Instruction: Generate impression based on medical findings.

Input: 58-year-old male with indolent lymphoma The examination is limited by lack of IV contrast.CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Coronary artery calcifications are seen.CHEST WALL: Small, stable left axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic hypodensities are identified, compatible with cysts given that they were present in 12/02.SPLEEN: Normal in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous bilateral renal cysts are seen.RETROPERITONEUM, LYMPH NODES: Peripancreatic soft tissue density measures 3.6 x 2.4 cm (series 4; image 91), previously 4.3 x 2.6 cm. 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: A 21 x 12 mm right obturator lymph node (series 4; image 170), previously 24 x 12 mm.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: Left inguinal hernia repair. Small right fat-containing inguinal hernia.OTHER: No significant abnormality noted

Output: Mild decrease in size of the reference peripancreatic and right obturator lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Known mesothelioma with large pleural effusion, pericardial fluid collection, s/p chest tube History: s/p chest tube Enlarged cardiomediastinal silhouette.Left chest tube placed draining a left pleural effusion with basilar atelectasis.Small lung volumes.No significant pneumothorax.

Output: Left chest tube with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: Collapse of LLL 2/2 to constipation/obstipation. History: Constipation Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: MaleReason for Study: Reason: r/o ptx after lung biopsy History: chest pain Stable cardiac mediastinal silhouette.Scattered areas of scarring/discoid atelectasis unchanged.Left apical nodule as noted on recent CT.Old bilateral rib fracture deformities redemonstrated.No evidence of a pneumothorax post biopsy.

Output: No pneumothorax identified post procedure.


Instruction: Generate impression based on medical findings.

Input: Chest tightness. Intermittent chest pain and dyspnea with exertion No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: sob History: sob Unremarkable cardiac and mediastinal silhouettes. Chronic interstitial opacities with no superimposed acute pulmonary finding. Right lower lung calcified granuloma. No large pleural effusions.

Output: Chronic interstitial opacities with no superimposed acute pulmonary finding.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia, pnemothorax History: hypoxia ET tube tip approximately 2 cm above the carina. Venous catheters unchanged.Cardiomegaly with small lung volumes.Bilateral nonspecific opacity compatible with edema, atelectasis and small effusions.

Output: ET tube in acceptable position. .


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate for effusions or opacities History: shortness of breath, h/o CHF Moderate to severe cardiomegaly with pulmonary vascular redistribution.Mild interstitial edema is present with septal lines inferiorly but no significant sized pleural effusions.No specific evidence of infection.

Output: CHF, with cardiomegaly and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Line placement Interval advancement of left jugular catheter, tip now projects at the confluence with the SVC. In addition a new catheter has been placed adjacent to this prior line, tip extends only into the proximal jugular. Other demonstrates definite postprocedural associated complication however one catheter is not well advanced.Underlying cardiopulmonary appearance similar

Output: New left jugular catheter placed and the existing catheter advanced


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Shortness of breath. No focal airspace opacity, pleural effusions or pneumothorax. Stable cardiomediastinal silhouette with aortic arch calcifications.Surgical cholecystectomy clips.

Output: No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.History of multiple myeloma scheduled for autologous stem cell transplant. The cardiomediastinal silhouette is normal. No focal pulmonary opacity or pleural effusions. Focal lesion along the anterolateral aspect of the left 5th rib; consider further work up considering history of multiple myeloma.

Output: No acute cardiopulmonary abnormality.Focal lesion along the anterolateral aspect of the left 5th rib, concerning for pathological fracture or focal plasmacytoma given history; consider further work up.


Instruction: Generate impression based on medical findings.

Input: Reason: acute abnormality? History: shortness of breath Perihilar bronchial thickening compatible with asthma. No sign of pneumonia or other complications.

Output: Bronchial thickening compatible with asthma.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: volume overload? infection? cough, orthopnea, LE edema. hx of untreated HTN. History: as above Prominent right cardiac border, probably related to scarring, and unchanged.No sign of CHF or active pulmonary disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: SWAN positioning History: above Median sternotomy with mild cardiomegaly.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter in right pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Right jugular Swan-Ganz catheter placement.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p thoracentesis, evaluate for PTX History: admitted with aspiration pneumonia, shortness of breath and cough. Unchanged position of left ICD.Interval improvement of right mid to lower lung airspace opacities with residual patchy airspace opacities.Significant interval improvement of right pleural effusion status post thoracentesis without evidence of pneumothorax. Small residual right pleural effusion remains.Stable appearance of opacified left hemithorax compatible with prior pneumonectomy.

Output: Interval improvement of right middle and lower lung airspace opacities as well as improvement of right pleural effusion status post thoracentesis. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.POD 2. Post cardiac for rheumatic mitral valve disease. Interval removal of right jugular introducers and right chest tube, now with a small 10 mm right apical and medial pneumothorax. Atelectasis in the medial segment of the right middle lobe associated with mild thickening of the major fissure is new. Patchy subsegmental atelectasis elsewhere about the same. No specific evidence of pulmonary edema. Worsening subcutaneous emphysema right chest wall.Minimal pleural fluid and atelectasis in the right costophrenic angle posteriorly.

Output: 1 cm pneumothorax on the right post tube. Right middle lobe medial segmental atelectasis is new.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: worsening tachycardia, cough, congestion, ?aspiration History: tachycardia, cough, congestion, ?aspiration Redemonstration of complete opacification of the left hemithorax.Septal lines at the right lung base compatible with edema and associated small right pleural effusion. No focal areas of consolidation in the right lung.

Output: Complete opacification left hemithorax compatible with large pleural effusion and underlying atelectasis. Mild edema at the right lung base without evidence of consolidation.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and mitral valve disorder Marked nonspecific cardiomegaly with underlying mild diffuse pulmonary changes suggesting early edema minimally greater on the right. Enlarged pulmonary arteries are also supportive and suggestive of pulmonary hypertensionMidline sternotomy

Output: Early CHF and cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: HTN History: HTN Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 79 years, Female. Reason: concern for overflow diarrhea, evaluate stool burden. Also has h/o recurrent SBO History: intermittent diarrhea and constipation. Average to less than average stool burden. Nonobstructive bowel gas pattern. No free air on upright views. Left upper quadrant surgical clips and bowel anastomosis sutures again noted. Vascular calcifications.

Output: Average to below average stool burden. Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for infiltrate History: Hypoxia, fever Small lung volumes with bilateral basilar nonspecific consolidation and atelectasis.Findings are suggestive of aspiration and infection.

Output: Bilateral lower zone consolidation and atelectasis suggestive of aspiration and infection.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female. Stool and gas leaking from vagina. Evaluate rectovaginal fistula. Rectal tumor. Cervical cancer. Additional history from prior CT requisition and data indication rectal cancer. CHEST:LUNGS AND PLEURA: Stable micronodules. Left apical thickening stable. No pleural effusions.MEDIASTINUM AND HILA: No pathologic size nodes. Sliding hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given that limitation, the following observations as are made. Gallstones redemonstrated. Hypodense masses in the dome of the right lobe and lateral segment left lobe redemonstrated it measured less accurately due to lack of intravenous contrast. Using narrow liver windows I estimate the lateral segment left lobe lesion to measure 7.2 x 3.8 cm Series IV image 68. Previously 5.9 x 3.2 cm. I estimate the lesion in the dome of the right lobe to measure 5 x 4.5 cm Series IV image 56. Previously 4.6 x 3.9 cm.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Massive thickening both adrenal glands. Unchanged.KIDNEYS, URETERS: Highly atrophic left kidney redemonstrated. Nephrolithiasis right kidney redemonstrated in the upper and lower poles. No hydronephrosis. Ileal conduit.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate size sliding hiatal hernia (I believe EGJ is above diaphragm) with a large paraesophageal component redemonstrated. No evidence of ascites or carcinomatosis. Nonobstructive parastomal hernia containing colon with colostomy right lower quadrant.Ileostomy left lower abdomen with omentum and parastomal hernia. No fluid in the hernia sac.BONES, SOFT TISSUES: Midline surgical scar.OTHER: Atherosclerotic disease common no evidence of aneurysm.PELVIS:UTERUS, ADNEXAE: Markedly thickened and nodular contour to the vagina and cervix with gas within communicating to rectum consistent with large rectovaginal fistula related to tumor / therapy. This is difficult to separate from rectosigmoid. Sagittal reconstructions were made to distinguish these structures.Large adnexal calcifications stable may represent calcified nodes or tumor or ovarian lesions. BLADDER: Surgically absent.LYMPH NODES: Calcified pelvic lymph nodes unchanged. Small lymph node vascular. Surgical clips consistent with lymph node dissection along the right iliac chain and in the left distal external iliac region.BOWEL, MESENTERY: See above. No ascites. Redemonstration of rectal thickening and nonspecific hypodensity in thickening in the presacral fat. BONES, SOFT TISSUES: Midline surgical scar.OTHER: No significant abnormality noted.

