Instruction: Generate impression based on medical findings.

Input: 57-year-old female with pancreatic cancer status post 6 cycles of folfirinox. Evaluate disease status. CHEST:LUNGS AND PLEURA: Upper lobe predominant centrilobular emphysema.. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Right jugular central venous catheter with tip in the SVC. ABDOMEN: LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple procedure. Operative bed is stable in appearance with small soft tissue density in seen adjacent to the gastrojejunal anastomosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta.Multiple small intraperitoneal lymph nodes appearing similar to prior study.BOWEL, MESENTERY: Status post Whipple procedure with patent gastrojejunal and jejunal anastomoses. No evidence of bowel obstruction.BONES, SOFT TISSUES: Central abdominal wall laxity with probable mesh repair as seen previously.PELVIS:UTERUS, ADNEXAE: 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.

Output: Stable postsurgical changes with small soft tissue density reidentified adjacent to the gastrojejunal anastomosis. No definite evidence of metastatic disease on this noncontrast examination.


Instruction: Generate impression based on medical findings.

Input: Male; 20 years old. Reason: intubated, please compare atelectasis to previous History: intubated, please comment on atelectasis ET tube tip 3 cm above the carina. Right Port-A-Cath, tip at the SVC/RA junction. NG tube extends beyond the inferior margin of the image.Right basilar atelectasis/consolidation is mildly increased compared to the prior day's study.No pneumothorax.

Output: Mild interval increase in right basilar atelectasis/consolidation. Stable tubes and lines.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Shortness of breath. Persistent linear right basilar opacities suggestive of scarring/atelectasis. No new focal opacity to suggest acute infection. Blunting of the right costophrenic angle consistent with scarring/atelectasis, unchanged. No significant interval change in size of the cardiac silhouette. Calcified hilar lymph nodes.

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


Instruction: Generate impression based on medical findings.

Input: 44 years, Female. Reason: SBO? History: SBO? Dextrocardia and right-sided stomach bubble. The heart size is upper limits of normal in size. Nasogastric tube with tip projecting over the fundus of the stomach. There is gaseous distention of multiple loops of both large and small bowel. No pneumoperitoneum is evident. Intrauterine device in place.

Output: Gaseous distention of multiple loops of large and small bowel most consistent with ileus. Situs inversus.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Tachypnea, fevers, and secretions. Stable cardiomediastinal silhouette. IVC filter is again noted. Enteric feeding tube tip extends beyond the inferior margin of the image. Right midlung opacity is not significantly changed compared to prior. Left basilar opacity slightly improved compared to prior.

Output: Stable right midlung opacity, consistent with pneumonia, and improved left basilar opacity.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: sob and LE swelling History: above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: rule out pneumonia History: tachypnea Study limited by leftward patient rotation. Calcified granulomas at the left lung base. No focal lung consolidation or evidence of overt left-sided heart failure. Normal heart size. Aortic atherosclerosis. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Nontraumatic heart valve disorder. Right-sided foraminal interstitial opacities are stable. Devices without significant change. No significant pneumothorax.

Output: No pneumothorax or acute change.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of hypoxemia and fluid overload. Evaluate for pulmonary edema. Stable appearing cardiomegaly and low lung volumes. No convincing evidence of edema. AICD with leads in the expected location.

Output: Cardiomegaly and low lung volumes without convincing evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: increased shortness of breath History: increased shortness of breath Increased right effusion and lung opacities. Line position stable. Peripheral nodular opacities left lung are unchanged from previous exam. No pneumothorax.

Output: Increase right lung opacities and effusion. No change in the peripheral nodular opacities left lung.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Pt with swan catheter, eval for placement History: see above Left IJ Swan-Ganz catheter with tip again overlying the left interlobar pulmonary artery. Cardiomegaly again seen with massive enlargement of the pulmonary arteries.Mild interstitial edema pattern. Small right pleural effusion with adjacent atelectasis. No pneumothorax

Output: 1.Swan-Ganz catheter with tip again overlying the left interlobar pulmonary artery.2.Stable cardiomegaly with massive enlargement of the pulmonary arteries.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: s/p transbronchial bx. eval for PTX History: s/p procedure Interval placement of a left glenohumeral prosthesis.Atherosclerotic disease affects the distal transverse arch and descending thoracic aorta. Previously noted left upper lobe nodular opacity which corresponds to a nodule noted on recent CT, is not well visualized. Streaky mid to lower zone opacities may be related to edema from recent procedure. No evidence of pneumothorax. The heart size remains normal.

Output: No evidence of postprocedural pneumothorax. Mid to lower zone streaky opacities may represent mild edema related to recent procedure.


Instruction: Generate impression based on medical findings.

Input: Acute kidney failure. Check for infection Moderate scoliosis without superimposed additional cardiopulmonary acute abnormality. Minimal left lung streaky densities suggesting scarring and/or atelectasis. Overlying rib deformity and healed fracture

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Low-grade fever, vomiting, immunocompromise evaluate for aspiration. Normal heart size. Low normal lung volumes come change. No focal air space opacities or visible signs of aspiration.

Output: No acute pulmonary abnormality. Specifically no visible signs of aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and cough Large left pleural effusion with underlying compression again observed without significant change. No additional new abnormalities

Output: Large left pleural effusion unchanged


Instruction: Generate impression based on medical findings.

Input: 61 years old Female. Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: pt on bipap w/ pulm fibrosis and pna, worsening of pna? effusion? History: bipap Severe basilar predominant interstitial lung disease, with upper lobe emphysema.A slight increase in basilar markings and small pleural effusions could indicate mild superimposed edema.No specific evidence of infection.Median sternotomy for CABG.

Output: Severe fibrosis and emphysema, with possible superimposed edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PTX or widened mediastinum History: mid-sternal chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out TB History: rule out TB - no clinical findings Unremarkable cardiac and mediastinal silhouette.Mild scarring at the left base.No significant pulmonary or pleural disease.Moderate scoliosis.

Output: No sign of TB or other active disease.


Instruction: Generate impression based on medical findings.

Input: Acute kidney failure NG replaced with a Dobbhoff coiled in the proximal stomach. Right jugular dialysis catheter again extends to the RA junction.Underlying cardiopulmonary appearance is also similar without evidence of complication and includes right basilar opacification largely the right lower lobe. Small effusion and partial collapse suspected, yet overall appearance essentially unchanged in the interval.

Output: NG removed and Dobbhoff placedd


Instruction: Generate impression based on medical findings.

