Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: pulmonary edema History: upper airway sounds, shortness of breath Enteric tube extends inferiorly off the field-of-view. Mild patchy bibasilar opacities. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: hypoxia History: hypoxia. Again seen are diffuse hazy perihilar opacities, slightly improved in comparison from prior examination. Low lung volumes. Left pleural effusion with adjacent atelectasis/consolidation.

Output: Low lung volumes with slightly improved perihilar opacities. Left pleural effusion with adjacent atelectasis/consolidation is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.History: Scleroderma, ILD. Symptoms: Productive cough. Query pneumonia. Unremarkable cardiomediastinal silhouette.Stable diffuse fine interstitial abnormalities, consistent with known interstitial lung disease. No evidence of superimposed infection.No focal pulmonary opacity.No pleural effusions.

Output: Stable diffuse fibrosis. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: febrile, concern for PNA History: wheezes Enlarging left pleural effusion and persistent left lower lobe consolidation consistent with pneumonia.Small lung volumes.Heart size normal.Right jugular catheter tip at cavoatrial junction.

Output: Enlarging left pleural effusion with left lower lobe consolidation, suggestive of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest pain and shortness of breath. Unusual appearance of the right lower mediastinum and paramediastinal region which is at least mildly suspicious for pneumomediastinum but could be artifact of rotation and motion. Air in the midesophagus. Large lung volumes suggesting COPD/emphysema. Basal scarring. Mild vascular unsharpness, probably the result of motion and aspirated secretions. No specific signs of pulmonary edema or pneumothorax.

Output: Unusual appearance of the right lower mediastinum; pneumomediastinum cannot be excluded. Suggest repeat or follow-up radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: evaluate for hemothorax History: open chest , bleeding Slight improvement in left pleural fluid consistent with hemothorax causing left lung compression atelectasis.Small right lung volume, unchanged.Multiple ECMO cannulae unchanged.IABP catheter tip about 4 cm below the top of the aortic arch.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery. Open sternotomy wound.

Output: Slight improvement in left lung aeration, otherwise unchanged. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval for pneumonia History: fever, chills Increased interstitial opacities within the lungs. Focal scarlike opacity again noted within the upper aspect of the right lung. Moderate cardiomegaly again noted. 3 cardiac leads are noted, with termination difficult to assess due to underlying congenital heart disease. Occluder device again noted.

Output: Interstitial opacities within the lungs which may represent pulmonary edema or atypical infection.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: 19M with post operative fever, CT suggestive of LLL consolidation. History: post operative fever, concern for pulm process. Upon discussion with the floor nurse scarring for the patient, patient is postop day 2 from an abdominal operation. Interval pneumoperitoneum. Trace pleural effusions. The lungs are clear with interval volume loss. No pneumothorax.

Output: Postoperative pneumoperitoneum. No evidence of pulmonary infection.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: s/p AVR History: s/p AVR No change in pulmonary opacities suggestive of edema and pleural effusions with left lower lobe consolidation.Chest tubes remain in place with no pneumothorax.IABP catheter distal tip 5 cm below the top of the aortic arch.Right jugular Swan-Ganz catheter tip in main pulmonary artery.

Output: No change in pulmonary opacities and pleural effusions. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: FemaleReason for Study: Reason: pacemaker, chest pain - new, eval lead position History: chest pain Left-sided ICD. Port-A-Cath unchanged.Cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: Left-sided ICD unchanged with lead wires in similar positions to prior exam. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Atelectasis left lung. Complete collapse of the left lung with opacification of the airways beyond the level of the proximal left main bronchus consistent with endobronchial debris or mucous plug.Small volume of pleural fluid on the right as well as interstitial edema, about the same. Volume of pleural fluid on the left difficult to quantify.Left posterior rib fracture deformities with callus formation appear chronic.Dilated loops of bowel in the upper abdomen incompletely assessed.

Output: Left lung remains collapsed with large volume of fluid/debris in the airways, possibly due to mucous plugging. Dilated loops of bowel the upper abdomen, correlate with abdominal radiograph when feasible.


Instruction: Generate impression based on medical findings.

Input: 36 year old female with MALT lymphoma of the breast CHEST:LUNGS AND PLEURA: Few punctate micronodules remain in the lungs, some which are calcifiedMEDIASTINUM AND HILA: Bilateral supraclavicular nodes are again identified, not pathologically enlarged by CT criteria.CHEST WALL: Small bilateral axillary lymph nodes are identified. The dominant right axillary lymph node has decreased in size, measuring 19 x 11 mm, previously 25 x 15 mm (series 3; image 29).The previously seen right breast fluid collection has resolved.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver with scattered areas of sparing.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: 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: Left adnexal surgical clip.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: Decrease in size of the dominant right axillary lymph node.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Necrotizing Fasc, intubated History: Necrotizing Fasc, intubated Unchanged pulmonary opacities and pleural effusions.Mild cardiomegaly.ET tube tip approximately 4 cm above the carina.Left jugular catheter, tip in SVC.Dobbhoff tube doubled back in the stomach before it and and NG tube extend below the lower margin of the image.

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


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: eval fx History: MVC, CP The cardiomediastinal silhouette is normal.There are no airspace or interstitial opacities. There is no pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Postop evaluate lung fields status post AVR, MVR and CABG. Hardware, cardiopulmonary monitoring and support devices unchanged in position. Small to moderate pleural effusions unchanged. Moderate pulmonary edema. Bronchial wall thickening and reticulonodular opacities suggest superimposed aspirate, though not specific. Postoperative pneumopericardium/pneumomediastinum. Probable small anterior subpulmonic pneumothorax on the right.

Output: No acute change. Pulmonary edema and possible superimposed aspiration of secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: eval for PNA History: cough, R flank pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: evaluate for infection, etiology of SOB History: sob Cardiomegaly with extensive interstitial disease and underlying emphysema.Minimal pleural effusions are present.

Output: Cardiomegaly, with extensive interstitial opacities suggestive of edema with underlying emphysema. Atypical infection such as viral etiologies is also in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Reason: AKI on CKD rule out obstructive process. History: Rising creatinine Examination limited by left chest tube; left kidney not accessible.RIGHT KIDNEY: Kidney measures 12.6 cm in length. Increased parenchymal echogenicity and cortical thinning. No hydronephrosis.LEFT KIDNEY: Not visualized.URINARY BLADDER: Foley catheter in bladder.OTHER: No significant abnormalities.

Output: 1.No hydronephrosis in right kidney. Left kidney not visualized.2.Increased renal cortical echogenicity suggesting medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: hx of SCLC with large mass on left collapsin lung; please re-eval pt is s/p first chemo dose History: SCLC Spiculated masslike opacity again noted in the central aspect of the left lung. No new focal lung opacity. No pleural effusion or pneumothorax. Unchanged heart size. Left PICC and pericardial drain, unchanged.

Output: No substantial change.


Instruction: Generate impression based on medical findings.

Input: 83-year-old male with shortness of breath. Cardiomediastinal silhouette is unchanged.Unchanged elevation of left hemidiaphragm. No consolidation, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality and no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old. Reason: worsening tumor burden? effusioN/ History: SOB in lung CA pt, Right sided CHF Heart size is normal.Postsurgical abnormalities in the left hemithorax and right perihilar radiation changes which appear similar to prior study.Bone island in the right posterior eighth rib, unchanged.No specific evidence of edema or infection.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval infection, edema, effusion History: cp, sob; reported h/o chf, p/w tachycardia Low lung volumes and bilateral pleural effusions with adjacent atelectasis. Septal lines. No focal pulmonary opacity.

Output: Bilateral pleural effusions and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: 61yr old male with history of MM; pre-auto sct evaluation History: evaluate Cardiomegaly with small lung volumes.Large central pulmonary arteries are consistent with pulmonary arterial hypertension.No evidence of infection or contraindication to stem cell transplant.

