Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Chest tube clamp trial Extensive subcutaneous emphysema. Left chest tube is unchanged in position. Surgical clips and median sternotomy fixation plate unchanged.Cardiomediastinal silhouette is normal.Interval increase in size of bilateral pneumothoraces, now moderate in size.Bilateral perihilar atelectasis due to lung collapse.

Output: Interval increase in size of bilateral pneumothoraces, now moderate in size.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Check NG tube placement. NGT has been advanced with tip now along the gastric fundus. Right chest port unchanged in position. Patchy opacity at the right lung base unchanged.

Output: Advancement of nasogastric tube which now terminates in the gastric fundus.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Septic shock. Post intubation and central line placement. Interval placement of endotracheal tube with the tip terminating at the carina, projecting to the right. Interval placement of an enteric tube with the tip terminating at the gastric body, sidehole at the gastroesophageal junction. Interval placement of right central line with tip terminating at the upper superior vena cava. No pneumothorax. Left chest wall pacer, leads unchanged.Left basilar subsegmental atelectasis, unchanged. No focal consolidation, pleural effusion or pneumothorax. Splenic artery calcifications.

Output: 1.Interval placement of endotracheal tube with the tip terminating at the carina, projecting to the right. 2.Interval placement of an enteric tube with the sidehole at the gastroesophageal junction. 3.Interval placement of right central line with tip terminating at the upper superior vena cava. No pneumothorax.Findings discussed with Dr. Duong, MICU fellow at 1030am on 8/31/16.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and pleural effusion Persistent bilateral left over right pleural effusions with underlying compression atelectasis. No significant change. No new cardiopulmonary abdomen allergiesBilateral subclavian catheters/ICD and left jugular venous access unchanged

Output: Bilateral effusions without significant interval change


Instruction: Generate impression based on medical findings.

Input: Reason: hx of urothelial carcinoma in bladder and left ureter, evaluate for metastatic disease History: see above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.75-year-old female with history of lung cancer presents with altered mental status. Patient is rotated, slightly limiting interpretation of this radiograph. Unchanged appearance of right hemithoracic volume loss and elevation of the right hemidiaphragm compatible with right upper lobectomy. Severe architectural distortion of the right hilum, not appreciably changed allowing for rotation but poorly assessed by plain film technique. No new airspace opacities. No large pleural effusions. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 71 year-old female with pancreatic cancer. Evaluate disease status. CHEST:LUNGS AND PLEURA: Stable right upper lobe micro-nodule (series 4, image 39), unchangedMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The right-sided port terminates within the SVC. ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No focal mass or pancreatic ductal dilatation. Mild infiltrative changes around the SMV remain.A trace pocket of air is seen in the pancreatic head. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Small fat-containing posterior diaphragmatic hernia on the left.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: Diverticulosis. Sutures are noted in the rectosigmoid colon along with numerous pericolonic clips in this regionBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No interval change. No definite evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: LVAD check Swan-Ganz mildly advanced, tip currently projects further into the right pulmonary outflow tract. ICD and LVAD unchangedMarked cardiomegaly with left moderate effusion and underlying compression of the lower lobe unchanged

Output: Mild repositioning of Swan-Ganz catheter


Instruction: Generate impression based on medical findings.

Input: Reason: known R mass History: new lung ca dx; OSH tx Extensive poorly defined opacity in the right upper hemithorax consistent with known lung carcinoma, probably with associated atelectasis.Possible small right pleural effusion.Status post median sternotomy with a prosthetic aortic valve in place.

Output: Extensive right upper zone opacity compatible with tumor and atelectasis, which could be better evaluated by CT scan.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: CTICU History: Daily CXR Severe cardiomegaly, with unchanged pulmonary edema and left lower lobe consolidation.Stable small pleural effusions.Tracheostomy tube tip approximately 3 cm above the carina.A Dobbhoff tube extends below the lower margin of the image. ECMO cannulae and ICD are unchanged.

Output: Cardiomegaly and unchanged pulmonary opacities. Stable support devices. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Evaluate for infiltrate. Pulmonary edema. Severe cardiomegaly, unchanged from prior. Diffuse left-sided interstitial and airspace opacities, with decreased left retrocardiac opacity. Moderate left pleural effusion, unchanged. Small right pleural effusion or thickening.

Output: Severe cardiomegaly with asymmetric pulmonary edema, underlying infection cannot be excluded. Previous retrocardiac opacity has improved. Consider assessment of shunt patency if infection has been excluded clinically.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: neutropenia Mild scarring of the left costophrenic angle, not significantly changed.No sign of pneumonia or other acute findings.Catheter tip in the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: is there an infiltrate History: chest pain The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Question left pleural effusion, abnormal chest sounds The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change. No pleural effusion can be identified.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Pleurx chest pain. Unremarkable cardiomediastinal silhouette.No focal pulmonary opacities, pneumothorax, or pleural effusions.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: chest pain History: chest pain Equivocal reticular opacities, but no specific evidence of edema or pneumonia.Unremarkable mediastinal contours and cardiac silhouette.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: F/u ICU CXR History: F/u ICU CXR No change in pulmonary opacities and effusions. Stable cardiomegaly.Right PICC, tip in the SVC.

Output: Stable cardiomegaly, pleural effusions and pulmonary opacities suggestive of edema with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Hypoxia. Focal nodular opacity in the right apex measuring approximately 2 cm. No pleural effusion or pneumothorax. Aortic calcification. The cardiomediastinal silhouette is normal. Diffuse reticular opacity may be consistent with scarring. Surgical staples in the abdomen.

Output: Focal nodular opacity at the right apex measuring approximately 2 cm. Correlation with chest CT is suggested. No acute cardiomediastinal abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: picc placement History: picc placement for inotropes Cardiomegaly with suggestion of mild interstitial edema.Right jugular Swan-Ganz catheter, tip difficult to trace in its entirety be on the right pulmonary artery level.Left subclavian ICD, leads unchanged in position.New left PICC, tip is far as at least the left brachiocephalic vein at the SVC.

Output: New PICC placement, with persistent cardiomegaly and the suggestion of mild edema.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: lung cancer History: s/p LLL for Stage I NSCLC Postop changes from left lower lobectomy. No new opacity.

Output: Postop changes from left lower lobectomy. No new opacity.


Instruction: Generate impression based on medical findings.

Input: Chest pain Interstitial edema with multiple septal lines similar to prior study, consistent with pulmonary edema. Marked cardiomegaly.Rugger-jersey spine consistent with history of chronic renal failure.Left chest wall AICD lead ends in right ventricle. Right dialysis catheter ends in right atrium.

Output: Congestive heart failure, similar to prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Tracheostomy Lines and tubes are unchanged as are postoperative changes. Left lower lobe atelectasis and left pleural effusion again noted. Nodular opacities again noted at the right lung base. Unchanged heart size. No pneumothorax.

Output: No substantial change compared to previous study.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with acute onset confusion, slurred speech, facial droop, altered mental status. Evaluate for cardiomegaly, pneumonia, effusion. Mild bibasilar atelectasis. No focal airspace opacities. No significant pleural effusions. No pneumothorax. Normal cardiomediastinal silhouette. Tortuous thoracic aorta.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female. Follow-up IPF. LUNGS AND PLEURA: Stable appearance of subpleural fibrotic changes and bilateral basilar mild bronchiectasis and bronchial wall thickening consistent with idiopathic pulmonary fibrosis. Supine expiratory views demonstrate focal areas of ground glass and increased lucency though not significant enough to suggest hypersensitivity pneumonitis. Postsurgical changes involving the lingula, stable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Mild thoracic scoliosis.UPPER ABDOMEN: Cholecystectomy clips, otherwise no significant abnormality noted.

