic small right pleural fluid collection unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.With shortness of breath, please rule out pulmonary edema. Redemonstration of moderate to severe cardiomegaly with bibasilar predominant interstitial and airspace opacities. No large pleural effusions demonstrated on the lateral film. Sternotomy hardware is redemonstrated with interval loosening of screw from the most superior plate.

Output: Moderate to severe cardiomegaly with bibasilar predominant interstitial and airspace opacities likely consistent with edema. Interval loosening of sternotomy screw as above.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: eval pacemaker placement History: L sided pain/sharp at pacemaker site Presternal ICD generator has rotated compared to prior exam. Cardiomediastinal silhouette is unremarkable. Coronary stents noted. No pleural effusions or pneumothorax. Flattening of the diaphragms again noted. Faint opacity over the left upper lung appears stable to slightly decreased.

Output: Presternal ICD generator has rotated compared to prior exam.Findings discussed with Dr. Mulligan on 5/4/15 10:10AM.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, 75 years old.Reason: s/p trach with continued vent requirements Tracheostomy tube in place and unchanged. Multiple overlying skin staples.Bilateral perihilar and basilar opacities with nonspecific consolidation are not significant change compared to the prior exam.Unchanged elevation of the right hemidiaphragm.Bilateral moderate-sized pleural effusions. No pneumothorax.

Output: Nonspecific pulmonary opacities and perihilar consolidation are not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.History of bilateral lower extremity edema. Bilateral rib deformities noted, likely old, healed fractures.The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: No evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.IABP question placement IABP marker projects 3.5 cm below the expected level of the top of the aortic arch.Elevation of the right hemidiaphragm.Cardiothoracic ratio appears similar to previous.No specific signs of pulmonary edema.Basal opacities may reflect atelectasis and can be followed on routine films.

Output: IABP marker 3.5 cm below the expected level of the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: bacteremia s/p OHT, evaluate for pneumonia History: febrile in setting of Relatively low lung volumes with persistent blunting of the costophrenic angles from scarring. Mid to lower zone reticular opacities appear chronic. No consolidation or interval pneumothorax. The heart size is normal.

Output: No specific evidence of pneumonia. Basilar scarring and blunting the costophrenic angles unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: shortness of breath, history of NHL 2008 treated with chemo and RT History: SOB, fatigue Mild radiation related changes in the medial aspect of the upper lobes with superior retraction of the hila, right greater than left, likely related to treatment for lymphoma.

Output: No acute cardiopulmonary process. Radiation-related changes again noted within the medial aspects of the upper lobes.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval chest tube placement History: pneumothorax s/p R sided chest tube at OSH Small right apical pneumothorax with right-sided chest tube in place.Right basilar atelectasis.Heart size normal. No specific evidence of infection or edema.Stable left upper lobe nodule.

Output: Small right apical pneumothorax with chest tube in position. Right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: Asthma, frequent infections. Cardiomediastinal silhouette is normal. No focal opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval for mediastinal widening History: epigastric pain Large lung volumes consistent with COPD.No other significant abnormality.Mediastinal contours are unremarkable.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Contusion of right frontal wall of the thorax. DVT of lower extremity. Tubes and hardware similar in position, with presumed chest wall drains bilaterally.Large right pleural fluid collection and small to moderate volume of pleural fluid on the left.Severe perihilar distribution airspace and interstitial opacity; interval improved aeration at the right base may be the result of diminished pleural fluid.

Output: Improved aeration of the lungs on the right may be the result of decrease in pleural fluid. Overall, interstitial and airspace opacities bilaterally appear similar.


Instruction: Generate impression based on medical findings.

Input: 19 year-old female presents with abdominal pain, history of exploratory laparotomy. No focal airspace opacity, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.No pneumoperitoneum or mural. Relative paucity of bowel gas with small amounts of air in a non-distended right colon.

Output: Mild paucity of bowel gas without specific evidence of bowl obstruction. The colonic air speaks against a high-grade bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: 73 year old female with history of lymphoproliferative disorder CHEST:LUNGS AND PLEURA: Mild left apical scarring, unchanged.MEDIASTINUM AND HILA: Prevascular lymph node is unchanged on image number 37, series number 3 measuring 7 mm in diameter.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular left adrenal gland is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node is unchanged measuring 7-mm in diameter image number 114, series number 3.Index left para iliac lymph node is smaller, now measuring 1.2 x 1.2 cm image number 155, series number 3. The second reference measurements are the same lymph node near the left adnexa measures 1.8 x 1.2 cm image number 185, series number 3, smaller compared to previous study.Previously measured left upper quadrant soft tissue density measures 1.9 x 1.5 cm on image number 91, series number 3, slightly smaller compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the reference , pelvic and omental soft tissue nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Post-op History: CTICU Daily CXR Chest tubes are present with no pneumothorax.Minimal subsegmental atelectasis noted.ET tube tip 6 cm above the carina.Right jugular introducer sheath.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Shortness of breath, cough, sputum. Asthma. Upper normal heart size. No pneumothorax. No focal airspace opacities suggest pneumonia.

