Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: cp History: cp Chronic appearing basilar interstitial opacities.No change to indicate superimposed edema or pneumonia.Flat diaphragms consistent with COPD. Heart size normal.

Output: COPD and basilar scarring, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with gastric cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Small 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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference gastrohepatic lymph node now measures 18 x 11 mm on image number 87, series number 3, slightly enlarged. Other perigastric lymph nodes are also minimally enlarged.BOWEL, MESENTERY: Diffuse gastric wall thickening representing patient's known history of gastric cancer is unchanged. There is hazy soft tissue density within the greater omentum adjacent to the stomach which represent peritoneal extension.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: Gastric thickening associated with hazy soft tissue density in the greater omentum adjacent to stomach which may represent peritoneal spread.


Instruction: Generate impression based on medical findings.

Input: Tachypnea, evaluate pulmonary edema. IABP marker no longer identified. Fixation hardware projects over the cervical spine.Lung volumes remain low but are slightly improved.Pleural fluid collection similar in volume, with basal atelectasis on the left.Improving atelectasis in the region of the lingula, but no acute change in diffuse pulmonary opacities elsewhere. There is only a mild component of pulmonary edema.

Output: Improved aeration in the region of the lingula but otherwise no acute change in for diffuse pulmonary opacities suspicious for pneumonia and pleural fluid. There is only mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old. Interval removal of multiple lap sponges with an open sternotomy wound.No evidence of a retained lap sponge or other unexpected radiopaque foreign body.ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Balloon catheter with its tip in the descending aorta at the level of T8.Scope extending to the mid esophagus.Cardiomegaly with basilar nonspecific airspace opacity, unchanged.

Output: No evidence of retained foreign object. This was communicated directly to the attending surgeon, Dr. Song, at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Enteric tube adjustment Enteric tube seen with side-port just beyond gastroesophageal junction. Nonobstructive bowel gas pattern.

Output: Enteric tube as above.Please refer to same day chest radiography for additional findings.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: hx of chronic cough for 2 months and history of breast cancer; smoker History: cough No focal airspace opacities or pleural effusions is present.The cardiomediastinal silhouette is unremarkable.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT terminates 4 cm above the carina. A discrete generator overlies the mid left lung with a single lead extending superiorly into the left neck incompletely visualized.Lungs are grossly clear yet mildly decreased in size. This correlates with semiupright portable technique. Cardiomediastinal contours are grossly within limits

Output: ETT well-positioned


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: ett, central line History: ett, central line ET tube has been placed with its tip 5 cm above the carina.NG tube with its tip in the stomach.Right IJ venous catheter with its tip in the SVC.Decreased lung volumes with stable cardiomediastinal silhouette.Right basilar atelectasis and possible small effusion slightly increased from the prior exam.

Output: Interval intubation with ET tube in adequate position. Mild increasing right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with unexplained weight loss, ex-smoker. Evaluate for malignancy. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the lingula on image number 35/104.MEDIASTINUM AND HILA: Enlarged left lobe of the thyroid extending retrosternally into the superior mediastinum. Right lobe of the thyroid also contains nodules. Several nonenlarged mediastinal lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Multiple parenchymal calcifications in the atrophic pancreas suggestive of chronic pancreatitis. No focal pancreatic masses.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Several nonenlarged bilateral para-aortic lymph nodes are present. The etiology is unknown.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: Enlarged thyroid gland with retrosternal extension. A thyroid neoplasm cannot be excluded.Chronic pancreatitis. Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: 76 years, Male. Reason: evaluate dobhoff placement History: on BiPAP w/ Dobbhoff placed Bilateral pulmonary opacities. Please refer to dedicated chest for further evaluation. Dobbhoff tube with tip in the gastric body. Multiple surgical clips are noted throughout the abdomen. Apparent suture line in the left upper quadrant. Pelvis is excluded from view.

Output: Dobbhoff tube with tip in the gastric body.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p esophagectomy with chest tube History: same Chest tube at the right apex with no significant pneumothorax.NG tube tip projected over the lower mediastinum.Bilateral pulmonary opacities compatible with edema, atelectasis and small effusions.Free intraperitoneal air and subcutaneous air consistent with recent surgery.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for pulmonary edema, other cause of hypoxemia, hardware positioning History: ADHF, BiVAD placement, pulmonary edema Support hardware unchanged in position.Bibasilar lung opacities, worse on the left, are unchanged. Stable cardiomegaly and small pleural effusions.

Output: Bibasilar lung opacities, worse on the left, are unchanged. Stable cardiomegaly and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: 26 y/o with AML s/p transplant now with relapse and resp sx. please evaluate for atypical PNA History: congestions Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Catheter tip in the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: ecmo History: ecmo Stable tubes and devices.Unchanged minimal pulmonary opacities.

Output: Unchanged tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.History of esophagectomy, left PICC placement. Placement of left PICC with tip at left axilla.Thoracic gastroesophageal stent, skin staples, and mediastinal surgical clips again noted.Cardiomediastinal silhouette is unchanged. Left hemidiaphragm remains elevated.Small right greater than left effusions and patchy basilar opacities are stable to slightly improved. No visible pneumothorax.

Output: Left PICC tip not located centrally.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.CHF, IABP. Unchanged cardiomegaly. IABP radiopaque marker projects 4-cm below the top of the aortic arch. Left subclavian single lead ICD unchanged in position.Mild dependent atelectasis, but no conclusive signs of pulmonary edema.

Output: No conclusive signs of pulmonary edema. Cardiomegaly. IABP marker projects 4-cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: 63 years old Male. Reason: NG tube placement History: NG tube placement assessment after adjustment. Enteric tube tip extends beyond the lower margin of the submitted radiograph. ET tube tip appears to be immediately proximal to the carina. Again seen are extensive patchy airspace opacities throughout the right lung, including a masslike opacity at the right apex. No significant pleural effusion or pneumothorax is identified. Chronic midthoracic spinal deformity and lower cervical spine fixation hardware again noted.

Output: Abnormal position of the ET tube and need to be adjusted.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: please eval for neoplasm History: Intermittent pain in the chest wall area. Former smoker Heart size normal, the aorta tortuous but consistent with age.No significant pulmonary or pleural abnormality.No findings to account for the patient's chest wall pain.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: f/u hemothorax History: f/u hemothorax Small lung volumes with persistent mild-to-moderate pulmonary edema and left lower lobe consolidation with a left pleural effusion.Small right pleural effusion.ET tube tip approximately 2 cm above the carina.Right jugular catheter, tip in SVC.Right subclavian ICD unchanged.

Output: No change in edema and left lower lobe consolidation. Stable tubes and devices. Stable pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old. Worsening shortness of breath. Examine known pneumothorax. EPIC: history of metastatic osteosarcoma. LLL wedge resections. Left chest tube terminates at the apex. Moderate left hydropneumothorax with pleural fluid at the base with overlying atelectasis. Peripheral left upper lobe opacity may represent a hematoma or a mass.Possible nodule at the left base as seen on the lateral.Post-surgical volume loss in the left lung with presence of surgical sutures.Right costophrenic angle is blunted, likely a small pleural effusion.Left chest wall subcutaneous emphysema.a

Output: Moderate left hydropneumothorax with chest tube in place.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent moderate nonspecific artery mainly with small to moderate effusions greater on the right with streaky densities in both bases, likely atelectasis. Minimal edema cannot be excludedRight jugular catheter extends into the mid SVC unchanged

Output: Persistent nonspecific changes concerning for mild to moderate CHF


Instruction: Generate impression based on medical findings.

