Instruction: Generate impression based on medical findings.

Input: 62-year-old male evaluate for gastrointestinal stromal tumor progression CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small right adrenal nodule is unchanged measuring 1.8 x 1.2 cm on image number 98, series number 3. Other nodule in the right adrenal gland is also unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Round, well-defined gastric mass is grossly unchanged measuring 3.3 x 3.1 cm on image number 93, series number 3.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Pelvic images are significantly affected from the left hip prosthesis artifact.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Evaluate for pneumonia, productive cough Lower thoracic and lumbar immobilization hardware partially visualized. Several catheters are noted posterior to the patient.Basilar atelectasis and trace pleural effusions. Lung volumes are large, suggestive of emphysema, with scarlike opacity at the right apex. No specific evidence of pneumonia. Heart size is normal.Several air-filled loops of colon are present; however, pneumomediastinum is also noted. Findings were discussed with Dr. Devine at time of image interpretation.

Output: Pneumomediastinum. Likely emphysema with scarlike opacity right upper lobe. Suggest continued surveillance of these nodules with radiographic follow-up recommended after acute abnormalities are addressed.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Chest pain evaluate for cardiopulmonary disease. Low lung volumes. Mild basal atelectasis on the right. Tortuous thoracic aorta. Mild thickening of the fissures and unsharpness of the pulmonary vasculature may indicate very mild pulmonary edema.

Output: Nonspecific findings which may indicate mild pulmonary edema versus underinflation artifact.


Instruction: Generate impression based on medical findings.

Input: Evaluate for position of enteric tube Residual contrast in portions of colon, making evaluation suboptimal. No specific evidence for bowel obstruction. Interval removal of previously seen enteric tubes. Now visualized catheter overlying left upper quadrant laterally with additional smaller caliber catheters overlying upper mid abdomen (see key images), uncertain whether related in part to reported enteric tube. Right-sided pelvic nephroureteral stent related to renal transplant. Multiple surgical clips and skin staples.

Output: Evaluation for reported enteric tube suboptimal, refer to discussion above.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: eval enteral tube History: eval enteral tube Improved inflation but worsening of basilar airspace opacities accompanied by pleural effusions and retrocardiac atelectasis.Embolization coils noted probably and bronchial arteries.Heart size normal.An NG tube terminates in the stomach.ET tube tip approximately 5 cm above the carina.

Output: Improved inflation with increased airspace opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Assess for Pleural effusion History: SOB Moderate left-sided pleural effusion with left basilar atelectasis again noted. Increase in small right pleural effusion with increased right basilar opacity. No new focal lung consolidation. Unchanged heart size. No pneumothorax.

Output: Moderate left-sided pleural effusion with left basilar atelectasis again noted. Increase in small right pleural effusion with increased right basilar opacity, likely atelectasis or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: intubated History: intubated Nonspecific basilar opacities compatible with atelectasis and aspirated secretions.ET tube tip approximately 4 cm above the carina.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.PICC placement. Right midline catheter terminates in the periphery of the right subclavian vein.Lung volumes remain low with basal scarring and a chronic appearing interstitial abnormality.

Output: Right midline catheter terminates in the projection of the lateral right subclavian vein.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: assess PICC line tip position History: 55 y.o. woman with gastric bypass and severe edema and hypoproteinemia requiring PN PICC terminates in the superior aspect of the SVC. Mild bibasilar opacities with small pleural effusions. No pneumothorax. Mild cardiomegaly.

Output: PICC terminates in the superior aspect of the SVC. Mild bibasilar opacities which may represent atelectasis and/or consolidated lung with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: 2 years s/p LUL for T2aN0 stage IB adenocarcinoma History: follow up Stable cardiomediastinal silhouette.Persistent elevation left hemidiaphragm and mild volume loss in left lung related to prior surgery.The right lung is clear.

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


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: 51F w/ h/o metastatic breast ca on PDL1 inhibitor who presents w/ fever, cough, abd pain and diarrhea, eval for infection History: cough Left-sided Port-A-Cath with its tip in the SVC.The cardiomediastinal silhouette is unremarkable. The lungs are clear.No large pleural effusions.Evidence of a right mastectomy and left breast prosthesis..

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


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with extensive stage small cell lung cancer status post 4 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Interval development of right lower lobe nodular air space opacity which, given the rapid time course of development, most likely represents infection, possibly bacterial or fungal.Nodular opacity within the right major fissure is unchanged (axial image 37/90). Previously noted right upper lobe nodule is not seen on the current exam. Left upper lobe nodule is unchanged (axial image 22/90). Scattered additional micronodules unchanged.No pleural effusions.MEDIASTINUM AND HILA: A right paratracheal lymph node is slightly smaller measuring 1.2 x 2.1 cm on axial image 31/141 (compared to 2.4 x 1.4 on 2/4/08). Right hilar lymphoid tissue is also slightly smaller measuring 1.7 x 1.4 cm on axial image 41/141 (compared to 1.8 x 1.6 cm on 2/4/08). Borderline enlarged subcarinal lymph node is unchanged (axial image 47/141).Cardiac size is normal with no pericardial effusion.CHEST WALL: Right-sided Port-A-Cath with its distal tip in the right atrium. Multiple metastatic lesions to the vertebral bodies are unchanged including a minimal compression fracture of a lower thoracic vertebral body (coronal image 39/113).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule is stable measuring 1.3 x 1.3 cm on axial image 90/141.KIDNEYS, URETERS: Small bilateral renal cystlike lesions are unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal metastatic disease to the bones as above.OTHER: No significant abnormality noted

Output: 1.New right lower lobe airspace disease which is most likely infectious in etiology.2.Interval decrease in the size of reference lymph nodes.3.Stable bony metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB and LE edema s/p delivery, eval for pulm edema History: SOB and BLE edema Heart size about upper normal. Lower zone interstitial opacity with multiple septal lines compatible with edema and minimal pleural effusions.

Output: Mild interstitial edema and minimal pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for tamponade/effusion History: dropped BPs s/p surgery ET tube tip 7.5 cm above the carina. Swan-Ganz catheter tip in the right main pulmonary artery partially withdrawn since the previous radiographs.Cardiomegaly with marked mediastinal widening in the area of the aortic arch and adjacent pulmonary opacity that may represent atelectasis or loculated fluid.Basilar subsegmental atelectasis.

Output: Large mass in the area of the aortic arch that may represent hematoma, not appreciably changed. A contrast-enhanced CT scan is recommended if one has not been performed elsewhere recently.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Renal cell transplant on prednisone, febrile with cough. Low lung volumes unchanged. Normal heart size. Tortuous thoracic aorta. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: ett History: ett Improvement in upper lobe opacities.Stable appearance of basilar opacities, left greater than right.No pneumothorax.Stable line position.

Output: Interval improvement in the upper lobe opacities with no change in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Asthma rule out structural lung disease. Normal heart size.No focal airspace opacities or pleural fluid. No pneumothorax or pneumomediastinum.Dense well-circumscribed opacity projecting over the superior mediastinum most likely represents the overlying manubrium.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Hypoxia. Evaluate for aspiration versus edema. Borderline cardiomegaly with mild left basilar predominantly interstitial opacities which are stable and could represent atelectasis, aspiration or scarring. Right jugular line tip over the SVC. No pneumothorax.

Output: Mild left basilar opacities, stable.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female evaluate pneumothorax status post right thoracentesis. Small to moderate right sided pneumothorax not significantly changed with associated layering fluid at the base. Peripheral right mid lung nodule unchanged compared to prior CT. Normal cardi0mediastinal silhouette.

Output: Small to moderate right sided hydropneumothorax not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: effusion History: SOB ET tube tip approximately 3 cm above the carina.Venous catheters unchanged.Airspace and interstitial pulmonary opacity and small effusions unchanged.Pigtail catheter at the right lung base.

