Instruction: Generate impression based on medical findings.

Input: New onset A. fib. Interval removal of right chest tubes with a 21 mm right apical hydropneumothorax. Right pleural fluid increased in volume, partially extending into the fissures and paramediastinal pleural space. Postoperative changes on the right. Intraspinal catheter has also been removed. No pneumothorax on the left. Minimal atelectasis on the left is improving. Persistent elevation of the right hemidiaphragm suggesting phrenic nerve injury.

Output: Small to moderate right apical hydropneumothorax post chest tube removal. Right pleural fluid volume increased.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with history of shortness of breath. Left-sided ACD/pacemaker with leads in the expected location.Stable cardiomegaly. Right basilar opacities have mildly increased compatible with edema or infection. There are calcifications of the thoracic aorta.

Output: Right basilar opacities have mildly increased compatible with edema or infection/aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Pt has port placed at OSH - please eval location prior to starting TPN History: Port placement Enteric tube in place entering the left upper quadrant with tip not included in the examination. Right subclavian port catheter with tip overlying the right atrium approximately 4 cm inferior to the cavoatrial junction. Left subclavian single lead ICD with tip overlying the right ventricle. Vascular stent overlying the right upper extremity and axilla.Cardiac silhouette is borderline enlarged. Calcified aortic arch.Low lung volumes with partially loculated right-sided pleural effusion with localized component along the minor fissure and associated atelectasis. Mild left retrocardiac atelectatic changes also present. No pneumothorax.

Output: 1.Partially visualized enteric tube enters the left upper quadrant with tip not included in the study.2.Right subclavian port catheter with tip overlying the right atrium approximately 4 cm inferior to the kidney with junction.3.Partially loculated small to moderate sized right right pleural effusion with bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Check for metastatic disease. Bladder cancer No cardiopulmonary abnormalities other than mild COPD. ICD and borderline cardiomegaly unchanged

Output: Mild COPD


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: iABP placement History: as above Heart size normal.No specific evidence of infection or edema.Right subclavian biventricular ICD noted.IABP catheter proximal marker within 2 cm of the top of the aortic arch.

Output: Unchanged support devices. No specific evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: MaleReason for Study: Reason: eval for infection, COPD History: chronic cough The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Moderate degenerative changes in the thoracic spine.Bullet fragment identified posteriorly in the right lower hemithorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: s/p chest tube removal History: NA Slight improvement in pulmonary opacities suggestive of edema and atelectasis. Stable small pleural effusions.Chest tubes and right jugular catheter removed.Status post valve repairs.

Output: Slight improvement in pulmonary opacities with removal of support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval OSH PICC placement History: PICC PICC line tip in the SVC.Mild residual basilar subsegmental atelectasis, markedly improved compared to previous.

Output: Catheter tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with history of supraglottic larynx cancer status post chemo/RT. CHEST:LUNGS AND PLEURA: Postoperative change noted status post right upper lobe wedge resection. The previously followed right upper lobe nodule is no longer evident. Mild right pleural thickening is likely postoperative. Soft tissue density along the fissures on the right probably represents atelectasis. A small right pleural effusion is evident.An anterior lingular nodule has not significantly changed (axial image 44/102). Left lower lobe calcified granuloma are identified.Predominantly upper lobe centrilobular emphysema, unchanged.MEDIASTINUM AND HILA: Superior mediastinal and prevascular lymph nodes are mildly larger. A reference prevascular node measures 7 x 17 mm on axial image 33/144, increased from 5 x 14 mm.Aortic atherosclerotic calcifications noted. The cardiac size is normal. No pericardial fluid. Prominence of the main pulmonary artery is noted.Evidence of extensive anterior neck dissection is noted. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Mild dilatation of the intra-and extrahepatic biliary ducts is unchanged. Cholecystectomy clips noted in the gallbladder fossa.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postoperative changes with a stable lingular nodule and mild lymphadenopathy


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Post Chest Tube Removal History: Chest Tube Removed Right chest tube removed with no significant pneumothorax; but only a minimal amount of pleural air is seen at the periphery of the right lung base. Basilar scarring or atelectasis and surgical sutures unchanged.Stable right chest wall soft tissue emphysema.

Output: Right chest tube removed with no large pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pneumonia History: feverish, cough, dyspnea Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Status post TECAB. Improved lung volumes. Left basal scarring is now evident. No focal airspace opacities or signs of pulmonary edema. Minimal pleural thickening or loculated fluid laterally on the leftNo pleural fluid or pneumothorax. Coronary stent. Normal heart size.

Output: Improved lung aeration with left basal scarring and minimal pleural thickening or fluid laterally.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with metastatic adenocarcinoma of unknown primary after biopsy of scalp lesion. Please evaluate for source CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter nodule in the right lower lobe image number 59, series number 4.10 x 7 mm lymph node adjacent to the esophagus on image number 75, series number 3.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple metastatic lesions in the liver. There is lesion in the right lobe measures 20 x 19 mm image number 89, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Numerous mesenteric and omental deposits throughout the abdomen and pelvis. A reference lesion in the transverse mesocolon measures 25 x 24 mm image number 105, series number 3.BONES, SOFT TISSUES: Enhancing soft tissue mass in the anterior abdominal wall measuring 12 x 13 mm image number 122, series number 3 consistent with metastatic disease. Additional deposits are present around the umbilicus. Multiple small sclerotic lesions in the lower lumber vertebral body, nonspecific.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Reference pelvic peritoneal or deposits in the right paracolic gutter measures 3.7 x 2.4 cm Schommer 160, series number 3. Multiple additional deposits are also seen in the pelvis and on the sigmoid colon and rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Nonspecific lung nodule. Metastatic liver lesions.Peritoneal carcinomatosis. Metastatic lesions in the anterior abdominal wall.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Is there pulm edema? History: chest pain and dyspnea Mild basilar interstitial edema with subsegmental atelectasis, slightly worse than on the prior study.Cardiomegaly status post median sternotomy with tortuous aorta.Large central pulmonary arteries are suggestive of pulmonary arterial hypertension.

Output: Mild basilar edema with small pleural effusions, with focal subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Assess for fluid overload versus pneumonia Moderate to severe cardiomegaly. Small pleural effusions. Unsharpness of be lung interstitium suggestive of pulmonary edema.

Output: Cardiomegaly and with vascular unsharpness is suggestive of mild CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Reason: post op, eval ETT, lung fields History: s/p MVR, TVR ET tube tip approximately 3 cm above the carina.Right jugular catheter is extending to the area of the right jugular and innominate vein.Small lung volumes with basilar atelectasis and effusions.Chest tubes project over the right lower hemithorax.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old, with history of Ewing sarcoma. Evaluate for disease after stem cell transplant. The study is limited due to late phase of contrast secondary to scanner malfunction. Within this limitation, the following observations are made.LUNGS AND PLEURA: Post surgical change status post left upper lung resection including volume loss, scarring , atelectasis and surgical suture is evident. A nodular opacity contiguous with postsurgical scarring measures 1.7 x 2.9 cm on axial image 35, series 5, which is suspicious for residual or recurrent disease. Two right upper lobe micronodules are nonspecific and have not changed in the interval.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left chest wall port catheter, tip at the RA/SVC junction.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: 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: Orthopedic hardware within the right femoral head is incompletely visualized.OTHER: No significant abnormality noted

Output: 1.Postsurgical change in the left upper lobe with an associated nodular opacity suspicious for residual or recurrent disease.2.Stable right upper lobe micronodules.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: lung eval History: sob Support hardware unchanged in position with stable patchy peripheral interstitial and airspace opacities bilaterally.