Output: 1. Stable appearance of fibrotic changes, more consistent with idiopathic pulmonary fibrosis, without significant findings to suggest hypersensitivity pneumonitis.2. Other findings as described above, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval consolidations History: resp failure Feeding tube extends inferiorly off the field-of-view. Other lines and tubes, unchanged. Diffuse pulmonary opacities, unchanged. Moderate right pneumothorax and small pneumoperitoneum, again noted. Unchanged heart size.

Output: Feeding tube extends inferiorly off the field-of-view. A guidewire is in the feeding tube.Unchanged diffuse pulmonary opacities.Ectopic gas, as above.


Instruction: Generate impression based on medical findings.

Input: Age: 23 yearsGender: MaleReason for Study: Reason: tubular structure in IVC seen on TTE, please evaluate port placement History: s/p port placement Right Port-A-Cath with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Mild scoliosis of the thoracolumbar spine.

Output: Right Port-A-Cath with its tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: AMC XR History: AM CXR Stable cardiomediastinal silhouette. Left-sided chest tube unchanged.Right-sided chest tube has been removed.No evidence of a pneumothorax.Bilateral basilar atelectasis similar to prior exam.

Output: Interval removal of a right-sided chest tube. No pneumothorax identified. Persistent basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 20 year-old male with history of pain. Evaluate for fracture. Cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions or pneumothorax. No evidence of displaced rib fracture.

Output: No acute cardiopulmonary abnormalities or evidence of displaced rib fractures.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: shortness of breath, chest pain History: as above Small lung volumes.No acute abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: infection History: AMS No significant cardiopulmonary abnormality.Small lung volumes.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Lung cancer. Chest tubes x 2, pneumothorax. Right-sided chest tubes unchanged in position.Small 7-mm right pneumothorax, not significantly changed. Moderate right pleural fluid collection. Diffuse edema-like abnormality with reexpansion of the left lower lobe since previous study. Right costophrenic angle opacity persists.

Output: Right pneumothorax measures 7-mm.


Instruction: Generate impression based on medical findings.

Input: Rheumatic tricuspid insufficiency Swan-Ganz has been removed, however right jugular sheath remains, tip projects at the confluence with the left innominate. A new right PICC line terminates in the upper SVCICD unchanged.Cardiopulmonary appearance is also similar with edema-like changes and a large right effusion with small lung volumes and mild cardiomegaly

Output: Swan-Ganz removed


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: 63yo M, assess swan position History: as above IVC Swan-Ganz catheter, peripherally in a branch the left descending pulmonary artery.Possible edema, the lungs otherwise unremarkable.An NG tube terminates in the stomach.ET tube tip approximately 5 cm above the carina.

Output: Swan-Ganz catheter, the tip far peripherally located in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: re-evaluate PTX History: PTX Right apical chest tube tip now projects inferiorly. Loop recorder superimposes the cardiac shadow. Surgical clips project over the neck bilaterally.The cardiomediastinal silhouette is apparently magnified and probably enlarged. Diffuse pulmonary opacities are largely unchanged. No evidence of pneumothorax.

Output: Interval resolution of right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: Eval for infectious process History: Decreased breath sounds LLL, previous fever Median sternotomy, heart size normal.No significant pulmonary or pleural abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: pneumonia History: crackles left lower lung; tachycardia Borderline heart size. No focal pulmonary opacity suggestive of pneumonia. Minimal nonspecific bronchial wall thickening. No pleural effusion or pneumothorax.

Output: Borderline heart size. Minimal bronchial wall thickening which is nonspecific but most commonly seen with asthma or bronchitis. No focal pulmonary opacity suggestive of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 19 year-old male with history of testicular cancer (teratoma). Assess for disease. CHEST:LUNGS AND PLEURA: Nodular density seen in the right upper lung (series 4, image 62) is most likely a small lymph node. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Borderline enlarged right hilar lymph node is seen on series 3, image 46, measuring 1.6 x 1.5 cm. 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: Borderline nodes are seen posterior to the pancreatic head. For reference, a node (series 3, image 120) measures 1.3 x 0.9 cm.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. Nonenlarged external iliac nodes. For example, on series 3, image 196, a small node measures 1.1 x 0.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Few borderline lymph nodes as described above for which continued surveillance is recommended. However, no specific evidence of active disease.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.SOB status post lung transplant. Transplanted right lung with patchy mainly peripheral lung opacities minimally improved since the prior study but not resolved. Small right pleural effusion is unchanged.Fibrotic native native left lung unchanged. Right seventh rib fracture deformity is chronic.

Output: Overall slight improvement in opacities involving the transplanted right lung.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female with history of melanoma 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: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Index right inguinal lymph node is stable measuring 10 by 11 mm on image number 202, series number 3. Small convex left femoral node is unchanged, measuring 6 mm in diameter image number 196 of series number 3. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Cough and fever No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits. Note is made of bilateral mammoplasties with calcified capsules. Curvilinear radiopaque density at the level of the soft tissues of the neck/chin is of uncertain etiology, likely postsurgical.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: eval left pleural effusion History: s/p first rib resection Status-post resection of the left first rib. Subcutaneous gas in this area is likely postoperative. No change in left pleural effusion with overlying atelectasis. Left apical pleural thickening likely represents an extrapleural hematoma and is also unchanged.No new pulmonary opacity or pneumothorax is seen. The cardiomediastinal silhouette is normal.

Output: No change in left pleural effusion or left apical extrapleural hematoma.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: neutropenic fever History: as above No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of CLL on chemotherapy regimen. Please evaluate all previously measured lesions: left axillary, right obturator, jugulodigastric and right common iliac. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: Interval decrease in size of bilateral bulky axillary adenopathy with the reference lesion measuring 10.6 mm x 18.6 mm (image 33, series 3) compared to 23.3 mm x 12.8 mm on 7/28/09. Stable right gynomastia best seen on image 50, series 3, measuring 2.1 cm x 0.9 cm compared to 2.1 cm by 0.9 cm on the prior exam.ABDOMEN:LIVER, BILIARY TRACT: Stable hypodense liver lesions are again noted. The gallbladder is not visualized.SPLEEN: Splenomegaly, unchanged from the prior exam.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A hypodense, well circumscribed lesion is seen in the cortex of the left kidney, unchanged from prior study.RETROPERITONEUM, LYMPH NODES: Interval decrease in size of several previously noted mesenteric intraperitoneal lymph nodes. The reference left common iliac lymph node measures 8.9 mm x 11.7 mm (image 167, series 3) compared to 16 mm by 15 mm on the previous exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: There is interval decrease in the size and number of several pelvic lymph nodes. A representative right obturator lymph node, best seen on image 197, series 3, measures 2.7 cm x 0.9 cm compared to 1.6 cm by 3.8 cm on the previous exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Interval decrease in size of adenopathy, indicating response to treatment


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: effusion, ? Improvement after HD History: effusion Persistent left pleural effusion with left base atelectasis.Right lung unremarkable.Heart size relatively normal.

Output: Persistent left pleural effusion with left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: shortness of breath History: shortness of breath Improvement in lung volumes. No new focal pulmonary opacity. Nodular lesion along the superior margin of the left hemidiaphragm likely represents nipple shadow and can be reevaluated on imaging follow-up. Unchanged heart size. Unchanged central venous catheter.

Output: No acute cardiopulmonary process on radiography.Nodular lesion along the superior margin of the left hemidiaphragm likely represents nipple shadow and can be reevaluated on imaging follow-up. This change from the initial preliminary dictation was text paged to Elizabeth Lafontant at 8:25 AM on 11/19/2015


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and lung transplant Persistent mildly decreased lung volumes with scarring observed in the right lung base without interval change or new superimposed acute abnormality. Clamshell sternotomy and associated pleural and right rib changes, unchanged

Output: Right basilar scarring without superimposed new acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male 50 years old Reason: PNA History: Chest pain Streaky left basilar opacity suggests aspiration/atelectasis, superimposed infection not excluded. No pleural effusion or pneumothorax is evident. Cardiomediastinal contours are within normal limits for size.