Output: Rectovaginal fistula. Numerous other findings including nonobstructive parastomal hernias, nephrolithiasis right kidney, atrophic left kidney, large hiatal hernia probably sliding with a paraesophageal component, marked thickening adrenal glands, liver lesions difficult to measure accurately due to lack of intravenous contrast.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: ptx History: sob Small left pneumothorax, compared to previous.Left chest tube in place located laterally.Extensive pulmonary abnormalities and bronchial valves as previously described.

Output: Essentially stable left pneumothorax. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Male 32 years old with chest pain and shortness of breath. The cardiomediastinal silhouette with marked cardiomegaly is unchanged. Increased blood flow in the upper lung zones compatible chronic anemia. No new pulmonary opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Kidney donor No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: mets lung cancer, on therapy, respiratory infection. CT showed RML collapsed. Pls c/w this cxr w/ CT to evaluate status. History: Please eveluate RML collapsed and disease status. Interval reexpansion of right middle lobe. Status post right upper lobectomy. Pulmonary nodules were better evaluated on CT.

Output: Interval reexpansion of right middle lobe.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with history of right upper lobe lung nodule. CHEST:LUNGS AND PLEURA: A right apical nodule measures approximately 6 mm in longest dimension and is unchanged (axial image 16/73). An additional right upper lobe nodule is unchanged and measures 10 x 14 mm on axial image 20/73. A right lower lobe nodule and adjacent subpleural nodule are unchanged (axial image 37/73). A right lower lobe nodule is unchanged and measures 14 x 12 mm and axial image 51/73. No new masses. No focal consolidation, edema or pleural effusion. MEDIASTINUM AND HILA: A hypoattenuating lesion within the thyroid is unchanged.No significant hilar or mediastinal lymphadenopathy. The cardiac size is normal with no pericardial effusion.Small paraesophageal lymph nodes are unchanged.CHEST WALL: Status post left mastectomy with surgical clips in the left axilla. No definite evidence of bony metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions within the left kidney are noted. The largest of the lesions is unchanged when compared to the prior exam of 4/20/06. A smaller, more anterior lesion (axial image 103/136) has decreased in size.The left renal vein is circumaortic.PANCREAS: 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 noted

Output: Stable disease in the chest with other stable findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old. Right jugular catheter tip in the inferior right atrium and catheter from the right arm extending to the SVC.Small lung volumes with chronic interstitial disease and possibly superimposed edema, unchanged.

Output: Right jugular catheter tip in the inferior right atrium.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old. NG tube is in place with its tip in the stomach.Right PICC line with its tip in the right atrium.Stable cardiomediastinal silhouette.Diffuse interstitial/airspace opacities in both lungs with pleural effusions and basilar atelectasis similar in appearance to the prior exam.

Output: Interval placement of a right PICC line with its tip in the right atrium. Subsequent imaging demonstrates appropriate repositioning. Extensive pulmonary opacities and pleural effusions redemonstrated.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: rule out fracture History: fall Cardiac silhouette is normal in size. There is abnormal convexity of the right superior mediastinal margin with fullness of the retrosternal space and marked elevation of the right hemidiaphragm with right basilar atelectasis. Lungs are otherwise clear.

Output: Abnormal convexity of the right superior mediastinal margin is highly concerning for an anterior mediastinal mass with associated phrenic nerve paralysis. The possibility of an ascending aortic aneurysm remains in the differential considerations. Recommend CT chest with IV contrast for further evaluation.Findings discussed with provider Kevin Concordia on 12/22/2016 8:35 AM


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Evaluate right IJ line position status post central line placement. Motion artifact. Right jugular catheter extends to the SVC.No significant pneumothorax.Enlarged central pulmonary vasculature unchanged.Vascular unsharpness and bronchial wall thickening suggestive of edema and atelectasis, about the same.Probable cardiomegaly, unchanged.

Output: Right jugular catheter extends the SVC level, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male status post right hemicolectomy with complicated postoperative course. Evaluate source of infection. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions which have increased in size compared to previous CT. Endotracheal tube is in place. Focal consolidation the right middle lobe which may represent pneumonia.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Midline tissue defect likely secondary to wound dehiscence. No evidence of bowel obstruction. Previously described small amount of free fluid and free air is decreased in size. No evidence of loculated collection. Small amount of hematoma posterior to the rectus muscles in the pelvis in the extraperitoneal space secondary to recent surgery. Within the interval nasojejunal tube is placed. Ileocolonic anastomosis was taken down and the right lower quadrant ileostomy and left lower quadrant mucous fistula was performed. A drain is placed into the colon on the left side. 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: Small amount of extraperitoneal hematoma as described above.OTHER: No significant abnormality noted

Output: Interval increase in the size of the bilateral pleural effusions and new right middle lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Cough and atrial fibrillation Cardiac monitor is projected over the left hilar region without additional acute pulmonary abnormalities. Of note however is a abnormal contour to the left ventricle and a possible aneurysm, follow-up imaging for comparison including a CT may be indicated in the appropriate clinical setting. Pager 4717 contacted and messages left at the designated number, given no alternative.

Output: Abnormal contour to the posterior cardiac margin, raising concern for possible left ventricular aneurysm. Service contacted


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: intubated History: intubated Small lung volumes.Mild cardiomegaly.No specific evidence of infection or edema.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Right PICC, tip in the SVC.

Output: Cardiomegaly with small lung volumes, but no acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Hypothermia, altered mental status. Follow-up x-ray after IV fluid resuscitation for infiltrates. Rule out pneumonia. Development of a right lower lobe peribronchial distribution airspace opacities. This may be seen to a lesser extent on the left. Probable small right pleural effusion. Left subclavian pacemaker lead directed inferiorly, unchanged in position.

Output: Right lower lobe airspace opacities suspicious for aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with history of metastatic breast cancer on bevacizumab; 2-3 day history of worsening left headache. CHEST:LUNGS AND PLEURA: Interval increase in loculated right pleural fluid/pleural based metastases extending into the fissures.Stable centrilobular emphysema. MEDIASTINUM AND HILA: Unchanged precarinal lymph node measures 2.3 cm x 1.2 cm (image 34 of 212, series #3).CHEST WALL: Patient status post left mastectomy. Left port with tip in the SVC/right atrial junction.ABDOMEN:LIVER, BILIARY TRACT: Previously seen hypervascular lesions appear unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Unchanged low attenuation lesion within the pancreas; likely a cyst, but too small to characterize.KIDNEYS, URETERS: Right lower pole cyst remains unchanged.RETROPERITONEUM, LYMPH NODES: Retrocaval lymph node measures 2.1 x 1.0 cm (image 95 of 212, series #3); previously it measured 2.1 x 1.2 cm. This is likely unchanged given slice variation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: IVC filter in place.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: Sigmoid diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Slight interval increase in right pleural effusion/pleural metastases. The remainder of the examination is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: swan ganz, infiltrate History: advanced HF Cardiomegaly with no change in pulmonary edema and pleural effusions.Right subclavian Swan-Ganz catheter tip in right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: evaluate for infection History: AMS Mild cardiomegaly.No specific evidence of infection or edema.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Fatigue rule out infection, edema or effusion. Metastatic breast cancer per prior report. Left subclavian chest port tip at the SVC.Bilateral pulmonary masses and nodules similar to recent prior radiograph. No visible pleural fluid. Reticulonodular opacities in the left lung slightly increased and may reflect aspiration or infection.Mediastinal and hilar lymphadenopathy unchanged.Bilateral mastectomies with chest wall surgical clips.