Output: Heart size appears upper normal, however this may be exaggerated due to magnification from portable technique. More accurate assessment may be made with erect PA and lateral chest films when feasible. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: Infiltrates History: fever Right apical opacity likely due to scarring. This was better evaluated on prior CT. No new findings to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.ET tube placement. Low endotracheal tube with tip less than 1 cm above the level of the carina.Dobbhoff tube tip in the gastric body and can be advanced.Left jugular catheter and right basal chest tube unchanged in position.Layering pleural fluid on the left with associated atelectasis. Diffuse predominantly interstitial opacities bilaterally without significant change. Subcutaneous emphysema right chest wall, with a trace subpulmonic right pneumothorax.

Output: Low endotracheal tube. Dobbhoff tube may be advanced. No acute change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Status post OHT. Normal heart size. No visible lymphadenopathy. No focal airspace opacities. Sternotomy hardware appears intact.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: eval for edema, effusions, infiltrates History: sob Left subclavian ICD has been placed with proximal coil projecting over the SVC/artery, distal coil projecting over the RV, and leads overlying the right atrium and probably the coronary sinus.Hazy perihilar opacities most consistent with edema. Focal subsolid opacity projecting over the medial aspect of the right upper lobe could reflect acute atypical edema or infection.

Output: Mild CHF. Subsolid opacity in the right upper lobe could reflect infection


Instruction: Generate impression based on medical findings.

Input: Check defibrillator ICD, right jugular Swan-Ganz and underlying cardiopulmonary appearance significant for redistribution of pulmonary vasculature and mild cardiomegaly are all unchanged other than minimal repositioning and retraction of the Swan-Ganz catheter. Note is made of vascular aortic stents incompletely visualized and overlying the inferior edge of the image

Output: Swan-Ganz mildly repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: pre op History: eval for infection No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: ngt placement History: ngt pulled 2 inches NG tube with its side-port in the distal esophagus.Decreased lung volumes with mild cardiac enlargement and tortuosity of the aorta.Nonspecific basilar opacities suggestive of atelectasis.Surgical clips identified in the right upper abdomen.

Output: NG tube with its side port in the distal esophagus and tip at the GE junction.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: ecmo History: ecmo Support devices unchanged.Stable cardiac enlargement.Perihilar opacities suggestive of edema.Left retrocardiac consolidation/atelectasis small pleural effusions similar to prior exam.No new pulmonary opacities identified.No evidence of pneumothorax.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: ETT check ETT remains 5 cm above the carina. Bilateral jugular catheters also similar, specifically the right jugular dual port projects into the innominate. NG well-positionedCardiopulmonary appearance is also similar with mixed interstitial and patchy opacities greater both bases and on the right with suspected small effusions. Subtle detail is difficult to discern given overlying artifact

Output: Grossly similar cardiopulmonary appearance again concerning for pneumonia


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: interval exam, pt with worse saturation History: desaturation with incr O2 requirements after event Endotracheal tube and right subclavian port catheter remains unchanged. Interval removal of enteric tube.Stable cardiomediastinal silhouette. Prominent bilateral hila.No significant change in bilateral lung aeration with evidence of pulmonary edema, scattered nodular densities and more discrete left retrocardiac opacity likely representing atelectasis and small pleural effusion. Trace right pleural effusion. No pneumothorax.

Output: No significant change in bilateral lung aeration with evidence of pulmonary edema, scattered nodules and more discrete left retrocardiac atelectasis and small pleural effusion with or without consolidation/aspiration. Correlate with fluid status.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with shortness of breath. Evaluate for acute COPD exacerbation versus pneumonia versus CHF. Mild cardiomegaly with perihilar interstitial opacities and septal lines and small pleural effusions most compatible with CHF. No pneumothorax.

Output: Mild pulmonary edema secondary to CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old, with right tonsil squamous cell cancer, history of chemo/RT. CHEST:LUNGS AND PLEURA: Patchy centrilobular nodularity and consolidation in the lingula and left base probably represents aspiration given the presence of bronchial debris. Developing infection cannot be excluded. Much less severe findings at the right base probably reflect the same process.Subpleural right lower lobe micro-nodule is unchanged (image 37, series 5).MEDIASTINUM AND HILA: Heterogeneous enhancing tissue within the base of the tongue is better evaluated on the accompanying neck CT.Tracheostomy tube in stable position.Multiple mediastinal lymph nodes have increased in size. A reference AP window node measures 1.4 x 1.7 cm on image 36, series 3, compared to 0.8 x 1.2 cm.The cardiac size is normal. No pericardial fluid. Aortic and coronary artery atherosclerotic calcifications are present.CHEST WALL: Right chest wall port catheter, tip in the SVC.T9 vertebral body compression deformity is unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypoattenuating lesions are unchanged and probably represent benign cysts.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic atherosclerotic calcifications.BOWEL, MESENTERY: G tube in place.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Bibasilar nodularity and consolidation, worse on the left, probably represents aspiration.2.Progression of mediastinal lymphadenopathy as above.3.Stable findings in the abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: Patient with new onset fever, white count, possible lung source? History: Fever, tachycardia, Streaky bibasilar opacities are consistent with atelectasis. No pneumothorax or large pleural effusion is evident. The cardiac and mediastinal contours are within normal limits for size.

Output: Streaky bibasilar opacities consistent with atelectasis, possibly related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: intubated, assess interval change History: intubated, assess interval change Reason: intubated, assess interval change History: intubated, assess interval change Endotracheal tube terminates 3 cm above the carina. The right dual-lumen port catheter remains in stable position, traversing in a horizontal fashion, likely toward the central left brachiocephalic vein. The remaining support devices are unchanged in position.No significant change in the right lower lobe consolidation and bilateral patchy opacities extending from the mid to lower zones. Small pleural effusions are stable. No interval pneumothorax. Heart size is normal.