Input: Reason: post op History: post op ET tube tip approximately 5 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Small lung volumes with basilar atelectasis and small pleural effusions.No pneumothorax or other acute change.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Left sided CP, hx of DVT 3 weeks ago History: reproducible chest pain, lower extremity edema and pain, metastatic endometrial cancer. Right internal jugular port catheter tip projects over the right atrium.Heart size is normal. Persistent moderately tortuous aorta.No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality. Stable exam.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with stage II colorectal cancer. Status post chemotherapy. Please evaluate for recurrent disease. CHEST:LUNGS AND PLEURA: Small right middle lobe nodule appears minimally reduced, measures 3.6 mm (image 29, series 6), compared to 4.6 mm on the previous exam. There is compressive atelectasis of the lingula.MEDIASTINUM AND HILA: Cardiomegaly with calcifications of the coronary arteries, aortic root and mitral annulus.A catheter is noted in the left and right brachiocephalic veins.Heterogeneous enhancement of right thyroid gland with calcification, unchanged. Multiple multiple surgical clips noted inferior to the thyroid gland.Multiple prominent lymph nodes, not enlarged by CT criteria noted in the anterior mediastinum, prevascular space, pretracheal, subcarinal region, best seen on image 27, series 4CHEST WALL: No significant abnormality noted..ABDOMEN:LIVER, BILIARY TRACT: Multiple calcified granulomas are redemonstrated. Minimal periportal cuffing noted. There is diffuse heterogeneous enhancing pattern without any obvious focal lesions throughout the liver, this could be due to difference in timing of contrast injection. Minimal biliary prominence noted in the left lobe (image 71, series 4). Common bile duct appears slightly dilated, measuring up to 10 mm, in the midportion and distal portion, with gradual tapering into the ampulla, mostly unchanged in comparison to prior study. Cholecystectomy clips noted. Hepatic vessels appear patent. SPLEEN: Splenule noted in the splenic hilum.PANCREAS: Multiple, at least 3 low attenuation lesions noted in within the head and uncinate process of the pancreas (image hundred, series 4), image 125, series 4) but are not completely evaluated. Pancreatic duct is not dilated. No other lesions in the body and tail of pancreas. No peripancreatic fat stranding. Cannot comment whether these lesions were seen on prior exam, probably seen on 9/14/09 (noncontrast study).ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: Dense calcification at the origin of bilateral renal arteries. No obvious focal lesions within the kidneys.RETROPERITONEUM, LYMPH NODES: Multiple subcentimeter not enlarged retroperitoneal lymph nodes. A reference left aortic lymph node is mildly decreased in size and measures 1.1 x 0.7 cm (image 126, series 4), previously measured 0.9 cm x 1.3 cm.BOWEL, MESENTERY: Multiple diverticuli in the colon without evidence of diverticulitis. Minimal fat stranding noted within the mesentery throughout the abdomen, nonspecific..BONES, SOFT TISSUES: No significant abnormality noted.OTHER:Atherosclerosis of the aorta and its branches with dense calcification at the origin of celiac axis, and renal arteries and SMA..PELVIS:UTERUS, ADNEXAENo significant abnormality noted...BLADDERNo significant abnormality noted...LYMPH NODESNo significant abnormality noted...BOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitisBONES, SOFT TISSUES: Few degenerative changes in the thoracic spine.OTHERNo significant abnormality noted...

Output: 1.Slight decrease in size of subcentimeter retroperitoneal lymph nodes2.minimal biliary prominence in the left lobe. Common bile duct is dilated up to 10 mm, unchanged. At least 3 low attenuation lesions within the head of the pancreas, probably seen on prior imaging (not convincing due to lack of IV contrast), no evidence of pancreatic ductal dilatation.3.Atherosclerotic changes of abdominal aorta and its branches, with dense calcification at the origin of bilateral renal arteries, unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: 51 year old male with chronic, recurrent uveitis, evaluate for lymphadenopathy History: 51 year old male with chronic, recurrent uveitis, evaluate for lymphadenopathy Mediastinal and hilar lymphadenopathy is present, not substantially different. Bibasilar reticulation and linear opacities again noted. Focal nodular opacity in the lower lateral aspect of the right lung overlying the anterior right fifth rib, unchanged compared to at least 6/2014. Unchanged heart size.

Output: Findings suggestive of sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: 50 old male. Follow-up melanoma CHEST:LUNGS AND PLEURA: Granuloma right base some patchy airspace disease is seen in the right base pullout aspiration versus atelectasis. No effusions.MEDIASTINUM AND HILA: Small and pathologic sized mediastinal nodes unchanged. Calcific granulomata right hilum.CHEST WALL: Asymmetric gynecomastia on the left. Adjacent to surgical clips right axillary node measures 2.8 x 2.3 cm series image 23. Previously 2.6 x 2.1 cm.ABDOMEN: The exam is not sensitive for the detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic right kidney. Hypodense lesions left kidney consistent with simple cysts based on density.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered colonic diverticulosis. No evidence of diverticulitis, ascites or carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Atelectasis versus an infiltrate right base correlate. Stable right axillary node and left sided gynecomastia. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old. History of sob, light headed. Cardiomegaly and ICD unchanged. Mild basilar atelectasis without new airspace opacity, effusion, or pneumothorax.

Output: No acute abnormalities or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: right anterior chest pain for 3 days 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: 39 year old male, intubated. Evaluate ET tube. Interval intubation with ET tube 6 cm above the carina. AICD leads and other hardware unchanged. Bilateral pleural effusion similar to recent study. Increased left perihilar opacity could be due to aspiration. Increased right perihilar streaky opacity which could also be due to aspiration with associated volume loss due to mucous plugging. Globular cardiomegaly unchanged.

Output: ET tube 6 cm above the carina. Increased bilateral perihilar opacities could be due to aspiration. There is associated volume loss likely due to mucous plugging on the right. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Minor placement of IABP. Right neck central venous catheter and right chest tube are unchanged in position. IABP catheter marker is also unchanged in position. Stable mild cardiomegaly. Mild pulmonary vascular congestion. Interval worsening of right middle lobe airspace disease.

Output: Worsening right middle lobe airspace disease and mild vascular congestion.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: pneumothorax History: prolonged air leak following extended pleurectomy decortication Stable position of left apically directed chest tube and right port catheter.No significant change in the left mid to lower zone opacities which represent subsegmental atelectasis and possible edema and/or hemorrhage. Stable amount of fluid in the pleural space, appearing loculated at the apex. Calcified pleural plaques are noted on the right.

Output: Stable position left chest tube. No significant change in the fluid within the pleural space and mid to lower zone opacities.


Instruction: Generate impression based on medical findings.

Input: Cough Mild chronic appearing bibasilar scarring with atelectasis and borderline cardiomegaly. No definite superimposed acute cardiopulmonary abnormality despite diminished lung volumes. Persistent bronchial wall thickening again concerning for bronchitis

Output: Borderline cardiomegaly with minimal scarring and suspected bronchitis


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: sp lung txp History: - Unchanged lower lung zone edema like opacities and pleural effusions.Tracheostomy tube tip approximately 3 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.Second larger right jugular catheter tip at cavoatrial junction level.

Output: Unchanged pulmonary opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Productive cough and chest pain. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No signs of pneumonia. If patient remains symptomatic, follow-up PA and lateral chest radiograph may be obtained in 7-10 days.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval for pulm edema History: dyspnea There is unfavorable progression of bilateral interstitial and airspace opacities. Infection with superimposed edema is likely. Continued follow-up recommended.

Output: Unfavorable progression of left basilar opacities as well as right lung interstitial opacities. Infection with superimposed edema should be considered. Follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: interval changes History: as above. LVAD, left subclavian AICD, sternotomy fixation, tracheostomy, right PICC unchanged.Right-sided opacities suggestive of edema and atelectasis unchanged.Retrocardiac/left lower lobe opacity suggestive of atelectasis.Bilateral pleural effusions, right greater than left.Stable cardiomediastinal silhouette

Output: No significant interval change in bilateral effusions and right pulmonary opacities suggestive of atelectasis/edema.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.ETT adjustment. ETT tip 4.5 seen above the level of the carina.Large laterally loculated left pleural fluid collection with adjacent compressive atelectasis and consolidation left upper lobe unchanged.Moderate to large subpulmonic pleural fluid collection on the right with patchy airspace opacities throughout the right lung also similar in appearance. Right jugular chest port tip at the right atrium.Enteric tube tip in the proximal stomach.

Output: ETT tip 4.5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Evaluate lung fields r/o consolidation/effusion History: O2 requirement Right IJ dialysis catheter and central venous line remain unchanged. Status post median sternotomy and likely CABG surgery.Stable cardiomediastinal silhouette.No interval change in bilateral pleural effusions and atelectasis. No pneumothorax.

Output: Stable appearance of the chest with bilateral pleural effusions and underlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer metastatic to bone. Question of areas of uptake. Multiple areas of iodine avid metastatic disease is seen, which is very similar in extent to the recent diagnostic scan. Osseous lesions are identified within the calvarium, spine, and pelvis. Thyroid bed activity has decreased from the prior examination and may reflect "stunning" of normal thyroid tissue. There is expected I-131 activity in the salivary glands, stomach, and colon.

Output: Widespread, predominately osseous, metastatic disease similar to the previous diagnostic scan.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: Evaluate volume status History: Cirrhosis, multiple diuretics, ascites; room air/euvolemic The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: r/o infection History: sepsis Pleural effusions and basilar atelectasis. Slightly worsened versus difference in patient positioning.Heart size normal.Surgical drain in the right anterior chest wall unchanged in position.

