Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Rule out pneumothorax, assess for pulmonary edema. Worsening hypoxia since this morning. Limited film due to quality and motion.Extensive basal platelike opacities, about the same. No pneumothorax. Interval development of air lucency in the right neck and chest wall consistent with subcutaneous emphysema. Pneumomediastinum is now evident.No specific evidence of pulmonary edema.

Output: Pneumomediastinum and subcutaneous emphysema. No signs of pulmonary edema. Unchanged lower lobe volume loss bilaterally.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: r/o PNA History: as above Interval placement of a right dual-lumen port with the catheter terminating at the azygos vein level. 2 clips occupy the left breast. A metallic stent occupies in the right upper abdomen.Large lung volumes. No evidence of pneumonia or edema. The heart size is normal.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Check for pulmonary edema. Shortness of breath Interval improving and decreased patchy opacities again observed in both bases and more streaky in nature suggesting atelectasis and/or aspiration currently. No new superimposed focal airspace processes. Specifically the right upper lobe focal opacity has cleared.Borderline cardiomegaly. No effusions

Output: Marked interval improvement of previously described patchy airspace opacities and suspected near complete resolution of prior multifocal infection. Currently changes support atelectasis and/or less likely aspiration


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: for confirming line placement History: Swan placement Mild basilar edema and pleural effusions left larger than right.Worsening left lower lobe consolidation.Right jugular Swan-Ganz catheter terminates in the right interlobar pulmonary artery, replacing an IVC Swan-Ganz.Left PICC, tip in axillary region.

Output: Swan-Ganz catheter replacement, the tip in the right interlobar pulmonary artery. Worsening left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: 61 y/o with recurrent ovarian cancer a/f nausea, vomiting, increasing O2 requirement, decreased breath sounds History: see above New pleural effusions and basilar atelectasis.Ill-defined upper lung zone nodular opacities.Heart size normal.Right jugular catheter, tip in SVC.

Output: Pleural effusions and basilar atelectasis, new since the prior study. Upper lobe nodular opacities could represent infection.


Instruction: Generate impression based on medical findings.

Input: 6-year-old male with history of neuroblastoma status post MIBG. Baseline pre-stem cell transplant evaluation. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: Central venous catheter is noted with its tip terminating at the cavoatrial junction. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Surgical clips are noted adjacent to the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of fluid is seen in the right pararectal space posterior to the bladder (series 6, image 123/151).

Output: Small amount of fluid is seen in the right pararectal space as described above. Otherwise no significant abnormalities noted.


Instruction: Generate impression based on medical findings.

Input: Reason: swan History: swan Swan-Ganz catheter tip in the right main pulmonary artery.Other devices unchanged.Cardiomegaly with lower zone interstitial opacity compatible with edema and probable small pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Check chest tubes Left basilar mediastinal chest tubes, bilateral jugular catheters including a Swan-Ganz, tracheostomy tube and LVAD are all unchangedCardiopulmonary appearance is also grossly similar given differences in technique. Specifically mild changes suggesting edema with stable nonspecific retrocardiac partial consolidation persists.

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Dyspnea question effusion. Left side down lateral decubitus view of the thorax.The left upper lobe appears collapsed. Dependent pleural fluid on the left, moderate in volume. Subsegmental atelectasis at the right lung base. NGT sidehole beyond the GE junction. Tip of an IVC filter is seen.

Output: Left upper lobe atelectasis. The left pleural effusion, although it appears to be layering, has not significantly changed in positioning and I am not entirely able to exclude loculated components. There is a free-flowing component which is now overlying the left apex.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Support devices are unchanged in position.Stable pulmonary edema and pleural effusions. Heart size unchanged. No pneumothorax.

Output: Persistent pulmonary edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Rule out foreign object. No unexpected radiopaque foreign body.Endotracheal tube tip 5 cm from the carina. Right IJ Swan-Ganz catheter tip is coiled in the main pulmonary artery.Left subclavian AICD lead unchanged.New LVAD.3 mediastinal drains are present.Tricuspid and aortic valvular prostheses. Endoscope terminating in the midesophagus is noted.IABP marker approximately 7 cm from the top of the aortic arch.Right axillary surgical clips.Low lung volumes.No new airspace opacities.Stable mild cardiomegaly.

Output: No unexpected radiopaque foreign body. Support devices as above.These findings were discussed by telephone with Dr. Jeevanandam, the attending surgeon, on 1715 hours at 11/9/2015.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: short of breath History: short of breath Serpiginous radiopaque line overlying the neck soft tissues and left hemithorax correlating with interscalene block catheter.Cardiac silhouette is within normal limits in size.Left lung volume loss with mild left retrocardiac atelectasis. Question trace left pleural fluid. Right lung is clear. No pneumothorax.Partially visualized fixation screws overlying the left scapula.

Output: Left lung volume loss with mild left retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: 22 years old Female. Reason: assess for acute process, shortness of breath, intermittent chest pain, history of ehlers danlos History: assess for acute process, shortness of breath, intermittent chest pain, history of ehlers danlos. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval pna History: sob Large lung volumes compatible with COPD. No interval edema or pneumonia. Scarring in the retrocardiac location. Heart size is normal.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: resolution of the pneumonia History: admitted for pneumonia in 4/15 Significant improvement in previous abnormalities although there is still residual opacity in the left lower lobe behind the heart, consistent with slow to resolve pneumonia.Heart size normal.No new findings.

Output: Improvement but not yet resolution of left lower lobe opacities. Pleural effusions have resolved.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with lung nodule. CHEST:LUNGS AND PLEURA: Diffuse, basilar-predominant subpleural reticulation with mild honeycombing and traction bronchiectasis appears similar to prior study.Right upper lobe spiculated nodule (series 6, image 25) again measures 12 x 8 mm and appears similar to earlier available study from June 2009.Left upper lobe nodule (series 6, image 19) is also unchanged dating back to 2009.Subcentimeter lingular nodule unchanged from prior study from May 2011 but new from June 2009. It can be followed on subsequent examination.Scattered calcified granulomas.MEDIASTINUM AND HILA: Enlarged mediastinal lymph nodes, unchanged. Heart size mildly enlarged without pericardial effusion. Mild coronary artery calcifications.Tracheal diverticulum as seen previously.CHEST WALL: Degenerative changes of the spine. UPPER ABDOMEN: Hilar hernia.

Output: 1. Right upper lobe spiculated nodule unchanged from June 2009. Small lingular nodule unchanged from May 2011 but new since June 2009. Given patient's high risk history with pulmonary fibrosis, a follow-up CT examination is recommended in one year.2. UIP pattern fibrotic changes of the lungs, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Shortness of breath, lower extremity edema History: As above Moderate size left pleural effusion compressing the left lung base.Right lung unremarkable.Heart size obscured by the effusion.

Output: Moderate size left pleural effusion, unknown etiology but underlying infection or tumor is possible.


Instruction: Generate impression based on medical findings.

Input: 20 year-old male with lung cancer. Tachypnic, shortness of breath. CHEST:PULMONARY VASCULATURE: Study is not diagnostic for evaluation of pulmonary embolus given poor opacification of the pulmonary arteries.LUNGS AND PLEURA: Innumerable large masses are again seen throughout both lungs, compatible with patient's known metastatic testicular cancer. Largest mass is again seen in the right upper lobe, measuring 6.4 x 5.7 cm (series 9, image 50); previously, measuring 7.5 x 5.3 cm.MEDIASTINUM AND HILA: Multiple mediastinal and hilar metastases as seen previously.. Heart size normal without pericardial effusion.Right jugular central venous catheter with tip in the right atrium.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Study is not diagnostic for evaluation of pulmonary embolus given poor opacification of the pulmonary arteries.2. Innumerable pulmonary metastases, consistent with patient's known testicular cancer.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Episode of near syncope. Mild cardiomegaly. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Wheezing evaluate for pneumothorax or effusion. Extensive calcified nodules unchanged, consistent with old, healed granulomatous disease. Normal heart size.No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: pneumonia? Pulmonary edema? History: chest pain Unchanged mild cardiomegaly. Post median sternotomy and stent placement. The inferior 3 sternotomy wires are fractured, unchanged.Mild perihilar and basilar interstitial opacities, unchanged. No focal consolidation or pleural effusion.