Output: No significant change in the right lower lobe consolidation with small pleural effusions and mid to lower zone bilateral opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: R/o opacity in patient with AML and fever History: Fever- unclear etiology Small pleural effusions and basilar atelectasis have not significantly changed, not conclusive evidence of infection.Unremarkable mediastinal contours and cardiac silhouette.Right PICC, tip at right atrial level.

Output: Unchanged basilar atelectasis and pleural effusions, without reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: s/p LVAD History: SOB, productive cough Cardiopulmonary monitoring and support devices appear unchanged in position. Unchanged cardiomegaly, enlargement of the central pulmonary vasculature, edema, pleural fluid and atelectasis.

Output: Stable pulmonary edema with no new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: s/p thora, r/o pneumothorax History: s/p thora, r/o pneumothorax Right greater than left pleural thickening/effusions again noted. Reticular abnormality again noted in the right lung. Left lung remains clear except for slight increase in left basilar atelectasis. Vascular stent again noted overlying the right hemithorax. Unchanged heart size. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: triple lumen line placement History: IV access Interval extubation and removal of the Swan-Ganz catheter.New right jugular catheter with its tip projected in the area of the SVC at its junction with the azygos vein.Perihilar and basilar streaky opacities suggestive of aspirated secretions and possibly infection, not significantly changed since the earlier exam of the same day, but markedly increased since 9/6/2016

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: intubated History: as above Small lung volumes with nonspecific basilar opacities suggestive of edema and/or aspiration.Small pleural effusions noted.ET tube tip approximately 4 cm above the carina.Right subclavian catheter, tip in SVC.An NG tube terminates in the stomach.

Output: Unchanged basilar opacities consistent with edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: pneumonia History: weakness, elevated wbc ct Left pleural effusion with left basilar consolidation, suggestive of infection.Right lung unremarkable although there is a very small right pleural effusion. Heart size normal.

Output: Pleural effusions left larger than right with left lower lobe consolidation, possible infection.


Instruction: Generate impression based on medical findings.

Input: 76 years old, Female, Reason: r/o pna History: r/o pna New right-sided pleural effusion. Decreased lung volume with diffusely increased hazy opacity in the right lung which may reflect a layering effusion although is suspicious for infection. Streaky left basilar opacities likely aspirate or atelectasis. The heart size within normal limits.Again seen is a suspected osteophyte formation at T12 .

Output: New right-sided pleural effusion with diffuse hazy opacity in the right lung which may represent infection although a layering effusion can have a similar appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: post op MVR CABG History: post op MVR CABG ET tube tip in the right main bronchus about 2 cm distal to the carina.Swan-Ganz catheter tip in the main pulmonary artery.Opacity and volume loss in the left lower lobe consistent with atelectasis.A text page was sent to Dr. Martin at the time of reporting.

Output: Distal location of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: assess ett History: intubated ET tube tip 4 cm above carina. NG tube tip in stomach. Port catheter unchanged.Persistent basilar opacities suggestive of edema and atelectasis with bilateral pleural effusions.

Output: ET tube tip 4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Feeding tube extends inferiorly off the field-of-view. Other iatrogenic devices, unchanged and as expected. Slight increase in diffuse pulmonary opacities. Loculated right pleural effusion, unchanged. No pneumothorax.

Output: Slight increase in pulmonary edema. Loculated right pleural effusion again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: sob, eval for ADHF History: sob, eval for ADHF Chronic appearing right hemidiaphragm elevation with overlying atelectasis.No specific evidence of infection or edema.Mild cardiomegaly.

Output: Right hemidiaphragm chronic elevation, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: trach History: asx Extremely small lung volumes, with volume loss and opacity at the left base compatible with atelectasis and likely aspirated secretions.Tracheostomy tube and venous catheters unchanged. The tip of a right jugular catheter is in the area of the right atrium or possibly right ventricle.

Output: Small lung volumes with left lower lobe atelectasis, and no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: Chest pain History: chest pain Lungs clear. Heart size normal.No pleural effusion. No pneumothorax.Stable position of dual-lumen chest port.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval lung fields History: s/p afib ablation Worsening basilar opacities suggestive of postop atelectasis.Chest tube with no pneumothorax.Heart size normal.Left atrial and its ligation clip.Right jugular catheter removed.

Output: Increased basilar postop atelectasis. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.History of pulmonary edema and hypoxia, evaluate endotracheal tube placement. Endotracheal tube with tip approximately 5 cm above the carina. Enteric tube with tip in stomach and sidehole near gastroesophageal junction. Right internal jugular catheter with tip in the SVC.Stable cardiomegaly. Perihilar airspace opacities as well as basilar effusions and consolidation not significantly changed. No pneumothorax.

Output: Cardiomegaly with bilateral effusions and consolidation, similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Febrile neutropenia. No focal pulmonary opacities to suggest infection. No pneumothorax or pleural effusions.Cardiomediastinal silhouette is within normal limits.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Check for cardiomegaly. Kidney transplant Mild nonspecific cardiomegaly unchanged without additional new pulmonary abnormality. SVC stenting also placed in the interim

Output: Mild cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Check IABP placement. IABP marker unchanged in position projecting over the proximal descending thoracic aorta 2.5 cm below the top of the aortic arch. Right jugular Swan-Ganz catheter tip at the right main pulmonary artery level. A left subclavian ICD is unchanged in position. No pneumothorax. Unchanged cardiomegaly. No specific signs of pulmonary edema.

