Instruction: Generate impression based on medical findings.

Input: 63-year-old female with metastatic breast cancer. Compare prevascular node, left hilar node, hepatic dome lesion and right hepatic lesion. CHEST:LUNGS AND PLEURA: Left lower lobe pleural nodularity stable. Reference lesion (image 71; series 5) measures 4 mm in diameter. MEDIASTINUM AND HILA: Prevascular index lymph node has decreased in size slightly and currently measures 12 x 7 mm (image 37; series 3). Left hilar index lesion measures 10 x 6 mm (image 37; series 3), unchanged.CHEST WALL: Hiatal hernia.ABDOMEN:LIVER, BILIARY TRACT: Unchanged fatty infiltration of the liver, which makes the innumerable metastatic lesions more difficult evaluate. Index lesion near the hepatic dome, measures 14 x 15 mm (image 70; series 3). Other liver lesions are also grossly stable in size and number. Second lesion more inferiorly in the right hepatic lobe measures 24 x 24 mm (image 83; series 3), probably unchanged given differences in technique. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing left upper pole stone is unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged peripancreatic lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus and a small exophytic lesion anterior to the uterus are stable. Both have been described in detail previously. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic bone lesion in the left iliac bone is stable.OTHER: No significant abnormality noted.

Output: Overall no substantial interval change compared to previous measurements given above.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of shortness of breath. Evaluate for parenchymal disease. LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Several round hypodensities in the dome of the liver are nonspecific on this examination.Increased density in the inferior endplates of several thoracic vertebral bodies is likely degenerative in etiology.

Output: No finding to explain the patient's shortness of breath.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, 56 years old.Reason: bx History: none The cardiomediastinal silhouette is normal.2 right lung nodules are again noted. There is no pneumothorax.

Output: Expected postbiopsy appearance without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male status post LVAD. Evaluate for pneumonia, effusions, pneumothorax. Intact sternotomy wires. Mitral valve prosthesis in place. LVAD device partially imaged unchanged in position. Right PICC terminates in the axilla.Unchanged hydropneumothorax on the right. Perihilar interstitial opacities and small left pleural effusion also unchanged. No new pulmonary opacities. Stable cardiomediastinal silhouette.Decreasing subcutaneous emphysema on the right.

Output: No significant interval change in cardiopulmonary appearance including right hydropneumothorax and pulmonary edema. No evidence of infection


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: balloon pump positioning History: balloon pump Intra-aortic balloon pump terminates at the proximal descending thoracic aorta. Left ICD pulse generator and electrodes are unchanged in position.Cardiomegaly is stable.No interval edema or pneumothorax.

Output: Stable cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Status post unwitnessed fall. Rule out trauma. Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Within this limitation, nondisplaced fractures of the posterior right 7th through 10th ribs cannot be excluded.Scoliosis.Normal heart size.Mild fissural thickening on the right.No pneumothorax or visible fluid.Focal subsolid opacity right upper lobe of unclear etiology etiology and could represent infection, but is indeterminate in appearance.

Output: 1. Questionable right 7th through 10th rib irregularities posteriorly, mildly suspicious for fracture. Further characterization with rib series suggested. 2. Focal right upper lobe opacity could represent aspiration or pneumonia, but should be followed to radiographic resolution with PA/lateral chest radiographs in 6 weeks.


Instruction: Generate impression based on medical findings.

Input: Female; 55 years old. Reason: rule out pneumonia History: cough, sob Moderate bibasilar opacities, compatible with effusions, nonspecific atelectasis/consolidation, and metastatic disease, increased since prior CT. Underlying infection is a possibility.Normal heart size.Right Port-A-Cath tip near the superior cavoatrial junction.

Output: Increased basilar opacities as above. Underlying infection is a possibility.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: ETT placement History: ETT position changed ET tube tip has been pulled back, the tip is approximately 2 cm above the carina. The right IJ catheter is unchanged in position.Low lung volumes with diffuse coarse interstitial opacities and small bilateral pleural effusions consistent with ARDS are unchanged.

Output: ET tube tip is approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history metastatic melanoma, lung metastases, large left inguinal mass; baseline study prior to restarting chemotherapy CHEST:LUNGS AND PLEURA: Multiple metastatic lesions to the lungs have slightly increased in size on comparison to prior study.Right major fissure reference lesion measures 3.4 x 4 cm (series 4, image 50), previously measuring 3 x 4.1 cm. Right lower lobe reference lesion has increased in size, measuring 6.2 x 4.9 cm (series 4, image 61), previously measuring 5.4 x 4.7 cm.Left upper lobe lesion also appears to have increased in size on comparison to prior study (best seen on series 80216, coronal image 55). It currently measures 5.9 x 4.4 cm in the coronal plane, previously measuring 5.4 x 4.2 cm.MEDIASTINUM AND HILA: Subcarinal lymph node measures 2.6 x 3.4 cm (series 3, image 45), previously measuring 2.3 x 2.3 cm.CHEST WALL: Right greater than left thyroid lobe nodules appearing similar prior study ABDOMEN:LIVER, BILIARY TRACT: Low-density focus in right hepatic lobe (series 3, image 87) appears unchanged on comparison to prior study.SPLEEN: Splenic calcifications and perihilar splenule unchangedPANCREAS: 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. Stable fat containing ventral hernia (series 3, image 147)BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left groin lymph node measures 8.6 x 7.1 cm (series 3, image 195), previously measuring 8.4 x 7.3 cm. Numerous additional smaller nodes in the left groin are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Slightly enlarged left groin mass with interval enlargement of multiple pulmonary metastases


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Patient w/ dyspnea on exertion (hx of AV replacement), please eval for PNA/ pulmonary edema Marked cardiomegaly with pulmonary vascular redistribution stable.No pleural effusions or pneumothorax. Mild chronic interstitial opacities, unchanged.Patient status post sternotomy. Aortic and mitral valve prostheses.

Output: No interval change. No new pulmonary opacity. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: syncope yesterday, now with neuro symptoms, right sided paresthesias History: above No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Presents with shortness of breath. Globular cardiomegaly which may represent pericardial effusion. Low lung volumes and basilar subsegmental atelectasis. No focal airspace opacities. Possible small left pleural effusion. Retrocardiac atelectasis and questionable basilar edema.

Output: Globular cardiomegaly, possibly due to pericardial effusion. Retrocardiac atelectasis and questionable basilar edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: chest pain, volume status? History: chest pain Heart size normal common the aorta is tortuous.Moderate symmetric hilar and mediastinal lymphadenopathy is present.No significant pulmonary or pleural abnormality.

Output: Symmetric hilar and mediastinal lymphadenopathy, suggestive of sarcoidosis. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 8 years after completion of induction therapy, followed by MIE for management of initial T3N1 squamous cell carcioma with residual T2N0 disease in specimen. Here today for follow up. History: none Normal heart and mediastinum with a moderate scoliosis.No significant pulmonary abnormalities.Retrocardiac opacity consistent with esophagectomy and gastric interposition.

Output: No acute abnormalities and no sign of metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: intubated History: as above ET tube tip 4 cm above carina. NG tube tip in stomach.Right pleural effusion with associated atelectasis slightly decreased. Stable left lower lung zone atelectasis and edema. Pulmonary nodules were better seen on prior CT

Output: Right pleural effusion with associated atelectasis slightly decreased.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Right IJ central line placement. Patient is rotated. Right jugular catheter tip projects over the expected location of the superior cavoatrial junction allowing for patient rotation. No pneumothorax. Left paratracheal opacity consistent with goiter. Interval removal of Swan-Ganz catheter. Small pleural effusions, cardiomegaly and atelectasis unchanged.

Output: Allowing for patient rotation, the catheter tip projects over the region of the superior cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Intubated in MICU. ET tube locations? History: Intubated in MICU. ET tube locations? Study limited by rightward patient rotation. Interval removal of enteric tube. Unchanged basilar opacities. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Study limited by rightward patient rotation.Unchanged basilar opacities. No large pleural effusion or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: pna History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Altered mental status rule out infection, edema, effusion. Low lung volumes. Interstitial opacities compatible with pulmonary fibrosis, similar to prior study but increased compared to 4/2014. No pleural fluid or signs of a superimposed acute process.