Output: Decreased mild pulmonary edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: r/o infiltrate History: atypical left-sided CP Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: persistent 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: Chest pain and asthma No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Pleuritic chest pain and dyspnea PULMONARY ARTERIES: There are no filling defects in the pulmonary arteries to suggest pulmonary embolism.LUNGS AND PLEURA: There is mild centrilobular edema. There are subtle ground glass opacities in the right lower lobe. Scarring or atelectasis noted in the left lingula and right middle lobe. Other hepatic changes are also noted in both dependent lung bases.MEDIASTINUM AND HILA: There are no enlarged mediastinal or hilar lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: The visualized upper abdominal contents are within normal limits.

Output: 1.No evidence of pulmonary embolism.2.Subtle groundglass opacities on the axial images in the right lower lobe reflect septal thickening when correlating with the sagittal and coronal images. This is of uncertain clinical significance, though atypical pneumonia remains possible in the proper clinical context.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: sob, hx of met prostate cancer History: sob No significant cardiopulmonary abnormality.Lower thoracic vertebral sclerotic metastases.Right jugular catheter, tip in SVC.

Output: Vertebral metastases. No significant cardiopulmonary abnormality, however.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: eval lung fields, chest tubes History: s/p robotic MVR Gradually worsening opacities consistent with edema, with pleural effusions.Chest tubes unchanged with no pneumothorax.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter tip in right ventricular outflow tract, and a second right jugular catheter terminating in the SVC. Left PICC, tip in distal left subclavian. New IVC ECMO cannula.

Output: Worsening edema like opacities. Unchanged support devices except for a new IVC ECMO cannula.


Instruction: Generate impression based on medical findings.

Input: 69 years, Male. Reason: Abdominal Pain Lateral decubitus view demonstrates pneumoperitoneum. Surgical clips seen in the chest. Right pleural effusion. Sigmoid stent and j-tube are unchanged in position. Mildly distended loops of small bowel are less prominent compared to prior exam. Moderate stool burden.

Output: Pneumoperitoneum, which may be due to j-tube or sigmoid stent. Unchanged sigmoid stent position. Mildly distended small bowel loops, less prominent compared to prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old. Support devices are stable in position. Stable cardiomegaly. No pneumothorax or pleural effusion.

Output: No acute interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Chest pain No pleural effusion or pneumothorax. The cardiac mediastinal silhouette is within normal limits. No focal pulmonary opacities to suggest infection.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with metastatic prostate cancer, status post two cycles of investigational treatment, evaluation of disease CHEST:LUNGS AND PLEURA: Scattered micronodules unchanged.Minimal dependent bi-basilar atelectasisMEDIASTINUM AND HILA: Multiple enlarged lymph nodes identified in the subcarinal, prevascular, aortopulmonary window and hilar region, mostly unchanged. Index right hilar lymph node is slightly enlarged measuring 1.1 x 1.4 cm in image number 42, series number 3, unchanged. Mild interval increase in size of a pretracheal lymph node which is a new referenced measurement, measures 1.1 x 0.9 cm (image 27 comes series 3), previously measured 5 x 5 mm.CHEST WALL: Metastatic left scapular, posterior left 7th rib, T7, vertebral body and sternal lesions are unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index aortocaval reference node is unchanged measuring 7 by 5 mm on image number 122, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval increase in the size and density of some of the sclerotic bone metastases involving the pelvic bones and lumbar vertebral bodies.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval increase in the size and density of some of the sclerotic bone metastases involving the pelvic bones and lumbar vertebral bodies, especially, L2, L3, vertebral body.OTHER: No significant abnormality noted

Output: Interval increase in the size and density of some of the sclerotic bone metastases involving the pelvic bones and lumbar vertebral bodies.Minimal interval increase in the size of the right pretracheal lymph nodeStable right hilar lymph node


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: assess for improving pulmonary edema History: hypoxia Nasogastric tube extends below the lower margin of the image. Interval removal of left IJ central venous catheter.Stable cardiomediastinal silhouette.Low lung volumes. Bilateral perihilar and basilar opacities compatible with edema, atelectasis, effusions, not definitely changed, allowing for differences in projection.

Output: Pulmonary edema and pleural effusions, not significantly changed allowing for differences in projection.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Encounter for screening for respiratory tuberculosis. Normal cardiomediastinal silhouette.The lungs are clear.No pleural or parenchymal abnormalities.

Output: Normal chest radiograph. No radiographic signs of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: COPD, polymyositis and smoking history. CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. No evidence of interstitial lung disease. No air trapping on expiration series.MEDIASTINUM AND HILA: Mild heterogeneous thyroid enlargement. Minimal pericardial thickening is unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Mild centrilobular emphysema.2. No evidence of interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with presumed fungal pneumonia status post 5 unit bleed of unknown etiology. Evaluate for mediastinal or retroperitoneal hematoma. CHEST:LUNGS AND PLEURA: Extensive bilateral groundglass and air space opacities with bibasilar atelectasis/consolidation compatible with the patient's stated history of pneumonia are grossly unchanged.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion.A right-sided central venous catheter terminates in the SVC. The ET tube terminates above the carina.CHEST WALL: No significant abnormality noted.ABDOMEN: This noncontrast examination is insensitive for the detection of solid organ pathology. Within this limitation, the following observations are made.LIVER, BILIARY TRACT: Stones or sludge layer within the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic.RETROPERITONEUM, LYMPH NODES: An extensive, right retroperitoneal hematoma tracks along the psoas muscle which is enlarged compared to the contralateral side and likely represents the source of the hemorrhage. The maximal axial dimensions of the hematoma measure 12.2 x 6.7 cm on axial image 128/218. The right psoas muscle measures 5.4 x 5.0 cm on axial image 155/218.BOWEL, MESENTERY: A Dobbhoff tube terminates in the body of the stomach.BONES, SOFT TISSUES: Diffuse anasarca is noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified uterine fibroid noted.BLADDER: The bladder is catheterized and decompressed.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.

Output: 1.Extensive right retroperitoneal hematoma is likely the result of hemorrhage from the psoas muscle.2.Unchanged pulmonary opacities compatible with pneumonia.3.Diffuse anasarca.A preliminary interpretation of this exam was provided to Dr. Rosen overnight by the radiology resident on call without discrepancy.


Instruction: Generate impression based on medical findings.

Input: Solitary pulmonary nodule Motion degrade sensitivity. The solitary left chest tube again projects towardsThe apex without a change or significant underlying pneumothorax. Minimal overlying chest wall emphysema.Persistent decreased lung volumes with basilar atelectasis and elevated left hemidiaphragm. Large hiatal hernia. Consider serial imaging if further characterization is required

Output: Left chest tube grossly unchanged without significant interval additional new cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval for focal abnormality, ED bounce back with cough, sob, and multiple other complaints History: cough, sob, Low lung volumes with streaky basilar opacity right lung base likely atelectasis.No pleural effusion. No pneumothorax.