Input: 50-year-old male with history of piriform sinus cancer CHEST:LUNGS AND PLEURA: Left lower lobe mass measures 5.4 by 4.1 cm in image number 77, series number 3 increased from previous study in January 2011. Right upper lobe micronodular is unchanged. Biapical scarring is unchanged.MEDIASTINUM AND HILA: Index subcarinal lymph node measures 19 x 12 mm on image number 45, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference supraceliac axis lymph node measures 19 x 19 mm on image number 91, series number 3, not significantly changed from prestudy. Other retroperitoneal lymph nodes are also grossly unchanged.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: Minimal interval increase in the size of the left lower lobe mass invading the diaphragm. Other findings are grossly stable.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: metastatic squamous cell cancer to Rt lung History: post op scan, sx jan. 2016 Right chest tube removed with a small amount of pleural air and fluid over the apex, and right hemithorax postsurgical volume loss.Left lung unremarkable.

Output: Right chest tube removal with a small apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: Hx PE, History: sob Stable cardiomediastinal silhouette.Evidence of prior granulomatous disease.The lungs are clear and free of any focal areas of consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: line pulled back, re-eval placement History: s/p TLC In RIJ Right jugular catheter is extending to the right atrium, one of which has been slightly withdrawn. The larger bore catheter extends further distally. Cardiomegaly with nonspecific interstitial opacity, unchanged from previous.

Output: Jugular catheters extending into the right atrium with slight interval adjustment.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: worsening cough, hypoxia History: as above Patchy airspace opacities unchanged suggestive of aspiration and/or infection.Right jugular catheter tip at cavoatrial junction level.A Dobbhoff tube terminates in the stomach.Right PICC, tip in axillary region.

Output: New right PICC. Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: hypoxia History: as above Perihilar opacities suggestive of edema are mildly decreased. Other findings stable.

Output: Perihilar opacities suggestive of edema are mildly decreased.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: MaleReason for Study: Reason: 32 yo M, CF exacerbation, worsened crackles on exam History: crackles on exam Right Port-A-Cath unchanged.Stable cardiomediastinal select. Chronic interstitial opacities and basilar predominant bronchiectasis and bronchial wall thickening similar in appearance to the prior exam.No new focal areas of consolidation.No pleural effusions.

Output: Chronic findings compatible with cystic fibrosis. No acute abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval infection, edema, effusion History: fevers, chills, cough Mild basilar scarring and an eventration right hemidiaphragm.Unremarkable mediastinal contours and cardiac silhouette.No specific evidence of infection or edema.

Output: Basilar scarring, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old. Reason: r/o pulm edema History: tachypnea Increased pleural effusions and right greater than left basilar opacities. Mild cardiomegaly again noted. Port catheter terminates in the SVC. No definite pneumothorax.

Output: Increase in right greater than left pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Chest pain and SOB rule out fluid or pneumonia. Mild cardiomegaly.Borderline pulmonary vascular redistribution, but no specific signs of pulmonary edema. No pleural fluid. No focal airspace opacities. Lumbar spine appears sclerotic which may be the result of chronic renal disease but is incompletely evaluated by this technique.

Output: Mild cardiomegaly. Borderline hypervolemia but no specific signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o ptx History: sob, pleuritic chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 22 years, Female. Reason: eval for SBO History: nausea Nonobstructive bowel gas pattern. Below average stool burden. No pneumoperitoneum or pneumatosis. Leftward curve of the thoracolumbar spine is noted.No pleural effusion, focal airspace opacity or pneumothorax. Heart size is normal.

Output: No evidence of obstruction.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p LVAD History: s/p LVAD Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly and mediastinal widening, without significant change.Small lung volumes with basilar atelectasis.No pneumothorax or other acute change.

Output: Basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Scattered micronodules, some of which are calcified, unchanged.New 2.1 x 1.4 cm spiculated nodule in the right middle lobe anteriorly on image number 81, series number 4. There is a smaller new nodule next is large spiculated nodule in the same location.MEDIASTINUM AND HILA: Stable fluid attenuation area in the mediastinum. . It measures 2.2 x 0.7 cm on image number 42, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hypodense area in the right lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval development of new spiculated right middle lobe mass and a satellite nodule right. This may represent a primary bronchogenic carcinoma. Biopsy


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: SOB, eval for PNA History: SOB, eval for PNA Interstitial opacities and pleural effusions have improved although patchy left mid and lower lung zone airspace opacity is progressed suggestive of aspiration or infection.

Output: Left mid and lower lung zone opacities suggestive of infection with underlying chronic lung disease. This could be better evaluated by CT and tumor excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Pain rule out free air. Tachycardia, nausea, vomiting. Nasogastric tube terminates in the mid thoracic esophagus. No visible free intraperitoneal air.Right chest port unchanged in position.Patchy airspace opacity or scarring at the right lung base unchanged.

Output: Nasogastric tube terminates in the mid thoracic esophagus, no visible free intraperitoneal air on this semi-upright study.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: swan History: swan Cardiomegaly status post sternotomy.No specific evidence of infection or edema.IVC Swan-Ganz catheter, tip in right main pulmonary artery.

Output: Cardiomegaly without acute edema.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: ams History: ams Low lung volumes. No focal lung consolidation. Likely normal heart size given low lung volumes. No large pleural effusion or pneumothorax. Large patient body habitus.

Output: Low lung volumes. No focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pna History: ams, hypoglycemia Heart size upper normal.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Malignant mesothelioma CHEST:LUNGS AND PLEURA: Right-sided pleural effusion is unchanged. Scattered micronodules are unchanged. Calcified nodules in the lingula are unchanged.MEDIASTINUM AND HILA: Reference cardiophrenic nodule is unchanged measuring 20 x 11 mm image number 60, series number 3. Other nonenlarged mediastinal lymph nodes are also unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measuring 10 x 13 mm, unchanged from previous study. Right adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 7 x 7 mm image number 109, series number 3, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of ascites is unchanged. Reference right upper quadrant soft tissue density is unchanged measuring 23 x 14 mm image number 92, series number 3. Other small ill defined soft tissue densities throughout the peritoneum also unchanged. The maximal thickness of the collection at the dome of the left hemidiaphragm on the coronal series is 16mm, slightly increased.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: Peritoneal wall thickening is unchanged. Small amount of ascites is unchanged.

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Screening for respiratory tuberculosis. The cardiomediastinal silhouette is normal.No focal pulmonary opacity or large pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for PNA History: as above Right central line terminates in SVC. Enteric tube terminates in the stomach, the side port is near the gastroesophageal junction. Low lung volumes with small right pleural effusion. No pneumothorax. Subsegmental atelectasis with superimposed multifocal opacities better demonstrated on 9/17/2016 CT.Multiple prominent loops of bowel are better demonstrated on same-day abdominal radiograph.

Output: Low lung volumes. Previously seen multilobar groundglass opacities on prior chest CT are poorly defined in this study.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluation of pneumothorax History: - Bilateral chest tubes in place with a moderately large left pneumothorax and a small right pneumothorax, not appreciably changed. Extensive underlying lung disease as previously described and probable small pleural effusions. Subcutaneous emphysema on the right.

Output: Bilateral pneumothoraces, larger on the left, with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: ECMO decannulation eval lung fields History: none Unchanged mediastinal widening status post sternotomy, with mild cardiomegaly.Small pleural effusions and left lower lobe consolidation are unchanged.Stable support devices.

Output: Unchanged pulmonary opacities and pleural effusions. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Why does she have a persistent cough? History: Cough. Previous smoker Calcified granulomata and lymph nodes from healed granulomatous disease such as tuberculosis or histoplasmosis.Mild bronchial wall thickening is present suggestive of asthma or chronic bronchitis.No sign of infection or edema.Heart size normal.