Output: Chronic appearing interstitial lung disease with slight progression compared to exam of 4/18/2014. No signs of a superimposed acute process.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old, short of breath with myositis. LUNGS AND PLEURA: Predominantly basilar, bilateral groundglass and interstitial opacities with associated bronchiectasis, without evidence of honeycombing, is compatible with fibrotic type NSIP (nonspecific interstitial pneumonitis). No air trapping on expiration views.Predominantly upper lobe centrilobular emphysema.Scattered pulmonary micronodules, the largest of which measures 7 mm in the right upper lobe on axial image 31, series 5.MEDIASTINUM AND HILA: Surgical clips in the thyroid bed.Enlarged prevascular, pretracheal and superior mediastinal lymph nodes. A reference right paratracheal node measures 2.1 x 1.6 cm on axial image 35/93. No definite evidence of hilar adenopathy, although the evaluation is limited on this noncontrast exam.Mild cardiomegaly and a small pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: The left adrenal gland is thickened but incompletely visualized.

Output: 1.Predominantly basilar interstitial abnormality compatible with fibrotic NSIP, possibly related to collagen vascular disease.2.7-mm right upper lobe micronodule. In the context of a smoking history, CT follow-up in 3 to 6 months is recommended. Otherwise, follow-up in 6 to 12 months is sufficient.3.Mediastinal lymphadenopathy of uncertain etiology and significance.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: IABP placement History: IABP placement Left-sided ICD and IABP unchanged. IABP located in the distal transverse arch.Decreased lung volumes again noted. Stable cardiomegaly redemonstrated.Lung appearance unchanged. Small left pleural effusion.No pneumothorax.

Output: IABP marker position unchanged. New small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: any infiltrate? History: H/O Bronchiectasis, R/O infiltrate Redemonstration of large lung volumes and diaphragmatic flattening. Right middle lobe and lingular atelectasis and bronchiectasis again noted.Cardiomediastinal silhouette is unremarkable.No pleural effusions. No pneumothorax.No focal consolidation.

Output: No acute cardiopulmonary abnormalities. Right middle lobe and lingular atelectasis and bronchiectasis again noted.


Instruction: Generate impression based on medical findings.

Input: Gelosis. History lung cancer. Now with dyspnea on exertion Moderate COPD changes there persistent right upper lobe pleural abnormality and healing rib deformities. Extensive pleural thickening remains similar without evidence of new interval change or superimposed acute process.The remaining lungs are otherwise clear. No effusions.The cardiac and mediastinal contours are well within limits.

Output: Extensive COPD changes without superimposed new acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: ETT, PNA History: as above ET tube unchanged with its tip 5 cm above the carina.Enteric tube with its tip beyond the margin of image.Stable marked cardiac enlargement with pulmonary vascular redistribution.Patchy airspace opacities and pleural effusions more marked on the left similar to the prior exams.

Output: ET tube unchanged with its tip approximate 5 cm above the carina. Stable cardiopulmonary appearance with cardiomegaly, pulmonary edema, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p thora. r/o pneumo History: s/p thora r/o pneumo Status post left thoracentesis with removal of a fair amount of fluid, and no pneumothorax.Mild basilar atelectasis is unchanged.An NG tube terminates in the stomach.

Output: No pneumothorax following successful thoracentesis.


Instruction: Generate impression based on medical findings.

Input: SOB question pneumonia. Left lobe masslike airspace opacity. Basal atelectasis or scarring, left greater than right. Normal heart size. Prominent central pulmonary vasculature suspicious for pulmonary hypertension.

Output: Left lower lobe opacity may represent pneumonia in the appropriate clinical context. In an adult patient, follow-up PA and lateral chest radiographs recommended in 6 weeks to assess for resolution in order to exclude the presence of an underlying nonbenign process.


Instruction: Generate impression based on medical findings.

Input: Reason: mediastinal widening? pna? ptx? History: acute chest pain Dextroscoliosis with otherwise normal heart size and mediastinal contours.Right suprahilar mass and interstitial opacity, better shown on the CT scan of the same day.Moderate elevation of the right hemidiaphragm.

Output: Findings consistent with known metastatic lung cancer, better demonstrated on a CT scan of the same day.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.SOB question fluid overload. Slight worsening of bilateral interstitial and airspace opacities. There appears to be a new focal nodular opacity in the left upper lobe.

Output: Worsening of pulmonary opacities. Although some septal thickening is present suggesting edema, the progressive worsening and presence of nodular opacities is atypical for CHF and alternate etiologies including but not limited to atypical infection should be ruled out.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.PICC to far, pulled back 7 cm. Left upper extremity PICC projects over the superior vena cava. Nasogastric tube looped in the stomach. Basal atelectasis persists.Loop of large bowel in the right upper quadrant appears dilated, consistent with history of ileus or partial small bowel obstruction.

Output: Appropriate position of left PICC which terminates in the projection of the superior vena cava.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: lung field progression History: lung field progression Tracheostomy tube in place. Right internal jugular central venous catheter tip in the SVC. Left endobronchial valves again noted. Status post LVAD and tricuspid valve surgery.Stable cardiomediastinal silhouette.Grossly unchanged bilateral pulmonary opacities and small to moderate bilateral pleural effusions with a loculated component on the left.No pneumothorax.

Output: No appreciable interval change in pleural effusions and patchy bilateral opacities suggestive of interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: r/o pulmonary edema; ADHF, airway edema History: new hypoxia, tachycardia Mild basilar interstitial opacities suggestive of edema accompanied by small pleural effusions.Heart size upper normal.

Output: Mild CHF with edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Left flank pain after seizure. Evaluate for rib fracture or effusion. The cardiomediastinal silhouette is unremarkable.Low lung volumes but 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, 82 years old.Reason: Eval termination of HD line History: positioning of HD line (old) Right IJ line terminates deep within the right atrium. Low lung volumes makes detailed cardiopulmonary assessment difficult. Interstitial pulmonary edema. Small pleural effusions. Heart size likely at the upper limit of normal given low lung volumes. Diffuse osteopenia. Mid lower thoracic vertebral plasty changes. No pneumothorax.

Output: Right IJ line terminates deep within the right atrium. Interstitial pulmonary edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.SOB and oxygen evaluate lung. Diffuse interstitial and airspace opacities, most consistent with edema, slightly worse. Small pleural effusions. Oral contrast material in the projection of the stomach.

Output: Severe CHF.


Instruction: Generate impression based on medical findings.

Input: Male; 47 years old. Reason: chest pain History: chest pain LVAD and left sided ICD unchanged.Stable cardiac enlargement. Mild streaky bibasilar opacities, most compatible with subsegmental atelectasis and/or scarring. No new focal air space opacities.

Output: No specific evidence of edema or pneumonia. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: RSV and blasto pneumonia, left sided pleural effusion, still with tachypnea and SOB, ?progression History: RSV and blasto pneumonia, left sided pleural effusion, still with tachypnea and SOB, ?progression Left central catheter is unchanged in position.Severe cardiomegaly with the left silhouette obscured by diffuse parenchymal opacities, unchanged. Small right pleural effusion with associated atelectasis. No pneumothorax.

Output: No significant change in cardiomegaly and opacification of the left hemithorax.


Instruction: Generate impression based on medical findings.

Input: Reason: ? hilar lympadenopathy History: pvcs Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.No sign of lymphadenopathy.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: pt with cough and is tachy and hypoxic--assess for PNA History: cough Bilateral lower zone airspace opacity, most severe in the right middle lobe and left lower lobe, compatible with pneumonia, possibly secondary to aspiration.No sign of lymphadenopathy or pleural effusions.

Output: Findings compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: shortness of breath History: shortness of breath Cardiomegaly.No specific evidence of infection or edema.Prior IVC Swan-Ganz catheter removed.Status post extubation.Left jugular catheter tip in left brachiocephalic vein.NG tube removed.

Output: Cardiomegaly, without edema. Device removal.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male with chest tube placement Chest tube is not visualized.Severe chronic interstitial fibrosis without interval change. No pneumothorax. Extensive chest wall subcutaneous emphysema unchanged.