Output: Reticulonodular opacities in the left lung may reflect aspiration or infection. No visible change in pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent moderate pleural effusions greater on the left with basilar atelectasis and marked decreased lung volumes. Questionable mild cardiomegaly with retrocardiac consolidation. Overall appearance similar to August.

Output: Left pleural effusion with basilar nonspecific atelectasis/consolidation, left over right


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: leukocytosis, evidence of pneumonia? History: pneumonia? The cardiomediastinal silhouette is unremarkable. There is no focal airspace opacity, pleural effusion or pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: respiratory distress History: severe distress, COPD, lung cancer Severe cardiomegaly, unchanged.Right mid and lower lung airspace opacity, slightly increased in the lower lung, of uncertain etiology. The differential diagnosis includes infection and radiation reaction depending on the clinical history and presentation.A previously described underlying mass is not clearly visible.No other significant change.

Output: Increased airspace opacity in the right lower lung which may be due to infection or radiation reaction.


Instruction: Generate impression based on medical findings.

Input: 70-year-old male presents with shortness of breath. Plate and screw device affixes the cervical spine. Duodenal and biliary stents incompletely evaluated on this study and projects over the upper abdomen at midline. There is been interval removal of enteric tube.The cardiomediastinal silhouette is normal. Trace bibasilar pleural fluid. No focal pulmonary opacity or pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male history metastatic prostate carcinoma with rising PSA. Restaging please compare to previous scans. CHEST:LUNGS AND PLEURA: Centrilobular emphysema. Scattered micronodules some calcified. No interval change.MEDIASTINUM AND HILA: Coronary artery calcifications. No pathologic size lymph nodes.CHEST WALL: Previously seen parasternal soft tissue mass is increased in size. As seen on series 2 image 53 to measure 34.3 x 13.3 mm. It previously measured 20.1 x 16.7 mm however a more comparable measurement repeated on the previous scan would be on series 3 image 53/221 where the lesion would measure 21.8 x 5.9 mm. This should be used for comparison. Diffuse sclerotic osseous metastases. These are unchanged.ABDOMEN:LIVER, BILIARY TRACT: Few scattered hypoattenuating foci in the liver are again seen. There unchanged in size and number. Mild central biliary prominence status post cholecystectomy is also unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule measures 9.2 x 7.8 mm on series 2 image 91. Previously measured 10 x 9.2 mm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal diffuse sclerotic osseous metastases unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: More conspicuous enhancing soft tissue in the prostate bed suggesting recurrence. As the series 3 images 173 -- 178.BLADDER: No significant abnormality notedLYMPH NODES: Right obturator lymph node is increased in size. It measures 43.3 x 14.8 mm on series 3 image 161. The previously measured 22.1 x 14.3 mm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multifocal diffuse sclerotic metastases unchanged.OTHER: No significant abnormality noted

Output: Increase in size of parasternal mass. Increase in size of pelvic lymph node. Possible increase in size of soft tissue in prostate bed. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: AM CXR History: AM CXR Stable cardiomediastinal silhouette.Bilateral chest tubes unchanged without evidence of a significant pneumothorax.Enteric tube has been removed.Basilar opacities are again compatible with atelectasis and pleural effusions.No new pulmonary opacities identified.

Output: Interval removal of the NG tube. Stable cardiopulmonary appearance with basilar opacities compatible with pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: Eval for Pneumothorax History: S/P CHest tube removal Interval bilateral chest tube removal with no evidence of pneumothorax.Left PICC is coiled at the axillosubclavian junction. Other findings stable.

Output: Interval bilateral chest tube removal with no evidence of pneumothorax.Left PICC is coiled at the axillosubclavian junction.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: concern for aspiration pna History: sob, increased work of breathing, secretions that look like tube feeds Tracheostomy tube and left subclavian catheter unchanged.There are decreased lung volumes with stable cardiomediastinal silhouette.Pleural effusions and basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with encephalopathy. Evaluate for shunts and portosystemic circulation. Morbid obesity. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Nodular contours of the liver, suspicious for chronic liver disease. Cirrhotic morphology. The portal vein and major branches, splenic vein, and IVC are all patent. There is a large left gonadal vein which is associated with varices in the left common iliac region, seen best on coronal image 70. This may represent a point of portosystemic shunting.SPLEEN: Splenomegaly. The spleen measures 13.8 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged lymph nodes in the retroperitoneum were described previously on a noncontrast examination. The current examination shows that these left periaortic and paraspinal structures are varices and not lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction. Circumferential air in the transverse colon, rectum and in the hepatic flexure likely represents trapped air surrounding stool rather than pneumatosis. This was seen on the prior examination.BONES, SOFT TISSUES: 7.7 by 3-cm cystic lesion in the subcutaneous tissue of left lower back. Its etiology is unknown. This was present on the prior examination and is unchanged.OTHER: Moderate ascites. Anasarca.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Bladder is moderately distended, but otherwise unremarkable.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: Suspected portosystemic shunting of the left gonadal vein in the left common iliac region, see above.Chronic liver disease, cirrhosis, and ascites.Enlarged retroperitoneal lymph nodes described previously are due to varices and not lymphadenopathy.Left lower back subcutaneous cystic lesion of indeterminate etiology is stable.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: r/o pulm edema History: SOB, new O2 requirement. Cardiomegaly with cephalization of the pulmonary veins. Diffuse bilateral interstitial opacities are noted. No definite evidence of pleural effusion.

Output: The above findings are suspicious for CHF.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: ards History: ards ET tube tip 4 cm above the carina.Right IJ catheter tip is in the brachiocephalic vein, left IJ catheter tip is in the left brachiocephalic vein.Enteric tube tip is within the stomach and extends off the inferior margin of the image.Stable cardiomediastinal silhouette.Persistent bilateral interstitial and airspace opacities and small bilateral pleural effusions. No new pulmonary opacities.No pneumothorax.

Output: ET tube tip 4 cm above the carina. Stable pulmonary opacities and small effusions consistent with ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: yes History: cough, chills Heart size is normal. Aorta is mildly tortuous. No focal airspace opacities, large pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female 9 months old Reason: position of Dobbhoff tube History: Status post burn.VIEW: Abdomen AP (one view) 4/13/2016 at 2213 hours. Note is made that that the x-ray only includes the upper abdomen. Central line tip is at the right atrium. Feeding tube is tightly coiled towards itself several times either at the gastric antrum or in the duodenum. No evidence of free air.

Output: Misplaced feeding tube.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with metastatic breast cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hemangiomas in the liver, unchanged from previous study. Punctate hypodense lesions are also unchanged but there two small circular characterize. Cholelithiasis is 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: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions involving the thoracic vertebral bodies representing metastatic disease, unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: sob, dyspnea History: as above Right central venous catheter with its tip in the SVC.Stable cardiomediastinal silhouette.Increased interstitial opacities with septal lines and patchy airspace opacity compatible with edema slightly increased from the prior exam.No pleural effusions.

Output: Slight interval increase in interstitial opacities and patchy airspace opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Reason: 51 y/o ESRD HTN, recent cath, with nausea and back pain History: nausea, back pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: location of ETT, lines, chest tubes History: s/p orthotopic heart transplant Iatrogenic devices are unchanged. Slight increase in diffuse pulmonary opacities. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: Support devices stable. Some increase in basilar pulmonary opacities and edema.


Instruction: Generate impression based on medical findings.

Input: Patient with acute shortness of breath. Evaluate for PE. Laryngeal cancer status post laryngectomy. PULMONARY ARTERY: No evidence of PE. LUNGS AND PLEURA: A well-circumscribed nodule measuring 6 mm in the lingula (image116/series9) has slightly increased in size (this measured about 4mm on prior study dated 5/14/08). A micronodule in the left upper lobe (image89/series9) is unchanged. Left basilar opacities with bronchiectasis, compatible with chronic aspiration. Moderately severe emphysema.MEDIASTINUM AND HILA: Tracheostomy tube. No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Gastrostomy tube. A stable left adrenal nodule, likely adenoma.LOWER EXTREMITIES: No evidence of DVT.