Output: Cardiomegaly, with large central pulmonary arteries consistent with PA hypertension.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Per surgery team, this is not RFO study and was entered in error. Double lumen endotracheal tube is noted, with one lumen collapsing the left lung and the other lumen about 4 cm above the carina. Right chest tube is in place..

Output: Per surgery team, this is not RFO study and was entered in error.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: fluid balance History: sob Left-sided presternal ICD unchanged.Stable cardiomediastinal silhouette.Scattered areas of scarring/discoid atelectasis.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: pna? History: coughing thick yellow sputum x1 month No pulmonary or pleural abnormalities.Cardiomediastinal silhouette is within normal limits.

Output: No evidence of acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: r/o infection History: sob and tachypnea recent dx of pneumonia Mild nonspecific opacities either scarring or subsegmental atelectasis.No specific evidence of infection or edema.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: pna History: sob Cardiomegaly with diffuse moderate to severe bilateral predominantly interstitial abnormalities with small pleural effusions. Appearance suggestive of CHF or possibly infection. Right jugular and right PICC central lines tips are both somewhat obscured although likely project over the right atrium. No pneumothorax. Left subclavian ICD grossly intact.

Output: Moderate to severe CHF pattern. Superimposed infection is also possible.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: eval ETT, lung fields History: s/p AVR Endotracheal tube terminates approximately 3 to 4 cm from the carina. Swan-Ganz catheter terminates in the main PA. Chest tubes and mediastinal drain are noted. Diffuse pulmonary opacities, as before. No pneumothorax. Unchanged heart size.

Output: Lines and tubes, as above. No substantial change in diffuse pulmonary opacities given differences in inspiration.


Instruction: Generate impression based on medical findings.

Input: Male; 67 years old. Reason: h/o CHF and concern for volume overload; eval for pulm edema History: CHF exacerbation Severe cardiac enlargement and/or pericardial effusion.No specific evidence of edema or infection.

Output: Severe cardiac enlargement and/or pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: ETT placement History: respiratory failure, HCAP, parainfleneza virus Endotracheal tube is been removed and a tracheostomy tube in place with its tip 5 7-m above the carina.Right IJ venous catheter with this tip in the SVC.NG tube with its tip in the stomach.Cardiomediastinal silhouette is unremarkable.Diffuse interstitial opacities throughout both lungs unchanged.

Output: Interval extubation and placement of a tracheostomy tube. Diffuse interstitial opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with history of rectal cancer. Status post resection on adjuvant therapy, Xeloda evaluate for recurrence CHEST:LUNGS AND PLEURA: Subsegmental atelectasis in the lung bases and lingular region is unchangedMEDIASTINUM AND HILA: The tip of the right Port-A-Cath is in the right atrium.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Calcified granuloma noted within the liver parenchyma.SPLEEN: Calcified granulomas noted within the splenic parenchyma as well.PANCREAS: Fatty infiltration of the pancreasADRENAL GLANDS: Diffuse thickening of the adrenal glands, likely representing hyperplasia is unchanged.KIDNEYS, URETERS: Benign-appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening of the distal ileal loops in the pelvis, nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically removedBLADDER: No significant abnormality noted.LYMPH NODES: 9 mm right inguinal lymph node on image number 180, series 4 is unchangedBOWEL, MESENTERY: Mild wall thickening of the distal ileal loops in the pelvis, nonspecific. Status post resection of the rectum.Colectomy noted in the left lower quadrant.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Wall thickening of the distal ileal loops in the pelvis, nonspecific and unchangedNo evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female dropping hematocrit. Looking for retroperitoneal or thoracic bleed. CHEST:LUNGS AND PLEURA: Minimal emphysematous changes. Moderate bilateral pleural effusions. No lung nodules.MEDIASTINUM AND HILA: A atherosclerotic calcifications. No definite evidence of aneurysm. Central line. Heart size normal.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs about the to lack of intravenous or oral contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: No definite focal lesions. Some streak artifact in the patient's right arm as the patient was unable to raise the right arm. Gallstones layering in the not hydropic gallbladder. No obvious biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Focus of calcification in the left kidney centrally consistent with nephrolithiasis. No evidence of hydronephrosis or hydroureter. No other renal calcifications.RETROPERITONEUM, LYMPH NODES: No pathologic size nodes. Atherosclerotic calcifications aorta renal arteries and iliac vessels. Caval filter in place. No evidence of retroperitoneal bleed.BOWEL, MESENTERY: No significant abnormality. No evidence of intraperitoneal bleed. No bowel wall thickening or dilatation. TheBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A no significant abnormality. Rectal catheter in place.BONES, SOFT TISSUES: Right femoral venous line in place. Minimal fat stranding in the groin. No evidence of hematoma. Some fatty replacement of the muscles. Some stranding in the subcutaneous fat no evidence of hematoma.OTHER: No significant abnormality noted.

Output: No specific site of bleed to 6 explain drop in hematocrit. Several findings including bilateral pleural effusions, cholelithiasis, left nephrolithiasis, atherosclerotic disease, caval filter. Catheters as above.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: cp/sob/cough History: cp/sob/cough Cardiomediastinal silhouette is unremarkable.Increased reticular interstitial opacities in both lungs compatible with interstitial lung disease and possible superimposed edema.No focal areas of consolidation.No pleural effusions.

Output: Increased interstitial opacities in both lungs with mild volume loss, right greater than left, compatible with interstitial lung disease. Concomitant superimposed edema cannot be excluded. CT of the chest with ILD protocol is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Confirm placement of IABP. HF. Cardiomegaly. Tubes and lines unchanged, with IABP marker in the projection of the mid descending thoracic aorta approximately 7 cm below the expected level of the top of the aortic arch (approximately the T6/T7 level).No acute pulmonary abnormality.

Output: IABP marker at the T6/T7 level.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: evaluate for cavitary lesion, evidence of latent tb History: positive quant gold Streaky opacities at the right costophrenic angle most compatible with subsegmental atelectasis. Left basilar opacities are unchanged. No interval appearance of pleural effusion or consolidation. The heart size is upper limits normal, unchanged

Output: Basilar opacities favor atelectasis and a component of scarring. No new findings to suggest acute infection.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with cough and shortness of breath. Cardiomediastinal silhouette is within normal limits.No focal consolidation, large pleural effusion, or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: s/p liver transplant, intubated History: intubated ET tube tip at carina. Other support hardware unchanged. Lungs hypoinflated. No new opacity.

Output: ET tube tip at carina.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: pna? edema? History: chest pain Left-sided ICD unchanged. Stable marked cardiac enlargement.Perihilar opacities suggestive of edema.Small right pleural effusion.No focal areas of consolidation with interval clearing of the right upper zone airspace opacity.

Output: CHF with cardiomegaly, edema, and right pleural effusion. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female 35 years old Reason: assess for acute process - sob with exertion History: assess for acute process - sob with exertion No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable. Leftward tracheal indentation likely due to thyroid nodules.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: PRE Lung or Heart-Lung Transplant Evaluation History: PRE Lung or Heart-Lung Transplant No acute cardiopulmonary abnormality. Calcified granulomas. Emphysema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Flulike symptoms, pneumonia exposure. Low normal lung volumes. No focal airspace opacity, pleural fluid or pneumothorax. Normal heart size.

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


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Shortness of breath No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary process. 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: 44 yearsGender: MaleReason for Study: Reason: Patient reports SOB History: SOB Motion limits evaluation.ET tube with its tip slightly above the carina.Right IJ Swan-Ganz with its tip in the pulmonary artery.IABP marker cannot be identified due to motion artifact.Chest/mediastinal tubes in place.Cardiac enlargement with perihilar opacities compatible with edema.

Output: Interval intubation. Stable cardiopulmonary appearance allowing for limitation of examination.


Instruction: Generate impression based on medical findings.