Output: Stable patchy peripheral interstitial and airspace opacities which may be due to edema or aspirate.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with history of Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Reference right apical nodule measures 7-mm on image number 17, series number 5. Reference inferior peripheral right upper lobe nodule measures 8 by 3-mm image number 36, series number 5. These nodules are stable.MEDIASTINUM AND HILA: Reference prevascular lymph node measures 13 by 9-mm image number 26, series number 3, not significantly changed. Other mediastinal lymph nodes are relatively stable. Prominence of right hilar lymphoid tissues, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterine fibroid 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: Female, 58 years old.History: Breast cancer (2013), colon cancer (2013). Symptoms: Cough, dyspnea. Surgical clips to right axilla and chest wall.Stable cardiomediastinal silhouette.No focal pulmonary opacity or pleural disease.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval for PNA History: altered mental status Small lung volumes.No specific evidence of infection or edema.Heart size upper normal and the aorta tortuous.

Output: Small lung volumes, otherwise unremarkable. Resolution of prior pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.History: Soft tissue cancer, status post esophageal stent. Persistent anastomotic leak. Esophageal stent, pleural drainage catheter, PICC line with tip in the right atrium, all unchanged.Left infrahilar and diffuse right lung opacities may be positional and related to layering of of mild right pleural effusion as well as atelectasis/aspiration.No new focal pulmonary opacities.

Output: No significant interval change in appearance of left infrahilar and diffuse right lung opacities, which are compatible with aspiration/atelectasis and layering of small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female; 57 years old. Reason: eval acute process History: AMS Interval removal of the enteric tube.Normal cardiac and mediastinal silhouettes.Mild streaky bibasilar opacities, most likely due to subsegmental atelectasis and/or scarring. No specific evidence of pneumonia. No pleural effusions.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Admitted with COPD exacerbation, recent pneumonia. Unchanged chronic findings of rightward tracheal deviation at the level of the proximal to mid thoracic trachea by a left paratracheal opacity. Mild cardiomegaly. Elevation of the left hemidiaphragm. Mild left apical pleural retraction. Mild prominence of the pulmonary hila consistent with pulmonary hypertension.Mixed nodular and groundglass opacities on a background of probable emphysema, not appreciably changed from the recent plain film allowing for differences in technique but new from 2013.

Output: Coarse nodular and groundglass opacities on a background of emphysema, new from the exam 2013. Consider further evaluation with thoracic CT for further characterization. Differential considerations include infectious bronchiolitis/bronchitis, inflammatory or cellular bronchiolitis in the appropriate clinical scenario.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: neoplasm LUL History: s/p VATS LUL for T1aN0 stage IA well differentiated adenocarcinoma. Left hemithorax volume loss from left upper lobectomy.No evidence of new or recurrent tumor.Heart size normal.

Output: Status post left upper lobectomy without evidence of new or recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval ETT, CT placment, r/o pneumo / effusion History: as above Endotracheal tube tip approximately 4 cm above the carina.Interval removal of Swan-Ganz catheter.Enteric tube with tip beyond the inferior margin of the film.Bilateral chest tubes are stable in position with no significant pneumothorax.The bilateral airspace opacities, right greater than left have not significantly changed.

Output: Line position stable with no significant change in appearance of pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: s/p picc History: s/p picc Unchanged basilar opacities left greater than right.Right PICC, tip at SVC/RA junction level. Other tubes and catheters are stable.

Output: Right PICC placement. Stable basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: r/o acute process -- ams hx ?cancer History: r/o acute process -- ams hx ?cancer The cardiac and mediastinal silhouette is normal.No specific evidence of infection, edema, or effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old. Extubation with CVA. Evaluate for aspiration. Interval extubation. Right jugular catheter tip in the jugular vein. Right chest tube is unchanged without significant pneumothorax. NG tube coiled in the stomach.Decreased basilar atelectasis. Small pleural effusions persist. Focal opacity lateral to the right hilum, unchanged. No new focal pulmonary opacity.

Output: Decreased basilar atelectasis. Interval extubation.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.History of pancytopenia with fever. Right internal jugular catheter tip is in the SVC. Left PICC tip in the right atrium.Cardiomediastinal silhouette unchanged and slightly enlarged.Mild bibasilar opacities are again seen with small bilateral pleural effusions.

Output: Bilateral pleural effusions with mild basilar edema; slightly worse on right.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Tachypnea. Asthma exacerbation. Focal opacity at the right apex, partially obscured by the first rib. Large hiatal hernia with adjacent atelectasis. Mild atelectasis adjacent to the right hemidiaphragm. Left chest port unchanged in position.

Output: Focal opacity at the right apex, partially obscured by the right first rib. This is new from the recent CT of 3/13/2016, and could reflect infection. If patient is on systemic steroids, PA and lateral chest radiographs would be recommended for better characterization to exclude atypical features.


Instruction: Generate impression based on medical findings.

Input: Reason: Transient shortness of breath History: Transisent shortness of breath Mild cardiomegaly with a tortuous calcified aorta.Calcification of the coronary arteries and mitral annulus.Mild scarring of the posterior costophrenic angles without no pleural effusions.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 64 years old Female. Reason: chest pain, new afib History: cp. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Reason: r/o ptx History: CP Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Feeding tube placement. The Dobbhoff tube tip overlies the distal gastric body.Multifocal airspace opacities, see the same-day chest radiograph report for further details.Focal air distended small bowel loops in the left hemiabdomen may represent focal ileus. Air is seen in portions of the distal colon. The pelvis not included in the field-of-view.

Output: The Dobbhoff tube tip overlies the distal gastric body.Multifocal airspace opacities, see same day chest radiograph report.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of colorectal cancer, hemicolectomy. Right liver lobe metastatic lesion CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Right liver lobe hypodense mass measuring 4.4 x 2.8 cm on image number 91, series number 12. This lesion is in segment 8. There is a large cystic lesion in the posterior segment of the right lobe measuring 4.6 x 4.8 cm on image number 91, series number 12. This may represent a large complex cyst, however, biliary cystadenoma cannot be excluded.There is a 1.1 x 1 cm hypodense lesion in the left lobe liver image number 88, series number 12 suspicious for metastatic disease.A subcentimeter lesion in the right lobe on image number 88, series number 12 is too small to accurately characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The penile left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large metastatic lesion in the right lower liver. Small metastatic lesion in the left lobe of the liver. Large cystic lesion in the right lobe. Biliary cystadenoma cannot be excluded. Subcentimeter lesion in the right lobe which is too small to accurate characterize.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia and shortness of breath ETT remains 3 cm above the carina. The 2 right jugular sheath are similar position.2 right chest tube projects in a circular fashion fashion, one coiled traversing the midlung with an enlarged pleural fluid collection, compressing the underlying lung left lung grossly clearProsthetic mitral valve

Output: Unchanged 2 right chest tubes


Instruction: Generate impression based on medical findings.

Input: Hypoxemia The scattered and largely basilar interstitial and airspace opacities are merely shifting and increasing, with particular interest and increase in the right upper lobe. Suspected shifting edema possibly secondary to patient positioning. Probable small effusionsModerate cardiomegaly with decreased lung volumes essentially unchanged.Bilateral jugular catheters are unchanged, the right extends into the proximal SVC and the left terminates in the right atrium

Output: Probable suggesting CHF without significant overall interval change


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: r/o fx/dislocation History: rib pain, l shoulder pain No obvious rib fracture. No pneumothorax.Heart size normal.Lungs clear.No pleural effusion.