Output: IABP marker projects over the descending thoracic aorta 2.5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: evaluate for source of chest pain History: chest pain Status post median sternotomy.Heart size normal.Remnants of a left subclavian ICD and left jugular catheter been removed.Linear scarring or subsegmental atelectasis improved in the right lung base.

Output: Status post heart transplant, with no acute abnormality or new finding.


Instruction: Generate impression based on medical findings.

Input: Reason: History of lung cancer now with SOB with report of bronchus compression but please eval for other causes of sob History: sob Chest tube extending to the right apex with a moderate loculated pneumothorax and underlying pulmonary atelectasis.Pleural thickening or loculated effusion is present laterally.PICC line tip in the area of the right atrium.Mild left basilar opacity compatible with atelectasis and probably a small effusion.

Output: Extensive abnormalities in the right hemithorax with pneumothorax, atelectasis and pleural thickening or loculated effusion. These findings could be better evaluated by CT scan if one has not been performed recently elsewhere.


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath with desaturation, assess fluid status History: desaturation Mild cardiomegaly with large lung volumes consistent with COPD. Basilar interstitial opacity with several septal lines and small pleural effusions, suggestive of CHF.

Output: Findings suggestive of CHF with underlying emphysema.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: 68yoM with Swan ganz and IAPB check interval change and placement History: see above Support devices and changed with IABP marker in the proximal descending aorta.Stable cardiac mediastinal silhouette.Basilar opacities compatible with pleural effusions and atelectasis are unchanged.

Output: Support devices are unchanged with IABP marker in the proximal descending aorta. Stable cardiopulmonary appearance with pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 87-year-old female with history of PleurX catheter. Left PleurX catheter with tip projecting along the posterior medial aspect of the left hemithorax. Nasoenteric tube tip outside the field of view. Cholecystectomy clips are present. Right upper extremity PICC has been removed.Stable cardiomegaly, basilar predominant interstitial opacities, atelectasis and small bilateral pleural effusions. Left lower lobe consolidation appears stable. Large hiatal hernia.

Output: 1. Stable left PleurX catheter.2. Extensive nonspecific lower zone atelectasis, pleural effusions, and consolidation suggestive of aspiration and/or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: chest pain History: above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Cough No new cardiopulmonary abnormality and persistent focal mass observed in the AP window. Borderline cardiomegaly.

Output: Unchanged mediastinal changes representing suspected lymphadenopathy. No superimposed pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: swan History: swan, pulm edema Right IJ dialysis catheter, left-sided PICC, IVC approach Swan-Ganz catheter and enteric tube remain unchanged.Stably enlarged cardiac silhouette.Interval worsening in bilateral interstitial and somewhat patchy airspace opacities, particularly over the mid and lower lung regions, likely related to edema and atelectasis. No pneumothorax.

Output: Slight interval worsening in bilateral interstitial and airspace opacities likely related to edema. Correlate with fluid status.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: ETT repositioned, OGT placed History: above Endotracheal tube advanced to carina.No change in basilar opacities. No change in gastric distention.

Output: Endotracheal tube advanced to the carina. No other changes.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: placement History: intubation placement Interval retraction of endotracheal tube, now terminating about 4.5 cm above the level of the carina. The enteric tube continues out of the field-of-view, terminating in the stomach. Low lung volumes without left pleural effusion. The right lung base is out of the field-of-view. No focal pulmonary abnormality. Heart size within normal limits.

Output: Interval retraction of endotracheal tube, now terminating 4.5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: r/o worsening effusion History: hypoxia Support devices unchanged. Low lung volumes. Continued decrease in size of right pleural effusion. Left perihilar lower lung opacities likely secondary to atelectasis and aspirated secretions have increased.

Output: Continued decrease in size of right pleural effusion. Left perihilar lower lung opacities likely secondary to atelectasis and aspirated secretions have increased.


Instruction: Generate impression based on medical findings.

Input: Fever. Normal cardiomediastinal silhouette. The lungs are well-inflated and clear. No focal airspace opacities, pleural fluid or pneumothorax.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: chest pain History: chest pain Left humeral hardware partially visualized.Persistent right peribronchial opacities with bronchiectasis, increasing right paratracheal thickening. Left upper lobe reticulonodular opacities. While a component of this may be chronic, new infection is a consideration. Several staples are noted at the peripheral right mid zone. Heart size remains normal.

Output: Bilateral upper lobe reticulonodular opacities and right paratracheal thickening suspicious for acute on chronic infection.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: 21yo with sickle cell crisis, persistent hypoxia, increasing leukocytosis and left clavicular tenderness. R/o pneumonia/acute chest. Also asses left clavicle if fracture History: see above Heart size upper normal.No significant pulmonary or pleural abnormality.No sign of infection or infarction.Left clavicle unremarkable.

Output: Heart size upper normal, otherwise unremarkable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: daily am cxr History: daily am cxr Iatrogenic devices are unchanged. Lower lung volumes. Increased basilar opacities, likely atelectasis. Question small left pleural effusion. No pneumothorax. No pneumothorax.