Output: Unchanged or slightly worsened pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 24 year-old female with neuroblastoma CHEST:LUNGS AND PLEURA: Parenchymal and pleural-based nodules, most in the lower lobes, not significantly changed. The reference right lower lobe nodule is stable, measuring 14 x 11 mm (series 5; images 72).MEDIASTINUM AND HILA: Matted Mediastinal adenopathy is unchanged.CHEST WALL: Metastatic lesions involving the right humerus, sternum and thoracic vertebra, especially T5 and T6, remainABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic lesions, the largest in the posterior segment of the right lobe, are unchangedSPLEEN: Multiple perisplenic nodules are stable.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is severely atrophic. Soft tissue nodules adjacent to the right kidney are unchanged.Subcentimeter simple cyst in the lower pole of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered osseous metastatic lesions, stable.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Scattered metastatic lesions involving the lumbar spine, pelvis and right femur are again identified.

Output: Stable, diffuse metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Line placement Interval placement of a left jugular catheter, without complication. The left subclavian Hickman and right jugular line are otherwise unchanged.Cardiopulmonary appearance is otherwise similar without new superimposed focal abnormality

Output: Left jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: r/o pna History: cough Cardiomediastinal silhouette is within normal limits. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Tachypnea Interval exchange of the ETT for a tracheostomy tube terminating 7 cm above the carina. Mild underlying cardiomegaly without additional pulmonary abnormality, which includes interval clearance improved aeration of the left lower lobeG-tube projects over left upper quadrant

Output: Tracheostomy tube placed


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Minimal atelectasis at the lung bases, stable.MEDIASTINUM AND HILA: Left thoracic inlet mass is significantly smaller and measures 7 mm in diameter image number 12, series number 3.CHEST WALL: Left 10th rib metastases is also grossly smaller. Bilateral scapular , sternal or and humeral metastases are better seen on today's study and more sclerotic.ABDOMEN:LIVER, BILIARY TRACT: Again noted biloba or extensive metastatic disease in the liver, increased in size and number compared to previous study. The liver is almost complete replaced by these lesions. Previously measured index lesion now measures 3.6 x 3 .2 cm on image number 107, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy. Size of the adenopathy is significantly smaller compared to previous study. Previously measured aortocaval node now measures 1.5 by 0.9 cm on image number 120, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Again noted diffuse metastatic disease to the vertebral bodies and pelvic inlet. These appear more sclerotic and conspicuous on today's study compared to previous study.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Right sided, asymmetric wall thickening of the bladder is improved but persistsLYMPH NODES: Index right pelvic node is significantly smaller and now measures 1.3 by 1 cm image number 172, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bone metastases throughout the sacrum and iliac bone are again noted and appear more sclerotic compared to previous study. However the soft tissue component of the right iliac bone metastases has decreased. Bilateral femur metastases.OTHER: No significant abnormality noted

Output: Interval decrease in the size of the left thoracic inlet mass, retroperitoneal and pelvic adenopathy.Bone metastases overall appear more sclerotic and conspicuous compared to previous study


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval lung fields History: s/p CABG Patient has been extubated. Other lines and tubes, not substantially changed. Possible left pneumothorax has resolved. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in diffuse pulmonary opacities given differences in inspiration. Unchanged heart size.

Output: No significant pneumothorax. Diffuse pulmonary opacities, consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with history of Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Diffuse emphysema with multiple blebs is redemonstrated. Biapical scarring.Present right lower lobe scarring is unchanged. Bilateral nonspecific subcentimeter pleural-based densities are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node is unchanged measuring 11 x 10 mm image number 120, series number 3. Other smaller retroperitoneal lymph nodes also unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.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: 42 years old Female. Reason: Infiltrates History: fever. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The tip of Port-A-Cath projects over the atriocaval junction.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Tachypnea question effusions. Small lung volumes. Diffuse pulmonary opacities, most pronounced in the right upper lobe. Probable cardiomegaly.

Output: Diffuse pulmonary opacities nonspecific and could reflect edema, infection or other pathology. Pleural fluid cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: r/o perf viscous History: massive hematemesis, on eliquis, recent G-tube plcmt, recent NGT trauma to esophagus Minimal retrocardiac streaky opacity unchanged,Elsewhere, the lungs are unremarkable and the heart size normal.

Output: Stable minimal retrocardiac opacity.


Instruction: Generate impression based on medical findings.

Input: +PPD No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: ETT tube retracted by 2cm History: respiratory failure Endotracheal tube terminates approximately 4 cm from the carina. Other iatrogenic devices, unchanged. Improvement in diffuse pulmonary opacities. Low lung volumes with bibasilar opacities again noted. Left-sided pleural effusion, as before. Unchanged cardiomegaly. No pneumothorax.

Output: Improvement in pulmonary edema. Persistent bibasilar opacity and left pleural effusion. Endotracheal tube terminates approximately 4 cm from the carina.


Instruction: Generate impression based on medical findings.

Input: 68 year old male with shortness of breath. Evaluate for pneumothorax. Left apical pleural thickening/scarring not significantly changed. No focal airspace opacity, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No interval change in cardiopulmonary appearance with no superimposed acute process. No pneumothorax as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: trach dependent, hypoxemic with MDR aspiration PNA, tachycardic History: tachycardia, hypoxemia Tracheostomy tube, unchanged. Right IJ line again crosses the midline terminating within the left subclavian vein. Multifocal lung consolidation, not substantially different compared to last study though there is clear trend toward worsening compared to more remote studies. Unchanged heart size. No pneumothorax. Small left greater than right pleural effusions again noted.

Output: Trend toward increasing multifocal lung consolidation consistent with pneumonia, aspiration, or atypical pattern of cardiogenic and/or noncardiogenic edema.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: post thora cxr History: post thora cxr Stable cardiomediastinal silhouette.Low lung volumes with interval improvement in left aeration with residual bibasilar atelectasis/scarring and likely trace pleural effusions. No pneumothorax.

Output: No pneumothorax status post left thoracocentesis with improvement in left basilar aeration.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: eval for pneumonia History: SOB Stable cardiac cardiomediastinal silhouette with marked atherosclerotic changes of the aorta.Mild basilar scarring/discoid atelectasis.Increased lung vines compatible COPD.No focal areas consolidation.No pleural effusions.Tracheal deviation from right to left compatible with goiter.Cardiomediastinal surgery clips re-demonstrated.

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


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Fever. Right lower lobe opacity suspicious for infection.Unremarkable cardiomediastinal silhouette.

Output: Right lower lobe opacity suspicious for infection. Given the patient's age follow up to resolution is recommended to exclude underlying neoplasm.


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube placement History: ET tube placement ET tube tip approximately 5 cm above the carina.NG tube tip in the stomach.Mild blunting of the right posterior costophrenic angle compatible with a small effusion.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: PNA? History: tachypnea, increased WBC Left PICC line with its tip in the SVC.Stable cardiomediastinal silhouette.Markedly decreased lung volumes with chronic appearing interstitial opacities suggestive of fibrosis.No focal airspace opacities.No pleural effusions.Mild gaseous distention of loops of bowel in the left upper abdomen.

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


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: prolonged URI with SOB, concern for pneumonia History: SOB The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: ptx History: chest tubex2 Right chest tubes in place with a minimal apical pneumothorax, decreased from previous.Mild interstitial opacity is compatible with edema and atelectasis with focal atelectasis and consolidation in the left lower lobe.No new findings.

Output: Decreased right pneumothorax and no new findings.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: MaleReason for Study: Reason: is there a fx/pneumo History: left rib pain s/p fall tachy The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No obvious rib fractures.No evidence of pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: patient w right sided infiltrate, eval for possible pneumonia versus improvement after diuresis History: cough Slight improvement in edema like opacities with pleural effusions.No specific evidence of infection.Heart size upper normal.