Output: Streaky opacity at the right lung base likely atelectasis from low lung volumes. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with thymoma status post chemotherapy. Please evaluate for disease and compare with previous scans. CHEST:LUNGS AND PLEURA: Prior noted large basilar reference nodules are now no longer visualized (right lung base or left lung base posteriorly. There do remain small micronodules unchanged (for example series 8, image 14 left apex and along right major fissure inferiorly (series 8, image 48)) but some of these have apparent punctate high attenuation may represent granulomas. Postoperative changes and scarring are unchanged.No pleural disease or effusions are seen. Left lower lobe atelectasis is again seen unchanged.MEDIASTINUM AND HILA: Left anterior mediastinal postoperative changes again seen. No evidence of recurrent mass or new masses are seen. No adenopathy.CHEST WALL: Postoperative changes in the sternum. No other significant abnormalities.ABDOMEN:LIVER, BILIARY TRACT: Two lesions again seen in left lobe of the liver. The more superior (series 6 and 70) appears to abut focal fatty deposition in a characteristic location just adjacent to it which occasionally can simulate a larger total size a lesion. The lesion as I would measure today measures 2.5 x 2.6 cm and is essentially unchanged dating back to the first examination here 11/10/2010. There are no definite characteristics to characterize this lesion. The second more inferior lesion (series 6, image 84) appears to have peripheral nodular discontinuous enhancement and is also unchanged dating back to 2010 and most likely represents a small hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right ureteral stent in expected position again seen. No significant abnormality noted. There is been marked reduction in size of the prior noted right renal lesion which is now difficult to visualize but best estimate of residual lesion would be on series 6, image 102 approximately 2.0 x 1.1 cm compared with previous 3.8 x 2.7 cm. similarly the left lower pole lesion which previously measured 4.5 x 2.7 cm, can no longer be visualized on today's examination.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: Prior hysterectomy. No other abnormality.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: 1. Marked improvement and near complete resolution of bilateral renal mass lesions. 2. Larger lung nodules no longer visualized. Residual punctate micronodules remain not characterizable, but may represent prior granulomatous disease as some have high density components potentially. 3. Two liver lesions again seen -- these remain essentially unchanged dating back to 2010 and I would favor benign nature. 4. No other changes are significant abnormality since prior examination.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: EVALUATE FOR ACTIVE TB HX +PPD OR )+ QuantiFeron History: The cardiomediastinal silhouette is within normal limits. Large lung volumes and flattening of the diaphragms compatible with COPD. No focal airspace opacity, significant pleural effusion, or pneumothorax. Specifically, no evidence of tuberculosis.

Output: Large lung volumes and flattening of the diaphragms compatible COPD. No focal airspace opacity or specific evidence of tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pneumonia History: cough, shortness of breath, wheezing, left mid lung rhonchi and expiratory low pitch wheeze Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pna v infiltrate v pleural effusion History: fever, sob Enteric feeding tube tip terminates out of the field of view inferiorly. Left pleural effusion and associated atelectasis/consolidation unchanged from the prior. Low lung volume. The cardiac and mediastinal contours are unchanged. No pneumothorax is evident.

Output: Unchanged left pleural effusion and associated atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: 58M with CHF and hardware, assess volume status. History: CHF Swan-Ganz catheter has been removed. No interval change in degree of cardiomegaly with mild interstitial opacities.ICD leads unchanged.No new findings

Output: CHF with interstitial edema. No acute change.


Instruction: Generate impression based on medical findings.

Input: Status post Hickman catheter removal; Hickman catheter dysfunction, initial encounter The right-sided central venous (IJ) catheter seen on the chest radiograph time stamped 1427 has been removed. A left-sided catheter with its tip in the left subclavian vein is incompletely imaged on this study. The prevertebral soft tissues of the neck are within normal limits. There is a non-segmentation anomaly of C4 and C5. The lower cervical spine is not well visualized on the lateral view due to overlying anatomy.

Output: Removal of Hickman catheter and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: infiltrate, edema History: advanced HF Mild basilar subsegmental atelectasis and edema with small pleural effusions, slightly worse.Moderate cardiomegaly.Left subclavian ICD, leads unchanged in position.Right jugular Swan-Ganz catheter, tip directed towards the right interlobar pulmonary artery.

Output: Slight worsening of basilar opacities suggestive of edema and subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 81-year-old with history of CLL and recurrent effusions, evaluate effusions. Right chest tube terminates at the medial apex, unchanged.Right perihilar opacity consistent with fluid loculated in the fissure with adjacent atelectasis, unchanged.Persistent atelectasis of the left lower lobe without significant interval change.Moderate bilateral pleural effusions.

Output: Persistent moderate bilateral pleural effusions with possible loculation of fluid on the right.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.CHF exacerbation versus pleural effusions or pneumonia, COPD exasperation, shortness of breath Cardiomegaly. Calcifications of the thoracic aortic arch. Basilar interstitial opacity compatible with pulmonary edema and bilateral pleural effusions, left greater than right, without significant interval change compared to 11/8/2015.

Output: CHF with edema and effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Coronary bypass procedure Interval removal of right jugular sheath with persistent moderate bilateral pneumothoraces, in which both sides demonstrate subpulmonic component. Chest tubes are also similar position both projected apically, the right at the level of aortic archThe IABP marker remains 1 cm from the aortic arch, essentially unchanged.Lungs otherwise remain clear of focal abnormality

Output: Unchanged chest tubes and moderate pneumothoraces. Right jugular catheter removed


Instruction: Generate impression based on medical findings.

Input: Reason: Evidence of pulmonary edema, infection, or pulmonary compromise? History: Wheezing, increasing oxygen requirement Patchy bilateral airspace and interstitial opacity, better shown on the CT scan of the same day, compatible with infection, and less likely edema. Unremarkable cardiac and mediastinal silhouette.

Output: Patchy diffuse airspace and interstitial opacity most compatible with infection.


Instruction: Generate impression based on medical findings.

Input: Fever Streaky densities in both bases suggesting atelectasis without additional acute distinct cardiopulmonary abnormality

Output: Atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: r/o pnx, air leak CT History: as above The apex of the chest tube appears to be inferiorly displaced when compared to prior examination. Further, adjacent pleural line indicative of pneumothorax is visualized lung the superior and lateral aspect of the parenchyma measuring about 1.9 cm from chest wall. Right lateral chest tube is unchanged in position. Abdominal drain is unchanged. Endotracheal tube terminates about 6.7 cm above the carina with inflated cuff above the thoracic inlet. Swan-Ganz catheter terminates in the right ventricular outflow tract.Low lung volumes with bibasilar atelectasis and unchanged mild edema.

Output: Right pneumothorax as above. Endotracheal tube terminates almost 7 cm above the carina with cuff above the vocal cords.These findings discussed with Tristan Levy at 4:27 PM on 9/27/2016 by telephone.


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: as above Moderate cardiomegaly with a mitral valve prosthesis, unchanged. Postsurgical scarring at the right base and screw and plate fixation device in the right fourth rib.

Output: Moderate cardiomegaly with no sign of pulmonary edema or other acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: pneumonia, bronchitis History: cough, fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with history of rectal cancer CHEST:LUNGS AND PLEURA: Stable emphysematous changes. Subcentimeter nodule at the level of the carina and the right middle lobe is unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant colostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Unremarkable.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: Postsurgical changes in the pelvis.

Output: No significant change from previous study


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with recent history of right cecal adenocarcinoma, status post right hemicolectomy. CHEST:LUNGS AND PLEURA: Biapical scarring. No lung nodules to suggest metastatic disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter nonspecific lesions in the liver which are too small to actively characterize but are most likely benign. Cholelithiasis without evidence of cholecystitis or biliary dilatation.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: Status post right hemicolectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:Artifacts from bilateral hip prosthesis severely limits evaluation of the pelvic part of the study.UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease. Cholelithiasis without cholecystitis or biliary dilatation.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: interval exam, pt intubated History: interval exam, pt intubated Lines and tubes are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable layering pleural effusions, increased on the right. Left lower lobe atelectasis again noted. Unchanged heart size. No pneumothorax.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable layering pleural effusions, increased on the right. Left lower lobe atelectasis again noted.