Input: Age: 38 yearsGender: FemaleReason for Study: Reason: Cough, fever, URI symptoms, evalute for pneumonia History: Cough, fever Bilateral central venous catheters unchanged. There are decreased lung volumes with stable cardiomediastinal silhouette.Minimal basilar atelectasis without focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: ? Chest pain History: ? PTX Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Post device placement and AP lateral, evaluate for pneumothorax Left chest wall ICD with leads in the right atrium, right ventricular apex, and coronary sinus. No significant pneumothorax. The cardiac and mediastinal silhouette is normal. No significant pulmonary or pleural abnormality.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Chronic respiratory failure. Hypoxia and rales Mild improvement with predominantly basilar moderate CHF with moderate effusions. No discrete new superimposed focal airspace abnormalityTracheostomy tube and right jugular dialysis catheter are unchanged

Output: Mildly improving moderate CHF


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old. ET tube tip approximately 2 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery.Balloon catheter in the proximal descending aorta.Cardiomegaly with basilar opacity compatible with atelectasis and small effusions, unchanged.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male presents for evaluation of Swan-Ganz catheter placement. Swan-Ganz catheter has its tip overlying the right interlobar pulmonary artery. Multiple surgical clips project over the mediastinum. Defibrillator has its tip overlying the expected right ventricular apex.Stable cardiomegaly. Minimal improvement of bibasilar streaky opacities consistent with atelectasis. Continued improvement of mild pulmonary edema. Minimal decrease in right pleural effusion. No left pleural effusion. Calcifications overlying the right upper quadrant of the abdomen are indeterminate but most likely calcified gallstones.

Output: Swan-Ganz catheter overlies right interlobar pulmonary artery. Mild improvement of right sided pleural effusion, pulmonary edema, and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Chest pain Minimal basilar scarring without superimposed new acute abnormality. Borderline cardiomegaly

Output: Borderline cardiomegaly without additional airspace acute abnormalities


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Status post thoracentesis evaluate for pneumothorax. No pneumothorax.Severe pulmonary edema and moderate right pleural fluid collection unchanged. Slight decrease in pleural fluid volume on the left which remains moderate to large. Atelectasis and consolidation in the lingula nonspecific.Embolization coils project over the mediastinum.

Output: No pneumothorax. No acute change in pulmonary opacities. Slight decrease in left pleural fluid volume.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: r/o acute process History: sharp right sided chest pain, no trauma Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: assess for acute lung changes specifically worsening or improvement of hemothorax History: recent hemothorax and takeback to OR Support devices stable.No change in basilar opacities. No pneumothorax.

Output: No significant interval change in basilar opacities. Support devices stable.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: assess for infiltrate History: bilateral pain below ribs concern, for pneumonia Small lung volumes with a diffuse interstitial abnormality suggestive of edema, although atypical infection is in the differential diagnosis.No large pleural effusions.Heart size leased upper normal.

Output: Diffuse interstitial opacities, suggestive of edema or atypical infection. A follow-up CT is been performed, which may suggest interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: Postoperative cardiac arrest. ETT tip about 2.5-3 cm above the level of the carina. An enteric tube terminates in the mid thoracic esophagus. Central lines unchanged in position.No pneumothorax. No signs of pulmonary edema or significant aspiration. Lung volumes are low.

Output: Enteric tube is situated overlying the mid thoracic esophagus. Low lung volumes, but no visible acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval for infiltrate/edema/ptx History: chest pain sob Complete left hemithorax opacification with rightward shift of the mediastinum consistent with a large pleural effusion compressing the left lung.Unremarkable right lung.

Output: Complete left hemithorax opacification presumably from a large pleural effusion or hemothorax. Underlying malignancy is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Reason: ? pna History: previous pna no improvement in sx Extensive chronic scarring and volume loss in the right hemithorax with underlying emphysema.Scarring of the right apex unchanged. Normal heart size allowing for marked shift of the mediastinum to the left with coronary artery calcification.Increased blunting of both costophrenic angles, laterally on the right and posteriorly on the left, suggestive of small pleural effusions.

Output: Increased blunting of the costophrenic angle suggestive of small pleural effusions and no other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: history of bladder ca s/p cystectomy History: history of bladder ca sp cystectomy Unremarkable cardiac and mediastinal silhouette.Port catheter with its tip in the SVC.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male history prostate cancer metastases post chemotherapy. Reevaluate. The pain. Elevated creatinine. CHEST:LUNGS AND PLEURA: Multifocal lung nodules consistent with metastases. Index lesions remeasured as follows.Right middle lobe series 5 image 45, 6.9 x 6.9 mm. Previously measured 6.1 mm.Both legs lesion left upper lobe series 5 image 55, 8.6 x 6.8 mm. Previously measured 8 mm in long axis. No new lesions. No pleural effusionsMEDIASTINUM AND HILA: Small mediastinal nodes unchanged. None pathologically enlarged. Turner other calcifications.CHEST WALL: Minimal gynecomastia unchanged.ABDOMEN: The exam is not sensitive detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Cortical thinning. There is hydronephrosis and proximal hydroureter on the left two .of obstruction in the adenopathy. The appearance is unchanged from the most recent prior exam but is worse 10/11/4/2009.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta redemonstrated. Focal area of bulge and asymmetry seen in the mid abdominal aorta may be somewhat distorted by the adenopathy. Maximal diameter the coronal plane 28.5 mm is seen on series 80292 image 59/hundred 24. Extensive retroperitoneal adenopathy redemonstrated. One of the left periaortic nodes although March 10 surrounding nodes is estimated to measure 44.1 x 23.3 mm in series per image 122. Previously measured 31.4 x 22.7 mm.A second more caudal left periaortic node measures 37.4 x 35.8 mm on series 2 image 134. It previously measured 33.6 x 29.9 mm.Adenopathy continues along the common iliac chains.BOWEL, MESENTERY: No significant abnormality noted. There is extrinsic mass effect on the third portion of the duodenum from the preaortic adenopathy. This mass effect is increased somewhat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Small common iliac lymph nodes unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mixed lytic lesion right ilium unchanged.OTHER: No significant abnormality noted

Output: While measurements of the lymph nodes are less accurate due to lack of intravenous contrast some of the nodes measure larger. No new sites of disease. Micronodules lungs as measured above. Persistent hydronephrosis on the left. Other findings as above. (Discussed with Peter O'Donnell, MD, covering).


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old. ET tube is in place with its tip approximately 4 cm above the carina.There are decreased lung volumesMediastinal mass (goiter) unchanged.Basilar opacities are compatible with pleural effusions and atelectasis.

Output: Interval placement of ET tube. Increasing pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: assess for PNA History: cough and central pain Cardiomegaly.No specific evidence of infection or edema.Old shunt to project over the right chest wall. Mild cardiac enlargement, otherwise unremarkable.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: interval changes History: as above ET tube, NG tube, and left IJ venous catheter unchanged.Stable cardiomediastinal silhouette.Mild interval improvement in the interstitial opacities at the right lung base.

Output: Support devices unchanged. Interval improvement in the right basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.SOB with diminished breath sounds in right versus left. Normal cardiomediastinal silhouette. The lungs are well-inflated and clear. No focal airspace opacities, pleural fluid or pneumothorax.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Status post lung transplant. Evaluate for foreign body. Patient is status post lung transplant. Bilateral diffuse airspace opacity is improved from the prior study. At least small effusions. No pneumothorax. Small amount of subcutaneous emphysema.Extensive supportive hardware including 3 right-sided chest tubes, 3 left-sided chest tubes, ECMO catheters, right-sided chest port tip overlying the right atrium, left IJ catheter, endotracheal tube, mediastinal drain, and esophageal temperature probe are in radiographically acceptable position. Left upper extremity PICC terminates at the level of the subclavian vein.