Output: Small effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Worsening DOE, history of sarcoidosis question airway disease. Bilateral basal scarring. Low lung volumes. No pleural fluid, pneumothorax or focal airspace opacity. No visible lymphadenopathy. Heart size is unchanged.Though the patient is slightly rotated, there appears to be progressive rightward tracheal deviation by a left paratracheal soft tissue mass, statistically most likely a goiter. The trachea appears to be patent.

Output: No acute pulmonary abnormality. Interval progression of rightward tracheal deviation due to a probable thyroid goiter with substernal extension.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: chest pain History: as above The cardiomediastinal silhouette is normal.There are no focal pulmonary opacities or large pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old. Reason: cardiac silhouette; lung infiltrate History: chest pain; cough Moderate cardiomegaly consistent with history of Ebstein anomaly. Interval placement of an ASD occluder.No convincing evidence of pulmonary arterial enlargement. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: Cardiomegaly without acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male with large cell lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: Evaluate for causes of chest pain History: Chest discomfort Severe cardiomegaly status post sternotomy, with a tortuous aorta.Foci of subsegmental atelectasis or linear scarring are present, but no acute edema or pneumonia.

Output: Severe cardiomegaly and a tortuous aorta, unchanged. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 22-year-old male presents with hypoxia. Evaluate for pneumonia. An endotracheal tube is approximately 1.5 cm above the carina. Enteric tube extends below the field-of-view. A right internal jugular venous catheter has its tip overlying the superior vena cava.The cardiomediastinal silhouette is normal. Right basilar opacities consistent with atelectasis due to mucoid impaction. New right pleural effusion. Left basilar opacities as with aspiration appears slightly improved. No pneumothorax.

Output: Right lower lobe atelectasis likely due to mucus impaction, worsen from prior. Slightly improved left basilar consolidative opacities, consistent with aspiration pneumonia. Attention on follow-up.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: concern for expanding pneumo History: hypotension ET tube in high position with its tip approximately 7 cm above the carina.NG tube with the side port in the stomach.Stable cardiomediastinal silhouette.Left lower lobe airspace opacity compatible with infection.Right lung is clear.No significant pneumothorax identified.

Output: ET tube in a high position. Increasing left lower lobe airspace opacity compatible with infection/aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: 49 year old with known right sided malignant pleural effusion now status post pleurX catheter placement, evaluate effusion, pneumothorax History: SOB Right Pleurx coiled at the right lung base with interval decrease in right pleural effusion. No significant pneumothorax. Other findings stable.

Output: Right Pleurx coiled at the right lung base with interval decrease in right pleural effusion. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male patient with right lower lobe lung cancer. Evaluate lobar quantification. The comparison chest radiograph performed on 05/17/2016 demonstrates a large right lower lobe opacity and right pleural effusion.The ventilation images show an absence of ventilation in the right lower lung, corresponding to the large consolidation seen on chest radiograph. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show an absence of perfusion in the right lower lung, corresponding to the large consolidation seen on chest radiograph.Quantitation of relative single breath ventilation (using the posterior image):Left lung: 83.2 % (upper segment 18.2%; middle segment 42.6%; lower segment 22.5%)Right lung: 16.8% (upper segment 4.9%; middle segment 10.7%; lower segment 1.2%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 86.4% (upper segment 17.4%; middle segment 50.2%; lower segment 18.8%)Right lung: 13.6% (upper segment 4.5%; middle segment 8.3%; lower segment 0.8%)

Output: Absence of ventilation and perfusion in the right lower lung, corresponding to findings seen on chest radiograph and CT. Perfusion with quantitative values as described above.


Instruction: Generate impression based on medical findings.

Input: Fever No definite significant interval change in the cardiopulmonary appearance, however the both lung bases are not well visualized due to semiupright positioning. Again serial imaging and/or possibly follow-up lateral projection if patient can tolerate would be helpfulRight jugular catheter extends into the mid SVC. Unchanged right subclavian stent.Extensive pancreatic calcifications project over left upper quadrant

Output: No apparent interval change or new acute abnormality within the limitations described, see above


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: FemaleReason for Study: Reason: cough, pleurtic pain, shortness of breath, evaluate for pneumonia History: as above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No pneumothorax is identified.

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


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Chest pain. Evaluate for abnormality. No abnormal focal pulmonary opacitiesNo pleural effusions, or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Weight loss and smoking history No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Stroke Moderate nonspecific cardiomegaly with minimal basilar streaky densities in the left lung base probable atelectasis. Aspiration and/or event early infection cannot entirely be excluded requiring serial imaging.ETT terminates 3 cm above the carina. ICD and NG tube are otherwise observed in grossly expected positions

Output: ETT well-positioned


Instruction: Generate impression based on medical findings.

Input: Female; 49 years old. Reason: Metastatic colorectal cancer, placement needed prior to the start of chemo, please provide bi-dimensional measurements History: none CHEST:LUNGS AND PLEURA: Multiple scattered pulmonary nodules bilaterally. The largest in the right base (series 4 image 67) measures 5 mm.. No prior chest CTs for comparison, however, no lesions were present in the lung bases on abdomen/pelvis CT 2/10/12, consistent with metastases. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall port tip in the SVCABDOMEN:LIVER, BILIARY TRACT: Progression of innumerable hypoattenuating lesions with new lesions, nearly replace the left hepatic lobe, consistent with metastases. Reference lesion in the lateral left hepatic lobe (series 3 image 77) measures 2.1 x 1.7 cm. Additional reference lesion in the medial left hepatic lobe (series 3 image 90) measures 2.2 x 2.3 cm.The gallbladder is not well visualized.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: Borderline enlarged gastrohepatic and retroperitoneal lymph nodes, increased from prior.BOWEL, MESENTERY: Right lower quadrant ostomy, new from prior. Circumferential bowel wall thickening in the sigmoid flexure with adjacent fat stranding and lymphadenopathy, consistent with primary neoplasm, overall, stable from prior. Transverse colon proximal to this lesion is dilated and distal colon are decompressed, similar to prior.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Progression of metastatic disease with new pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: h/o asthma \T\ prior PEs \T\ PNA , SOB/asthma exam History: SOB No evidence of airspace opacity, pneumothorax or pleural effusion. Cardia mediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Evaluate IABP placement History: s/p IABP The intra-aortic balloon, marker is now positioned with in the mid descending thoracic aorta, repositioning is advised. The left univentricular AICD electrodes unchanged.Stable cardiomegaly without pulmonary edema. No pneumothorax.

Output: Intra-aortic balloon pump marker positioned in mid descending thoracic aorta, repositioning recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT History: ETT ET tube tip approximately 3 cm above the carina.Small lung volumes with resolving perihilar and basilar opacity compatible with atelectasis and aspirated secretions.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Shortness of breath. Bladder cancer. Underinflated lungs again noted. Linear retrocardiac opacity may reflect atelectasis or scarring. Lungs are otherwise clear. No pneumothorax.

Output: Linear atelectasis or scar at the left lung base. Lungs otherwise underinflated but clear.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with emphysema, mycetoma, recurrent pleural effusion. Thoracentesis with 450 cc removed. Evaluation for pneumothorax. Embolization coils project over the superior mediastinum.Increasing perihilar and basilar interstitial and airspace opacities with moderate pleural effusions. No pneumothorax. Unchanged cardiomediastinal silhouette.

Output: Increasing interstitial and airspace opacities with moderate pleural effusions most compatible with increasing pulmonary edema likely secondary to CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Anesthesia of skin, evaluate pneumonia. Left upper lobe paramediastinal mass consistent with known neoplasm. Areas of subsolid opacity just below the level of the mass in the upper lobes bilaterally could represent pneumonitis if the patient has had recent radiation therapy. Infection is possible but considered less likely.Lung volumes remain low normal. Basal scarring.Multifocal peribronchial opacities reflect underlying interstitial lung disease.Cervical spine stabilization hardware incompletely visualized.The upper thoracic vertebral body sclerosis previously was characterized as metastatic disease.