Output: Severe chronic interstitial lung disease and subcutaneous emphysema w/o acute change.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Multiple pleural-based and parenchymal nodules are again identified and are unchanged in size and number. Nodule at the character of the right lobe measures 13 x 12 mm on image number 49, series number 4.. The reference nodule in the left lower lobe now measures 2 x 2 cm on image number 61, series number 4MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal lesions in the liver. However, multiple soft tissue nodules have appeared in the fat between the liver and the left kidney largest measuring 11 mm suspicious for metastatic disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland is obscured by multiple metastatic lesions. Left adrenal gland is also not well seen.KIDNEYS, URETERS: Status post left nephrectomy. Soft tissue density masses around the upper pole of the right kidney has significantly increased in size. The reference nodule adjacent to the diaphragm now measures 3.1 x 2 cm. (Image number 92, series number 3). Before it was measuring 18 x 14 mm. Patient's known right lower pole mass is also increased in size measuring 3.3 x 2.2 cm on image number 120, series number 3 when it was previously measuring 2.7 x 2.4 cm.Multiple nodules in the right perinephric space suspicious for metastatic disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple peritoneal and mesenteric masses are increased in size. The reference right upper quadrant soft tissue mass now measures 2.6 x 2.8 cm image number 114, series number 3. New small nodules are also developed in the peritoneum most on the right side.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bilateral bladder diverticula not significantly changed.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral lung metastases have not significantly changed.Right lower pole mass, perinephric soft tissue masses and mesentery/peritoneal soft tissue masses are increased in size and number.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with a history of thyroid cancer status post surgery and I-131 treatment. There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. Complete resolution of previous neck activity. No increased activity consistent with functioning thyroid tissue is currently seen.Probe uptake of the neck is 0.13%.

Output: No functioning thyroidal tissue currently.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p pacemaker placement History: s/p pacemaker placement Cardiomegaly status post sternotomy.Stable left pleural collection likely loculated fluid.Left subclavian pacemaker revised, now terminating in the right atrial appendage.

Output: Left subclavian pacemaker revision without complication.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male intubated in CCU with IABP and VA-ECMO, ? Placement post trip to OR. Check OG tube placement. ET tube, left jugular catheter tip, cardiac assist cannulae and enteric tube tip unchanged. IABP marker unchanged overlying the distal descending aorta. Right IJ Swan-Ganz catheter tip unchanged overlying the right main pulmonary artery. Bilateral pleural effusions and perihilar interstitial opacities with marked cardiomegaly not significantly changed.

Output: No interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: SOB after bronch History: sob Port catheter terminates in the RA, as before. Diffuse pulmonary nodules again noted throughout the lungs. Loculated right pleural effusion again noted. Unchanged heart size. No pneumothorax.

Output: Diffuse pulmonary nodules again noted throughout the lungs consistent with metastatic disease. Unchanged right loculated pleural effusion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of metastatic breast cancer CHEST:LUNGS AND PLEURA: Reference lesion in the left upper lobe measures 5 mm on image number 22, series number 4, slightly enlarged from previous CT., larger reference lesion in the right lower lobe measures 2.8 by 2.7-cm on image number 56, series number 4, slightly enlarged compared to previous study.Other bilateral lesions are also slightly enlarged.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 11 by 9-mm image number 27, series number 3. This is stable from previous CT.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Loop 3 liver hemangiomas are unchanged. Cholelithiasis, unchanged. No evidence of biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass, suspicious for metastatic disease measures 2.5 x 1.5 cm on image number 94, series number 3. It was measuring 2.2 x 1 cm on image number 100, series number 5 from the previous study. It is slightly enlarged compared to previous study. Right adrenal gland is normal.KIDNEYS, URETERS: Left simple renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Soft tissue densities in the anterior abdominal wall, linear density, and appearance is unchanged compared to previous study. Index lesion in the right lower quadrant now measures 2.8 by 2-cm in image number 112, series number 3. Previously, it was measuring 17 by 14-mm image number 120, series number 5. Given the presence of air in the anterior abdominal wall, these may represent post injection changes, however, possibility of metastatic disease cannot be entirely excluded.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: Destructive lesion of the right acetabulum measures 4.1 x 2 .3 cm, image number 181, series number 3, slightly enlarged compared to previous study. Sclerotic lesions in bilateral iliac bones suspicious for metastatic disease are also stable. Other sclerotic lesions through the vertebral bodies are also stable, but suspicious for metastatic disease. Sclerotic lesion involving the right pubic bone is stable.OTHER: No significant abnormality noted.

Output: Slight interval increase in the size of the lung lesions and left adrenal metastatic disease. Bone metastases are grossly stable. Other than minimal interval increase in the size of the right destructive acetabular disease.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: eval lung fields History: s/p CABG, hx of CHF Right PICC line with its tip in the SVC.Enteric tube with its tip beyond the margin of the image.Stable cardiomediastinal silhouette.Bilateral pleural effusions and interstitial/airspace opacity similar to the prior exam.

Output: Stable pulmonary appearance with bilateral pleural effusions, edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: rule out fluid overlaod History: shortness of breath and tacypnea Port catheter terminates in the cavoatrial junction. Feeding tube again terminates within the body of the stomach. No change in diffuse pulmonary opacities as well as bibasilar opacities and pleural effusions. No pneumothorax.

Output: No substantial change.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Acute pulmonary edema. Lung volumes remain low normal.Diffuse pulmonary opacities bilaterally with slight improvement in the upper lobes the prior study.Old, healed fracture deformity of the distal right clavicle with abundant callus formation.

Output: Slight improvement in diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: consolidation seen on 1 view CXR and CTAP, infectious process? History: fever, dry cough, RUQ abdominal pain Cardiomediastinal silhouette is within normal limits. Stable low lung volumes. Bibasilar atelectasis/consolidation unchanged.Retained oral contrast noted in the bowel.

Output: Bibasilar atelectasis/consolidation without significant change from prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: r/o pna History: fever of unknown origin Nonspecific basilar opacities consistent with aspiration, or even infection, with small pleural effusions.Left PICC, tip at the cavoatrial junction.

Output: Nonspecific opacities which could represent infection, more likely aspiration with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: CHF History: SOB Left apical volume loss and fibrosis.Heart size upper normal.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: first npenic fever History: as above Venous catheter tip in SVC. Lungs hypoinflated. No focal opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old. New right jugular catheter with its tip in the area of the SVC. No pneumothorax or other complications.Bilateral nonspecific airspace opacity suggestive of edema with bilateral effusions greater on the right.A more recent radiograph has been interpreted.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Signs of pulmonary edema? PNA? History: Hypoxia, HF Swan-Ganz catheter terminates within the right pulmonary artery. Cardiac leads terminating within the expected location of the RA appendage, RV apex, and a cardiac vein. No focal lung consolidation. Probable mild interstitial pulmonary edema. Marked cardiomegaly. No large pleural effusion or pneumothorax.

Output: Mild interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with locally advanced cholangiocarcinoma CHEST:LUNGS AND PLEURA: Biapical scarring.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Intrahepatic biliary dilatation. Metallic stents placed in the common bile duct extends into the right hepatic duct. There is ill-defined soft tissue density at the hepatic hilum consistent with patient known history of cholangiocarcinoma. Difficult to measure this mass. No focal lesions in the liver suspicious for intrahepatic metastases.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts likely benign.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: Ill-defined soft tissue density at the hepatic hilum causing biliary dilatation consistent with patient's known history of cholangiocarcinoma. Metallic biliary stent extending from the common bile duct into the right hepatic duct.Biapical scarring.


Instruction: Generate impression based on medical findings.

Input: Reason: pulmonary edema, new consolidation History: respiratory acidosis Further interval retraction of a dual-lumen catheter with its tip likely in the soft tissues, projecting over the right apical area.Other devices are unchanged.Cardiomegaly with RVAD and LVAD in place.Left lower lobe opacity compatible with atelectasis and interstitial diffuse opacities suggestive of edema.

Output: Extravascular location of dual lumen catheter.A text message was sent to Dr.Reed at the time of interpretation.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: respiratory distress History: respiratory distress Nonspecific interstitial and airspace opacities suggestive of edema or aspiration, unchanged.Mild cardiomegaly.Cervicothoracic spine stabilization hardware.

Output: Unchanged pulmonary opacities suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: 84 years old Male. Reason: assess ETT position, pulmonary opacities History: s/p intubation. There is no significant change as compared with prior study. The right interstitial and airspace opacities are again identified. The tip of the NG tube projects over the stomach. The ET tube and left IJ catheter are stable in position.

Output: The NG tube is in position. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: COPD The cardiomediastinal silhouette is unremarkable.Lingular focus of scarring/discoid atelectasis.No focal areas of consolidation.No pleural effusions.