Output: Lines and tubes, as above. Probable increased basilar atelectasis. Small left pleural effusion again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Assess etiology of syncopal episode. Low normal lung volumes. Unchanged heart size. Air space opacities in the bases in a pattern suggestive of aspirated secretions with associated atelectasis. No pneumothorax.

Output: Basal opacities most consistent with aspiration and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for active TB History: Unremarkable cardiac and mediastinal silhouette. Focal pleural thickening along the right major fissure on the right, likely chronic.No sign of active infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Chest pain History: Chest pain Heart size without upper normal with no evidence of CHF.No significant pulmonary or pleural disease.

Output: Borderline heart size with no other significant findings.


Instruction: Generate impression based on medical findings.

Input: 59 year old female with history of breast cancer on chemotherapy; evaluate. CHEST:LUNGS AND PLEURA: Interval resolution of bilateral pleural effusions. Significant decrease in nodular pleural thickening. The reference right apical lesion measures 0.2 x 2.8 cm (image 24 of 213); previously it measured 0.8 x 3.0 cm. Numerous, bilateral pulmonary nodules are approximately stable; however, comparison is difficult due to previous pleural effusions and atelectasis.MEDIASTINUM AND HILA: Approximately unchanged mediastinal lymphadenopathy. Reference subcarinal node measures 1.7 x 1.4 cm (image 39 of 213); previously it measured 1.4 x 2.0 cm. Differences in measurement are likely due to slice variation. Lymph nodes in the superior pericardial recess appear more confluent with loss of intervening fat planes. Decrease in hilar adenopathy.CHEST WALL: Enlarging left supraclavicular lymph node measured 2.0 x 1.0 cm (image 10 of 213). Bilateral mastectomies with mammoplasties.ABDOMEN:LIVER, BILIARY TRACT: Increase in size and number of hepatic metastases. The largest is in segment 3 and measures 2.3 x 1.9 cm (image 80 of 213).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter, low attenuation lesion in the inferior pole of the right kidney; too small to characterize.RETROPERITONEUM, LYMPH NODES: Increase in size of aortocaval and left para-aortic lymph nodes (image 113 of 213).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Unchanged right adnexal cyst.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: Overall mixed response.1. Interval resolution of bilateral pleural effusions with significant decrease in pleural metastases. Decrease in hilar adenopathy with approximately stable mediastinal adenopathy.2. Approximately stable pulmonary nodules.3. Increase in size and number of numerous hepatic metastases.4. Enlarging retroperitoneal and left supraclavicular lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for cardiomegaly or effusion History: palpitations Median sternotomy, heart size normal.No specific evidence of infection or edema.

Output: No significant abnormality. Prior median sternotomy.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: LVAD pt History: LVAD pt Iatrogenic devices are unchanged. No pneumothorax. Unchanged mild bibasilar opacities. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p aspiration History: SOB Right IJ and right subclavian central venous catheters unchanged in position. Nasogastric tube extends below the lower margin of the image.Stable cardiomediastinal silhouette.Left greater than right pleural effusions with adjacent atelectasis, stable. Right upper lung zone airspace opacities appear similar to the prior exam.

Output: Right sided pulmonary opacities compatible with aspiration appear unchanged from the prior exam. Otherwise stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Tachycardia Right PICC line unchanged, tip projects into the upper SVC.The superior segment of the left lower lobe and diffuse scattered nodular opacities are again observed without significant interval change. Moderate left effusion. No specific findings to suggest new superimposed acute abnormalityOld healing right ninth rib fracture

Output: No significant interval change. Persistent right lower lobe pneumonia


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: SOB History: SOB The heart is normal in size, considering technique. Limited assessment of the mediastinum and hila.Bilateral bronchial wall thickening. No abnormal focal lung parenchymal opacities.The pleural spaces are within normal limits.Surgical clips overlie the right upper quadrant abdomen.

Output: No abnormal radiographic findings to explain patient's symptoms.Diffuse bronchial thickening is considered indeterminate, may be reactive. Correlate with smoking history.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: pna? History: HIV, double vision Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Apical scarring.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p AVR and IABP History: CT in place Median sternotomy with cardiomegaly and a slight increase in basilar subsegmental atelectasis.Status post aortic valve replacement.Multiple chest tubes no pneumothorax.Right jugular Swan-Ganz catheter withdrawn leaving the introducer in place.

Output: Slight increase in basilar atelectasis but no pneumothorax or other complication.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Heart failure, IABP placement. IABP marker projects 4-cm below the top of the aortic arch. Right jugular Swan-Ganz catheter tip at the right main PA level. Left subclavian ICD incompletely visualized.Low lung volumes with basal atelectasis. Bronchial wall thickening and peri-bronchovascular groundglass opacity nonspecific but suggests mild component of edema. No pneumothorax.

Output: IABP marker projects 4-cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: s/p aortic graft History: above Pulmonary opacities are unchanged, sparing the right mid to lower lung zone.Bilateral pleural effusions are stable.Mild cardiomegaly.Left subclavian pacemaker, leads unchanged in position.Right PICC, tip at SVC/RA junction level.

Output: Unchanged tubes and devices, and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: new renal mass, eval pulmonary mets History: renal mass Moderate cardiomegaly. Small lung volumes.Small pleural effusions seen on the lateral view.No specific evidence of infection or edema.