Instruction: Generate impression based on medical findings.

Input: Cardiomegaly Diffuse mild 4 quadrant fibrotic changes with mild cardiomegaly demonstrates somewhat globular shape and raising concern for a possible pericardial effusion. No effusions. Please note a somewhat focal posterior focal opacity best accretion the lateral projection and possibly overlying the right chest wall. It is difficult to distinguish from possible osseous sclerotic lesion in what appears to be T11 or possibly an intra-pulmonary abnormality questionably appreciated through the diaphragm on the PA projection. Consider follow-up imaging and/or comparison with prior imaging if available to exclude a possible intrapulmonary process such an infarct or possible early infection.

Output: Mild cardiomegaly with chronic interstitial changes with questionable right lower lobe focal opacity and/or possibly sclerotic lesion within the vertebral body. Please see detail provided and consider follow-up imaging if comparison is not available if there is concern for an acute process


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Intubated and emphysema MV assess Dobbhoff placement. Dobbhoff tube tip off the caudal margin of the film. NGT has been removed. ETT tip about 2 cm above the level of the carina.No focal airspace opacities. Mild right basal scarring.

Output: Dobbhoff tube tip beyond the caudal margin of the film. Low endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: worsening hypoxia History: dyspnea New right pneumothorax, 22 mm separation between pleural surfaces.Gradually increasing left lower lung zone edema like opacities with left pleural effusion and densely fibrotic native right lung.ET tube tip approximately 6 cm above the carina.A Dobbhoff tube terminates in the stomach.Left jugular catheter tip in left brachiocephalic vein at the midline.

Output: New right pneumothorax. Findings were text paged to Elizabeth Martin at the time of dictation 10/27/2016 at 10:55 AM.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: r/o acute process History: chest pain Lungs and pleural spaces are clear. Heart size is upper limits of normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.History of esophageal perforation status post stent placement. Right chest tube has been removed. Enteric tube, esophageal stent, and 2 left chest tubes are unchanged.The cardiomediastinal silhouette is unchanged.There is a minimal amount of right pleural fluid. No pneumothorax. Scattered left-sided pulmonary opacities unchanged.

Output: Interval removal of right chest tube with small amount of pleural fluid but no pneumothorax. Stable examination otherwise.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Evaluate effusion History: sob Heart size normal, with a pneumopericardium, and a pericardial drain in place.Pleural effusions and left basilar consolidation, the latter improved.

Output: Pericardial drain, with a pneumopericardium and improved left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: SOB. Mediastinal drains. Sternotomy hardware similar in alignment. Left subclavian pacemaker unchanged.Question of trace pneumomediastinum on the left which can be followed on subsequent exam and could be the result of mediastinal drain manipulation, correlate with history.Mild diffuse edema-like opacity bilaterally without significant change and more confluent than elsewhere in the left apex raising possibility of atypical infection.

Output: Unchanged edema-like interstitial abnormality, correlate for signs of infection.


Instruction: Generate impression based on medical findings.

Input: Cough and wheezing Right basilar scarring and moderate cardiomegaly exaggerated by technique and decreased lung volumes. No definite acute superimposed abnormality, however serial imaging may be needed to ensure.Right subclavian ICD unchanged

Output: Cardiomegaly and right basilar scarring without definite superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval ET tube placement, infiltrate, edema History: sepsis Small lung volumes with mild basilar interstitial abnormality.Heart size normal.ET tube tip 9 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Nonspecific basilar interstitial abnormalities. High ET tube.


Instruction: Generate impression based on medical findings.

Input: 52 year-old male with rectal cancer. Evaluate for chemotherapy response. CHEST:LUNGS AND PLEURA: Patchy, bilateral groundglass opacities are new and may represent drug reaction. Infection is considered less likely. Right lower lobe calcified granuloma unchanged. No pleural effusions.MEDIASTINUM AND HILA: New thrombus is noted within the SVC adjacent to a central venous catheter.A right paratracheal lymph node has increased in size measuring 2.3 x 1.5 cm on axial image 40/228 which previously measured 1.9 x 1.0 cm. Additional pretracheal and AP window lymph nodes are also larger.Cardiac size is normal with no pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Previously referenced hypoattenuating lesion within the dome of the liver measures 3.4 x 4.9 cm on axial image 16/228 and is smaller compared to the prior exam where it measured 4.0 x 6.2 cm. Additional small hypoattenuating lesions within both lobes of the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule is unchanged. KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: A lymph node within the left pelvis measures 1.5 x 2.7 cm on axial image 177/228 and is unchanged. A smaller lymph node adjacent to the rectosigmoid is unchanged on axial image 180/228.BOWEL, MESENTERY: Previously noted rectal wall thickening is not clearly evident on today's exam.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.New patchy ground glass lung opacities most likely represent a drug reaction.2.New thrombus in the SVC.3.Interval increase in size of mediastinal lymph nodes.4.Interval decrease in size of the dominant liver lesion.5.Stable pelvic lymphadenopathy.The incidental finding of new SVC thrombus was directly communicated to Dr. Ray at 1445 hrs on 5/13/08.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: is there pul edema History: sob The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: chest pain History: chest pain Persistent hypoinflation with basilar opacities and a small left pleural effusion

Output: Persistent hypoinflation with basilar opacities and a small left pleural effusion


Instruction: Generate impression based on medical findings.

Input: 59 year-old female with known toxic uninodular goiter , right neck thyroid or parathyroid nodule LUNGS AND PLEURA: Scattered, nonspecific micronodules. No suspicious pulmonary nodules or masses. No evidence of a pleural effusion.MEDIASTINUM AND HILA: Small nonspecific hypodensity within the right lobe of the thyroid gland.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary are calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant pulmonary or pleural abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Status post ICD placement. Note that the lateral view is limited by patient positioning and structures overlapping the chest.Stable position of the left chest ICD with right ventricular lead. Mild basilar linear opacities, likely atelectasis. No additional focal lung opacity, pleural effusion or pneumothorax is evident.Upper limits normal/mildly enlarged cardiac silhouette size, unchanged.

Output: Stable position of the left chest ICD with RV lead. No evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP location History: IABP Interval extubation. Balloon catheter in the proximal descending aorta and Swan-Ganz catheter tip in main pulmonary artery.Other devices unchanged.Cardiomegaly with pulmonary edema and retrocardiac atelectasis.

Output: CHF with interval extubation and no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrates History: dyspnea ET tube tip within 1 cm of the carina.Catheter tip in the SVC.Moderately large bilateral pleural effusions with underlying atelectasis.No significant interval change allowing for position and inflation.

Output: Pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p central line placement History: pancreatitis No change in pleural effusions and basilar opacities.Right subclavian catheter tip at the RA level.ET tube tip 7 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Basilar opacities and pleural effusions are stable. New right subclavian catheter placement.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval for pathology History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Elevated white count and immunosuppressed patient Persistent and essentially unchanged bilateral basilar reticular nodular opacities consistent with known previously described interstitial lung disease. No definite superimposed focal airspace abnormality, however left lower lung ill-defined opacity cannot entirely be excluded. Aspiration versus possible infection given history must be considered and excluded.Left PICC line extends into the right atriumPersistent underlying cardiomegaly exaggerated by decreased lung volumes

Output: Questionable left lower lung nonspecific focal opacity superimposed upon chronic changes. Concern for possible infection versus aspiration


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Presenting with leukocytosis. Cardiomegaly with bilateral left greater than right pleural effusions with underlying atelectasis. Aortic calcifications. Interval placement of right IJ central venous catheter with tip in the right atrium.