Output: 1. No evidence of PE or DVT.2. A nodule in the lingula has slightly increased in size: The differential diagnosis includes indolent primary cancer, hamartoma or less likely an intrapulmonary lymph node. Follow up CT is recommended in approximately 8 to 12 months unless intervention is planned.Dr. Gaetano was notified of the findings and recommendations.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Evaluate pneumonia, similar to speech, breakthrough seizure. Apparent cardiomegaly may be artifact of magnification related to portable technique, incompletely assessed. No focal pulmonary opacities. Elevation of the right hemidiaphragm is chronic. Spina bifida occulta of the lower cervical and upper lumbar spine.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: R/o pneumonia and recurrent pleura effusions, productive cough and fever x 3 weeks History: productive cough and fever The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: cardiac History: CP Median sternotomy with mild to moderate cardiomegaly left-sided predominant.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.LVAD unchanged in position.

Output: Stable cardiomegaly and position of devices.


Instruction: Generate impression based on medical findings.

Input: Reason: evalute ETT position History: advanced ETT ET tube tip approximately 4 cm above the carina. Catheter tip in the SVC.Pulmonary opacities compatible with edema, pleural effusions and atelectasis, not significantly changed.Skin folds over the right apex but no pneumothorax.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Chest pain and shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with history of metastatic melanoma. Please compare reference lesions. CHEST:LUNGS AND PLEURA: Left lower lobe mass measures 6.4 x 3.5 cm (series 3, image 51) and is grossly unchanged in the axial plane. It previously measured 6.4 x 2.6 cm on 7/29/2009. In the coronal plane, however, it appears slightly more robust accounting for position differences, and therefore continued surveillance is recommended.No suspicious nodules or pleural effusion.MEDIASTINUM AND HILA: Reference conglomerate of AP window lymph nodes is relatively unchanged accounting for differences in technique, measuring 2 x 2 cm (series 3, image 29); it measured 2 x 1.9 cm on 6/2/2009 and 2.1 x 1.8 cm on 7/29/2009. Stable mildly prominent hilar lymph nodes.Heart size normal without pericardial effusion.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: Previously referenced mesenteric lymph node has shifted in location, but using the coronal images for tracking, it now measures 14 x 7 mm (series 3, image 139), previously measuring 16 x 8 mm (relatively stable).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Grossly stable examination with possible slightly increased prominence of left lower lung mass as described above.


Instruction: Generate impression based on medical findings.

Input: Acute myocardial infarction, catheter placed ETT, NG, Dobbhoff, Swan-Ganz and right chest tube are all unchanged. Pulmonary appearance is significant for increasing groundglass opacities again consistent with suspected ARDS without additional superimposed focal processes. Change in appearance may be partially due to semiupright and portable technique. Mild cardiomegaly

Output: Unchanged ETT and chest tube


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Dyspnea rule out pneumonia. Coarse reticulonodular opacities bilaterally with questionable slight improvement since the patient's initial study, though the differences could be due to improved lung volumes. Persistent airspace opacity associated with volume loss in the right upper lobe should be followed by CT to complete radiographic resolution. No new findings.

Output: Diffuse pulmonary opacities, most likely pneumonia though they should be followed to complete radiographic resolution by CT 6-8 weeks after patient's initial chest CT scan to ensure resolution. There may be slight improvement in the diffuse opacities however the improvement could be artifact of improved lung inflation. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male 32 days old Reason: are the pneumothoraces resolved History: cT in place on HFOVVIEW: Chest AP (one view) 1/7/2016 at 0350 hours. ET tube tip is below thoracic inlet. NG tube terminates at the stomach. Left upper extremity central line tip is at the left innominate vein. 3 right-sided chest tubes are again noted and unchanged.Cardiac silhouette size is normal. Small residual right-sided subpulmonic pneumothorax is again noted. Bilateral diffuse lung haziness and left lung base opacity unchanged

Output: Persistent right-sided subpulmonic pneumothorax and left lung base opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: endotracheal tube History: endotracheal tube ET tube tip approximately 4 cm above the carina.Right jugular catheter tip in right atrium.Severe cardiomegaly with bilateral airspace opacity suggestive of edema and atelectasis, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: post extubation History: tachypnea Unchanged basilar opacities suggestive of atelectasis with small pleural effusions.An NG tube terminates in the stomach.

Output: Unchanged basilar opacities and pleural effusions following extubation.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Evaluate for pneumothorax status post trach. No pneumothorax. Cardiomegaly is unchanged with streaky basilar opacities and possible bilateral pleural effusions. Interval placement of tracheostomy with the tip 5 cm above the carina, and NG tube looped in stomach with tip in the gastric fundus.

Output: Interval placement of tracheostomy without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: see hx for portable History: Failure to thrive. Unremarkable cardiac and mediastinal silhouette.Mild blunting of the left posterior costophrenic angle which could be due to a very small effusion or scarring.

Output: Possible small left effusion and no other acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: ETT placement History: ETT placement Endotracheal tube terminates 2.5 cm above the carina. Right IJ central catheter unchanged. Interval placement of nasogastric tube which terminates inferior to the caudal margin of the image.Cardiomegaly. Layering bilateral pleural effusions not significantly changed when accounting for patient position. Persistent retrocardiac consolidation and atelectasis.

Output: Bilateral pleural effusions, cardiomegaly with retrocardiac consolidation and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: evaluate lung fields History: CHF Median sternotomy with cardiomegaly and basilar consolidation left greater than right, unchanged.Left jugular Swan-Ganz catheter tip in right main pulmonary artery.Stable LVAD and right subclavian ICD.Right PICC, tip in axillary region.

Output: Unchanged support devices. Stable left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: eval lung fields History: sore throat, cp New nodular opacities within the right upper lobe with subtle nodularity within the right middle lobe and some degree of right middle lobe atelectasis. Otherwise, normal study.

Output: New nodular opacities in the right lung with some degree of right middle lobe atelectasis suggestive of aspiration and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with shortness of breath. Evaluate for interstitial lung disease. CHEST:LUNGS AND PLEURA: Basilar-predominant honeycombing peripherally with traction bronchiectasis also seen at the lung bases. No significant air trapping.MEDIASTINUM AND HILA: Multiple small mediastinal lymph nodes. Enlarged main pulmonary artery is suggestive of pulmonary hypertension.Heart size normal without pericardial effusion. Moderate to marked atherosclerotic calcifications of the coronary arteries.Patulous esophagus with air-fluid level.Heterogeneously enlarged thyroid gland.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Cholecystectomy clips.

Output: Interstitial lung disease with fibrosis in a UIP pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: evaluate for infectious source, neutropenic fever, history of multiple myeloma Right internal jugular catheter tip projects over the SVC.Heart size is normal.Nodular opacity overlying the left lower lobe likely represents a nipple shadow. No radiographic evidence of infection.Small right pleural effusion. Bibasilar scarring/atelectasis.Multiple healed rib fractures. Status post multilevel thoracic kyphoplasties.

Output: No acute cardiopulmonary abnormality. No radiographic evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Pleural effusion 2. Right basilar chest tubes again unchanged in position projecting in traverse the lung base towards the midline. Decreasing overlying chest wall emphysema. Minimal right basilar atelectasis. No associated significant pneumothoraxRight upper and left lung are clear.Left subclavian single port unchanged

Output: 2 right chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval for changes in RLL mass History: AMS Interval resolution of the right basilar opacity. Cardiomegaly and vascular congestion remain.

Output: Interval resolution of right basilar opacity. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: r/o infection History: leukocytosis, immunosuppressed The cardiac mediastinal silhouette is unremarkable.Mild elevation right hemidiaphragm with bilateral basilar scarring/discoid atelectasis.No focal areas of consolidation.No pleural effusions.Degenerative changes within the thoracic spine with mild kyphosis and anterior wedging of several mid thoracic vertebrae.