Output: Slight improvement in persistent diffuse airspace opacities. Supportive hardware in radiographically acceptable position. No suspicious retained radiopaque foreign body.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: 19-year-old male with headache, question shunt malfunction.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views) 11/23/2016 Ventriculostomy tip is left of midline in the middle cranial fossa. Shunt exits the skull via a right occipital burr hole. The distal shunt traverses the right neck and terminates at the level of the tricuspid valve without shunt discontinuity. Orphan shunt fragments are identified in the right neck and chest.There is a dysmorphic appearance of the skull. Cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity, pleural effusion or pneumothorax. Horizontally oriented skin staples are seen at the lower margin of the image.

Output: VA shunt terminates at the level of the tricuspid valve. No shunt discontinuity.


Instruction: Generate impression based on medical findings.

Input: Reason: Is mucus plug any better? History: Continued tachypnea Complete opacification of the left hemithorax with volume loss, consistent with atelectasis.Interstitial opacity on the right suggestive of edema with a small right effusion.A more recent radiograph has been interpreted.

Output: Increased left lung atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 93 yearsGender: FemaleReason for Study: Reason: eval for widened mediastinum, ro PTX, pulm edema History: fall, syncope, tachypnea, chest pain Stable cardiomediastinal silhouette with atherosclerotic changes of the aorta.Minimal basilar scarring/discoid atelectasis.No focal areas of consolidation.No pleural effusions.No pneumothorax.

Output: Neck were changed to


Instruction: Generate impression based on medical findings.

Input: Metastatic thyroid cancer. Evaluate for progression of disease. CHEST:LUNGS AND PLEURA: Multiple nodules are again identified in both lungs, without change in size. Reference right upper lobe lesion (image 24, series 4) measures 12 x 10 mm, previously 11 x 11 mm. Left upper lobe nodule (image 29, series 4) measures 8 mm, previously 8 mm. Other pulmonary nodules are also stable in size. Scattered calcified micronodules are again identified. Suture in the left lower lobe. No evidence of pleural effusion.MEDIASTINUM AND HILA: Status post thyroidectomy. No significant mediastinal, or hilar lymphadenopathy. Normal heart size. No evidence of pericardial effusion.CHEST WALL: Healed rib fractures in the right fourth and fifth ribs. A hemangioma in the T10 vertebrae, unchanged. Osteolytic lesion involving the glenoid on the right is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Stable, well circumscribed low attenuated lesions in the liver most likely representing cysts.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Two ill-defined low attenuated masses in the left kidney compatible with metastatic disease are again seen, without change in size. Ill-defined low attenuated lesion in the right renal cortex (image 104, series 3), likely representing a metastatic lesion, has increased in size, now measuring 18 mm (image 104, series 3), previously 12 mm.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. Mild degenerative changes in the upper lumbar spine.OTHER: No significant abnormality noted

Output: 1.No change in number or size of pulmonary metastases.2.Slight increasing size of right renal hypodense lesion, which likely represents a metastasis. Unchanged left renal masses, compatible with metastases.3.Stable osteolytic right glenoid metastatic focus.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: ET in place? History: ET in place ET tube unchanged.Decreased lung via the stable cardiac mediastinal silhouette.Left basilar atelectasis.No new pulmonary opacities identified.

Output: ET tube unchanged with its tip 4 to 5 cm above the carina. Mild basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: CHF ETT removed. Mild increasing basilar changes again suggesting mild edema with layered moderate effusions with marked nonspecific cardiomegaly. Retrocardiac opacity again most like represents compression atelectasis, however partial consolidation cannot be excluded.ICD, Swan-Ganz and LVAD are all otherwise unchanged. IABP remains 2 cm beyond the arch

Output: ETT removed


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Shortness of breath. On BiPAP. Subsegmental scarring again noted at the lung bases. Normal heart size. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Reason: eval of rales on examination. History: left chest rales Heart size normal, the aorta tortuous but consistent with age, unchanged.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube position History: s/p esophagectomy Right chest tubes unchanged with no significant pneumothorax.Resolving pulmonary opacity compatible with edema, with moderate pleural effusions and basilar atelectasis.Mediastinal widening consistent with gastric interposition with an NG tube projected over the lower mediastinum.

Output: Resolving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: This is a patient with 7 weeks of prolonged coughing. Please evaluate for cardiopulmonary disease. History: Cough and sputum. 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: PICC line placement. Leukemia No cardiopulmonary abnormality. Left PICC line extends into the innominate approximately 3 cm from the confluence with the SVC

Output: No acute disease and left PICC line placed


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of metastatic renal cell cancer The study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Patchy ground glass opacity in the lung bases have improved. Minimal ground glass opacities remain in the right lower lobe.MEDIASTINUM AND HILA: Minimal pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic metastases lesions are again seen replacing most of the liver. Index reference lesion in the left lobe measures 5.5 x 3.4 cm in image number 93, series number 3. Reference right lobe lesion measures 6.9 x 5.1 cm in image number 106, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence at the nephrectomy site. Left kidney is unremarkable, given the limitations of lack of IV contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Expansile rib lesion anteriorly on the right side is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the ground glass opacities. Hepatic lesions are grossly unchanged.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of larynx cancer. Rule out recurrence. Rule out chest metastases. LUNGS AND PLEURA: Apical interstitial abnormality compatible with radiation change. Nonspecific pulmonary micronodules in the right middle lobe, at the level of the right major fissure and left lower lobe. Mild centrilobular and paraseptal emphysema. Stable scarring at the bases. There is slightly more prominent interstitial abnormality at the left base likely a combination of scarring as well as aspiration. No pleural effusions. No new nodules.MEDIASTINUM AND HILA: Stable appearance of the opening anterior trachea. Normal cardiac size. No pericardial effusions. Coronary artery calcifications.Small mediastinal nodes stable. No significant hilar lymphadenopathy.CHEST WALL: The reference left axillary node measures 2.0 x 1.5 cm, increased. The right axillary node has also mildly increased.UPPER ABDOMEN: Gastric diverticulum, unchanged.

Output: 1. Increasing bilateral axillary lymph nodes consistent lymphoma or infection.2. Stable appearance of pulmonary micronodules.3. Possible new aspiration at the left base.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: 61-year-old male with history of pulmonary lymphoma CHEST:LUNGS AND PLEURA: Biapical scarring with subpleural cysts are unchanged.Index micro-nodule in the right upper lobe now measures 4-mm in diameter on image number 19, series number 5, unchanged from previous study. Other scattered micronodules are also unchanged.MEDIASTINUM AND HILA: Calcified right hilar lymph nodes are unchanged.CHEST 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: Punctate right lower pole renal stone, unchanged. Left mid pole small hypodense lesion is unchanged.RETROPERITONEUM, LYMPH NODES: Index retroperitoneal lymph node inferior to the aortic bifurcation is stable measuring 11 by 8mm image number 136, series number 3. Other small retroperitoneal lymph nodes are also stable.BOWEL, MESENTERY: Multiple subcentimeter mesenteric lymph nodes are stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Please see aboveBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Somnolence, ETT placement. Endotracheal tube tip at the thoracic inlet level. Right jugular catheter unchanged in position. Low lung volumes. Layering pleural effusions and atelectasis appear slightly worse however this may be exaggerated due to differences in patient positioning. No pneumothorax.

Output: ETT at the thoracic inlet level and may be advanced. Apparent worsening of pleural fluid and atelectasis may be positional.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: transvenous pacer placement History: as above Unchanged cardiac lead. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Unchanged cardiac lead. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: volume overload History: cp, sob Examination is limited by patient motion.Stable cardiomediastinal silhouette with right cardiophrenic opacity representing prominent epicardial fat pad.The lungs are clear.No pleural effusions.

Output: Stable cardiac enlargement without evidence of pulmonary edema or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: lung infiltrate History: SOB; cough Cardiomegaly, small lung volumes and a suggestion of pulmonary edema.No specific evidence of infection.There may be small pleural effusions.