Output: Improving edema, without evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: productive cough in immunosuppressed patient concerning for pneumonia History: productive cough Left mid and lower lung zone scarring.No specific evidence of infection or edema.Surgical clips are projected over the left side of the chest.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: balloon pump placement/ET tube History: balloon pump/ET tube ET tube tip is approximately 5 cm above the carina. IABP balloon pump marker is in the proximal descending aorta. Right IJ central venous catheter tip in the superior vena cava. Enteric feeding tube tip projects over the proximal stomach. Stable cardiomediastinal silhouette with increasing left lung opacity that is compatible with atelectasis, which is suggestive of mucous plugging.

Output: Support devices are unchanged. Increasing left lung opacity compatible with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Fever. Unchanged position of right jugular catheter.The left lung base is obscured due to elevation of the left hemidiaphragm however at the level of the diaphragm, new opacities are seen, which may reflect aspiration or infection. No pneumothorax. The right lung is clear.

Output: New left basal opacities which are obscured by the left hemidiaphragm may reflect acute aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: 54 years old Male. Reason: chest pain History: chest pain. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Bladder cancer surveillance for metastasis Normal heart size. Scattered benign nodules unchanged since at least 2012, likely granulomas. No new or suspicious lesions. No pneumothorax or pleural fluid. No visible lymphadenopathy.

Output: No acute cardiopulmonary abnormality. No signs of pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.SOB and palpitations. SVT broke with adenosine. No focal pulmonary opacities, pleural fluid or pneumothorax. Mild atherosclerotic calcification of the thoracic aorta.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.SOB and hypoxia. Diffuse skeletal sclerosis unchanged.Right jugular catheter tip in the right atrium.Mild-to-moderate cardiomegaly and enlargement of the pulmonary vasculature unchanged.Basal atelectasis bilaterally, right greater than left. Small volume of pleural fluid bilaterally. Mild pulmonary edema.

Output: Mild hypervolemia/edema.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Chest pain and history of sickle cell rule out acute chest. Cardiomegaly with prominence of the central pulmonary vasculature suggestive of pulmonary hypertension. Coarse pulmonary opacities with relative sparing of the lung apices. No pleural fluid.

Output: Diffuse reticular opacities in a pattern suggestive of diffuse bronchiolitis and interstitial pneumonia, possibly viral.


Instruction: Generate impression based on medical findings.

Input: Elevated white count and cough Minimal nonspecific interstitial changes in both lung bases. Mild new right pleural thickening and irregularity of the right lung base is observed without effusion. Mild bronchial wall thickening and the appearance although possibly related to bronchitis, minimal edema cannot be entirely excluded. Cardiac and mediastinal contours are well within limits.

Output: Minimal nonspecific interstitial changes at both lung bases, no frank additional findings to support edema however early changes and/or viral/atypical pneumonia cannot be excluded. Serial imaging will be helpful


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Catheter placement. Left jugular catheter has been advanced, now terminating at the SVC.No significant change in right greater than left pleural effusions and associated atelectasis. Airspace opacities seen previously have cleared. No pneumothorax. Pigtail catheter overlying the upper abdomen as well as a left upper quadrant drain, incompletely visualized.

Output: Left jugular catheter terminates at the SVC level. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: assess placement of pulmonary catheter History: PE receiving lytics Small radiopaque markers (arrows) are projected over the mediastinum and may be located in the pulmonary artery catheter.The catheter is apparently not otherwise radiopaque.Moderate cardiomegaly and large goiter, unchanged.

Output: Small radiopaque markers projected over the mediastinum which may correspond to the pulmonary artery catheter in question.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o pulmonary edema History: SOB; CHF EF 19% Moderate cardiomegaly with flat diaphragms consistent with COPD.No specific evidence of infection or edema.

Output: Cardiomegaly without acute edema. Probable COPD.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: aspiration History: aspiration Patchy interstitial and airspace opacities slightly worsened in the right midlung consistent with edema and superimposed infection or aspiration.Right jugular catheter, tip in SVC.

Output: Worsening interstitial and air space opacities consistent with aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: 52M s/p thoracotomy, wedge resection x3 s/p chest tube placement History: Right chest tube Right chest tube with no pneumothorax following wedge resection.Postsurgical opacities right lower lung zone.Right jugular catheter, tip in SVC.

Output: No pneumothorax following right wedge resection, chest tube in place.


Instruction: Generate impression based on medical findings.

Input: 38 years old Male. Reason: Pneumothorax ? History: SOB. Diffuse subcutaneous emphysema noted in the neck and left chest wall. There is a moderate-sized pneumothorax in the left upper lung. The cardiac silhouette is normal.

Output: Left pneumothorax.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval for evidence of infection History: hx of hiv, noncompliant with therapy, with cough, chills, sweats. Linear atelectasis right lung base periphery, the lungs otherwise unremarkable.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: Mild right basilar subsegmental atelectasis, otherwise unremarkable. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Pain, mesothelioma. Status post pleurectomy 2 right chest tubes again project into the apex with a third chest tube projected across the lung base. Minimal chest wall and neck emphysema yet no significant associated pneumothorax.Underlying right lung partially reexpanded with streaky patchy densities likely representing atelectasis, however underlying airspace process cannot be excluded and serial imaging will be needed.Left lung infiltrates minimal basilar atelectasisCardiac and mediastinal contours are grossly within limits

Output: Chest tubes are unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: CP, sob, recent PNA History: above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 80-year-old female with history of hypertrophic cardiomyopathy who presents to the ED with chest pain. Mild cardiomegaly and moderately tortuous aorta, unchanged. Atherosclerotic calcifications of the aortic arch are again noted. Persistent basilar subsegmental atelectasis/scarring. No new focal pulmonary opacity. No pleural effusions or pneumothorax.Suture material projects over the upper abdomen.

Output: Persistent subsegmental atelectasis/scarring without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with history of metastatic leiomyosarcoma and new subtle from vagina CHEST:LUNGS AND PLEURA: Linear subpleural density in the right lung base, image number 65, series number 5 is better seen on today's study and likely represents linear scarring.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Bilobar multiple metastatic lesions are again noted. Index lesion in segment 8 measures 3.7 by 3 cm on image number 83, series number 3. Lesion in the left lobe measures 4.8 x 3.6 cm on image number 80, series number 3. Both of these lesions and other metastatic lesions have increased in size within the interval. Persistent intrahepatic biliary dilatation and pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is dilated. Pancreatic head is likely invaded by the ill-defined portacaval mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Poorly marginated infiltrative portacaval mass measures now measures 4.9 x 3.1 cm on image number 92, series number 3, unchanged.Infrarenal abdominal aortic aneurysm now measures 2.7 cm, not significantly changed from previous study. Right common iliac artery aneurysm measures 2.3 cm, slightly enlarged compared to previous study.BOWEL, MESENTERY: Duodenal lipoma is unchanged.BONES, SOFT TISSUES: Again noted numerous subcutaneous soft density nodules in the anterior abdominal wall. There is significant increase in size and number. These may represent metastatic disease versus subcutaneous injections. Clinical correlation is recommended.OTHER: No significant abnormality noted.PELVIS:Artifact from retained barium in the rectum significantly limit optimal evaluation of the pelvis.UTERUS, ADNEXA: Not well visualized. Ill-defined soft tissue densities the vagina may represent fluid versus recurrent disease.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the hepatic metastatic lesions. Portacaval mass is stable in size, however, now likely invades the pancreatic head causing pancreatic ductal dilatation.Pelvic images are suboptimal due to artifact from retained barium. Pelvic MRI is recommended for further evaluation, to rule out recurrence or fistula.Interval increase in the size and number of the subcutaneous soft tissue nodules in the anterior abdominal wall. These may represent metastatic disease versus changes secondary to injection. Clinical correlation is recommended.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female patient with severe GERD and occasional chest pain with solids and liquids. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no mucosal surface abnormalities. A small hiatal hernia was visualized that measured 3.1 x 2.5 cm (series 12). During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave (cine series 11).TOTAL FLUOROSCOPY TIME: 4:39 minutes

Output: 1.Small hiatal hernia.2.No spontaneous or provoked reflux observed.3.Normal esophageal motility.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: Chest pain, assess pacemaker placement. Stable severe cardiomegaly with an enlarged pulmonary artery. ICD placement is unchanged. No acute cardiopulmonary process.