Output: Bilateral basilar scarring/discoid atelectasis. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: Stage IV lung cancer. 4 months after pericardial biopsy and right pleurx catheter placement for malignant pleural effusion History: increasing shortness of breath, increasing amount of drainage from pleurx drainage Right-sided Pleurx catheter unchanged.Increasing opacification right hemithorax compatible with increasing pleural effusion and underlying atelectasis.Innumerable pulmonary nodules again noted.

Output: Increasing right pleural effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: r/o infiltrate History: cough Dual lumen left port with tip in the SVC.Abnormalities of the left ribs consistent with history of osseous metastases.Borderline cardiomegaly, unchanged.No air space opacities.Small retained wire fragment on the left is unchanged.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: evaluate effusionVIEW: Chest AP Endotracheal tube tip is between thoracic inlet and carina. A chest tube is present in each hemithorax. Right neck and mediastinal surgical clips are identified. There are two atrial lines. Epicardial pacer leads remain in place. Cardiomegaly unchanged. There are bilateral small pleural effusions unchanged. Bilateral hazy lung opacities unchanged. There is soft tissue edema. There is a catheter at the right axilla.

Output: Right pleural effusion unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 86 yearsGender: FemaleReason for Study: Reason: eval for effusion/ edema History: sob Mild cardiac enlargement with increased lung volumes compatible COPD.Chronic interstitial opacities similar in appearance to multiple prior exams.No new pulmonary opacities identified.Apical pleural thickening, left greater than right.Questionable small pleural effusions.Evidence of prior granulomatous disease.

Output: Mild cardiac enlargement with chronic appearing interstitial opacities and evidence of previous granulomatous disease. No specific evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: assess pneumo History: sp endobronchial valves with small persistent leak, ct put to water seal assess for expansion of pneumo Left pneumothorax appears increased in size compared to prior study, now measuring 9 mm, previously 6mm. Left lung base opacity without change from prior study, likely atelectasis/volume loss. Left chest tube in place. Right central venous catheter tip in the SVC/atrial junction. Endobronchial valves again noted in the left hilum. Right axillary surgical clips noted.

Output: Minimal increase in pneumothorax compared to the morning study.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: sepsis History: SOB Decreased lung volumes.Stable cardiomediastinal silhouette.Chronic right upper lobe fibrotic changes.Mild increasing basilar atelectasis.No focal areas of consolidation.No pleural effusions.

Output: Increasing basilar atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: ptx? pna? L chest pain History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: FemaleReason for Study: Reason: is there an infiltrate History: cough, chills, report of temp 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: 62-year-old male with history of type B dissection status post IR fenestration now with abdominal pain. Evaluate for worsening dissection. CHEST:LUNGS AND PLEURA: Stable left pleural effusion with linear left lower lobe atelectasis/consolidation with air septal thickening and more nodular densities compatible with pulmonary edema.MEDIASTINUM AND HILA: Patient status post aortic root repair with stable aneurysmal dilatation of the aortic arch. The origin of the right subclavian artery is also aneurysmal (series 81112, coronal image 55), measuring 2.6 cm in caliber.Prominent mediastinal lymph nodes as seen previously.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: Renal cysts bilaterally.RETROPERITONEUM, LYMPH NODES: Vascular findings: Type B aortic dissection is reidentified with fenestration in the distal descending thoracic aorta. There is increasing mural thrombosis of the proximal portion of the false lumen cephalad to this fenestration. The intimal flap extends from the descending thoracic aorta to just proximal to the level of the renal arteries. Patient is also status post fenestration of the proximal descending abdominal aorta with interval equalization of contrast opacification in both the true and false lumens. The celiac, superior is enteric, right renal and left renal arteries are patent. The internal mesenteric artery is patent as well.BOWEL, MESENTERY: No evidence of abnormal bowel wall thickening or obstruction. No free air.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Postsurgical changes from aortic root repair with no significant change in the extent of known aortic dissection. Since recent fenestration procedure by interventional radiology, there is equalization in the opacification of the true lumen and false lumen. The major visceral aortic branches are patent.2. Pulmonary edema, pleural effusions, and lingular/left lower lobe atelectasis as seen previously.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: fever History: fever New basilar atelectasis and pleural effusions.Heart size normal.Right axillary vascular stent.

Output: New basilar opacities suggestive of aspirated secretions or either infection, with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male evaluation of rectal cancer CHEST:LUNGS AND PLEURA: Mild-moderate emphysematous changes are identified. Diffuse mild bronchial wall thickening is noted.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged without focal lesion. Hazy soft tissue at the porta hepatis, at the celiac trifurcation and just inferior to the origin of the SMA are identified. The soft tissue causes focal narrowing of the main portal vein at the porta hepatis (series 80372; image 57), without visualized thrombosis. Despite absence of portal vein thrombosis, extensive cavernous transformation of the portal vein is identified. A small nonocclusive thrombus is seen in one of the collateral vessels. The splenic and superior mesenteric veins are patent.A 7-mm calcification in the right upper quadrant is noted within the gallbladder neck. No intrahepatic biliary dilatation is identified.SPLEEN: The spleen is mildly enlarged.PANCREAS: No significant abnormality notedADRENAL GLANDS: Slight thickening of the left adrenal gland without focal nodule.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes are seen, including an 11 x 9 mm aortocaval lymph node (series 4, image 132).BOWEL, MESENTERY: Diffuse haziness of the mesentery is seen.BONES, SOFT TISSUES: Minimal fat- containing ventral hernia.OTHER: Mild ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No focal lesion is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Ascites layers in the pelvis.

Output: Infiltrative soft tissue involving the porta hepatis and para-aortic region. Findings may represent tumor infiltration.Cavernous transformation of the portal vein secondary to narrowing of the main portal vein by the soft tissue mass, with other signs of portal hypertension (splenomegaly, ascites).Cholelithiasis.Emphysema/chronic bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Shortness of breath. No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits. Multiple biliary stents project over the midline of the upper abdomen.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 37-year-old female with shortness of breath and hepatic adenoma, presenting with abdominal pain CHEST:Subsegmental atelectasis. Trace right-sided pleural effusion.No evidence of mediastinal adenopathy.ABDOMEN:LUNG BASES: Linear atelectasis and trace right-sided pleural effusion and the lung basesLIVER, BILIARY TRACT: There is a large, heterogeneous and hemorrhagic mass in the right lobe of the liver measuring 11.5 by 11.3-cm image number 74, series number 3. Given the history of patient's known hepatic adenoma this lesion is consistent with a hemorrhagic adenoma.Additional multiple other lesions are also noted in both lobes of the liver, enhancing in the arterial phase and then become isodense on the other phases consistent with other adenomas. These are best seen on arterial phase images. An index left lobe adenoma measures 1.8 x 1.9 cm image number 25, series number 10. These lesions appear uncomplicated.Inferior to the large hemorrhagic lesion, in the right lobe of the liver there is an ill-defined, heterogeneous area, as seen on image number 99, series number 13. This may represent another hemorrhagic adenoma versus extension of the hemorrhage from the more superiorly located adenoma.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.

Output: Multiple adenomas in both lobes of the liver. Large right lobe adenoma demonstrates hemorrhage. A smaller, more inferiorly adenoma may also be hemorrhagic. These findings are discussed with the primary team (Dr. McDaniel) at the time of the dictation.


Instruction: Generate impression based on medical findings.

Input: 42 years old Male. Reason: swan placement History: swan placement. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is no evidence of infiltrate, pleural effusion or pneumothorax. The Swan-Ganz catheter and ICD lead position unchanged.

Output: The above findings are consistent with mild CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Tachypnea and altered mental status. Multifocal dense air space opacities with progression on the left.

Output: Continued worsening of multifocal air space opacities, atypical for pulmonary edema and most consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: r/o pneumonia History: cough and wheezing in immunosuppressed host Surgical clips identified in the axilla bilaterally.Mild elevation left hemidiaphragm.Nodular opacities in the right infrahilar and left retrocardiac region may represent metastatic disease.No focal areas of consolidation.No pleural effusions.

Output: Right infrahilar and left retrocardiac nodular opacities concerning for metastatic disease. Recommend CT of the chest with IV contrast for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and leukocytosis Persistent right basilar airspace opacities and moderate to large pleural effusion without significant interval change. Left lung remains clear.Scoliosis with exaggeration of aortic tortuosity.Unchanged right jugular dual port

Output: Unchanged right airspace opacities and effusion concerning for pneumonia


Instruction: Generate impression based on medical findings.