Output: No evidence of pneumothorax or acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with metastatic renal cell carcinoma on treatment holiday status post Nexavar toxicity CHEST:LUNGS AND PLEURA: No gross change in the innumerable, bilateral pulmonary metastases. The reference nodule in the right middle lobe measures 8 x 6 mm (series 4; image 70) and the left lower lobe reference nodule measures 10 x 10 mm (series 4; image 94), unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Lytic lesion in the scapula on the left was not included on the prior study, precluding evaluation of chronicity.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic hypodensities are unchanged from 2005, compatible with cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. The two soft tissue nodules in the nephrectomy bed are unchanged, the larger measuring 2.1 x 1.2 cm (series 3; image 133).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion in L3, unchanged.OTHER: The infrarenal abdominal aorta 2.5 centimeters in greatest transverse dimension, unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: sob History: sob Low lung volumes. Probable basilar subsegmental atelectasis or scarring. No focal lung consolidation. No large pleural effusion or pneumothorax. Patient status post right shoulder surgery.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with history of metastatic mass carcinoma CHEST:LUNGS AND PLEURA: Index small intrapulmonary lymph node is unchanged on image number 44, series number 6, measuring 8 x 7-mm..Other punctate nodules, also unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Enhancing mass in the uncinate process of the pancreas measures 2 x 2.2-cm image number 118, series number 4.ADRENAL GLANDS: Status post right atherectomy. Left adrenal gland is unremarkable.KIDNEYS, URETERS: Status post right nephrectomy. Small left renal cysts are unchanged. Enhancing soft tissue mass in the right nephrectomy bed measures 17 x 16 mm on image number 115, series number 4, unchanged.RETROPERITONEUM, LYMPH NODES: Status post retroperitoneal lymph node to section.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Again noted Changes secondary to RF ablation in the left gluteal region.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study. Index lesions are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Postoperative respiratory failure. Right IJ central venous catheter tip at the cavoatrial junction. Enteric feeding tube tip extends in the inferior margin of the image and sidehole projects at the gastric cardia. Mild cardiomegaly. Low lung volumes with bibasilar subsegmental atelectasis.

Output: Low lung volumes with bibasilar subsegmental atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: S/P bronchoscopy with biopsies History: SOB Moderate right pneumothorax.

Output: Moderate right pneumothorax. Findings discussed with Dr. Parker at the time of report.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.ET tube placement right IJ central line placement. High endotracheal tube with tip 10 cm above the level of the carina, at the level of the thoracic inlet.Right jugular catheter tip at the SVC/RA junction. No pneumothorax.High nasogastric tube, with sidehole projecting over the distal esophagus and distal tip straddling the GE junction.Presumed ventriculoperitoneal shunt tubing projecting over the right thorax.Patchy atelectasis suggestive of aspirated secretions, most pronounced in the right upper lobe. Small pleural effusions.

Output: High nasogastric and endotracheal tubes. Signs of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: edema? pna? History: COPD, CHF, shortness of breath Moderate cardiomegaly with pulmonary vascular congestion and the suggestion of basilar edema. No specific evidence of infection.

Output: Mild CHF with cardiomegaly and the suggestion of edema.


Instruction: Generate impression based on medical findings.

Input: Reason: swan placement position History: swan placement Swan-Ganz catheter tip in the area of the right descending pulmonary artery, unchanged.Cardiomegaly with ICD leads in place.Mild lower zone interstitial edema with multiple septal lines and small pleural effusions.

Output: Swan-Ganz catheter tip in the distal right descending pulmonary artery, with its tip probably in a proximal lower lobe branch.


Instruction: Generate impression based on medical findings.

Input: Evaluate aorta and axillofemoral graft. History of coarctation of the aorta. Right flank mass. 3-D images were not performed due to inadequate opacification of the axillary-femoral graft (due to occlusion). CHEST: Focal calcified pleural plaque in the left lower lung (series 3 comminuted E4). Minimal biapical emphysematous changes. Subcentimeter mediastinal nodes are identified. The right subclavian artery is prominent, stable.Atherosclerotic changes affect the proximal descending aorta, with mild mural plaque and wall calcification, stable.Left shoulder degenerative changes.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A 2.1 X 1.9 cm lesion is seen in the lower pole the left kidney (series 8, image 141), previously measuring 1.3 x 1.0 cm. It exhibits at least 20 HU enhancement and demonstrates a thin enhancement (image 141).Bilateral simple renal cysts are seen.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes are identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: A graft extends from right axillary artery to the right common femoral artery. No flow is identified within the graft, though the right common femoral artery is reconstituted-these findings are similar to those found on 12/21/02. Thick-walled fluid collection measuring 7.6 x 4.8 cm maximally extends along the midportion of the graft, increased in size from 2005. There is focal 2.1 x 1.9 cm dilatation of the right common femoral artery just distal to the graft, reported in 2005.PELVIS: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: Mildly enhancing, complex left renal lesion: renal cell carcinoma until proven otherwise.Thrombosed right axillary-femoral graft, unchanged, with reconstituted right common femoral arterial flow. Thick-walled fluid collection along the midportion of the graft continues to increase in size.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Arrest. Tube placement. Shortness of breath. ETT tip 4 cm above the level of the carina. Right upper lobe is obscured by overlying EKG pad external to the patient. No visible pneumothorax or signs of pulmonary edema.Unable to exclude opacities in the right upper lobe, suggest short-term follow-up film after removal of pad from the chest wall.Partially visualized IVC filter.

Output: ETT tip 4 cm above the carina. Unable to exclude opacities in the right upper lobe due to an overlying EKG pad; if present, abnormality in this location could be due to acute mitral valve prolapse. Suggest follow-up chest radiograph after removal of this pad.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Please evaluate for fluid overload or other opacity. History: Intubated, seizures. ET tube unchanged. NG extends beyond the field-of-view of study. Embolization coils present in the left neck.No new opacity to suggest pneumonia. No evidence of edema.

Output: No evidence of pulmonary edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 23 year-old female with history of asthma exacerbation and subjective fever. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax. Mild bronchial wall thickening.Mild rightward thoracic curve.

Output: Mild bronchial wall thickening can be seen in reactive airways disease, but otherwise no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.History: Meningioma, NSTEMI status post Cath Lab with no stenting. Preoperative evaluation (excision of meningioma). Right central venous catheter with tip in the SVC.Elevation of the right hemidiaphragm with mild overlying atelectasis/scarring.No pleural effusions.No pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Lung transplant. Right chest wall and neck subcutaneous emphysema, slightly improved.Clamshell sternotomy and chest wall staples consistent. Dobbhoff tube tip projects over the gastric body.Unchanged appearance of cardiomegaly mediastinal silhouette with probable postoperative hematoma and small amount of pneumomediastinum.Apical hydropneumothoraces about the same.Diffuse edema-like opacities and atelectasis bilaterally without significant change and may reflect hyperacute rejection.

Output: No significant change in hydropneumothoraces and edema-like pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: lung ca History: lung ca Peripheral right upper lobe mass with associated rib destruction again noted. Adjacent reticulonodular opacities again noted within the upper aspect of the right lung. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No new focal pleural parenchymal opacity. Peripheral right upper lobe mass with associated underlying rib destruction again noted.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with metastatic adenocarcinoma of unknown primary. CHEST:LUNGS AND PLEURA: Severe emphysematous changes. 6 x 6 mm pulmonary nodule in the right lobe on image 15, series 4, unchanged.No pleural effusion is present.MEDIASTINUM AND HILA: The heart size is normal. The pulmonary arteries remain borderline enlarged. A right hilar lymph node measuring 15 x 11 mm, not significantly changed (series 3; image 47).Coronary calcifications are seen.CHEST WALL: Enlarged axillary lymph nodes have improved. A reference node measures 6 x 6 mm in the right axilla (series 3; image 17), previously 13 x 10 mm.ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar hepatic lesions are again demonstrated, the largest in the left lobe, mildly increased in size but not in number. The index lesion in the medial segment of the left lobe measures 3.3 x 2.5 cm (series 3; at 90), previously 2.6 x 2.0 cm.The liver is enlarged. The portal vein is dilated.Moderate biliary dilatation involves the lateral segment of the left lobe, unchanged. The left hepatic vein is narrowed not visualized in the periphery, also unchanged. The portal drain remains narrowed in the left lobe.SPLEEN: The spleen remains greatly enlarged with homogeneous enhancement.PANCREAS: No definite pancreatic lesion is identified.ADRENAL GLANDS: The left adrenal gland is nodular.KIDNEYS, URETERS: Small bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: Gastrohepatic, portacaval, porta hepatis and periaortic/portacaval adenopathy is again identified. The reference portacaval lymph node measures 26 x 13 mm (series 3; image 106), not significantly changed. The reference periaortic lymph node measures 24 x 23 mm (series 3; image 125), previously 23 x 21 mm. The reference gastrohepatic lymph node measures 18 x 17 mm (series 3; image 90), previously 15 x 14 mm.BOWEL, MESENTERY: BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal ascites, increased.Haziness and mild nodularity of the omentum is seen, not significantly changed, suspicious for carcinomatosis.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: An enlarged left external iliac chain lymph node at the groin measuring 23 x 11 mm (series 3; image 176), not changed. Another enlarged external iliac lymph node measures 1.9 x 1.5 cm (series 3; image 161, previously 1.8 x 1.4 cm).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 1.8 x 1.4 cm soft tissue metastatic lesion involves the superior aspect of the posterior sacrum on the right (series 3; image 148). In retrospect, it measured 8 x 7 mm, but did not have a soft tissue component.OTHER: Large amount of pelvic ascites, increased.Right common iliac artery stent. Stent extending from the left common artery to the external iliac artery.