Output: Cardiomegaly, small lung volumes and small pleural effusions. No evidence of metastases although CT would be more sensitive if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia. Line placement ETT remains 3 cm above the carina. NG tube projects beyond the inferior edge of the image. New right jugular catheter terminates in the proximal SVC near the RA junction. No apparent postprocedural complicationMild cardiomegaly with decreased lung volumes and moderate layered effusions. Mild diffuse edema and/or even partial consolidation from infection cannot be excluded. Serial imaging may again will be needed

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Shortness of breath and cough. Evaluate for pneumonia or sarcoid exacerbation. The cardiomediastinal silhouette is normal.There are extensive perihilar, left upper lobe, and bibasilar chronic interstitial fibrotic changes as well as apical bulla and perihilar bronchiectasis. There is a slight worsening of the basilar opacities which may be related to fibrosis or inflammatory changes. No pleural effusion or specific evidence of superimposed infection.

Output: Extensive chronic changes related to sarcoidosis and emphysema. A slight increase in these findings in the lung bases may be related to worsening fibrosis or inflammatory changes however, there is no specific evidence of superimposed infection.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Postop, evaluate lung fields status post CABG postop day number one, MVR The intra-aortic balloon pump terminates in the proximal descending thoracic aorta and is currently inflated. The endotracheal tube terminates 3 cm superior to the carina. The remaining support devices remain in stable position.Slight increased atelectasis and consolidation involving the left lower lobe with small left pleural effusion. No significant pneumothorax is present.

Output: Increased left lower lobe postoperative atelectasis and consolidation. Stable position of support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: Pt w/ ADHF History: SOB, LE Edema Increasing pleural effusions with probable basilar atelectasis. Probable mild interstitial pulmonary edema. Unchanged cardiomegaly. Iatrogenic devices are unchanged.

Output: Probable mild congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with metastatic breast cancer. Increased right-sided pain. Evaluate disease progression. CHEST:LUNGS AND PLEURA: Biapical scarring likely represents radiation fibrosis and is unchanged. Right middle lobe micronodule is slightly smaller (axial image 49/102). No new pulmonary nodules or masses. No focal consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: Hypoattenuating lesion within the right thyroid is incompletely evaluated. Cardiac size is normal with no pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Right-sided Port-A-Cath in place with its distal tip in the SVC. Right breast prosthesis is unchanged. Postoperative changes within the left breast with scarring along the chest wall and left axillary surgical clips unchanged.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions within the liver noted likely representing metastases. Progression of an inferior right lobe lesion which measures 3.3 x 3.2 cm on axial image 105/146 (previously measured 1.8 x 1.5 cm on 11/27/07). New lesion noted within the inferior lobe of the right liver (axial image 105/46).SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple blastic lesions within thoracic and lumbar vertebral bodies as well as a mild compression fracture of an upper thoracic vertebral body are unchanged.OTHER: No significant abnormality noted

Output: 1.Stable right middle lobe micronodule with no evidence of disease progression in the chest.2.Progression of metastatic disease within the liver.3.Stable bony metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: AMS History: AMS No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Other History: CHF Aortic balloon catheter, Swan-Ganz catheter and ICD leads unchanged.Cardiomegaly with interstitial opacity compatible with edema and atelectasis. No new findings.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: eval for free air History: see above Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.No free air under the diaphragm.

Output: No specific evidence of infection, edema or pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Minimal atelectasis and/or scarring persistently decreased lung volumes overall improvement is observed since October. No superimposed new airspace abnormalityBorderline cardiomegaly. Mediastinal contours are otherwise within limits. Cholecystectomy clips

Output: Minimal atelectasis and/or scarring without new abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval for edema/infiltrate History: hypoxia Mild cardiomegaly status post sternotomy for CABG.No specific evidence of infection or edema.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: History of cholangiocarcinoma CHEST:LUNGS AND PLEURA: Scattered small bilateral pulmonary micronodules are unchanged.MEDIASTINUM AND HILA: There is thrombus in the left lower lobe pulmonary artery. Subcentimeter mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Index lesion in the right hepatic lobe measures 5 x 4 cm on image number 83, series number 6, slightly enlarged compared to previous study. Non-reference lesions also appear slightly enlarged.Again noted metallic stents in the common bile duct. Intrahepatic biliary dilatation persists.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Normal.KIDNEYS, URETERS: Punctate bilateral renal cysts are unchanged.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: Slight interval increase in the size of the hepatic masses. Intrahepatic biliary dilatation is stable.New right lower lobe pulmonary embolus. Dr. Geynaismann was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: ETT placement. ETT tip 3 cm above the level of the carina. Pleural fluid and atelectasis about the same. Slight improvement in pulmonary edema on the left.

Output: ETT tip 3 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: positive QuantiFeron gold, asymptomatic History: positive QuantiFeron gold Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields, s/p trach History: as above Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with nonspecific basilar opacity compatible with edema, atelectasis and effusions, unchanged allowing for improved inflation.No pneumothorax or other acute change.

Output: Improved pulmonary inflation and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: assess for pulmonary edema, effusions History: decompensated heart failure Cardiomegaly with pulmonary edema and pleural effusions consistent with CHF. No change in left subclavian catheter with tip in left brachiocephalic vein, left of midline.