Output: Stable severe cardiomegaly and enlarged pulmonary artery, consistent with pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Device placement 82-lead left subclavian ICD has been placed with the generator during the mid left lung, however lead tips are otherwise projected into the expected locations. No immediate postprocedural complications observed in this limited evaluation. Specifically the lungs are clear.Moderate nonspecific cardiomegaly and aortic tortuosity, exaggerated by mild scoliosis

Output: Left subclavian ICD placed


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.History of cough The cardiac and mediastinal contours are within normal limits.No abnormal focal lung parenchymal opacities.Blunting of the costophrenic angle likely due to pleural thickening. No pneumothorax.

Output: No abnormal radiographic findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: r/p pna History: hypoxia, tachypnea, NH patient A defibrillator obscures the left lower lung. ICD lead positions are unchanged.No significant change in coarse interstitial opacities. No pneumothorax. The heart size is stable. Calcified mediastinal and hilar lymph nodes.

Output: No new focal lung opacity to suggest infection.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: et tube position History: et tube ET tube tip is 2 cm above the carina. Enteric tube tip projects over the gastric antrum. IVC Swan-Ganz catheter is looped in the right atrium with tip in the left lower lobe pulmonary artery. Impella device is unchanged.Cardiomediastinal silhouette is mildly enlarged and unchanged.No large pleural effusions or pneumothorax.Mild improvement in perihilar opacities suggestive of improving edema.

Output: 1.Improving pulmonary edema appearance.2.IVC Swan-Ganz catheter is in the left lower lobe pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: trach in right place History: ET tube in ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.Cardiomegaly with basilar opacity compatible with atelectasis, slightly improved.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: pna History: previously diagnosed pna. + SOB The cardiac silhouette is enlarged but stable.There is minimal subsegmental bibasilar atelectasis but no additional focal pulmonary opacity. Calcified nodule noted in the peripheral left lower lobe. No pleural effusions.

Output: Cardiomegaly without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate, pna, ET tube placement History: resp failure ET tube tip approximately 2 cm above the carina.An NG tube terminates in the stomach.Moderate cardiomegaly with small lung volumes.Focal retrocardiac opacity compatible with subsegmental atelectasis and aspirated secretions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: RIJ central line placement History: n/a Right jugular catheter tip in the area of the SVC with no pneumothorax or other complications.Underinflated lungs with focal subsegmental atelectasis in the posterobasal segments of both lower lobes.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p esophagectomy History: s/p esophagectomy Bilateral chest tubes in place with no significant pneumothorax. NG tube tip over the lower mediastinum consistent with recent esophagectomy.Small lung volumes with diffuse nonspecific interstitial and air space opacity.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: Brain tumor, 53-year-old female CHEST:LUNGS AND PLEURA: Linear atelectasis in the lung bases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Small amount of air in the bladder, etiology is unknown.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: No evidence of metastatic or primary tumor in the chest abdomen and pelvis.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.History of CHF, AICD. Patient was dizzy last night and fell and has SOB. Left subclavian ICD, leads are unchanged in position.The cardiomediastinal silhouette is normal. There is no pleural effusion, pneumothorax, or abnormal pulmonary opacity.Degenerative changes affect the imaged spine.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.SOB, DOE evaluate for edema or infection. Unchanged cardiomediastinal appearance with mild cardiomegaly. Main pulmonary artery is prominent which is at least mildly suspicious for pulmonary hypertension.Low lung volumes, but no focal airspace opacities or specific signs of pulmonary edema. No pneumothorax or visible pleural fluid.

Output: Mild cardiomegaly with signs of pulmonary hypertension, but no convincing evidence of pulmonary edema and no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma No cardiopulmonary acute abnormalities. Osseous structures appear mildly mottled however this may be secondary to demineralization as much as diffuse myelomatous involvement. Please correlate with pending dedicated imaging

Output: No cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: 66 years old Male. Reason: intubated, pneumonia. History: pneumonia. Streaky opacities in the right perihilar region and left perihilar region and bilateral lower lungs unchanged as compared with prior study. The ET tube and NG tube are stable in position.

Output: Stable linear opacities in both lungs, which are most likely due to subsegmental/subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with right lower quadrant pain. Gas/bloating. Incomplete colonoscopy. Evaluate for obstruction, adhesions, mass. Status post hysterectomy, cholecystectomy, and appendectomy. LUNG BASES: Mild right basilar scarring/atelectasis.ABDOMEN: LIVER, BILIARY TRACT: Two hypoattenuating foci in the liver are too small to characterize thereStatus post cholecystectomy. The portal and hepatic vasculature are patent.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: Atherosclerotic calcifications of the descending aorta.BOWEL, MESENTERY: Left-sided colonic diverticulosis without evidence of acute inflammation. No obstruction.BONES, SOFT TISSUES: Degenerative changes of the spine.PELVIS: Evaluation of the pelvis is limited by streak artifact from hip prostheses.UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Left-sided colonic diverticulosis.BONES, SOFT TISSUES: Bilateral hip prostheses. Degenerative disease of the spine, sacroiliac joints, and pubic symphysis. Possible old posttraumatic deformity of pubic rami and ischium bilaterally.

Output: No findings to account for patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer. Re-assess pulmonary nodules. CHEST:LUNGS AND PLEURA: Increase in size of a pulmonary nodule in the peripheral right lower lobe (image 49, series 5), currently measuring 16 x 14 mm, previously measuring 6 x 8 mm. No change in size of the 4-mm subpleural nodule (image 41, series 5) and irregularly-shaped confluent density in the region of linear scarring (image 152, series 2), measuring 13 x 10 mm.No new lung nodule. No pleural effusion.MEDIASTINUM AND HILA: New right hilar lymphadenopathy, with the largest lymph node measuring 20 x 10 mm (image 30, series 3). Mildly enlarged right paratracheal lymph nodes, increased in size compared to previous.CHEST WALL: Degenerative changes in the thoracic and lumbar spine.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No change in the right adrenal nodule measuring 13 x 10 mm (series 3, image 78), which likely represents an adenoma.KIDNEYS, URETERS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.VASCULATURE: No significant abnormality noted.BOWEL, MESENTERY: The ill-defined nodular densities in the anterior omentum appear unchanged.SOFT TISSUES: No significant abnormality noted.

Output: Increase in size of one of the lung nodules and right paratracheal lymph nodes. New right hilar lymphadenopathy. Findings are compatible with progression of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: pna v infiltrate History: sob Right internal jugular central venous catheter tip terminates at the cavoatrial junction. The right upper extremity PICC tip terminates in the SVC. The Dobbhoff tube tip terminates out of the field of view inferiorly. There is persistent complete opacification of the left hemithorax consistent with a combination of postobstructive/passive atelectasis and pleural effusion. The right lung remains well aerated.

Output: Persistent complete opacification of the left hemithorax consistent with a combination of postobstructive/passive atelectasis and effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: 81F with HA, CP, SOB History: HA, CP, SOB Stable cardiac mediastinal silhouette.Scattered areas of scarring/discoid atelectasis.No new pulmonary opacities noted.No pleural effusions.Surgical clips in the right upper abdomen.Dextroscoliosis of the thoracic spine.

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


Instruction: Generate impression based on medical findings.

Input: Female; 57 years old. Reason: RIJ dialysis catheter placement History: renal failure Interval placement of right jugular central venous catheter with tip in the SVC.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 or pneumothorax.

Output: Right jugular central venous catheter tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: evaluation of SOB, CP History: SOB, CP Lungs are hypoinflated with linear scarring and atelectasis at the bases. Otherwise no acute cardiopulmonary abnormality.