Output: Mild increase in size of the hepatic lesions. Increase in size of the right sacral metastatic lesion. Stable metastatic adenopathy.Haziness and mild nodularity of the omentum suspicious for carcinomatosis, unchanged.Increased ascites.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: s/p thoracentesis History: n/a Right lower lung zone opacity noted similar to the prior CT.Right pleural effusion diminished in size.No significant pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: placement of new central line History: as above Right IJ line terminates at the cavoatrial junction. No pneumothorax. No new pleural parenchymal opacities. Unchanged heart size. No pneumothorax.

Output: Right IJ line terminates at the cavoatrial junction. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old with history of thorascopic esophagectomy converted to an open case, nothing missing Curled tubular density in the neck was verified to be external to the patient. Chest tubes in place. Enteric tube tip projects over gastric body. No radiopaque foreign objects identified.

Output: No radiopaque foreign objects identified.Dr. Ferguson was notified of findings on 3/2/2016 at 1200.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Cough, rule out pneumonia. A tracheostomy tube is in stable position. Stable cardiomegaly. No focal airspace opacities or pneumothorax. No pleural effusions. Multiple surgical clips in the neck, unchanged.

Output: No significant acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: pulm edema History: leg edema, h/o cardiac sarcoid, ICD Left chest ICD with tips unchanged.The cardiac shadow is normal. The superior mediastinum is again widened with deviation of trachea to the left consistent with known superior mediastinal mass better characterized on CT chest 03/10/12 as large right thyroid lobe. The mass is stable since the prior radiograph in June.Redemonstration of hilar adenopathy on the lateral view correlating with history of sarcoidosis.No focal pulmonary opacity to suggest pneumonia or edema. No pneumothorax.

Output: 1.No specific evidence of infection or edema. 2.Right superior mediastinal mass characterized as large right thyroid lobe on prior CT chest from 2012 is unchanged since prior radiograph in June 2016.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Fall with cough. Evaluate for pneumonia or trauma. Left basilar atelectasis with a moderate pleural effusion. No evidence of pneumothorax.Cardiomegaly with a tortuous aorta, unchanged.

Output: Left basilar atelectasis with a moderate left pleural effusion. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.ICU. Enteric feeding tube tip extends in the inferior margin of the image. Stable cardiomediastinal silhouette. Bibasilar opacities, left greater than right, suggestive of edema and small pleural effusions, unchanged.

Output: Stable basilar opacities suggestive of edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with shortness of breath postoperative day two status post cystectomy. Please evaluate for PE. CHEST:PULMONARY VASCULATURE: Questionable, nonobstructing embolus in left descending pulmonary artery (series 5, image 220). Study is diagnostic at the level of the segmental pulmonary arteries.LUNGS AND PLEURA: Bibasilar atelectasis/consolidation with small pleural effusions. Right middle lobe atelectasis/consolidation is noted as well. Small focus of ground glass opacity is seen adjacent to the left heart border, which is nonspecific. No suspicious nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Note is made of an aberrant right subclavian artery, normal variant anatomy.Hiatal hernia.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Free intraperitoneal air compatible with recent surgery. Expected postoperative air in the right renal collecting system.

Output: 1. No definite pulmonary embolus identified. However, questionable, nonobstructing embolus in left descending pulmonary artery as above.2. Bibasilar and right middle lobe atelectasis/consolidation with small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: r/o infiltrate History: chest pain The cardiomediastinal silhouette is normal.Calcified granuloma are noted without focal pulmonary opacity or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Endotracheal tube placement. Endotracheal tube tip is about 4 to 5 cm above the carina. Right central venous catheter terminates in the atriocaval junction, unchanged. Question of minimal left pleural effusion. No pneumothorax. Persistent left basilar opacity and interval development of right basilar streaky opacity.

Output: Bibasilar streaky opacities consistent with aspiration or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Hematemesis Left jugular catheter again extends into the mid SVC. LVAD unchangedLungs remain clear other than minimal basilar atelectasis

Output: No new acute abnormality other than suspected atelectasis or less likely aspiration. LVAD unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for infection/effusion/pneumothorax History: sudden onset chest pain and dyspnea Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p cardiac surgery History: eval lung fields Unchanged chest tubes with minimal left apical pneumothorax.Left basilar consolidation, to a lesser extent the right base as well, unchanged.Right jugular Swan-Ganz catheter removed.

Output: Minimal left apical pneumothorax, with unchanged basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Hypoxia. Right central venous catheter tip in the right atrium.Stable cardiomediastinal silhouette.Loculated left pleural effusion, improved from the prior exam.Bibasilar subsegmental atelectasis, left greater than right, unchanged.Chronic interstitial opacities likely reflecting mild chronic interstitial edema, without new focal opacities.

Output: Improved loculated left pleural effusion, without acute abnormality evident.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval for hcap History: crackles, leukocytosis drop in bp Mild bibasilar atelectasis but no definitive evidence of pneumonia.

Output: Mild bibasilar atelectasis but no definitive evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: pre-op History: - Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with basal cell cancer CHEST:LUNGS AND PLEURA: Subsegmental atelectasis in bilateral lower lobes and right middle lobe and water loss in the left hemithorax are unchanged.MEDIASTINUM AND HILA: Left infrahilar ill-defined soft tissue density in this grossly unchanged. This lesion is very difficult to measure. At the location, where it was was measured before, now it measures 1.2 x 1 cm image number 60, series number 3.CHEST WALL: Partially calcified left axillary node is unchanged measuring one by 1.1 cm on image number 25, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: 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: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No change in the pulmonary parenchymal findings. No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: acute post procedure changes History: shortness of breath Cardiomegaly with diffuse bilateral airspace opacity, increased compared to previous, compatible with edema. Swan-Ganz catheter tip in the main pulmonary artery and aortic balloon catheter tip projected 3 cm below the top of the aortic arch.

Output: Pulmonary edema, increased compared to previous.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: Evaluate for PNA History: Fevers, weakness x1 week, crackles on LLL No significant change in bilateral peribronchial thickening. No specific evidence of infection or edema.Normal appearing cardiomediastinal silhouette.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: r/o pneumonia History: fever, recent +BAL for Acinetobacter Unchanged left lower lobe opacity and small left pleural effusion. Right lung remains clear. Unchanged heart size. No pneumothorax. Pigtail drain overlies the left upper quadrant of the abdomen, as before.

Output: Unchanged left lower lobe opacification which may represent atelectasis and/or consolidated lung with small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: 60F hx of ca on chemo here with ams. t History: tachy, borderline hypotensive Right chest wall Port-A-Cath tip terminates in the superior vena cava. Low lung volumes. Multiple large perihilar masses are again seen, overall appearing similar to the prior study. No new definite focal consolidation, pleural effusion or pneumothorax is evident. Calcified left hilar lymph nodes again evident.

Output: Multiple perihilar masses are essentially stable compared to 2/21/2016. No evidence of superimposed acute infection.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of IABP placement. IABP marker projects over the proximal descending aorta. Remaining tubes and lines are unchanged. Moderate cardiomegaly, unchanged. Stable bibasilar opacities and small pleural effusions.