Output: Left basilar opacity suggestive of aspiration/atelectasis, superimposed infection not excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: sp intubation, fevers History: as above Pulmonary edema and pleural effusions are unchanged, the left basilar consolidation has improved.ET tube tip 7 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Improving left base consolidation but stable edema and pleural effusions. ET tube tip 7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: pleuritic CP History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 91 yearsGender: MaleReason for Study: Reason: obvious masses History: weight loss, smoking history Increased lung volumes compatible with COPD.Cardiac size is normal.Marked tortuosity of the aorta.Lungs are clear.Free peritoneal air is identified underneath right hemidiaphragm.Degenerative changes in the thoracic spine with anterior wedging of multiple thoracic vertebrae of indeterminate age.

Output: No acute cardiopulmonary abnormalities are identified. Evidence of free peritoneal air. No suspicious pulmonary nodules or masses.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Rales and SOB rule out infection. Normal heart size. No focal airspace opacity or pleural fluid.DISH of the spine.Patient is rotated, limiting evaluation of the mediastinum. Rounded opacity at the level of the thoracic inlet projecting to the right of midline incompletely evaluated and most likely represents summation of vascular and skeletal structures however abnormality cannot be excluded.

Output: No signs of infection. Rounded opacity at the level of the thoracic inlet most likely the result of rotation with summation artifact of skeletal and vascular structures however is incompletely evaluated. Suggest follow-up chest radiograph when feasible for confirmation of benign etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Clinical concern for obstruction. No pneumoperitoneum on upright images. Enteric feeding tube projects over the distal gastric body. Multiple dilated loops of small bowel compatible with small bowel obstruction. Residual enteric contrast noted in the colon. Scarring in the atelectasis noted in the right lower lobe. Left upper extremity PICC tip in the superior vena cava.

Output: Persistent small bowel obstruction without pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: aspiration in a pt with severe CP and trach/PEG. Tracheostomy tube terminates at the thoracic inlet. Severe levoscoliosis is again noted.Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities with no evidence of aspiration and/or infection.


Instruction: Generate impression based on medical findings.

Input: Reason: icu hx pancreatitis w/bil pleural effusions History: respiratory failure Small lung volumes with interstitial opacitiescompatible with edema and atelectasis. Bilateral pleural effusions, greater on the right, unchanged.Tracheostomy tube and venous catheters also unchanged.

Output: Edema, atelectasis and pleural effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure Moderate nonspecific cardiomegaly without additional cardiopulmonary abnormalities unchanged. IABP marker remains projected over the aortic arch. ICD well-positioned

Output: IABP unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Assess IABP placement. IABP marker is not identified. Right jugular VAD tip at the level of the right brachiocephalic vein 1 to 2 cm above the expected level of the azygos arch. Left subclavian ICD unchanged.Improving pleural fluid and atelectasis, with mild residual edema-like opacities.

Output: No intra-aortic balloon pump marker is identified. Improving pleural fluid and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Tachypnea, head and neck cancer. Evaluate pleural effusion/edema. Tracheostomy tube is present. Left chest port catheter tip likely terminates in the azygous vein. Gastrostomy tube is noted.Bibasilar opacities likely representing edema and bilateral pleural effusions are not significantly changed. Elevation of the right hemidiaphragm. The heart size is stable.

Output: Similar appearance of edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 18 year-old female with history of PNET of the liver. On therapy evaluation. CHEST:LUNGS AND PLEURA: Small nodular density is seen posteromedially in the right lower lobe (series 4, image 75), which may represent residual disease/atelectasis as seen on prior CT from 3/13/2009. No other lesions or suspicious nodules are identified. No pleural effusion is noted.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: Left parasternal chest wall Port-A-Cath has its tip in SVC. ABDOMEN:LIVER, BILIARY TRACT: The previously seen, heterogeneously enhancing lesion with internal areas of necrosis as well as calcifications is reidentified in the right hepatic lobe, which abuts but does not appear to invade the IVC. It is significantly smaller in size on comparison to prior study from 3/24/2009. The portal vasculature is patent, and no biliary ductal dilatation is seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Inferior displacement of right kidney has improved with the decrease in the size of the hepatic lesion. Renal vasculature appears to be patent without evidence of thrombus. Normal left kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Interval decrease in size of the right hepatic tumor. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: 27 year old M prior history of sickle cell disease s/p haplo/cord stem cell transplant. Rhinorrhea, productive cough, crackles on exam. Evaluate for pneumonia. History: cough, h/o stem cell transplant Small lung volumes.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.Left jugular catheter, tip at RA level.

Output: No significant abnormality. No evidence of acute infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: h/o CHF and a-fib now w/ sob History: sob Cardiomegaly.Small lung volumes.No acute abnormality.Left subclavian ICD, leads unchanged in position.

Output: Small lung volumes, with cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Shortness of breath. Probable small pleural fluid collections, chronic on the right.Mild basal atelectasis. Lung volumes slightly decreased from previous.Scattered patchy opacities suggestive of aspirated secretions, but no specific signs of pneumonia.Tracheostomy tube in place.

Output: Small pleural effusions and signs of aspirated secretions, but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: cough Moderate cardiomegaly.Marked elevation of the right hemidiaphragm with overlying subsegmental atelectasis.Mild chronic interstitial opacity at the left base.

Output: Chronic abnormalities with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Worsening shortness of breath.Newly diagnosed subsegmental PE. Emphysematous changes with an upper lobe predominance. Streaky bibasilar opacities appear most consistent with subsegmental atelectasis. Left lower lobe nodular opacity, better characterized on recent chest CT, appears to correspond to linear scarring/atelectasis.

Output: Bibasilar atelectasis. Left lower lobe nodular opacity, better characterized on recent chest CT, appears to correspond to linear scarring/atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Preop Lead placement History: Preop Lead placement Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Left subclavian pacemaker, leads unchanged in position.Disconnected right subclavian pacemaker lead unchanged.

Output: No significant abnormality. Unchanged bilateral pacemaker leads.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax History: chest tube Slightly decreased left pneumothorax with a chest tube directed medially and inferiorly.Bilateral interstitial opacity with septal lines suggestive of edema and elevation of the left hemidiaphragm with overlying subsegmental atelectasis.Esophageal stent and enteric tube, unchanged.

Output: Slightly decreased left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: s/p pleurectomy History: - To left-sided apically directed chest tubes are unchanged in position.Persistent low lung volumes. Small left pneumothorax with patchy consolidation and atelectasis at the left lower lobe extending into the costophrenic angle. Partial resolution of left subcutaneous emphysema. Blunting of the right costophrenic angle suspicious for atelectasis.

Output: Persistent small left pneumothorax in the setting of 2 chest tubes. Left lower lobe atelectasis and consolidation not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.HCAP and septic shock ET tube tip approximately 4 cm above the carina. NG tube extends below the lower margin of the image. Right jugular catheter, tip in the SVC. Left subclavian ICD, leads unchanged in position.Mild cardiomegaly, unchanged.Diffuse bilateral pulmonary interstitial opacities, not significantly changed.

Output: Stable pulmonary opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Interval exam on vent with trach. Moderate pleural fluid, right greater than left, increased on the right compared to prior. Basilar atelectasis is slightly worse. Enlargement of the central pulmonary vasculature compatible with pulmonary hypertension similar to earlier prior studies. Airspace opacity lateral to the right hilum is new and may reflect aspiration and/ or developing infection. Tubes and lines unchanged.

Output: Airspace opacity on the right may reflect aspiration and/or developing infection. Enlarged central pulmonary vasculature is compatible with pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: r/o pleural effusion History: CML on dasatinib. Hx of breast ca . Hx of PE Small right pleural effusion with adjacent atelectasis or scarring.Possible minimal left effusion.Mild cardiomegaly.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: Small pleural effusions right larger than left, otherwise unremarkable except for mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Syncope, ICD History: above Moderate cardiomegaly. No specific evidence of infection or edema.New left subclavian dual chamber ICD, leads in appropriate position.