Output: Cardiomegaly with bilateral left greater than right pleural effusions similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: VAD History: VAD Cardiopulmonary monitoring and support devices, unchanged.Small lung volumes with bilateral opacity compatible with edema, atelectasis and pleural effusions.No pneumothorax or other acute change.

Output: Edema, atelectasis and effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with history of Hodgkin's lymphoma presenting with small bowel obstruction. 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: 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: A small amount of ascites is evident. Multiple loops of dilated small bowel are evident with a transition point likely identified in the distal jejunum/proximal ileum (axial image 160/233). Distal rectal gas is evident. These findings are compatible with a partial small bowel obstruction. The appearance is similar to the patient's prior small bowel obstruction as noted on the CT exam of 10/23/08 but appears less severe on the current study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Findings as above compatible with partial small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Partial small bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Fever and sepsis No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: 85 y/o M with PMHx of mesothelioma, interval change from R mucous plug History: SOB Near-complete whiteout of the right hemithorax again noted. Left lower lobe retrocardiac opacity, unchanged. Likely unchanged heart size. No pneumothorax.

Output: Near-complete whiteout of the right hemithorax again noted. Left lower lobe retrocardiac opacity, unchanged. Likely unchanged heart size. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 52 year-old female with new diagnosis of APML, please rule out pulmonary spread LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Gastric banding is identified.

Output: No significant pulmonary or pleural abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with leg swelling and worsening shortness of breath. Evaluate for CHF. Cardiomediastinal silhouette is within normal limits.Large lung volumes suggestive of COPD. Bibasilar interstitial opacities likely represent chronic lung disease. Small bilateral pleural effusions. No consolidation or pneumothorax.Scoliosis.

Output: Small bilateral pleural effusions, improved compared to most recent CT. No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: confirm OSH PICC line placement History: confirm PICC line placement Right upper extremity PICC tip at the cavoatrial junction.The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: Right upper extremity PICC tip at the cavoatrial junction. No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Reason: r/o aspiration or pna History: cough Unremarkable cardiac and mediastinal silhouette. Bilateral rib fracture deformities of uncertain age and etiology.No sign of pneumonia or other active pulmonary disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: 52M with leukocytosis, assess for pulmonary source of infection History: see above Persistent atelectasis and consolidation in the left lower lobe, decreased in volume and extent, with a probable associated pleural effusion.Vascular stent in the area of the right innominate and subclavian vein.

Output: Nonspecific atelectasis and consolidation in the left lower lobe, slightly decreased.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Repositioned ET tube. Endotracheal tube has been pulled back, now at the thoracic inlet level. Other tubes and lines unchanged in position. Small left hydropneumothorax, pneumothorax component slightly larger. Subcutaneous emphysema left chest wall. Atelectasis and consolidation bilaterally, with slightly improved aeration on the left.

Output: High endotracheal tube tip at thoracic inlet level. Small left hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: 68M h/o bladder cancer s/p chemo and cystectomy. Surveillance imaging History: history of bladder cancer Median sternotomy, heart size normal.No significant pulmonary or pleural abnormality.No sign of metastases.

Output: No significant abnormality. No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Lung cancer. Evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Right upper lobe cavitating lesion is grossly unchanged in size with more fluid content. Previously mentioned ground glass opacities in the upper lobes have almost completely resolved. Right upper lobe tree in bud opacities are again noted. Right lower lobe atelectasis. Right lower lobe tree in bud opacities have improved.MEDIASTINUM AND HILA: Right superior mediastinal lymph node is unchanged measuring 11 x 11 mm on image number 9/218. A pretracheal lymph node measures 2.5 x 1.6-cm image number 39/218, unchanged.Right hilar mass measuring 2.1 x 1.5 cm which may represent an enlarged lymph node.CHEST WALL: Again noted the bony destruction of second third and fourth right posterior ribs.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate stone in the right kidney without hydronephrosis. Subcentimeter hypodense lesions in both kidneys, most likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 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: Right upper lobe cavitary malignant lesion with metastases to the right upper ribs. Mediastinal and right hilar adenopathy.Previously described ground glass opacities have resolved and centrilobular opacities improved.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: eval lung fields History: s/p LVAD exchange Status post redo sternotomy, sternal wound with surgical sponges and surgical drains overlying the region, unchanged.Lower lung zone opacities are consistent with edema slightly worse than before.LVAD and presternal ICD unchanged.Right jugular Swan-Ganz catheter, tip in right interlobar pulmonary artery.ET tube tip approximately 4 cm above the carina.

Output: Open surgical wound containing surgical sponges, with increasing pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Persistent cough, after URI and breast RT, and on ACE inhibitor, check for infiltrate History: Persistent cough, after URI and breast RT, and on ACE inhibitor, Mild scarring or subsegmental atelectasis left lung base periphery.No other significant abnormality.Right chest wall surgical clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Status post thoracentesis. Moderate right pleural effusion. No pneumothorax. Retrocardiac masslike opacity is now visible. Please refer to CT for more specific findings. Redemonstration of distal esophageal stent.

Output: Moderate right pleural effusion without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval for free air History: distention, pain, obstipation, poss bowel obs Mild cardiomegaly, with a tortuous aorta.No specific evidence of infection or edema.No free intraperitoneal air.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: pna, cardiomegaly effusion History: copd exacerbation Basilar subsegmental atelectasis, which could be the result of aspirated secretions, or mucous plugging or atypical infection.No pleural effusions.Heart size normal.

Output: Basilar subsegmental atelectasis, nonspecific but either mucous plugging or atypical/viral infection.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: pna evolution History: na No change in left-sided opacities. New linear atelectasis on the right. NG tube tip in stomach. PICC unchanged

Output: No change in left-sided opacities. New linear atelectasis on the right.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with stage I seminoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Normal study.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: r/o driveline fx History: r/o driveline fx Mild cardiomegaly status post sternotomy.No significant pulmonary or pleural abnormality.LVAD and ICD unchanged, the drive line not imaged.

Output: Mild cardiomegaly, unchanged support devices. For Drive line evaluation please refer to the accompanying abdomen radiograph reported separately.


Instruction: Generate impression based on medical findings.

Input: 16-year-old female with fever, evaluate for pneumonia.VIEWS: Chest AP/lateral (two views) 5/6/2015 at 08:19 The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. No focal opacities are seen.

Output: Normal appearance of the lungs, no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.ET placement. Hypoxia. ET tube tip in the right mainstem bronchus. NG tube tip in the stomach. Vascular coils and pigtail catheter project over the left upper abdominal quadrant.Layering large left pleural effusion with underlying left basilar atelectasis, slightly increased compared to prior. Low left lung volume likely secondary to right mainstem bronchus intubation.Cardiomegaly.

Output: Right mainstem bronchus intubation with increased left lung atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: altered mental status, improving. Also hypoxia requiring nasal cannula. Assess for acute cardiopulmonary abnormality, History: see above Severe cardiomegaly status post sternotomy.Basilar opacities suggestive of edema, atelectasis and pleural effusions have slightly increased.ICD and LVAD unchanged.Right jugular catheter, tip in SVC.

Output: Slight worsening of basilar opacities suggestive of increased atelectasis and edema.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Intraoperative hypotension History: hypotension Endotracheal tube tip 4 cm above the carina.Transesophageal ultrasound probe tip in the distal third of the esophagus.Right internal jugular approach pulmonary artery catheter and sheath, with the tip of the catheter directed toward the right main pulmonary artery.Median sternotomy wires and hardware. Two mediastinal drains. Epicardial pacer wires and mediastinal clips.The heart size is normal. Left lower lobe subsegmental atelectasis. The right lung is clear. No large pleural effusion.