Input: 70 old female with pancreatic mass now with fevers and abdominal pain CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver and pneumobilia. Status post cholecystectomy. Biliary stent is in place. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Ill-defined hypodense area around the biliary stent with prominent pancreatic duct is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Previously described retroperitoneal lymph node is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral pleural effusions, otherwise no significant change in the size of the pancreatic mass or retroperitoneal lymph node.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Left apical ptx History: left apical ptx Small left apex pneumothorax is not significantly changed. Other findings stable. Chest tube unchanged in position.

Output: Small left apex pneumothorax is not significantly changed


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: line placement History: as above Right IJ central venous catheter with tip overlying the mid to distal SVC. Endotracheal tube and enteric tube remain unchanged.Stable cardiac silhouette.Patchy interstitial and airspace opacities remain unchanged. Small right pleural effusions suspected. No pneumothorax.

Output: Right IJ central venous catheter with tip projecting over the mid to distal SVC. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: assess ETT position, changes in lung fields History: s/p intubation, COPD Nonspecific edema like opacities are unchanged.ET tube tip approximately 2 cm above the carina.Right jugular catheter, tip in SVC.An NG tube terminates in the stomach.

Output: Unchanged pulmonary opacities suggestive of edema. ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.SOB and cough question lung infiltrate. Metallic fragments project over the right hemithorax, unchanged.Interval removal of enteric tube.Normal heart size.Scarring at the right lung base, with some adjacent atelectasis.No focal airspace opacities.

Output: No signs of pneumonia or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male, evaluate for interval change. Left IJ Swan-Ganz catheter tip unchanged. Right IJ catheter tip in the SVC/RA junction. Other support devices unchanged. Continued clearance of interstitial opacities without superimposed focal opacities/consolidation. No significant pleural effusions. No pneumothorax. Stable cardiomegaly.

Output: Improving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Increased VT burden evaluate Swan placement Swan-Ganz catheter from an IVC approach terminates at the level of the right interlobar pulmonary artery. The IABP marker is not conclusively identified, most likely due to motion artifact. The lungs remain clear.

Output: Swan-Ganz catheter tip at the level of the right interlobar artery.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: tachypnea, eval effusions and edema History: increased WOB Bilateral internal jugular catheters and ICD with lead stable in position.There is stable cardiomegaly.Lung volumes are low and there are small pleural effusions with adjacent atelectasis.

Output: Stable support devices, cardiomegaly, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: eval ETT, lung fields History: s/p CABG Endotracheal tube terminates approximately 3 to 4 cm from the carina. Intra-aortic balloon pump terminates over the inferior margin of the aortic arch. Swan-Ganz catheter terminates within the main PA. Mediastinal drain/chest tubes noted. Diffuse pulmonary opacities with small left pleural effusion consistent with pulmonary edema. Unchanged heart size. No significant pneumothorax.

Output: Lines and tubes, as above. Pulmonary edema pattern, as before.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Shortness of breath. The heart is normal in size.Persistent mild bilateral bronchial thickening. No abnormal focal lung parenchymal opacities. Lung volumes are normal.The pleural spaces and visualized bones are within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: left sided chest pain x 5 day, r/o acute pathology History: chest pain Heart size upper normal.No significant pulmonary or pleural abnormality.No displaced rib fracture or pneumothorax.

Output: Heart size upper normal, otherwise unremarkable. Given the patient's history of chest pain, a pericardial effusion is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Hypoxemia and malnutrition with peripheral edema. Evaluate for effusions, edema or other cause of hypoxemia. Moderate volume of pleural fluid bilaterally with severe pulmonary edema. Mild compressive atelectasis lung bases. Fluid on the right now extends over the right lung apex. Peripheral catheter from the right terminates at the SVC level.

Output: Moderate pleural effusions with severe pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: s/p MVR History: s/p MVR Heart size at least upper normal, status post mitral valve repair.Edema has nearly resolved but there is new basilar atelectasis with stable pleural effusions.Improved lung inflation.

Output: Near resolution of edema but there is basilar atelectasis and stable pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Reason: s/p pacemaker History: s/p pacemaker Right IJ sheath remains in place. Critically terminating in expected location of the right atrium and right ventricle. Mild interstitial pulmonary edema again noted. Unchanged cardiomegaly. No pneumothorax

Output: Right IJ sheath remains in place. Critically terminating in expected location of the right atrium and right ventricle. Mild interstitial pulmonary edema again noted. Unchanged cardiomegaly. No pneumothorax


Instruction: Generate impression based on medical findings.

Input: Reason: hx of emesis and abdominal fistula, new O2 requirement and cough concern for aspiration History: cough, O2 req Small lung volumes with bilateral pleural effusions andBasilar atelectasis, not significantly changed. No specific evidence of aspiration.Venous catheter directed medially in the right side of the neck, not in a usual location and possibly extraluminal.Multiple air-fluid levels in the bowel.

Output: Pleural effusions and atelectasis. Abnormal location of venous catheter as described.


Instruction: Generate impression based on medical findings.

Input: Reason: post-intubation History: intubation ET tube tip approximately 4 cm above the carina.NG tube tip in the stomach with the sidehole in the area of the GE junction.ICD leads unchanged.Bilateral lower zone opacity compatible with consolidation and pleural effusions, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Swan History: Swan Support hardware unchanged. Lungs better inflated with no new opacity.

Output: Swan-Ganz tip in right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: lung infiltrate History: chest pain, SOB Unremarkable cardiac and mediastinal silhouette. Streaky basilar opacities suggestive of subsegmental atelectasis with moderate elevation of the left hemidiaphragm.No specific evidence of pneumonia or CHF.

Output: Basilar subsegmental atelectasis of uncertain etiology.


Instruction: Generate impression based on medical findings.

Input: Reason: endocarditis s/p MVR History: endocarditis s/p MVR Status post removal of a Swan-Ganz catheter.Venous catheter and chest tubes unchanged.Large layered out right pleural effusion and a smaller left effusion.Underlying opacity compatible with atelectasis.

Output: Interval removal of a Swan-Ganz catheter and no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: 44M trached in MICU with hypothermia and lactic acidosis, ?pneumonia, ?placement History: 44M trached in MICU with hypothermia and lactic acidosis, ?pneumonia, ?placement Support devices are unchanged in position.Small bilateral pleural effusions and nonspecific mid to lower zone patchy opacities unchanged. No pneumothorax.

Output: Persistent small pleural effusions and bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: cough History: cough, bibasilar crackles Mild cardiomegaly.No significant pulmonary or pleural abnormality.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o acute process History: sob Interval extubation, removal of right central catheter and nasogastric tube.Large lung volumes. Mild left ventricular enlargement. Interval resolution of previous left lower lobe opacity. No pneumothorax.

Output: Improved aeration left lower lobe. No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 76 year old male with prostate cancer. LUNGS AND PLEURA: Right upper lobe micronodule on axial image 25/85. Bibasilar subsegmental atelectasis. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Prevascular lymph node measures 0.9 x 1.9 cm on axial image 36/85 and has decreased in size when compared to the study of 2/19/08 where it measured 2.4 x 1.4 cm.Cardiac size is normal. No pericardial effusion.CHEST WALL: Lytic lesions affect multiple midthoracic vertebral bodies and a right lateral rib with endplate compression of several vertebral bodies. The appearance is unchanged.UPPER ABDOMEN: No significant abnormality noted.

Output: Bony metastatic disease with no evidence of progression. Interval decrease in the size of the referenced prevascular lymph node.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: pneumonia History: sob No focal lung consolidation. Normal heart size. Bullet fragment overlies the mediastinum. No pleural effusion or pneumothorax.

Output: No convincing evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Decreased energy Bilateral moderate to large pleural effusions with underlying compression. Postsurgical lung transplant changes.Calcified hilar and mediastinal lymph nodes again suggests remote granulomatous disease exposure

Output: Bilateral new nonspecific effusions


Instruction: Generate impression based on medical findings.