Output: Upper lobe opacities could be post therapeutic pneumonitis rather than infection if the patient has a history of radiation therapy to the left upper lobe mass. Infection cannot be excluded but is considered less likely.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate lung fields History: s/p CABG Marked cardiomegaly with evidence of previous median sternotomy.Small lung volumes with no specific evidence of edema or infection.Mild retrocardiac atelectasis.

Output: Cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Slow transit, constipation Suboptimal study secondary to patient motion artifact and technique. Persistent ileus noted.Please see same day chest radiography for additional findings.

Output: Persistent ileus, no significant change from prior exam when differences in technique accounted for.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval for PNA History: sepsis No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: History of sarcoma status post 20 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Stable 4 mm micronodule adjacent to the right oblique fissure (series 5, image 40), consistent with intrapulmonary lymph node. No new suspicious nodules or pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest port tip in the SVC. Small hiatal hernia.ABDOMEN:LIVER, BILIARY TRACT: Stable moderate intrahepatic biliary ductal dilatation. Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Stable mild pancreatic ductal dilatation with atrophy of the body.ADRENAL GLANDS: Stable left adrenal nodule.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The large, heterogeneous retroperitoneal mass which is situated posterior to the pancreatic head has mildly increased in size, now measuring 6.0 x 5.4 cm (image 96 series 4), previously 5.2 x 4.8 cm. The mass displaces and compresses the adjacent IVC without a defined fat plane between the two. The vasculature remains patent.Left periaortic lymph node is unchanged.Mild infrarenal abdominal aortic aneurysm with extension to the bifurcation is stable as is the borderline aneurysmal dilatation of the right common iliac artery.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hysterectomy. The hypodense right adnexal lesion again measures 3.4 x 2.6 cm (series 4, image 156), not significantly changed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe degenerative changes in the spine without suspicious focal osseous lesion.OTHER: No significant abnormality noted.

Output: Slight enlargement of retroperitoneal mass. Otherwise, stable examination.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with large cell lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Right thyroid nodule, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Feeding tube; left lower lobe collapse. Lines and tubes are unchanged. Dense left lower lobe opacification and small left pleural effusion again noted. Follow right basilar atelectasis, not substantially different. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged dense left lower lobe opacification, likely atelectasis, and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval for focal process History: cough, intermittent fevers Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval pulm edema, infection, effusion History: sob, crackles in R base, large volume of ivf recently from chemo w/ pulm edema prior to discharge Unchanged bilateral small pleural effusions with basilar atelectasis. Mildly progressed interstitial and airspace opacities and cardiomegaly compatible with edema.Right jugular central venous catheter terminates in the SVC.

Output: Cardiomegaly and findings compatible with edema, mildly progressed.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with pleuritic chest pain. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: No PE or other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate cardiomediastinum History: usual back pain Unremarkable cardiac and mediastinal silhouette. No significant pulmonary abnormalities.Healed rib fractures on the left, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: intubated History: intubated Support devices unchanged.Stable cardiomediastinal silhouette.Perihilar/basilar opacities compatible with edema and atelectasis.Pleural effusion similar to prior exam.Redemonstration of a mitral valve prosthesis.

Output: Support devices unchanged. Stable cardiopulmonary appearance with edema, atelectasis, and small effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: FemaleReason for Study: Reason: eval ETT, lung fields History: s/p MVR ET tube with its tip approximately 2 cm above the carina.Right IJ Swan-Ganz catheter with its tip in the right pulmonary artery.Chest/mediastinal tubes in place with suggestion of a right subpulmonic small pneumothorax.Right basilar opacities compatible with atelectasis and pleural effusion.Stable cardiomediastinal silhouette.Median sternotomy redo.

Output: Postoperative chest with right basilar opacity compatible with atelectasis and effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Reeval pulmonary edema. Interval extubation. Interval removal of enteric tube.Stable cardiac enlargement. Perihilar/basilar edema appears similar to the prior exam. There is interval increase in bilateral pleural effusions, left greater than the right.

Output: Interval increase in bilateral pleural effusions, left greater than the right. Perihilar/basilar edema not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: pleural effusions History: sob ; pleural effusions Little interval change in cardiomegaly with basilar opacities and effusions.

Output: No significant change in basilar opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Lupus with wheezing and crackles rule out consolidation. Small to moderate volume of pleural fluid bilaterally with associated atelectasis, minimally increased compared to the prior examination, though the lung volumes have improved. Cardiothoracic ratio remains upper normal. No focal airspace opacities.

Output: Small to moderate pleural effusions with associated compressive atelectasis at the lung bases.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Worsening pulmonary edema, pneumothorax, atelectasis. Run of SVT. Worsening hypoxia. Right central line with tip terminating at the cavoatrial junction, unchanged. Marked cardiomegaly, unchanged. Interstitial and airspace opacities, not appreciably changed. Unchanged moderate right and small left pleural effusions, with adjacent subsegmental atelectasis.

Output: Interstitial and airspace opacities, with marked cardiomegaly and bilateral effusions, not appreciably changed, compatible pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: icu History: icu Support devices, including the right upper extremity catheter with a redundant loop at the junction of the right jugular and brachiocephalic veins, are unchanged.Stable cardiomediastinal silhouette with moderate cardiomegaly.Large, possibly partly loculated, right pleural effusion is not significantly changed.No new pulmonary opacities or pneumothorax.

Output: Large loculated right pleural effusion is not significantly changed. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: s/p left lower lobe resection History: NA Support tubes and lines unchanged.Volume loss in left hemithorax compatible recent left lower lobe resection.Streaky bibasilar opacities suggest atelectasis, unchanged.Probable small left pleural effusion, unchanged.No pneumothorax.The heart size is normal.

Output: Basilar atelectasis and small left pleural effusion unchanged from the prior.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.HIV disease left lower lobe rales on exam. Sub-solid opacity in the right cardiophrenic angle with adjacent bronchial wall thickening. No pleural fluid, pneumothorax or pneumomediastinum. Normal heart size.

Output: Right lower lobe opacity suspicious for pneumonia. Recommend follow-up PA and lateral chest radiographs in 6 weeks to assess for resolution. Though this is most likely bacterial, if the CD4 count is below 200, a CT may be obtained to exclude the possibility of opportunistic infection.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: 78yoF pHTN p/w worsening function History: as above Dual-lead pacemaker unchanged. Basilar edema and small pleural effusions slightly improved. Apical calcification is unchanged.

Output: Basilar edema and small pleural effusions slightly improved.


Instruction: Generate impression based on medical findings.

Input: Reason: lung infiltrate History: SOB, cough Unremarkable cardiac and mediastinal silhouette. Large lung volumes consistent with emphysema. Interstitial opacity compatible with bronchiectasis and scarring. No specific evidence of pneumonia.

Output: COPD and bronchiectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Motion degrades sensitivity.Persistent nonspecific cardiomegaly with extensive patchy mixed interstitial airspace opacities greater in both bases and in the left lower lobe.

Output: Unchanged appearance including cardiomegaly and nonspecific multifocal pulmonary opacities


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: assess for pna History: cough Postsurgical volume loss and scarring in the right lung. The interstitial and airspace opacities in the left lower lung previously characterized on chest CT which likely represents postobstructive pneumonia related to partial obstruction of the left lower lobe bronchus visible in retrospect on recent chest CT, without interval change.. No large pleural effusion or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above No evidence of pulmonary metastases.

Output: No evidence of pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: eval lung fields History: s/p MVR, afib ablation ET tube, right IJ venous catheter, and right-sided chest tubes unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Small pneumomediastinum.No pneumothorax identified.Decreased lung volumes with basilar atelectasis.Small left pleural effusion.Mitral valve annuloplasty redemonstrated.