Output: Cardiomegaly with pulmonary edema and pleural effusions consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: ETT positioning History: ETT adjustment Cardiomegaly with pulmonary opacities suggestive of edema or ARDS, unchanged.Right jugular Swan-Ganz catheter tip somewhat peripherally in the right descending pulmonary artery.ET tube tip approximately 4 cm above the carina.Left PICC, tip in the SVC.An NG tube terminates in the stomach.

Output: ET tube tip approximately 4 cm above the carina. Stable pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 67 year old male status post AVR, post op study. Left sided port catheter tip in the SVC. Bioprosthetic aortic valve, sternotomy wires and spinal fixation hardware unchanged. No focal airspace opacities. Bilateral moderate pleural effusion with adjacent atelectasis unchanged. No pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: Moderate pleural effusions with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: intubated ET tube tip approximately 3 cm above the carina.Catheters and left pleural drain unchanged.Diffuse airspace opacity and moderate effusions, without significant interval change.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: pre-op CABG History: NA No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 72 year old female with pleuritic chest pain. Evaluate for PE CHEST:PULMONARY VASCULATURE: Large PE in left upper lobe pulmonary artery (series 9, image 94) extending to the subsegmental level, and also involving an inferior segmental branch. No right sided embolus identified. Study is diagnostic to the level of the subsegmental pulmonary arteries.LUNGS AND PLEURA: Consolidation along the major fissure seen peripherally in the left upper lobe is compatible with hemorrhage.Bibasilar scarring/atelectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality.

Output: Large PE in left upper lobe pulmonary artery with associated hemorrhage in the left upper lobe.Findings communicated to the ED via telephone at 15:15.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: evaluate for pneumonia History: cough, night sweats The cardiomediastinal silhouette is normal.There is no focal pulmonary opacity or pleural effusion.

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: 63-year-old male with abdominal distention. Compare to films from 12/15 which was read as showing "distal colonic ileus." Above average stool burden. Nonobstructive bowel gas pattern. No intramural or free air. Lungs are clear, cardiomediastinal silhouette is normal.

Output: Above average stool burden without obstruction.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: newly diagnosed hodgkin's lymphoma. Needs CXR for clinical trial History: n/a Large anterior mediastinal mass consistent with the provided diagnosis of Hodgkin's lymphoma.Heart size normal.No significant pulmonary or pleural abnormality.

Output: Large anterior mediastinal mass consistent with known Hodgkin's lymphoma.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old. Shortness of breath RLL crackles. History of PE. Unremarkable cardiac and mediastinal silhouette.No evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 5-year-old male with history of neuroblastoma. Echo showed questionable obstruction in SVC. CHEST:LUNGS AND PLEURA: Previously seen right lower lobe opacity is reidentified and appears smaller on comparison to prior study. No new opacities are seen. MEDIASTINUM AND HILA: Evaluation of the SVC is limited due to the central venous catheter tubing; however, it is grossly patent and opacified by contrast. Please note that small mural thrombi are not fully evaluated on this study.No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.NG tube is seen entering the stomach.CHEST WALL: No significant abnormality noted. Left subclavian central venous catheter tip is at the SVC/RA junction.UPPER ABDOMEN: Absence of the right adrenal gland is again noted. Otherwise no significant abnormality is seen.

Output: Evaluation of the SVC is limited due to the central venous catheter tubing; however, it is grossly patent and opacified by contrast. Please note that small mural thrombi are not fully evaluated on this study. If further evaluation for SVC thrombus is clinically warranted, an ultrasound with Doppler evaluation may be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: r/o PNA History: fever Right central venous catheter tip in the right atrium. The cardiomediastinal silhouette is normal.There are no focal pulmonary opacities or pleural effusions.

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: Male, 43 years old.Bloating, nausea, distention. Paucity of bowel gas with minimal amounts of air within the right upper quadrant. Midline surgical staples. Surgical clips, the majority of which are in the left upper quadrant. Ostomy tube overlies the right pelvis. Suture material within the pelvis. Enteric tube terminates overlying the gastric body with sidehole at the level of the gastric cardia. Contrast is visualized within the urinary bladder. A portion of catheter tubing is seen projecting inferior to the bladder, previously seen as rectal tube on prior CT or of uncertain significance if the tube has been replaced.Left central venous catheter terminates at the atriocaval junction. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No focal pulmonary opacities.

Output: 1. Nonspecific bowel gas pattern.2. Enteric tube sidehole is at the level of the gastric cardia, and may be advanced.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: chest pain History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: check pulmonary status History: check pulmonary status Cardiomegaly with persistent left lower lobe consolidation and mild basilar edema with small pleural effusions.Right subclavian catheter tip in SVC/RA junction level.

Output: Unchanged edema, pleural effusions and left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: 88 year-old female history of chest tube removal. Interval removal of left-sided chest tube. No significant residual pneumothorax. Stable cardiomediastinal silhouette. Tortuous and calcified aorta. Partially obscured left perihilar mass. Left basilar atelectasis and pleural effusion.

Output: Interval removal of left sided chest tube with no significant residual pneumothorax. Otherwise, stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: History of bright red blood per rectum and abdominal pain with weight loss. CT showed a colonic mass. Evaluate for pulmonary metastases. CHEST:LUNGS AND PLEURA: Innumerable pulmonary nodules consistent with metastatic disease. Although most are less than 1 cm in size, the largest in the right lung base is approximately 2.2 by 2.2 centimeters image 25/36. MEDIASTINUM AND HILA: No significant abnormality noted, except for mild aortic ectasia. A distal esophageal thickening or hiatal hernia present areaCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Please refer to the dedicated abdomen and pelvis CT 9/30/2008.

