Instruction: Generate impression based on medical findings.

Input: 48-year-old male with mantle cell lymphoma CHEST:LUNGS AND PLEURA: The previously described subcentimeter nodular opacities have overall improved. The reference lesion in the left lower lobe (series 4, image 66) now measures 4 x 2 mm; previously 6 x 6 mm.MEDIASTINUM AND HILA: The reference right hilar lymph node (series 4, image 39) measures 16 x 12 mm (previously 28 x 11 mm). The reference subcarinal lymph node measures 14 x 5 mm, previously 15 x 10 mm (series 4, image 43). The left hilar and mediastinal nodal prominence has resolved.CHEST WALL: The reference left axillary node measures 7 x 6 mm, previously 13 x 8 mm (series 4; image 17).Healing right lateral seventh rib fracture, new.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: The reference peripancreatic lymph node is stable, measuring 14 x 7 mm (series 3, image 93)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: 8 x 7 mm reference right common iliac lymph node (series 3, image 154), mildly decreased in size (previously 12 x 9 mm). The reference right external iliac lymph node now measures 12 x 4 mm (series 3, image 170), previously 14 x 7. The reference of right inguinal lymph node (series 3 comminuted 197) is mildly decreased in size, now measuring 10 x 10 mm (previously 12 x 10)BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Decrease in size of virtually all of the reference pulmonary nodules and lymph nodes.New healing right seventh rib fracture.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with non-Hodgkin lymphoma. Status post chemotherapy, possible relapse. CHEST:LUNGS AND PLEURA: Bilateral groundglass opacities a result. Lingula nodule measures 14 x 9 mm, smaller compared to previous CT. Right lower lobe nodule measures 6 x 9 mm image number 66, series number 5.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Spleen measures 14.5 cm. New hypodense lesions in the spleen suspicious for lymphoma involvement. A reference lesion measures 8mm on image number 87, series number 4.PANCREAS: 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: Interval decrease in the size of the pulmonary nodules and interval resolution of the bilateral groundglass opacities. Splenomegaly is unchanged. New small hypodense lesions in the spleen suspicious for lymphoma involvement.


Instruction: Generate impression based on medical findings.

Input: Tracheostomy tube Bilateral chest tubes, ECMO tubing, ICD and tracheostomy tube are all unchanged. Dobbhoff projects into the mid gastric lumen and right jugular catheters terminate in the proximal SVCMild cardiomegaly with nonspecific patchy opacities in both lung bases with overall improving aeration and lung volumes. Suspected resolving edema

Output: Chest tubes unchanged and resolving superimposed moderate edema


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Shortness of breath. Asthma exacerbation. Lungs are clear. Heart normal size. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: pre-op History: pre-op Four sternotomy wires are in place, which appear intact. No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: MaleReason for Study: Reason: chest pain and SOB x2 weeks; hx of PE History: chest pain and SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Cough and bronchial mass Near complete opacification and volume loss of the right hemithorax with pronounced mediastinal shift. Changes correlate with suspected increased obstruction from the known bronchial mass and possibly postprocedural treatment changes. Small-to-moderate effusionThe left lung remains similar and clear throughout. No gross cardiac or mediastinal contour change

Output: Increased postobstructive changes and diminished aeration of the right lung. CT evaluation may be needed for further characterization


Instruction: Generate impression based on medical findings.

Input: Male, 91 years old.Reason: s/p avr, eval for atelectasis and pleural effusions History: SOB Median sternotomy hardware and other support devices are unchanged.Minimal right apical pneumothorax. Increasing large right pleural effusion and compressive atelectasis of the right lower lobe. Left lower lobe atelectasis mildly increased. Cardiomegaly unchanged.

Output: Minimal residual right apical pneumothorax. Increasing large right pleural effusion and compressive atelectasis of the right lower lobe.


Instruction: Generate impression based on medical findings.

Input: 80-year-old male with acute shortness of breath. Median sternotomy. Right chest port catheter tip in SVC.Moderate cardiomegaly with increasing perihilar interstitial opacities, septal lines and pleural effusions. No pneumothorax.

Output: Increasing perihilar interstitial opacities and pleural effusions most compatible with pulmonary edema. However the pleural effusions may also be from progression of known mesothelioma.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: RUL collapse History: hypoxia Minimally improved aeration of the atelectatic right lung. Mediastinal shift to right persists.No change in left basilar pneumothorax. Line position stable.

Output: 1. Minimal change in atelectasis of right lung with mediastinal shift to right.2. Little change in left basilar pneumothorax.3. Line position stable.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old with history of robotic mitral valve repair, RFO for BMI > 40, counts are correct Chest tubes project over the right thorax. Right IJ catheter with tip in the SVC. Endotracheal tube with tip approximately 4-5 cm above the carina.Enlarged cardiomediastinal silhouette with mitral valve prosthesis noted. Patchy right lung and retrocardiac opacities with left pleural effusion. No radiopaque foreign object identified.

Output: Post-operative changes without evidence of retained radiopaque foreign object.Dr. Belky was paged (1509) at 3:45 pm, however, unable to be reached.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male status post LVAD. Evaluate for pleural effusions. LVAD in place. Left chest wall AICD with single lead unchanged in the right ventricular apex.No focal airspace opacities, pleural effusions or pneumothorax. Mild cardiomegaly.

Output: No pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: interval change in lung opacities, cardiac silhouette History: hypotension, c/f poss hemothorax, or pleural blood Two right chest tubes, with increasing consolidation of the entire right lung consistent with acute rejection. Severe emphysema left upper lobe.ET tube tip approximately 5 cm above the carina.Left jugular Swan-Ganz catheter tip in ventricular outflow tract.

Output: Worsening consolidation of the entire right lung consistent with acute rejection.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Assess for pneumonia History: Productive cough, chest pain, previous HCAP Progressive right-sided volume loss with low lung volumes. Perihilar architectural distortion. Opacity projects over the mid left tracheal wall which may be an endoluminal. Further evaluation with a PA and lateral radiograph is recommended. Blunting bilateral costophrenic angles from scarring or trace effusions.

Output: Further evaluation with a PA and lateral radiograph to exclude an endotracheal lesion is recommended.


Instruction: Generate impression based on medical findings.

Input: Concern for pulmonary edema Streaky retrocardiac opacity suggests atelectasis. No new focal consolidation or large pleural effusion is evident. Low lung volumes.Deviation of trachea to the right similar to previous studies. Marked cardiomegaly.Median sternotomy wires intact. Pacemaker lead position unchanged. Port catheter tip in SVC. Surgical clips overlying left cardiac border.

Output: Atelectasis. No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: Swan catheter placement History: See above Mild cardiomegaly, small lung volumes and suggestion of basilar edema, improved since the prior study.Right jugular Swan-Ganz catheter tip in right main or right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Right jugular Swan-Ganz catheter, tip in right main right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Tachypnea, respiratory failure question volume overload. Dissection of the aorta. ETT tip 4 cm above the level of the carina. Right jugular introducer and aortic stent graft unchanged in position. Layering pleural fluid on the left similar in volume. Partially loculated pleural fluid on the right unchanged. Dependent atelectasis, but no specific signs of pulmonary edema.

Output: No appreciable change and pleural fluid volume. No specific signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: r/o edema/infection History: sob Mild cardiomegaly status post sternotomy.Mild basilar edema with a right pleural effusion similar to the prior study consistent with CHF.No specific evidence of infection.

Output: CHF with mild edema and a right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: IABP History: see above No significant cardiopulmonary abnormality.Right subclavian IABP, proximal marker projects 1 cm below the aortic arch. Right subclavian ICD unchanged.

Output: Unchanged support devices. No significant pulmonary or pleural abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor COPD with flat diaphragms.No other significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: r/o edema History: LE edema Unremarkable cardiomediastinal silhouette.Lungs clear. No pleural effusion. No pneumothorax.

Output: No specific findings of infection or edema


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.History of shortness of breath. There is cardiomegaly.Right chest wall port catheter tip in the SVC/RA junction.There are bilateral pleural effusions, right greater than left, in addition to basilar interstitial opacity.