Output: Support devices unchanged. Basilar atelectasis and small left pleural effusion improved from the prior exam. Small pneumomediastinum without evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.6 months after right upper lobectomy for early stage adenocarcinoma. Interval resolution of right pleural fluid collection and subcutaneous emphysema. Mild elevation of the right hemidiaphragm with overall slight improvement in right lung volume.Postsurgical changes of a right upper lobectomy with a nonspecific scarlike opacity near the apex, recently evaluated by CT.Healed rib deformities on the left. Scattered granulomas.

Output: Postsurgical volume loss with scarlike opacity near the apex, please refer to separately reported recent CT. No additional new findings


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Fever evaluate for aspiration Lungs are clear. Heart size within normal limits. No pneumothorax. Tracheostomy and gastrostomy tubes again noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Failed RV lead extraction; New PPM generator implanted History: None ICD leads projected in the area the right atrial appendage and right ventricular apex.Retained lead fragments, unchanged from the previous radiograph.Tricuspid valve prosthesis in place.Mild cardiomegaly but no sign of CHF or infection.

Output: ICD leads in expected locations with retained fragments, unchanged from previous.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with bladder cancer CHEST:LUNGS AND PLEURA: Emphysema is unchanged. Mild biapical scarring and subcentimeter nodules are unchanged.MEDIASTINUM AND HILA: Calcified right hilar adenopathy unchangedCHEST 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: Left hydronephrosis and hydroureter is unchanged. Right-sided hydronephrosis as improved.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:Prostate: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy. Ileal conduit and ileostomy in the right lower quadrant.LYMPH NODES: Right inguinal lymph node is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval improvement of the right-sided hydronephrosis and worsening of the left-sided hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Neck pain, worse in the past two months. Chest pain and shortness of breath. LUNGS AND PLEURA: Smoothly marginated right lower lobe nodule (74/122) measuring 12 x 8 mm with internal calcification, suggestive of a benign etiology. Additional small nonspecific micronodules are present elsewhere.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Limited evaluation with no gross abnormalities.

Output: Small right lower lobe nodule with benign morphology and internal calcifications suggestive of a granuloma or hamartoma. No apparent basis for chest pain or dyspnea.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: 72yr old male with history of DLBCL; pre-auto sct evaluation History: evaluate Right chest wall port catheter tip in the low SVC.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No evidence of infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 88 yearsGender: MaleReason for Study: Reason: pacemaker placement? History: see above Left-sided pacemaker with lead wires in right ventricle and probably within the right atrium.There are decreased lung volumes with cardiac enlargement.Catheter noted extending from the inferior margin projected over the heart probably representing a pericardial drain.Perihilar interstitial opacities compatible with edema.Left retrocardiac consolidation/atelectasis and right middle lobe atelectasis.Probable small pleural effusions.Air-filled mildly dilated loops of bowel in the upper abdomen.No evidence of a pneumothorax.

Output: Left-sided pacemaker placement with lead wires in right ventricle and possibly in the right atrium although this cannot be stated with certainty. Recommend PA and lateral views. Right middle lobe atelectasis most likely related to patient's known carcinoid tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Endotracheal tube. Left subclavian line appears to now terminate at the brachiocephalic vein/SVC junction. Left IJ central venous catheter appears to been retracted slightly in the interim. Endotracheal tube has also been retracted, with the distal tip approximately 8 cm above the carina. Mid and lower lung opacities, unchanged. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Interval retraction of left IJ central venous catheter and endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: Subcutaneous emphysema and chest pain. Assess pneumomediastinum, chest wall emphysema and atelectasis. Extensive subcutaneous emphysema, left greater than right, about the same.Pneumomediastinum remains but is improved compared to earlier films this week. Left basal opacity favored to represent atelectasis or aspirate, about the same. Sternotomy hardware appears similar in alignment. Presternal soft tissue swelling increased in density, likely the result of subcutaneous edema but nonspecific.No specific signs of pulmonary edema, though there are trace residual pleural fluid collections.

Output: Improving pneumomediastinum. No significant change in subcutaneous emphysema or atelectasis. Probable increase in subcutaneous edema in the presternal region should be correlated with physical examination.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval ETT, lung fields History: s/p CABG Two left chest tubes but no pneumothorax.Mild basilar atelectasis left greater than right.Right jugular introducer unchanged.

Output: Unchanged basilar atelectasis with no pneumothorax. No ET tube identified despite the clinical history.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: bilateral pleural effusions, eval for interval change History: see above Stable cardiomediastinal silhouette. Bilateral pleural effusions and basilar atelectasis similar in appearance the prior exam.No new pulmonary opacities identified.

Output: Bilateral pleural effusions and basilar atelectasis without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: FemaleReason for Study: Reason: ARDS History: ARDS There are decreased lung volumes with mild cardiac enlargement and some widening in the mediastinum.Perihilar/basilar opacities are compatible with edema and atelectasis.Probable small pleural effusions.Dobbhoff tube with its tip in the stomach.Right PICC line with its tip in the RA.

Output: Bilateral pulmonary opacities compatible with edema/ARDS, infection and hemorrhage cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 66 year-old female with pancreatic head mass CHEST:LUNGS AND PLEURA: Calcified nodule in the right lung.MEDIASTINUM AND HILA: 4.2 x 4.5 cm hypervascular mass in the superior mediastinum likely arising from left lobe of the thyroid suspicious for thyroid neoplasm. Additional upper mediastinal adenopathy. A reference, lymph node measures 14 x 9 mm on image number 20, series number 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst, measuring 4-cm in diameter in the left lobe. Subcentimeter hypodense lesion on image number 17, series number 4 adjacent to the gallbladder in the liver, which is too small to accurate characterize. Heterogeneous enhancement of the liver secondary to invasion of the main portal vein. Intra-extrahepatic biliary dilatation.Gallbladder is also distended. 17 x 13 mm mass in the distal common bile duct causing biliary dilatation and dilatation of the cystic duct as well as the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic ductal dilatation in the tail and distal body of the pancreas. No definite mass is identified within the pancreas to explain this ductal dilatation. Pancreatic duct in the head and body are unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infiltrative soft tissue density encasing the celiac trunk, SMA, and invading the main portal vein and SMV.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: Mass in the region of the distal common bile duct causing biliary dilatation and hydropic gallbladder. Pancreatic duct is dilated focally in the distal body and tail. No definite mass could be identified to explain this dilatation on CT. Pancreatic duct in the head and body is normal in size. M.R.C.P. is recommended mended for evaluation of distal common bile duct and focal mass in the body of the pancreas.Infiltrative retroperitoneal mass encasing major vessels and causing thrombosis of the main portal vein.Subcentimeter lesion in the liver, nonspecific, however, metastatic disease cannot be excluded.Superior mediastinal mass, likely representing a thyroid neoplasm. Finding of aspiration is recommended. Additional upper mediastinal adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: s/p chest tube removal History: NA Interval removal of chest tubes. Very small bilateral pneumothoraces noted. Patchy bibasilar opacities with probable small pleural effusions. Unchanged heart size.

Output: Interval removal of bilateral chest tubes with small apical pneumothoraces, likely clinically insignificant. Patchy bibasilar opacities which may represent atelectasis and/or consolidated lung with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Concern for pneumonia History: abdomen pain, +trach and g tube Cardiac mediastinal silhouette is unchanged. Surgical clips overlie the upper chest and neck. Volume on the left is improved. The left hemidiaphragm is no longer elevated. Bibasilar atelectasis is improved. No specific evidence of infection or edema. No pneumothorax.Tracheostomy and G-tube are noted.