Input: Reason: endotracheally intubated History: above ET tube tip approximately 3 cm above the carina.Other findings unchanged.A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with small bowel obstruction, nausea and vomiting Limited study due to lack of IV contrast.CHEST:LUNGS AND PLEURA: 6-mm left apical nodule is unchanged, best seen on image number 10, series number 5. Right upper lobe spiculated nodule measuring 1.2 by 1.1-cm image number 28, series number 5, unchanged. Focal air space opacity in the left lower lobe, new from previous study which represent early pneumonia. Focal groundglass opacity in the right lower lobe best seen on image number 51, series number 5 again suspicious for pneumonia. Interval increase in the size of the right upper lobe nodule on image number 32, series number 5. This nodule now measures 7 mm in diameter. Previously, it was measuring 3 mm in diameter image number 36 on series number 5.MEDIASTINUM AND HILA: Index precarinal lymph node measures 2.2 x 1.4 cm image number 25, series number 3, increased in size compared to previous study.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval the local note multiple hypodense lesions in the liver. Lack of IV contrast precludes opal evaluation of these lesions. An index lesion in the left lobe measures 2.6 x 2.1 cm image number 69, series number 3. Another hypodense lesion is seen at the edge of the left lobe of the liver, on image number 63, series number 3. No evidence of biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney is surgically absent. Vascular calcifications/nonobstructing stones in the left kidney unchanged.RETROPERITONEUM, LYMPH NODES: Again noted ill-defined soft tissue mass in the right retroperitoneum abutting the IVC, aorta and third portion of duodenum. Lack of IV contrast severely limits evaluation of the extent of this lesion. It's grossly unchanged, however, it's not possible collectively measure this lesion. There is also additional retroperitoneal adenopathy, grossly unchanged compared to previous study.Small amount of ascites.No evidence of small bowel obstruction, however, described retroperitoneal mass may be causing obstruction at the level of the duodenum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited study due to lack of IV contrast. Large retroperitoneal mass abutting the duodenum and retroperitoneal major vessels and metastatic adenopathy.Interval development of focal lesions in the liver. These cannot be optimally characterized due to lack of IV contrast but may represent metastatic disease. MRI of the liver is recommended for further evaluation.Interval increase in the size of the some of the metastatic lung nodules and mediastinal adenopathy.Interval development of of small amount of ascites.Interval development of bilateral air space opacities in, nonspecific, or may represent pneumonia.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female, breast cancer restaging. Comparison to the 9/29/08 exam. CHEST:LUNGS AND PLEURA: Right apical fibrosis most likely representing postradiation change is stable.Scattered micronodules are unchanged. New foci of subpleural thickening in the left lower lobe is nonspecific but unlikely to represent metastatic disease. No suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Postoperative changes status post right mastectomy, stable. Surgical clips are evident within the right axilla. Stable right axillary lymph node. Calcifications within the left breast are also unchanged.ABDOMEN:LIVER, BILIARY TRACT: Multiple areas of fibrosis, capsular retraction, right lobe atrophy and caudate lobe hypertrophy are again seen compatible with pseudocirrhosis. Foci of low attenuation scattered diffusely throughout the liver are more numerous and/or larger when compared to prior examinations. A previously referenced segment 6 lesion measures 1.0 x 0.9 cm on axial image 84/195 and is grossly unchanged. However, a lesion in the left lobe measures 1.4 x 1.1 cm on axial image 77/195 compared to the prior exam where it measured 1.0 x 0.7 cm. This increase in size and number of visible lesions most likely reflects disease progression, particularly when compared to more distant prior examinations. The possibility exists that some of these newly visualized lesions represent foci of necrotic tumor which were iso-enhancing on prior exams; however, we consider this option to be less likely.The portal and hepatic vasculature is patent.A small amount of perihepatic ascites is 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: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified fibroid uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Increasing number and size of liver lesions most likely representing progression of metastatic disease.2.Stable posttreatment changes within the chest.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female a with uterine cancer CHEST:LUNGS AND PLEURA: Subcentimeter nonspecific nodule in the right lower lobe on image number 51, series number 4. On the previous study pleural effusion and dependent atelectasis limits evaluation of the site of this nodule. Previously seen bilateral pleural effusions a result. Previously seen right middle lobe calcified nodule is unchanged. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis 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: No significant abnormality noted.BOWEL, MESENTERY: Fat containing paraumbilical hernia is unchanged.: Nonobstructive colonic segments in the hernia involving the inferior lumber triangle (Petit`s hernia).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not seen.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study. Nonspecific right lower lobe punctate nodule.Multiple hernias as described above.


Instruction: Generate impression based on medical findings.

Input: Respiratory failure. Intubation Interval ETT placement, tip projects 3 cm above the carina. Dobbhoff and right subclavian catheters are otherwise unchanged.Motion heavily degrees sensitivity, however marked CHF is again suspected and observed with basilar atelectasis greater on the left. Partial consolidation again cannot entirely be excluded

Output: ETT placement


Instruction: Generate impression based on medical findings.

Input: Patient presenting with headache and dizziness, evaluate for VP shunt malfunction. SHUNT DEVICE: We see no shunt tubing overlying the skull/neck cervical spine. There is a shunt tubing within the spinal canal with its tip overlying the middle to lower thoracic spine. It courses inferiorly and exits the spinal canal at the level of L2/L3. The tubing then courses along the right flank, extending anteriorly and entering the abdomen, ultimately coiling in the pelvis. The pressure valve is difficult to visualize on the lateral view of the chest due to overlying soft tissue. However its position appears similar to that seen on the prior study based on PA view of the chest and abdomen. Tubing in the vicinity of the shunt valve is radiolucent and hence difficult to evaluate but also appears similar to prior study without specific findings of discontinuity.There is an approximately 20 cm separate fragment of shunt tubing within the lumbar spinal canal. This appears similar to prior study and can represent an orphaned shunt tube from a previous shunt device.SKULL: 2 views of the skull were provided. There is no shunt tubing or acute abnormalities.CERVICAL SPINE: The C7 vertebral body and the cervicothoracic junction are not well seen on lateral view due to overlying anatomy. There are surgical changes of the upper cervical spine but no acute abnormality. No shunt tubing.CHEST: The lungs are underinflated but clear, no acute abnormalities.ABDOMEN: Nonobstructive bowel gas pattern noted.

Output: Shunt device as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: daily CXR History: n/a Lower lung zone airspace opacities with pleural effusions not significantly changed.Bilateral chest tubes are stable in position with no significant pneumothorax.Tracheostomy tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.2. Right jugular catheters terminate in the SVC.

Output: Unchanged pulmonary opacities with pleural effusions. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: asthma exacerbation History: SOB, wheezing No focal airspace opacities, pleural fluid or pneumothorax. Heart size is normal. Very mild bronchial wall thickening consistent with provided history of asthma.

Output: Bronchial wall thickening consistent with asthma. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: r/o SBO vs. ileus History: abdominal pain, nausea, emesis There are small bilateral pleural effusions, bibasilar subsegmental atelectasis and slight prominence of pulmonary vascular markings. No pneumothorax.There is free air beneath the bilateral hemidiaphragms which may represent patient's postsurgical status.Prominent slightly dilated loops of small bowel may represent developing ileus. Surgical staples are seen in the lower abdomen and pelvis.

Output: 1. Pneumoperitoneum, likely postoperative in etiology. Please correlate with patient's recent hospital course and surgical/procedural history. 2. Prominent slightly dilated loops of small bowel may represent developing ileus.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Distended abdomen evaluate for free air. History of ulcer/G. I. bleed. Semierect portable film. No visible free intraperitoneal air. Small right pleural fluid collection.Chronic appearing interstitial abnormality suggestive of sequela of aspiration.Eventration of the right hemidiaphragm with adjacent atelectasis.

Output: No free intraperitoneal air is appreciated on the semi-upright examination. Please note that small volume of free air or may not be visible due to lack of fully erect positioning. An abdominal CT has been scheduled for today's date, please refer to separate report.


Instruction: Generate impression based on medical findings.