Output: Lucency at the left lung base, suspicious for an anterior pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated patient. review film to evaluate lung fields History: intubated. hydrocephalus with shunt Interval advancement of the NG tube with its tip now in the body of the stomach.ET tube and venous catheter unchanged.Basilar opacities compatible with atelectasis, also unchanged.

Output: Basilar atelectasis and no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: Swan genz placement History: CHF- swan genza placement Support devices unchanged.Decreased lung volumes with stable cardiac enlargement.Perihilar/basilar edema, pleural effusions, and basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with metastatic sarcoma CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule is increased in size and now measures 18 x 13 mm number 13, series number 5. Additional nodules in both lungs and increase in size and number consistent with progression of metastatic disease. Postsurgical changes in the right lung are again noted.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Bonk date hypodensity in the adult the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mass in the right kidney measures 6.2 x 5.5 cm on image number 92, series number 3 and has increasing size. Tumor thrombus extends into the right renal vein and IVC.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference right external iliac lymph node measures 10 x 9 mm in image number 156, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Fat-containing left inguinal hernia is unchanged.

Output: Progression of pulmonary metastatic disease interval increase in the size of the right renal mass with tumor thrombus extending into the right renal vein and IVC.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval for acute process, hx lung ca, s/p resection History: chest pain/sob Cardiomegaly.Small lung volumes.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: PNA, ETT placement History: Intubated Stable adequate position of ET tube overlying the mid trachea. There is mild hyperinflation of the ETT balloon, recommend slight deflation to avoid tracheal injury. Enteric tube versus below the diaphragm.Persistent right basilar subsegmental atelectasis, improved from prior.Suggestion of upper lobe predominant emphysema.No signs of pleural effusion or pneumothorax.

Output: Stable adequate position of ET tube overlying the mid trachea. There is mild hyperinflation of the ETT balloon, recommend slight deflation to avoid tracheal injury. Resolving right basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: r/o cardiopulm History: chest pain Clear lungs. No pleural effusion or pneumothorax. Normal heart size. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 50 years, Male. Reason: abdominal pain, C diff colitis - assess for perforation History: abdominal pain, C diff colitis - assess for perforation Dobbhoff tube in the gastric body. Nonspecific bowel gas pattern. No free intraperitoneal air. Refer to same day chest radiograph for additional findings.

Output: No free intraperitoneal air.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Cough. Right internal jugular central venous catheter tip in the SVC. Leadless pacemaker.Cardiomediastinal silhouette is moderately enlarged.Bibasilar opacities compatible with pleural effusion and adjacent atelectasis, unchanged.No pneumothorax.

Output: No significant change in bilateral pleural effusions with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval for PNA History: sepsis, hypoxic Again demonstrated is the tortuous aorta as well as the dense opacity of the left lung base. No significant interval change. No other specific evidence of infection or edema.Support devices stable in position.

Output: Stable appearance of a left base opacity and dilated and tortuous descending aorta. No interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: eval resolution of opacity History: as above Right upper lobe consolidation becoming slightly more extensive over the last several days.Nodular opacities elsewhere consistent with mucoid impaction with underlying cystic fibrosis, especially in the left lower lobe.Heart size normal.Right jugular catheter, tip at cavoatrial junction.

Output: Right upper lobe consolidation, and opacities elsewhere, slightly more extensive consistent with infection with underlying cystic fibrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.History of Hodgkin's lymphoma, pre-stem cell transplant evaluation. Bilateral central venous catheters terminate at the cavoatrial junction.No focal airspace opacities or pleural effusions. No pneumothorax.

Output: No significant abnormalities.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, 75 years old.Reason: r/o pneumothorax History: chest tube removal Chest tubes removed with no pneumothorax. Small pleural effusions and residual left basilar atelectasis are noted, improved.Left subclavian ICD, leads unchanged in position.

Output: No pneumothorax following tube removal.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval for PNA History: URI, productive cough, No focal lung opacity, pleural effusion or pneumothorax. The heart size is normal. Mild tortuosity of the aorta.

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


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: icu History: icu The right upper extremity PIC catheter remains looped in the right jugular vein with the tip overlying the right brachiocephalic vein.Bilateral chest tubes and ECMO cannulae are unchanged in position.Large loculated right pleural effusion with associated atelectasis appears similar to the prior exam. Left basilar atelectasis is unchanged. The left costophrenic angle is not included in the field-of-view.

Output: Large loculated right pleural fusion. No significant change.


Instruction: Generate impression based on medical findings.

Input: 78 years, Male. Reason: ng tube placement History: ng tube Enteric tube with tip in the distribution of the proximal gastric body. Gaseous distention of the small and large bowel may represent a generalized ileus. The lower pelvis is excluded from the field-of-view.Small right pleural effusion. Findings above the diaphragm are better seen on recent chest radiograph.

Output: Enteric tube with tip in the distribution of the proximal gastric body.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with history of known pleural effusion. Large right pleural effusion has increased in size. Stable right middle and lower lobe atelectasis. The left lung is unremarkable.

Output: Increase in size of large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Dialysis patient Mildly improving lung volumes, however mixed interstitial and bilateral patchy densities in both bases representing possible aspiration versus edema from volume overload persists. Small effusions cannot be excluded.Right jugular catheter extends into the mid SVC. Mild cardiomegaly

Output: Suspected volume overload and atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Cough, fever and SOB. Moderate bilateral central bronchial wall thickening.No focal airspace opacities. Normal heart size. No pleural fluid or pneumothorax.

Output: Moderate central bronchial wall thickening suggestive of bronchitis. No visible signs of pneumonia however if the patient remains symptomatic, consider short-term plain film follow-up.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with fever, hypotension, signs of sepsis. Looking for source of fever and sepsis. Patient has history of Clostridium difficile colitis. CHEST:LUNGS AND PLEURA: Micronodules unchanged. New bilateral pleural effusions moderate in size with associated atelectasis or consolidation.MEDIASTINUM AND HILA: Small mediastinal nodes are unchanged. Nonpathologic in size.CHEST WALL: Loss of height of mid thoracic vertebral body, unchanged.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small nodes unchanged. Caval filter.BOWEL, MESENTERY: No significant abnormality noted. No signs of colitis.BONES, SOFT TISSUES: Minimal anasarca.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No free or loculated fluid. Scattered colonic diverticulosis.BONES, SOFT TISSUES: Osteopenia. Coarsened trabecular pattern, unchanged. This may be related to patient's history of myeloma.OTHER: Right femoral venous line.

Output: New large bilateral pleural effusions. Other findings essentially unchanged from prior exam. No obvious source of sepsis.


Instruction: Generate impression based on medical findings.

Input: Pyloric dilation. EGD Marked interval improvement with a decreased air-fluid level observed in the gastric pull-up is also diminished in overall diameter in size. Change correlates with recent procedure and diminished intraesophageal contentsCardiac and underlying pulmonary appearance remains otherwise unremarkable

Output: Improved gastric pull up appearance with diminished intraluminal contents


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: s/p ICD History: s/p ICD New left-sided ICD placed with lead wires in the right atrial appendage, right ventricle, and coronary sinus.Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.No evidence of a pneumothorax.

Output: Left-sided ICD placed without complication.


Instruction: Generate impression based on medical findings.

Input: Reason: 80 y/o M with diastolic heartfailure and pulm HTN p/w volume overload, eval fluid status History: as above Cardiomegaly with vascular redistribution.Lower zone interstitial edema and small pleural effusions consistent with CHF, similar to previous.