Output: CHF with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: assess for infiltrate History: assess for infiltrate Lower lung zone edema-like opacities with increasing focal opacity in the left mid lung periphery suggestive of infection or infarction. Moderate size right pleural effusion.Heart size normal.Tracheostomy tube.

Output: Focal left midlung opacity suggestive of infection or infarction, with a right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: swan in place? History: swan Swan-Ganz catheter tip in the right main pulmonary artery.ICD leads unchanged.Cardiomegaly with bilateral opacity compatible with pleural effusions and atelectasis, greater on the right.

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


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: cough, body aches, rhonchi b/l Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Hypoxia, assess for pulmonary opacities or effusion. Small left lung volume with elevation of the left hemidiaphragm. Large left pleural fluid collection with atelectasis of the majority of the left lung. The underlying left lung appears to have severe bronchiectasis.Right paramediastinal fibrosis, progressed. Mild bronchial wall thickening on the right is new. Right basal opacity more suggestive of atelectasis than infection.

Output: Mild pulmonary edema superimposed upon emphysema. Progressive radiation changes in the right lung, consider short-term follow-up plain films to exclude developing pneumonia. Chronic findings in the left hemithorax are without visible change.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Conversion to open surgery. No unexpected radiopaque foreign bodies. Left-sided chest tube is noted. Small left-sided hydropneumothorax is present. Skin defect noted along the lateral chest wall with mild subcutaneous emphysema.

Output: No radiopaque foreign body.


Instruction: Generate impression based on medical findings.

Input: Reason: eval mediastinum History: retrosternal chest pain Unremarkable cardiac and mediastinal silhouette. Small lung volumes with diffuse nonspecific interstitial opacity, possibly due to edema, with underlying emphysema.Bilateral lower lobe nodular opacities, previously characterized by CT scan, are poorly visualized due to superimposed effusion opacity, but are probably decreased in size. These could be better evaluated by CT scan.

Output: Diffuse interstitial opacity, possibly due to edema with underlying emphysema, and lower lobe nodules of uncertain etiology which could be better characterized by CT scan.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with metastatic prostate cancer. Evaluate for progression of disease. Acute renal failure. CHEST:LUNGS AND PLEURA: Stable pulmonary nodules bilaterally. Reference right lower lobe nodule (series 5, image 61) measures 1 x 1 cm; stable accounting for differences in technique. No new suspicious nodules identified.Apical emphysematous changes as seen previously.MEDIASTINUM AND HILA: Reference left paratracheal lymph node (series 3, image 34) again measures 1.5 x 0.7 cm.. Heart size normal without pericardial effusion.CHEST WALL: Diffuse osseous metastases as seen previously. ABDOMEN: LIVER, BILIARY TRACT: Cholelithiasis without evidence of inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 8-mm right renal stone at the UP junction with upstream hydronephrosis and mild perinephric stranding. Two other stones are reidentified in the right renal pelvis. No perinephric collections.No left renal stones. Left upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: Diffuse atherosclerotic calcifications of the descending aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osseous metastases as seen previously, involving the spine, ribs, scapulae.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Diffuse osseous metastases involving the spine, pelvis, and femora.

Output: 1. Obstructing 8-mm stone at right UP junction with mild hydronephrosis.2. Diffuse osseous metastases as seen previously. No definite new sites of disease.3. Stable pulmonary nodules.Findings communicated to Dr. Szmulewitz (pager: 3195) via telephone at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Rule out free air. Portable erect chest radiograph.Low normal lung volumes. The lungs are clear.No visible free intraperitoneal air.Normal heart size.

Output: No visible free intraperitoneal air and no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Line placement evaluate for pneumothorax. Right jugular catheter introducer in expected location, terminating over the right brachiocephalic vein just above the azygos arch level.Low lung volumes with basal atelectasis.Right apical pneumothorax with maximal pleural separation from the chest wall of about 16 mm.Surgical clips, staples and a drain project over the upper abdomen.

Output: 16mm right apical pneumothorax. HART, THEODORE (1060) notified via WebXchange text page at 8:20 a.m. on 5/14/2016


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: pna v infiltrate v ETT placement History: SOB with ETT Moderate lower lung zone opacities suggestive of edema with pleural effusions, unchanged.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter tip at cavoatrial junction level.

Output: Unchanged pulmonary opacities and pleural effusions suggestive of CHF more so than pneumonia. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Evaluate lung fields for edema, infiltrate History: heart failure Moderate cardiomegaly status post sternotomy for CABG.Mild basilar scarring but no specific evidence of edema or pneumonia.

Output: Cardiomegaly but no specific evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: evaluate for pleural effusion History: dyspnea Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Mild to moderately distended bowel extends into the right subdiaphragmatic region.Right subclavian catheter, tip in SVC.

Output: Small lung volumes, which may be the result of mild to moderate bowel distention. No effusion or other significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Right-sided thoracentesis. Rule out pneumothorax. Marked cardiomegaly, unchanged. Increased right partially loculated and small left pleural effusions, with adjacent subsegmental atelectasis/consolidation. Increased left lower lobe consolidation. Bibasilar scarring. The right hilum is obscured by adjacent airspace opacities and scarring. Atherosclerotic calcification of the aorta.Post right axillary lymph node dissection.

Output: No pneumothorax. Increased moderate right pleural effusion. Bilateral lower lobe atelectasis/consolidation, increased within the left lower lobe, probably multifocal pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: eval ETT placement History: intubated ET tube placed with its tip near the carina.NG tube with its tip in the stomach.New right upper lobe opacity suggesting atelectasis and pleural effusion.Underlying interstitial opacities in right lung compatible with edema.Left lung is clear.

Output: Right pleural effusion and increasing right upper lobe atelectasis with ET tube tip near the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Shortness of breath, new cough, and crackles in the lungs. The cardiomediastinal silhouette is stable.Low lung volumes with increased right basilar opacity. Right apical opacity is unchanged and likely reflects tortuous brachiocephalic vessels.Trace left pleural effusion/pleural thickening.Severe degenerative changes affect the osseous structures.

Output: Increased right lower lobe opacity which is favored to represent infection over aspiration/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: resolution of pna History: Previous RUL collapse. Interval resolution of right upper lobe consolidation. No new acute focal airspace opacity. No pneumothorax or pleural effusion.Stable mildly enlarged cardiomediastinal silhouette with prominent right atrium.

Output: Interval resolution of right upper lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: 63 years, Female. Reason: DHT placement History: DHT placement Enteric tube is tip is seen entering the left lower lobe bronchus. Distended stomach is noted. Pelvis is excluded from the field-of-view. Please see same day chest radiograph report for thoracic findings.

Output: Enteric tube is tip is seen entering the left lower lobe bronchus. Follow-up images time stamped 11/20/2016 at 20:40 showing enteric tube tip in the proximal gastric body is already available at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: pt with increase SOB, r/o infection History: shortness of breath Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: sob History: sob Very limited assessment of the cardiomediastinum secondary to rotation. The overall position of the support apparatus is unchanged.Nondiagnostic study for pulmonary pathology. Suggestion of bilateral layering pleural effusions.

Output: Overall stable position of support apparatus, considering severe limitations secondary to technique.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval for pneumonia History: stroke workup Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild spinal curvature.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: increasing o2 requirements History: Oxygen desaturation Motion artifact obscures the lower aspect of the thorax. No new focal pleural parenchymal opacity. Underlying pulmonary fibrosis again noted. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Study limited by motion artifact which of stairs the lower aspect of the thorax. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Stool burden, evaluate for constipation, no bowel movement with lactulose and kayexalate Below average stool burden, consistent with patient's history. Mildly dilated small and large bowel with relative paucity of gas beyond splenic flecture, suggestive of ileus although a developing large bowel obstruction cannot be entirely excluded. Right basilar atelectasis.