Output: IABP marker projects over the proximal descending aorta, but otherwise stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: r/o pna History: productive cough Stable cardiomediastinal silhouette.Increased lung volumes compatible COPD.Basilar scarring/discoid atelectasis similar to the prior exam.No new pulmonary opacities identified.No pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: chest pain, eval for fluid overload/PNA History: chest pain, eval for fluid overload/PNA No pleural effusion or pneumothorax. No focal pulmonary abnormality or reliable evidence of edema. Moderate cardiomegaly and sternotomy hardware, unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and fever Unchanged cardiopulmonary appearance with small bilateral effusions and minimal atelectasis. No new focal airspace abnormality and the peripheral right upper focal opacity has previously described on recent CT chest examination is unchanged.Dobbhoff remains in the gastric lumen. ICD unchanged

Output: Mild cardiomegaly without new distinct airspace abnormality. Mild suspected pulmonary edema persists


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: evaluate IABP placement History: cardiogenic shock Superior aspect of the IABP now terminates 9.4 cm from the top of the aortic arch. Unchanged cardiomegaly. Increase in diffuse pulmonary edema. Probable small pleural effusions. No pneumothorax. Previously demonstrated nodular opacity at the right lung base is no longer apparent.

Output: Apparent repositioning of IABP, as above. Increased pulmonary edema with small pleural effusions. Unchanged cardiomegaly.Previously demonstrated nodular opacity at the right lung base is no longer apparent.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: h/o copd adhf vfib History: new oxygen requirement Right PICC line with its tip in the right innominate.There are decreased lung volumes with basilar opacities compatible atelectasis and possible effusions.No focal areas of consolidation.Stable cardiomediastinal silhouette.Multiple fractured sternotomy wires unchanged with evidence of a prior CABG.

Output: Persistent nonspecific basilar opacities compatible with atelectasis and possible small effusions.


Instruction: Generate impression based on medical findings.

Input: Dobbhoff tube placement Dobbhoff tube located in distal esophagus and further advancing recommended. Mild to moderate small and large bowel dilatation, suggestive of ileus. Left femoral approach line seen overlying left sacrum.

Output: Further advancing of Dobbhoff tube recommended.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with fever, increased oxygen requirement. Rule out for pneumonia. Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity or pleural effusion.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: icu History: icu Pleural effusions and basilar consolidation unchanged.Stable chest tubes with no pneumothorax.Open sternotomy wound with ECMO cannula, stable in appearance.Overlying surgical drains noted and surgical sponge material.IABP catheter distal tip 5 cm below the top of the aortic arch.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: Unchanged pulmonary opacities and multiple support devices. No significant pneumothorax. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval ETT, cuff History: cuff deflated and ETT advanced Endotracheal tube again projects 10-11cm superior to the carina, although the previously seen overinflated balloon is now not included in the examination.Stable cardiomediastinal silhouette.Stable aeration of bilateral lungs with patchy left basilar airspace disease and diffuse abnormality involving the fibrotic native right lung. No pneumothorax.

Output: Endotracheal tube again projects 10-11cm superior to the carina, although the previously seen overinflated balloon is now not included in the examination.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: s/p TECAB History: s/p TECAB Moderate cardiomegaly.No specific evidence of infection or edema.Resolution of prior basilar opacities and pleural effusions.

Output: Resolution of prior opacities and pleural effusions. No new findings. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with recurrent pleural effusion, ascites, liver failure, hepatitis C CHEST:LUNGS AND PLEURA: Massive right pleural effusion with near complete collapse of the right lung with mild contralateral mediastinal shift and depression of the right hemidiaphragm.MEDIASTINUM AND HILA: The right-sided central line terminates at the atriocaval junctionCHEST WALL: GynecomastiaABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liverSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lower lumbar surgery.OTHER: Mild ascites

Output: Massive right pleural effusion with near complete collapse of the right lung with mild contralateral mediastinal shift and depression of the right hemidiaphragm.Cirrhotic morphology of the liver. Mild ascites. Gynecomastia.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: mechanical intubation History: mechanical intubation ET tube with its tip 2 cm above the carina.NG tube with its tip in the stomach.Cardiomediastinal silhouette is unremarkable.Improvement in the left upper lobe opacities.No new pulmonary opacities identified.

Output: ET tube with its tip 2 cm above the carina. Interval improvement in left upper lobe opacities .


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: F/u Swan placement History: Cardiogenic shock Cardiomegaly with small lung volumes, lower lung zone edema and mild retrocardiac atelectasis, progressed since the prior study.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Worsening CHF now with pulmonary edema and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent moderate right pleural effusion with underlying atelectasis. Lungs otherwise grossly clear. Marked scoliosis limits evaluation of the mediastinal and cardiac contours

Output: Atelectasis with right pleural effusion unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old. New left jugular catheter extending to the SVC with no pneumothorax or other complications.Small lung volumes with basilar atelectasis.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: r/o infiltrate History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with fever of unknown origin. Bone marrow transplantation. Pleuritic chest pain. Findings detail is limited by respiratory motion.CHEST:LUNGS AND PLEURA: Patchy opacity in the posterior aspect of the left lower lobe likely represents pneumonia. Patchy opacities are seen within the lingula. The 5-mm pulmonary nodule in the right lower lobe (series 6, image 38). Calcified granuloma in the right lower lobe.Small left and trace right pleural effusion.Complete evaluation of pulmonary embolus is not possible given the phase of the study and patient motion. However, no central pulmonary embolus is seen.MEDIASTINUM AND HILA: A few small mediastinal lymph nodes are visualized.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Several subcentimeter hypodense lesions are scattered throughout the liver. Many of these remain grossly unchanged in size when compared to the prior noncontrast study.Mild focal prominence of the common bile duct is stable.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: Mixing artifact is noted within the distal IVCBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hysterectomy. The ovaries are not visualized.Small soft tissue density in the right adnexa (series 4, image 169) is stable from 8/25/05.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: Limited examination due to motion.Patchy left lower lobe pneumonia. Other patchy lingular opacities can be due to infection or inflammation.No evidence of central pulmonary embolism. The study is not performed as a dedicated PE protocol.No localized inflammatory changes in the abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female please evaluate for metastatic disease. Hyperbilirubinemia. CHEST:LUNGS AND PLEURA: Right upper lobe consolidation posteriorly. This may be secondary to the pulmonary embolus. Two subcentimeter nodules one in the right upper lobe on image number 14 and the other one is in the left lower lobe image number 61.MEDIASTINUM AND HILA: Segmental right upper lobe pulmonary embolus.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypodense mass in the left lobe of the liver causing biliary dilatation and atrophy of the left lobe suspicious for cholangiocarcinoma. Minimal intrahepatic biliary is also present in the right lobe. Gallbladder is collapsed with gallstones. Adenopathy at the hepatic hilum measuring 2 x 2 cm. Distal common bile duct is normal in caliber. The mass likely invades the hepatic artery and SV: (ml) forward flow volume: (ml) backward flow volume: (ml) regurgitant fraction: (%) absolute stroke volume: (ml) mean flux: (ml/sec) stroke distance: (cm) mean velocity: (cm/sec) 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: Thrombus in the infrahepatic IVC, superior to the IVC stent.BOWEL, MESENTERY: Omental soft tissue densities consistent with peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left ovary is enlarged measuring 4 x 3.4 cm. small amount of free fluid in the pelvis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right upper lobe pulmonary embolus and associated consolidation in the right upper lobe. A few subcentimeter nodules in the lungs, nonspecific.Ill-defined mass in the left lobe causing biliary dilatation and invading the proximal common bile duct associated with hepatic adenopathy and peritoneal carcinomatosis. Small amount of ascites. This mass is highly suspicious for cholangiocarcinoma.Thrombus in the IVC above the level of the IVC filter.Enlarged left ovary. Pelvic ultrasound may be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Presumed HCC. New baseline scan prior to treatment. Compare to previous. CHEST:LUNGS AND PLEURA: Several scattered pulmonary nodules are noted. There is a scarlike opacity in the right apex. A 4-mm micronodule is seen in the left apex (image 14, series 11). MEDIASTINUM AND HILA: Cardiomegaly with pericardial effusion. Calcified right hilar lymph nodes, likely due to prior granulomatous infection.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There is a 10.8 x 7.6 cm heterogeneous, space occupying lesion with central necrosis within the right lobe of the liver. The lesion demonstrates arterial enhancement with prompt delayed washout of the contrast. It appears similar to the study from 10/12/2010. The right hepatic vein, main portal vein, splenic vein and superior mesenteric vein are not visualized and likely thrombosed. The hepatic arteries are patent. There are multiple tortuous markedly enlarged collateral vessels with associated splenomegaly.The background liver parenchyma is not cirrhotic. There is mild biliary prominence. Gallbladder sludge.Pelvic ascites.SPLEEN: Marked splenomegaly with AP dimension measuring up to 17 cm, unchanged from 10/12/2010.PANCREAS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter bilateral hypodense renal lesions are nonspecific but appear similar to the prior study. Markedly enlarged spleen displaces the left kidney inferiorly.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged compression fracture of T12 vertebral body. Mottled appearance of the visualized skeleton with multiple sclerotic lesions, concerning for metastases.OTHER: Anasarca.PELVIS:UTERUS, ADNEXA: Not visualized, may be atrophic or surgically absent. There is a 2.8 x 2.0 cm soft tissue lesion in the left vulvar distribution. Please correlate for physical examination.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As above.OTHER: Pelvic ascites. Anasarca.Surgical clips in the left lower quadrant.