Output: Lungs are hypoinflated with linear scarring and atelectasis at the bases. Otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Post device placement in EP Lab Presternal defibrillator now located at the left chest wall, however no change in the location of the lead. No underlying pneumothorax.Stable bibasilar patchy opacities and biapical pleural or extrapleural thickening.Heart size unchanged and mildly enlarged.

Output: ICD replaced without associated acute cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Pleural Effusion Increased size of at least partially loculated left-sided pleural effusion with associated left basilar atelectasis. Right lung remains clear. Heart size, unchanged. No pneumothorax.

Output: Increased size of at least partially loculated left-sided pleural effusion with associated left basilar atelectasis. Right lung remains clear.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female recently discharged from hospital after being found to have a terminal ileum mass on CT scan done on 11/2007. Patient has history mesentery ischemia and status post bypass in 2002. Please evaluate extent of mass in ileum and for any evidence of metastatic disease. CHEST:LUNGS AND PLEURA: Previously described scattered calcified granulomas and tiny nonspecific pulmonary nodules or opacities are unchanged.MEDIASTINUM AND HILA: Thoracic aortic aneurysm distal to the left subclavian artery and measures 4.6 x 4 . 7 cm, increased in size compared to previous CT. lack of contrast precludes further evaluation. No pathologic hilar or mediastinal adenopathy is seen.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Lack of IV contrast we limits evaluation of the liver. Previously described hypodense lesions in the liver are too small to characterize but unchanged. Cholelithiasis is present without evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Marked atrophy of the right kidney with punctate stones. Bilateral stents in both renal arteries are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Small fibroids unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described irregular wall thickening involving the terminal ileum and distal ileum are again noted.BONES, SOFT TISSUES: Multiple lucent lesions in the pelvis are unchanged.OTHER: No significant abnormality noted.

Output: Irregular wall thickening involving the distal ileum. Further evaluation with colonoscopy or enteroclyisis may be helpful.Interval increase in the size of the thoracic artery aneurysm.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval for pleural effusions History: shortness of breath Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Probable nipple shadows overlie the lower aspect of the thorax symmetrically. Repeat study with nipple markers could be considered if clinically indicated.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Metastatic sarcoma. CHEST:LUNGS AND PLEURA: The previously described patchy bilateral air space/groundglass opacities are mildly improved.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference lesion in the dome of the liver measures 15 x 13 mm, previously measuring 18.5 x 13.9 mm the (series 4, image 69). A lesion in segment two of the liver measures 4.8 x 3.8 cm, previously measuring 5.6 x 4.5 cm. Large lesion in segment 3 of the liver measures 8.7 x 8 .4 cm, previously 9.4 x 8.6 cm. No new lesions are identified.SPLEEN: No significant abnormality noted. A small splenule is seen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Chronic left hydronephrosis with associated cortical thinning is stable. Right renal cysts are again notedThe large heterogeneously enhancing mass with scattered calcifications in the left mid abdomen has not significantly changed in size, measuring 17.3 x 16.5 cm. Compression of the adjacent psoas muscle and upper pole the left kidney remainRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 2.8 x 1.8 cm lesion in the subcutaneous fat of the left anterior abdomen is stable (series 4, image 101). The lesion in the subcutaneous fat at the level of the right iliac crest is also unchanged (series 4, image 157).OTHER: 1.6 x 1.6-cm calcified splenic artery aneurysm, stable.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Soft tissue mass abutting the bowel in the mid pelvis is not significantly changed, much of which represents vascularity.BOWEL, MESENTERY: Sutures are noted at the rectosigmoid colonBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: Overall stable primary metastatic disease.Mildly improved pulmonary opacities, likely secondary to drug reaction in this clinical scenario.


Instruction: Generate impression based on medical findings.

Input: Sickle cell disease with chest pain and cough Persistent unchanged scattered and largely basilar scarring consistent with known sickle cell disease. Mild to borderline cardiomegaly. No specific superimposed findings to suggest infection or infarction. Azygos lobe unchanged, a normal variant.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: FemaleReason for Study: Reason: eval for pneumoniat History: fever, cough productive of purulent sputum, Left lower lung rhonchi The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: Eval for infection, consolidation, edema History: Shortness of breath, Leukocytosis Sternotomy with mild to moderate cardiomegaly.Improving basilar opacities suggestive of edema, pleural effusions and resolving atelectasis.

Output: Cardiomegaly with improving basilar opacities and no reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate ballon pump positioning History: above Superior metallic margin of the IABP terminates 1.5 cm from the top of the aortic arch. Other iatrogenic device are unchanged. No new focal lung consolidation. Unchanged cardiomegaly. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: No substantial difference compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Evaluate for right sided effusion. History of pancreatitis. Large right pleural effusion. Underlying airspace disease cannot be excluded. The cardiomediastinal silhouette is unremarkable. The left lung is clear.

Output: Large right pleural effusion. Underlying airspace disease cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: ro pneumonia History: cough, fever Stable cardiomediastinal silhouette.Bronchial wall thickening similar to the prior exam.No focal areas of consolidation.No pleural effusions.

Output: Bronchial wall thickening without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Fever of unknown origin patient w/ persistent cough. Eval for aspiration, obstructive pneumonia History: Persistent fever, cough Respiratory motion degrades fine detail. Small lung volumes and cardiomegaly are unchanged. Tracheal deviation at the thoracic inlet likely secondary to a goiter.Multiple bilateral pulmonary nodules compatible with metastases.No specific evidence of infection or edema.

Output: Multiple metastases without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: pleural effusion, s/p pleurex History: pleural effusion Extensive lobulated right pleural thickening consistent with tumor, unchanged.Small right pleural effusion stable, Pleurx catheter unchanged in position.Left hemithorax unremarkable.Left subclavian catheter, tip at cavoatrial junction.

Output: No change in right pleural effusion or pleural tumor, and no pneumothorax, Pleurx catheter unchanged in position.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with history of bilateral subsegmental PE and palpitations. PULMONARY ARTERIES: Pulmonary embolus examination performed with diagnostic technique demonstrates no evidence of pulmonary embolus. Pulmonary arteries are normal in size and patent in appearance. LUNGS AND PLEURA: Stable appearance of the right upper lobe pulmonary nodule measuring approximately 4.2 mm as best seen on image 22/150, series 9.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. Heart size within normal limits. No evidence of pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No evidence of pulmonary embolus.2. Stable appearing right upper lobe pulmonary nodule. If patient has a history of smoking, a one year follow up is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: TLC placement, CHF and breath Interval placement of right internal jugular central venous catheter with its tip in the SVC. ETT tip 4 cm above the carina. Dobbhoff tube tip in the gastric fundus.Cardiomegaly, unchanged. Bilateral pleural effusions and nonspecific bibasilar airspace opacities, unchanged. No pneumothorax.

Output: Right central venous catheter tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: ETT placementVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right internal jugular central line again noted. The right chest tube is unchanged. Again partially visualized multiple hepatic artery embolization coils. Cardiothymic silhouette normal. Bilateral lung opacities again noted not significantly changed. There are bilateral small pleural effusions without pneumothorax.

Output: ET tube tip below thoracic inlet and above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Follow up ICU chest x-ray. Chronic systolic heart failure. Heart transplantation. Small effusion and underlying right basilar consolidation, stable. Left lung base is now essentially clear. Right jugular catheter and chest drainage catheters has been removed. No pneumothorax. Left PICC line tip over the left subclavian vessels. Additional lines are stable.

Output: No pneumothorax status post right jugular and chest drainage catheter removal. Stable right pleural effusion and right basilar consolidation. Improved left base opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: infectious workup, altered metal status The heart size is at the upper limit of normal. No focal pulmonary opacities, pleural effusion, or pneumothorax. No specific evidence of pneumonia.