Output: Innumerable pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female status post procedure for staging of cancer. Evaluate for presence of perforation or infection CHEST:16 x 8 mm spiculated mass in the left upper lobe suspicious for primary bronchogenic carcinoma. Diffuse emphysema.Subcentimeter, subpleural opacity in the left lower lobe on image number 48, series number 5. Other subcentimeter nodule is in the lower lingula image number 51, series number 5. 11 x 6 mm nodule on image number 56 , series number 5 in the lower lingula..Multiple nonenlarged mediastinal lymph nodes. Index AP window lymph node measures 10 x 9 mm image number 36 on series number 3.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion on image number 101, series number 3 in the right lower liver. Minimal pneumobilia, likely secondary to recent procedure.SPLEEN: No significant abnormality notedPANCREAS: Ill-defined mass in the pancreatic head associated with surrounding fat stranding, which range date tumoral invasion and/or inflammation secondary to mild pancreatitis. Ancreatic duct is dilated in the body and detailed.There is peripancreatic adenopathy. Metallic stent in the common bile duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Severe atherosclerotic changes in the abdominal aorta causing approximately 50% stenosis and focal dissection.Proximal left common iliac artery aneurysm measuring 2-cm in diameter. Extensive atherosclerotic changes throughout the iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.

Output: No free intra-abdominal air to suggest perforation.Left upper lobe spiculated mass suspicious for primary bronchogenic carcinoma.Large pancreatic head mass causing pancreatic ductal dilatation. Stranding on the mass likely represents invasion of the mass and mild pancreatitis.Severe atherosclerotic changes causing approximately 50% stenosis of the, abdominal aorta as well as proximal left common iliac artery aneurysm.Dr. Trilisky was notified and acknowledged about the above findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: 82yo M hypotensive in pre-op. History: Hypotension Unremarkable cardiac and mediastinal silhouette. Status post median sternotomy with at least one stent in a left coronary artery.Small lung volumes with no gross abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female 10 months status post left lower lobe superior segmentectomy and left upper lobe apical posterior segmentectomy for stage I b adenocarcinoma. Also with history of breast and esophageal carcinoma. Now with new mass. CHEST:LUNGS AND PLEURA: Continued decrease in size of left upper lobe nodule representing an organizing hematoma/infarct. Previously noted nonspecific subcentimeter nodule in the right lung (image 48/92) is unchanged in appearance. MEDIASTINUM AND HILA: Postsurgical changes from gastric pull up are identified. New enlarged necrotic lymph node identified in the AP window (image 24/140). Reference left paraaortic lymph node (image 47/140) measures 26 x 31, previously 21 x 25 mm. Please note that this reference node has been remeasured on the prior study in order to produce more reproducible measurements. Necrotic lymph nodes also identified adjacent to the suture line in the left lung (image 37/140) that is increased since the prior examination. The heart size is normal no pericardial effusion.CHEST WALL: Dense tissue noted in the right breast likely corresponds with patient's history of breast cancer. Surgical clips noted in the right axilla.ABDOMEN:LIVER, BILIARY TRACT: A new 2.5 x 2.2 cm mass is noted in the left lobe of the liver with a central area of low attenuation that may represent necrosis. Additional areas of low-attenuation are identified within the liver (image 75 and image 100/140).SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Right adrenal lesion is unchanged.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Cystic lesion in the pancreatic neck is stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ventral wall hernia containing nonobstructed large bowel and mesenteric fat, stable. A small amount of fluid is present within the hernia sac.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: 1. Interval increase in paraaortic and mediastinal lymphadenopathy2. Interval development of hepatic lesions that likely represent metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p transbronchial biopsy History: s/p bronch Chronic appearing left hemithorax volume loss and right basilar scarring.Status post left lung transplant.Emphysematous native right lung.No pneumothorax following biopsy.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: Eval heart and Lungs History: Angina The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: ards History: ards Tracheostomy and venous catheter unchanged.Small lung volumes with diffuse interstitial opacity compatible with ARDS, not significantly changed. No new findings.

Output: Findings compatible with ARDS with no acute change.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with non-Hodgkin lymphoma. Reevaluate and compare to previous. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating left renal cyst. Nonobstructing left renal stones.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta and iliac arteries.Numerous small retroperitoneal lymph nodes appearing similar to prior study. Reference aortocaval lymph node (series 80356, image 132) measures 0.8 x 1 cm (stable).Subtle infiltration of the fat along the origins of the celiac and superior mesenteric arteries as seen previously.BOWEL, MESENTERY: Sigmoid diverticulosis.Reference mesenteric lymph node with punctate calcifications (series A0356, image 115) measures 1.5 x 1.9 cm (stable).BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Sigmoid diverticulosis.BONES, SOFT TISSUES: Lumbar spine fusion.

Output: Stable exam with reference measurements as above.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: Suspected retained catheter fragment within the superficial segment tissues of neck; sob History: Suspected retained catheter fragment within the superficial segment tissues of neck; sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No radiopaque foreign object identified.

Output: No significant abnormality.