Output: Below average stool burden. Mildly dilated small and large bowel with relative paucity of gas beyond splenic flecture, suggestive of ileus although a developing large bowel obstruction cannot be entirely excluded. Continued follow up suggested.


Instruction: Generate impression based on medical findings.

Input: 53 year old female with history of carcinoid tumor CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Index right lobe lesion is smaller now measuring 7 mm in diameter on image number 90, series number 3. Segment 4 lesion is not seen on today's study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the index liver lesion. The second index lesion is not well visualized on today's study. MRI of the liver may be more helpful for follow-up of these small, ill-defined liver lesions.


Instruction: Generate impression based on medical findings.

Input: Reason: increased WOB History: see above ET tube tip approximately 1 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery. Pacemaker leads unchanged.Patchy bilateral air space opacity with partial atelectasis in the right upper lobe and pleural effusions, greater on the left.No new findings.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: pleuritic chest pain, leukocytosis History: pleuritic chest pain, leukocytosis Right central venous catheter with its tip in the SVC.Decreased lung volumes with borderline cardiac enlargement.Left pleural effusion and basilar atelectasis of undetermined chronicity.No focal areas of consolidation.Marked dextroscoliosis of the thoracic spine with evidence of prior kyphoplasties.Surgical clips in left axilla.

Output: Left pleural effusion and left basilar atelectasis of undetermined chronicity. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Male 30 years old Reason: lung infiltrate History: chronic cough Cardiomediastinal silhouette is unremarkable.No focal air space opacity or pleural effusion.

Output: No significant cardiopulmonary abnormality. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: please evaluate R pleural effusion for loculation History: R pleural effusion and history of renal cancer. CHEST:LUNGS AND PLEURA: There is now a large right pleural effusion which is loculated but not clearly loculated.There appears to be at least one large pulmonary metastasis, difficult to visualize without contrast as it is obscured by the pleural effusion. A small left pleural effusion is present.MEDIASTINUM AND HILA: Extensive mediastinal lymphadenopathy has progressed. For example, a large nodal mass in the region has enlarged to 34 x 65 mm (29/98) previously 30 x 15 mm. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Extensive metastatic disease.

Output: Significant disease progression, with a lobulated but not clearly loculated right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Stable cardiac enlargement.Decreased lung volumes with basilar predominant interstitial opacities compatible with fibrosis similar to the prior exam.No new pulmonary opacities identified.Right pleural effusion/thickening unchanged.No evidence of a pneumothorax.

Output: Stable cardiopulmonary appearance with pulmonary fibrosis and right pleural thickening/effusion. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: sob Feeding tube tip in the upper esophagus.Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with nonspecific basilar opacity compatible with atelectasis and pleural effusions.No other significant change.

Output: Feeding tube tip is in the proximal esophagus.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of renal cancer, status post resection CHEST:LUNGS AND PLEURA: Previously described right middle lobe nodule has been resected with in the interval.There is a subcentimeter nodule in the lingula on image number 50, series number 3 measuring 7 mm. This has increased in size compared to previous study where it was measuring 4 mm on image number 46, series number 4. Other subcentimeter nodules in the left lung on image number 46, 72 and 85, series number 3 and subcentimeter nodule in the right lower lobe image number 61 are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes involving the right kidney. Bilateral punctate stones without evidence of hydronephrosis. Simple appearing left upper pole cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval resection of right middle lobe nodule. Bilateral subcentimeter nodules, most of which are stable. One of the nodules in the right middle lobe has slightly increased in size compared to previous study.Postsurgical changes involving the right kidney. Simple appearing left renal cyst. Punctate stones without evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: post-TAVR History: post-TAVR A percutaneously deployed Sapien valve occupies the aortic position. Interval placement of a right IJ sheath that terminates at the posterior right 5th rib. Left-sided pacemaker with electrodes are unchanged in position. Cervical immobilization hardware is again noted.No interval pneumothorax or edema following aortic valve placement. The heart size remains normal. Slight decreased lung volumes.

Output: No complication following the placement of a percutaneous (Sapien) aortic valve.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Tachycardia, hyperglycemia History: As above Overlying life vest device obscures the lungs. No definite focal lung consolidation. No evidence of overt left-sided heart failure. Heart size at the upper limit of normal. Prominent central pulmonary arteries, as before. Aortic atherosclerosis, unchanged. Vascular stent again noted in the upper left hemithorax. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with colon cancer status post two cycles of therapy. Compare to last CT. CHEST:LUNGS AND PLEURA: Worsening pulmonary metastases bilaterally. For example, the lesions in the azygoesophageal recess are confluent and bulkier, extending to the right mainstem bronchus with adjacent lymphangitic spread of tumor seen as well.Reference right apical mass (series 5, image 23) measures 2.5 x 2 cm; previously measuring 2.2 x 1.9 cm.Reference right middle lobe mass (series 5, image 52) measures 4.6 x 4.4 cm; previously measuring 3.5 x 3.5 cm.Reference right lower lobe lesion is not distinctly visualized given background changes from lymphangitic spread of tumor and adjacent new right pleural effusion.MEDIASTINUM AND HILA: Reference right hilar adenopathy measures 4.6 x 2.4 cm (stable); however there is increasing mediastinal lymphadenopathy, particularly of the subcarinal lymph nodes. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Right chest Port-A-Cath with catheter tip in distal SVC. Median sternotomy wires.Expansile right clavicular mass has increased in size. It measures 3.9 x 3.2 cm; previously measuring 2.5 x 2.3 cm.Destructive lesion in the left T10 vertebra involving posterior elements with invasion into the spinal canal (series 3, image 72). It measures approximately 4.2 x 3 cm (series 3, image 75) in the axial plane. It is present previously but has increased in size. It measures approximately 3.9 x 2.8 cm on the study from 9/29/2010. It measured 3.4 x 2.8 cm on study from 8/28/2010.ABDOMEN: LIVER, BILIARY TRACT: Cholelithiasis. Intrahepatic biliary ductal dilatation, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left upper adrenal nodule (series 3, image 98) measures 2.3 x 1.1 cm; previously measuring 2.5 x 1.1 cm.Left lower adrenal nodule (series 3, image 102) measures 1.8 x 1.7 cm (stable).Right adrenal nodularity similar to prior study.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly increased retroperitoneal lymphadenopathy. Reference confluent retrocaval lymphadenopathy (series 3, image 118) measures 2.8 x 1.6 cm; previously measuring 2.5 x 1.6 cm.Reference right retrocrural lymph node (series 3, image 94) measures 1.5 x 1.5 cm (stable).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Wall thickening in the sigmoid colon appears similar to prior study. Previously seen soft tissue density mass in the adjacent mesentery (series 3, image 172) measures 1.5 x 1.2 cm; previously measuring 1.2 x 1.1 cm.BONES, SOFT TISSUES: Intra-medullary rod seen in the proximal left femur. Bilateral fat containing inguinal hernias again noted.

Output: 1. Growing, destructive lesion involving the posterior elements of the T10 vertebra on the left with invasion into the spinal canal.2. Worsening pulmonary metastases.3. Mildly increased retroperitoneal lymphadenopathy.Findings were directly communicated to Linda Janisch (APN) of the hematology/oncology service at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: fever, diarrhea Normal heart size and mediastinal contours.Large bore catheter extending to the SVC/RA junction.Mild blunting of both costophrenic angles compatible with small pleural effusions.No sign of pneumonia.

Output: Small effusions with no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p intubation, assess line placement History: as above ET tube 6.5 cm above the carina and right jugular catheter tip in the right atrium.NG tube coiled in the stomach.Cardiomegaly with bilateral opacities suggestive of edema, atelectasis and pleural effusions.Bullet fragments projected over the upper abdomen.

Output: ET tube in acceptable position. Low position of jugular venous catheter.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p OHT History: Leukocytosis Unremarkable cardiac and mediastinal contours with sternal fixation devices in place.Catheter tip in the SVC.No evidence of pulmonary edema or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: position of hickman History: she can "feel" the line in her neck / especially when she coughs and swallows Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Left jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: evaluate lung parenchyma s/p diuresis History: SOB Mild cardiac enlargementIncreased interstitial opacities in the perihilar and basilar regions improved from the prior exam.Scarring/discoid atelectasis in left midlung.No focal areas of consolidation.No large pleural effusions.