Output: Cardiomegaly with a suggestion of edema consistent with CHF. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with metastatic colorectal cancer CHEST:LUNGS AND PLEURA: Index left upper lobe lesion with surrounding groundglass opacity is slightly smaller and now measures 2.2 by 1.6 cm on image number 39, series number 5.Reference right upper lobe nodule now measures 2.6 by 1.5 cm on image number 38, series number 5, slightly smaller compared to previous study. Paragraph index discrete nodule in the left posterior costophrenic angle now measures 2.2 by 1.8 cm on image number 85, series number 5.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Mild fatty infiltration of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small hypodense lesion in the midportion of the left kidney measuring 1.3 cm unchanged on image number 112 coarsens number 3. Follow-up of this lesion is recommended since it does not demonstrate fluid signal density.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: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Presacral soft tissue densityBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval minimal decrease in the size of the index parenchymal lung lesions.Follow-up imaging is recommended for further evaluation of the stable, small left renal lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: evaluate for progressive pulmonary edema History: new o2 requirement, worsening systolic function Cardiomediastinal silhouette similar to prior including cardiomegaly, mitral annular calcifications, and aortic atherosclerotic calcifications.Increasing basilar predominant interstitial opacities as well as increased small effusions. Additional nonspecific increased retrocardiac opacity compatible with atelectasis and effusion.Severe degenerative changes of the visualized osseous structures.Partially visualized gastrostomy tube.

Output: Increased basilar opacities and small effusions compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: Numerous subcentimeter, spiculated micronodules in both lungs suspicious for metastatic disease. A reference nodule measures 5-mm in the left lower lobe on image number 225, series number 6.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right axillary adenopathy. A reference lymph node measures 3.7 x 2.1 cm in image number 37, series number 4.Mass in the right chest wall measuring 1.8 x 1.9 cm on image number 83, series number 4.ABDOMEN:LIVER, BILIARY TRACT: Nine by 8mm enhancing mass in the right anterior abdominal wall indenting the liver. No evidence of focal intrahepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged retroperitoneal lymph nodes. The reference noted in the left there are decreased in measuring 12 by 7 mm on image number 127, series number 4.BOWEL, MESENTERY: Multiple borderline enlarged mesenteric lymph nodes. A reference node measures 11 by 8mm on image number 166, series number 4.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: Right axillary adenopathy. Right chest wall and right anterior abdominal wall enhancing nodules consistent with metastatic disease.Numerous subcentimeter lung nodules suspicious for metastatic disease.Multiple borderline enlarged mesenteric and retroperitoneal lymph nodes as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Hypoxia Cardiomediastinal silhouette is upper limits of normal. Low lung volumes. Right pleural effusion. Diffuse interstitial and airspace opacities without significant change from prior study, compatible with infection or aspiration. Left sided central venous catheter tip in the innominate confluence. The NG tube extends below the diaphragm outside the field-of-view. Right upper quadrant drain noted. Left chest wall skin staples, midline abdominal skin staples, and right upper quadrant clips noted.

Output: Right pleural effusion. Diffuse interstitial and airspace opacities, compatible with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Hematemesis Give an mild differences in technique and positioning, the moderate right pneumothorax and extensive overlying chest wall emphysema appears similar in size to prior exam for the intrathoracic component, however there is questionable new increased right to left mediastinal shift and an underlying right chest tube projected towards the hilar region. Close serial imaging with the patient's square least centered will be helpful in further delineation. Pager 1604 contacted The chest wall at the same as markedly increased.ETT, NG and right jugular catheter appear unchangedThe cardiac and mediastinal contours are within limits.

Output: Right chest tube placed, see above


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: eval for tuberculosis History: patient with + tuberculin skin test Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval for pneumo, pt coded History: pt just coded, bradycardic w/ hypotension Cardiomegaly.Small pleural effusions may be present subsegmental atelectasis behind the heart.ET tube tip within 2 cm above the carina.

Output: Low ET tube. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Coffee-ground emesis. Evaluate repair of hiatal hernia. Lung volumes remain low with significant compressive atelectasis at the lung bases. Retrocardiac opacity without internal air smaller than on the previous study, consistent with a large known posterior mediastinal fluid collection. Please refer to same day CT for additional findings.

Output: Persistent large posterior mediastinal fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: eval pna/ abscess History: cf - prolonged exacerbation Persistent focal opacity at right apex. Other areas of extensive bilateral bronchiectasis and mucous plugging are also unchanged. PICC tip in left axillary vein.

Output: Persistent focal opacity at right lung apex which likely represents pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: LIJ placement (not new) History: LIF Cardiomegaly with minimal scarring or subsegmental atelectasis in the right lower lobe.No specific evidence of infection or failure.Left jugular catheter advanced into the SVC.Right jugular or subclavian catheter tip at SVC/RA junction level.

Output: Left jugular catheter repositioning.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: sob History: sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: pna History: pna Interval placement of a left IJ central catheter with the tip terminating at the posterior left 4/5 rib interspace. The patient is rotated to the left. Subsegmental atelectasis and consolidation of the left lower lobe with associated pleural effusion. Continued follow-up to resolution is recommended.

Output: Left lower lobe subsegmental atelectasis and consolidation with pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: chest pain, shortness of breath, possible GI malignancy History: short of breath, chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 89 years old Female. Reason: HYPOTENSIVE History: HYPOTENSIVE. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is a mild interstitial edema. The tip of the double-lumen catheter project over the right atrium. Postthoracotomy changes are noted.

Output: The above findings are consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: sepsis, AMS c/f aspiration pna vs CAP History: see above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male, evaluate for recurrence and/or metastatic disease for colon cancer. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Enlarged thyroid gland extending into the superior mediastinum.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple subcentimeter lesions in the liver, too small to accurate characterize.SPLEEN: Subcentimeter lesion in the spleen, nonspecific. Calcifications in the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal stones. Left-sided moderate hydronephrosis and dilated left ureter. Left retroperitoneal soft tissue density measuring 17 x 14 mm in made to the left ureter and causes the left hydronephrosis. (Image number 159, series number 4)RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy A reference node measures 17 x 16 mm in image number 122, series number 4.BOWEL, MESENTERY: 2.9 x 2.6 cm soft tissue mass in the left lower quadrant lateral to the descending colon on image number 169, series number 4. Additional small subcentimeter nodular densities in the peritoneum more prominent on the left side suspicious for carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is significantly enlarged.BLADDER: Bladder is slightly thick walls which was secondary to enlarged prostate and cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Retroperitoneal adenopathy causing left-sided hydronephrosis.Peritoneal carcinomatosis with the largest mass in the left lower quadrant as described above.Bilateral nephrolithiasis.Enlarged prostate.Retrosternal goiter.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: SOB History: SOB, tenuous respiratory status Pacemaker leads in place, unchanged.Large bilateral pleural effusions with underlying opacity consistent with atelectasis and possibly edema.No new findings.

Output: Pleural effusions consistent with CHF, without interval change.


Instruction: Generate impression based on medical findings.

Input: Fever No acute cardiopulmonary abdomen about the given technique

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the left descending pulmonary artery.Impella device in the area of the left ventricle, unchanged. Moderately large pleural effusions with underlying atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: eval pneumomediastinum, infection, edema, effusion, concern for booerhaave History: hematemesis, h/o etoh abuse, blood in oropharynx Low lung volumes with mild basilar atelectasis. Lungs otherwise clear.Heart size normal.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p left lower lobectomy, ongoing airleak. eval for interval change History: asx Left chest tube in place. Diffuse left subcutaneous emphysema unchanged. Right middle lobe residual atelectasis unchanged. No measurable pneumothorax.

Output: Stable exam. No measurable pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: assess bullet lodged in chest. Needs clearance to do MRI History: none Large lung volumes consistent with COPD, with scattered bullae.No specific evidence of infection or edema.Heart size normal.Bullet fragments are projected over the right posterior chest wall.