Output: 1. Unchanged large hepatic mass as described above. Marked splenomegaly, extensive portosystemic shunting and pelvic ascites. Likely thrombosed right hepatic vein, main portal vein, splenic vein and SMV. These findings are unchanged from 10/12/2010.2. Mottled appearance of the entire skeleton with sclerotic lesions, concerning for metastases.3. T12 compression fracture, unchanged.4. Pulmonary micronodules as detailed above.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval widening mediastinum History: chest pain Small lung volumes with pleural effusions, basilar edema and atelectasis.Heart size likely normal.No evidence of mediastinal widening other than distention of the systemic veins.

Output: Small lung volumes with basilar opacities, nonspecific but possibly CHF related.


Instruction: Generate impression based on medical findings.

Input: 55 years old Female. Reason: cat p History: cough. Left upper lobe opacity compatible with pneumonia. The cardiac silhouette is normal. There is no evidence of pleural effusion or pneumothorax. Nodular density in the fat of the left axilla, which can be due to enlarged lymph nodes.

Output: Left upper lobe consolidation, suspicious for pneumonia. Suggest follow-up to ensure the resolution and to rule out tumor. Probable enlarged lymph node in the left axilla. Suggest clinical correlation.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Malignant neoplasm of testis rule out metastases. Normal heart size. No visible lymphadenopathy or pleural fluid. No suspicious pulmonary nodules or masses. Retroperitoneal surgical clips.

Output: No findings to suggest thoracic metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.2014 history of surgical treatment of a high esophageal perforation most likely related to an intubation injury. Normal heart size. No pneumomediastinum or pneumothorax. The lungs are clear.

Output: No acute cardiopulmonary abnormality. No pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p oht History: s/p oht Iatrogenic devices are unchanged. Bibasilar subsegmental atelectasis or scarring again noted. Unchanged cardiomegaly. No pneumothorax.

Output: No substantial difference compared to last study.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: r/o pneumonia History: fever of unknown origin Blunting of right costophrenic angle likely represents development of small effusion.Basilar opacities persist. This some interval increase in both cardiac size as well as perihilar opacities.Line position stable.No pneumothorax.

Output: 1. Basilar opacities persist2. Increasing perihilar opacities3. Development of small right effusion.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with shortness of breath, evaluate for pleural effusion and worsening cancer lesions. CHEST:LUNGS AND PLEURA: A small right pleural effusion is noted. There is no evidence of consolidation or other focal processes. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged and cirrhotic in morphology. There are numerous confluent bilobar masses within the liver parenchyma, consistent with the patient's known diagnosis of HCC. These findings are unchanged when compared to the prior exam. Again seen is enhancing tumor thrombus within the portal venous system. SPLEEN: Splenomegaly is again noted. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild upper abdominal adenopathy is again noted.BOWEL, MESENTERY: Extensive varices are seen adjacent to spleen and about the distal esophagus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is been an increase in the amount of abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.Increased amount of abdominal ascites.2.New small right pleural effusion.3.Stable liver lesions and portal venous tumor thrombus


Instruction: Generate impression based on medical findings.

Input: Reason: 40yoF esophageal leak with drain, recent sepsis, pneumonia, now with fever History: fever Increased opacity at the left base compatible with pleural effusion and underlying atelectasis.Normal heart size and mediastinal contours. Feeding tube traversing the esophagus.

Output: Left pleural effusion and underlying nonspecific opacity, slightly increased, possibly related to infection.


Instruction: Generate impression based on medical findings.

Input: 90 year-old female with history of right subscapular pain. Evaluate for malignancy. Mild cardiomegaly. Calcified and tortuous thoracic aorta. Large lung volumes compatible with COPD. Chronic appearing opacities are present at the left base likely representing atelectasis and/or scarring. No pleural effusions or pneumothorax.Moderate degenerative changes at the right shoulder.

Output: Cardiomegaly and chronic findings at the left base without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: s/p CT History: S/p CT Right subpulmonic chest tube unchanged with persistent opacification of the right hemithorax with a small amount of air in the pleural space.Retrocardiac atelectasis and left effusion with pulmonary metastases are stable.

Output: Stable right chest tube, with unchanged near complete opacification of the right hemithorax.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: sob, multiple medical problems including chf, sarcoid, asthma History: above Mild cardiomegaly with a presternal ICD lead in place.Small lung volumes with no sign of pulmonary edema or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Crackles Motion degrades sensitivity. New bilateral basilar opacities greater on the left, likely representing atelectasis, however aspiration or even multifocal infection cannot be excluded in this limited evaluation. Unchanged right total port. Mild cardiomegaly

Output: Increasing bilateral basilar changes concerning for possible infection and/or atelectasis. See detail


Instruction: Generate impression based on medical findings.

Input: Amyloidosis No cardiopulmonary abnormalityNumerous air filled small bowel segments however are observed in the upper abdomen, however none are overtly abnormally dilated or positioned in this incomplete exam

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Colon cancer. Metastatic to the liver. Postchemotherapy. CHEST:LUNGS AND PLEURA: Scattered, date calcified granulomas in both lungs are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted. Hiatal hernia is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty liver. Previously described bilobar subcentimeter low-attenuation foci are unchanged. The reference lesion in segment 4 again measures 9 x 9 mm on image number 91/228. No new lesions. No ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: 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: Subcentimeter hypodense lesions throughout the liver are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: preop Robotic ASD repair History: fatigue/CVA Normal heart size with a mild dextroscoliosis.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.CABG evaluate lung fields. Interval extubation. NGT has been removed. Right jugular catheter and bilateral chest tubes unchanged in position.Low lung volumes with basal atelectasis and signs of pulmonary fibrosis. Superimposed edema-like opacities bilaterally, slightly worse. Vascular calcification versus IABP marker at the level of the proximal descending thoracic aorta.

Output: Pulmonary fibrosis with mild superimposed edema.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.History of lung abscess under treatment. Follow-up. The heart is normal in size. The mediastinal contours are within normal limits.Increased lung volumes and signs of upper lobe predominant emphysema. The previously seen right lower lobe residual nodule after resolution of lung abscesses is poorly defined, less conspicuous than on prior chest radiograph. No new abnormal focal lung parenchymal opacities.No pleural effusion or pneumothorax.No osseous lesions are present.

Output: No findings to suggest new acute infectious process or recurrent lung abscess.The right lower lobe nodular opacity sequela of resolved lung abscesses is less conspicuous than on prior chest radiograph.Persistent signs of COPD and emphysema.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: s/p right lung biopsy History: s/p right lung biopsy Stable cardiomediastinal silhouette.Decreased lung volumes and chronic interstitial fibrosis similar in appearance to the prior exam.No new pulmonary opacities identified.No evidence of a pneumothorax post biopsy.Small right pleural effusion unchanged.