Output: Lingular scarring/discoid atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: respiratory distress History: as above Interval extubation. Left portacatheter remains accessed.Increasing left pleural effusion with basilar consolidation suspicious for pneumonia.

Output: Worsening left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: evaluate for PNA History: SOB Cardiomegaly status post sternotomy.Small effusions are noted.No reliable evidence of edema or pneumonia.

Output: Cardiomegaly status post sternotomy. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Evaluate pleural effusion, dyspnea The right port is no longer accesseed. Right basilar Pleurex catheter remains in stable position.  Progressive pulmonary opacities background of pulmonary nodules suspicious for edema, infection is in the differential. Stable pleural effusions which are small to moderate in size. Cardiac silhouette is obscured but remains unchanged. Pleural parenchymal thickening with effusion is tracking over the apices. No interval pneumothorax.

Output: Progressive pulmonary opacities most compatible with edema on a background of pulmonary nodules. Mild to moderate pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Line placement History: Central line placement Persistent right hemithorax opacification, slightly worse.Edema pattern left lower lung zones slightly worse.Right jugular catheter tip in SVC.Right nephrostomy tube.

Output: Slight worsening of right hemithorax opacification, and a new right jugular catheter placement.


Instruction: Generate impression based on medical findings.

Input: Reason: acute pathology History: desat ET tube tip approximately 4 cm above the carina.Right jugular catheter tip in the area of the jugular vein.Bilateral lower lobe airspace opacity suggestive of aspiration and atelectasis. Interval improvement in basilar opacities consistent with effusions and atelectasis.

Output: Partial resolution of basilar atelectasis and effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: post-pull History: post-pull Right-sided chest tube has been removed.There is now demonstration of a moderate to large size right sided pneumothorax.Stable cardiac mediastinal silhouette.Left retrocardiac opacity is compatible with atelectasis.

Output: Interval removal of right-sided chest tube with development of a moderate to large sized right-sided pneumothorax. Surgical resident at the notified at 11:20 AM.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p pleurectomy History: - Chest tubes at the left apex with no significant pneumothorax.Volume loss and opacity in the left lung compatible with atelectasis and edema.

Output: Chest tubes in place with edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old, with right chest and right axilla pain. History of PE/DVT. PULMONARY ARTERIES: Suboptimal examination due to poor contrast bolus timing. No large central thrombus. Nondiagnostic beyond the main pulmonary arteries.LUNGS AND PLEURA: Previously noted dependent consolidation has improved. Subtle ground glass opacities in the bases may reflect aspiration, atelectasis or resolving edema.Scattered calcified granulomas, unchanged. MEDIASTINUM AND HILA: Cardiomegaly has improved. No pericardial effusion. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Mild inflammatory stranding about the right subclavian vein with associated small lymph nodes are of uncertain etiology and significance.UPPER ABDOMEN: The spleen is not visualized. Diffusely hyperdense liver may reflect iron overload. Punctate hypodensity in the right lobe (image 91, series 8054) is too small to characterize.Right renal hypodense lesion is unchanged and probably represents a benign cyst.

Output: 1.Suboptimal examination for PE. No large central thrombus.2.Infiltration about the right subclavian vein with associated lymphadenopathy may reflect phlebitis of uncertain etiology.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: post transplant, eval hardware and lung fields History: hypoxemia, post OHT ET tube with its tip 4 cm above the carina.Right IJ Swan-Ganz with its tip in the pulmonary artery.IABP marker in the proximal descending aorta.Chest/mediastinal tubes in place without evidence of a pneumothorax.Decreased lung volumes with basilar atelectasis on the left.The median sternotomy.

Output: Postoperative chest with left basilar atelectasis and possible small effusion.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of COPD and worsening cough. Mild cardiomegaly.Bilateral pleural effusions. Diffuse reticular opacities in a pattern suspicious for aspiration related bronchiolitis. Mild atelectasis at the right lung base and retrocardiac region. Calcified mitral annulus. No pneumothorax.

Output: Diffuse opacities with atelectasis suspicious for bronchiolitis, most likely related to aspiration, though infectious bronchiolitis is possible.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Altered mental status question lung infiltrate Lung volumes are at least high normal. Probable underlying emphysema. Bronchial wall thickening suggesting bronchitis. Mild cardiomegaly. Atherosclerotic calcification of the thoracic aorta at the level of the arch. Right paratracheal soft tissue with mild leftward tracheal deviation nonspecific by plain film technique, statistically most likely a goiter. Loss of height, with deformity and sclerosis of T12. Deformity of the left side of L1 and L2 also noted, incompletely evaluated.Degenerative changes of the glenohumeral joints.

Output: Probable COPD/bronchitis. No specific signs of pneumonia. There is a T12 compression fracture of unclear chronicity; the underlying bone appears somewhat sclerotic which could indicate a pathologic fracture. This may be further evaluated with dedicated bone technique films of the thoracic and lumbar spine when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Worsening pulmonary edema or other pathology History: Worsening post-op hypoxemia Worsening pulmonary opacities suggestive of edema or aspiration.Small pleural effusions noted.Chronic appearing elevation left hemidiaphragm.Moderate gaseous distention of bowel.

Output: Worsening pulmonary opacities consistent with edema or aspiration.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p choly now with new inspiratory right lower chest pain, cough History: right lower chest pain with insipiration Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: eval ICD History: pacemaker fired, don't know what kind it is Cardiomegaly, but no reliable evidence of edema or pneumonia.Right subclavian single lead ICD tip in RV apex region, the lead and generator appear intact.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: assess ETT position History: intubated, complex mandibular reconstruction ET tube identified with its tip approximately 2 cm above the carina.The cardiomediastinal silhouette is unremarkable.The lungs are clear.Multiple surgical clips are identified in the axilla as well as neck.

Output: ET tube with its tip approximately 2 cm above the carina. Postsurgical changes noted within the left axilla and neck. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with perihilar and lower zone opacity compatible with edema, atelectasis and small pleural effusions.No new findings.

Output: Multiple lines, tubes and devices unchanged.


Instruction: Generate impression based on medical findings.

Input: 40-year-old male with CLL and non-small cell lung cancer status post recent CABG. CHEST:LUNGS AND PLEURA: Postsurgical changes are redemonstrated in the left upper lobe. Soft tissue adjacent to the suture line is unchanged in size and morphology. The soft tissue extends inferiorly to become contiguous with a left superhilar mass which measures 2.9 x 2.4 cm on axial image 36/109 and is smaller when compared to the prior measurements of 4.1 x 3.7 cm. Local mass effect with persistent narrowing of the distal left main pulmonary artery and left upper lobe pulmonary artery is noted.A left subpleural nodule on axial image 40/109has increased in size when compared to the prior exam.Right upper and right middle lobe nodules are unchanged. A previously noted 1 cm right lower lobe nodule is no longer evident.Upper lobe emphysematous changes are redemonstrated. Left basilar round atelectasis and scar like opacities are unchanged. No pleural effusions.MEDIASTINUM AND HILA: Left hilar soft tissue mass is smaller as described above. Reference subcarinal lymph node measures 1.2 x 2.4 cm on axial image 45/220 and is grossly unchanged. Scattered pretracheal, prevascular and superior mediastinal lymphadenopathy is grossly unchanged.Cardiac size is normal. No pericardial fluid. Extensive coronary artery calcifications are noted.CHEST WALL: Multiple left axillary lymph nodes are slightly larger. Metastatic disease affecting the T11 vertebral body is grossly unchanged.ABDOMEN:LIVER, BILIARY TRACT: Segment 8 lesion, hyperdense peripherally with low-attenuation centrally, is unchanged. Likewise, a small hyperdense focus in the dome is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cystic lesions are unchanged.RETROPERITONEUM, LYMPH NODES: Gastrohepatic, portal hepatic, mesenteric and retroperitoneal lymphadenopathy is grossly unchanged within the field of view of the prior examination. For future reference, a left para-aortic node measures 1.1 x 1.3 cm on axial image 126/220.Extensive atherosclerotic calcification is evident within the aorta and its branches. Particularly severe calcification is evident at the celiac axis and the origin of the left renal vein.BOWEL, MESENTERY: Scattered colonic diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral external iliac lymphadenopathy is noted. For future reference, a right external iliac node measures 1.9 x 2.2 cm on axial image 187/220.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Hyperdense focus within the right psoas muscle measures 2.9 x 3.2 cm on axial image 169/220 most likely representing metastatic disease. This finding was not included within the field of view of the prior examination.OTHER: No significant abnormality noted

Output: 1.Mixed response in the chest with interval decrease and/or resolution of some lesions while others have increased in size.2.Stable disease in the abdomen within the field of view provided on prior examinations.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: r/o pneumonia, pnuemo History: SOB Stable cardiomediastinal silhouette.Ill-defined right basilar opacity similar to that noted on the prior CTs may represent neoplasm.Scattered areas of scarring/discoid atelectasis in the left lung similar to the prior exam.No new focal areas of consolidation.No large pleural effusions.