Output: Bronchial wall thickening, nonspecific, but consistent with asthma or chronic bronchitis. No other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 13-month-old female status post trauma. No evidence of acute or healing fractures. Bone mineralization and modeling are normal.Left sided aortic arch, cardiac apex, and stomach indicate normal situs. Hypoinflated lungs without focal opacities or pleural effusions. Disorganized, nonspecific abdominal gas pattern.The mastoid air cells are not aerated; this finding can be seen in otitis media. Prominent adenoids are seen which narrow the pharyngeal airway.

Output: No radiological evidence of acute or healing fractures.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: picc placement History: picc placed Chronic appearing elevation right hemidiaphragm.No other significant abnormality.Right PICC, tip in the SVC.An NG tube terminates in the stomach.

Output: Right PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female presents with chest pain. Mitral valve prosthesis unchanged. Plate and screw device affixes the right fourth rib.The cardiomediastinal silhouette is stable. No focal pulmonary opacity. Blunting of the right costophrenic angle appears chronic. No large pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-transplant evaluation Chronic left hemidiaphragm eventration.No pulmonary or pleural abnormality.Unremarkable cardiomediastinal silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: eval pleural effusion status History: cough Improvement in left lower lobe consolidation although there is atelectasis in the right base possibly from aspirated secretions.No large pleural effusion.Shunt tubing courses over the right side of the chest and a catheter over the upper abdomen.

Output: Resolution of left lower lobe consolidation, but right basilar subsegmental atelectasis may be the result of aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Evaluate for infiltrate History: shortness of breath, wheezing Unchanged cardiomediastinal silhouette including normal heart size.Large lung volumes compatible with COPD/emphysema.Interval resolution of previously seen basilar opacities without new focal opacities. No large effusions.

Output: COPD/emphysema without pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: FemaleReason for Study: Reason: post op scan History: lung nodule The cardiomediastinal silhouette is unremarkable.Interval improvement of left basilar atelectasis.No new pulmonary opacities identified.No pleural effusions.

Output: Minimal left basilar atelectasis. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Reason: patient with continued hypoxia, sending for vq scan, they request cxr History: hypoxia Mild cardiomegaly, probably not significantly changed allowing for technique.No evidence of CHF or acute pulmonary disease.

Output: Mild cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old with history of shortness of breath, evaluate for pneumonia Left subclavian catheter unchanged position. Decreased lung volumes with chronic elevation of right hemidiaphragm. Diffuse interstitial opacities, which are better characterized on CT dated 9/24/2015, appearing increased in the left lower lobe. Query mild superimposed edema. Stable cardiomediastinal silhouette. No pleural effusions.

Output: Chronic interstitial changes, which are better characterized on CT dated 9/24/2015, with increased left lower lobe opacities suggestive of atelectasis or infection. Query mild superimposed edema.


Instruction: Generate impression based on medical findings.

Input: Left flank pain, fall on Coumadin, dropping hemoglobin. CHEST:LUNGS AND PLEURA: Small left-sided pleural effusion. Dependent atelectasis in the left lower lobe. Mild bronchiectasis. Nonspecific groundglass density in the left upper lobe.Linear deep tendon atelectasis.MEDIASTINUM AND HILA: Calcified adenopathy in the mediastinum and left hilum.CHEST WALL: There is a large left chest wall hematoma extending to the left flank. It measures 10.1 x 6.6 cm. Multiple rib fractures involving the T10 through T12 left posterior ribs. The left transverse process of L1 vertebral body is also likely fractured .ABDOMEN:The study is limited due to lack of IV contrast.LIVER, BILIARY TRACT: Ill-defined hypodense lesion in the posterior segment of the right lobe with peripheral calcifications indeterminate on this noncontrast CT. It measures 13 x 10 mm. No biliary dilatation.SPLEEN: There are multiple calcified granulomas in the spleen.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: Left chest wall and flank hematoma associated with posterior left rib fractures as described above. Fracture of the L1 left transverse process.No evidence of traumatic injury within the abdomen.Small left-sided pleural effusion and dependent atelectasis in the left lower lobe.These findings were discussed with the ER resident at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p minimally invasive esophagectomy History: asymptomatic Distended gastric pull-up. Mild left basilar atelectasis.Chest tubes removed with no pneumothorax.NG tube withdrawn.Right jugular catheter, tip in SVC.

Output: No pneumothorax following chest tube removal. Mild left basilar atelectasis unchanged.


Instruction: Generate impression based on medical findings.

Input: 52 years old Male. Reason: evaluate for pneumonia History: hyperglycemia, PMH diabetes type 1. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax.The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: dyspnea History: dyspnea Interval increase in bilateral, perihilar airspace and interstitial opacity suggestive of infection or hemorrhage. An edema component is also likely. Heart size normal. Port catheter tip at orifice SVC junction.

Output: Interval increase in bilateral, perihilar airspace and interstitial opacity suggestive of infection or hemorrhage. An edema component is also likely.


Instruction: Generate impression based on medical findings.

Input: 71 year old with prostate cancer. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable subcentimeter left supraclavicular nodes, unchanged. Postsurgical changes of a CABG. Calcified coronary arteries.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 cyst in the midpole of the left kidney with adjacent cortical scarring, unchangedRETROPERITONEUM, LYMPH NODES: Stable, small interaortocaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: ProstatectomyBLADDER: Status post ileal diversion procedure.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sutures are seen in the sigmoid colon. Clips are seen adjacent to the rectum and obturator regions.Small ventral hernia containing sidewall of a small bowel loop without evidence of obstruction, unchanged. Bulge in the left anterior abdominal wall in the left lower quadrant, unchanged.BONES, SOFT TISSUES: Unchanged blastic metastasis involving the right iliac bone.OTHER: Atherosclerotic disease.

Output: Stable examination. Unchanged metastasis to the right iliac bone.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with shock, Swan placement. Evaluate swan. Left IJ Swan-Ganz catheter tip in the right pulmonary artery. Left chest wall AICD with lead in the right ventricular apex.Near-complete resolution of bibasilar opacities. No significant pleural effusions. No pneumothorax. Mild cardiomegaly.

Output: 1. Left IJ Swan-Ganz catheter tip in the right pulmonary artery. 2. Near complete resolution of bibasilar opacities likely resolving edema/atelectasis.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with history of lung cancer status post chemotherapy. Please compare with previous study and evaluate treatment response. CHEST:LUNGS AND PLEURA: Innumerable pulmonary nodules again compatible metastases. They are grossly stable in size and number.Reference right lower lobe nodule (series 5, image 64) again measures 8 mm in maximal axial diameter.The largest nodule is again seen in the right upper lobe (series 5, image 33), again measuring 11 x 11 mm.Stable bronchiectasis in the superior segment of the right lower lobe with internal debris.Suture line is again seen at the left lung base.No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Interval placement of a biliary stent and a pancreatic duct stent with upstream dilatation of the intra- and extrahepatic biliary ducts as well as the main pancreatic duct. Pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic stent with dilated main pancreatic duct. Pancreatic atrophy predominantly affecting the tail.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.

Output: 1. Innumerable pulmonary nodules compatible with metastases are grossly stable in size and number.2. Interval placement of biliary stent and a pancreatic duct stent with continued dilatation of the biliary ducts and pancreatic duct.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: evaluate for pneumonia History: fever Small lung volumes with basilar atelectasis worsening on the left, suggestive of aspirated secretions or infection.

Output: Increasing left basilar opacity suggestive of aspirated secretions or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: concern for pneumothorax History: sudden increase in plateau pressure Endotracheal tube tip 5 cm from the carina.Right internal jugular catheter tip projects over the proximal SVC. Left PICC tip projects over the confluence of the anomalous veins.Enteric tube is partially visualized, however the distal tip is not seen.Unchanged diffuse pulmonary opacities and bilateral pleural effusions unchanged. Stable cardiomediastinal silhouette.No pneumothorax.