Output: Interval improvement in the coarse interstitial opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: PRE Lung or Heart-Lung Transplant Evaluation History: PRE Lung or Heart-Lung Transplant Two chest tubes bilaterally, with no significant pneumothorax. Unchanged basilar opacities consistent with edema.Right jugular catheter, tip in SVC.Perioperative left third rib fracture.

Output: No significant pneumothorax. No change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: sob History: as above Focal opacity in the mid aspect of the right lung, better evaluated on same chest CT. Please see that report for further details. Marked improvement of pleural effusions and upper lung opacities noted on previous radiograph. Normal heart size. No pneumothorax.\

Output: Endotracheal tube terminates approximately 4 cm from the carina.Focal opacity in the mid aspect of the right lung, better evaluated on same chest CT. Please see that report for further details.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: MI History: CP sob Small lung volumes with the basilar linear atelectasis and bilateral small pleural effusions. The cardiac silhouette appears normal. There is no evidence of pneumothorax.

Output: Hypoinflated lungs with basilar atelectasis and small bilateral pleural effusions unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax? History: sudden onset chest tightness Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: hypoxemia, tachypnea History: hypoxemia, tachypnea Status post median sternotomy with surgical drains but no pneumothorax.Basilar atelectasis improved on the right slightly worse on the left, likely from aspirated secretions or mucous plugging.Small left pleural effusion.Dobbhoff tube removed.

Output: Persistent basilar atelectasis, but no pneumothorax, chest tubes in place.


Instruction: Generate impression based on medical findings.

Input: 82 years old Male. Reason: evaluate volume status, infiltrates, edema, effusions History: respiratory failure. Stable cardiomegaly, and patchy opacities in the right lung. Bilateral pleural effusions. The tracheostomy tube and double lumen catheter as well as a right subclavian catheter are stable in position.

Output: Cardiomegaly and bilateral pleural effusions, unchanged. The patchy opacities in the right lung, which can be due to edema or infection or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: patient with CP, SOB, s/p chest tube removal, want to eval for pntx History: SOB Left-sided chest tube has been removed.No significant pneumothorax identified.Stable cardiomediastinal silhouette.Emphysematous changes in the upper lobes and basilar fibrosis redemonstrated.No new pulmonary opacities noted.

Output: Interval removal of a left-sided chest tube. No significant pneumothorax identified. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: cardiopulmonary abnormality History: chest pain No significant cardiopulmonary abnormality.Bullet fragment projected over the mid chest unchanged.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Fever Underlying scattered mild reticular changes decreased lung volumes which are nonspecific. In light of the patient's history, concern for bronchopneumonia in the setting of fever must be considered, however no focal discrete consolidation is observed. No definite effusions. Scattered calcified granulomaCardiac and mediastinal contours remain significant for mild tortuosity of the aorta and atherosclerotic changesUnchanged right subclavian single port extending into the upper SVC

Output: Recurrent changes again concerning for possible bronchopneumonia in the setting of fever and immunosuppression


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: ro pna History: cough, syncope Left subclavian AICD with a single lead in the right ventricle.Moderate to severe cardiomegaly. Tortuous thoracic aorta.Low lung volumes with streaky bibasilar platelike opacities, suggestive of subsegmental atelectasis/scarring. No pneumothorax or pleural effusion.Mild gaseous distention of the colon, partially imaged.

Output: Cardiomegaly and streaky nonspecific bibasilar opacities suggestive of atelectasis/scarring.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with history of diverticulitis CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules. Index nodule measures 4-mm image number 38, series number 5.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst, unchanged. Small left renal cysts are also unchanged.RETROPERITONEUM, LYMPH NODES: SMV is patent. Previously seen fat stranding around the SMV and associated thrombosis of the SMV have resolved.BOWEL, MESENTERY: Inflammation involving the terminal ileum and cecum a result. Small right lower quadrant lymph nodes persist.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: Interval resolution of previously noted SMV thrombosis and fat stranding surrounding the SMV.Right lower quadrant lymph nodes cannot ileocecal valve and terminal ileum persists. Wall thickening of the terminal ileum and cecum and ascending colon have resolved.Scattered bilateral micronodules.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: asses pneumo History: pneumo Surgical changes of a prior median sternotomy again noted. Epicardial pacing leads noted.Interval near resolution of previously seen pneumomediastinum. The cardiomediastinal silhouette is smaller and now at the upper limits of normal. Diffuse hazy interstitial opacities bilaterally are nonspecific. No pneumothorax.

Output: Near resolution of previously noted pneumomediastinum. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval ptx improvment or worsening History: see above There is no significant residual left pneumothorax. Chest tube in place.No change in bilateral lung opacities.No change in cardiomegaly.

Output: 1. No significant residual left pneumothorax2. No change in bilateral lung opacities.


Instruction: Generate impression based on medical findings.

Input: Cough Mildly improving aeration with decreasing streaky densities in both bases, suspected resolving aspiration or and atelectasis. No new superimposed focal air space process projected upon mild minimal interstitial changes, presumably chronic in nature.The cardiac and mediastinal contours are within limits

Output: Improved aeration and suspected resolving superimposed aspiration and/or atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: s/p RIJ central line, assess for PTX and line placement History: none No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infection History: DKA Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: FemaleReason for Study: Reason: post op, eval lung fields History: s/p AVR, MVR, Maze ET tube with its tip at the carina.Right IJ Swan-Ganz with its tip in the pulmonary artery.Chest/mediastinal tubes unchanged without evidence of a pneumothorax.Marked cardiac enlargement with perihilar edema and pleural effusions similar to the prior exam.Persistent left retrocardiac consolidation/atelectasis.

Output: ET tube in low position should be repositioned. Cardiomegaly with increasing pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval effusions History: effusions Moderately large pleural effusions with underlying atelectasis.Catheter tip in the SVC.No new findings.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Pleural biopsy, mesothelioma Marked asymmetry with decreased volume on the left correlating with known mesothelioma with suspected moderate to large effusion. Partial collapse and/or consolidation of the left lower lobe. Specifically no discrete pneumothoraxRight lung is grossly clear other than minimal changes in the bases, likely atelectasis and possible small effusionNo definite distinct cardiac or mediastinal contour abnormality given limitations and lack of prior exam for comparisonMidline sternotomy

Output: Extensive left sided changes compatible with known mesothelioma. No definite superimposed immediate postprocedural consultation such as pneumothorax. Please correlate with recent CT


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: moniot fluid overload History: sob Persistent perihilar and interstitial opacity consistent with edema. ET tube, dialysis catheter, and enteric tube are unchanged.

Output: Persistent perihilar and interstitial opacity consistent with edema.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old. Reason: 30yo M w/ hs bacteremia, now with fever History: as above Central venous catheter terminates within the SVC. Interval extubation. Improving right upper lobe opacity. Nodular fullness of the right hilar and right paratracheal regions, unchanged. Unchanged moderate cardiomegaly given the increase in lung volumes. No pneumothorax.

Output: Improvement in right upper lobe opacity. Placement of right IJ catheter without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with bilateral pleural effusions and aspiration. No pleural effusions or pneumothorax. Right Port-A-Cath is unchanged in position with tip at the atriocaval junction. Cardiopulmonary silhouette is stable without new focal pulmonary opacity. Superior mediastinal widening consistent with previously demonstrated mediastinal lipomatosis.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of presumed fungal pneumonia on CT. Follow-up. Without the administrations of IV contrast evaluation of the solid organs in for lymphadenopathy is limited.LUNGS AND PLEURA: Continued interval marked decrease in the right upper and lower lobe focal consolidations and surrounding ground glass opacity.New left pleural effusion with associated atelectasis.No significant mediastinal or hilar adenopathy.MEDIASTINUM AND HILA: New pericardial effusion.Right central venous catheter tip within the SVC.CHEST WALL: Minimal degenerative changes of the spine. Sclerotic area at the inferior aspect on the right of the L1 vertebral body that has been stable since 10/18/2010.UPPER ABDOMEN: Status post cholecystectomy.