Output: Nodular opacity in the right middle lobe appears be slightly increased from the prior exam highly suspicious for primary lung neoplasm. Recommend dedicated CT of the chest with IV contrast for better evaluation. No evidence of acute infection. The attending ED physician was notified by phone on 9/28/2015 at 9:15 AM.


Instruction: Generate impression based on medical findings.

Input: Female 30 years old Reason: s/p CT History: ptx Persistent left pneumothorax though significantly decreased compared to previous chest radiograph.Interval development of left pleural effusion. No focal air space opacity.No significant midline shift.Left chest tube in place with tip in apex.

Output: Interval improvement in left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with constipation, nausea, abdominal pain. Evaluate cause of pseudoobstruction.Additional history: Lung cancer with liver metastases CHEST:LUNGS AND PLEURA: 3.6 x 2.0 cm mass with spiculated borders in the right lower lobe (series 7; image 48).11 x 10 mm spiculated nodule in the left upper lobe is also seen (series 7; image 14), which is suspicious for a second primary malignancy.A small endobronchial lesion in the right lower lobe is most likely a mucous plug.The lungs are moderately severe emphysematous changes. A punctate calcified left upper lobe granuloma is seen.MEDIASTINUM AND HILA: Enlarged lymph nodes are seen in the paratracheal, subcarinal and right hilar regions. The largest is subcarinal in location measuring approximate 3.9 x 3.4 cm.Dense coronary artery calcifications.CHEST WALL: See belowABDOMEN:LIVER, BILIARY TRACT: More than 10 hypodense lesions are seen throughout the right lobe and the medial segment of the left lobe of the liver, mostly large in size. The largest lesion measures 4.2 x 4.2 cm in segment 5 (series 5; image 118). Subcentimeter hypodensities are also seen in the lateral segment of the left lobe.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered subcentimeter lymph nodes are identifiedBOWEL, MESENTERY: No evidence of bowel obstruction. Barium from a prior examination reaches the rectum. No dilated loops of small bowel are seen.A nasogastric terminates at the gastro-duodenal junction.BONES, SOFT TISSUES: As belowOTHER: Moderate atherosclerotic diseasePELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small bilateral fat-containing inguinal herniasBONES, SOFT TISSUES: Numerous lytic lesions scattered throughout the thoracic spine with involvement of the upper lumbar spine, compatible with metastatic disease. No significant compression is identified. A nondisplaced pathologic fracture affects the posterior aspect of the T7 posterior rib on the right (series 5; image 44).OTHER: Borderline aneurysmal dilatation of the right common iliac artery (2.0 cm).Aneurysmal dilatation of the left internal iliac artery (1.8 cm) on series 5; image 170. Borderline aneurysmal dilatation of the right internal iliac artery (1.5 cm) on series 5; image 170.

Output: Right lower lobe pulmonary mass, compatible with known carcinoma. Extensive mediastinal and right hilar adenopathy.Spiculated lesion in the left upper lobe is suspicious for a second primary malignancy.Numerous large hepatic and osseous metastases.No evidence of obstruction.Extensive atherosclerotic disease with mild aneurysmal formation, described above.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for interval change in balloon pump placement History: IABP Balloon pump catheter in the descending aorta, unchanged. Interval removal of a Swan-Ganz catheter.Venous catheters at the SVC/RA junction.Cardiomegaly with small lung volumes and no acute change.

Output: Balloon pump catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: 70 years old Male. Reason: eval pulm edema History: progressive sob. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There are small bilateral pleural effusions. The cardiac pacemaker/defibrillator electrodes are stable in position.

Output: The above findings are consistent with CHF, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p bilateral wedge resection History: s/p bilateral wedge resection Chest tubes been removed and there is no pneumothorax.No complication of recent wedge biopsies.Chronic appearing blunting right costophrenic angle.Right jugular catheter tip at cavoatrial junction.

Output: No complication of recent wedge biopsies and no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Tachycardia evaluate for infection. Right jugular catheter and left subclavian ICD unchanged in position. No focal pulmonary opacities. A portion of the left upper lobe is obscured and cannot be assessed.

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


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Non-Hodgkin's lymphoma. Status post left lower lobe nodule biopsy. Evaluate for pneumothorax. A left chest wall port tip terminates at the cavoatrial junction, unchanged. No focal pulmonary opacity, pneumothorax or pleural effusion. The known left lower lobe pulmonary nodule identified on CT chest February15, 2016, is not visible on radiographic imaging. The cardiomediastinal silhouette is normal.

Output: No pneumothorax or acute interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Chest pain. Normal and mediastinal silhouette. The lungs are clear. No pleural fluid or pneumothorax. No focal airspace opacities.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 34 years old Female. Reason: evaluate after ASD closure device placed History: asd. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. The ASD closure device is noted.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of ovarian cancer status post abdominal surgery for small bowel obstruction. Presenting with fever, sepsis and abdominal distention CHEST:LUNGS AND PLEURA: Bilateral large pleural effusions, new from previous CT. Bilateral dependent atelectasis.Additional groundglass opacities in the left upper lobe is suspicious for pneumonia.MEDIASTINUM AND HILA: Esophagus is diffusely dilated throughout its course.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Small rim enhancing lesion in the dome of the liver is unchanged and suspicious for peritoneal deposit.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hydronephrosis has improved.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Amount of ascites and loculation has increased within the interval. Small amount of air in the pelvic ascites is likely secondary to recent surgery. The amount of bowel dilatation has decreased within the interval. Enhancement of the peritoneum may be secondary to carcinomatosis, infection or recent surgery. Wall of the small bowel loops is diffusely thickened, likely a combination of ascites and peritoneal carcinomatosis.BONES, SOFT TISSUES: Metastatic lesions in the anterior abdominal wall are less well seen but are unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: Bilateral new large pleural effusions and dependent atelectasis. Left upper lobe groundglass opacities suspicious for pneumonia.Interval increase in the amount and loculation of the ascites.Hydronephrosis and bowel obstruction have improved.Peritoneal carcinomatosis and abdominal wall metastatic lesions are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: s/p right chest tube for pneumothorax - CT removed - eval for residual pneumothorax History: h/o pneumothorax Interval removal of right-sided chest tube. Very small right apical pneumothorax again noted. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged heart size.

Output: Interval removal of right-sided chest tube. Very small right apical pneumothorax again noted.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: swan History: swan Right IJ Swan-Ganz catheter still extending well within the right upper lobe pulmonary artery and directed cephalad.Left PICC line with its tip in the SVC.Stable cardiac mediastinal silhouette.The lungs are clear.

Output: Swan-Ganz catheter still extending well into the right upper lobe pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: Infiltrates History: fever Markedly decreased lung volumes with increased bibasilar subsegmental atelectasis.No specific evidence of pneumonia.

Output: Increased atelectasis but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Evaluate for pleural effusion Status post left pneumonectomy with stable leftward mediastinal shift and opacification of the left hemithorax. The right lung is hyperinflated but otherwise normal.Left chest wall ICD with leads unchanged in orientation.

Output: Status post left pneumonectomy with stable opacification of the left hemithorax. The right lung is hyperinflated but otherwise normal.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: PNA History: SOB, s/p OHT Improving left lower lobe consolidation and left pleural effusion.Heart size normal status poststernotomy.Right chest wall ICD remnant unchanged. Right jugular Swan-Ganz catheter tip in right pulmonary artery.Right PICC, tip in right atrium.

Output: Unchanged support devices. Improving left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Wheezing No acute cardiopulmonary abnormality. Minimal bronchial wall thickening can be seen with asthma and/or bronchiolitis.

Output: Questionable reactive airways such as minimal asthma and/or bronchiolitis


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: assess lines History: as above Mild cardiomegaly status post sternotomy with persistent pleural effusions right larger than left.Nonspecific right basilar opacity likely edema.Right subclavian IABP, proximal marker 3 cm below the top of the aortic arch.Left subclavian ICD, leads unchanged in position.