Output: No specific evidence of infection or edema. Improved aeration in the left lower lobe compare to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Chest pain Borderline cardiomegaly without superimposed frank acute cardiopulmonary abnormality. Specifically no definite findings to suggest infection or failure. Mild diffuse chronic change.Marked interval degenerative changes of both shoulders including changes suggesting AVN. Marked atherosclerotic changes greater on the right.

Output: No distinct acute cardiopulmonary abnormality superimposed upon mild diffuse chronic change


Instruction: Generate impression based on medical findings.

Input: 36-year-old male with history of metastatic colon cancer,planning for radioembolization. Expected radiotracer activity is identified throughout the left hepatic lobe. Minimal radiotracer uptake in the kidneys and thyroid gland is compatible with a minimal portion of free pertechnetate. No abnormal extrahepatic abdominal foci is otherwise evident. There is a small amount of activity in the lungs (lung fraction = 2.7%).

Output: Minimal lung shunting fraction as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Postop day 2 lung transplant. The lower left lateral chest tube has been pulled back slightly. Other chest tubes not significantly changed in position. Interval extubation, removal of enteric tube and Swan-Ganz catheter. The left subclavian introducer remains. Sternotomy hardware.Moderate right pleural effusion with fluid contusion along the chest tube tract. No significant sized pneumothorax. Mild edema-like abnormality.Minimal subcutaneous emphysema left chest wall. Gaseous distention of the stomach.

Output: Volume of pleural fluid on the right has slightly increased. Mild edema-like abnormality. Gaseous distention of the stomach.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Cough and fever. Heart size is at least upper normal. Linear scarring in the left midlung. No focal airspace opacities. Severe spinal osteophyte formation.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: eval line placement History: new line placed Low lung volumes. No focal lung consolidation. Iatrogenic devices are unchanged. Unchanged mild cardiomegaly. No pneumothorax or large pleural effusion.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: PNA workup History: leukocytosis Left chest port with tip in the SVC, directed medially.Basilar pulmonary opacities and pleural effusions, unchanged. No pneumothorax.Unchanged cardiomediastinal silhouette, with mild cardiomegaly.Severe degenerative changes affect both shoulders as well as the thoracic spine.

Output: Bilateral lower lung zone pulmonary opacities and pleural effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Cough and wheezing. Evaluate for pneumonia. No focal pulmonary opacities, pleural effusion, or pneumothorax.Enlarged pulmonary arteries, suggestive of severe pulmonary hypertension. Equalization of pulmonary blood flow, without evidence of pulmonary edema.Cardiac silhouette is within normal limits.

Output: Enlarged pulmonary arteries suggestive of pulmonary hypertension. Please refer to CT chest from the same day for additional findings.


Instruction: Generate impression based on medical findings.

Input: 50 year old male advanced IABP, ? placement ET tube, left jugular catheter tip, cardiac assist cannulae and enteric tube tip unchanged. IABP marker unchanged in the distal descending thoracic aorta. Right IJ Swan-Ganz catheter tip unchanged overlying the right main pulmonary artery. Bilateral pleural effusions and perihilar interstitial opacities with cardiomegaly unchanged.

Output: IABP marker unchanged in the distal descending thoracic aorta. No interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: ? chest pain History: ? PTX Left-sided 3-lead ICD device.Minimal basilar subsegmental atelectasis. No evidence of pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Chest pain. Image interpretation limited by motion. Left subclavian ICD. Unchanged cardiomegaly. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.Probable moderate pulmonary edema.No visible pneumothorax.

Output: Moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old Reason: difficult to visualize iabp marker on prev xray, eval History: see above Cardiomegaly. No focal airspace opacities, pleural effusion, or pneumothorax.IABP marker proximal descending thoracic aorta. Swan-Ganz catheter tip remains in right interlobar pulmonary artery. ICD leads unchanged position.

Output: IABP marker proximal descending thoracic aorta. Swan-Ganz catheter tip remains in right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: FemaleReason for Study: Reason: Hickman catheter History: Hickman catheter Right central venous catheter unchanged.Stable cardiac enlargement.The lungs are clear.No large pleural effusions.Chronic osseous deformity involving the left upper hemithorax.

Output: Right central venous catheter tip in the SVC. Stable cardiopulmonary appearance without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Monitoring intubated patient. COPD exacerbation. Tubes and lines unchanged. Large lung volumes, consistent with COPD. Coarse interstitial opacities bilaterally without significant change. Possible small pleural effusions, unchanged.

Output: No acute change in cardiopulmonary appearance. Diffuse pulmonary opacities are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: ett History: ett ET tube tip approximately 4 cm above the carina.NG tube tip in the stomach.Cardiomegaly with bilateral airspace opacity and septal lines compatible with edema, with moderately large bilateral pleural effusions.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for edema History: sob Small lung volumes with marked cardiomegaly, unchanged.Bilateral chronic appearing interstitial opacities with areas of linear scarring and subsegmental atelectasis. Partial atelectasis in the right upper lobe, unchanged from previous.

Output: Cardiomegaly and chronic interstitial abnormalities but no reliable evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: r/o PNA, infiltrate History: SOB, cough, L pleuritic chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Aortic atherosclerosis again noted. 1.3 cm splenic arterial aneurysm again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: intubated History: intubated The endotracheal tube is approximately 4 cm above the carina. The right central venous catheter is in the right atrium. The enteric tube projects over the fundus of the stomach. Mediastinal and pleural drains, sternotomy wires and appliances, and LVAD are unchanged in position.The cardiomediastinal silhouette is unchanged. The persistent left lower lobe consolidation and small pleural effusion are unchanged. There is right basilar subsegmental atelectasis.

Output: Persistent left lower lobe opacity with small pleural effusion and right basilar subsegmental atelectasis. Trace right pneumothorax no longer seen.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: 64 year-old woman with aortic insufficiency, all colas tree, palpable lymph node in the neck, groin. Evaluate for liver lesion. CHEST:LUNGS AND PLEURA: Mild emphysema. Bilateral scattered calcified lung nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral axillary adenopathy. Left axillary lymph node measures 2.1 x 1 cm image number 25, series number 4.Small amount of pericardial effusion.ABDOMEN:LIVER, BILIARY TRACT: Simple cyst in the right lobe of the liver.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, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal pericardial effusion, mild cardiomegaly,


Instruction: Generate impression based on medical findings.

Input: Dyspnea No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: eval pathology History: CP, Af Dextrocardia with complete situs inversus, incidental finding.No specific evidence of infection or failure.

Output: Dextrocardia with situs inversus. No specific evidence of infection or failure.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Productive cough for 5 days now with acute shortness of breath. Also history of chronic pulmonary emboli. Stable cardiomegaly and median sternotomy for mitral valve replacement.New small wedge-shaped opacity projected over the right lung base which is nonspecific and could be intrapulmonary or within the body wall. Additional mild basilar subsegmental atelectasis.Probable very small right pleural effusion, unchanged.

Output: New small wedge-shaped opacity projected over right lung base which could be intrapulmonary or within overlying soft tissues. Dedicated PA and lateral radiographs recommended for further evaluation. Alternatively, this could be further evaluated with chest CT if performed to evaluate for pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: 64 yr old patient with uterine cancer s/p 3 cycles of Taxol/Carboplatin with a CT and CXR follow up eval disease process compare to prior imaging History: none Right port tip in SVC. No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality and no specific findings of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 22 yearsGender: MaleReason for Study: Reason: sob, cp, hx esrd History: sob/cp esrd Stable marked cardiac enlargement.Perihilar airspace and interstitial opacities compatible with pulmonary edema slightly improved from the prior exam.No focal areas of consolidation.The large pleural effusions.

Output: Cardiac enlargement with pulmonary edema slightly improved from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old. ET tube tip approximately 3 cm above the carina.Airspace opacity and pleural effusion, greater on the right, suggestive of aspiration pneumonia, new since 8/4/2016.A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: r/o acute cardiopulm process History: chest pain, SOB Low lung volumes. Cardiomegaly. No specific evidence of infection or edema.