Output: Moderate cardiomegaly, otherwise unremarkable except for an ICD.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: evaluate Swan ganz position Right Swan-Ganz Ganz catheter tip in the right interlobar pulmonary artery. Right-sided subclavian ICD lead and generator in place. Stable marked cardiomegaly. Mild interstitial opacities compatible with edema.

Output: Mild interstitial opacities compatible with edema. Right Swan-Ganz Ganz catheter tip in the right interlobar pulmonary artery.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, 22 years old.Reason: cough, chest pain History: cough, chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: eval for cardiomegaly History: chest pain Moderate cardiomegaly.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Right rib fracture, probable syncope. Multiple angulated and displaced right sided posterolateral rib fractures are noted with visible deformity and volume loss of the right upper thorax. Normal heart size. Tortuous thoracic aorta.A small right pleural fluid collection is noted; in the context of acute rib fracture this may reflect hemothorax and serial plain film monitoring is recommended to exclude enlargement of the fluid collection.Lucency at the right apex suspicious for a small (less than 1cm) residual pneumothorax.

Output: Small right pleural fluid collection in the setting of multiple displaced acute right rib fractures may represent hemothorax. Right apical lucency (less than 5 mm) suspicious for a small residual pneumothorax. Recommend close interval chest radiograph serial imaging every 2 to 3 hours to exclude expansion of fluid collection and assess for resolution or worsening of pneumothorax. If the fluid collection enlarges, patient condition worsens or the patient's hematocrit level drops, then a CT of the thorax with IV contrast would be recommended.Results and recommendations discussed with the clinical service (J. Johnson of the ED) at 1:00 PM on 7/12/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Left Rib pain History: Left Rib Pain Streaky basilar subsegmental atelectasis.No displaced rib fracture or pneumothorax.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: eval pna History: Dyspnea. Cardiomediastinal silhouette is within normal limits.Left retrocardiac atelectasis with minimal air space opacity.Linear opacity at the right lung base likely reflective of atelectasis.No pleural effusion is identified.

Output: Bibasilar atelectasis without specific evidence of infection. Follow-up may be obtained if patient's symptoms do not improve.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Bladder cancer status post radical cystectomy and nephrectomy evaluate for metastatic disease. Normal heart size. No visible pulmonary nodules or masses by plain film technique. Left chest wall dissection clips. Generalized changes of the spine.

Output: No visible pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: found down, now with AMS; eval for PNA, cardiomegaly History: fall, AMS Mild to moderate cardiomegaly.Right pleural effusion partially located in the major and minor fissures.An underlying pulmonary abnormality is possible.Patchy opacity left lower lung zone.

Output: Right pleural effusion partially located in the fissures, with nonspecific basilar interstitial opacities. Follow-up with PA and lateral recommended when the patient's condition permits.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.RUL for management of stage II atypical carcinoid complicated by Cushing syndrome Normal heart size. Tortuous thoracic aorta. No pleural fluid or pneumothorax. No suspicious nodules.

Output: No suspicious nodules visible by plain film.


Instruction: Generate impression based on medical findings.

Input: 75 year-old female with right pleural effusion and hepatomegaly CHEST:LUNGS AND PLEURA: Large right sided pleural effusion extending from the base to the apex. Small left-sided pleural effusion. Atelectasis of the right lower lobe and dependent atelectasis on the left side.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly with heterogeneous enhancement of the liver. No focal intrahepatic lesions.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: A right lower quadrant soft tissue density at the junction of ileo-cecal valve. The ileum appears to intussuscept into the colon. No evidence of proximal bowel struck shunt. The colonic or distal small bowel mass in that location is likely. Further evaluation with endoscopy is recommended.BONES, SOFT TISSUES: Generalized anasarca.OTHER: Small amount of ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: CT finding suspicious for ileocolonic intussusception. No evidence of small bowel obstruction. A Proximal colonic or distal ileal mass is suspected as a lead point.Generalized anasarca, large right-sided and small left-sided pleural effusion and small ascites.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: is there pneumonia? History: doe Moderate bilateral pleural effusions, left greater than right with basilar edema and atelectasis.

Output: Moderate bilateral pleural effusions, left greater than right with basilar edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: 61 years old Male. Reason: 61M with neutropenic fever and worsening cough. History: cough, fever. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. Stable streaky opacities in the left upper lung. There is a prominence of the soft tissue density in the left infrahilar region.

Output: Prominence of the soft tissue density in the left infrahilar region, which is nonspecific. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: swan placement History: swan Swan-Ganz catheter tip in the right main pulmonary artery.ICD lead and venous catheters are unchanged.Diffuse opacity compatible with edema, atelectasis and small effusions.

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


Instruction: Generate impression based on medical findings.

Input: 44 year-old female with non-Hodgkin's lymphoma status post chemotherapy CHEST:LUNGS AND PLEURA: Minimal lingular atelectasis. Stable nodular opacity adjacent to the right oblique fissure, likely an intrapulmonary node, unchanged (series 4, image 48)MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral breast implants.ABDOMEN:LIVER, BILIARY TRACT: Numerous arterially enhancing lesions in the liver are unchanged, thought to represent multiple FNH versus hepatic adenomas. These may be further differentiated using MRI as clinically indicated.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: 18 x 9 mm left external iliac node (series 3, image 170), not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic focus in the left iliac bone is stable from 5/07, likely a bone island.OTHER: No significant abnormality noted.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: shortness of breath History: SOB, CHF There is borderline cardiomegaly, otherwise cardiomediastinal silhouette is normal.There is increased, perihilar interstitial opacity with subtle septal thickening peripherally.ACDF plate and screws noted.

Output: Mild cardiomegaly with pulmonary edema compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o free air under diaphragm History: abdominal pain and dilated loops yesterday Streaky basilar opacities compatible with subsegmental atelectasis.No visible free intraperitoneal air.Port catheter with its tip in the upper right atrium.

Output: Basilar atelectasis and no visible free air.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: swan History: swan Mild cardiomegaly and possible retrocardiac atelectasis, but no evidence of edema.IABP catheter proximal marker 6 cm below the top of the aortic arch.Left jugular Swan-Ganz catheter tip unchanged, still in the proximal right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter unchanged, tip in proximal right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate ETT History: intubated ET tube tip approximately 4 cm above the carina.Right jugular catheter tip in the area of the jugular vein.Small lung volumes with perihilar and basilar opacities suggestive of atelectasis and aspirated secretions, slightly improved on the left side.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old with chest discomfort. Evaluate for pneumonia. Stable cardiac mediastinal silhouette with mild cardiomegaly. Large lung volumes with flattening of the diaphragms suggestive of COPD. Left upper lobe nodules from prior granulomatous disease appear unchanged compared to the prior chest CT. No focal airspace opacity, pleural effusion or pneumothorax. Hiatal hernia. Degenerative changes affect the thoracic spine.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: right lateral mid thoracic pain, assess for PNA History: right sided pain Heart size upper normal, and the aorta tortuous suggestive of systemic hypertension, unchanged. No significant pulmonary or pleural abnormality.No findings to account for the patient's pain.

Output: Heart size upper normal, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: mucus plugging leading to lung segment being obstructed History: pao2 low A right subclavian and right internal jugular central venous catheter positions are unchanged. Endotracheal tube tip is approximately 3.1 cm above the carina. Feeding tube terminates outside of the field of view, likely within the stomach. A second poorly visualized enteric tube probably terminates in the proximal stomach.Low lung volumes with unchanged bibasilar opacities and left retrocardiac opacity. Trace bibasilar effusions. No pneumothorax. Stable cardiomediastinal silhouette.

Output: Unchanged left retrocardiac atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60 yo male with IABP in place History: check IABP placement IABP marker in proximal descending thoracic aorta. Other findings stable.