Output: Unchanged opacities and pleural effusions, and stable support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT daily check History: intuabted ET tube tip approximately 2 cm above the carina.Bilateral opacity compatible with atelectasis and nonspecific consolidation.Mediastinal widening consistent with excess fat and lymphadenopathy as shown on recent CT scan.Large pulmonary artery consistent with pulmonary hypertension.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: evaluation of effusion History: hypoxia Central venous catheters, unchanged. Apparent improvement in moderate size right pleural effusion. No new focal pleural parenchymal opacity in the left hemithorax. Unchanged cardiomegaly. Massive enlargement of the pulmonary arteries again noted.

Output: Improvement in right pleural effusion now moderate in size.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: r/o pneumonia History: fever/cough chest pain Small pleural effusions with overlying subsegmental atelectasis.No reliable evidence of pneumonia.Heart size normal.

Output: Small pleural effusions, unknown etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: et tube History: intubated Lines and tubes are unchanged. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: resp insufficiency History: same Stable position of right-sided chest tubes with no evidence of pneumothorax. No change in basilar opacities.Line position stable.

Output: No significant pneumothorax or change in line position.


Instruction: Generate impression based on medical findings.

Input: Small left-sided pneumothorax.VIEW: Chest AP (one view) 02/23/15, 1029 Endotracheal tube tip is below the thoracic inlet. Feeding tube has been removed. Umbilical venous line tip is at level of left hepatic vein. Right chest tube is again seen. Side port is in subcutaneous tissues.Cardiothymic silhouette is normal in size. Right pneumothorax is small to moderate in size. It is time and remains slightly shifted. No left pneumothorax is identified. No focal lung opacity is present.

Output: Decrease in size of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: eval new PICC position History: as above Left lower lobe consolidation with pleural effusions new since the prior study.Tracheostomy tube tip approximately 5 cm above the carina.Right PICC, tip at cavoatrial junction level.A Dobbhoff tube terminates in the stomach.

Output: PICC placement. New pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female 13 years old; Reason: rule out metastases History: none There is scattered uptake in the thyroid bed and neck which correlates with patient's known disease. There is a radiotracer uptake outlining the colon, specifically the descending and sigmoid colon which is an expected finding. There is no suspicious uptake below the level of the diaphragm.

Output: Uptake in the thyroid bed and neck correlates with patient's known disease. There are no other suspicious foci to suggest new metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Previously seen pleural effusions have resolved.Minimal residual basilar scarring or subsegmental atelectasis is noted.Heart size upper normal with coronary calcifications.No evidence of metastases.

Output: No significant abnormality. Resolution of prior pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with recurrent ovarian cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Multiple small hypodense foci in the spleen are unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nephroureteral stent on the left side terminating within the urinary bladder and mild left-sided hydronephrosis unchanged.RETROPERITONEUM, LYMPH NODES: Index left para-aortic node is unchanged measuring 1.1 x 0.4 cm image number 121, series number 3. Aortocaval lymph nodes appear slightly smaller.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus and ovaries are not visualized.. Previously described large heterogeneous mass in the pelvis is significantly smaller, now measuring 2.7 x 2.4 cm image number 161, series number 3. A smaller component of the mass is present more inferior and to the right of the measured lesion. Small amount of free fluid in the pelvis.BLADDER: No significant abnormality noted.LYMPH NODES: Index left external iliac node is also significantly smaller and now measures two by 1.3 cm on image number 177, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant the region the size of the previous described pelvic mass and left-sided pelvic adenopathy. Aortocaval lymph node is also slightly smaller.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Motion degrades sensitivity.Nonspecific diffuse mixed interstitial and airspace opacities greater in both bases with layered moderate to large pleural effusions. Mild cardiomegaly. Moderate aortic atherosclerotic changes and tortuosity incompletely appreciated largely due to rotation. Prosthetic aortic valveMidline sternotomy and cardiac monitor projects over lower midline.

Output: Suspected moderate CHF given limitations of the study, serial imaging will be helpful


Instruction: Generate impression based on medical findings.

Input: Reason: 65 y/o man w/ a hx of lung transplant and a fever History: fever Hyperinflated left native lung consistent with emphysema.Right transplanted lung with a small right pleural effusion but no specific evidence of pneumonia.Postsurgical bridging between the right fifth and sixth ribs.

Output: Small right pleural effusion but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: L sided pleural pathology History: L pleuritic pain Biapical pleural scarring, unchanged.No sign of pneumothorax or other acute change. Catheter tip in the SVC.Large lung volumes with bronchial thickening suggestive of bronchitis and COPD.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Cough. No focal airspace opacity, pleural effusions or pneumothorax.The cardiomediastinal silhouette is normal.

Output: No significant cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: intubated History: intubated Lines and tubes are unchanged. Development of right pleural effusion and right basilar opacity with question of small left pleural effusion. Unchanged heart size. No pneumothorax.

Output: New pleural effusions, right greater than left. New right basilar atelectasis and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Altered mental status rule out infection. Moderate left and small right pleural fluid collections, perhaps minimally increased. Nonspecific basal opacity and atelectasis on the left slightly worse, but probably similar on the right.Left apical pleural or extrapleural thickening again noted. Superior mediastinal prominence which may be due to vascular tortuosity or goiter but is nonspecific by plain film, unchanged. No signs of interstitial edema.

Output: Moderate pleural effusions with basal atelectasis appearing slightly increased on the left. No conclusive pneumonia was appreciated in this area on a recent CT scan which included the lung bases.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: evaluate pleural effusions History: SOB Persistent small right pleural effusion with right basilar pigtail catheter in place. No residual pneumothorax.Elevation of the right hemidiaphragm again noted. Bilateral basilar bandlike opacities represent discoid atelectasis, unchanged from priors.The mediastinal contours are partially obscured. The heart is normal in size.

Output: Adequate position of right basilar pigtail pleural catheter. Small right pleural effusion again noted. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: MaleReason for Study: Reason: eval acute process History: recurrent syncope, AICD Right-sided ICD unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with history of tracheostomy. Tracheostomy tube and support devices unchanged. Stable cardiomegaly. Small left pleural effusion/pleural thickening. New focal opacity in the left mid lung which may represent atelectasis or aspiration.Partially imaged IVC filter. G-tube in the stomach.

Output: New focal opacity in the left mid lung which may represent atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.SOB and chest pain question heart failure. Low lung volumes.Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. No signs of CHF.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Evidence of pneumonia History: Cough Increased opacity at the right base compatible with atelectasis and nonspecific consolidation.Severe mediastinal widening and left lower lobe nodule as previously described, without significant change.Port catheter extending to the SVC.

Output: Increased right basilar opacity which may be secondary to aspiration and/or infection.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of follicular non-Hodgkin's lymphoma. Restaging exam. CHEST:LUNGS AND PLEURA: Scattered micronodules unchanged. No new nodules or masses. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Pretracheal, right hilar and AP window lymphadenopathy is unchanged to slightly smaller. A reference pretracheal node measures 1.4 by 1.0 centimeters on axial image 31/215 and is slightly smaller when compared to the prior exam where it measured 1.6 x 1.0 cm. Cardiac size is normal. No pericardial fluid. Cystic lesion within the thyroid is unchanged as well.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule is unchanged measuring 1.6 x 2.1 cm on axial image 96/215.KIDNEYS, URETERS: Stable right renal hypoattenuating lesion probably represents a benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Soft tissue nodule adjacent to the gastric wall on axial image 94/215 measures 3.2 x 2.2 cm and is grossly unchanged. Colonic diverticula with no evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left external iliac lymph node measures 1.8 x 0.9 cm on axial image 179/215 and is slightly smaller when compared to the prior exam where it measured 2.1 x 1.1 cm.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: As above.OTHER: Surgical clips in the inguinal region bilaterally.

Output: 1.Overall improvement in several reference measurements as described above.2.Other findings are stable.


Instruction: Generate impression based on medical findings.

Input: Reason: f/u s/p aspiration History: hypoxia Small lung volumes with bilateral nonspecific air space opacities compatible with the history of aspiration.Large left pleural effusion, unchanged.Venous catheters extending to the SVC.

Output: Findings consistent with aspiration pneumonia with a large left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: s/p Left IJ cordis to triple lumen cath exchange History: s/p Left IJ cordis to triple lumen cath exchange Basilar consolidation left greater than right with pleural effusions left larger than right, unchanged.Prior left jugular access sheath replaced with a catheter terminating in the SVC.