Output: Stable pulmonary edema. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: transvenous pacer History: pacer Median sternotomy with an upper normal size heart.Linear atelectasis or scarring left lower lobe unchanged.Right jugular transvenous pacemaker, tip in the expected location of the RV apex.

Output: Right jugular temporary pacemaker, appropriate position although a lateral view would be more conclusive.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: post op History: cough Large hiatal hernia. Mild basilar subsegmental atelectasis.No specific evidence of infection.

Output: Large hiatal hernia and mild basilar subsegmental atelectasis, but no sign of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old with shortness of breath and diminished lung sounds. Evaluate for pneumonia. Right chest port catheter tip is in the SVC. Right subclavian and SVC stents are unchanged.Stable cardiomegaly.Mild scattered chronic appearing interstitial opacities are unchanged.No evidence of infection or edema. No pleural effusion or pneumothorax.Stable osseous sequela of sickle cell disease.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: r/o pneumonia History: leukocytosis, tachycardia Lungs hypoinflated. Right port tip at RA/SVC junction. No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: pneumonia, pneumothorax History: chest pain, SOB Clear lungs. No pleural effusion or pneumothorax. Mild blunting of the left costophrenic angle, likely pleural scarring. No acute bony abnormality. Normal heart size. Patient status post sternotomy and CABG

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: DVS with high impedance, evaluate for breaking of connecting wire. SHUNT DEVICE: There is a deep brain stimulator device with 2 electrodes positioned just left of midline and one electrode positioned right of midline. Electrodes exits the skull via 3 burr holes in the frontal skull and course down the left scalp, left posterior neck, anterior chest wall, and abdomen before terminating in a battery which overlies the left hemiabdomen. The intracranial portions of the electrodes are straight. Once the electrodes exits the cranium, there is redundancy of the wires overlying the skull. However, there is no evidence of discontinuity.SKULL: Deep brain stimulator electrodes without additional abnormality noted.CERVICAL SPINE: No radiographic abnormality noted.CHEST: Low lung volumes. Normal cardiac and mediastinal contours. No focal pulmonary opacities.ABDOMEN: No radiographic abnormality noted. There is a catheter projecting over the lower pelvis.

Output: Deep brain stimulator device without evidence of discontinuity.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.History of asthma. Concern for pneumonia. The cardiac and mediastinal contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities, specifically, no evidence of pneumonia.The pleural spaces and bones are within normal limits.

Output: No radiographic findings to suggest pneumonia, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of salivary gland cancer CHEST:LUNGS AND PLEURA: Scattered subcentimeter lung nodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter hypodense lesions in the liver unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small periumbilical fat containing hernia is 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: 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: 64-year-old female with history of metastatic sarcoma CHEST:Previously described right upper lobe airspace opacity has nearly completely resolved. Subcentimeter nodular density near the right fissure on image number 40, series number 5 likely representing an intrapulmonary lymph node is unchanged.No evidence of enlarged mediastinal or hilar lymph nodes.New small thrombus in the right lower lobe segmental arteries best seen on image number 54 through 57.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Internal and external biliary dilatation is unchanged. Again noted multiple metastatic lesions in both lobes of the liver. Index lesion in segment 5 of the liver has significantly increased in size and now measures 2.6 by 2.2-cm on image number 83, series number 4. Lateral segment left lobe lesion has also increased in size and now measures 3.7 x 3.1 cm image number 17, series number 4. There are also new lesions in the liver consistent with metastatic disease.Hyperdense material/lesion within the distal common bile duct. Further evaluation with ERCP or M.R.C.P. may be helpful.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Portacaval mass measures 3.5 x 4.3 cm image number 95, series number 4, slightly smaller compared to previous study. This mass has infiltrative nature and kidneys the retroperitoneum and surrounding vasculature.Small infrarenal abdominal aortic aneurysm is unchanged.BOWEL, MESENTERY: Duodenal lipoma, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Benign-appearing cystic lesion in the right adnexa is unchanged.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 increase in the size and number of hepatic metastases.Interval near complete resolution of the right upper lobe air space opacity.Small pulmonary emboli in the right lower lobe segmental branches.Dr. Undevia was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: assess IABP, interval lung fields History: as above Balloon catheter marker in the proximal descending aorta, unchanged.Interval removal of the Swan-Ganz catheter.Cardiomegaly with pleural effusions, edema and atelectasis, not significantly changed.

Output: CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT remains 2 cm above the carina. Left jugular sheath and underlying cardiopulmonary appearance otherwise similar given differences in technique and mild motion. Mild CHF suspected with small lung volumes

Output: ETT minimally advanced


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Pancytopenia question pneumonia Diffuse reticulonodular opacities bilaterally the, slightly progressed. Left PICC tip at the SVC.

Output: Progression of reticular and nodular opacities compatible with opportunistic infection. Differential considerations include but are not limited to viral pneumonia, suggest reduced dose thoracic CT for further characterization if required.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: s/p SC-ICD with array implant --> r/o pneumothorax and evaluate leads position History: as above Left pneumothorax, 16 mm, following ICD placement.Cardiomegaly.Small lung volumes.Left subclavian ICD placement.

Output: Post procedure left pneumothorax. This was discussed with Dr. Bowman at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: 78M with persistently elevated WBC History: leukocytosis Enlarging right pleural effusion extending into the fissure.New left basilar opacityWhich could be infection or infarction. Left subclavian pacemaker, leads unchanged in position.

Output: Enlarging pleural effusion in the left base peripheral opacity suggestive of infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Female 86 years old with history of shortness of breath and atrial fibrillation, evaluate for effusion/edema/PNA Stable cardiomegaly. Increased basilar opacities and pleural effusions consistent with consolidation and atelectasis in the setting of pulmonary edema.

Output: Pulmonary edema superimposed on chronic basilar consolidation and fibrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: eval for sarcoidosis History: positive RF, numbness, history of asthma No specific evidence of infection or edema.Moderate thoracolumbar scoliosis.

Output: No significant abnormality. No evidence for sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval lung fields History: s/p CABG Support devices are unchanged in position.Mid to lower zone opacities suggestive of early edema with small pleural effusions. Heart size is mildly enlarged, stable. Decreased subcutaneous emphysema at the left lateral chest wall. No pneumothorax.

Output: Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 21 year-old male with ulcerative colitis presents with right-sided abdominal pain which is not typical of his ulcerative colitis. Previous cholecystectomy for this pain without relief CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Numerous tiny lymph nodes are seen along the mesenteric border of the entire colon, related to known ulcerative colitis.BOWEL, MESENTERY: Short segment minimal thickening of the distal descending colon without surrounding inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted LYMPH NODES: Numerous tiny lymph nodes are seen along the mesenteric border of the entire colon, related to known ulcerative colitisBOWEL, MESENTERY: No significant abnormality.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal focal thickening of the distal descending colon without surrounding inflammatory changes, likely related to known history of ulcerative colitis.


Instruction: Generate impression based on medical findings.

Input: Reason: consolidation History: septic shock Moderate cardiomegaly with pacemaker leads unchanged.Mild basilar opacities consistent with atelectasis and probably small effusions.Possible mild lower zone edema.No specific evidence of pneumonia.

Output: Probable CHF with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Hypertension The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Moderate degenerative changes throughout the thoracic spine.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: MaleReason for Study: Reason: hypoxia History: seizures, hypoxia Right central venous catheters with their tips in the RA and SVC.Decreased lung volumes with cardiac enlargement and pulmonary vascular redistribution.Perihilar and basilar interstitial airspace opacities suggestive of edema/atelectasis.Median sternotomy is intact with mediastinal surgical clips.