Output: Normal exam given semiupright portable technique. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Increased respiratory rate. Heart failure Interval replacement and/or repositioning of the right jugular dialysis catheter, tip projects into the proximal SVC. NG removed.Underlying cardiopulmonary appearance is otherwise similar with decreased volumes with basilar subsegmental atelectasis. Known right suprahilar mass similar in appearance

Output: Repositioning and/or replacement of right jugular dialysis catheter


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of renal transplant and fever of unknown origin CHEST:LUNGS AND PLEURA: Trace bilateral pleural effusions.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. Index right paratracheal lymph node measures 1.7 x 1 cm on image number 30, series number 3. Calcifications near the heart. Trace pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver which cannot be characterized as a lack of IV contrast. Index right lobe lesion measures 2.1-cm in diameter image number 74, series number 3.SPLEEN: 2-cm nonspecific densities within the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys consistent with patient's known history of chronic renal failure.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive peritoneal calcifications throughout the abdomen and in the pelvis. These can be seen in patients with chronic renal disease undergoing dialysis, however, metastatic process cannot be excluded.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Transplant kidney is noted within the right iliac fossa. No evidence of hydronephrosis. Chief measures 13 cm, slightly enlarged.PELVIS:UTERUS, ADNEXA: Lack of IV contrast limits optimal evaluation.. There is soft tissue in the region of the uterus. Further evaluation with pelvic ultrasound and clinical history is recommended.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal calcifications.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited study due to lack of IV contrast. No CT findings to explain patient's fever.Borderline enlarged mediastinal lymph nodes.Extensive peritoneal calcifications. These can be seen in patients with chronic renal failure undergoing dialysis, however, metastatic peritoneal disease cannot be entirely excluded.Pelvic soft tissue density in the region of the uterus. Pelvic ultrasound is recommended for further evaluation of the uterus


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for PNA History: Hx COPD, here with 4 days SOB, DOE, cough productive of white-yellow sputum Normal heart size with a mitral valve ring and intact sternotomy fixation devices.No sign of pneumonia or other acute pulmonary abnormalities.Focal scar-like nodular opacity in the left upper lobe, better evaluated on a recent CT scan.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Renal failure, HTN, EKG showing LV strain pattern, evaluate for cardiomegaly History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: evaluate location of ET tube after repositioning Enteric tube has been advanced with side port now within the body of the stomach. Endotracheal tube, unchanged. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax. Hilar fullness again noted.

Output: Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: 46 years old Male. Reason: inhalation injury, ETT placement History: inhalation injury, ETT placement. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The tip of the ET tube is about 4.3 cm above the carina. The cardiac silhouette is normal. The enteric tube tip is below the lower margin of the image.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old with Hypoxia. Increasing opacity at the left base is consistent with a pleural effusion with underlying consolidation and atelectasis. There is also a stable right pleural effusion. Extensive airspace opacities are again present as characterized on yesterdays chest CT although there is mild interval improvement in the left upper lobe opacity. The ET tube is in appropriate stable position and an enteric tube projects over the stomach extending beyond the field-of-view. A right internal jugular central venous catheter terminates at the cavoatrial junction and is in stable position. An anterior chest wall plate and screws are unchanged in position, however the right inferior screw has partially withdrawn although is unchanged in position compared to prior chest x-rays.

Output: Extensive bilateral airspace opacities as previously described on yesterday's chest CT with some improvement in the left upper lobe opacity and increasing left lower zone opacity, compatible with edema, effusion, and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: placement of R IJ TLC History: see above Extensive nodular opacities consistent with impacted bronchi in this patient with known cystic fibrosis.Focal nodular opacity developing in the left midlung could represent a site of infection.ET tube tip high, its 8 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Mucoid impaction and possible developing infection left midlung, with known cystic fibrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia? low grade temp History: as above..getting chemo Unremarkable cardiac and mediastinal silhouette. Port catheter with its tip in the SVC.Focal scarring in the left upper lobe.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for residual infectious processes or new intersitial findings. History: Worsening PFTs, more SOB Unremarkable cardiac and mediastinal silhouette. Large lung volumes suggest COPD with mild blunting of the posterior costophrenic angles, likely chronic.No acute abnormalities.

Output: Probable COPD but no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Status post MAZE Interval resolution of previously seen basilar atelectasis and pleural effusions.Cardiomegaly with left chest wall ICD in place, unchanged.

Output: Interval resolution of basilar atelectasis and bilateral pleural effusions.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: Reason: iabp placement History: see above Aortic balloon catheter markerProjected 2 cm below the top of the aortic arch. ICD lead, cardiomegaly and moderate left pleural effusion unchanged.

Output: Balloon catheter marker 2 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: FemaleReason for Study: Reason: central line placement History: central line placement Left central venous catheter with its tip in the SVC.The cardiac mediastinal silhouette is unremarkable.The lungs are clear.Multiple surgical clips in the right upper abdomen with right upper quadrant drainage tube noted.

Output: Placement of left central venous catheter without complication. No acute cardiopulmonary abnormalities. Interval right upper quadrant surgery.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval for PNA History: Fever, malaise, productive cough, SOB since Monday Cardiomegaly.Bronchial wall thickening is present consistent with asthma or chronic bronchitis.No reliable evidence of pneumonia.

Output: Cardiomegaly with bronchial wall thickening suggestive of asthma or chronic bronchitis, or possible viral infection.


Instruction: Generate impression based on medical findings.

Input: 40 year-old male with metastatic sarcoma CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule measures 9 by 8mm image number 40, series number 5. The lesion is smaller compared to previous study. Other lung nodules are also smaller.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal mass measures 3.9 x 3.6 cm on image number 9 in 6, series number 3, smaller compared to previous study. Enhancement of the lesion is decreased. Extension of the tumor thrombus into the right renal vein and possibly to the IVC is unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Thickwalled bladder suspicious for cystitis.LYMPH NODES: Reference right external iliac lymph node measures 10 by 8mm image number one on the 60, series number 3, unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the lung nodules and right renal mass. Retroperitoneal and pelvic lymph nodes are stable.


Instruction: Generate impression based on medical findings.

Input: 18-year-old male. AMS, respiratory failure. Fulminant hepatic failure. CHEST:LUNGS AND PLEURA: Diffuse multifocal areas of airspace disease and extensive bibasilar consolidation right greater than left. The latter aspiration pneumonias. Some of these have fuzzy margins - rule out drug reaction in addition.MEDIASTINUM AND HILA: ET tube in place. NG tube in place. Small shotty axillary nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver normal size 18 cm cephalocaudad. Normal density no evidence of fatty liver. No focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered shotty retroperitoneal nodes.BOWEL, MESENTERY: Generalized mild small bowel dilatation consistent with ileus. No ascites. No intramural air or free air. NG tube tip in the stomach.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Ileus. No ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Generalized ileus. Diffuse patchy airspace disease rule out pneumonia, aspiration, drug reaction superimposed.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Shortness of breath History: Shortness of breath Endotracheal tube terminates 2 cm from the carina. Enteric tube remains with the proximal aspect of the stomach. No new focal lung consolidation. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent mildly bronchial wall thickening again nonspecific and possibly related to asthma and/or bronchitis. No new superimposed focal airspace process. No effusionsCardiac and mediastinal contours are within limits

Output: Bronchial wall thickening concerning for asthma and/or bronchitis


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with history of dyspnea. Evaluate Pleurx. Right Pleurx catheter unchanged in position. Stable appearing right pleural effusion accounting for technical differences. The left lung is unremarkable. Left 6th rib metastatic lesion with probable pathologic fracture. Stable cardiomediastinal silhouette.

Output: Stable right Pleurx catheter and pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female; 60 years old. Reason: r/o pulmonary edema History: shortness of breath Stable right jugular central venous catheter.Stable cardiomegaly.Small bilateral pleural effusions with underlying atelectasis and probable edema, similar to prior study.

Output: No significant interval change in findings suggestive of mild CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: intubated History: intubated Unchanged pulmonary edema with small pleural effusions.Mild improvement in left basilar consolidation.ET tube tip 7 cm above the carina.Left subclavian ICD, leads unchanged in position.Right PICC, tip in the SVC.An NG tube terminates in the stomach.IVC filter noted.