Output: Left jugular catheter exchange. Unchanged pulmonary opacities or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female; 18 years old. Reason: eval acute process History: first onset seizure Normal cardiomediastinal silhouette. Low lung volumes. No focal airspace opacity or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain L sided, ?ptx/pna History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and hemoptysis Interval mild improving decreased patchy superimposed changes suggesting resolving edema with a persistent right upper lobe opacity essentially unchanged. This latter finding again suggests probable hemorrhage or infection, consistent with the questionable focal process described on recent CT.Borderline cardiomegaly with an unchanged mildly elevated right hemidiaphragm.

Output: Unchanged right upper lobe focal process with overall mild improvement in the superimposed edema-like changes


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: r/o acute cardiopulm process History: L chest pain, tender to palpation. Hypoplastic left first rib. Sternal cerclage wires similar to previous exam. Surgical clips in the upper abdomen. No focal air space opacity.No pneumothorax, pulmonary edema, or significant pleural effusion.Unremarkable cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: r/o acute cardiopulm process History: asymptomatic, r/o infectious trigger for acute devic's flare Lungs and pleural spaces remain clear. Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: MaleReason for Study: Reason: ARDS, aggressive diuresis, eval for worsening opacities History: see above Decreased lung volumes with perihilar and basilar air space/groundglass opacities compatible with edema .Stable cardiomediastinal silhouette.Pleural effusions again noted.Left PICC line with its tip in the left subclavian vein.

Output: Minimal improvement in pulmonary opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: pneumonia, acute chest History: new fever New basilar subsegmental atelectasis which may be the result of aspirated secretions or mucous plugging, or related to vaso-occlusive disease.No specific evidence of infection.Heart size normal.

Output: New basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with productive cough. Increased lung volumes. The heart size is normal. Upper lobe predominant emphysema. No abnormal focal pulmonary opacity. No pneumothorax or pleural effusions.

Output: No acute cardiopulmonary abnormality to explain symptoms.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Evaluate IABP placement History: Evaluate IABP placement Small lung volumes with a small right pleural effusion but no reliable evidence of edema.Prior granulomatous disease.IABP marker distal tip 4 cm below the top of the aortic arch.IVC Swan-Ganz catheter tip in right interlobar pulmonary artery.Left jugular catheter, tip in the RA.

Output: No change in support devices or in lung appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for abnormality, infiltrate/effusion History: new onset afib Normal heart size with an aortic valve prosthesis.Small lung volumes with diffuse severe chronic interstitial opacity, considerably increased since the previous radiograph, previously characterized by CT scan.No specific evidence of CHF or infection.

Output: Severe chronic interstitial disease with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pna? edema? History: cough, course breathsounds Examination is mildly limited secondary to inability to properly position patient due to prior stroke.No pleural effusion or pneumothorax. No focal pulmonary abnormality. Heart size is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: ETT placement. Low endotracheal tube with tip about 2 cm above the level of the carina. A left jugular catheter is unchanged in position, projecting over the left mediastinum, probably in a left-sided SVC.Unchanged cardiomegaly, pleural fluid and atelectasis.

Output: Low endotracheal tube with tip 2 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: fever History: eval Normal heart and mediastinal contours.Moderate perihilar bronchial thickening, which can be seen in bronchitis or asthma.No specific evidence of pneumonia.

Output: Possible asthma or bronchitis but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Ventriculoperitoneal shunt and vomiting.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 10/13/15 Ventriculostomy tube tip is to the right of midline in the middle cranial fossa. The tubing courses along the right head and neck. It continues over the right chest and has its tip in the right atrium. No shunt discontinuity is seen.A right occipital burr hole is noted, the site of a prior shunt.Mild peribronchial thickening is seen.A gastrostomy tube is present. A moderate amount of feces is seen in the colon. Mildly dilated bowel is noted.

Output: No evidence of right ventriculoatrial shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Tachycardia and history of TB Layered moderate to large right pleural effusion with underlying atelectasis with small lung volumes similar to prior exam given suspected more horizontal partial supine positioning.Dobbhoff and right jugular catheter unchanged

Output: Persistent right pleural effusion with underlying basilar atelectasis and/or partial consolidation


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with an enlarged aorta at the arch seen on chest x-ray. Evaluate for aortic aneurysm. Patient with history of untreated hypertension. LUNGS AND PLEURA: Left lower lobe granuloma (image 53/82). MEDIASTINUM AND HILA: Heterogeneous thyroid gland with subtle nodularity. The ascending aorta is within normal size limits. Normal cardiac size. No pericardial effusions. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant axillary lymphadenopathy. Degenerative changes.UPPER ABDOMEN: Probable fatty liver.

Output: Thoracic aorta is within normal size limits. No evidence of aneurysm or dissection.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: eval for PAN History: fever, cough, sob Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Clear lungs.


Instruction: Generate impression based on medical findings.

Input: 96 years old Female. Reason: s/p Thoracentesis History: s/p Thoracentesis. Marked cardiomegaly with diffuse bilateral interstitial opacities and pleural effusion compatible with CHF, unchanged. Aortic prosthetic valve is again noted.

Output: Above findings are consistent with the CHF. However superimposed infection cannot be excluded. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: Respiratory Distress History: Respiratory distress Esophageal stent and left pleural catheter unchanged.ET tube difficult to visualize, however probably unchanged.Stable cardiomediastinal silhouette.Upper lobe predominant opacities stable.No new pulmonary opacities identified.Small right pleural effusion similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance with nonspecific pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: ICD malfunction, History: SOB No significant cardiopulmonary abnormality.Left subclavian biventricular dual-chamber ICD, leads in appropriate position and intact in appearance.

Output: ICD, leads appearing intact.


Instruction: Generate impression based on medical findings.

Input: Hypotension Moderate COPD changes and scarring without superimposed new cardiopulmonary airspace abnormality. Cardiac and mediastinal contours remain within normal limitsUnchanged right jugular dialysis catheter, tip extends into the right atrium

Output: Unchanged dialysis catheter and underlying chronic pulmonary changes


Instruction: Generate impression based on medical findings.

Input: Unclassified double ILD. Previous aspergilloma. Question chronic aspiration. Positive serology is but no definite connective tissue disease. Question progression or new findings. LUNGS AND PLEURA: Diffuse severe reticulonodular and cystic interstitial disease most severe in the subpleural regions and in the lung bases. There is moderately extensive subpleural honeycombing, also most severe at the lung bases.Compared to the previous examination there has been moderate progression with some increase in the extent of honeycombing and some areas of slightly more confluent disease, such as in the superior segment of the left lower lobe. There is minimal ground glass opacity.No pleural effusions and no significant air trapping.MEDIASTINUM AND HILA: Moderate lymphadenopathy throughout the mediastinum and hila without significant interval change.Moderately dilated air filled esophagus, not significantly changed.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Interval progression of interstitial disease with extensive honeycombing, suggestive of UIP.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: r/o pNA History: sob, likely decompensated CHF There is cardiomegaly with pulmonary vascular redistribution.The lungs are clear.No focal areas of consolidation.No pleural effusions.

Output: Cardiomegaly without evidence of pulmonary edema or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Pleruavac placed on waterseal. Want to confirm no pneumothorax History: airleak on pleuravac Right chest tube with interval improvement of subpulmonic air and small right pneumothorax.Right basilar opacity is unchanged.Small right pleural effusion.Mild cardiomegaly.

Output: Small right pneumothorax with interval improvement of subpulmonic air. Persistent right pleural effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female 72 years old Reason: New right apical consolidation on CXR 10/15. Continues to spike despite broad spectrum abx. Assess for worsening infection vs possible progression of cancer History: hx of met lung adenocarcinoma, febrile despite broad spectrum abx, right apical consolidation on CXR 10/15 New small bilateral pleural effusions with adjacent subsegmental atelectasis. Increased right upper lobe airspace opacity, likely pneumonia. Unchanged right extrapulmonary mass. Right mediastinal stent unchanged. Cardiomediastinal silhouette is unchanged.