Output: Markedly decreased lung volumes with cardiac enlargement and the suggestion of perihilar/basilar edema and/or atelectasis. Upright PA and lateral views are recommended for better evaluation.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with metastatic colon cancer. CHEST:LUNGS AND PLEURA: Stable 2 mm nodule in the left lung base.Tree in bud opacities and bronchial wall thickening are now scattered in the right upper lobe.MEDIASTINUM AND HILA: Mildly enlarged paratracheal lymph node, measuring 16 x 14 mm (series 3; 32), previously 13 x 10 mm.Postsurgical changes of a CABG. Diffuse atherosclerotic disease.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypodensities, the largest of which are definitely cysts, unchanged.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic disease remains.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: Sutures are seen in the sigmoid colon. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Development of right upper lobe tree in bud opacities, suggestive of bronchiolitis rather than endobronchial metastases. Mild interval enlargement of the paratracheal lymph node could be reactive in nature.Otherwise, stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Status post CABG evaluate lung fields. ETT 2.5 cm above the level of carina. Right jugular introducer and left chest tube unchanged in position.Lung volumes remain low low with basilar scarring and atelectasis, left greater than right. Left pleural effusion unchanged. No pneumothorax.

Output: Low endotracheal tube. Otherwise, no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Recent travel to Mexico now with 4 months of chronic nonproductive cough. Left subclavian pacemaker unchanged in position.Low lung volumes.Small pleural effusions are new.Basal compressive atelectasis, but no specific signs of pneumonia or edema.A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: Low lung volumes with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: et tube History: et tube ET tube and NG tube unchanged.Left PICC line with tip in left axilla.Endobronchial valves in the right upper lobe redemonstrated.Again noted is extensive subcutaneous and mediastinal emphysema .No pneumothorax identified.Pulmonary opacities and basilar atelectasis similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance with extensive subcutaneous and mediastinal emphysema. Diffuse pulmonary opacities compatible with known diagnosis of sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Reason: Hypoxia, h/o ILD and sarcoidosis History: Hypoxia Severe chronic interstitial disease with reticular opacities and multiple upper zone cysts, consistent with the clinical history of sarcoidosis, increased in severity compared to previous radiographs.A CT scan has been performed and provides more detailed evaluation.

Output: Severe chronic interstitial disease, increased from previous, consistent with sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: PNA, CHF History: chest pain, cough Circular radiopaque structure projecting over the clavicular head on the PA radiograph is likely posterior to the patient on the lateral view. Large lung volumes with blunting of the posterior and right costophrenic angles from trace effusions. The heart size is normal. No evidence of infection or edema.

Output: No evidence of pneumonia or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out pneumonia, vs volume vs enlargement History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old Reason: Evidence of pneumonia History: Shortness of breath, wheezing A snap projects over the left midlung and is presumably external to the patient.Mild cardiomegaly with tortuous aorta, unchanged.Mild bibasilar subsegmental atelectasis. No new pulmonary opacities or specific evidence of infection.No large pleural effusion or pneumothorax.

Output: No evidence of pneumonia or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: sob, atelectasis? History: sob Moderate cardiomegaly with diffuse bilateral opacity compatible with edema and pleural effusions, not significantly changed.Catheter tip in the SVC.No new findings.

Output: Pulmonary edema and pleural effusions, unchanged or slightly increased.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: SOB, h/o CHF History: Above No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with renal cell carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable bilobar benign hepatic cysts. Stable dilated common bile duct measuring up to 2.4-cm. minimal intrahepatic biliary dilatation. These findings are stable from previous study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy site is clear. Right renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with renal cell cancer status post 6 cycles of treatment CHEST:LUNGS AND PLEURA: Right lower lobe nodule measures 22 x 18 mm, previously 21 x 18 mm and series 6; image 66). Right upper lobe nodule which may extend through the oblique fissure measures 25 x 20 mm (series 6; image 47), previously 24 x 20 mm.MEDIASTINUM AND HILA: Right suprahilar lymph node measures 28 x 23 mm (coronal series, image 59), previously 29 x 23 mm. Subcarinal lymph node measures 4.2 x 2.3 cm previously 4.3 x 2.4 cm (series 5; image 47). The other right hilar and mediastinal lymph nodes are not significantly changed. CHEST WALL: The right IJ catheter terminates in the right brachiocephalic vein.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right-sided hernia containing small and large bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable thoracic metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Periprosthetic fracture around right knee joint, preop. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Calcified and noncalcified nodules statistically most likely reflect granulomas, though they are nonspecific by plain film. No visible pleural fluid or pneumothorax. Healed fracture deformities of left-sided ribs.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: MaleReason for Study: Reason: Pt with hickman catheter, tripped overnight. Please check position. History: None Bilateral PICC lines been removed.Right central venous catheter with its tip in the SVC.No pneumothorax.The cardiomediastinal silhouette is unremarkable.The lungs are clear.

Output: Right central venous catheter with its tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.ETT. Endotracheal tube tip 3-cm above the level of the carina. Left subclavian central line tip near the SVC. NGT looped overlying the stomach. Mild basal atelectasis.

Output: Low endotracheal tube, 2-cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? cancer, fever ,tachy History: fever Right middle lobe opacity compatible with known mass and associated atelectasis, better seen on the recent CT scan. No specific evidence of pneumonia. Port catheter with its tip in the SVC. Moderate elevation of the right hemidiaphragm.

Output: Right middle lobe mass and atelectasis with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: check for consolidation; pt w/poor oxygenation History: AMS. There is opacity in the left lower lobe with bronchograms, unchanged as compared with prior study. Bibasilar atelectasis is noted.

Output: Left lower lobe consolidation, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.History of altered mental status with possible sepsis. Right PICC tip is seen in the SVC.Cardiomediastinal silhouette is obscured.There are moderate bilateral pleural effusions with adjacent consolidation along with bilateral interstitial opacities.

Output: Moderate bilateral pleural effusions with adjacent edema, atelectasis, and consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p OLT, Kidney TRP F/U Pleural Effusions History: s/p OLT, Kidney TRP F/U Pleural Effusions Left IJ sheath remains in place. Left subclavian line again noted. Probable left axillary drain again noted. Right-sided tube/drain again noted overlying the right upper abdomen. Low lung volumes. Mild pulmonary edema. Small left-sided pleural effusion. Unchanged cardiomegaly. No significant pneumothorax.

Output: Lines and tubes, as above.Low lung volumes. Mild pulmonary edema. Small left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: leukocytosis 18, ?pna History: none Streaky retrocardiac opacification is new which may reflect aspiration or infection given the history. Cardiomegaly is stable. No pneumothorax.

Output: Streaky new retrocardiac opacity suspicious for infection/aspiration given the history.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Hypoxia, tracheostomy, vent dependence. Tracheostomy tube and venous catheter unchanged; the right-sided catheter extends across the midline to the left with tip directed peripherally in the projection of the left brachiocephalic vein.Diffuse airspace opacities without acute change.

Output: No acute change in diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: line placement History: line placement Swan-Ganz catheter terminates in the RPA.Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild pulmonary edema/. Basilar opacities persist, likely atelectasis. Unchanged cardiomegaly.

Output: Mild edema and basilar opacities, as before.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: Postop, hx of myasthenia gravis. Baseline CXR. History: None Low lung volumes makes detailed cardiopulmonary assessment difficult. Focal nodule noted at the right lung apex, as before Mild basilar opacities, likely atelectasis or scarring. Likely normal heart size given low lung volumes. Aortic atherosclerosis. NG tube terminates within the distal aspect of the stomach. A drain overlies the mid aspect of the abdomen. Large patient body habitus.

Output: No acute cardiopulmonary process on radiography. Right upper lobe nodule, as before.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: swan in place History: as above Changes of prior sternotomy again noted. Surgical clips project throughout the mediastinum. Left subclavian line has its tip overlying the superior cavoatrial junction. A Swan-Ganz catheter has its tip projecting over the right main pulmonary artery.Cardiomediastinal silhouette, left pleural effusion, and bilateral pulmonary opacities are largely unchanged. Minimal increase in right-sided pleural effusion. Mild septal lines consistent with mild pulmonary edema.