Output: Cardiomegaly but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Stable, partially calcified old lobe opacity in the right upper lobe on image number 30, series number 5, measuring 14 x 12 mm,. Calcified right upper lobe granuloma.MEDIASTINUM AND HILA: Anterior mediastinal soft tissue density is stable measuring 29 right on millimeter image number 37, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable CT findings.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: eval for edema History: chest pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Chest pain and shortness of breath. Cardiomediastinal silhouette is normal.No air space opacity, large effusion, or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: intubated History: intubated ET tube with its tip 5 cm above the carina.NG tube has been placed with its tip beyond the margin of the image.Decrease in findings is stable cardiac enlargement.Basilar opacities are compatible with pleural effusions and atelectasis/edema.

Output: ET tube slightly retracted with its tip now 5 cm above the carina. Stable cardiopulmonary appearance with cardiomegaly, pleural effusions, and basilar atelectasis/edema.


Instruction: Generate impression based on medical findings.

Input: Reason: pulmonary edema? PNA? large effusion? PTX? History: syncopal episode, cardiac arrest Normal heart size with moderate left superior mediastinal widening which corresponds to lipomatosis, demonstrated on a previous thoracic CT scan.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain Normal heart and mediastinal contours.Mild right lower lobe opacity and blunting of the right costophrenic angle suggestive of partial atelectasis and a small pleural effusion. This could be better evaluated with erect PA and lateral chest radiographs when feasible.

Output: Right basilar opacity with probable atelectasis and effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: pre op History: sob Marked cardiomegaly with a single lead ICD device unchanged.Vascular redistribution but no sign of pulmonary edema or effusions.

Output: Cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: cp History: cp Normal cardiomediastinal silhouette.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: 53F with persistent pleural effusion, assess after drain removal History: persistent pleural effusion Moderate right pleural effusion compressing the right lower lobe, with no pneumothorax following recent chest tube removal.Left lung unremarkable.Heart size normal status poststernotomy.

Output: Unchanged right pleural effusion following recent chest tube removal.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with metastatic colorectal cancer, status post chemotherapy, colon and lung resection. Evaluate disease status. CHEST:LUNGS AND PLEURA: Reference right subpleural nodule seen on the prior exam is obscured by the pleural effusion.New moderate right pleural effusion is partially loculated. MEDIASTINUM AND HILA: Paratracheal adenopathy is seen with reference node measured 16 x 11 mm on image number 24, series number 3, not significant changed. Other small mediastinal lymph nodes are not changed. Bilateral hilar lymph nodes are again seen, unchanged. Diffusely enlarged thyroid. Coronary artery calcifications. CHEST WALL: Right sided venous access device in the expected position. Status post median sternotomy and coronary artery bypass graft. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis or biliary dilatation is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Annular mass surrounding the sigmoid colon is resolved and no longer seen. No evidence of bowel obstruction. No evidence of pericolonic adenopathy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Previous described left inguinal lymph node measuring 1 cm is unchanged. (Image number 185, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Bilateral fat containing inguinal hernias.

Output: No significant change in the mediastinal lymph nodes and right lung nodule.The mass in the sigmoid colon is no longer seen.New loculated right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 69 years, Male. Reason: Pt with bloating and drainage around j tube. Evaluate for obstruction. History: Pt with bloating and drainage around j tube. Evaluate for obstruction. Nonobstructive bowel gas pattern with average stool burden. Gastrojejunostomy tube course is similar to that seen on prior fluoroscopic study performed on 4/22/2016, with its tip projecting far distal to the ligament of Treitz.Hyperinflated lungs with unchanged bibasilar subsegmental atelectasis/scarring. There is no pleural effusion or pneumothorax. Tracheostomy tube tip projects over the thoracic inlet.

Output: Nonobstructive gas pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: Back and chest pain History: respiratory distress / increasing work of breathing No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with lung cancer. Evaluate disease as follow up for chemo/RT. CHEST:LUNGS AND PLEURA: Interval development of patchy ground glass and nodular opacities in the right lung on background of severe centrilobular and paraseptal emphysema. There are ill-defined subpleural opacities and reticulation in the right lower lobe. Mild bronchial wall thickening. Left lung emphysema and scattered micronodules appearing similar to prior study.Reference right middle lobe nodule (series 5, image 42) measures 9 x 10 mm (stable).MEDIASTINUM AND HILA: Right paraesophageal lymphadenopathy (series 4, image 30) measures 12 x 22 mm; stable.Right paratracheal lymphadenopathy (series 4, image 34) measures 22 x 13 mm; stable.Reference right hilar lymph node (series 4, image 40) measures 10 x 14 mm; stable.Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcifications as seen previouslyPANCREAS: 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: Small fat-containing umbilical hernia, unchanged.

Output: 1. Interval development of patchy right lung opacities. Findings are nonspecific but may be secondary to inflammatory changes from radiation and/or infection.2. Stable right lung mass and mediastinal/hilar lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: History of puriform sinus cancer. Evaluate for disease recurrence. LUNGS AND PLEURA: Subpleural micronodules in the right lung, unchanged and likely benign.Diffuse ground glass opacity in the left lower lobe, slightly increased from previous, probably secondary to aspiration.MEDIASTINUM AND HILA: No significant lymphadenopathy or other findings.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Small cyst in the left kidney. No significant abnormality noted.

Output: Ground glass opacity in the left lower lobe suggestive of aspiration. No sign of metastases.


Instruction: Generate impression based on medical findings.

Input: Heart failure, check for pleural effusion Left jugular catheter has been minimally advanced, tip now extends into the SVC approximately 3 cm beyond the confluence.The diffuse mixed interstitial and airspace opacities greater in both bases remain nonspecific with cardiomegaly. Small effusions.

Output: Nonspecific patchy and largely basilar opacities again concerning for edema although infection cannot be excluded


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: eval aspiration History: intubated Improvement in left sided predominant pulmonary opacities suggestive of edema or pneumonia, increased opacity now in the right lower lung zone.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Improvement in left-sided pulmonary opacities now present in the right however. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: History of Paget's sarcoma of the right humerus. Status post resection in 2005. Right middle lobe nodule. Stable on last CT scan. LUNGS AND PLEURA: Partially calcified and irregularly marginated right middle lobe nodule measuring 10 x 8 mm, unchanged since 9/18/2010 and most likely benign.Additional nonspecific micronodules, also unchanged.MEDIASTINUM AND HILA: Asymmetric enlargement of a right lobe of the thyroid gland, unchanged.No significant lymphadenopathy.Moderate coronary artery calcification.Catheter tip in the SVC.Small hiatal hernia.CHEST WALL: Moderate right axillary lymphadenopathy, not significantly changed.The catheter port in the right anterior chest wall.UPPER ABDOMEN: Bilateral renal cysts and aortic atherosclerosis.

Output: Stable pulmonary nodules and no specific evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Chest pain on the right after fall. Low lung volumes. Unchanged cardiomegaly. Highly tortuous thoracic aorta. Central pulmonary vasculature appears at least upper normal in caliber. Calcified mediastinal and hilar lymph nodes. Atherosclerotic calcification of the thoracic aorta at the level of the arch. The cervical airway is not visualized however this is similar to the appearance of 2007.No pneumothorax or pleural fluid.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Displaced right posterior rib fractures involving at least the right eighth rib, the more inferior ribs on that side are not clearly visualized and fracture cannot be excluded.