Output: COPD or emphysema. No specific evidence of infection or edema. Bullet fragments described above.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Sarcoidosis status post bilateral lung transplant. Small lung volumes. Cardiomegaly and mediastinal widening about the same. Tubes and lines unchanged in position.Moderate to large pleural effusions unchanged. Edema-like abnormality, right greater than left, similar to previous.

Output: No acute change in cardiopulmonary appearance with pleural fluid and edema-like opacities.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with history of melanoma, pulmonary nodules, status post treatment with IFN. CHEST:LUNGS AND PLEURA: Multiple pulmonary micronodules are reidentified, some of which are calcified and probably reflect prior granulomatous or inflammatory disease. No interval change in size of micronodules. No new nodules or masses. No pleural effusion.Left upper lobe scarring/fibrosis is unchanged.Foci of tree in bud opacity within the right lung (axial images 43 and 65/100) are nonspecific but may represent early infection.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged. Cardiac size is normal with no pericardial effusion. Coronary artery calcifications noted. Calcified hilar lymph nodes likely represents prior granulomatous disease.CHEST 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: Referenced porta hepatis lymph node measures 3.1 x 0.9 cm on axial image 97/215 and is unchanged.Atherosclerotic calcifications affect the abdominal aorta.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: Multiple diverticula are evident in the sigmoid and descending colon. Inflammatory infiltration about the descending colon is new on axial image 130/215 and raises the question of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: An aneurysm of the right common iliac artery measures 2.2 cm on axial image 149/215 and is unchanged.

Output: 1.Stable pulmonary nodules. 2.No evidence of disease progression in the chest, abdomen or pelvis.3.Questionable diverticulitis of the descending colon.4.Stable right common iliac artery aneurysm.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: interval exam, pt s/p trach History: interval exam, pt s/p trach Worsening pulmonary opacities particularly on the right suggestive of infection or aspiration.Tracheostomy tube tip approximately 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter tip in brachiocephalic vein, and a left jugular in the SVC.

Output: Worsening right-sided opacities suggestive of infection or aspiration. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: 5-year-old female with shortness of breath status post VATs with a chest tube. Evaluate for pulmonary opacities and pneumothorax..VIEW: Chest AP (one view) 12/10/2015 at 0948 hours Right chest tube is in place. Moderate-sized right pneumothorax. No significant interval change in the opacities in the right midlung and right base. Left lung is normal in appearance. Cardiothymic silhouette is normal. Left thoracic curve is present.

Output: Moderate-sized right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: s/p cardiac surgery History: s/p cardiac surgery ET tube tip approximately 5 cm above the carina. Right subclavian ICD, unchanged. ECMO catheters are again noted. Right jugular catheter unchanged in position. Median sternotomy hardware. Impella device is unchanged.Cardiomegaly is unchanged. Dense, bilateral, central airspace opacities, unchanged and may represent edema or aspiration.

Output: Unchanged support devices as above. Severe central, bilateral opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: pneumonia?, HIV+ History: fever/cough Stable cardiomegaly with diffusely increase interstitial opacities suggesting edema.No pleural effusion or pneumothorax.No focal areas of consolidation.

Output: No interval radiographic change in the appearance of cardiomegaly with mild pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: sob Mild basilar atelectasis again noted. No new focal pleural parenchymal opacity. Focal opacity in the mid aspect the left lung, likely loculated fluid within the fissure. Marked cardiomegaly again noted. No pneumothorax.

Output: Mild basilar atelectasis again noted. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: assess IABP, swan placement History: s/p swan and IABP Line position stable.No change in bilateral lung opacities.

Output: No change in bilateral lung opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: ETT ET tube tip approximately 4 cm above the carina.Right jugular catheter tip in the area the jugular vein.Focal airspace opacity in the superior segment of the right lower lobe and moderate pleural effusions with basilar atelectasis, slightly increased.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with CHF, diabetes and chronic kidney disease presents with right sided abdominal pain radiating to back Evaluation of the solid organs is limited by lack of IV contrastCHEST:LUNGS AND PLEURA: There is increased reticulation in the lower lobes with some sub pleural fibrotic changes.MEDIASTINUM AND HILA: Calcified mediastinal and right hilar lymph nodes are identified. Several enlarged bilateral hilar and mediastinal lymph nodes are seen. For reference, conglomerate subcarinal lymph node measures 4.3 x 2.4 cm.Coronary artery calcifications. ICD.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. Cholelithiasis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous bilateral renal cysts have not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appendix.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small saccular bulging of the infrarenal abdominal aorta just above its bifurcation, unchangedPELVIS: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: Fatty infiltration of the liver.Cholelithiasis.Bilateral hilar and mediastinal adenopathy with some calcified lymph nodes. Correlate for the possibility of sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.ET tube. Bilateral pulmonary opacities suggesting edema and effusions have slightly improved from previous. ET tube is 3 cm above the carina. NG tube over the stomach. Inferiorly placed Swan-Ganz catheter with tip over the right main pulmonary artery, unchanged. No pneumothorax.

Output: ET tube 3 cm above the carina. Lung fields slightly improved.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with history of endometrial cancer CHEST:LUNGS AND PLEURA: Bilateral scattered small nodules are unchanged.MEDIASTINUM AND HILA: Enlarged left lobe of the thyroid is unchanged. There is a large heterogeneous solid nodule extending into the superior mediastinum.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: Index right pericaval lymph node is unchanged measuring 7 mm in diameter image number 126 on series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Chill cavity is again noted. The amount of enhancement within dimensional cavity has decreased. Calcifications and thrombi within the right portal vein are unchanged. Mildly enlarged left ovary is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: 56M with cough, LLL crackles on exam History: 56M with cough, LLL crackles on exam Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or failure.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 33-day-old male with desaturations. Evaluate right pneumothorax status post chest tube placement.VIEW: Chest AP (one view) 11/20/2015, 0402. Endotracheal tube with tip above the carina. Feeding tube is in the stomach with side-ports in the lower esophagus. Interval replacement of the inferior chest tube with unchanged position of the superior chest tube. Interval improvement in size of the right pneumothorax, now with small residual right subpulmonic pneumothorax. Hazy opacity in the left lower lobe, similar to prior study.

Output: Improving right pneumothorax following chest tube replacement.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: overload? History: as above Cardiac silhouette is mildly enlarged.Pulmonary vascular redistribution. Few septal lines could represent mild edema. Peripheral right lower lung opacity is nonspecific and could represent infection or potentially infarction. No pleural effusion or pneumothorax.

Output: Enlarged cardiac silhouette with perihilar vascular congestion and question minimal interstitial edema.Nonspecific right lower lung peripheral opacity may represent pneumonic consolidation or potential pulmonary infarction in the proper clinical setting.


Instruction: Generate impression based on medical findings.

Input: 30-year-old male with headache SHUNT DEVICE: A left transparietal approach shunt catheter with intracranial tip in the midline middle cranial fossa. The radiopaque, extracranial component of the catheter courses through the soft tissues of the left side of the neck and anterior chest wall. It enters the left upper quadrant with tip in the pelvis. No evidence of kinking or discontinuity. SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: Mild rightward curvature of the thoracic spine. The lungs are unremarkable.ABDOMEN: There is leftward curvature the lumbar spine. VP shunt catheter tubing terminates in the pelvis. There is an additional intrathecal catheter with tip at the T11-T12 level exiting at the L1-L2 level and entering the abdomen in the right lower quadrant with drain in the pelvis.

Output: No evidence of shunt discontinuity or kinking.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: r/o pneumonia History: cough, sob Interval increase in size of the cardiac silhouette, indeterminate in nature although concerning for a new pericardial effusion.New moderate bilateral pleural effusions are also noted. The right pleural effusion demonstrates a subpulmonic distribution. No pneumothorax.Signs of pulmonary edema associated with multilobar subsegmental atelectasis.Intact median sternotomy wires.