Output: Findings consistent with volume overload.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Right pleural effusion status s/p IR drain placement and fluid removal History: as above Improvement in right pleural effusion status post placement of right basilar pigtail drain. No new focal pleural parenchymal opacity in the left lung. Unchanged cardiomegaly. No pneumothorax.

Output: Improvement in right pleural effusion status post placement of right basilar pigtail drain. No new focal pleural parenchymal opacity in the left lung. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: Postop, eval lines/tubes/devices History: Above ET tube tip in the right main bronchus. Other findings unchanged.A more recent radiograph has been interpreted.

Output: Low position of ET tube. This has been adjusted on subsequent radiographs.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: assess for acute process - scd chest pain History: assess for acute process - scd chest pain No new focal lung consolidation. Pleural parenchymal scarring again noted at the left lung base. Unchanged cardiomegaly. No pneumothorax. Bony changes consistent with sickle cell disease. Calcified spleen consistent with autosplenectomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of gastric non-Hodgkin's lymphoma now with nausea, weight loss, night sweats CHEST:LUNGS AND PLEURA: Punctate bilateral micronodules are seen, unchanged.MEDIASTINUM AND HILA: Small thyroid nodule, stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic hypodensities remained. Cholecystectomy.SPLEEN: Partially calcified exophytic nodule in the superior pole of the spleen, unchanged from 2003PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measuring 18 x 16 mm, unchanged when remeasured (series 3; image 88).KIDNEYS, URETERS: Bilateral scarring and cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic versus surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable bilateral subcentimeter micronodules and left adrenal nodule.


Instruction: Generate impression based on medical findings.

Input: 66-year-old man with metastatic bladder cancer status post two cycles of chemotherapy reevaluate disease. CHEST:LUNGS AND PLEURA: No new lung nodules or effusions.Bronchiectatic changes redemonstrated. In small nodular density right base series 5 image 65 and left base has the appearance of a scar.MEDIASTINUM AND HILA: No new sites of disease. Right cardiophrenic node measurements is 165 is 1.6 x 1.2 cm significantly decreased in size from the prior.CHEST WALL: No significant abnormality notedABDOMEN: Not sensitive for detecting lesions in the solid organs due to the lack of IV contrast. Given that limitation the following observations made.LIVER, BILIARY TRACT: The lesion in the dome of the left lobe series 4 image 82 2.9 x 2.7 cm.Lesion in the dome of the right lobe is difficult to identify compared to the previous scan. I believe it is on series 4 image 22 and measures 2.6 x 2.2 cm. No new lesions are seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic right kidney with air in the collecting system and nephroureterostomy stent identified. Right kidney with persistent hydronephrosis and hydroureter moderately severe.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal nodes are seen in the para-aortic area unchanged the prior exam. Some of these are pathologic in size.BOWEL, MESENTERY: Portacaval node decreased in size series 4 image 103 measures 1.7 x 0.9 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Penile prosthesis. Postsurgical changes with lymph node dissection prostatectomy.BLADDER: Neobladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No new sites of disease. Some lesions are decreased in size. Details as above.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: dr cart - lung cancer History: dr cart - lung cancer Interval intubation with the endotracheal tube terminating 5 cm above the carina. A Dobbhoff tube terminates at the gastric fundus. Right lower lobe bronchial stent unchanged in position. External defibrillator pads have been placed. Right IJ central catheter in stable position.Interval decrease volumes with right sided consolidation becoming more confluent. No pneumothorax.

Output: Progressive right-sided consolidation with interval decreased lung volumes.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: iabp History: iabp Stable cardiomegaly. Swan-Ganz catheter tip in the left descending pulmonary artery and IABP marker in the aortic arch. Left IJ central venous catheter tip in the left innominate vein. Low lung volumes with basilar atelectasis, appearing similar compared to prior exam.

Output: Stable support devices without superimposed acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for post thoracentesis pneumothorax History: s/p thoracentesis Right internal jugular central venous catheter tip terminates at the cavoatrial junction.There is no pneumothorax. Interval decrease in size of the right pleural effusion and associated atelectasis. Small left pleural effusion and associated basilar atelectasis similar to prior. Mild basilar interstitial opacities slightly decreased from prior. Mild cardiac enlargement persists.

Output: 1.Decreased right pleural effusion, no pneumothorax.2.Stable small left pleural effusion and slightly improved basilar interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p open resection of left sided solitary fibrous tumor. Final pathology revealed 25cm tumor. History: sob Interval resolution of subcutaneous emphysema and small left apex pneumothorax. Postop change on the left with no acute findings.

Output: Postop change on the left with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: daily am cxr History: daily am cxr Lines and tubes are unchanged. Diffuse pulmonary opacities and pleural effusions again noted. Probable small pneumothoraces again noted, not substantially different. Unchanged heart size.

Output: Diffuse pulmonary opacities and small pleural effusions again noted. Probable small pneumothoraces, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Worsening SOB. Malignant neoplasm of lung. Left upper lobe masslike consolidation adjacent to the posterior aspect of the mediastinum unchanged. No visible additional pulmonary nodules. No evidence of pulmonary edema or new focal airspace opacity. Mild left apical loculated pleural fluid and small volume of fluid in the posterior costophrenic angle on the left unchanged.

Output: Left upper lobe paramediastinal masslike consolidation which was previously described as post therapeutic changes but is nonspecific by plain film. No new acute pulmonary abnormality. Small volume of pleural fluid on the left is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: confirmation of picc line History: picc line Cardiomegaly.Small lung volumes.Overall lung appear haziness most likely due to overlying soft tissue.Left PICC, tip in left axillary region.

Output: Left PICC, tip in left axillary region.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old. Fever. Evaluate for pneumonia. Normal cardiomediastinal silhouette. No evidence of infection or edema.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Status post mitral valve repair and A. Fib ablation. Cardiomegaly with bilateral interstitial and left sided airspace opacities are stable. Right jugular Swan-Ganz catheter has been pulled back with 2 right jugular axis lines tips over the SVC. Bilateral chest tubes are again present. There is a small left apical pneumothorax measuring approximately 1 cm, not visualized previously.

Output: New small left apical pneumothorax. Swan-Ganz catheter has been pulled back. Extensive bilateral pulmonary opacities are stable.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Severe emphysema without significant interval change. Decreased lung findings and right hilar fullness against correlating with previously described hilar mass. No specific pulmonary changes to suggest edema or pneumonia. Azygous lobeCardiac silhouette is within limits. Marked tortuosity aorta unchanged. Dobbhoff projects in the distal stomach. Retained contrast is observed overlying the lower mediastinum and cardiac silhouette, presumably esophageal. A small diverticulum suggested and correlates with recent CT

Output: Severe emphysema without interval change


Instruction: Generate impression based on medical findings.

Input: Reason: altered mental status History: AMS Unremarkable cardiac and mediastinal silhouette. Marked elevation of the right hemidiaphragm of uncertain chronicity with mild overlying atelectasis.Multiple healed rib fractures on the left.No acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: Why is he hypoxic? History: hypoxia Volume loss in the right lung with pleural thickening/effusion and interstitial airspace opacities similar to the prior exam.Stable cardiac enlargement.The left lung is clear.

Output: No interval change in the right-sided pleural effusion/thickening, volume loss, and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: 49F cirrhosis, h/o hepatic hydrothorax s/p TIPS now SOB History: SOB Lungs hypoinflated though there is no evidence of significant pleural effusion or new pulmonary opacity. Heart size stable. S/P TIPS .

Output: Lungs hypoinflated though there is no evidence of significant pleural effusion or new pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of ET tube placement. ET tube tip 3 cm above the carina. NG tube tip projecting over the proximal gastric body. Stable cardiomediastinal silhouette. Improved left retrocardiac aeration with residual bibasilar atelectasis/scarring.