Output: 1. Continued interval marked decrease in right upper and lower lobe consolidations.2. New small left pleural effusion and new pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: ECMO for diaphragmatic hernia. Removal of blood from right hemithorax. Cannulas reposition.VIEW: Chest AP (one view) 04/06/15, 1252 Endotracheal tube tip is above the thoracic inlet. Feeding tube tip is in the stomach and multiple side ports are in the esophagus. ECMO cannulas remain in place. Right chest tube is again seen. Umbilical venous line tip is at level of inferior vena cava. Umbilical arterial line tip is at T10.Soft tissue edema continues. Mediastinum is slightly shifted to the right where it was on 04/04/15, 0613. Hemithoraces are completely opacified.

Output: Complete opacification of hemithoraces. Mediastinum slightly shifted to the right, in its expected location.


Instruction: Generate impression based on medical findings.

Input: Check chest tubes Postsurgical mediastinal and left basilar chest tubes, LVAD, ICD and bilateral jugular catheters are unchanged. ETT terminates 5 cm above the carina.Underlying cardiopulmonary appearance is also similar with associated marked cardiomegaly and retrocardiac opacities and small left effusion, all uncertain significance. See such report

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: Eval for sarcoidosis and cause for SOB History: intermittent SOB, fatigue Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of sarcoidosis.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Ovarian cancer, status post chemotherapy CHEST:LUNGS AND PLEURA: Punctate nodule in the right minor fissure is unchanged. No new nodules.MEDIASTINUM AND HILA: 5-mm left thyroid lobe nodule is unchanged.CHEST WALL: Left axillary adenopathy measures 3.6 x 3.4 cm image number 21, series number 3. Reference pleural-based left-sided mass is smaller measuring 10 x 9 mm number 31, series number 4. Right paraspinal pleural based mass is also significantly smaller measuring 12 x 4 mm on image number 58, series number 4. Right posterior pleural metastasis measures 2.7 x 1.3 cm, not significantly changed.ABDOMEN:LIVER, BILIARY TRACT: Mass adjacent to the right lobe of the liver is smaller now measuring 2.7 x 1.6 cm image number 95, series number 3. No intrahepatic focal lesion.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: Left para-aortic adenopathy displacing the left renal vein anteriorly measuring 2.8 x 3.8 cm and is not significantly changed and best seen on image number 102, series number 3. It was measuring 4.3 x 2.8 cm on image number 100, series number 3 on CT dated 8/27/2008. Adenopathy extends to the periceliac region.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: Multiple lesions compatible with patient's known metastasis from ovarian cancer. Left axillary and retroperitoneal adenopathy is not significantly changed. Extrahepatic metastatic lesion in in the posterior abdominal wall is smaller. Some of the pulmonary based metastases are also smaller.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.OR check for foreign objects. No unexplained radiopaque foreign objects. Interval removal of surgical sponges.Right jugular Swan-Ganz catheter with tip in the pulmonary outflow tract, enteric tube with tip in the stomach, left central venous catheter with tip in SVC, left subclavian ICD with unchanged position of leads, mediastinal/ chest tubes and circulatory assist device tubes noted.Stable bilateral airspace and interstitial opacities consistent with edema . Severe cardiomegaly redemonstrated. Left retrocardiac consolidation/atelectasis . Bilateral pleural effusions are present.Open sternotomy.

Output: No unexplained radiopaque foreign objects. Stable pulmonary edema, tubes and lines as noted above. These findings were discussed by telephone with Dr. David Onsager, the attending surgeon, on 8/27/2015 at 10:24 AM.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with angiosarcoma of breast (history of breast cancer, XRT). Currently on Taxol. Evaluate disease progression. CHEST:LUNGS AND PLEURA: Left apical scarring/fibrosis as well as nonspecific mosaic attenuation as seen previously, the latter of which may represent edema. Scattered micronodules are again identified bilaterally, appearing similar to prior study. Largest left lung nodule (series 4, image 43) measures 6 mm (stable). Largest right lung nodule (series 4, image 75) measures 8 mm (stable). MEDIASTINUM AND HILA: Coronary artery calcifications. Small mediastinal lymph nodes appearing similar to prior study. Heart size normal without pericardial effusion.CHEST WALL: Left breast skin thickening also appears similar to prior study. Previously seen soft tissue nodule in left lower outer quadrant is less well-defined, thereby making objective measurements difficult. However it approximately measures 2.5 x 1.6 cm (series 3, image 52); previously measured 3.1 x 2.5 cm.Left axillary surgical clips.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute inflammation. Multiple small low-attenuation foci in the liver are unchanged. No intra-or extrahepatic biliary ductal dilatation. The portal and hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small hypodense foci in left kidney, stableRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Multiple pulmonary micronodules are unchanged on comparison to prior study from 7/23/2009 with reference measurements given above.2. Left breast nodule is less well-defined but appears to be smaller on comparison to prior study.


Instruction: Generate impression based on medical findings.

Input: Female; 53 years old. Reason: 53 yo female with history of MM; pre-auto SCT evaluation History: evaluate Lungs are clear.Normal heart size.Slight scoliosis of the thoracolumbar spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 59-year-old man with history of pleural mesothelioma. Please compare to all previous measurements. CHEST:LUNGS AND PLEURA: Stable right-sided pleural thickening with increase in size of intrafissural nodules (image 54 and 62/106). Stable left sided pleural plaques. No new pulmonary nodules. Reference measurements are as follows:1. At the level of the manubrium (image 25/164): 31 mm at the two o'clock position (increased from 23 mm on prior exam), 27 mm at the 5 o'clock position (increased from 12 mm on the prior exam).2. At the level of the right pulmonary artery (image 51/164): 19 mm mm at the two o'clock position (increased from 16 mm on prior exam), 17 mm at the 3 o'clock position (increased from 13 mm on prior exam). This measurement includes the wall of the esophagus.3. At the level of the right superior pulmonary vein (image 58/164): 17 mm at the two o'clock position (increased from 10 mm on prior exam) and 26 mm at the 9 o'clock position (increased from 20 mm on prior exam).MEDIASTINUM AND HILA: SVC is significantly attenuated at the thoracic inlet as seen on image 27/164. External compression of the right atrium by tumor mass. Right apical tumor continues to abut the trachea and esophagus, with no evidence of airway compromise. Enlarged mediastinal lymph nodes which appear stable in size from prior exam. Heart size is within normal limits, with no evidence of pericardial effusion.CHEST WALL: Multifocal areas of tumor involving the right-sided ribs appear stable. Stable compression fracture of a lower thoracic vertebral body, with no new destructive lesions identified.ABDOMEN:LIVER, BILIARY TRACT: Interval increase in size of mass involving the chest wall with invasion of the hepatic capsule as seen on images 83 and 101/164. No new focal lesions are seen within liver.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS: Retroaortic left renal vein, normal variant.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.OTHER: Interval development of ascites with bilateral peritoneal caking by tumor.

Output: 1. Interval progression of disease.2. Interval development of ascites with peritoneal tumor.3. Significant attenuation of the SVC at the thoracic inlet.


Instruction: Generate impression based on medical findings.

Input: Pulmonary edema and trach location. NGT has been replaced by a Dobbhoff tube with tip beyond the caudal margin of the radiograph. Moderate right pleural fluid collection and pulmonary edema without significant change. Tracheostomy tube tip at the level of the clavicular heads, about 5 cm above the expected level of the carina.Cardiomegaly with enlargement of the central pulmonary vasculature unchanged.

Output: No significant change in moderate pulmonary edema. Tracheostomy tube tip 5 cm above the expected level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: assess for pneumonia, aspiration or otherwise History: fever The heart is normal in size. Right IJ venous catheter in projection of SVC.Left basilar bandlike opacities represent discoid atelectasis, stable from prior studies.No new abnormal lung parenchymal opacities to suggest pneumonia, although assessment is limited in a single expiratory projection. No pleural effusion or pneumothorax.