Output: New signs of pulmonary edema, moderate bilateral pleural effusions and pulmonary venous hypertension.Interval enlargement of the cardiac silhouette, which is partially obscured although concerning for new pericardial effusion. Recommend correlation with echocardiogram.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Evaluate for placement of central line History: intubated, sedated. Recent cvc placement RIJ Right IJ line terminates just above the cavoatrial junction. Lines and tubes are unchanged otherwise. Increased bibasilar opacities. Small pleural effusions are noted. Mild pulmonary edema, as before. Unchanged heart size. No pneumothorax.

Output: Increased bibasilar opacities. Mild pulmonary edema again noted. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with history of pneumonia who presents with shortness of breath and productive cough. Cardiomediastinal silhouette is within normal limits.Low lung volumes. No pleural effusion, pneumothorax, or focal airspace opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Status post cervical fusion. Anterior fusion of C5-C6 with interposed disc material in anatomic alignment without evidence of complication, similar to prior. Joint space narrowing of C3-4, C4-5 and C6-7 is redemonstrated. Atherosclerotic calcifications of bilateral carotids again noted. Sternotomy wires and surgical clips partially visualized in the chest.

Output: Anterior fusion of C5-C6 with interposed disc material in anatomic alignment without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: pneumonia History: SOB Focal subsegmental atelectasis or scar in the mid upper aspect of the right lung. Left suprahilar fullness which may represent localized atelectasis or focal lung opacity. Left posterior costophrenic angle opacity. Normal heart size. No pneumothorax.

Output: Left suprahilar fullness which may represent localized atelectasis or focal consolidated lung. Indeterminate left lower lobe posterior costophrenic angle atelectasis, consolidation, and/or effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval for focal pneumonia History: increased suction requirement Focal atelectasis or scarring left lung base, and fibrosis in the right apex, unchanged.Tracheostomy tube tip approximately 5 cm above the carina.Two right jugular catheters terminate at the right atrial level.

Output: Left base and right apical scarring likely, unchanged with no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: central line change History: none No significant cardiopulmonary abnormality.Right jugular catheter, tip at SVC/atrial junction level, exchange for a smaller catheter.Right upper quadrant drainage catheter unchanged.NG tube removed.

Output: No significant abnormality. Status post right jugular catheter exchange without complication.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Cough, recent pneumonia, evaluate for ongoing pneumonia or effusions. Persistent opacity in the right middle lobe associated with subsegmental atelectasis, unchanged to perhaps slightly worse.Mild septal thickening on the right is new.Right jugular chest port tip at the SVC, unchanged.Cardiomegaly, about the same.No visible pleural fluid.

Output: No significant change in subsegmental atelectasis and nonspecific opacity in the right middle lobe. Interval development of mild interstitial abnormality in the right lung which may reflect a component of edema given the presence of cardiomegaly. Consider ILD protocol thoracic CT with expiratory sequence given persistence of findings and abnormalities seen on prior imaging for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with appendiceal carcinoma CHEST:LUNGS AND PLEURA: Stable emphysema and right lung base. Beulah.MEDIASTINUM AND HILA: Pulmonary arteries are enlarged, suggestive of prominent arterial hypertension. Posterior mediastinal adenopathy, measuring 12 x 14 mm on the left lower chest, anterior to the descending aorta is unchanged. Reference left retrocrural adenopathy has slightly increased in size, now measuring 21 x 15 mm on image number 84, series number 3. Right retrocrural adenopathy is also slightly enlarged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Minimal irregularity of the peritoneum surrounding the liver is unchanged. No focal liver lesions. Mild intrahepatic biliary dilatation is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable benign renal cysts.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes are increased in size. Reference right para-aortic lymph node measures 13 x 10 mm on image number 96, series number 3, not significantly changed from previous study. However, other retroperitoneal lymph nodes have significantly enlarged within the internal. For comparison, aortocaval lymph node now measures 3.2 x 2 .7 cm, image number 107 whereas it was previously measuring 1.5 x 10 mm image number 102, series number 3.BOWEL, MESENTERY: Small mesenteric nodules are unchanged.BONES, SOFT TISSUES: Mild stranding in the anterior abdominal wall has decreased, significance is unknown.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: UnremarkableLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the retroperitoneal adenopathy


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: right heart failure, CXR prior to V/Q scan History: shortness of breath No new focal lung consolidation. Moderate cardiomegaly again noted. No pleural effusion or pneumothorax. No acute bony abnormality. Large patient body habitus.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: here with sickle cell pain x 3 days. + chest pain. hx of acute chest History: chest pain, joint pain, mild sob Left Port-A-Cath with its tip in the SVC.The heart size is normal. There is pulmonary vascular redistribution.Perihilar and basilar mild interstitial opacities suggestive of edema.No focal areas of consolidation.Extensive osseous changes related to sickle cell disease.

Output: Perihilar/ basilar interstitial opacities suggestive of edema. No specific evidence of infection. Extensive osseous changes secondary to sickle cell disease.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: sob, likely chf exacerbation History: 48581 Severe cardiomegaly but no significant pulmonary edema.

Output: Severe cardiomegaly but no significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Reason: eval pacemaker History: swelling over pacemaker Left pacemaker with lines in appropriate position. Lungs clear of airspace opacities. No pleural effusion. No pneumothorax.Stable cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality or interval change


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: Right jugular catheter sheath and LVAD unchanged.Patchy bilateral nonspecific airspace opacity compatible with pneumonia and/or aspiration, slightly improved since the previous day.No new findings.

Output: Patchy airspace opacity, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.History of malignant neoplasm of larynx. SOB, evaluate for pneumonia. Right chest port unchanged in position. Gastrostomy tube retention device projects over the left upper quadrant.Skin folds on the left, but no pneumothorax.Coarse interstitial markings with thickening of the fissures and moderate pleural fluid consistent with edema. Retrocardiac atelectasis and consolidation unchanged.

Output: Severe hypervolemia/pulmonary edema. Persistent left basal consolidation consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Acute on chronic heart failure assess Swan-Ganz catheter placement. Swan-Ganz catheter incompletely visualized, presumably due to motion, portion of the catheter can be seen in the caudal aspect of the right ventricle just to the left of midline.Left subclavian ICD unchanged in position. Balloon pump marker is not identified on the current study, possibly due to motion. Epicardial pacing wires.Lung volumes remain low with coarse interstitial markings. Unchanged cardiomegaly.

Output: Swan-Ganz catheter not visualized in its entirety, likely due to motion, but can be followed to the proximal aspect of the right ventricle. Follow-up films recommended. Unchanged cardiomegaly and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: CHEST: Examination limited by scan coverage in field of view.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: Not imaged.UPPER ABDOMEN: Not imaged.

Output: No significant abnormality noted in the extracardiovascular portions of the examination.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: S/P OHT, routine follow-up History: as above Pacer generator and leads unchanged. Sternotomy sutures unchanged.The cardiomediastinal silhouette is borderline enlarged but stable.Chronic reticulonodular interstitial opacities are also stable. There are no new focal pulmonary opacities or pleural effusions.

Output: Stable examination with chronic interstitial opacities but no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male with history of esophageal cancer with metastatic to the peritoneum. Complains of back pain and abdominal pain. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions unchanged from previous CT.MEDIASTINUM 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: The amount of ascites is degrees within the interval. A reference pocket of ascites between the spleen and stomach now measures 8 x 6.6 cm. Extensive peritoneal carcinomatosis is unchanged. No evidence of bowel obstruction.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: Bilateral large pleural effusions, unchanged.Interval decrease in the amount of ascites. Extensive peritoneal carcinomatosis unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: crepitus on auscultation History: crepitus Interval extubation. Enteric tube has been removed. Heart prosthesis and median sternotomy hardware noted.Small left pleural effusion with left cardiac opacity is not significantly changed. No definite pneumothorax. The heart size is stable. Extensive subcutaneous emphysema appears similar to mildly improved from the prior study.