Output: IABP marker in proximal descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Aspiration? History: Hypoxemia NG tube extends beyond the field-of-view of study. Stable cardiomediastinal silhouette. No new opacity to suggest pneumonia or aspiration.

Output: No evidence of pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Right renal mass question metastases. Bilateral posterior upper lobe groundglass/subsolid opacities and volume loss.Pulmonary nodules, some of which are calcified, are without appreciable change by plain film technique.Interval development of irregular subsolid opacity in the right lung base.Right upper lobe paramediastinal lesion seen on CT is not visible by this technique.

Output: Multiple subsolid nodules and masslike opacities with new areas of disease in the right lung base. Multifocal semiinvasive/invasive adenocarcinomas cannot be excluded. CT of the thorax recommended.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male presents with hypothermia. Evaluate for pneumonia. A bullet fragment superimposed the right hemithorax and right scapula, unchanged.The cardiomediastinal silhouette is normal. No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary pathology.


Instruction: Generate impression based on medical findings.

Input: Female; 68 years old. Reason: restaging scans s/p 84 cycles of oral tki inhibitor sorafenib History: hx of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Index right upper lobe nodule (series 6 image 17) measures 1.3 x 1.1 cm, unchanged. Index right middle lobe mass (series 6, image 38) measures are 5.0 x 4.2 cm (previously 5.0 x 4.1 cm). Multiple other bilateral pulmonary nodules and masses appear roughly stable in size. No new lesions identified.MEDIASTINUM AND HILA: Left hilar mass (series 4 image 37) measures 3.6 x 4.5 cm (previously 3.5 x 4.4 cm). Right perihilar soft tissue masses, not significantly changed. Scattered coronary calcifications.Masslike protrusion in the distal esophagus, just above the diaphragm, is unchanged from multiple priors.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: Status-post left nephrectomy. Stable mild prominence of the right collecting system. Subcentimeter hypodensity in the midpole of the right kidney, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ventral midline upper abdominal hernia containing a single colonic wall (series 4, image 110) is consistent with a Richter hernia, not present on prior, but similar to 9/20/11. Additional fat containing periumbilical hernia, similar to prior.BONES, SOFT TISSUES: Sclerotic focus in the T8 vertebral body, unchanged.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: Peripherally calcified focus in the soft tissues anterior to the right hip (series 4 image 169) is unchanged, likely represents myositis ossificansOTHER: No significant abnormality noted.

Output: 1. No significant interval change in intrathoracic metastatic disease. No new lesions.2. Upper midline Richter's hernia, new from prior, similar to 9/20/11. No evidence of obstruction or inflammation.3. Distal esophageal mass, may represent metastasis or primary esophageal lesion, unchanged from multiple priors.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: concern for pulmonary edema/PNA(unlikely) in the setting of CAD with 2 week history of cough and worsening dependent edema. History: Cough, crackles in bases of lungs, increasing dependent edema. Minimal basilar scarring or atelectasis but no focal opacity to suggest pneumonia or significant pulmonary edema.

Output: Minimal basilar scarring or atelectasis but no focal opacity to suggest pneumonia or significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: cough, fevers, ruling out pneumonia History: cough and fevers No significant cardiopulmonary abnormality, except for minimal retrocardiac atelectasis.No reliable evidence of infection.

Output: Minimal retrocardiac atelectasis, with no reliable evidence of infection. If the patient remains febrile, a follow-up study in the next several days is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Evaluate for infiltrate. Shortness of breath with cystic fibrosis. No focal consolidation, pleural effusion or pneumothorax. Minimal left retrocardiac atelectasis. Normal cardiomediastinal silhouette. Status post cholecystectomy.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: r/o opacity History: DOE There is elevation left hemidiaphragm. Mild/moderate left-sided pleural effusion with underlying consolidation/atelectasis new from the prior CT.Cardiac size cannot be assessed.Right lung is clear.

Output: New left-sided pleural effusion and underlying consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with neutropenic fever and abdominal pain CHEST:LUNGS AND PLEURA: Left sided pleural effusion is decreased.MEDIASTINUM AND HILA: The tip of the port catheter is in the right atrium. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is enlarged. Nonspecific hypodense lesion in the left lobe is unchanged. It measures 12-mm image number 83, series number 3.SPLEEN: Splenomegaly is unchanged. Nonspecific 1 cm focal lesion is stable.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: Wall thickening involving the right-sided colon and terminal ileum has resolved.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The leiomyomatous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval development of wall thickening involving the sigmoid colon. Mild fat stranding is also present. No definite abscess. These findings are consistent with acute diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Acute sigmoid diverticulitis. Interval resolution of previous findings of typhlitis.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: cough History: cough, tachycardia No significant cardiopulmonary abnormality.No evidence of edema or pneumonia.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: edema History: AMS Small lung volumes.No specific evidence of infection or edema.Status post TIPS.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval for pneumonia, aspiration work-up History: dysphagia, cough Patient is status post sternotomy. Mitral and tricuspid valve prostheses in place. Left-sided ICD generator and leads are unchanged in position, with redundancy of the coronary sinus lead, partially extending into the suprahepatic IVC. New metallic density in the adjacent soft tissues.Stable cardiomegaly with associated retrocardiac atelectasis. Right lung base scarring without change. No significant pleural effusions or pneumothorax.

Output: No acute cardiopulmonary process. No significant interval change. No specific findings of pneumonia. New metallic density in the adjacent soft tissues, correlate with history and physical exam.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: 54 yearsGender: FemaleReason for Study: Reason: SOB History: see above Stable cardiomediastinal silhouette. Nonspecific basilar opacities unchanged.Upper lobe predominant emphysema.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with COPD and nonspecific basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Chest pain evaluate for acute chest/pneumonia. Low lung volumes, unchanged.Normal heart size.No focal airspace opacities, pleural fluid or pneumothorax.Osseous sequela of sickle cell disease.

Output: No acute cardiopulmonary abnormality. Specifically, no radiographic signs of acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: neuroendocrine tumor chest mass, esophageal cancer, febrile and hypoxic eval pneumonia effusion History: dyspnea Left pleural effusion and lobulated pleural thickening not significantly changed.No specific evidence of infection or edema.Clamshell sternotomy.Right jugular catheter tip in SVC, unchanged.

Output: No specific evidence of infection or edema. Unchanged left pleural effusion and lobulated pleural thickening.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant No evidence of overt left-sided heart failure. No focal lung consolidation. No pleural effusion or pneumothorax. Marked cardiomegaly again noted. Aortic atherosclerosis, as before. Vascular stent noted overlying the upper aspect the left hemithorax. Central venous catheter has been removed.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval pulmonary edema, ETT History: intubated Unfavorable progression of bilateral pulmonary opacities and pleural effusions. Line position stable.

Output: Unfavorable progression of bilateral pulmonary opacities and pleural effusions


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: sp CABG History: - Open sternotomy wound with surgical sponges unchanged.Moderate cardiomegaly and gradually worsening edema like opacities as well as right upper lobe and left basilar consolidation.ET tube tip approximately 2 cm above the carina.Right jugular Swan-Ganz catheter tip in proximal right pulmonary artery.A Dobbhoff tube extends below the lower margin of the image.Surgical drains overlie the sternotomy.

Output: Open sternotomy, with gradually worsening pulmonary opacities consistent with edema as well as foci of dense consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: S/P cardiac surgery History: S/P cardiac surgery Lines and tubes are unchanged. Again, multiple lap pads overlie the mediastinum. Stable diffuse pulmonary opacities and pleural effusions with marked cardiomegaly.

Output: Congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: pneumonia? History: DKA No pleural effusion or pneumothorax. No focal pulmonary opacity. Cardiomegaly is unchanged.

Output: Cardiomegaly without specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.MVR evaluate lung fields. Interval extubation. Right jugular Swan-Ganz catheter tip projects over the pulmonary outflow tract. Mediastinal/pericardial drains in place. Sternotomy hardware and alignment.Patchy atelectasis and layering pleural fluid left greater than right about the same. No pneumothorax.