Output: Basilar atelectasis with no specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Reason: hx of ureteral cancer s/p radiation, evaluate for metastatic disease History: see above Unremarkable cardiac and mediastinal silhouette. Mild scarring at the left base.No significant pulmonary abnormalities.

Output: No sign of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: chest pain; cough, History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with history of metastatic prostate cancer CHEST:LUNGS AND PLEURA: Emphysema is unchanged. New linear atelectasis in the right lower lobe.MEDIASTINUM AND HILA: Pretracheal lymph nodes are slightly enlarged compared to previous study.This node measures 12 x 9 mm image number 44, series number 4. Previously closed measuring 8 x 8 mm on image number 45, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable small benign liver cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm and bilateral ectatic common iliac arteries are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged heterogeneous prostate.BLADDER: Diffuse wall thickening of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Extensive blastic bone lesions involving the entire skeleton is unchanged.

Output: Slight interval enlargement of the mediastinal lymph nodes. Extensive bone metastases are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: sepsis? History: sepsis Small lung volumes with resolution of perihilar interstitial opacity compatible with edema.Small pleural effusions, confirmed on a CT scan of the same day.No specific evidence of infection.

Output: Small lung volumes with interval clearing of pulmonary edema. Small residual pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: r/o abnormality History: left sided cp Cardiomediastinal silhouette is within normal limits.Mild streaky opacities at the left lung base. Mild bronchial wall thickening. No pleural effusions or pneumothorax.

Output: Mild streaky opacities at the left lung base may be due to mucous plugging or aspiration. Bronchial wall thickening may relate to asthma.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: PNA History: cough, S. pneumoniae bacteremia Nonspecific left base opacity worsening over last 5 days suggestive of infection or aspiration.Heart size normal.

Output: Worsening left basilar opacity consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: CT hx History: CT hx Right chest tubes unchanged in position.Basilar subsegmental atelectasis and cardiomegaly stable. Small pleural effusions.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Chest pain. Stable cardiomediastinal silhouette. No airspace disease pleural effusion or pneumothorax. Right chest port catheter unchanged in position.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: confirm LVAD placement History: none Worsening pulmonary opacities and pleural effusion suggestive of edema/CHF.IABP catheter distal tip now 5 cm below the top of the aortic arch, having been advanced.An NG tube terminates in the stomach.

Output: IABP repositioned. Worsening pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: placement of right IJ triple lumen History: placement of right IJ triple lumen New right jugular catheter tip in SVC.Other tubes and devices are unchanged.Left lower lobe consolidation with lower lungs and edema and severe cardiomegaly are stable.

Output: New right jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.PICC Left-sided PICC terminates within the right atrium approximately 5 cm from the cavoatrial junction.Clear lungs. Normal heart size. No pleural effusion or pneumothorax.

Output: Left-sided PICC terminates within the right atrium approximately 5 cm from the cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: GCT of the left proximal tibia, s/p curettage/cementation, please evaluate for metastasis History: above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with metastatic pancreatic cancer presents with 3 days worsening diffuse abdominal pain, nausea, vomiting CHEST:LUNGS AND PLEURA: Mild emphysematous changes. Small left upper lobe nodules remain, with the reference nodule measuring 5 mm, unchanged (series 5; image 40).MEDIASTINUM AND HILA: 18 x 17-mm paratracheal lymph node, unchanged (series 3; image 44). Other smaller mediastinal lymph nodes are unchanged.Coronary calcifications remain. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No change in the size of number of metastatic lesions involving the liver, with the reference lesion in segment two measuring 19 x 18 mm (series 3; image 95).SPLEEN: No significant abnormality notedPANCREAS: No significant change in the size of the pancreatic mass common measuring approximately 4 0.1 x 3.4 cm (series 3; image 130). Mild upstream pancreatic ductal dilatation is again noted. Mild haziness around the pancreas is now demonstrated.Invasion of the SMV is again noted, now with the development of thrombosis. Tumor encases a portion of the SMA, unchanged.Dilated mesenteric veins are again noted.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small bilateral renal hypodensities are unchanged. Bilateral punctate calcifications without evidence of obstruction.RETROPERITONEUM, LYMPH NODES: Peripancreatic and portacaval adenopathy are unchanged. The reference portacaval node measures 26 x 17 mmBOWEL, 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 significant change in the size the pancreatic head mass, hepatic metastases, adenopathy or left upper lobe pulmonary nodules.Development of thrombosis within the SMV.Mild peripancreatic and mesenteric fat stranding, compatible with pancreatitis, has mildly increased.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval evaluate position of picc History: s/p repositioning of picc Left-sided PICC terminates in the SVC near the cavoatrial junction. Enteric tube extends at least to the body of the stomach. Trend toward increasing diffuse pulmonary opacities, right greater than left. Small right pleural effusion, as before. Heart size and the upper limit of normal. Aortic atherosclerosis. No pneumothorax.

Output: Trend towards worsening diffuse pulmonary opacities most consistent with pulmonary edema, multifocal pneumonia, and/or pulmonary hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Please evaluate recent leadless pacemaker insertion History: Please evaluate recent leadless pacemaker insertion Leadless pacemaker projects over the right ventricle. Cardiac size upper limits normal. No pulmonary opacity, pleural effusions or pneumothorax.

Output: Leadless pacemaker in an appropriate position. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 15 years old Reason: s/p L vats and rul wedge resection History: s/p L vats and rul wedge resectionVIEW: Chest AP (one view) 4/23/15 at 1959 hrs. Pigtail has been replaced by a chest tube. Surgical sutures are noted. Right-sided hydropneumothorax. Normal right lung. Cardiac silhouette size is normal.

Output: Post surgical changes of the left lung with residual hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with history of endometrial cancer CHEST:LUNGS AND PLEURA: Calcified subcentimeter nodule in the right upper lobe is unchanged. No new nodules. Linear atelectasis in the lung bases are unchanged.MEDIASTINUM AND HILA: Prominent mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter exophytic lesion in the lower pole of the left kidney is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small periumbilical hernia containing nonobstructed bowel segments and fat is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Uterus and adnexa: 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, 79 years old.Reason: 79yo F w/ increased WOB, assess for change in pulmonary fields History: as above Patient has been extubated. Diffuse pulmonary opacities and pleural effusions, with trend toward increase. Unchanged right IJ catheter. Diffuse osteopenia with likely multilevel compression deformity and moderate convex-right thoracic scoliosis again noted. No pneumothorax. Heart size difficult to assess due to thoracic spinal curvature.

Output: Trend towards increase in diffuse pulmonary opacities and pleural effusions most suggestive of congestive heart failure versus multifocal pneumonia.


Instruction: Generate impression based on medical findings.

Input: Pancreas cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Biliary stent with expected pneumobilia. There is moderate intrahepatic biliary dilatation. No focal liver lesions suspicious for metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic body and tail with dilated duct. Soft tissue fullness in the pancreatic head which may represent patient's known cancer measures 1.7 by 1.3-cm on image number 117, series number 10, not significantly changed from previous study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Artifact from left hip prosthesis limits optimal evaluation of the pelvis.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: Right apical ptx History: right apical ptx Small right apical pneumothorax, not significantly changed compared to previous.Cardiomegaly with tricuspid and mitral valve rings as previously described. Basilar opacity consistent with atelectasis and small effusions.