Output: Diffuse subcutaneous emphysema appearing similar to mildly improved.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Referenced nodule in the right lower lobe measures 10 x 6 mm image number 207, series number 4, slightly smaller compared to previous study. Other nodules are also slightly smaller on the current study.MEDIASTINUM AND HILA: Reference paratracheal adenopathy measures 3.2 x 2.2 cm on image number 36, series number 3, not significantly changed compared to previous study. Reference right hilar lymph node measures 3.8 x 2.8 cm in image number 44, series number 3, slightly smaller compared to previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable right adrenal mass measuring 4.6 x 2.5 cm image number 93, series number 3. Left adrenal mass is slightly smaller measuring 9.2 x 4.6 cm image number 95, series number 3.KIDNEYS, URETERS: Status post right nephrectomy. Again noted tumoral involvement of the left kidney which is slightly less prominent compared to previous study. Extension of thrombus into the left renal vein is also again noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right paracolic gutter mass 8.8 x 4.3 cm in image number 135, series number 3, not significantly changed from previous study.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: Left gluteal mass is unchanged measuring 4.4 x 2.8 cm on image number 169, series number 3.OTHER: No significant abnormality noted

Output: Widespread metastatic disease with the measurements of index lesions given above. These lesions are either unchanged or slightly smaller.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pneumonia, port placement effusion History: weakness, mild SOB Moderate bilateral pleural effusions with elevation right hemidiaphragm.Mild basilar atelectasis.Port catheter with its tip at the junction of the SVC and azygos vein.Skin folds bilaterally but no pneumothorax.

Output: Pleural effusions and atelectasis but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: intubated History: intubated Cardiomegaly.Small lung volumes without specific evidence of edema or pneumonia.ET tube tip at the level of the thoracic inlet.A Dobbhoff tube terminates in the stomach. Right jugular venous access sheath remains in place following Swan-Ganz catheter removal.

Output: Swan-Ganz catheter withdrawn. No new findings.


Instruction: Generate impression based on medical findings.

Input: 80-year-old male presenting with renal cancer and post chemotherapy follow-up. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No hilar lymphadenopathy. Atherosclerotic calcifications of the coronary arteries is noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Pancreatic body mass measures 2.3 x 1.7 cm and is unchanged (series 4, image 98), previously measuring 1.7 x 2.3 cm. Pancreatic tail mass is also unchanged and measures 2.4 x 1.8 cm (series 4, image 97), previously measuring 2.4 x 1.8 cm.ADRENAL GLANDS: Reference adrenal mass is unchanged and measures 5.4 x 6.3 cm (series 4, image 97), previously measuring 6.4 x 5.5 cm.KIDNEYS, URETERS: Patient is status post right nephrectomy. Evidence of recurrence in the nephrectomy bed. The left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy. Atherosclerotic calcification of the abdominal aorta and its branches are noted.BOWEL, MESENTERY: Small mesenteric nodule in the left abdomen is unchanged (series 4, image 109). A second larger midline mesenteric mass appears stable compared to the prior exam and measures by by 5.6 x 5.4 cm (series 4, image 137), previously measuring 5.7 x 5.6 cm.BONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine.OTHER: There is a right inguinal hernia containing only mesenteric fat without evidence of fluid. Within the right inguinal hernia sac, previously described nodule measures 1.4 x 1.4 cm and is unchanged in size (series 4, image 187), previously measuring 1.2 x 1.6 cm. There is also a left inguinal hernia containing bowel and omentum without evidence of fluid, bowel wall thickening, or obstruction to suggest incarceration.

Output: 1.Stable reference pancreatic masses, left adrenal mass, central mesenteric mass, and left inguinal hernia nodule. No new masses are identified.2.Bilateral inguinal hernias appearing unchanged without evidence of incarceration.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male. Testicular cancer, stage I germ cell tumor of testis. Surveillance. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the right middle lobe as seen on image number 66 / 137 is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN: The examination is limited by the patient's inability to cooperate with breath-holding.LIVER, BILIARY TRACT: No significant abnormality or changeSPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: 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: Mixed lytic lesion with coarsened trabeculae in the right pubis at the symphysis is unchanged and likely represents a benign lesion such as fibrous dysplasia, posttraumatic or hemangioma.OTHER: Status post left orchiectomy

Output: No evidence of metastatic disease. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: metastatic melanoma on chemo w/ fever/hypoxia History: fever/hypoxia Left lower lobe scarring or subsegmental atelectasis, but no reliable evidence of edema or pneumonia.No sign of metastases.Left chest wall resection site.

Output: Left basilar subsegmental atelectasis or scarring, but no reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Evaluate mediastinum status post MVC. Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Assessment of the sternum in particular is limited and the presence of sternal fracture cannot be effectively ruled out by this exam. There appears to be very subtle loss of height of lower thoracic vertebral bodies posteriorly at approximately the level of T11 and T12, correlate for pain in this area to exclude possibility of acute compression fracture.Normal heart size. No pleural fluid or signs of pulmonary edema. No mediastinal widening. No pneumothorax.

Output: Unremarkable appearance of the mediastinum. Assessment of the skeletal structures is limited and correlation with bone-technique films of any suspected areas of injury would be recommended. Correlate for pain involving the lower thoracic spine as there is subtle mild loss of height of the posterior vertebral bodies at approximately the T11 and T12 levels.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Patient with acute kidney failure and now status post right IJ hemodialysis line placement. A right internal jugular catheter is seen with tip within the distal internal jugular vein. Tracheostomy tube noted. 2 enteric tubes are seen with tips beyond the field-of-view.The cardiac silhouette is enlarged but stable from the prior exam.There is subsegmental atelectasis in the bilateral lung bases. Mild interstitial opacities are again noted. No pneumothorax.No large pleural effusion.

Output: Interval placement of right internal jugular catheter with tip in the distal internal jugular vein; recommend advancing by approximately 10 cm.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: intubated History: intubated An endotracheal tube projects approximately 4 cm above the carina. Left internal jugular central venous catheter is tip overlying the superior vena cava. An enteric tube is coiled overlying the expected position of the stomach.The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: Lines and tubes stable as above. No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: 39 year old male with CHF, peripheral edema, sob, decreased exercise tolerance. Evaluate for pulmonary edema. Left sided ACID leads unchanged. Right IJ venous catheter tip in the SVC. Severe cardiomegaly. No focal airspace opacities. Bilateral small pleural effusions. No pneumothorax. Enlarged central pulmonary arteries consistent with pulmonary hypertension.

Output: No interval change in pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: recent pna, untreated because left AMA, hx of CHF, COPD here with SOB History: As above Large lung volumes, consistent with COPD, as well as moderate cardiomegaly. No evidence of pneumonia.5 mm right midlung nodule unchanged, likely inflammatory or nipple shadow.

Output: COPD without evidence of infection or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: s/p R VATS wedge History: s/p R VATS wedge Right apical chest tube is in place. No significant pneumothorax. Clear lungs. No acute bony abnormality. Normal heart size.

Output: Right apical chest tube is in place. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: worsening SOB, assess for pulmonary edema History: as above Moderate cardiomegaly with bibasilar left greater than right atelectasis.

Output: No significant change in cardiomegaly and bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Line placement Interval left jugular PICC line placed, tip extends into the proximal SVC. A band and ICD lead similar prior studyCardiopulmonary appearance is otherwise unchanged with mild cardiomegaly

Output: Left jugular PICC line placed


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: 72M hx POD18 s/p cystectomy/ileal conduit c/b SBO, persistent tachycardia, new onset SOB, increasing O2 requirement History: SOB, 88% on RA --> 92% on 2L NC NG tube with its tip in the stomach.Left PICC line with its tip in the SVC.Mildly decreased lung volumes.The cardiomediastinal silhouette is unremarkable.Mild basilar atelectasis.No focal areas consolidation.No large pleural effusions.

Output: Minimal basilar atelectasis. No acute abnormalities identified.