Output: Swan-Ganz projects over the proximal right main pulmonary artery. No substantial change in the appearance of the chest.


Instruction: Generate impression based on medical findings.

Input: Thoracentesis Interval enlarging bilateral pleural effusions with underlying edema and atelectasis. Right upper lobe focal mass grossly unchanged. Specifically no postprocedural complications observed.Surgical clips project over left chest wall and axilla. Left mastectomy

Output: Enlarging bilateral pleural effusions and right upper lobe mass grossly unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: chest pain History: chest pain Left midlung scarring or subsegmental atelectasis, otherwise unremarkable.Heart size normal.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female status post renal and pancreas transplant and recently diagnosed metastatic melanoma. Evaluate for bowel obstruction This study is limited due to lack of IV contrast.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: Again noted numerous hepatic metastatic lesions. Due to lack of IV contrast the referenced lesions cannot be well seen but are grossly unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophy of bilateral native kidneys. Transplant kidney in the right iliac fossa. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple mesenteric implants are again noted. Index mesenteric lesion measures 5.3 by 5.1-cm on image number 99, series number 3. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomas is enlarged uterus, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of bowel obstruction. Limited study slip of IV contrast. No significant change from previous study. Index hepatic lesions could not be accurately measured on this noncontrast study.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male postop from total colectomy now with fever and hypotension CHEST:LUNGS AND PLEURA: Dependent atelectasis.MEDIASTINUM AND HILA: There is a small pericardial effusion. No evidence of hilar or mediastinal adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas appears to be slightly ill-defined with subtle amount of surrounding fluid; while this may also represent postoperative changes, early pancreatitis cannot be entirely excluded.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple nonobstructing left and right renal stonesRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post total colectomy. A loop of proximal small bowel in the left hemiabdomen (series 8020, image 58) appears to be somewhat dilated without evidence of obstruction; the passage of contrast into the distal bowel is identified.Left-sided fatty infiltration in the left upper quadrant (series 3, images 109-122) and adjacent paracolic fluid may be postoperative in etiology. No findings to suggest abscess formation are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of peritoneal fluid; small amount of intraperitoneal free air, consistent with recent surgery.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: Status post total colectomy; small amount of pelvic free fluid without evidence of abscess formation.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Indistinct margins to the pancreas as well as subtle surrounding fluid density may represent early pancreatitis; correlation with lipase/amylase levels may be considered.2. Postsurgical changes of the abdomen/pelvis without evidence of abscess formationcspwr


Instruction: Generate impression based on medical findings.

Input: 42 years, Female. Reason: Evaluate for SBO. History: Vomiting, recent surgery. Chest radiograph demonstrates faint right upper lobe opacities and a small left pleural effusion. Suture material projects just left of midline. Residual contrast material is noted within the colon. Few dilated small bowel loops within the left upper quadrant without evidence of obstruction. No evidence of free intraperitoneal air.

Output: 1. Mild ileus pattern without evidence of obstruction.2. Faint right upper lobe opacities new from prior exam, correlate with symptoms of infection.


Instruction: Generate impression based on medical findings.

Input: 63 years old Male. Reason: eval for infection History: aspiration. Hypoinflated lungs with mild cardiomegaly. Streaky opacities are seen in the lower lungs, more on the right. The right central venous access catheter is stable in position.

Output: Bibasilar atelectasis, slightly worse as compared with prior study. And mild cardiomegaly, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: ? pna History: fever Left chest port tip in SVC.No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with breast cancer. CHEST:LUNGS AND PLEURA: A reference lesion in the lingula measures 2.1 x 2.0 cm on high-resolution axial image 163/248. This lesion has increased only minimally in size when compared to the prior exam of 11/20/08, high-resolution axial image 143/246, where it measured approximately 2.0 x 1.9 cm. This lesion has changed slightly in morphology with new projections of soft tissue density extending to the adjacent pleural surface.Slight increase in size of a previously noted lingular nodule on axial image 54/83. Numerous small pulmonary nodules are new (axial images 14, 16, 20, 33, 34/83).Small left pleural effusion is new.MEDIASTINUM AND HILA: Small bilateral thyroid cysts, unchanged.No pathologically enlarged hilar or mediastinal lymph nodes.The cardiac size is normal. No pericardial effusion. Normal variant aberrant right subclavian artery noted.CHEST WALL: Compression deformity of T6 with high-density material, compatible with prior vertebroplasty, unchanged in appearance. Partially sclerotic lesions in T8, T12, and several upper lumbar vertebral bodies are also unchanged.ABDOMEN:LIVER, BILIARY TRACT: Innumerable hypodense liver lesions are grossly unchanged. A reference lesion in the dome of the liver measures 1.6 x 1.1 cm on axial image 76/84 and has not significantly changed when compared to prior exams accounting for differences in technique and positioning.The liver contour is nodular, which may reflect pseudocirrhosis related to treated metastatic disease. SPLEEN: No significant abnormality notedADRENAL GLANDS: Left adrenal thickening is unchanged.KIDNEYS, URETERS: Wedge-shaped cortical defect in the right kidney is unchanged and may represent a prior infarct.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ascites is grossly unchanged from the most immediate prior examination (12/27/08) but has increased when compared to the exam of 11/20/08.BONES, SOFT TISSUES: See above.OTHER: No significant abnormality noted

Output: Progression of disease in the chest with multiple new small pulmonary nodules. Stable hepatic disease. Please refer to PET/CT examination of the same date for more details.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT eval History: intubated ET tube tip approximately 4 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Cardiomegaly with diffuse bilateral interstitial and airspace opacity compatible with edema.Moderate bilateral pleural effusions.NG tube tip in the stomach.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Worsening SOB, DOE history of CHF, chronic bronchitis. Evaluate for pleural effusions or pneumonia. Left subclavian ICD unchanged.Severe multichamber cardiomegaly unchanged.Mild retrocardiac atelectasis, but no convincing evidence of pulmonary edema.No large pleural effusions.

Output: Severe cardiomegaly but no acute pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: 66y/o male with ESRD s/p cardiac surgery with stridor and airway compromise History: stridor Endotracheal tube tip 2.6 cm superior to the carina. Left IJ central venous catheter overlies the left innominate vein.Stable cardiomediastinal silhouette status post mitral and aortic valve surgery.Redemonstration of multilobar bandlike and consolidative opacities with slightly worsened bibasilar aeration likely related to an increase element of atelectasis. Bibasilar pleural effusions are grossly unchanged. No pneumothorax.

Output: 1.Endotracheal tube tip 2.6 cm superior to the carina. 2.Slight worsening in bibasilar aeration likely due to worsening atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Asthma with acute exacerbation question pneumonia. By basilar left greater than right patchy atelectasis. Opacity on the left nonspecific and could reflect evolving infection. No pneumothorax. Normal heart size. No pleural fluid.

Output: Basilar opacities favored to represent atelectasis, likely result of bronchial mucus plugging. Evolving infection is not excluded. Consider short-term plain film follow-up if symptoms persist.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: ET tube advanced History: Et tube advanced ET tube tip 3-4 cm above carina. Other findings stable.

Output: ET tube tip 3-4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p cardiac surgery History: shortness of breath Pulmonary edema and left-sided predominant consolidation with pleural effusions have changed little since yesterday but are worse than two days ago.Multiple support devices are unchanged in position including a right jugular catheter tip in the right atrium, tracheostomy tube tip 5 cm above the carina, a Dobbhoff tube extending below the lower margin of the image, and both ICD and LVAD.Right PICC, tip in axillary region.