Output: Persistent small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with lung cancer. Screening CT status post chemo treatment CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions, right greater than left, increased in size. The lungs are emphysematous. Decrease in size of the right upper lobe nodule, now measuring 2.1 x 1.4 cm (series 5; image 38), previously measuring 3.3 x 2.3 cm on 11/7/09.MEDIASTINUM AND HILA: Right hilar and mediastinal soft tissue density has decreased in size. The ill-defined right hilar component measures approximately 2.2 x 2 .0 cm, previously 3.4 x 3.1 cm (series 3; image 39). The degree of narrowing of the lobar bronchi and pulmonary vasculature has improved.CHEST WALL: Stable subcentimeter hypodensity in the right lobe of the thyroid gland. Air-fluid level is seen in the esophagus with mild wall thickening, compatible with known esophagitis.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Thickening of both adrenal glands is unchanged.KIDNEYS, URETERS: Subcentimeter renal hypodensities are too small to definitively characterize, unchanged in size. Retroaortic left renal vein.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate pneumoperitoneum is identified, likely sequela of recent gastrostomy tube placement.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Regression of pulmonary disease.Moderate pneumoperitoneum is identified, compatible with gastrostomy placement from 12/28/09.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: edema History: new oxygen requirement Enlarging pleural effusions and worsening left basilar consolidation.Heart size obscured by the effusions.Right jugular catheter, tip in SVC.

Output: Enlarging pleural effusions and increasing left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: Eval for cardiopulmonary disease. History: Chest pain. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: s.p right nephrectomy eval for pneumothroax, please take upright History: s.p right nephrectomy eval for pneumothroax, please take cxr upright Right jugular catheter with tip in the SVC. Diffuse chronic interstitial disease with superimposed basilar opacities compatible with edema and pleural effusions. Stable cardiac silhouette. No large pneumothorax.

Output: CHF/volume overload without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male history of head and neck cancer. CHEST:LUNGS AND PLEURA: Few scattered micronodules, some of which are calcified, unchanged. No new lesions or evidence of pulmonary metastases.MEDIASTINUM AND HILA: Index superior right paratracheal lymph node (series 3 image 9) measuring 14 x 9 mm of apparent previously 15 x 10 mm). Left paratracheal lymph node at the same level with interval decrease in size.No significant mediastinal or hilar adenopathy.Extensive coronary artery calcifications with minimal pericardial fluid.CHEST WALL: Tracheostomy tube in place. Right Port-A-Cath tip in the SVC/RA junction.Few subcentimeter sclerotic lesions in the ribs, likely represent benign bone islands, unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate, nonobstructing bilateral nephrolithiasis, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube inflated within the gastric lumen. Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease. Few upper paratracheal borderline enlarged lymph nodes, decreased in size.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.AVR evaluate ETT, lung fields. 17 mm right apical pneumothorax.Left jugular Swan-Ganz catheter looped in the right atrium and extending into the suprahepatic IVC before extending into the pulmonary outflow tract and right descending pulmonary artery where it terminates in a subsegmental branch.Aortic valve prosthesis. Mediastinal drains. ETT tip about 5 cm above the expected level of the carina. IABP marker projects over the aortic arch level.Patchy atelectasis and airspace opacity bilaterally suggestive of aspiration.

Output: 17 mm right pneumothorax. Tortuous course and distal position of the Swan-Ganz catheter tip, consider repositioning.


Instruction: Generate impression based on medical findings.

Input: Hypoxia New mixed interstitial patchy opacities observed bilaterally with myocardium angle in suspected small layering effusions greater on the left.NG tube placed, tip extends beyond inferior edge of the image

Output: Interval increasing bilateral patchy opacities concerning for multifocal infection and/or less likely pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Concern for CHF exacerbation, worsening SOB, orthopnea, lower extremity edema over last month. Question pneumonia, effusion, cardiomegaly. Unchanged cardiomegaly.Markedly low lung volumes. Scattered patchy nodular opacities in the left upper lobe at site of prior linear opacity, partially resolved.Numerous nodular opacities in the right lung base.Small to moderate pleural effusions and hazy peribronchial opacities consistent with CHF.

Output: Mild CHF. Scattered nodular opacities may indicate aspiration or infection. Recommend follow-up PA and lateral chest radiographs after management of fluid status.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p Robotic MAZE History: ptx vs pulm edema Interval removal of lines and tubes. Increase in lung volumes. Basilar pleuroparenchymal opacities, not substantially changed. Unchanged heart size. No pneumothorax.

Output: Increase in lung volumes. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval for pulmonary opacities History: pharyngeal bleeding Large lung volumes, otherwise unremarkable.Tracheostomy tube tip 7 cm above the carina.Upper abdominal surgical clips are noted.

Output: Large lung volumes, otherwise unremarkable, tracheostomy tube in place and unchanged.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with non-Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: Punctate calcified granulomas.MEDIASTINUM AND HILA: Left thyroid lesion with coarse calcifications, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hepatic hemangioma, unchanged. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cysts. Circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: No significant change in the mesenteric mass, measuring 9.2 x 6.7 cm (series 3; image 125), previously 9.4 x 6.7 cm. Adjacent enlarged but smaller lymph nodes remain.BOWEL, MESENTERY: Small periumbilical hernia containing fluid, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small right inguinal hernia containing a small amount of fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old. Reason: s/p DDRT now with emesis, r/o ileus Surgical clips in the right upper quadrant and surgical staples overlying the left hemipelvis. Multiple dilated loops of small bowel, with air-fluid levels seen on upright imaging, compatible with high-grade incomplete obstruction. Some gas seen within the colon.No pneumatosis or portal venous gas. No free air seen on upright imaging.Tortuous thoracic aorta. No new focal airspace opacities, pleural effusions, or pneumothorax.

Output: Findings compatible with high-grade incomplete small bowel obstruction. See follow-up CT imaging for additional details.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: hX OF HCC with fever R/o pneumonia History: fevers Low lung volumes. No focal consolidation, effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No significant abnormalities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female 22 years old Reason: pneumothorax History: status post right lower lobe biopsy. Cardiomediastinal silhouette is within normal limits. No focal opacity, significant pneumothorax, pleural effusion is identified.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: 72yo F h/o breast cancer with productive cough, fever, congestion. Eval for pneumonia History: fever, cough, congestion Assessment of the lungs is very limited due to low lung volumes and elevation of the left hemidiaphragm.There is a poorly fine consolidative opacity in the right lower lobe which could represent atelectasis or pneumonia in the setting of cough and fever.Left lower lobe discoid atelectasis again noted.Small left pleural effusion is unchanged. No pneumothorax.The cardiac contours are partially obscured.Lytic lesions involving the left first rib and left scapula are again seen.

Output: Right lower lobe partial volume loss and consolidation may represent pneumonia in the appropriate clinical setting. Correlate with physical exam.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: S/p thoracentesis, evaluate for interval changes and complications History: SOB s/p thoracentesis Complete right hemithorax opacification with leftward shift of the mediastinum consistent with a large pleural effusion.No pneumothorax following thoracentesis.Gradually increasing left basilar opacities and left pleural effusion.Status post TIPS.

Output: Large right pleural effusion shifting the mediastinum to the left.


Instruction: Generate impression based on medical findings.

Input: Dyspnea, coarse breath sounds. Low lung volumes. Cardiomegaly and tortuosity of the thoracic aorta noted. No focal airspace opacities or visible signs of pulmonary edema. Interval removal of Dobbhoff tube.

Output: Low lung volumes. Cardiomegaly. No visible signs of CHF or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: pneumothorax, re evaluate History: SOB Right pneumothorax smaller than before although still quite large. The large left pneumothorax is unchanged.Pleural fluid has diminished.Bilateral Pleurx catheters.Right jugular catheter tip at SVC/artery junction level.