Output: ET tube tip 3 cm above the carina. Improved aeration of left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: eval fluid overload vs PNA History: SOB, fever Moderate cardiomegaly, with a mildly tortuous aorta.Possible small left pleural effusion, otherwise the lungs and pleura are unremarkable. No specific evidence of infection.Chest wall asymmetry likely accounts for apparent hypodensity on the left.

Output: Cardiomegaly, and possible small left pleural effusion, but no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: pt with chronic hypoxia, lacks right heart, new leukocytosis History: chronic hypoxia Interval increase in left effusion. Increase in left basilar opacity.No change in severe cardiomegaly.Interval placement of right dialysis catheter with tip in projection of superior vena cava. No pneumothorax.

Output: Interval increase in right pleural effusion and left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP, assess placement History: IABP, assess placement Aortic balloon catheter tip in the proximal descending aorta at the level of T7.Swan-Ganz catheter tip in the right main pulmonary artery.ICD lead in the area of the apex of the right ventricle.Severe cardiomegaly and pulmonary opacity compatible with interstitial edema, not significantly changed allowing for inflation.

Output: Balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: Pre kidney transplant evaluation, end stage renal disease. Rule out cardiomegaly and infiltrates. History: pre kidney transplant evaluation No significant cardiopulmonary abnormality.Vascular stents unchanged.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: History of bladder cancer, evaluate for metastatic disease. The cardiomediastinal silhouette is normal. No focal opacity, pleural effusion or pneumothorax. Stable degenerative changes of the thoracic spine.

Output: No radiographic evidence of pulmonary metastatic disease or other acute cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: s/p core biopsy of left based pleural mass, r/o pneumothorax History: s/p core biopsy of left based pleural mass Stable cardiomediastinal silhouette.Status post left upper lobectomy with mild volume loss in the left lung.Left paraspinal nodule noted on recent CT not well visualized on this exam.No evidence of a pneumothorax postprocedure.No new pulmonary acid is identified..

Output: No evidence of a pneumothorax post biopsy.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: interval change History: inteval change Right IJ Swan-Ganz with its tip in the pulmonary artery.LVAD unchanged.Chest/mediastinal tubes removed without evidence of a pneumothorax.Stable cardiac enlargement.Basilar atelectasis similar to the prior exam.

Output: Interval removal of chest/mediastinal tubes without evidence of a pneumothorax. Stable cardiopulmonary appearance of cardiomegaly and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Heart failure Questionable small effusions difficult to discern given semiupright portable technique. Persistent mildly decreased lung volumes with moderate nonspecific cardiomegaly. Overall no discrete definite change given differences in technique. I see similar in position and the left jugular PICC line has been removed.

Output: PICC line removed


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: eval for new PNA, r/o effusion, PTX History: worsening SOB Right PICC line and enteric tube unchanged.Decrease in cardiac enlargement.Perihilar/basilar opacities are compatible with edema.Left retrocardiac consolidation/atelectasis redemonstrated.Bilateral small pleural effusions.No new pulmonary opacities identified.Bullet fragment identified overlying the right apex.

Output: No significant interval change in the pulmonary opacities, retrocardiac consolidation/atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval OG tube History: eval OG Nasogastric tube is coiled in the oropharynx.Endotracheal tube at the carina.Basilar opacities likely representing atelectasis.Gastric distention.

Output: 1. NG tube coiled within the oropharynx2. Endotracheal tube at the carina. This should be withdrawn approximately 1 cm.3. Basilar opacities persist.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: SOB, hx of CHF History: SOB Small right pleural effusion. Very small left pleural effusion. Presumed basilar atelectasis. No evidence of overt left-sided heart failure. Moderate cardiomegaly. Calcified granuloma at the right lung base.

Output: Small right and very small left pleural effusions. Probable basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: pna? edema? History: chf, cough, shortness of breath, copd Left-sided ICD is identified with lead wires and right atrial appendage, right ventricle, and coronary sinus.Mild cardiac enlargement with perihilar and basilar edema.No focal areas of consolidation.Bilateral pleural effusions.

Output: CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Cough and fever No acute cardiopulmonary abnormality. Moderate marked tortuosity of the aorta appear similar to 2011

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with history of metastatic papillary thyroid cancer. CHEST:LUNGS AND PLEURA: Irregular focus of consolidation in the posterior segment of the right upper lobe (series 5, image 33) appears smaller in size and now demonstrates some cavitation, more likely representing improving infection than metastatic disease.The previously seen bilateral pulmonary and pleural-based metastases remain unchanged. Reference lesion in right lower lobe is stable, measuring 12 x 10 mm (series 5, image 71), previously 13 x 9 mm.. MEDIASTINUM AND HILA: Conglomerate of right hilar lymph nodes appears slightly smaller, measuring 14 x 16 mm (image 42 series 3), previously 15 x 17 mm. Subcarinal and pretracheal lymphadenopathy stable.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy.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: Retroperitoneal lymph nodes remain less than 1 cm short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lucent bone lesion in T11 vertebral body (series 3, axial image 84) is unchanged; it does appear to be slightly increased in size on comparison to initial study from 2008. This may represent a Schmorl's node; no other osseous abnormalities are identified.

Output: 1. Improving area of right upper lobe consolidation, likely representing resolving infection, although cavitary metastasis is a possibility.2. Intrathoracic metastatic disease unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Status post LVAD evaluate ETT and lung fields. Interval development of patchy subsegmental atelectasis in the right upper lobe with some dependent opacity, suggestive of aspirated secretions. Right basal opacities have cleared. Right jugular Swan-Ganz catheter can be followed to the main pulmonary artery level. Right PICC unchanged in position. LVAD in expected position. Mediastinal drains in place. Sternotomy hardware. Left basal chest tube. Moderate right pleural effusions. No significant pneumothorax.

Output: ETT tip about 4 cm above the level of the carina. Interval clearing of basal opacities seen previously but development of new opacities in the right upper lobe, most consistent with aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Hx of RCC. Eval for mets History: As above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: on immunosuppressive therapy for Crohn's mother with mesothelioma, R/O Any infections or asbestos exposure History: nil Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of acute disease nor of prior asbestos exposure.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: FemaleReason for Study: Reason: Productive Cough with brown expectoration,Fever History: Fever,Productive cough with brown expectoration The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with history of pulmonary micronodules (noted on CT chest 12/27/2014) presenting with cough of two week duration. Upper limits of normal or mildly enlarged heart.No focal areas of consolidation.

Output: Mildly enlarged heart. Symptoms could be related to pericarditis or other cardiac abnormalities based on history of multiple recurrent episodes of chest pain and negative CT scans.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: ptx? pna? chest pain History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Healed fracture lateral aspect of the left eighth rib versus summation artifact.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old. History of weight loss and tobacco use Heart size normal. No focal pulmonary opacity. Degenerative changes involving thoracic spine.

Output: No acute cardiopulmonary abnormality. If there is continued concern for malignancy, chest CT would provide more sensitive evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Cough for 2 weeks in smoker with probable COPD. Normal heart size. Central pulmonary vasculature upper normal.No focal airspace opacities, visible nodules or masses. No pleural fluid.Callus formation surrounding a left lower rib fracture deformity.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: hx of colonic perforation, r/o free air History: R abdominal pain Mild basilar subsegmental atelectasis, much improved compared to 6/13/2016.No free intraperitoneal air.

Output: Mild basilar subsegmental atelectasis. No evidence of pneumoperitoneum. A follow-up abdomen CT should be referenced.


Instruction: Generate impression based on medical findings.

Input: 68 years old Male. Reason: short of breath, COPD, History: on bipap, SOB. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination