Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: New tachypnea. Bullae on imaging History: Evaluate for edema, pneumothorax Right apical bullae unchanged.Cardiomediastinal silhouette is unremarkable.No new pulmonary opacities noted.No pleural effusions.No evidence of a pneumothorax.

Output: No interval change in the right apical bullae. No specific evidence of a pneumothorax or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: fever, cough - r/out PNA. BRCA on chemo History: cough, fever Left lower lobe airspace opacity, consistent with pneumonia.Port catheter with its tip in the SVC.

Output: Left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Positive TB test. No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: line placement History: patient pulled on line, confirm current location Right IJ catheter with its tip in the right atrium, not significantly changed.Left subclavian catheter tip is directed in the area of the left subclavian vein, previously extending to the SVC.Interval removal of the Swan-Ganz catheter.Mild right basilar opacity suggestive of a small retrodiaphragmatic and subpulmonic effusion, not significantly changed.

Output: Interval retraction of left subclavian catheter with its tip now projected in the area of the left subclavian vein.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: sepsis History: fever, cough, muscle aches New right upper lobe peripheral airspace opacity, also present in the right lung base, and mild left basilar subsegmental atelectasis.Median sternotomy, heart size normal.The azygos vein appears distended.

Output: Right upper lobe pneumonia, possibly extending into the right lung base. Alternatively, consideration could be given to infarct from pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: 79F with h/o lung cancer s/p lobectomy, HTN, COPD, p/w DOE, ?volume overload, ?pneumonia, ?malignancy recurrence History: 79F with h/o lung cancer s/p lobectomy, HTN, COPD, p/w DOE, ?volume overload, ?pneumonia, ?malignancy recurrence Cardiac size is borderline enlarged. No evidence of acute infiltrate, pleural effusion or pneumothorax. Stable scarlike opacities in the right middle lung zone.

Output: Borderline cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: concern for aspiration History: intraop vomitting Moderate right pneumothorax. Spinal stimulator as at level of mid thoracic spine.

Output: Moderate right pneumothorax.  -Findings relayed to Dr. Patel via text paging tool at the time of report.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute chest History: chest pain, hypoxia Cardiomegaly with interstitial opacity, increased from previous, suggestive of edema.Port catheter with its tip at the SVC/RA junction.Large main pulmonary artery suggestive of pulmonary hypertension.No evidence of pneumonia.

Output: CHF with interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: evaluate for ETT placement History: ETT tube The ET tube overlies the mid trachea, in adequate position. Enteric tube courses below the diaphragm.No interval change in appearance of right apical mass.Signs of emphysema. Improving interstitial pulmonary edema.No pleural effusion or pneumothorax.

Output: Adequate position of support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: increased dyspnea, hemoptysis History: as above Stable cardiomediastinal silhouette.Postsurgical changes following bilateral lung transplant with stable small bilateral pleural effusions/thickening and underlying subsegmental atelectasis/scarring. Interval improvement in diffuse interstitial opacities suggesting improving pulmonary edema superimposed upon a background of diffuse interstitial thickening and basilar bronchiectasis. No pneumothorax.Multiple air-fluid levels in minimally dilated loops of small bowel in the upper abdomen, consider dedicated imaging if there is concern for ileus or obstruction.

Output: Improving pulmonary interstitial edema pattern. Persistent bilateral pleural effusions/thickening.


Instruction: Generate impression based on medical findings.

Input: PICC line placement Left PICC line is observed with tip projected into the mid subclavian vein. No additional cardiopulmonary abnormality observed

Output: Left PICC line placed


Instruction: Generate impression based on medical findings.

Input: Abdominal pain, check for free air Nasogastric tube coiled in the proximal stomach. Right PICC line extends into the proximal SVC.Lungs are grossly clear and similar with mild decrease in overall volume. No gross free air, however exam limited with semiupright portable positioning

Output: NG well positioned


Instruction: Generate impression based on medical findings.

Input: Shortness of breath. Mild cardiomegaly.Right-sided aortic arch with severe atherosclerotic calcifications as on the previous exam. Lung volumes are large with bilateral basilar interstitial opacities that appear similar to the previous exam.Blunting of the left costophrenic angle appears unchanged and may be related to scarring.

Output: Right-sided aortic arch. No reliable evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Reason: post op History: post op ET tube tip approximately 6 cm above the carina. Swan-Ganz catheter tip in the main pulmonary artery.Aortic balloon catheter in the proximal descending aorta.Bilateral opacity compatible with edema, atelectasis and small pleural effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 22 years old Male. Reason: eval for worsening opacity, ETT placement History: intubated. ETT tip 2.0 cm above the level of the carina. Other tubes and lines unchanged. Extensive airspace opacities/consolidation bilaterally without acute change. There is evidence of pneumothorax.

Output: Extensive airspace opacities/consolidation bilaterally, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: lung infiltrate History: chest pain Unremarkable cardiac and mediastinal silhouette.Catheter tip in the SVC.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with history of hepatocellular carcinoma and renal cell carcinoma. CHEST:LUNGS AND PLEURA: No significant abnormality noted. MEDIASTINUM AND HILA: Multiple small mediastinal lymph nodes are again seen, unchanged. The previously described prevascular lymph node (series #12, image #31/219) measures 10 mm x 8 mm (previously 9 mm x 9 mm).CHEST WALL: ABDOMEN:LIVER, BILIARY TRACT: Surgical changes compatible with right hepatic lobe resection. There is compensatory hypertrophy of the caudate and left hepatic lobe.No focal liver lesions are identified.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Surgical changes status post partial right nephrectomy. A focal area of hypoattenuation in the right renal midpole is unchanged and likely represents postsurgical changes.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 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 noted

Output: Stable examination with postsurgical changes to the liver and kidney. No definite evidence of metastatic or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: hx of HgbSS p/w SOB; eval for acute chest History: SOB Small lung volumes.No specific evidence of infection or edema, or infarction.Heart size upper normal.

Output: Heart size upper normal, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: poss pna History: sob, high white count Normal heart size. There are extensive fibrotic changes in both lungs with sparing of the left lower lobe. There is an opacity in the left mid lung zone seen only on the AP view. No pleural effusion or pneumothorax.No displaced rib fracture.

Output: 1. Extensive fibrotic changes in both lungs with sparing of the left lower lobe. 2. Opacity in the left midlung zone may represent confluent fibrosis versus a space occupying lesion. If no prior imaging is available for comparison, a chest CT is recommended on a nonemergent basis for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: intubated History: see above Line position stable. Small lung 5 basilar opacities suggesting atelectasis.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: ? PNA History: cough and SOB Retrocardiac left lower lobe opacity. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Retrocardiac left lower lobe opacity consistent with pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: increasing SOB, ESRD, eval for volume overload vs PNA History: see above Cardiomegaly status post sternotomy.Basilar edema and retrocardiac consolidation are stable.Small pleural effusions are present.Unchanged LVAD and ICD.Right jugular catheter still terminate in the SVC.

Output: Cardiomegaly with pulmonary edema and retrocardiac consolidation, with no new findings. Small pleural effusions are present.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: s/p L thoracotomy History: s/p L thoracotomy Stable cardiomediastinal silhouette. Persistent left retrocardiac atelectasis.No new pulmonary opacities identified.Left sided chest tube unchanged.Subcutaneous emphysema along the left lateral chest wall.

Output: Persistent left retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: swan placement History: as above Mild cardiomegaly, unchanged.Swan-Ganz catheter tip in the right descending pulmonary artery and aortic balloon catheter in the proximal descending aorta with a marker about 2.5 cm below the top of the aortic arch..No new findings.

Output: Balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Reason: history of recent pneumonia History: as above Mild streaky opacity at the left base consistent with subsegmental atelectasis or scarring. Unremarkable cardiac and mediastinal silhouette. No sign of pneumonia.

Output: Mild residual atelectasis or scarring at the left base.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Evaluate for aspiration, pt choked History: Evaluate for aspiration Streaky opacities could represent mild aspiration. Stable right upper lobe scarring.

Output: Nonspecific basilar opacities consistent with mild aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: S/p aortic valve replacement POD 2 History: As above Pulmonary edema pattern, unchanged. Small pleural effusions, as before. Right IJ sheath, unchanged. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: infection w/o, PE? History: post op, fever, tachycardia and hypoxia Surgical drains again overlying the abdomen.Interval effacement of the cardiomediastinal margins with the cardiac silhouette remaining normal in size. Mild retrosternal pneumomediastinum.Small right and moderate left pleural effusions with underlying patchy bibasilar atelectasis. Persistent right pneumothorax with apical and basilar components.

Output: 1.Small right and moderate left pleural effusions with underlying atelectasis. Underlying consolidation is felt unlikely but cannot be entirely excluded.2.Grossly unchanged right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: 67F with ESRD presenting with significant cough, rhinorrhea, sore throat x 2 weeks History: significant cough, rhinorrhea, sore throat x 2 weeks, subjective fever No significant cardiopulmonary abnormality.Healed granulomatous disease noted.Spinal stabilization hardware upper thoracic spine.

Output: No significant abnormality. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval lung fields History: eval lung fields Improved left 17 mm pneumothorax, and improved 14 mm right pneumothorax, with chest tubes bilaterally.Minimal basilar subsegmental atelectasis.Left subclavian catheter, tip in left brachiocephalic.An NG tube terminates in the stomach.

Output: Improvement in pneumothoraces with no new findings.


Instruction: Generate impression based on medical findings.

Input: Reason: pulm edema History: bnp elevated Under cardiomegaly but no evidence of pulmonary edema or pleural effusions.No other significant findings.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: pneumonia, acute chest History: Hx of hgbss/beta thal presenting with pain crisis, elevated wbc ct. No focal lung consolidation. No pleural effusion or pneumothorax. Moderate cardiomegaly and enlarged pulmonary artery, as before. Port catheter again noted terminating at the caval atrial junction. Bony findings consistent with sickle cell disease/beta thalassemia.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval for CP History: as above Mild hyperexpansion consistent with COPD.No specific evidence of infection or edema.Heart size normal, the aorta tortuous but consistent with age.

Output: Mild COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male status post OHT with cough Surgical clips in the upper lungs again seen. ICD remnant unchanged. Sternotomy wires and spinal fixation hardware unchanged. No focal airspace opacities. Mild residual pleural fluid or thickening at the right costophrenic angle. No pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: Mild residual right pleural effusion or thickening, otherwise no acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Eval for Pneumonia History: Worsening RLL Consolidation and Rising WBC Stable support devices.Stable cardiomegaly.Stable basilar opacities.No significant pneumothorax.

Output: Stable support devices. Stable basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Post Lung Biopsy, Evaluate for Pneumothorax. Known chronic pneumothorax prior to procedure. History: Post- Biopsy Surgical artifacts and rib fractures in the right lateral chest again seen.The cardiomediastinal silhouette is normal.The chronic right pneumothorax appears stable in size. Bilateral pulmonary nodules are unchanged.There is a new air-fluid level at the right lung base.

Output: 1.New right pleural fluid collection, nonspecific. Short-term follow-up can be considered to exclude the possibility of hemothorax in the postprocedure setting. Discussed with Dr Greenstein, IR, by phone at 14:26 on 11/9/16.2.Stable, chronic right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: s/p bronch, robotic left lower lobe wedge section and left apical posterior segmental resection f History: post-op Surgical material noted in the left hemithorax.Stable cardiomediastinal silhouette.Grossly unchanged appearance of bilateral opacities compatible with scarring/atelectasis.No focal consolidation significant pleural effusion or pneumothorax.

Output: Surgical changes reflecting left lower lobe and left apical resections. Stable appearance of bilateral scarring/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: intubated, assess interval change History: intubated, assess interval change Endotracheal tube terminates 3 cm above the carina. Nasogastric tube and right central catheter remain in stable position.Persistent mediastinal widening secondary to known mediastinal mass and lymphadenopathy. The heart size remains normal. Blunting of the right costophrenic angle from subsegmental atelectasis or retained secretions. No interval pneumothorax, pleural effusion or pulmonary edema.

Output: Stable mediastinal enlargement from known mediastinal mass otherwise, no change.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: ? aspiration History: increased secretions Enteric tube terminates possibly in the proximal duodenum.ET tube has been retracted, with the tip between the thoracic inlet and the carina.The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: Interval retraction of ET tube. Otherwise, no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval of lung fields History: s/p esophagectomy Unchanged right pleural drain with no pneumothorax. Stable loculated right effusion and mild basilar atelectasis.A stent is unchanged in position.Right PICC, tip at SVC/artery junction level.

Output: No change in support devices and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old. Moderate cardiomegaly with basilar interstitial and airspace opacity compatible with atelectasis and nonspecific consolidation.ICD device extending to the area of the apex of the right ventricle.No pneumothorax or other significant interval change.

Output: Basilar atelectasis and nonspecific consolidation without significant interval change.


Instruction: Generate impression based on medical findings.

Input: 62 year old female with history of 4-cm retroperitoneal mass CHEST:LUNGS AND PLEURA: Right basilar atelectasis, unchanged.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. An index prevascular node measures 18 by 7-mm on image number 26, series number 3.CHEST WALL: Severe scoliosis.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined small hypodensity in the inferior aspect of the right lobe of the liver best seen on image number 104, series number 3, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Patient's known left para-aortic mass measures 4.2 x 3 cm on image number 94, series number 3, not significantly changed in size. This mass is separate from left adrenal gland.Ill-defined soft tissue density around the common hepatic artery is unchanged from previous study. Its etiology is unknown.Multiple collaterals in the right retroperitoneum and anterior abdominal wall consistent with thrombosis of the IVC, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracolumbar levoscoliosis. Significant degenerative disease. Compression to the spinal canal is present.OTHER: No significant abnormality noted.PELVIS:Evaluation of pelvic structures is very limited due to artifacts from the right hip prosthesis.UTERUS, ADNEXA: Uterus has lobulated contours. Bilateral adnexa cannot be well seen. Further evaluation with pelvic ultrasound may be helpful.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right hip prosthesis.OTHER: No significant abnormality noted.

Output: No significant change in the size of the left retroperitoneal mass. Its etiology is unknown and may represent chest, metastatic adenopathy or less likely pheochromocytoma. Clinical correlation is recommended. Ill-defined soft tissue density around the hepatic arteries also unchanged.Pelvic ultrasound is recommended for further evaluation of the lobulated uterus and left adnexa.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: MaleReason for Study: Reason: PNA History: chest pain There is moderate cardiac enlargement with chronic appearing basilar opacities suggestive of atelectasis and scarring.There is pulmonary vascular redistribution and prominence of the central pulmonary arteries.No focal areas of consolidation.No large pleural effusions.Median sternotomy is intact.

Output: Cardiomegaly, pulmonary vascular redistribution, and basilar atelectasis without specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old. Unremarkable cardiac and mediastinal silhouettes. No pulmonary or pleural abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 69F with mediastinal mass eval for change (aspiration, worsened obstruction) History: SOB Large superior mediastinal mass deviating the trachea to the left, as previously described.Small lung volumes with mild left basilar opacities suggest mild atelectasis.

Output: Large mediastinal mass with marked deviation of the trachea, previously characterized by CT scan, without significant change.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: IABP placement History: concern for IABP migration. Cardiomegaly.IABP marker has moved inferiorly by approximately 3 cm and now is located in the proximal descending aorta, above the left mainstem bronchus.Pacemaker leads are unchanged.Bilateral interstitial opacities suggestive of edema appear unchanged from the prior exam.

Output: IABP marker has moved inferiorly by approximately 3 cm and now is located in the proximal descending aorta, above the left mainstem bronchus.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: new hypoxia Small lung volumes with diffuse airspace and interstitial opacity, increased compared to a CT scan of 9/7/2016 which showed partial visualization of the lungs.The differential diagnosis includes pulmonary edema, infection, and acute exacerbation of chronic interstitial lung disease.Normal heart size and no large pleural effusion.

Output: Diffuse severe nonspecific airspace and interstitial pulmonary opacity, likely a combination of an acute process superimposed on chronic interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with bilateral rib pain. Cardiomediastinal silhouette is within normal limits. No pulmonary opacities, pleural effusions or pneumothorax. No displaced rib fracture is seen.

Output: No acute cardiopulmonary abnormality. No rib fracture is seen. Please note that PA/lateral chest radiographs have limited sensitivity in the detection of rib fractures. If there is continued clinical suspicion, dedicated rib radiographs could be considered.


Instruction: Generate impression based on medical findings.

Input: Cough and wheezing No cardiopulmonary abnormalities. Specifically no discrete focal air space abnormality or findings to support airway diseaseMild tortuosity of the aorta unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: r/o post surgical effusion/PTX History: none Median sternotomy with cardiomegaly.Right chest tube removed with no pneumothorax.Mild basilar opacities suggestive of edema or aspiration.Small pleural effusions.

Output: Mild CHF and/or aspiration. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 59 years old Male. Reason: post op History: same. Hypoinflated lungs with compression atelectasis. Probable new patchy opacities in the lower lungs, which can be due to edema, atelectasis or aspiration. The Swan-Ganz catheter has been removed. The right IJ catheter projects over the SVC.The mediastinal and abdominal drains are noted.

Output: Severe hypoinflated lungs with the compression atelectasis and possibly new opacities in the node lungs.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male, follow-up for fungal pneumonia. LUNGS AND PLEURA: Patchy ground glass opacities within the right upper lobe are still evident but appear less prominent. Nodular pleural based opacities on the left are also stable and may represent scarring.Subcentimeter nodule within the anterior right major fissure (axial image 69/92) is stable and may represent an intrapulmonary lymph node.Near complete resolution of left-sided pleural effusion and improvement in right sided pleural effusion.MEDIASTINUM AND HILA: Right-sided central venous catheter with its tip in the SVC.Stable small mediastinal lymph nodes.Cardiac size is normal. No pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Previously noted right chest wall nodule is incompletely evaluated on this study.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Improving groundglass opacities and pleural effusions.2.Stable pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Shortness of breath status post line placement. Right central venous catheter tip in proximal SVC. Surgical clips noted medial to right lung apex. Stable cardiomediastinal silhouette. Upper lobe predominant emphysema without pneumothorax. Basilar predominant interstitial and airspace opacities have worsened and may represent aspiration or edema. Small left pleural effusion.

Output: 1.Right central venous catheter tip in proximal SVC.2.Interval increase in basilar opacities. Differential considerations include worsening edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: eval PICC placement History: new PICC PIC line from the left arm with its tip in the left axilla.Mild basilar subsegmental atelectasis, and no other significant cardiopulmonary findings.

Output: PICC line tip in the left axilla.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Sepsis, evaluate for central line. Right jugular catheter tip projects over the cranial aspect of the right atrium.Asymmetric predominantly interstitial opacities and bronchial wall thickening, left greater than right, increased. No pneumothorax.

Output: Right jugular catheter tip overlying the cranial aspect of the right atrium, no pneumothorax. Worsening pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.IABP. IABP marker projects over the descending thoracic aorta projecting about 6.5 cm below the top of the arch (T6 level).Left jugular Swan-Ganz catheter tip at the right interlobar pulmonary artery.Low lung volumes with mild bronchial wall thickening and atelectasis.Pleural fluid volume unchanged, right greater than left.

Output: IABP marker at the T6 level, projecting about 6.5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: pleural effusion History: desaturation Mild basilar edema and gradually improving left lower lobe consolidation.Small pleural effusions.Mild cardiomegaly.

Output: Pulmonary edema with gradually improving left lower lobe consolidation. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 84 years old Male. Reason: Please evaluate lungs for fluid, volume status, planning for dialysis today History: Needs dialysis, evaluate volume status. Mild cardiomegaly with tortuosity of the thoracic aorta. Stable widening of the superior mediastinum with tracheal displacement suggestive of goiter. Bibasilar streaky opacities suggestive of atelectasis. A questionable nodular density is seen in the right upper lobe.

Output: Questionable new nodular density in the right upper lobe. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: assess for overload, infection History: assess for overload, infection Cardiomediastinal silhouette is stable. Right tracheal deviation, suggestive of goiter. Bilateral pleural effusions, right greater than left, with associated atelectasis. Perihilar interstitial opacities compatible with edema.

Output: Findings suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: Evaluate enteric tube Suboptimal study secondary to patient's body habitus, bilateral flanks excluded. Enteric tube seen with side-port in proximal stomach. No evidence of bowel obstruction. Possible right upper quadrant surgical clip. Please refer to same day chest radiography for additional findings.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Eval for pneumothorax History: S/P CT removal after LVAD implant Left pleural effusion. No pneumothorax. Interval removal of chest tube. Right PICC terminates in the right axilla. Interstitial opacities consistent with edema. No new focal pulmonary opacities. Cardiomediastinal silhouette is stable.

Output: Interval removal of right chest tube. Right PICC terminates in the right axilla. No other significant change.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with follicular non-Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: Stable centrilobular emphysema primarily affects the upper lobes. Scattered micronodules are unchanged when compared to the prior exam.Bilateral apical lung scarring.MEDIASTINUM AND HILA: The reference precarinal lymph node measures 1.6 x 0.7 cm (series 4, image 37), previously measuring 1.7 x 0.7 cm. The other small mediastinal and hilar lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. No focal hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable lipoma in the third portion of the duodenum. Scattered diverticula.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered diverticula.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Stable disease with no new sites of disease or metastases.2. Centrilobular emphysema.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: iABP placement History: as above Streaky subsegmental atelectasis left lower lobe, unchanged. IABP catheter proximal marker 3 cm below the top of the aortic arch.Left PICC, tip in the SVC.

Output: Unchanged retrocardiac subsegmental atelectasis and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: ICU survey; evaluate lung fields and lines History: s/p LVAD Iatrogenic devices are unchanged. Patchy bibasilar opacities again noted. Unchanged heart size. No definite pneumothorax.

Output: Patchy bibasilar opacities again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: hx of testicular cancer, evaluate for metastatic disease History: see above The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.Stable basilar scarring. No obvious metastatic disease.

Output: No acute cardiopulmonary process is identified. No obvious metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: extensive cardiac history (5-6 stents) with 3 weeks of left sided CP History: L sided CP Focal scarring or subsegmental left lung periphery. No specific evidence of infection or failure.Heart size upper normal.Left axillary vascular stent.

Output: Heart size upper normal, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: uri/hemoptysis History: pna Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with history of sarcoma CHEST:LUNGS AND PLEURA: There is a new soft tissue density pleural-based mass invading the posterior chest wall in the left posterior lateral chest wall, measuring 3 .2 x 2 .2 cm, image number 44, series number 3.Previously described pneumothorax is decreased in size. Previously described soft tissue density extending along the suture line to the hilum is unchanged. Small amount of left pleural effusion is unchanged. MEDIASTINUM AND HILA: Subcarinal lymph node measures 14 x 9 mm image number 43, series number 3. This density may also represent fluid is that of a lymph node. A prevascular lymph node measures 9 by 5-mm image number 33, series number 3. Previously it was measuring 9 by 6 mm on image number 33, series number 4.CHEST WALL: Postsurgical changes with left rib resections is again noted. Collection in the chest wall has almost completely resolved. Small amount of inflammation persists.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Right external iliac lymph node is unchanged, measuring 10 by 7-mm image number 179, series number 3. The clinical significance of this lymph node is not certain.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval development of a pleural based soft tissue mass in the left upper lobe. Internal resolution of previously described collection in the left chest wall.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: s/p MVR with CT Removal History: SOB Status post median sternotomy.Interval removal of right chest tubes, with slight reaccumulation of bilateral pleural effusions, slightly greater on the left.There is mild overlying atelectasis at the lung bases.No focal consolidation. Minimal left apical pneumothorax.

Output: Interval removal of chest tubes with slight recannulation of bilateral pleural fluid and associated atelectasis. Minimal left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: lung disease History: SOB when lying flat Ill-defined right upper lobe nodule consistent with lung cancer.Heart size upper normal.No specific evidence of infection or edema.

Output: Right upper lobe nodules consistent with lung cancer. A thoracic CT is recommended for follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: intubated History: ett Mild cardiomegaly with moderate lower lung zone opacities suggestive of edema accompanied by pleural effusions and retrocardiac consolidation.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Cardiomegaly and pulmonary edema consistent with CHF. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: 68 y/o lady w/ new onset tachypnea History: tachypnea Cardiomegaly, small lung volumes and increasing edema.Worsening basilar consolidation and pleural effusions.Right jugular catheter tip at cavoatrial junction level.Right PICC, tip in the SVC.

Output: Worsening basilar opacities consistent with edema, consolidation and pleural effusions, suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: s/p pacer generator change History: s/p pacer generator change No pneumothorax following pacemaker generator replacement.Left subclavian dual-chamber pacemaker leads remain in appropriate position.Unchanged chronic appearing elevation right hemidiaphragm.

Output: No pneumothorax following pacemaker generator replacement.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with history of urothelial carcinoma, status post radical cystectomy with ileal conduit. Evaluate for recurrence. CHEST:LUNGS AND PLEURA:Other nodules have regressed or remain stable in size. No new suspicious nodules or pleural effusion.MEDIASTINUM AND HILA: Stable mediastinal lymphadenopathy; reference lymph node (series 6 image 55) again measures 1.6 x 1.3 cm. Stable right hilar lymph nodes.CHEST WALL: Stable hypodense lesions in right thyroid lobe, unchanged. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe hemangioma is stable in size and appearance.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small mass at superior pole of left kidney measures 1.2 x 1.5 cm at coronal image 51 has been stable for all prior exams, may be due to atypical cyst vs. solid lesion. No significant interval change. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ileal loop urinary diversion right lower quadrant remains stable.PELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoproctectomy.BLADDER: Status post cystoproctectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1. Stable or decreased small pulmonary nodules and mediastinal lymph nodes. 2. No significant interval change since the prior exam.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male with pneumonia. Right upper extremity PICC is in the right subclavian vein. Partially imaged VP shunt catheter.Increasing retrocardiac consolidation. No significant pleural effusions. No pneumothorax. Normal cardiomediastinal silhouette.

Output: Increasing retrocardiac consolidation compatible with infection/aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.History of AML Stable cardiomegaly. No large pleural effusion or pneumothorax. Ill-defined questionable patchy right upper lobe airspace opacity, which may represent infection or atypical edema.

Output: Ill-defined right upper lobe opacity, which may represent infection or atypical edema. Recommend PA and lateral radiographs for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Reason: dypsnea History: dyspnea Mild cardiomegaly with no evidence of CHF or infection.Left jugular catheter tip in the right atrium, unchanged.No new findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Chronic airway obstruction to evaluate obstruction follow-up interstitial edema, pleural effusions from December 2014 Asymmetric lung volumes, right greater than left, with elevation of the left hemidiaphragm and left basal scarring. 11-mm nodular opacity in the right upper lobe, not conclusively present previously, possibly related to right first costochondral cartilage/osteophyte however an intrapulmonary nodules cannot be excluded.Right posterior costophrenic angle nodule identified on prior CT scans not visible by this technique.Mild nonspecific interstitial abnormality, but no signs of pulmonary edema. Scattered nodular opacities are nonspecific in appearance, too small to characterize.Trace volume of pleural fluid on the left unchanged.Vertebral body loss of height and osteopenia in the thoracic spine.

Output: Trace left pleural fluid collection, but no specific signs of pulmonary edema. Artifact from right first costochondral cartilage versus a nodule in the right upper lobe may be further characterized by CT when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: r/o infiltrates History: afib, syncope x 2 Probably basilar atelectasis or scarring. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. At least mild cardiomegaly. Tortuous and atherosclerotic aorta.

Output: No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: volume overload Swan-Ganz catheter and left jugular catheter unchanged. Left basilar opacity compatible with a small pleural effusion and atelectasis, not significantly changed from the previous radiograph.No new findings.

Output: Small left pleural effusion and atelectasis without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: ett placement, progression of pleural effusion History: as above Lines and tubes are unchanged. Large left pleural effusion again noted. Diffuse left lung opacities, unchanged. Right lung remains clear. Unchanged cardiomegaly.

Output: Lines and tubes are unchanged. Large left pleural effusion again noted. Diffuse left lung opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: S/P Cardiac Surgery History: S/P Cardiac Surgery Severe cardiomegaly with basilar consolidation and atelectasis and pleural effusions, with continued marginal increased at the left apex.Swan-Ganz catheter tip in the right main pulmonary artery.LVAD and ICD leads unchanged.

Output: CHF with increased continued increase in opacity and effusion on the left.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: s/p left upper lobe wedge resection. CT in place. History: asx Left chest tube unchanged in position.Persistent small left hydropneumothorax. Large lung volumes compatible with COPD with evidence of prior wedge resection left upper zone. Interval atelectasis left cardiophrenic angle with left upper lobe opacities unchanged.

Output: Persistent small left hydropneumothorax. New left cardiophrenic atelectasis.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female history of NSC lung cancer status post 6 cycles of chemotherapy ended 4/08. History of right renal artery aneurysm. Any abnormalities, changes since prior CT. There are CHEST:LUNGS AND PLEURA: Right upper lobe mass with associated spiculation is increased in size. It measured on series 4 image 21 has 2.1 x 1.3 cm.Several small lung nodules on the right than on the left elsewhere are unchanged.Superior septal emphysema.No effusions.MEDIASTINUM AND HILA: Left hilar confluent adenopathy increased in size now measuring on series 3 image 32 as 2.5 x 2 cm. In compresses the right main bronchus and its trifurcation.No evidence of left hilar, anterior mediastinal, diaphragmatic or retrocrural adenopathy. No axillary nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: New multifocal hypodensities scattered in the left lobe of the liver and a few in the right lobe. Some of these have the appearance of metastases. Others have a somewhat geographic pattern particularly the one along the confluence of the hepatic veins in the gallbladder fossa with suggestion of vessels going through it and could represent fatty infiltration. I favor this representing a combination of new metastases in possibly areas of fatty infiltration. No evidence of biliary dilatation. No hepatic or portal venous thrombosis.SPLEEN: Massive splenomegaly, unchanged. Cephalocaudad dimension the spleen is 22 cm as seen on coronal image 55. Enlarged splenic and portal vein.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Infiltrative mass in the right kidney has markedly increased in extent. As seen on series 3 image 105 it measures 3.2 x 3.1 cm. the left kidney is normal. There is no evidence of thrombus in the renal veins or IVC.Two there are two right splenic artery aneurysms the largest of which is seen on series 3 image 104 measuring 2.1 x 1.7 cm approximately unchanged.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal adenopathy along the aortocaval and left para-aortic areas increased compared to the prior exam. A cluster of nodes in the left periaortic area seen on series 3 image 111 measures 2.5 x 1.7 cm. There is no appreciable adenopathy in this area on the prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mottled appearance to all the pelvic bones and both femora consistent with metastatic disease. This is probably unchanged from the CT of 11/23/07.OTHER: Small amount of free fluid

Output: Progression of disease. New sites of disease including liver and the retroperitoneum. Some of the liver lesions could represent geographic fatty infiltration. Increase in size of right renal lesion. Splenic artery aneurysms stable. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out acute cardiopulm process History: dyspnea, tachy Large right loculated hydropneumothorax, not significantly changed from previous. Multiple bilateral pulmonary nodules and airspace opacity in the right lung compatible with nonspecific consolidation and atelectasis.

Output: Large right hydropneumothorax with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Evaluate for acute cardiopulmonary process History: chest pain, high cardiac risk No change in the degree of cardiomegaly. No significant pleural effusions. Some degree of vascular congestion but no frank pulmonary edema.No specific evidence of infection.

Output: No change in degree of cardiomegaly. No frank pulmonary edema at this time. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: R/o RUL infiltrate/mass or PTX History: Right-sided CP Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: evaluate infection History: SOB Mild cardiomegaly status post sternotomy.Unchanged right basilar subsegmental atelectasis and small right pleural effusion.IABP ring marker projects over the aortic arch.Left subclavian pacemaker, leads unchanged in position.

Output: Unchanged right basilar atelectasis and small right pleural effusion, and stable support devices.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of lymphoma CHEST:LUNGS AND PLEURA: Scattered subcentimeter nodules are unchanged.MEDIASTINUM AND HILA: Mixed response in the size of the extensive mediastinal adenopathy. Some of the lymph nodes in the decrease in size whereas some of them have increased in size within the interval. Index pretracheal lymph node is smaller measuring 2.2 x 1.8 cm image number 40, series number 3. Superior mediastinal lymph nodes on image number 29, series number 3, measures 2.1 x 1.3 cm whereas it was previously measuring 1.3 by 1.1 cm image number 29, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Mixed response. Interval decrease in the size of the some of the mediastinal adenopathy where some of the lymph nodes have slightly increased in size.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: evaluate lung fields post op History: s/p MVR, TVR, CABG Lines and tubes are unchanged. Question small left apical pneumothorax. Mild pulmonary edema and patchy bibasilar opacities again noted. Unchanged cardiomegaly.

Output: Question small left apical pneumothorax. Close imaging follow-up is suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: rule out infection History: syncope Improvement in lung volumes. Patchy basilar opacities, likely atelectasis. Query minimal interstitial pulmonary edema. Normal heart size. No pneumothorax.

Output: No acute cardiopulmonary process on radiography. Question minimal interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Eval ET tube History: intubated in MICU ET tube tip 5-6 cm above carina. NG tube tip in stomach.Pigtail drain on the right with stable to slightly decreased right pleural effusion, no evidence of pneumothorax.

Output: ET tube tip 5-6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval ETT History: Resp failure ET tube tip approximately 4 cm above the carina. Pleurx catheter projected over the left lung base with a moderately large residual effusion, increased from previous, and no pneumothorax.An NG tube terminates in the stomach.Diffuse opacity in the right with volume loss consistent with pleural effusion and underlying atelectasis, not significantly changed.

Output: Increasing left pleural effusion, mainly subpulmonic in location.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Febrile History: Febrile Mid to lower zone opacities favoring atelectasis with lower zone volume loss. An infective process is also in the differential. Small, right greater than left, pleural effusions. Mild cardiomegaly. No pneumothorax.

Output: Basilar opacities with volume loss of atelectasis. Associated infective processes consideration. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Eval for pneumothorax History: S/P Chest Tube Removal Interval chest tube removal with no evidence of pneumothorax. Stable basilar opacities with pleural effusions. Swan-Ganz catheter has been removed.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: evaluating for pna History: pt with cough x 1 month, now productive. no f/c at this time, but did 3 wks ago. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.Healed right rib fractures.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: swan History: as above Swan-Ganz catheter in main pulmonary artery. Other support hardware is stable. No significant pulmonary edema or pleural effusions. Skinfold on the left.

Output: Swan-Ganz catheter in main pulmonary artery. No significant pulmonary edema or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Intubated with ARDS. ETT tip 8 cm above the level of the carina. Left jugular catheter can be followed to the left brachiocephalic vein, the tip is not well visualized.Increased volume of pleural fluid on the right. Diffuse airspace opacity in the right lung along with compressive atelectasis in the dependent lung field not significantly changed. Retrocardiac atelectasis on the left, about the same.

Output: Possible slight increase in right pleural fluid collection, otherwise, no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: assess for PNA History: fever, stem cell transplant pt New left upper lobe opacity suggestive of infection.New left basilar opacity.Heart size normal.Right jugular catheter, tip in SVC.

Output: Left upper lobe pneumonia, possibly also in the left base.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Chest pain, recent flulike illness The cardiomediastinal silhouette is unremarkable. Calcifications of the aortic arch. No specific evidence of infection, edema, or effusions.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female 81 years old Reason: rule out chest metastasis History: History of high grade urothelial carcinoma The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. No pulmonary nodules are seen. There is no evidence of infection.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: swan placement History: changed Swan-Ganz catheter now loops at the level of the RA and terminates at the level of the right ventricle. Other lines and tubes, unchanged. A few spot opacities again noted. No new focal pleural parenchymal opacity.

Output: Swan-Ganz catheter now loops at the level of the RA and terminates at the level of the right ventricle.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Pneumonia. Respiratory failure. Inferior right upper lobe consolidation has improved. Right jugular catheter tip over the right atrium. ET tube is 3 cm above the carina. NG tube over the stomach. No pneumothorax.

Output: Improving right upper lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male who presents for evaluation of the right hilum. Cardiac size is normal. Large right perihilar mass posterior to the right hilum is again identified. No focal airspace opacities, pleural effusion, or pneumothorax.

Output: Large mass posterior to the right hilum. Further evaluation with a contrast enhanced CT of the chest is recommended.The finding of the large right perihilar mass on the initial radiograph from 5/8/2016 was discussed with Dr. Chali Mulenga at 8:45 AM on 5/9/2016.


Instruction: Generate impression based on medical findings.

Input: Reason: PRE Lung or Heart-Lung Transplant Evaluation History: PRE Lung or Heart-Lung Transplant Heart size upper normal with sternotomy fixation devices intact.Extensive chronic interstitial lung disease, greater in the upper lung zones, compatible with sarcoidosis.Blunting of the right costophrenic angle consistent with scarring, unchanged.No new findings.

Output: Severe chronic interstitial lung disease with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA History: cough, fever, smoker Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 19-day-old male with right pneumothorax. Evaluate.VIEWS: Chest AP/lateral (two views) 11/30/2015, 1750 Three right-sided chest tubes with one of the chest tubes tip located anteriorly and one tip located posteriorly. Side port of one of the chest tubes is in the right chest wall soft tissues. Endotracheal tube tip immediately below the thoracic inlet. Lower extremity PICC tip is in IVC. Enteric tube with tip in the proximal gastric body.Cardiomediastinal silhouette is normal. Persistent bilateral pulmonary opacities on a background of pulmonary interstitial emphysema. No significant change in right pneumothorax. Soft tissue edema persists.

Output: Persistent right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Cough and AIDS patient, green sputum. Bilateral groundglass and subsolid focal opacities.No pneumothorax or pleural fluid.Normal heart size.

Output: Bilateral pulmonary opacities consistent with multifocal pneumonia. PA and lateral plain film follow-up suggested in 6 weeks to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: is there an infiltrate History: cough with sputum, +temp Cardiac silhouette is borderline enlarged.Mild bibasilar subsegmental platelike atelectasis. No focal consolidation sizable effusion or pneumothorax.Remote right rib fracture deformities.

Output: Mild bibasilar subsegmental atelectasis. Otherwise, no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: post procedure eval for pneumothorax History: same Heart size about upper normal with evidence of previous median sternotomy.No pneumothorax or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: SOB status post aortic dissection. Interval removal of right jugular introducer without pneumothorax. There may be slight increase in mild left pleural thickening or fluid and costophrenic angle blunting. Differential density of the aorta on the frontal radiograph may correlate to known dissection, but the aorta does not appear to be enlarged and the cardiomediastinal silhouette is unchanged in size and contour. Low lung volumes but no specific evidence of edema.

Output: Mild left pleural thickening or fluid may be increased, difficult to compare to prior due to differences in technique.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old. Reason: eval for ptx, effusion History: dizziness, SOB Left-sided ICD with lead unchanged in position.Cardiomegaly with mitral valve prosthesis, unchanged. Large lung volumes consistent with COPD with multiple focal areas of scarring, unchanged from previous.No new focal areas of consolidation.No pneumothorax.Median sternotomy intact.

Output: Extensive chronic abnormalities without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: 36F s/p Roux-en-Y now with temp: 101.7, tachycardia History: Tachycardia, febrile Enteric tube tip in the stomach with sidehole proximal to the GE junction.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female 5 years old Reason: Compare pleural effusion, pneumothorax History: Chest tube pulled at \R\1600VIEW: Chest AP (one view) 12/11/2015 at 1812 hours. Interval removal of right-sided chest tube. Cardiac silhouette size is normal. No change in multiloculated hydropneumothorax and right lung opacity.

Output: No change in multiloculated hydropneumothorax and right lung opacity after chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: h/o multiple myeloma, acute onset chest congestion and cough x 8 days. r/o pneumonia. History: h/o multiple myeloma, acute onset chest congestion and cough x 8 days. No pleural effusion or pneumothorax. No focal pulmonary opacity. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: phrenic nerve injury? history of fall. C6-7 fracture History: shortnest of breath with exercise 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, 47 years old.Reason: infection? History: seizure The lungs and pleural spaces are clear. The heart size is normal.

Output: No specific evidence of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female 80 years old. Reason: Increasing WOB, oxygen desaturation. Concern for left hemidiaphragmatic paralysis. History: Hypoxia, increased work of breathing. Marked cardiomegaly, not significantly changed from prior examination.Low lung volumes and basilar opacities compatible with atelectasis and small pleural effusions bilaterally.

Output: Basilar atelectasis with bilateral pleural effusions, not significantly changed since prior examination.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Heart transplant status evaluate ET tube Patient is rotated. Carina is not clearly visualized, ETT tip at the level of the clavicular heads, approximately 6-7 cm above its expected level.Right jugular Swan-Ganz catheter unchanged in position. Lung volumes remain low with extensive basal atelectasis. No pneumothorax.

Output: The ETT tip is at the clavicular head level.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Shortness of breath. Unchanged central venous catheters. Low lung volumes with left greater than right bibasilar scarring. Persistent cardiomegaly. No definite pleural effusion or large pneumothorax. No focal pulmonary opacity.

Output: Unchanged cardiomegaly. Low lung volumes.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with chronic wheezing and abnormal pulmonary function tests LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative changes within the dorsal spineUPPER ABDOMEN: Demonstration of cholelithiasis

Output: Normal CT of the chest without evidence of significant lung disease.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: ptx History: vats Left lower lobe consolidation and lower lung zone edema pattern with pleural effusions, unchanged.Right jugular catheter, tip in SVC.Left chest tube, with no significant pneumothorax.Cervical spine CSF catheter externalized, unchanged.

Output: Stable left lower lobe consolidation pleural effusions, but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: Atypical pneumonia? History: Cough, night sweats, sinus congestion for 5 days The cardiomediastinal silhouette is unremarkable.There are increased lung volumes compatible COPD.No focal airspace opacities.No pleural effusions.Cervical stabilization hardware identified.Degenerative changes in the thoracic spine.

Output: Increased lung volumes compatible with COPD. No acute cardiopulmonary abnormalities identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Chest pain Mediastinal left basilar chest tubes are otherwise unchanged without evidence of new complication. Persistent decreased volumes and suspected atelectasis of the left lower lobe with air without partial consolidation is also similarSwan-Ganz has been removed without complication, however the right jugular sheath persists extending into the upper SVC

Output: Swan-Ganz removed


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old. Reason: eval for PNA History: chest pain Cardiomediastinal silhouette is unremarkable.No focal air space opacity, pleural effusion or pneumothorax. Metallic focus in the left lateral soft tissues.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: ETT, PNA History: ETT, PNA Small lung volumes with increased basilar opacities suggestive of aspirated secretions and atelectasis.ET tube tip 3 cm above the carina.NG tube tip is below the lower margin of the image.Rights cleaning catheter tip at right atrial level.

Output: Increased basilar opacities suggestive of aspirated secretions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: infection History: as above history of weakness Dobbhoff tube extends beyond the field-of-view of study.No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Desaturation Interval removal of the right chest tube with a small residual apical pneumothorax. Apical measurement is approximately 2 cm, yet subsequent images interpreted

Output: Right chest tube removed


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: eval for effusions, consolidations History: SOB Cardiomegaly, status-post sternotomy, with a mild edema pattern and small pleural effusions.ICD and LVAD unchanged.

Output: Stable CHF with pleural effusions and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: assess for worsening infection, edema, ptx History: copd, hypercarbic resp failure Improving pulmonary edema but persistence in the left lower lobe raises a question of a superimposed infection.Severe upper lobe emphysema.

Output: Improvement in edema but persistent left lower lobe opacities suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Swan History: as above Moderate cardiomegaly status post sternotomy.Improved moderate pulmonary edema.Right jugular Swan-Ganz catheter, tip in right pulmonary artery.Right jugular catheter tip at cavoatrial junction.Left subclavian ICD, leads unchanged in position.

Output: Slight improvement in pulmonary edema. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: 62-year-old man with newly diagnosed AML status post chemotherapy with respiratory distress, tachycardia, and hypoxia. Please evaluate for PE. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: Bilateral large pleural effusions. Diffuse bilateral predominantly upper lobe groundglass opacities which are worse than prior exam.MEDIASTINUM AND HILA: Small pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of pulmonary embolus. Large bilateral pleural effusions. Diffuse upper lobe groundglass opacities suggestive of drug reaction versus viral infection.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Eval for cardiopulmonary disease. History: leg swelling Severe cardiomegaly and enlarged pulmonary arteries are unchanged. Interval resolution of patchy opacities at the right lung base. No evidence of edema or effusions. Large hiatal hernia, as before.

Output: Cardiomegaly without acute abnormality. Interval resolution of right basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Tonsil cancer recent biopsy, check for pneumothorax Multiple new scattered bilateral pulmonary nodules in all 4 quadrants concerning for extensive metastatic disease. Lymphadenopathy is also suggestion both hilar and mediastinal regions, greater on the right.No postprocedural acute complicationsThe cardiac and mediastinal contours are otherwise within limits

Output: Extensive metastatic disease without evidence of superimposed acute postprocedural complication


Instruction: Generate impression based on medical findings.

Input: 27-year-old female. Swelling in chest around shunt site, headache. SHUNT DEVICE: Again seen is an intracranial shunt that exits the skull via a left parietal-occipital burr hole. The shunt then crosses the midline to course down the right scalp and neck and enters the right hemithorax to terminate near the right costophrenic angle. Much of the shunt device along the occiput is radiolucent and hence impossible to evaluate but overall appears similar to the prior study. The notch on the pressure valve is not well visualized but appears to be pointed superiorly. We see no abrupt kinks in the shunt tubing.SKULL: Note is made of extensive post-operative changes, similar to the prior study.CERVICAL SPINE: There is deformity of the posterior arch of C1, likely post-operative.CHEST: Small right pleural effusion, similar to the prior study.

Output: Shunt device appearing similar to the prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: evaluate tubes and lines History: s/p cardiac surgery Postoperative radiograph demonstrates endotracheal tube 4 cm above the carina. A right IJ Swan-Ganz catheter terminates in the proximal right pulmonary artery. Two subxiphoid mediastinal drains and a basilar left chest tube are present. Mediastinal hardware is well aligned.Basilar opacities represent subsegmental atelectasis. There are small bilateral pleural effusions. There is subcutaneous emphysema in the superior chest wall. No significant pneumothorax is visualized. There is lucency at the abdominal midline of uncertain etiology. A dedicated upright abdominal radiograph may be performed if there is clinical suspicion for pneumoperitoneum.

Output: Postoperative radiograph demonstrates interval sternal closure with basilar opacities of subsegmental atelectasis and pleural effusions. Nonspecific lucency at the subxiphoid location; further evaluation may be obtained with upright abdominal radiograph if there is suspicion for pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: FemaleReason for Study: Reason: rule out pneumonia History: cough, sob Stable cardiomegaly with pulmonary vascular redistribution and small pleural effusions.No focal areas of consolidation.

Output: Mild CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Small lung volumes with mild basilar opacity compatible with atelectasis and aspirated secretions. Subcutaneous emphysema in the left side of the neck.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: ? chest pain; rib fracture History: left sided reproducible chest pain Cardiomediastinal silhouette is normal. No pleural effusions or pneumothorax. No focal pulmonary opacity.Evaluation of ribs are limited on this non-dedicated study. No definite displaced rib fractures.

Output: No acute cardiopulmonary process. Evaluation of ribs are limited on this non-dedicated study. No definite displaced rib fractures.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: evaluate poor airway movement, elevated lactate History: SOB Unchanged basilar opacities and pleural effusions.Mild cardiomegaly.

Output: Unchanged pleural effusions and basilar opacities. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: chest pain r/o mass History: as above and dyspnea No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Mild cardiomegaly again noted. Aortic atherosclerosis, as before.

Output: No mass lesion is noted. However, if a chest wall is suspected, cross-sectional imaging would be much more sensitive in this assessment.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: r/o pneumonia History: cough Normal cardiac and mediastinal contours.No pleural or parenchymal abnormality.Scoliosis.

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


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: r/o pleural effusion, History: SOB Moderate cardiomegaly with moderate pulmonary edema worse compared to the prior study.Small pleural effusions are present.No specific evidence of infection.Right jugular catheter, tip at right atrial level.

Output: Cardiomegaly with moderate pulmonary edema and pleural effusions consistent with worsening CHF.


Instruction: Generate impression based on medical findings.

Input: 18 year-old female presenting with vomiting and constipation. History of alveolar soft part sarcoma. Intractable nausea and vomiting. Please evaluate for tumor progression/cause of nausea. CHEST:LUNGS AND PLEURA: Innumerable pulmonary nodules are again seen with interval growth of several nodules and many new nodules noted as well.For reference, large right perihilar nodule (series 4, image 40) measures 14 x 14 mm; previously measuring 12 x 12 mm. Nodule along left major fissure measures 11 x 13 mm (series 4, image 27); previously measuring 9 x 10 mm. Left lower lobe nodule (series 4, image 45) measures 12 x 12 mm; previously measuring 8 x 8 mm.MEDIASTINUM AND HILA: Several unenlarged prevascular lymph nodes are noted. Heart size normal without pericardial effusion.CHEST WALL: Left chest Port-A-Cath with catheter tip in right atrium. ABDOMEN:LIVER, BILIARY TRACT: Small amount of pericholecystic fluid is again seen without biliary ductal dilatation. New periportal edema is also identified. Nonopacification of the hepatic veins is likely secondary to phase of imaging.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Heterogeneously enhancing, partially necrotic left paraspinal mass is again identified. It measures 6.9 x 8.3 cm (series 3, image 115); previously measuring 7.2 x 9.2 cm.BOWEL, MESENTERY: Diffuse colonic wall thickening is identified without evidence of obstruction or free air.BONES, SOFT TISSUES: L3 and L4 laminectomies again seen. Lytic lesion within left aspect of L2 vertebral body measures 1.6 x 2.2 cm (series 3, image 101); stable. Lytic lesion within L3 vertebral body measures 2.1 x 2.1 cm and is also relatively unchanged accounting for differences in technique. Lytic, expansile lesion within the left pedicle of L4 measures 1.4 x 2.9 cm; previously measuring 1.4 x 2.6 cm.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: See above.

Output: 1. Innumerable pulmonary nodules, several of which have increased in size; many new nodules are seen as well.2. Diffuse colonic wall thickening compatible with colitis.3. Pericholecystic fluid persists without biliary ductal dilatation. Periportal edema within the liver is new since prior study.4. Interval decrease in the size of left paraspinal mass.5. Stable vertebral body metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: Right-sided chest pain Mild left basilar scarring. The heart size is normal. No pneumothorax or pleural effusions.

Output: Mild left basilar scarring without acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Neck pain after recent catheter is present. Right central venous catheter terminates at the atriocaval junction. Small left pleural effusion. No focal pulmonary opacity. No other significant abnormality to explain patient's symptomology.

Output: Right central venous catheter terminates at the atriocaval junction.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: MaleReason for Study: Reason: concern for pna History: concern for pna The cardiomediastinal silhouette is unremarkable.Bilateral basilar airspace opacities and consolidation compatible with multifocal pneumonia possibly secondary to aspiration.No pleural effusions.

Output: Bilateral basilar airspace opacities and areas of consolidation compatible with multifocal pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Tachypnea Mild interval increasing basilar edema, moderate effusions and vascular redistribution. Mild cardiomegalyUnchanged right jugular and left subclavian catheters. NG tube well positioned

Output: Increasing mild-to-moderate CHF


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Status post ECMO Right port tip and large bore cannula extending into the area of the right atrium, unchanged. Surgical clips and sternotomy hardware overlying mediastinum unchanged.Small right pleural effusion. Left pleural effusion tracking into the apex. Stable right lung base opacity compatible with atelectasis.

Output: Pleural effusions and lung base opacity without significant change from prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: eval for infection History: fever 102.7 The cardiomediastinal silhouette is normal. Multifocal pulmonary opacities are more conspicuous on prior radiograph and prior CT chest likely representing improvement. No focal opacities suggestive of pneumonia. Elevation of the right hemidiaphragm appears chronic. No large pleural effusion. No pneumothorax.

Output: Known pulmonary opacities are improved from prior examinations. No superimposed acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Bilious emesis, chest pain Moderate to marked gaseous gastric distention. Enteric tube seen with side-port overlying gastric fundus/proximal body. Relative paucity of small bowel gas. Gas and stool suggested in ascending and descending colon. Relative lucency seen in bilateral paracolic gutters, more pronounced on left side particularly in left upper quadrant, may be artifactual or related to intra-abdominal fat. Evaluation for free air not optimal on single submitted supine image. Bilateral femoral approach vascular catheters partially imaged.

Output: Moderate to marked gaseous gastric distention. Enteric tube seen with side-port overlying gastric fundus/proximal body.Relative lucency seen in bilateral paracolic gutters, more pronounced on left side particularly in left upper quadrant, may be artifactual or related to intra-abdominal fat. Evaluation for free air not optimal on single submitted supine image. If there is conical concern this would be better evaluated with upright or decubitus radiographs or CT.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of GIST, metastatic to liver. On Gleevec. Evaluate extent of disease. Compare to previous. CHEST:LUNGS AND PLEURA: Scattered micronodules. Mild apical paraseptal emphysema. Stable scarring in right middle lobe and left lung base. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Re-identification of intermediastinal soft tissues, compatible with residual thymus. No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Stable conglomerate left axillary lymph nodes (series 8, image 17), again measuring 2.2 x 1.3 cm.ABDOMEN: LIVER, BILIARY TRACT: Multiple hypodense hepatic lesions are reidentified, which have decreased in size since prior study. Reference right hepatic lobe lesion (series 8, image 115) measures 1.3 x 0.6 cm, previously measuring 1.5 x 0.9 cm.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left upper pole renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Stable small retroperitoneal lymph nodes. Reference left periaortic lymph node (series 7, image 70) measures 1.5 x 1 cm; which is stable accounting for differences in technique.BOWEL, MESENTERY: Status post right hemicolectomy.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Status post right hemicolectomy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Slight interval decrease in size of hepatic lesions. No new metastatic foci identified.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Findings status post PEG tube feeding, evaluate for aspiration Small lung volumes with interstitial opacities and pleural effusion suggestive of edema, although aspiration is also a differential consideration. The cardiomediastinal silhouette is normal. Surgical clips in the upper abdomen are again noted.

Output: Interstitial opacities and pleural effusion suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: Placement of subclavian trialysis catheter History: Renal Failure Bilateral pleural effusions and basilar opacities are unchanged, suggestive of CHF/hypervolemia.Moderate cardiomegaly.A Dobbhoff tube extends below the lower margin of the image.ET tube tip approximately 3 cm above the carina.Right subclavian catheter, tip in SVC.

Output: Unchanged pleural effusions and basilar opacities suggestive of CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.ET tube placement The lungs are clear without significant consolidation, edema, or effusion. Heart size is within normal limits. ET tube 2 cm above the carina. Probe in the distal esophagus. NG tube curled in the stomach. No pneumothorax.

Output: ET tube 2 cm above the carina. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Hypoxic respiratory failure Lower lung volumes. Multi-lobar patchy areas of consolidation have slightly increased and likely represents multifocal pneumonia. A moderate to large left-sided pleural effusion is stable with underlying consolidation/atelectasis as seen on the prior CT chest. A right-sided PICC line is in stable position near the cavoatrial junction. No pneumothorax. The cardiomediastinal silhouette is unchanged.

Output: Multi-lobar patchy areas of consolidation most likely reflecting multifocal pneumonia is apparently increased, possibly due to lower lung volumes. Stable moderate to large left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 65 years old Female. Reason: neutropenic fever History: fever. There is new patchy opacity in the right lower lobe. Unchanged opacities in the left upper lobe. Unchanged left pleural effusion with basilar atelectasis. The right PICC line is stable in position. No pneumothorax.

Output: New patchy opacity in the right lower lobe. Stable airspace opacity in the left lung and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: evaluate for pulmonary abnormality History: cough, dyspnea Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia No underlying cardiopulmonary acute abnormalities. Scattered calcified granulomata compatible with old healed granulomatous disease exposure

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Cough No cardiopulmonary abdomen the observed other than a moderately to markedly elevated right hemidiaphragm. Contour, specifically in the lateral projection, is most suggestive of chronic change over frank herniation, however correlation with prior outside imaging if available would be helpful to confirm. If suspicion remains high, CT evaluation may be indicated

Output: No acute abnormality observed, see details provided


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: trach in place, desat and concern for new aspiration. History: check for aspiration, interval development of PNA Tracheostomy tube and NG tube unchanged.Stable cardiac mediastinal silhouette.Left retrocardiac opacity compatible with atelectasis and may be secondary to aspiration.No pleural effusions.

Output: Left retrocardiac opacity compatible with atelectasis which may be secondary to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: eval for infil or mass History: sodium of 122 that is new, +cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Swan History: Swan Unchanged basilar opacities with cardiomegaly.Right jugular Swan-Ganz catheter tip peripherally in the right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Right jugular Swan-Ganz catheter tip peripherally in the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: assess for pulmonary edema, infection History: SOB Cardiomegaly with mild pulmonary edema and small pleural effusionsConsistent with CHF.LVAD and ICD are unchanged.Swan-Ganz and PICC have been removed.

Output: Cardiomegaly with mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: O2 requirement, History: o2 requirement Stable cardiomediastinal silhouette.Decreased lung volumes with basilar opacities compatible with atelectasis and possible small effusions similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: No interval change in the basilar opacities compatible with atelectasis and possible small effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Please re-eval Right pleural effusion. History: Right sided Lung cancer, h/o pneumothorax, pleural effusion. Pleurex catheter is draining, but he is feeling progressively more SOB Unchanged pulmonary opacities and pleural effusions.Right Pleurx catheter.

Output: Unchanged pulmonary opacities and pleural effusions. A more recent CT has been performed.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: s/p thora, r/o PTX History: s/p thora Enlarging pleural effusions with increased basilar subsegmental atelectasis.Stable right upper lobe mass.SVC stent.No significant pneumothorax.

Output: No pneumothorax following thoracentesis, with effusions slightly larger.


Instruction: Generate impression based on medical findings.

Input: Altered mental status Multiple scattered nodular opacities are observed more pronounced on the right with relative sparing of the lung bases. An extensive overlying artifact is also observed (most appreciated on the lateral projection) which may accentuate these abnormalities, however serial imaging and/or comparison with prior imaging is needed to ensure clearance or further characterize. Underlying scattered metastatic disease cannot entirely be excluded.Moderate tortuosity of the aorta with more mild atherosclerotic disease exaggerated by moderate scoliosis. Cardiac silhouette is within limits.Bilateral marked and incompletely visualized shoulder degenerative changes.

Output: Scattered nodular densities bilaterally, of uncertain significance and/or of definite evidence of calcification. Comparison with prior outside imaging if available or follow-up imaging to omit the possible artifact suggested. See detail provided. Pager 4094 contracted


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p lvad insertion History: s/p lvad Status post median sternotomy and LVAD placement, in appropriate position.Chest tubes are present with no pneumothorax.Postoperatively, small pleural effusions are present with retrocardiac atelectasis.ET tube tip approximately 2 cm above the carina.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: No pneumothorax following LVAD placement. Enlarging pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Appropriate PICC placement History: s/p PICC placement Unchanged pulmonary opacities/metastases and pleural effusions left larger than right.New right PICC, tip low in the right atrium.Left jugular port catheter tip at cavoatrial junction.Residual contrast material is seen in the colon.

Output: Right PICC placement, the tip low in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: ETT placement. History: as above. Support devices not significantly changed with ETT tip 6 cm above the carina. Unchanged position of enteric tube and left and right IJ central venous catheters.Pneumothorax may not be visualized due to technique.Low lung volumes.Bibasilar parenchymal-pleural opacities not significantly changed.Small to moderate bilateral layering pleural effusions again noted.

Output: Bibasilar parenchymal-pleural opacities with small to moderate bilateral layering pleural effusions not significantly changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: ro acute chest syndrome History: pt with sickle cell disease here with voc new onset cp and sob Cardiac silhouette is enlarged.Unchanged chronic vascular and interstitial prominence. No focal consolidation, pleural effusion, or pneumothorax.

Output: Stable sequelae of sickle cell disease. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: fevers for two months. No localized findings. R/O mass infiltrate History: as above No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.Stable eventration of the right hemidiaphragm.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: eval for aspiration pneumonia History: hypoxia and fever New right pleural effusion and right lower lobe consolidation consistent with pneumonia.Moderate cardiomegaly.A Dobbhoff tube terminates in the lower esophagus.

Output: New right lower lobe pneumonia. High Dobbhoff tube.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: pneumoniA History: fever, chills Relatively low lung volumes. The lungs and pleural spaces are clear. The cardiomediastinal silhouette is unremarkable. Multilevel osteophytes of the thoracic spine are again noted.

Output: Low lung volumes without evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: Check ETT /TLC placement History: Check ETT /TLC placement Moderate cardiomegaly with left lower lobe consolidation and left pleural effusion.Ill-defined opacity right lower lung zone could be edema or aspiration.ET tube tip approximately 3 cm above the carina.Two right jugular catheters terminate in the SVC.

Output: ET tube tip approximately 3 cm above the carina. Basilar opacities could be from aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: chest tube removal History: chest tube removal Mild basilar edema and left lower lobe consolidation are unchanged.Cardiomegaly stable following median sternotomy.Right jugular introducer catheter removed.Mediastinal drains withdrawn with no pneumothorax or complication.

Output: Unchanged pulmonary opacities and pleural effusions. No pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Retroperitoneal leiomyosarcoma. CHEST:LUNGS AND PLEURA: Subcentimeter nodule abutting the right major fissure is again noted which may represent an intrapulmonary lymph node.MEDIASTINUM AND HILA: The esophagus is dilated throughout its course.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal mass enlarging the uncinate process of the pancreas is again seen measuring 4.9 x 5.1 cm image number 95/213. The mass again displaces the inferior cava laterally. Right renal artery is patent and inferior to the mass. Again IVC is small in caliber but patent.BOWEL, MESENTERY: Possible lipoma in the third portion of duodenum is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Patient is status post hysterectomy. No adnexal masses.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in the size of the retroperitoneal mass consistent with patient's known history of leiomyosarcoma.