Output: No significant change in atelectasis and pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Rectal cancer, PICC line placement New right PICC line placed with tip projected into the axilla.Underlying cardiopulmonary appearance significant for questionable mild cardiac enlargement however exaggeration due to portable technique may account for the difference. Consider serial imaging

Output: ] Right PICC line placed


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: postop with increased O2 requirement from baseline, r/o pulmonary edema History: increased O2 requirement Lower lung zone opacities are suggestive of edema accompanied by small pleural effusions and right basilar scarring.Retrocardiac consolidation is likely atelectasis.Status post median sternotomy, with a new descending aortic endograft.

Output: New descending aortic endograft, with mild lower lung zone edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female presents with cough. Evaluate for bronchitis or pneumonia. Low lung volumes. Cardiomediastinal silhouette is normal. No focal pulmonary opacity, large pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality on this expiratory chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: IABP Evidence of prior median sternotomy. Surgical clips project over the mediastinum. A Swan-Ganz catheter has its tip in the right main pulmonary artery. Residual barium resides in the transverse colon. A pigtail pleural catheter superimposes the left hemithorax. An enteric tube tip projects over the gastric body. Endotracheal tube is approximately 7 cm above the carina. Radiopaque marker for the IABP is approximately 8cm below the top of the aortic arch.Low lung volumes makes detailed cardiopulmonary assessment difficult. The cardiomediastinal silhouette is stable. Bilateral hilar prominence. No new focal pulmonary opacity. Pleural effusions decreased when compared to the prior radiograph. No pneumothorax.

Output: 1.IABP placed low the descending aorta. Repositioning recommended.2.Endotracheal tube approximately 7cm above the carina. Repositioning recommended.3.Interval decrease in bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: 63M in CCU with IABP, ?placement History: 63M in CCU with IABP, ?placement IABP marker in proximal descending thoracic aorta just below the arch. Other findings stable.

Output: IABP marker in proximal descending thoracic aorta just below the arch.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.History of TECAB Right apical suture line due to prior wedge resection again noted. Mild attenuation of the right minor fissure and right upper lobe discoid atelectasis, unchanged.Interval resolution of interstitial pulmonary edema.The small bilateral pleural effusions previously noted have resolved in the interval. No pneumothorax.The heart is normal in size. Moderate posterior calcification of the aortic arch.The posterior third healed right rib fracture.

Output: Stable status post right upper lobe wedge resection. No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Diagnosis of ALL status post neutropenic fever. Pneumonia diagnosed at outside hospital. Evaluate for infection prior to additional chemotherapy. LUNGS AND PLEURA: Mild emphysema unchanged.The main bronchi are enlarged with bronchiectasis noted more peripherally, unchanged. Left lower lobe opacity measures 11 x 14 mm on axial image 64/110 and is smaller, likely reflecting resolution of an infectious process. Diffuse groundglass opacities have also improved. A right lower lobe opacity measures approximately 10 mm at axial image 78/110 and is also smaller. Right upper lobe calcified granuloma unchanged. Scattered additional micronodules unchanged.MEDIASTINUM AND HILA: Referenced prevascular lymph node is unchanged (axial image 41/110). No additional pathologically enlarged mediastinal or hilar lymph nodes. Cardiac size is normal with no pericardial effusion. Right Port-A-Cath in place with its distal tip in the SVC.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Previously noted liver hypodensity is not seen on the present exam.

Output: 1.Decrease in size of left lower and right lower lobe opacities with improving groundglass opacities likely reflects resolution of a diffuse infectious process.2.Stable scattered micronodules.3.Mild emphysema.


Instruction: Generate impression based on medical findings.

Input: 63 year-old female with recurrent metastatic GIST, status post palliative resection on 1/12/09. New onset of right knee pain. Evaluate for new metastases to spine and restage. CHEST:LUNGS AND PLEURA: There are new diffuse bilateral lung nodules of varying size compatible with metastases. Scarring in bilateral upper lobes, unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Expansile lytic lesion involving C7 vertebral body is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Since the prior examination, widespread diffuse hepatic metastases have developed. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate right sided hydronephrosis. Right-sided ureteral stent is in the expected position. The right renal collecting system contains heterogeneous hyperdense material, probably consisting of stones and debris.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A jejunostomy tube is in the expected position. There is an colostomy in the left lower quadrant. There is extensive pneumatosis of the right colon. No free intraperitoneal air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal ascites is present.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: The urinary bladder is overdistended and a right ureteral stent is in expected position. Findings suggest bladder outlet obstruction.LYMPH NODES: Bilateral inguinal enhancing masses are new. On the right, this measures 4 cm in diameter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Filling defects within the external iliac and common femoral veins bilaterally are suspicious for deep venous thrombosis.OTHER: The pararectal mass appears larger and cannot be clearly differentiated from the unopacified rectum. It appears increased in size, but cannot be accurately measured. Left pararectal mass appears larger.

Output: 1.There has been marked interval progression of metastatic disease with innumerable new lesions of varying size in the lungs and liver. 2.Marked right hydronephrosis and hydroureter. Right nephroureteral stent is in the expected position. Probable small stones and debris in the right renal collecting system.3.Patient's known pararectal masses are larger. New right > left groin masses. 4.C7 vertebral body lytic lesion is unchanged.5.Overdistended urinary bladder, possibly due to outlet obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Complains of nonradiating substernal chest pain worse with inspiration. Rule out ACS, pneumothorax. Unchanged appearance of the cardiomediastinal silhouette. No pneumothorax or visible pleural fluid. No focal airspace opacity. Scarring in the right middle lobe unchanged.

Output: No pneumothorax or acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: MaleReason for Study: Reason: s/p extubation, increased purulent sputum, concern for HCAP History: increased purulent sputum ET tube and right IJ venous catheter have been removed.Fiduciary clip identified in the mid esophagus.G-tube identified.Stable cardiac mediastinal silhouette.Basilar atelectasis redemonstrated with slight improvement at the right lung base.No new pulmonary opacities noted.No evidence of free peritoneal air.

Output: Interval extubation. Persistent basilar opacities slightly improved on the right compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: 14-week-old female with left chest tube and pleural effusion.VIEW: Chest AP (one view) 3/4/2015 6:08 Left chest tube tip unchanged. Feeding tube tip in the stomach. Right central line tip in the right atrium.Persistent mediastinal shift to the right. Bilateral coarse pulmonary opacities unchanged. Left pleural effusion increased from prior study. Left-sided pneumothorax is no longer seen. No pneumothorax on the right.

Output: Bilateral coarse pulmonary opacities with interval increase in left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: pna? free air? History: pleuritic chest pain, recent colonoscopy Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No significant pneumothorax.No pneumoperitoneum.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: new seizure History: new seizure The cardiomediastinal silhouette is normal in size.Low lung volumes. No focal airspace opacity, pleural effusion or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: intubated patient History: desaturations Line position stable. Bilateral pleural effusions and lung opacities are unchanged.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Dyspnea Persistent calcified scattered lymph nodes consistent with old healed granulomatous disease exposure with otherwise clear lungs. No effusions.The cardiac silhouette is within limits. Moderate tortuosity aorta otherwise stable

Output: No evidence of superimposed acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 66-year-old man with history of pain. There are postoperative changes of the proximal humeral diaphysis and humeral head from a rotator cuff repair. Alignment of the glenohumeral joint is anatomic and there is no evidence of hardware complication. Interval placement of a pacemaker generator is noted in the chest wall.

Output: Postoperative changes without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: swan History: swan placement Iatrogenic devices are unchanged. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: History of RCC. Eval for metastasis Unremarkable cardiomediastinal silhouette. Interval decrease in size of small left pleural effusion. Mild improvement in left lower lobe atelectasis. No new focal airspace opacities or pneumothorax.