Output: Apparent displaced posterior right eighth rib fracture without pneumothorax, which does not appear to be present on the CT performed immediately prior raising the question of artifact. Recommend correlation with physical examination for the presence of pain in this area and, if required, evaluation with bone-technique rib series. Highly tortuous thoracic aorta, incompletely evaluated. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: positive PPD - evaluate for evidence of active TB prior to nursing home entry History: none Chronic marked elevation left hemidiaphragm with overlying subsegmental atelectasis.Right lung unremarkable.The heart size cannot be evaluated because of the elevated diaphragm but the aorta is quite tortuous, but consistent with age.No active TB.

Output: No active TB. Chronic elevation left hemidiaphragm.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: Bi-V ICD placement History: BI-V ICD placement Cardiomegaly without edema or pneumonia.Unchanged left subclavian ICD following recent upgrade.No significant pneumothorax.

Output: Uncomplicated ICD revision.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Status post mitral valve repair. Mitral prosthesis similar in position. Improved expansion of the right lung. No significant pneumothorax. Small right pleural fluid collection. Diffuse opacities in the right lung without significant change. Bronchial wall thickening bilaterally, increased on the left.

Output: Improved expansion of the right lung. Persistent diffuse opacity on the right without significant change. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old. History of cough. Low lung volumes with bibasilar opacities consistent with atelectasis/aspiration not acutely changed since the prior study. Cardiac silhouette normal in size.

Output: Bibasilar atelectasis and aspiration without acute interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: evidence of pna History: fevers The cardiomediastinal silhouette is unremarkable.Marked elevation right hemidiaphragm unchanged.Pulmonary nodules again identified.No new pulmonary opacities .No pleural effusion.

Output: Persistent elevation of the right hemidiaphragm. No acute abnormality identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Please evaluate ETT placement History: as above Moderate to severe cardiomegaly.Improving patchy airspace opacities suggestive of edema and/or aspiration.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.An NG tube extends below the lower margin of the image.Left subclavian ICD, leads unchanged in position.

Output: Improvement in pulmonary opacities with no new findings. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 57 year-old female, assess for metastatic cervical cancer. CHEST:LUNGS AND PLEURA: Multiple suspicious appearing nodules are seen throughout the lungs. In the left upper lobe, a reference nodule measures 1.3cm x 1.3cm.  MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion.CHEST WALL: Thyroid nodules are noted. ABDOMEN:LIVER, BILIARY TRACT: Hyperdense lesion in the left lobe of the liver is noted. MRI is recommended for further evaluation. A few other small hypodense lesions in the right hepatic lobe are also seen, too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: Large well circumscribed round cystic mass is seen in the head of the pancreas. It measures 2.4cm x 2.0cm (Image 107, Series 3). The differential includes a pancreatic mucinous neoplasm versus an intraductal capillary mucinous neoplasm. MRI is recommended for further evaluation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: A few calcified fibroids are noted. The endometrial stripe is thickened. The cervix demonstrates a heterogeneous pattern, consistent with known history of cervical cancer.BLADDER: Small nodular soft tissue mass along the anterior surface of the bladder is likely a rectal remnant.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Multiple lung nodules consistent with metastases.2. Cystic lesion in the head of the pancreas may represent a mucinous neoplasm versus an IPMN. MRI is recommended for further evaluation.3. Hyperdense lesion in the left hepatic lobe is unlikely a metastases. MRI is however recommended for further evaluation.4. Heterogenous appearance of the cervix, consistent with known history of cervical cancer. 5. Nodular mass along anterior surface of the bladder is likely a urachal remnant.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Fever. Right upper extremity PICC tip terminates near the cavoatrial junction.Normal cardiac silhouette size. Mildly tortuous aorta.Small bilateral pleural effusions with adjacent scarring/atelectasis.

Output: Bilateral pleural effusions with basilar scarring/atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: 75M s/p hepatectomy now with hypotension and AKI History: hypotension and AKI Large degree of pneumoperitoneum likely related to recent abdominal surgery. Port catheter terminates in the SVC. Low lung volumes. No focal lung consolidation. Mild blunting of the left costophrenic angle. Heart size at the upper limits of normal. Aortic atherosclerosis.

Output: Question of small left pleural effusion or atelectasis. Aortic atherosclerosis. Pneumoperitoneum likely related to recent abdominal surgery.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of non-small cell lung cancer CHEST:LUNGS AND PLEURA: Right lower lobe mass measuring 2.4 by 2.4 cm suspicious for primary bronchogenic carcinoma. Subcentimeter nodules on image number 52, series number 5 in the right middle lobe..Subcentimeter fissure based nodule in the right lower lobe on image number 54, series number 5.MEDIASTINUM AND HILA: Fluid density pretracheal and AP window lesions likely represent fluid in the epicardial recess.Right hilar enlarged lymph node measuring 9 x 11 mm image number 45, series number 3. Subcarinal lymph node measuring 12 x 8 mm on image number 45, series number 3. Left bronchopulmonary and large lymph nodes also present.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Large metastatic mass in the right lobe of the liver measuring 11 x 9.1 cm on image number 89, series number 3. Other smaller metastatic lesions are also present in both lobes of liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole renal stone. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right lower lobe mass suspicious for primary bronchogenic carcinoma. Subcentimeter nodules in the right lower lobe and middle lobe.Hepatic metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out L sided pleural effusion History: L pleuritic chest pain Small lung volumes with mild basilar density compatible with atelectasis and small pleural effusions in the posterior costophrenic angles.A CT scan has been performed and provides more detailed evaluation.

Output: Mild basilar atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: s/p thoracentesis; evaluate for pneumo History: none Right IJ port catheter is grossly unchanged.Partially obscured cardiac silhouette is enlarged.Moderate size right pleural effusion is stable to slightly decreased since prior examination. No pneumothorax.

Output: No pneumothorax. Minimally improved aeration of the right lower lung with persistent moderate pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Scattered calcified granuloma without superimposed acute cardiopulmonary abnormality

Output: Old granulomatous disease without acute abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: renal cell cancer with increased SOB , Hx of bilateral pleural effusions History: Shortness of breath Stable cardiomediastinal silhouette. Unchanged basilar predominant interstitial and airspace opacities and pleural effusions. Low lung volumes. Left Pleurx catheter again noted.

Output: Interstitial and airspace opacities and pleural effusions without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: dobhoff placement History: none Feeding tube terminates within the mid aspect of the esophagus. Improvement in pulmonary edema. Otherwise no substantial difference.

Output: Feeding tube terminates within the mid aspect of the esophagus. Improvement in pulmonary edema. Otherwise no substantial difference.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male status post heart transplant, history of aspergillosis. Evaluate status of pneumonia. Please note that this noncontrast examination is insensitive for the evaluation of solid organ pathology.LUNGS AND PLEURA: Mild apical paraseptal emphysema. Suture line along the right major fissure noted. Numerous bilateral pulmonary nodules, some calcified, are unchanged in size. Previously referenced subpleural nodule in the superior segment of the left lower lobe has not significantly changed in size measuring 1.6 x 1.0 cm on high-resolution axial image 128/281. No new nodules or masses. No pleural fluid. Subtle basilar groundglass opacities are unchanged.MEDIASTINUM AND HILA: Numerous mediastinal clips and sutures are identified compatible with history of heart transplant. The cardiac size is normal. No pericardial effusion. Small mediastinal lymph nodes are unchanged.CHEST WALL: Status post median sternotomy.UPPER ABDOMEN: No significant abnormality noted.

Output: Multiple bilateral pulmonary nodules are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: CHF vs PNA History: shortness of breath There is mild improvement in the bilateral severe interstitial and airspace opacities. No change in cardiomegaly.

Output: Mild improvement in bilateral interstitial and airspace opacities. No other changes.


Instruction: Generate impression based on medical findings.