Input: Follow-up nodule LUNGS AND PLEURA: Multiple bilateral subcentimeter nodules, largest is located in a right lower lobe peripherally (image 77 series 5) measuring 8 mm. Overall appearance is similar to prior exam 1/10/11 from Heart Care Centers of Illinois, however two additional subcentimeter nodules are identified which may be partially due to technique and decreased motion. No effusions.MEDIASTINUM AND HILA: Heavy coronary calcifications and suspected left ascending coronary stent. Mild atherosclerotic changes. No lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Gallstones and retained debris. Liver on otherwise unremarkable. Adrenals and remaining upper abdomen unremarkableModerate degenerative spinal changes, greater involving the lower thoracic spine.

Output: Stable appearing scattered bilateral subcentimeter nodules, see references above. The increase in number of these nodules is thought to be secondary to improved technique.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: sob, eval for chf History: sob Low lung volumes.Pleural effusions and basilar atelectasis unchanged.Cardiomegaly.

Output: Moderate effusions and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for infiltrates History: intubated, leukocytosis ET tube tip approximately 3 cm above the carina.Moderate cardiomegaly with patchy lower zone opacities, compatible with edema or aspiration.No new findings.

Output: Persistent lower zone opacities compatible with edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: chest pain History: chest pain Cardiac silhouette is normal in size.Low lung volumes with element of bronchovascular crowding. No focal consolidation, sizable effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: eval swan History: eval swan Support devices unchanged with Swan-Ganz catheter tip in the right pulmonary artery.Stable cardiac enlargement.No new pulmonary opacities.

Output: Support devices unchanged with Swan-Ganz catheter tip in the right pulmonary artery. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: ett position History: ett adjusted Endotracheal tube remains high with the cuff immediately below the cords. Nasogastric tube and central catheter unchanged.No change in the right-sided pulmonary opacities. Diffuse interstitial opacities are now noted at the left base. Small pleural effusions are stable.

Output: Interval advancement of the endotracheal tube which remains high. Pulmonary opacities on the right are stable, increasing on the left.


Instruction: Generate impression based on medical findings.

Input: Evaluate for mass/adenopathy weight loss, nausea, left upper quadrant mass CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: 14-mm skin lesion in the left upper posterior chest wall.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Artifact from bilateral hip prosthesis limit optimal evaluation of the pelvis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT. Shotty retroperitoneal lymph nodes are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female 24 years old Reason: Assess for acute chest, pulmonary infiltrates History: cough, sickle cell pain Mild cardiomegaly, similar to slightly decreased in size. No focal airspace opacity, pleural effusion or pneumothorax.

Output: No focal opacity to suggest infection or vaso-occlusive disease. Mild cardiomegaly, similar to slightly decreased.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: hx of bladder cancer s/p radical cystectomy, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Retrocardiac pneumonia History: Sepsis Linear scarring or subsegmental atelectasis, no evidence of infection.Heart size normal.

Output: Linear atelectasis or scarring, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: MaleReason for Study: Reason: post op History: SOB The cardiomediastinal silhouette is unremarkable.Minimal scarring in left lower lobe.Interval clearing of a left pleural effusion left basilar consolidation.No pleural effusions.

Output: Interval resolution of the recently noted left pleural effusion and left basilar consolidation/atelectasis. No acute cardiopulmonary abnormality is identified.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Tube placement not deep enough. Verify tube is not in the bronchus. Dysphagia. No endotracheal tube is identified.Patchy peribronchial opacities, worst in the lower lung zones, suspicious for aspiration and possible early bronchopneumonia.

Output: No tube is identified within the central airways. Patchy peribronchial opacities consistent with aspiration and may reflect developing pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Pre-kidney evaluation, r/o infiltrates, r/o cardiomegaly History: Pre-kidney evaluation Question of very mild interstitial pulmonary edema. No evidence of for left-sided heart failure. New opacity in the infrahilar window only seen on lateral radiograph. Mild cardiomegaly, increased from previous study. No pneumothorax.

Output: New opacity in the infrahilar window on lateral radiograph without clear PA correlate. Consider correlation with chest CT for further evaluation.No evidence of overt left-sided heart failure or focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: 69 years old Female. Reason: Evaluate for mediastinum widening History: Chest pain. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema, worse as compared with prior study. There is also bilateral patchy air-space edema, worse as compared with prior study. Small amount of bilateral pleural effusions are noted.

Output: The above findings are suspicious for congestive heart failure. However superimposed infection in the right lung cannot be excluded. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: 42 year old female with pain. Evaluate for rib fracture Right PICC tip at the cavoatrial junction. No focal airspace opacities. No pleural effusion or pneumothorax. No evidence of a displaced rib fracture. Cardiomediastinal silhouette unremarkable.

Output: Right PICC tip at the cavoatrial junction. No evidence of a displaced rib fracture or other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Shortness of breath. Again seen are innumerable pulmonary nodules within the right lung, appearing similar to the prior study. There is a large left pleural effusion with underlying atelectasis/consolidation, appearing similar to the prior study. There is slight interval increase in size of right basilar opacity which may be a component of superimposed pulmonary edema. No significant interval change in size of the cardiac silhouette.

Output: Persistent large left pleural effusion. Slight interval increase in right basilar opacity on a background of innumerable pulmonary nodules may reflect a component of superimposed pulmonary edema vs. rapid disease progression.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, 54 years old. Right IJ venous catheter placed with its tip in the SVC.No evidence of a pneumothorax.Stable cardiomediastinal silhouette.Left basilar opacity most likely representing elevation of the left hemidiaphragm and intrathoracic extension of the stomach.No new pulmonary opacities identified.

Output: Interval placement of a right IJ venous catheter without complication. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: eval lung fields History: s/p AVR Low lung volumes makes detailed cardiopulmonary assessment difficult. Swan-Ganz catheter terminates within the main pulmonary artery. Chest tubes/drains are again noted. Apparent worsening diffuse bone opacities may be related to low lung volumes. No significant pneumothorax. Small pleural effusions. Unchanged heart size.

Output: Apparent worsening diffuse lung opacities may be related to low lung volumes. Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Postop, essential hypertension. ETT tip 2 cm above the carina. Left jugular Swan-Ganz catheter tip at the level of the main pulmonary artery. Sternotomy hardware appears in alignment. Mediastinal drain. Left basal pleural or pericardial drain.Small to moderate bilateral pleural effusions, left greater than right. Extensive atelectasis bilaterally.Contour abnormality of the aortic arch correlates to small saccular aneurysm seen on a prior CT.

Output: Pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Neutropenic fever Lungs are clear. Heart size within normal limits. Left PICC line has been removed and there has been placement of left jugular central line with tip over the SVC. No pneumothorax.

Output: Clear lungs. No pneumothorax post left jugular line placement with tip over the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Evaluate heart size, lung fields History: chest pain No significant cardiopulmonary abnormality.IABP tip 3 cm below the top of the aortic arch.

Output: No significant abnormality. IABP catheter in place.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: evaluate mediastinum History: atypical chest radiating to back Borderline heart size but otherwise no acute cardiopulmonary abnormality.

Output: Borderline heart size but otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval pulmonary edema History: hypercarbic resp failure, trach on vent The right lung has significantly improved compared to the prior study, but the left mid to lower lung zone remains consolidated.Tracheostomy tube, the tip at the level of the thoracic inlet.

Output: Marked improvement on the right, but persistent left mid to lower lung zone consolidation. Residual edema affects the right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval pulm edema History: pulm edema, crackles Swan-Ganz catheter terminates within the interlobar pulmonary artery. Other iatrogenic devices, unchanged. Unchanged cardiomegaly and left greater than right bibasilar opacities. No pneumothorax.

Output: Persistent bibasilar opacities. Trend towards improvement in diffuse left lung opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: lij cvc History: s/p cvc placement New left IJ line terminates over the azygos vein and is suspicious for an azygous vein placement. Low lung volumes. Mild diffuse pulmonary edema. No large pleural effusion or pneumothorax. Normal heart size.

Output: New left IJ line terminates over the azygos vein and is suspicious for an azygous vein placement. This could be corroborated with lateral radiograph. Suggest repositioning or placement of the catheter if high volume fluid/rate is administered through the catheter.