Output: Slight improvement in right pneumothorax but both remain large, but there is less pleural fluid.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with lung cancer. Evaluate response to therapy. CHEST:LUNGS AND PLEURA: A right upper lobe spiculated mass has changed in configuration slightly making direct comparison somewhat difficult. The tumor measures 2.3 x 1.9 cm on axial image 30/111 and is unchanged at this level which is equivalent to that used for the prior measurement. On several more inferior slices, however, the mass does appear fuller than on the prior exam. Previously noted adjacent punctate micro-nodule is no longer evident. A few, scattered new micronodules are evident (axial images 27, 32, 44, and 65/111).No focal consolidation, edema or pleural effusion. Moderate centrilobular emphysema is unchanged.MEDIASTINUM AND HILA: Interval improvement in pretracheal, prevascular, AP window and subcarinal lymphadenopathy. Reference subcarinal node measures 1.7 x 1.1 cm on axial image 46/147 (measured 2.2 x 1.8 cm on 1/23/08).CHEST WALL: Right subpectoral and axillary lymphadenopathy is improved. Reference right axillary lymph node measures 2.1 x 2.6 cm on axial image 21/147 (measured 3.1 x 3.2 cm on 1/23/08). No significant hilar lymphadenopathy.Cardiac size is normal with no significant pericardial effusion.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is contracted containing foci of high attenuation which likely represent gallstones.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small gastrohepatic lymph nodes unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Right upper lobe mass has changed somewhat in configuration, and although the reference measurement is stable, the mass appears slightly fuller in certain planes.2.Scattered new pulmonary micronodules.3.Improved axillary and mediastinal lymphadenopathy as above.4.Gallstones.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: rule out pneumonia History: cough, leukocytosis, no sob Small pleural effusions and left basilar subsegmental atelectasis or scar. Heart size is at the upper limit of normal. No pneumothorax. Port catheter again terminates in the SVC.

Output: Small pleural effusions and left basilar atelectasis or scar again noted.


Instruction: Generate impression based on medical findings.

Input: The cervical spine is in normal alignment, although there is mild-moderate reversal of the normal cervical lordosis. There is mild disk narrowing at C5-C6 and C6-C7. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. Mild endplate degenerative changes are seen at C6-C7. The spinal cord is of normal caliber and signal.At C4-C5, there is a trace disk bulge without stenosis.At C5-C6, there is a mild posterior osteophyte disk complex and bilateral uncovertebral hypertrophy. There is a mild there is minimal left foraminal narrowing.At C6-C7, there is a trace diffuse posterior osteophyte disk complex and left greater than right uncovertebral hypertrophy. There is moderate-severe left foraminal narrowing.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. There is a small amount of fluid within the esophagus.

Output: Minimal spondylotic changes most prominent at C6-C7 where there is moderate-severe left foraminal narrowing.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with esophageal cancer status post two cycles of chemo and 6 weeks of RT. Evaluate disease prior to surgical resection. CHEST:LUNGS AND PLEURA: Several punctate left upper lobe micronodules, one of which is calcified, are nonspecific. No suspicious nodules or masses. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Right thyroid lobe cystic lesion probably represents a benign cyst. Small prevascular nodule on axial image 60/167 may reflect a lymph node or residual thymus. The cardiac size is normal. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.Subtle thickening of the esophageal wall (axial image 91/167) probably represents the patient's primary carcinoma.CHEST WALL: Right chest wall port catheter with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small, enhancing gastrohepatic lymph node (axial image 105/167) is of uncertain significance. No evidence of pathologically enlarged mesenteric or retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Multiple nonspecific findings as described above with no definite evidence of metastatic disease to the chest or upper abdomen.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: History of renal cancer. CHEST:LUNGS AND PLEURA: Scarring of the left apex. Left upper lobe nodule measures 9 by 8mm image number 16/216. Additional left upper lobe nodule adjacent to the mediastinum measures 17 x 10 mm on image number 29/216. Small nodule adjacent to the left major fissure is also noted. Additional nodule in the lingula measures 9 x 8 mm on image number 79/216. Left posterolateral diaphragmatic hernia containing nonobstructing bowel segments are unchanged.MEDIASTINUM AND HILA: Punctate calcification in the mitral valve as well as within the left ventricle. The etiology of the left ventricular punctate calcification is unknown but may represent a small calcified thrombus versus calcification of the papillary muscles.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple cysts in the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: Previous described cystic lesion in the outside process is not well seen but grossly unchanged measuring 14 x 10 mmADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right simple renal cyst. The patient status post left nephrectomy. No evidence of tumor recurrence in the nephrectomy bed. Multiple surgical clips in the retroperitoneum without evidence of enlarged lymph nodes.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is significantly enlarged. There is a bulging in the right posterior lateral contour of the prostate superiorly.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mixed sclerotic and lytic areas in the left inferior pubis ramus and left iliac bone.. these changes may represent changes secondary to posterior process and/or Paget's disease. Further evaluation with bone scan may be helpful.OTHER: No significant abnormality noted

Output: Unchanged to minimally decreased nodules in the lungs.Mixed sclerotic and lytic changes in the left iliac bone and left inferior pubis ramus. These most likely represent changes secondary to osteoporosis and Paget's disease, however further evaluation with bone scan is recommended.Calcification in the mitral valve and within the lumen of the left ventricle which may represent a small thrombus versus capillary muscle calcification. Cardiac echography may be helpful for further evaluation.Enlarged prostate gland with contour lobulation right superolaterally. Correlation with PSA is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: pulm edema interval change History: SOB Extensive bilateral nonspecific airspace opacity, more suggestive of aspiration and infection than pulmonary edema, particularly based on earlier radiographs.No significant change since the previous day.

Output: Patchy bilateral airspace opacity more suggestive of aspiration and infection than pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Dyspnea status post left interscalene catheter placement. Rule out left pneumothorax. Left interscalene catheter, the presumed external portion projects over the mediastinum.No pneumothorax.Patchy atelectasis on the left is new. Scarring at the lung bases.Appearance of new mediastinal widening may be exaggerated by patient rotation and can be reassessed on a follow-up chest radiograph.Bilateral shoulder hardware. Partially visualized surgical drain projects of the left shoulder.

Output: No pneumothorax. Apparent mediastinal widening may be exaggerated by patient rotation however a follow-up film is recommended when feasible for confirmation. New left lower lobe retrocardiac atelectasis, most likely the result of aspirated secretions.Clinical service (Amanda Burress) notified via Web exchange text page at 9:42 AM on 3/8/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old. Interval placement of right central venous catheter with tip projections pre-vena cava. No pneumothorax.Lines otherwise stable in position. No interval change in small bilateral effusions.

Output: Interval right internal intravenous line position. No other significant change.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with uterine and ovarian cancer status post chemotherapy 3/2008. Evaluate and compare to 4/4/2008,. Comment on right upper lung nodule 6-mm image 56 retroperitoneal lymph nodes image 108. Past history 9/07 TAHBSO. 11/07 staging procedure. CHEST:LUNGS AND PLEURA: Index nodule right lung series 5 image 5 mm diameter, unchanged. Two other nodules one on image 31 and a subtle nodule on image 32 in the right lung. No new nodules. No effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small noted medial to the left adrenal gland is approximately unchanged measuring about 1.6 x 0.7 cm series 3 image 105. Long axis is somewhat sensitive to slice location.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Surgically absent. Pessary in place.BLADDER: No significant abnormality noted.LYMPH NODES: Hypodense node/collection adjacent to surgical clips in the right paracaval area is unchanged; measured on series 3 image 151 is 1.9 x 1.6 cm. It's measurement is also somewhat sensitive to slice location. No new nodes.Small distal left external iliac node unchanged since image 183 measures 1.2 x 0.7 cm.BOWEL, MESENTERY: No evidence of adenopathy ascites or carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with testicular cancer. The examination is limited due to patient's vomiting after injection of contrast and related respiration artifactsCHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: right hilar lymph node is unchanged, measuring 12 noted on image number 49, series number 3CHEST 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: Previously described compression of the left renal vein between the SMA and aorta is unchanged. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Previous described left retroperitoneal fluid collection has resolved.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE: 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: Previously described left retroperitoneal fluid collection has resolved.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: FemaleReason for Study: Reason: ETT eval History: pt intubated Support devices unchanged.Stable cardiac mediastinal silhouette.Diffuse pulmonary opacities and pleural effusions similar in appearance to the prior exam.

Output: Support devices unchanged with ET tube tip in satisfactory position. Stable cardiopulmonary appearance with diffuse pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer and renal cancer No cardiopulmonary abnormality

Output: Normal