Output: Mild interval improvement in left pleural effusion and left lower lobe subsegmental atelectasis. No new focal opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: 73M intubated in MICU, ?ETT placement, ?worsening pleural effusions History: 73M intubated in MICU, ?ETT placement, ?worsening pleural effusions ET tube tip at the thoracic inlet approximately 7 cm above the carina.Right IJ venous catheter with its tip in the SVC.Stable cardiac mediastinal silhouette with pleural effusions, edema, and basilar atelectasis.

Output: ET tube in high position with its tip 7 cm above the carina. Stable cardiopulmonary appearance with pleural effusions, edema, and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Status post pericardial window, evaluate lungs. Left-sided chest port tip in SVC. Large pericardial silhouette compatible with history of pericardial effusion status post pericardial window with two new drains projected over left mid and lower thorax. Inferior mediastinal drain has been removed.Moderate bilateral pleural effusions with underlying atelectasis and consolidation overall slightly improved.

Output: Changes related to pericardial window with interval removal of one drain and placement of two new drains. Basilar consolidation and atelectasis with pleural effusions slightly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: PA catheter History: PA catheter Moderate cardiomegaly with an interstitial edema pattern, unchanged.Right jugular Swan-Ganz catheter tip in main pulmonary artery.

Output: Right jugular Swan-Ganz catheter tip still in the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Lung mass s/p IR biopsy History: Lung mass s/p lung biopsy with persistent need for O2 Basilar opacities and pleural effusions slightly improved on the left consistent withInfection or aspiration. Right upper lobe opacity has nearly resolved.Tracheostomy tube tip 8 cm above the carina.

Output: Improving pulmonary opacities and persistent pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: rule out infection History: chest pain, SOB No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Aspiration pneumonia. Tachycardia. Lung volumes slightly decreased. Multifocal airspace opacities, predominantly in the right lower lobe. There are few new airspace opacities at the left lung base, along with some mild atelectasis. No pneumothorax. Cervical spine fixation hardware incompletely visualized.

Output: Slight decrease in lung volumes with new left basal opacities. Airspace opacities on the right are without significant change and are most consistent with pneumonia.. Differential considerations for this appearance include pulmonary hemorrhage, and much less likely multifocal intraalveolar adenocarcinoma. Follow-up to complete radiographic resolution recommended, a follow-up chest radiograph is recommended in 6 weeks.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: hypoxia, eval for acute change History: see above ET tube, and central venous catheters, and Dobbhoff tube unchanged.Stable cardiac mediastinal silhouette.Pleural effusions with perihilar/basilar interstitial opacities suggestive of edema.No new pulmonary opacities noted.

Output: Support devices unchanged. Stable cardiopulmonary appearance with pleural effusions and perihilar interstitial opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: R/o pneumonia History: Neutropenic fever Left-sided PICC terminates at the cavoatrial junction. Mild to moderate cardiomegaly. No focal lung consolidation. No pulmonary edema. No large pleural effusion or pneumothorax.

Output: Mild to moderate cardiomegaly. No focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for PNA History: TACHYCARDIA, FEVER Small lung volumes with mild streaky opacities on the right compatible with scarring or subsegmental atelectasis.Unremarkable cardiac and mediastinal silhouette. No sign of pneumonia.

Output: Mild atelectasis but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Status post picc placement History: picc placement Left upper extremity PICC with tip which is curled and possibly a branch of the axillary vein.Metallic focus, likely a bullet, overlies the mediastinum.Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: Left upper extremity PICC with tip in a branch of the axillary vein. Recommend repositioning.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: daily am cxr History: n/a Improvement in left basilar atelectasis, unchanged subsegmental atelectasis on the right with a small right pleural effusion.Heart size normal.Right jugular catheter, tip in SVC.NG tube removed.

Output: Improvement in basilar atelectasis on the left, unchanged on the right with a small effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: assess for opacities, signs of infection or effusion History: concern for infection Chronic appearing elevation right hemidiaphragm with overlying atelectasis, and small pleural effusions, unchanged.Healed or healing right sixth rib fracture with deformity.

Output: Unchanged chronic appearing right hemidiaphragm elevation with overlying atelectasis and perhaps small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: eval for worsening pneumothorax shown on CT History: pneumothorax on CT Right basilar consolidation with bilateral pleural effusions, not significantly changed.A right hydropneumothorax known by CT is not well visualized.Esophageal stent unchanged.Left subclavian port catheter tip at cavoatrial junction.

Output: Known right pneumothorax not well visualized, with no new findings.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: r/o pneumothorax History: s/p chest tube removal Left-sided chest tube has been removed.No significant pneumothorax identified.Decreased lung volumes with stable cardiac mediastinal silhouette.Mild basilar atelectasis and small effusions similar to the prior exam..

Output: Interval removal of left-sided chest tube without evidence of a significant pneumothorax. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: History of left lung collapse Tracheostomy tube and right jugular port both remain well-positioned.The underlying cardiopulmonary appearance with partial collapse of the left lower lung with an associated moderate effusion appears similar. Of note is the partial reexpansion of the left upper lobe, indicating partial resolution of previously observed and suspected mucous plugging.The right lung is otherwise similar with hyperexpansion and a small-to-moderate effusion as well as scattered interstitial changes largely in a perihilar distribution. Mild suspected edema again persists.Mild cardiomegaly suspected. Again difficult to confirm given left lower lobe changes described above

Output: Partial improvement of the left lung with reexpansion of left upper lobe, see details provided


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Pre-op eval for LVAD History: Pre-op eval Heart size upper normal.Coarse lower lung zone interstitial opacities are suggestive of edema with underlying emphysema, with a small right pleural effusion.Right PICC, tip in right subclavian.Left subclavian biventricular dual-chamber ICD unchanged in position.

Output: Interstitial opacities suggestive of edema with underlying emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Swan catheter in R IJ History: as above Global enlargement of the cardiac silhouette. Pacemaker in place, unchanged in position.The Swan-Ganz catheter is quite well within the right atrium. Repositioning is recommended.No signs of pulmonary edema.No pleural effusions or pneumothorax.

Output: Recommend repositioning of the Swan-Ganz catheter which appears coiled within the right atrium.


Instruction: Generate impression based on medical findings.

Input: 49 years old Male. Reason: eval for infiltrate, fluid History: wheezing, SOB. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: r/o dissection, concern for HF pulm edema History: chest pain, SOB Nonspecific left basilar opacity suggestive of atelectasis or scarring.Heart size normal, mediastinum unremarkable.No specific evidence of infection or edema.Right jugular catheter tip at SVC/artery junction level.

Output: Nonspecific left basilar opacity suggestive of atelectasis or scarring. Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Preop. Fracture of neck of right femur. Retrocardiac opacity on the left nonspecific but may be atelectatic lung. No pneumothorax or specific signs of pulmonary edema. Probable small left pleural effusion.

Output: Small left pleural effusion with a nonspecific retrocardiac opacity, statistically most likely to represent atelectasis though other processes may have a similar appearance. If there is clinical concern for aspiration pneumonia or PE as a complication of lung bone fracture, dedicated CT may be acquired if patient is unable to obtain PA and lateral films.This opacity should be followed to complete radiographic resolution by serial imaging.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Status post nephrectomy recently extubated now with low-grade fever. Low lung volumes. Interval removal of ET tube. Streaky bibasilar opacities most consistent with subsegmental atelectasis.No significant interval change in size of the cardiac silhouette. Left PICC tip projects at the level of the axillary vein.Subcutaneous emphysema is identified in the soft tissues overlying the right neck and right lateral hemithorax, unchanged.