Output: Improvement in left basilar consolidation but unchanged edema and pleural effusions. ET tube tip 7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of dyspnea. Evaluate for pneumonia or pleural effusion. Severe cardiomegaly with basilar predominant interstitial opacities compatible with edema. The pulmonary arteries are enlarged consistent with pulmonary arterial hypertension. Tracheostomy tube unchanged.

Output: Severe cardiomegaly, pulmonary edema and findings of pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: FemaleReason for Study: Reason: chest pain and productive cough History: above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Lung transplant Essentially unchanged fibrotic changes throughout the native left lung without discrete superimposed new focal airspace process. The right lung otherwise remains clear other than mild pleural thickening/scarring.Cardiac and mediastinal contours are otherwise grossly within limits demonstrate similar right to left shift.Lower cervical spine spine fixation unchanged yet limited in evaluation

Output: Chronic interstitial opacities throughout the left lung with otherwise unremarkable transplanted right lung


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: picc insertion History: picc insertion Persistent right-sided airspace opacity suggestive of infection or aspiration.Cardiomegaly noted, unchanged.Right PICC, tip in the SVC.

Output: Right PICC, tip in the SVC. Unchanged right-sided airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: History of tobacco use without weight loss, evaluate for thoracic abnormality. Cardiomediastinal silhouette within normal limits.Mild basilar predominant interstitial opacity without additional focal opacities. No suspicious pulmonary nodules or masses.

Output: Mild basilar predominant interstitial opacity, presumably chronic in the absence of prior comparison exams. No suspicious pulmonary nodules or masses, though CT could be obtained for further evaluation as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: lungs after chest tube removal Tracheostomy in place. Left IJ sheath noted. Defibrillator lead, unchanged. LVAD remains in place. No substantial change in diffuse pulmonary opacities given differences in inspiration. Unchanged cardiomegaly. Small left pleural effusion. No significant pneumothorax.

Output: No significant pneumothorax. No substantial change in diffuse pulmonary opacities given differences in inspiration.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with metastatic breast cancer status post chemo x 3 cycles. LUNGS AND PLEURA: Left apical fibrosis and bronchiectasis, likely the sequela of prior radiation therapy, are unchanged. Scattered pulmonary micronodules and scarlike opacities are unchanged. No focal consolidation, edema or pleural effusion. MEDIASTINUM AND HILA: The esophagus is patulous and fluid-filled, not significantly changed. Right hilar lymphoid tissue measures 1.4 x 1.7 cm on axial image 46/135 and is slightly smaller (measured 2.0 x 1.3 cm on 1/21/08). No new mediastinal or hilar lymphadenopathy. CHEST WALL: Status post left mastectomy. Left axillary surgical clips. Soft tissue density anterior to the clavicles with some adjacent fat stranding may be related to radiation therapy and is not significantly changed. Right-sided Port-A-Cath in place with its distal tip in the SVC.Lumbar scoliosis and degenerative changes affect the spine.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: The pancreas is atrophic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted

Output: No evidence of disease progression in the chest or abdomen. Other stable findings as above.


Instruction: Generate impression based on medical findings.

Input: Chest pain Diffuse mild interstitial changes without new superimposed acute cardiopulmonary abdomen. Borderline to mild cardiac magnet exaggerated due to scoliosis and portable technique. Overall appearance suggests chronic interstitial changes without additional abnormality

Output: Chronic interstitial changes with borderline cardiomegaly exaggerated due to technique


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with chest pain. Evaluate for etiology Cardiomediastinal silhouette is normal. No focal pulmonary opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Pneumonia. ETT 2.5 cm above the level of the carina. NGT tip off the caudal margin of the film.Layering pleural fluid on the right similar in appearance. Bilateral airspace opacities, right greater than left, without appreciable change.

Output: No acute change in pleural fluid and airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old evaluate ETT position and for interval change. ET tube retracted and tip approximately 4 cm above the carina. Additional support devices are unchanged.Stable cardiomediastinal silhouette. No new pulmonary opacity, pleural effusion or pneumothorax.

Output: Interval retraction of ET tube. No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Requesting second opinion regarding ILD diagnosed by outside M.D. History of cough and SOB. LUNGS AND PLEURA: Predominantly subpleural cystic and reticular opacities in the upper lobes, suggestive of emphysema with associated chronic interstitial disease.Relatively mild subpleural abnormalities at the lung bases with mainly reticular components and minimal honeycombing visible on the prone scans.Mild to moderate air trapping at the lung bases on the expiration views. MEDIASTINUM AND HILA: Extensive lymphadenopathy in the mediastinum, particularlyenlarged main pulmonary arch drain measuring 43 mm in diameter, suggestive of pulmonary hypertension.Moderate coronary artery calcification. in the paratracheal and prevascular areas with several lymph nodes measuring one to 1.5 cm in short axis.CHEST WALL: Moderate loss of height in the midthoracic vertebra with some associated degenerative change.UPPER ABDOMEN: Surgical clips in the gallbladder bed.Relatively small kidneys which are incompletely visualized with some perirenal fat stranding.

Output: 1. Features suggestive of both emphysema and interstitial fibrosis, most marked in the upper lobes but also involving the lung bases. Differential diagnosis includes UIP and hypersensitivity lung disease.2. Mediastinal lymphadenopathy and probable pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: History of brain tumor and shunt. Motor vehicle accident Shunt: The shunt appears intact without evidence of disruption or dissociation of the radiopaque portions. The proximal tip projects approximately 3 to 5 cm cranial to the sella along the midline. Shunt settings were not possible given angulation. The shunt traverses the anterior soft tissues of the right chest wall and extend into the abdomen terminating in the mid to lower abdomen along the midline.Skull: Discrete bur hole overlies the right occipital parietal margin. Old craniotomy appears intact with anchoring hardware and overlying mesh.C-spine: Minimal degenerative changes with maintenance of alignment. Soft tissues unremarkable.Chest: No cardiopulmonary abnormalityAbdomen: Unremarkable bowel gas patternC-spine: C-spine is well visualized in its entirety with maintenance of the vertebral body heights, alignment and disk spaces. Soft tissues are unremarkable. Neural foramina appear patent bilaterally.

Output: Grossly intact shunt as described above. No immediate acute shunt abnormalities observed within limitation in absence of prior exams for comparison


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Right-sided weakness. The left upper lobe is absent. Chronic mild pleural thickening, left greater than right, unchanged. Basal opacities unchanged and may reflect rounded atelectasis or organizing pneumonia, nonspecific by plain film.. Linear scarring in the left lung similar to previous.

Output: Chronic pulmonary and pleural abnormalities but no signs of aspiration or other acute pulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: MaleReason for Study: Reason: R/o pneumothorax History: Chest tube removal Right-sided chest tube and left IJ venous catheter have been removed.No significant pneumothorax identified.Stable cardiac enlargement.Interstitial opacities and bilateral pleural effusions redemonstrated.Left retrocardiac atelectasis improved from the prior exam.Median sternotomy intact without evidence of aortic valve replacement.

Output: Right-sided chest tube removed without evidence of a pneumothorax. Improvement of the left basilar atelectasis with persistent small pleural effusions and interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: assess NGT placement The trajectory of the enteric tube is obscured by motion artifact although appears to extend below the diaphragm.Interval progression of now multilobar and extensive consolidative opacities involving both lungs, indeterminate in nature and possibly multifactorial in nature. Differential diagnosis is wide, including infectious and noninfectious etiologies. Correlate with patient's history.The cardiac and mediastinal contours are obscured.

Output: The trajectory of the enteric tube is obscured by motion artifact although appears to extend below the diaphragm.Interval progression of extensive multilobar consolidative opacities, indeterminate in nature. Correlate with patient's history.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: eval for infiltrate, edema, and/or atelectasis History: increasing o2 requirement Slight worsening of edema and enlargement of pleural effusions.Left lower lobe consolidation.Status post sternotomy for mitral and aortic valve replacements.Left PICC, tip at cavoatrial junction level.

Output: CHF and possible left lower lobe pneumonia, with pleural effusions that on the right extending into the fissure.