Input: Advanced progressive endometrial cancer with vaginal bleeding. CHEST:LUNGS AND PLEURA: Several tiny nodules are seen in both lungs, several of which are calcified. They are unchanged in appearance. No new nodules identified.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes. Stable heterogeneous appearance of the thyroid gland.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple gallstones are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephroureterostomy catheters terminate within the urinary bladder. RETROPERITONEUM, LYMPH NODES: The reference retroperitoneal lymph node just caudal to left renal vein has increased slightly in size it currently measures 1.7 x 1.2 cm (image 114; series 3). The retroaortic left renal vein and vena caval filter are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Bladder cannot be well evaluated due to lack of IV contrast. In particular, the bladder mass previously described cannot be adequately measured. Few pockets of air are again noted within the bladder.LYMPH NODES: Right external iliac lymph node has enlarged and currently measures 2.5 x 2.0 cm (image 168; series 3). Inguinal lymph nodes again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited exam due to lack of IV contrast. Increased size of reference retroperitoneal and pelvic reference lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old, presenting with chest and back pain and shortness of breath with hypoxia. Remote history of PE, patient not anticoagulated. PULMONARY ARTERIES: Technically adequate exam. No evidence of pulmonary embolus.LUNGS AND PLEURA: Predominantly upper lung moderate emphysema is unchanged. Diffuse groundglass and interstitial opacities with thickening of the interlobular septae bilaterally are unchanged and probably at least partially chronic with some superimposed edema also possible.6-mm right lower lobe micronodule is unchanged on axial image 118, series 7. Previously referenced right middle lobe micronodule is no longer evident. 6-mm groundglass micronodule in the right middle lobe on axial image 79, series 7, is new.MEDIASTINUM AND HILA: Cardiomegaly with particular enlargement of the right atrium, unchanged. The main pulmonary arteries are mildly enlarged which can be seen in pulmonary artery hypertension. No pericardial effusion. Aortic atherosclerotic calcifications noted.No pathologically enlarged hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Reflux of contrast into the hepatic veins is compatible with right heart failure.

Output: 1.No pulmonary embolus.2.Stable interstitial abnormality is at least partially chronic although there may be some superimposed edema. 3.Scattered nonspecific micronodules, some new while others have resolved.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: pleural effusions, PNA History: sob Stable cardiomediastinal silhouette.Mild bilateral lung hyperinflation with mild bronchial wall thickening again seen and consistent with history of COPD/chronic bronchitis. No focal consolidation, sizable pleural effusion or pneumothorax.

Output: Stable appearance of the chest with no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: infection History: weakness Unremarkable cardiac and mediastinal silhouette. Port catheter with its tip in the SVC.Blunting of the costophrenic angles suggestive of scarring with underlying severe emphysema as shown on a previous CT scan.No specific evidence of pneumonia.

Output: Severe bullous emphysema with no acute change.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with history of cardiac angiosarcoma CHEST:LUNGS AND PLEURA: Index right lower lobe nodule on image number 67, series number 5 is stable measuring 5-mm. Additional nodule in the right middle lobe on image number 41, series number 5 is also stable. No new lung nodules.MEDIASTINUM AND HILA: Reference soft tissue density in the posterior mediastinum is unchanged measuring 18 x 18 mm in image number 64, series number 3. Borderline enlarged right hilar lymph node is stableCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver, stable. No focal liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination consisting of small lung nodules and posterior mediastinal soft tissue lesion.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate ETT History: intubated, pulm edema ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.Bilateral pulmonary opacity compatible with layering effusions and underlying atelectasis.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Status post TEVAR and TAVR. Extubation. Left chest tube tip projects over the costophrenic angle. Lung volumes remain low with basal atelectasis. No significant sized pneumothorax. Subcutaneous emphysema left chest wall. Right jugular catheter tip at the superior cavoatrial junction.

Output: Interval extubation. Lung volumes remain low.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: interval change History: interval change History of ECMO Interval extubation. Enteric tube extends beyond the field-of-view of study. Chest tubes are unchanged. Swan-Ganz catheter tip in main pulmonary artery. Right jugular venous catheter tip at RA/SVC junction.Stable cardiomegaly with minimal basilar atelectasis but no evidence of pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Chest pain, vague history. Question mediastinal widening or other abnormality. Tortuous thoracic aorta. No signs of mediastinal widening or visible hematoma. Coarse interstitial opacities suggestive of mild hypervolemia, though there is no convincing evidence of overt edema. Patchy opacity in the left lower lobe retrocardiac region nonspecific and could reflect atelectasis.

Output: Probable mild hypervolemia with patchy retrocardiac opacity, likely reflecting compressive atelectasis but nonspecific. No mediastinal widening. Suggest short-term radiographic follow-up with PA and lateral technique when feasible.


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube eval History: see above ET tube tip approximately 6 cm above the carina.Feeding tube tip in the gastric fundus.Right jugular catheter in the right brachiocephalic vein.Bilateral lower zone airspace opacities, increased compared to previous, suggestive of aspiration.External mattress artifact partially obscures the lungs.

Output: Increasing lower zone airspace opacities suggestive of aspiration and infection.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with metastatic colorectal carcinoma CHEST:LUNGS AND PLEURA: Index right lower lobe nodule is less well seen and smaller measuring 6 x 7 mm on image number 64, series number 5. No new nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right breast lesion is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver with numerous metastatic disease. Index right lobe liver mass measures 4.9 x 3.9 cm in image number 90, series number 3. This lesion is difficult to measure and appears to be slightly increased in size compared to previous CT. Other liver lesions are also stable to minimally increased in size.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index retroperitoneal adenopathy is unchanged measuring 1.5 x 1.3 cm Schommer 84, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scans of the right iliac bone is unchanged. Calcified lesion extending into right psoas muscle measures 3.1 x 1.7 cm on image number 165, series number 3.OTHER: No significant abnormality noted.

Output: Index lung lesions are smaller or resolved.Minimal interval increase in size of some of the hepatic metastases.Right iliac bone lesion is stable.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of squamous cell cancer of the tongue with recent colectomy at outside hospital for perforation secondary to diverticular disease. Concern for bladder injury according to outside hospital surgeon. CHEST:LUNGS AND PLEURA: Moderate bilateral pleural effusions with overlying atelectasis. No suspicious nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary calcifications.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: 1 cm left adrenal nodule.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colostomy in left lower abdominal quadrant. No evidence of bowel obstruction. Scattered foci of peritoneal free air presumably due to recent surgery.BONES, SOFT TISSUES: Degenerative changes of the spine.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Architectural distortion of the bladder with wall thickening superiorly (series 8048, coronal image 47). Small area of fluid attenuation within the superior aspect of the bladder wall containing high density focus as well; this may represent postsurgical changes versus a bladder diverticulum containing a punctate stone.Delayed scanning of the pelvis shows no abnormal extravasation of excreted contrast.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Colostomy left lower abdominal quadrant. No organized fluid collections to suggest abscess.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: Architectural distortion of the bladder with wall thickening superiorly. There is also a focus of fluid attenuation at the superior aspect of the bladder containing punctate high density material; these may represent postsurgical changes versus a bladder diverticulum with a punctate stone. Delayed scanning of the pelvis shows no abnormal extravasation of excreted contrast.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.ET tube placement. Endotracheal tube tip 4.5-cm above the level of the carina. Coarse interstitial and air space opacities bilaterally without significant change. Small pleural effusions. Nasogastric tube tip off the caudal margin of the film but the side hole is at the level of the gastric body.

Output: ETT tip 4.5-cm above carina. No acute change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pulmonary edema History: chest pain Normal heart size and clear lungs with no sign of pulmonary edema or infection.Marked evaluation of the trachea to the right at the thoracic inlet compatible with a goiter, unchanged from previous.

Output: Marked tracheal deviation consistent with a goiter, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate IABP position. History: See above. Balloon catheter marker in the descending aorta at the level of the aortic arch.PICC tip in the left subclavian vein.Mild cardiomegaly with no significant pulmonary abnormalities.

Output: Balloon catheter in the proximal descending aorta.