Output: Low lung volumes with bibasilar atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female status post motor vehicle accident 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: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with metastatic HCC, status post sorafenib. CHEST:LUNGS AND PLEURA: Subcentimeter subpleural nodule in left lower lobe (series 10, image 77) may be postinflammatory in etiology, unchanged. Pulmonary nodule along right major fissure (series 10, image 63), unchanged as well. No new suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Cirrhotic morphology with heterogeneous enhancement throughout the liver. Thrombus is reidentified in the right portal vein (series 9, image 109) and main portal vein (series 9, image 118) with increased extension of thrombus into the left portal vein (series 9, image 105) as well as interval extension into the superior mesenteric vein.Hypoattenuating tubular lesions near the hepatic dome likely represents thrombosed portal venous branches.Infiltrative right hepatic lobe mass is ill-defined and remains difficult to measure (series 9, image 112), but now appears to have increased extension into the left hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Heterogeneously enhancing left adrenal gland mass measures 5.2 x 4.6 cm (stable).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged gastrohepatic lymph nodes are slightly more prominent on comparison to prior study (series 8, image 23 for example).Atherosclerotic calcifications of the descending aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: Increasing ascites.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: Degenerative changes of the spine.OTHER: Increasing ascites.

Output: 1. Ill-defined right hepatic lobe mass with increasing tumor thrombus extending into the portal vein, again compatible with infiltrative HCC that appears to be also involving the left hepatic lobe as well. Gastrohepatic lymph nodes are also slightly more prominent than on prior study.2. Stable left adrenal gland metastasis.3. Stable pleural/fissural-based pulmonary micronodules.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: eval for PNA History: DKA, unknown trigger Decreased lung volumes with stable cardiomediastinal silhouette.The lungs are clear. 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 62 years old Reason: eval lung fields History: s/p CABG Left chest tube tip terminates in the left apex. Right central venous catheter tip terminates at the confluence of the right IJ and right brachiocephalic vein. No pneumothorax. Streaky left basilar opacity suggests atelectasis. There is a probable small left pleural effusion. The heart and mediastinal contours are within normal limits for size. There is moderate gaseous distention of the stomach.

Output: Left basilar atelectasis and probable small left pleural effusion, but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: GPA with tracheal and LMS stenosis History: dyspnea The heart is normal in size. Assessment of the mediastinum is very limited. Abnormal focal narrowing of the extrathoracic trachea is noted, in keeping with history of airway stenosisRight midlung nodular opacity measures approximately 14 mm and overlies the posterior right seventh rib. Right basilar bandlike opacities suggestive of scarring. There are signs of partial volume loss of the left upper lobe.No pleural effusion or pneumothorax. Suggestion of right basilar pleural thickening.Thoracal lumbar scoliosis.

Output: Focal narrowing of the extrathoracic trachea, in keeping with history of airway stenosis.Right midlung nodular opacity is concerning for a pulmonary nodule. In the setting of known granulomatosis with polyangiitis, further assessment with nonemergent chest CT is recommended to rule out the possibility of lung volume and.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: MaleReason for Study: Reason: eval for pathology History: chest pain 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: Cough, history of lung cancer. Bilateral pulmonary nodules consistent with known metastases and a right lower lobe mass without appreciable change. A nodule in the left upper lobe is more conspicuous on the current study, but this could be due to differences in technique. Right basal scarring/atelectasis about the same. Mild interstitial abnormality in the left lower lobe is new, most suggestive of mild edema..

Output: Mild interstitial abnormality in the left lower lobe suggestive of edema. One of the left upper lobe nodules appear slightly larger but this could be related to technique.


Instruction: Generate impression based on medical findings.

Input: Reason: re-eval s/p BT History: s/p BT Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for rib fracture, bone malignancy at right sternum History: chest tenderness Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.No gross sternal abnormalities are visible though the sternum is not well visualized on a chest radiograph.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: eval lung fields, hx multiple myeloma, immunocompromised History: fever, cough No significant cardiopulmonary abnormality.Prior right jugular catheter pulled back to the supraclavicular region.Left subclavian port catheter, tip at cavoatrial junction level.

Output: Near complete withdrawal of a right jugular catheter. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female status post right IJ placement. Evaluate line placement. Right internal jugular catheter tip is at the SVC.Moderate cardiomegaly with central pulmonary arterial enlargement, unchanged.No focal pulmonary opacity or pleural effusion.

Output: Right internal jugular catheter tip is at the SVC. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Mild COPD changes without discrete acute cardiopulmonary abnormality

Output: COPD


Instruction: Generate impression based on medical findings.

Input: s/p ICD History: DOE There are 2 ICD leads. The right atrial lead tip is pointed anteriorly. Median sternotomy hardware is intact.Cardiomediastinal silhouette is within normal limits. Mild bibasilar subsegmental atelectasis. No specific evidence of infection or edema.

Output: Left chest ICD with 2 leads in place.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: Rule out infection or fluid overload History: Weakness x2 months. 84 yo F with HTN, new onset A-Fib here The heart size is within normal limits. The aortic arch is calcified.Left lower lobe and lingular interstitial and airspace opacities are nonspecific but most consistent with infection in the appropriate clinical setting.Small left pleural effusion. No pneumothorax.

Output: Lingular and left lower lobe opacity of uncertain chronicity, most consistent with infection in the appropriate clinical setting but is nonspecific. Follow-up radiograph is recommended in 4-6 weeks.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: chest pain, eval for dissection, pneumonia History: see above Right basilar scarring or subsegmental atelectasis, otherwise unremarkable.Unremarkable mediastinal contours and cardiac silhouette.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Shortness of breath. History of metastatic melanoma. The left pleural effusion has significantly increased in size from prior chest radiograph although demonstrates stable size and morphology when compared to recent chest CT dated 12/15/2016, moderate in size. No pneumothorax. Trace right pleural fluid is noted.Stable multiple bilateral pulmonary metastatic nodules and metastatic masses when compared to recent cross-sectional study.Suggestion of new interstitial pulmonary edema, new from prior.Surgical clips in the right axilla again noted.Limited assessment of the bones.

Output: Interval increase in size of the now moderate left pleural effusion, when compared to prior chest radiograph.Pulmonary metastatic nodules and metastatic masses are also increased in size when compared to study from 11/30/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: 5/22/15 Left-sided video-assisted thoracoscopy/robotic assisted lower lobar wedge resection History: none Left chest tube removed status post left upper lobe wedge resection.No significant pneumothorax.COPD.

Output: No complication of recent wedge resection following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: rib fracture? PNA? History: rib pain bilaterally, cough, URI symptoms Left lower lobe opacity suggestive of aspiration or infection.Heart size upper normal.No displaced rib fracture identified, and no pneumothorax.

Output: Left lower lobe opacity suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: eval for evidence of infection History: near syncope Improvement in lung volumes. Central venous catheter terminates in the SVC. No new focal lung consolidation. No evidence of overt left-sided heart failure. Mild to moderate cardiomegaly again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 88 yearsGender: MaleReason for Study: Reason: ? pna History: ams Stable cardiomediastinal silhouette.Scattered areas of scarring/discoid atelectasis.No focal areas of consolidation.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, 60 years old.Reason: ett advanced, cuff leak History: as above Endotracheal tube tip is 7 cm above the carina. Nasogastric tube extends below the inferior extent of the image with its side hole now projected over the upper stomach.Perihilar opacities and basilar predominant bronchiectasis is unchanged from the prior study. The cardiomediastinal silhouette is unchanged. No pneumothorax or pleural effusion.

Output: Endotracheal tube tip is 7 cm above the carina. No change in lower lobe bronchiectasis, left greater than right.


Instruction: Generate impression based on medical findings.

Input: Right pigtail catheter placement for pleural effusion.VIEW: Chest AP (one view) 01/26/16, 1543 Endotracheal tube tip is below thoracic inlet. Right internal jugular line has its tip in right brachiocephalic vein. Ventriculoperitoneal shunt tubing is identified. Right chest tube is present and is coiled across the midline.Right pleural effusion is smaller. Hyperlucency is present in the right lung base. Left lower lobe opacity persists. Left pleural effusion layers over the apex. Cardiac silhouette size is normal.

Output: Decrease in size of right pleural effusion. Probable subpulmonic pneumothorax.