Output: No change since yesterday in moderate edema and foci of consolidation, worse than two days ago, however.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: chest pain, r/o infiltrate History: chest pain with increase heart rate No focal consolidation, effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No significant abnormalities. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: AML Unchanged well-positioned triple right jugular Hickman, without an underlying associated cardiopulmonary abnormality

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: r/o worsening pleural effusion History: worsening pleural effusion yesterday The cardiomediastinal silhouette is unremarkable.Persistent left pleural effusion and left basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Left pleural effusion and basilar atelectasis unchanged from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: Balloon Pump History: Balloon Pump Left-sided ICD unchanged.Right IJ Swan-Ganz catheter in place with its tip in the pulmonary artery.IVP marker in the proximal descending aorta.Stable cardiac enlargement with scattered areas of scarring/discoid atelectasis.No new pulmonary opacities identified.

Output: Interval placement of a Swan-Ganz catheter and IABP with marker in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: fever in patient with peritoneal cancer admitted for nausea/vomiting. Looking for evidence of aspiration or PNA Right central venous catheter terminates in the SVC. Enteric tube continues out of the field-of-view within the stomach. Right upper quadrant surgical staples.Bilateral effusions, increased from prior examination. Retrocardiac opacity likely represents increasing effusion. Minimal right effusion. Bibasilar subsegmental atelectasis. Prominence of the azygos vein and few septal lines may indicate a small amount of edema. Heart size is within normal limits.

Output: Small interval increase in bilateral pleural effusions. Retrocardiac opacity likely represents increasing effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Status post esophagectomy and cervical esophagostomy. Drain overlying the upper abdomen is noted. Left upper extremity PICC with tip in the mid subclavian. Interval removal of skin staples. No significant change in bilateral basilar pulmonary opacities compatible with pleural effusions with underlying atelectasis and possible consolidation. No pneumothorax.

Output: Unchanged pulmonary opacities compatible with pleural effusions and atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval ETT placement, aspiration History: intubated Cardiomegaly with mild basilar subsegmental atelectasis.ET tube at the thoracic inlet level.Left subclavian dual chamber ICD, leads in appropriate position.An NG tube extends below the lower margin of the image.

Output: High ET tube. Cardiomegaly with minimal basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval for free air History: abd pain No evidence of pneumoperitoneum. Port catheter terminates near the cavoatrial junction. Clear lungs. No large pleural effusion or pneumothorax. Mild blunting of the left lateral costophrenic angle. Normal heart size. Stent noted within the stomach.

Output: No pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: +PPD No acute cardiopulmonary abnormality superimposed upon minimal chronic appearing interstitial change

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: chest pain History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Spinal stimulation hardware and cholecystectomy clips noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female history of cough and fever. Evaluate for infection. Cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male appears septic. Evaluate for pneumonia. Cardiomediastinal silhouette is within normal limits.Large lung volumes. No focal pulmonary consolidation or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Patient with chest pain and shortness of breath. Evaluate for radiology. Cardiomediastinal silhouette is normal. No focal pulmonary opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Chest tube placement Right chest wall Port-A-Cath tip is at the superior cavoatrial junction. Left chest tube has been slightly retracted with tip tip points towards apex.Unchanged loculated appearing fluid in the left upper lobe pleural space.No significant change in left sided airspace opacities compatible with effusion and atelectasis/consolidation.Cardiomediastinal silhouette is normal.

Output: Slight interval retraction of left chest tube without complication. Otherwise stable cardiopulmonary appearance.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: 76 your old male with gastric cancer metastases on therapy. Evaluate for interval change. CHEST:LUNGS AND PLEURA: Redemonstration of severe interstitial fibrotic changes and emphysematous changes. Interval development of small bilateral pleural effusions. New airspace disease in the periphery of the left lower lobe, correlate with clinical symptoms.MEDIASTINUM AND HILA: Coronary artery calcification with evidence of prior surgery. Clustered small mediastinal and hilar nodes unchanged. With the history of prior thoracotomy these may be inflammatory in etiology.CHEST WALL: Status post median sternotomy. No axillary lymphadenopathy. Right-sided port catheter, left-sided pacing device. Right retrocrural lymph node measures 1.8 x 1.3 cm (image 99/220, series 3).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Note is made of a branched proper hepatic artery, a normal variant.SPLEEN: Small hypervascular lesion in the spleen (image 96/220, series 3), likely a hemangioma. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland is diffusely thickened with a discrete lesion measuring 1.4 x 2.1 cm (image 112/220, series 3), which appears unchanged to minimally larger compared to the prior study.KIDNEYS, URETERS: Multiple hypodense lesions consistent with renal cysts bilaterally, unchanged.RETROPERITONEUM, LYMPH NODES: Scattered clusters of preaortic and left para-aortic lymph nodes, the largest measuring 1.0 x 1.2 cm (image 130/220, series 3). Atherosclerotic calcification of the aorta.BOWEL, MESENTERY: Diffuse thickening of the stomach is again noted with the gastric wall thickening consistent with patient's known diagnosis of gastric cancer.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.PELVIS: Evaluation is limited due to extreme streak artifact from the patient's right hip arthroplasty.PROSTATE, SEMINAL VESICLES: Mostly obscured by streak artifact.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Scrotal enlargement with probable left-sided hydrocele unchanged. No ascites.

Output: 1. Scattered mediastinal and retroperitoneal adenopathy, unchanged.2. Left adrenal thickening with a discrete nodule unchanged to slightly larger in size.3. New airspace disease in the periphery of the left lower lobe, correlate with clinical symptoms.4. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: eval for pna History: fever, metastatic testicular ca Cardiac silhouette is normal in size.Question bilateral hilar adenopathy.Bilateral low lung volumes. Interval development of a left lung pulmonary nodules. There is also suggestion of faint right lung nodular densities.

Output: 1.Interval development of left lung pulmonary nodules with question bilateral hilar adenopathy and/or overlapping pulmonary nodules concerning for metastatic disease. Recommend CT chest for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: eval for pulm edema, effusion, ETT History: as above Lines and tubes are unchanged. Diffuse pulmonary opacities with confluent bibasilar pleural-parenchymal opacities and pleural effusions again noted. Unchanged heart size. No pneumothorax.

Output: No change in pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: 59yo F w/ sacral ulcer, now w/ SIRS, e/f infection History: as above Cardiomediastinal silhouette is normal. Elevation of the left hemidiaphragm. No pleural effusion or pneumothorax. Minimal bibasilar atelectasis. Small metallic density is seen in the spinal column at the level of L1. Leftward curvature of the spine.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Cough and chest pain No cardiopulmonary abnormality. Midline sternotomy unchanged and CABG clips

Output: Postsurgical midline sternotomy without underlying cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with colon cancer. Evaluate for pneumonia. Fatigue. CHEST:LUNGS AND PLEURA: Punctated calcified left upper lobe granuloma. No evidence of pneumonia.MEDIASTINUM AND HILA: Enlarged thyroid gland with multiple nodules. Calcified mediastinal and right hilar nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic metastases are grossly unchanged. Areas of capsular retraction have increased, suggestive of interval treatment. A calcified granuloma is seen in the right lobe of the liver. The vasculature is patent.The gallbladder is distended.SPLEEN: Splenic granulomata. Calcification at the splenic hilum is compatible with a calcified aneurysm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Portacaval, gastrohepatic and periesophageal adenopathy has mildly increased. The reference node measures 3.2 x 1.9 cm, previously 2.6 x 1.7 cm (series 3; image 90) .Small retroperitoneal lymph nodes are stableBOWEL, MESENTERY: Extensive diverticulosisBONES, SOFT TISSUES: Faint lytic foci are seen in T10, T11 and L2 vertebral bodiesOTHER: Trace ascites.PELVIS:UTERUS, ADNEXA: HysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Masslike thickening in the sigmoid colon (series 3; image 170) likely represents the site of known cancer. Extensive diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild increase of abdominal adenopathy without gross change in the diffuse hepatic metastases. Hypervascular metastases are very atypical for colon adenocarcinoma. Arterial phase imaging of the liver should be requested for subsequent follow-ups.Masslike thickening of the sigmoid colon, likely corresponding to known mass.Faint sclerotic foci in the thoracolumbar spine, of uncertain significance. Bone scan is suggested for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Reason: OSH transfer, difficulty weaning from BiPAP, questionable hx of PNA History: see above Moderate cardiomegaly with a tortuous calcified aorta.Port catheter with its tip in the SVC.Small lung volumes with moderately large bilateral pleural effusions, greater on the right, with underlying atelectasis.No specific evidence of pneumonia.