Output: Stable cardiopulmonary appearance. No evidence of a pneumothorax post procedure.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: for VQ scan History: for VQ scan, dyspnea, history of DVT ? CTEPD Lungs hypoinflated with nonspecific basilar opacities which may due to edema, atelectasis, or aspirate. A Simon Nitinol IVC filter is present. Surgical clips are noted in the upper abdomen.

Output: Lungs hypoinflated with nonspecific basilar opacities which may due to edema, atelectasis, or aspirate.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: infection History: hypoglycemia Improvement in basilar opacities and small pleural effusions. Focal extra pulmonary opacity with associated rib destruction again noted in the upper aspect the right hemithorax. Unchanged heart size. No pneumothorax.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: fever, eval for pneumonia Cardiomediastinal silhouette is within normal limits. No specific evidence of infection or edema. No pleural effusion or pneumothorax.Biliary stent in the right upper quadrant.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Check tracheostomy tube Unchanged Dobbhoff, Swan-Ganz and tracheostomy tube, the latter again terminates 8 cm above the carina. Right jugular sheath removedMild nonspecific cardiomegaly with persistent decreased lung volumes, mild predominantly interstitial changes in both lung bases with small effusions. Suspected persistent mild edema again cannot be excluded, however these changes are superimposed partially upon mild chronic interstitial change.

Output: Well-positioned tracheostomy tube without additional cardiopulmonary change other than right jugular sheath removed without complication


Instruction: Generate impression based on medical findings.

Input: 76-year-old female renal cancer baseline prior to starting therapy. No contrast please. CHEST:LUNGS AND PLEURA: Multifocal lung nodules a redemonstrated. Some of the increased in size. Reference nodule right lower lobe superior segment seen on series 5 image 42 measures 10.8 x 8.2 mm.Nodule at the right base as seen on series 5 image 64 and measures 12.6 x 4.1 mm.Scattered areas of consolidation right lower lobe and groundglass appearance in the right perihilar area somewhat more prominent than on prior exam. Correlate to out infection.MEDIASTINUM AND HILA: Mediastinal adenopathy is approximately unchanged. Pretracheal mass is difficult to separate from surrounding azygos vein. The estimated size and series 3 image 33 is 3.5 x 3.3 cm. Subcarinal mass measured on series 3 image 47, 4.7 x 3.2 cm. Its shape makes its dimensions markedly sensitive to slice location. Bulky superior mediastinal right paratracheal and right hilar masses are visually similar to the prior exam.Scattered right axillary nodes pathologic in size and clustering unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made.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: Left kidney surgically absent.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal retrocaval porta hepatis and peri-celiac nodes may be slightly more prominent. The basal and retrocrural node is difficult to separate from inferior vena cava and is remeasured on series 3 image 119 as 3.9 x 1.2 cm.Atherosclerotic changes aorta. Mild focal bulge in mid abdominal aorta does not meet criteria for aneurysm maximal dimension 2-cm coronal image 33/77.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Fibroids 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: Some increase in size of lung nodules and lymph nodes. No new sites of disease. Persistent airspace disease right lung correlate or infection. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Chest pain and cough for one month. Normal heart size. There is the suggestion of some dense linear and branching opacity in the left lower lobe anteriorly and possibly to a lesser extent in the right lung base. Though this is beyond the resolution for characterization by plain film technique, it could indicate bronchial mucus plugging from prior aspiration or possibly a low-grade indolent infection of the airways in the appropriate clinical setting. No focal airspace opacities to suggest pneumonia. No pleural fluid or pneumothorax.

Output: Subtle basal opacities mildly suspicious for bronchial mucus plugging, possibly as a result of aspirated or retained secretions. The possibility of a chronic low-grade airway infection can be considered in the appropriate clinical context and should be correlated with the patient's history.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: Pt with SOB; R/o pna or fluid overload History: SOB No new focal lung consolidation. Patchy bibasilar opacities, improved since previous study. Mild cardiomegaly, unchanged. No acute bony abnormality.

Output: Improvement in patchy bibasilar opacities. No new focal lung consolidation. Mild cardiomegaly again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: Et tube placement History: ET tube adjustment ET tube tip 3 cm above carina. NG tube tip in stomach. Venous catheter tip in SVC. IABP marker unchanged in proximal descending thoracic aorta. Left lower lobe atelectasis, consolidation, and effusion unchanged.

Output: ET tube tip 3 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for PNA History: COPD exacerbation No acute abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Reason: ? pneumonia, effusion History: cough, wheeze, AMS Unremarkable cardiac and mediastinal silhouette. Status post median sternotomy.Mild blunting of the right posterior costophrenic angle which may be due to a small effusion or atelectasis.No sign of pneumonia or other acute findings.

Output: Probable small right effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: right sided white out History: right sided white out The right hemithorax opacification is now near complete, denser than on the prior study. Improving opacity left lung base, left lung otherwise unremarkable.Right jugular catheter, tip in SVC.Right nephrostomy tube.

Output: Right hemithorax opacification worsening, near complete, likely due to atelectasis and an enlarging pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: cp History: fever Right-sided PermCath with tip in superior vena cava.Stable cardiac mediastinal silhouette.Low lung volumes with persistent retrocardiac opacity as well as additional nonspecific by basilar interstitial opacities. These findings can represent atelectasis, infection and/or aspiration.No significant pleural effusion. No pneumothorax.

Output: Low lung volumes with question of basilar opacities. These are nonspecific and can represent atelectasis, infection and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: pneumonia History: fever, bandemia Small bibasilar atelectasis or scarring is stable. Lungs are otherwise clear. Heart size within normal limits. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Left IJ line terminates at the junction of the left brachiocephalic vein and SVC. Low lung volumes. No new focal lung consolidation. Apparent cardiomegaly, likely related to low lung volumes. No large pleural effusion or pneumothorax. Calcified left basilar granuloma again noted.

Output: No pneumothorax status post line placement.


Instruction: Generate impression based on medical findings.

Input: Reason: LVAD device History: LVAD Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with vascular redistribution and mild compressive atelectasis in the left lower lobe.No new findings.

Output: LVAD and ICD leads unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Encounter for Neoplasm of uncertain behavior of both articular cartilage [D48.0] Cardiomediastinal silhouette is unremarkable. Pleural effusions are thorax. No focal pulmonary opacities.

Output: No acute cardiopulmonary abnormality. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with small bowel carcinoid on chemotherapy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Coronary calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There are innumerable metastatic lesions in the liver, some demonstrating arterial enhancement and others more cystic in nature, not significantly changed in size or number. Reference lesion in segment 5 measures 3.8 x 3.0 cm, previously 3.8 x 3.0 cm when remeasured (series 7; image 105).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular adrenal glands, unchanged.KIDNEYS, URETERS: Bilateral renal calculi, unchanged. Parapelvic cysts are seen in the left kidney.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic node is not significantly changed, measuring 16 x 10 mm (series 7; image 102).BOWEL, MESENTERY: Ventral hernia containing a sidewall of transverse colon and omentum, unchanged.Partially calcified mesenteric mass unchanged, measuring 2.7 x 2.3 cm (series 7; image 126). The mass encases the SMA, unchanged.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: Right inguinal hernia repair. Diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant changes. Findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: chest tube History: chest tube Right chest tubes unchanged with no significant pneumothorax.Small lung volumes with nonspecific basilar subsegmental atelectasis.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: MaleReason for Study: Reason: Cough, r/o inf History: cough There is mild/moderate cardiac enlargement with tortuous aorta.The lungs are clear.No large pleural effusions.

Output: Cardiomegaly without acute abnormalities. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: Hx of RCC. Eval for mets History: As above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 19 yearsGender: MaleReason for Study: Reason: confirm PICC adjustment History: as above Right PICC line with its tip at the SVC/RA junction.Decreased lung volumes.Stable cardiomediastinal silhouette.The lungs are clear.