Output: New small bilateral pleural effusions. Right upper lobe opacity, increased from prior exam, likely due to pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: pneumothorax History: post-procedure pneumothorax Right midlung pigtail chest tube and left-sided PICC remain unchanged. Status post median sternotomy and CABG surgery. Spiration endobronchial valves remain unchanged.Stable cardiomediastinal silhouette.Emphysematous changes with right upper lung predominance. Patchy left upper lung airspace disease. Question trace pleural effusions versus pleural thickening.Small right apical pneumothorax is unchanged.

Output: Unchanged small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: ET position History: ET position ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.NG tube tip in the stomach.No significant pulmonary abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Shortness of breath. Persistent very low lung volumes and bilateral basilar subsegmental atelectasis.Moderate bilateral pleural effusions are noted. A focal homogeneous opacity in the right base is more conspicuous than on prior study and most likely represents fluid within the right minor fissure. Attention on follow-up.No pneumothorax.The cardiac contours are partially obscured.

Output: Persistent moderate bilateral pleural effusions. Very low lung volumes and bilateral basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent small to moderate pleural effusions with elevated right hemidiaphragm and underlying atelectasis and/or scarring in both bases. Mild cardiomegaly. Overall appearance similar given differences in positioning and semiupright technique.

Output: No significant interval change in previously described bilateral basilar scarring and/or atelectasis with small to moderate effusions


Instruction: Generate impression based on medical findings.

Input: Reason: icu History: icu Venous catheter, chest tubes and cannulae unchanged, with the catheter from the right arm forming a redundant loop at the junction of the right jugular and brachiocephalic veins.Moderate cardiomegaly.Large right pleural effusion that may be partly loculated, not significantly changed.No new findings.

Output: Large right loculated effusion without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval lung fields History: cp Interval extubation. Cardiomediastinal silhouette within normal limits. Lungs clear airspace and interstitial opacities. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval ETT History: Resp failure No sign of an ET tube in the trachea.Small lung volumes with diffuse nonspecific opacity and pleural effusions.Left jugular catheter extending to the SVC.

Output: Diffuse pulmonary opacities and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: ro acs History: voc, crackles on exam Reason: ro acs History: voc, crackles on exam Persistent low lung volumes. Diffuse increased sclerosis with vertebral body changes compatible with sickle cell disease. Interval decrease in the bilateral airspace opacities with chronic reticular opacities remaining. Heart size is mildly enlarged.

Output: Mild cardiomegaly. Low lung volumes with chronic interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval ETT History: intubated Status post median sternotomy with chest tubes and no pneumothorax.Small lung volumes with basilar atelectasis likely mucous plugging related to recent surgery.ET tube tip approximately 1 cm above the carina.Right jugular Swan-Ganz catheter, tip directed towards the right main pulmonary artery.

Output: Basilar atelectasis postop. Low ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Placement of Swan. Right jugular Swan-Ganz catheter tip at the level of the right main pulmonary artery. Left subclavian ICD unchanged. Cardiomegaly, similar to previous. No pneumothorax. There may be a small volume of pleural fluid on the left.

Output: Interval retraction of Swan-Ganz catheter with tip now at the level of the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female 68 years old Reason: 68yoF OSH transfer NSTEMI History: as above Bilateral total shoulder arthroplasty devices are noted.Normal heart size. Atherosclerotic calcification of the aortic arch.Calcified granuloma in the right mid lung.No focal consolidation, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: infection? History: cough, sputum production Basilar opacities suggestive of atelectasis and bronchial wall thickening may be the result of aspiration.Small lung volumes.Heart size normal.Tracheostomy tube, the tip at the level of the thoracic inlet.Right jugular catheter, tip in SVC.

Output: Basilar opacities suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: 63 year-old female history of shortness of breath. The cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath ICD and right subclavian Swan-Ganz again projects into the right pulmonary flow tract just beyond the upper lobe bifurcation.Other than minimal scarring and/or atelectasis, lungs are otherwise clear. Moderate nonspecific remaining

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: evaluate for infectious process History: sob Multifocal opacities similar to the prior examination with scarring and subsegmental atelectasis at the right mid zone. Chronic elevation of the right hemidiaphragm is stable. No new consolidation, pulmonary edema or pleural effusion. The heart size remains within limits of normal.

Output: Findings compatible with sarcoidosis without superimposed infection.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: left lateral rib pain evaluate for pneumonia versus fracture History: History of breast cancer, pain Persistent bilateral pulmonary nodules, and right lower lobe mass consistent with metastatic disease, is smaller in diameter compared to prior radiograph, but similar in size to most recent CT accounting for differences in technique. Interval improvement in superimposed interstitial and airspace opacity. No new focal airspace opacity. Surgical clips again noted overlying the left chest. Cardiomediastinal silhouette is unremarkable.

Output: Widespread pulmonary metastases are again noted. Interval improvement in superimposed interstitial and airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: s/p decortication History: htx, ptx Left-sided chest tubes again noted. Mild left-sided subcutaneous emphysema with question of very small left-sided pneumothorax, likely not unexpected. No new focal pleural parenchymal opacity in the right hemithorax. Unchanged heart size. No large pleural effusion.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.History of bronchiectasis. Status post lung transplant. Postsurgical changes from bilateral lung transplant, including chest wall subcutaneous emphysema.Endotracheal tube tip is in the right mainstem bronchus. A cannula device overlies the mediastinum.There are 2 right and 2 left chest tubes, several surgical clips, a left central venous catheter tip overlying the left brachiocephalic vein, and a right-sided chest port with its tip in the lower SVC.No unexpected radiopaque foreign body.Scattered streaky opacities favoring atelectasis.

Output: Postsurgical changes from bilateral lung transplant with no unexpected radiopaque foreign body. The endotracheal tube tip is in the right mainstem bronchus.Findings were discussed with Dr. Wigfield by the resident on call.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Baseline imaging prior to planned biopsy of mediastinal node. Malignant neoplasm of unspecified part of left bronchus or lung, secondary malignant neoplasm of unspecified site. Mediastinum is shifted leftward, with obscuration of the cardiomediastinal silhouette. Right subclavian chest port tip at the SVC level. No visible nodules or masses in the right lung. Mild atelectasis on the right.Marked elevation of the left hemidiaphragm with increased distance between the diaphragm and gastric air bubble which may indicate either subpulmonic fluid or thickening of the adjacent subdiaphragmatic peritoneal surface.Assessment of the remaining left lung is limited; there may be a suture line present at the level of the fourth interspace. Loculated fluid is not readily discernible from any underlying mass on the left.There appears to be some irregularity of left ribs 7 and 8 posteriorly, poorly visualized.

Output: Left hemithorax volume loss, pleural fluid and nonspecific opacification which could be postsurgical or the result of underlying tumor. Subdiaphragmatic fluid versus intraperitoneal mass effect upon the gastric air bubble.


Instruction: Generate impression based on medical findings.

Input: 94 year-old female with history metastatic colorectal carcinoma. Evaluate for progression. CHEST:LUNGS AND PLEURA: Small nodularity in right lung base is seen on series 5, image 68/100.Previously referenced nodule in left lung base has decreased in size (series 5, image 55/100). MEDIASTINUM AND HILA: Small mediastinal lymph nodes remain stable.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Diffuse biliary hamartomas limit evaluation of the liver. Reference metastatic lesion adjacent to gallbladder fossa remains difficult to evaluate however appears to remain stable in size, measuring 2.6 cm x 1.7 cm (series 3, image 111/190).Another ill-defined area of hypoattenuation is seen in the posterior right hepatic lobe on series 3, image 90/190. It looks to be unchanged on comparison to previous exam.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Stable left adnexal cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: Pelvic small bowel loops are not well opacified, therefore, cannot be optimally evaluated.BONES, SOFT TISSUES: Heterogeneous appearance of the sacrum and the right femoral neckwith mixed areas of sclerosis and lucency is unchanged. .OTHER: No other significant abnormality noted.

Output: 1.Previously referenced ill-defined liver lesion remains stable as does a second ill-defined area on comparison to prior exam.2.New small, pleural-based nodularity is seen in right lung base.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Fever and hypoxemia. Pneumonia. Evaluate for changes in opacities and pulmonary edema. Increased dense lung opacities, right greater than left, with relative sparing of the left upper lung compatible with extensive pulmonary edema and/or infection. Slightly increased multifocal linear opacities compatible with atelectasis. Small pleural effusions.Upper limits normal cardiac silhouette size, unchanged. Mediastinal surgical clips and sternal wires, unchanged in position.

Output: Increased air spaces opacities compatible with extensive pulmonary edema and/or infection with small pleural effusions.