Output: Cardiomegaly with pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: post extubation History: as above The endotracheal tube has been removed, as has the nasogastric tube.Low lung volumes. Left basilar opacity consistent with atelectasis and small left pleural effusion unchanged. Basilar interstitial opacities appear similar to the prior exam, consistent with mild edema.Unchanged mild cardiomegaly.

Output: Unchanged mild basilar edema and small left pleural effusion with admixed left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: Cough with green sputum. Cardiomediastinal silhouette is normal. Large opacity overlying left lower lobe with an air-fluid level, left hemidiaphragm is obscured. There is overlying opacity favored to reflect atelectasis.No pleural effusion or pneumothorax.

Output: Left lower lobe opacity with air-fluid level consistent with an infected pulmonary sequestration as further characterized on subsequent imaging.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: r/o pneumonia History: cough, chest pain The heart is normal in size.Lung volumes are normal. No abnormal focal opacities to suggest pneumonia.The pleural spaces are within normal limits.Mild thoracal lumbar scoliosis.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: ETT History: ETT. Interval intubation and NG tube placement. Endotracheal tube is approximately 3 cm above the carina. NG tube is in the stomach.Low lung volumes. Bibasilar subsegmental atelectasis.Subcutaneous emphysema in the left neck.Lingular atelectasis again noted.

Output: Endotracheal tube in acceptable position. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: 26-year-old female with recent catheterization now with groin AV fistula.Numbness and pain. Concern for hematoma. CHEST:Heart is significantly enlarged consistent with patient's known history of dilated cardiomyopathy. Groundglass opacities at the lung bases likely are secondary to pulmonary edema. The study is limited due to lack of IV contrast. However no evidence of mediastinal, hilar or axillary adenopathy. This appearance is unchanged compared to previous CT.ABDOMEN:LIVER, BILIARY TRACT: Findings consistent with right-sided heart failure engorged hepatic veins. Hepatomegaly.SPLEEN: No significant abnormality notedPANCREAS: Unchanged cystic lesion of the pancreas measuring 5.9 x 2.9-cm on image number 94, series number 3.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild ascites is minimally decreased in size.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Generalize anasarca.PELVIS:UTERUS, ADNEXAE: 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 evidence of hematoma in the right groin. No retroperitoneal hematoma.

Output: No evidence of right groin hematoma. Ascites is slightly decreased in the interval. Other findings secondary to patient's known dilated cardiomyopathy and large pancreatic cystic lesion are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: 70 yo M s/p esophagectomy History: eval pulm edema Resolution of diffuse pulmonary edema with residual basilar atelectasis and small effusions.Interval removal of a Swan-Ganz catheter.ICD lead and NG tube unchanged.

Output: Resolution of pulmonary edema with residual atelectasis and effusions.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of esophageal carcinoma. Evaluate disease status. CHEST:PULMONARY ARTERIES: Filling defects within the left descending pulmonary artery extending into segmental branches, as well as in the the distal right main pulmonary artery extending into several low bar and segmental branches and within branches of the right upper lobe are compatible with multiple pulmonary emboli. [Jennifer Shouldis (7894) notified at the time of interpretation on 4/10/2009.]LUNGS AND PLEURA: Previously noted, nonspecific micronodules, some of which are calcified, remain unchanged. No new nodules.MEDIASTINUM AND HILA: No significant adenopathy. Previously noted right hilar lymph node stable at 6 x 9 mm. Mildly enhancing esophageal mucosa and wall thickening of the distal esophagus, with small adjacent paraesophageal lymph nodes noted (image 78) the. For reference, the outer wall to outer wall dimension of the esophagus at this level measures 25 x 19 mm.Right central line tip in SVC. Median sternotomy wires, unchanged. Heavy coronary calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic metastases and lesions due to prior portal vein thrombosis. One of the lesions in the posterior right lobe appears slightly larger (image 110) although this could be secondary to differences in technique. Hepatic granulomas..SPLEEN: Previously reported ill-defined hypoattenuating lesions in the spleen are no longer identified. Splenic granulomas.ADRENAL GLANDS: Mild enlarged left adrenal gland unchanged. Normal right adrenal gland.KIDNEYS, URETERS: Large bilateral renal cysts, unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative changes of the spine.

Output: 1. Bilateral pulmonary emboli.2. Persistent mucosal thickening and enhancement of the distal esophagus a; recurrent disease cannot be ruled out. Suggest evaluation with PET scan.3. Hepatic lesions are very poorly evaluated with questionable increase in size of one of the metastatic lesions. This could be confirmed by dedicated hepatic protocol abdominal CT if it would affect clinical management of the patient.


Instruction: Generate impression based on medical findings.

Input: Reason: Evidence of pneumonia? History: SOB/Cough/Fevers Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: ?PNA History: Fever Left perihilar upper and lower lobe airspace opacity with a component of subsegmental atelectasis, but compatible with pneumonia in the appropriate clinical setting.Unremarkable cardiac and mediastinal silhouette.

Output: Left upper and lower lobe mild airspace opacity, compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male presents with left-sided chest pain and palpitations. Evaluate for edema, effusion, or infection. The cardiac mediastinal silhouette is normal. No focal pulmonary opacity. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: FemaleReason for Study: Reason: CP, SOB History: above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: effusion? History: SOB/tachypnea Interstitial and airspace opacities remain moderate to severe, accompanied by bilateral pleural effusions, unchanged.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Biapical scarring unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensities in the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: 18 by 9 mm small cystic lesion in the tail of the pancreas is unchanged likely representing a small, branch type intrapancreatic mucinous neoplasm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study


Instruction: Generate impression based on medical findings.

Input: Reason: assesment for L lung field after aggressive pulm toilet History: hypoxia Partial reexpansion of the left lung with residual Pleural effusion and underlying atelectasis. Small right pleural effusion unchanged. Catheter tip in the SVC.NG tube coiled in the stomach.

Output: Partial reexpansion of the left lung.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Where is endotracheal tube? ARDS. ETT tip 4.5 cm above the level of the carina. Right PICC and left jugular catheter unchanged in position.Patient is significantly rotated, but this limitation, a sense of pulmonary opacities are not appreciably changed.

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


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Assess for increased pulmonary edema or development of opacities to suggest new infection History: Persistent SOB The lung volumes. Persistent mild elevation of the right hemidiaphragm.The cardiac and mediastinal contours are partially obscured. Suggestion of hiatal hernia.Right middle and right lower lobe bandlike opacities represent chronic subsegmental atelectasis. No new abnormal lung parenchymal opacities are noted.No pleural effusion or pneumothorax.

Output: No signs of pulmonary edema.Persistent elevation of the right hemidiaphragm and adjacent right middle and right lower lobe chronic subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Chest pain. Left subclavian ICD unchanged in position.Interval worsening of pulmonary edema, with chronic pleural fluid or thickening on the right about the same. Cardiomegaly, about the same. The central pulmonary vasculature appears enlarged.

Output: Worsening CHF. Cardiomegaly with signs of pulmonary hypertension.