Output: Right PICC line minimally adjusted with its tip at the SVC/RA junction.


Instruction: Generate impression based on medical findings.

Input: Dyspnea No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: assess ET tube placement History: assess ET tube placement ET tube tip approximately 4 cm above the carina.ICD leads unchanged.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube removal History: pneumothorax Interval removal of the right chest tube with a residual moderate right hydropneumothorax and underlying atelectasis. Left upper lobe nodules, recently characterized by CT scan.No new findings.

Output: Persistent right hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Minimal atelectasis without residual or recurrent effusions.

Output: Minimal atelectasis without acute superimposed new abnormality


Instruction: Generate impression based on medical findings.

Input: Respiratory distress. Effusion and chest tube placement.VIEW: Chest AP (one view) 02/28/15, 0320 Tracheostomy tube tip is below thoracic inlet. Right chest tube remains in place.Bilateral pleural effusion continues right moderate in size and left small. Opacities in left mid lung have worsened. Opacities in the bases persist. Cardiac silhouette size is normal.Right thoracic and left thoracolumbar curves are again seen.

Output: Continued bilateral pleural effusion and worsening left lung opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: intubated History: intubated Median sternotomy with severe cardiomegaly.Worsening pulmonary edema with pleural effusions.Status post extubation.Right jugular Swan-Ganz catheter tip directed towards the right main pulmonary artery.

Output: Slight worsening of edema accompanied by pleural effusions following extubation.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: evaluate ET placement History: hypoxia Lower lung zone opacities consistent with edema as well is left lower lobe consolidation and pleural effusions are unchanged.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Unchanged pulmonary opacities, tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Metastatic lung cancer to the spleen, adrenal gland. On chemo (status post 3 cycles). Evaluate for changes. CHEST:LUNGS AND PLEURA: Centrilobular emphysema. No new lung nodules identified. No pleural effusion.MEDIASTINUM AND HILA: Right paratracheal mass (image 38, series 4) has increased in size, now measuring 18 x 13 mm, previously measuring 12 x 14 mm.Calcified mediastinal and left hilar lymph nodes, compatible with previous granulomatous infection, unchanged. Right chest Port-A-Cath with its tip in the SVC. Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic hypodensities with peripheral enhancement in the left lobe, compatible with hemangiomas.SPLEEN: Increasing cystic hypodensity in the upper pole of the spleen (image 100, series 4) measures 21 mm x 24 mm, previously, measuring 21 x 18 mm., More inferior low-density lesion is not significantly changed in size since 8/2010.Calcifications consistent with previous granulomatous infection. AADRENAL GLANDS: Hypodense masses in both adrenal glands, compatible with metastases, have increased in size. Largest of the left adrenal masses (image 114, series 4) measures 28 x 21 mm, previously measuring 22 mm x 24 mm. Largest of the right adrenal masses (image 106, series 4) measures 14 x 16 mm, previously measuring 13 x 11 mm.KIDNEYS, URETERS: Bilateral cysts are stable.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe degenerative changes and degenerative disk disease at the L2-3 level. No anterior wedging L1 and L2.OTHER: Atherosclerotic disease of the aorta.

Output: 1. Increasing splenic and bilateral adrenal hypodense masses and right paratracheal lymphadenopathy, compatible with progression of metastatic disease. 2. Stable hepatic hypodensities with peripheral enhancement, most likely representing hemangiomas.


Instruction: Generate impression based on medical findings.

Input: Right jugular line placement Right jugular catheter projects into the proximal SVC. No immediate postprocedural complications observedModerately decreased lung volumes elevated right hemidiaphragm and questionable mild cardiomegaly. Motion degrades sensitivity, consider serial imaging if further delineation and characterization is desired

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Wet cough and delirium, evaluate for pneumonia. Enteric tube has been removed. Right chest port with tip at SVC atrial junction.Cardiomediastinal appearance is unchanged.No new focal opacities to suggest pneumonia.Mildly prominent upper abdominal bowel loops.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: effusion, pneumonia History: hypoxia Left lower lobe atelectasis, consolidation and possible pleural effusion, generally unchanged.Multiple skin folds on the right but no pneumothorax.Surgical artifacts consistent with previous median sternotomy.

Output: Left lower lobe atelectasis and consolidation, suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: PRE Lung or Heart-Lung Transplant Evaluation History: PRE Lung or Heart-Lung Transplant Unchanged moderate interstitial lung disease previously characterized by CT.No superimposed edema or pneumonia.

Output: Unchanged moderate interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Thoracic aortic aneurysm without rupture. Intubated, evaluate ETT. ETT tip 4.5cm above the level of the carina.Moderate to large pleural effusions with associated atelectasis and consolidation bilaterally.Left subclavian central line tip in the right atrium.Enlargement of the cardiomediastinal silhouette nonspecific in appearance but similar to a scout image from a CT dated 12/28/2015 which demonstrated aneurysmal dilatation of the distal arch and descending aorta.

Output: ETT tip 4.5 cm above carina. Large pleural effusions with associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: chf, pna History: sob Left Port-A-Cath unchanged.Stable cardiomediastinal silhouette.Left upper lobe mass redemonstrated.No new pulmonary opacities identified.

Output: Left upper lobe mass unchanged. No acute abnormalities. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Shortness of breath. Type II DM, with diabetic nephropathy rule out pneumonia. SOB, AMS. Unchanged cardiomegaly. Atherosclerotic calcification of the thoracic aorta. Diffuse peribronchial opacities, most pronounced in the left upper lobe, have progressed, suspicious for infection.

Output: Interval worsening of pulmonary opacities suspicious for acute infection. Underlying interstitial pathology cannot be excluded, plain film follow-up suggested after medical management.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer Interval resolution of previously observed minimal basilar probable edema. Mildly decreased lung volumes, unchanged. Left subclavian ICD similar to prior. No superimposed acute pulmonary abnormality

Output: Interval improved aeration with resolution of previously observed basilar probable edema and small effusions. No suspicious new findings to suggest metastatic disease


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: infection History: AMS Right central venous catheter with its tip in the RA.Decreased lung volumes with mild cardiac enlargement.Increasing perihilar and basilar opacities compatible with edema, atelectasis, pleural effusions.Increasing left retrocardiac consolidation/atelectasis.

Output: Increasing basilar opacities compatible with edema, atelectasis, and pleural effusions. Left retrocardiac consolidation/atelectasis which may be a source of infection .


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: SOB History: ? fluid vs PNA Moderate cardiomegaly, the heart larger than before.New lower lung zone interstitial and airspace opacities consistent with edema accompanied by small pleural effusions. Left subclavian pacemaker, leads unchanged in position.

Output: New CHF with cardiomegaly, pulmonary edema and small pleural effusions. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.COPD. Desaturation. Shortness of breath. Moderate bilateral pleural fluid collections about the same.Significant basal atelectasis remains, with reexpansion of the right middle lobe.Hazy opacity consistent with layering pleural fluid, edema and atelectasis not significantly changed.

Output: Pleural fluid and atelectasis with overall slight improvement on the right but no change on the left.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infection, edema, mass History: shortness of breath, h/o copd, chf on bipap Unremarkable cardiac and mediastinal silhouette. Large lung volumes consistent with COPD.No acute abnormalities.

Output: COPD with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: Fever with chest pain , evaluate for pneumonia History: chest pain Bibasilar and medial left lung subsegmental atelectasis increased since the prior chest CT. Probable small right pleural effusion. No focal consolidation. Bilateral pulmonary nodules suspicious for metastases were better seen on the prior CT..

Output: Increased bilateral subsegmental atelectasis. Probable small right pleural effusion. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Tracheostomy tube, Dobbhoff appear unchangedNonspecific decreased lung volumes with patchy basilar perihilar opacities suggesting edema with pleural effusions appear similar. Again special note is made of retrocardiac suspected partial consolidationChest tube projects over right lung base unchanged and without associated pneumothorax

Output: Right chest tube unchanged