Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval PNA History: AMS Cardiomegaly with a tortuous and dilated aorta, the descending portion stented.Small lung volumes.No specific evidence of infection or failure.

Output: Cardiomegaly and a tortuous and dilated stented aorta. No specific evidence of infection or failure.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Hypoxemia question effusion. Hardware and devices unchanged in position. Worsening interstitial opacities and hazy groundglass, most notably in the left upper lobe, suggestive of bronchiolitis and developing pneumonitis, possibly related to aspiration. Increasing pulmonary edema.

Output: Moderate pulmonary edema. Reticulonodular appearance suggestive of aspiration bronchiolitis/ pneumonitis on the left.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: FemaleReason for Study: Reason: Pt admitted with PICC in place, please assess position. History: On TPN Left-sided PICC line with its tip in the SVC.Decreased lung volumes with stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions

Output: Left PICC line with its tip in the SVC. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old. Atrial fibrillation. Preop. Basilar streaky opacities consistent with aspiration and atelectasis, similar to prior exam. Stable cardiomediastinal silhouette.

Output: Basilar opacities consistent with aspiration and atelectasis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Productive cough and generalized weakness. Unchanged cardiomegaly. Interval improvement in posterior lung atelectasis and bronchial wall thickening. Persistent paramediastinal opacity in the lower lungs most suggestive of atelectasis, though it could represent an infection in the appropriate clinical context.

Output: Persistent paramediastinal opacities are more suggestive of atelectasis than pneumonia, but the latter may be considered in the appropriate clinical setting. Otherwise, pulmonary opacities are improving.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Moderate cardiomegaly with mild chronic basilar interstitial opacities.No sign of pulmonary edema or pneumonia.Coarse benign type calcification in the left breast.

Output: Moderate cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: infection History: AMS Mild cardiomegaly with low lung volumes. No specific evidence of infection or edema. No pneumothorax.

Output: Mild cardiomegaly but no specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Cancer of the soft palate. LUNGS AND PLEURA: Large lung volumes and emphysematous changes consist with COPD. Superimposed right upper lobe abnormalities including a round focus of groundglass in the superior aspect of the posterior segment and patchy more tree in bud like abnormalities peripherally towards the minor fissure. Additional atelectasis with additional mixed abnormality in the right middle lobe and lingula. Remaining lungs are clear.No suspicious nodules or effusions.MEDIASTINUM AND HILA: No significant abnormality noted. Extensive atherosclerotic changes extending largely throughout the descending aorta.CHEST WALL: Degenerative changes with scoliosis most pronounced involving the upper lumbar spine. No suspicious lytic or blastic osseous abnormalities.UPPER ABDOMEN: Suspected focal fat adjacent to the falciform ligament. Small punctate suspected renal cysts in the right, partially visualized. No additional abnormality seen this limited view of the upper abdomen

Output: Suspected changes suggesting aspiration over respiratory bronchiolitis. Suspected post radiation changes in the apex. No suspicious findings to suggest tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female metastatic ACC lung cancer. Pregnant. Status post two cycles chemo. Reassess CHEST:LUNGS AND PLEURA: Emphysematous changes. The lymph node along the fissure in the right base MIP image 42/69, unchanged. No new nodules.MEDIASTINUM AND HILA: Right paramediastinal mass is visually similar in extent. It is very irregular in shape making comparison of measurements difficult. I remeasured on image 16/203 is 2.5 x 1.9 cm. No new sites of disease.Index lesion in the right hilum, image 43, 1.3 x 0.9 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: A new lesion is seen in segment 6, image 102/203 and measures 3.1 x 2.2 cm. On very narrow windows it is possible this lesion may have been present previously. Remainder of the liver is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small lesions unchanged likely cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta with some ulcerated plaques are demonstrated. Some eccentric neural thrombus in the distal abdominal aorta where an ulcerated plaque, unchanged. No pathologic sized retroperitoneal nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Probable progression of disease in the liver. Other lesions are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.ETT placement, check volume status. Endotracheal tube terminates 4 cm above the level of the carina. Right jugular catheter, left jugular catheter and visualized portion of enteric tube are unchanged in position.Large pleural effusions with associated atelectasis about the same. Patchy airspace opacities bilaterally, right greater than left, are slightly improved. Spinal fixation hardware.

Output: ETT 4 cm above carina. Slight improvement in pulmonary opacities. No significant change in pleural fluid volume or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: cardiomegaly, effusion History: syncopal episode No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Dissection of thoracic aorta evaluate lung fields. Interval placement of a left jugular introducer which terminates above the level of the thoracic inlet in the projection of the left jugular vein.Interval placement of a Dobbhoff tube which extends beyond the caudal margin of the radiograph.Right jugular introducer and a pericardial drain have been removed.Left-sided chest tubes unchanged in position.Unchanged mediastinal widening and left apical extrapleural hematoma. Patchy opacities in the lungs bilaterally may be the result of aspiration. Left lower lobe is partially collapsed/consolidated. Fluid extends into the fissure on the left. No specific signs of pulmonary edema.

Output: Significant compressive atelectasis of the left lung due to pleural and extrapleural fluid/hematoma with persistent left basal paramediastinal opacity likely reflecting collapsed and consolidated lung. Patchy opacities on the right may be the result of prior aspiration with atelectasis. No convincing evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and wheezing Given mild differences in patient positioning and technique, no discrete cardiopulmonary abnormalities other than mild COPD changes

Output: No acute disease given semiupright portable positioning. Mild COPD


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: for comparison to prior CXR before bronch tomorrow History: re-evaluation of known CA. Interval near complete opacification of left hemithorax.Right lung remains clear.Mediastinal silhouette not well assessed.

Output: Near complete opacification of the left hemithorax may reflect atelectasis and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: IABP History: IABP Iatrogenic devices are unchanged. Left basilar atelectasis. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval for reaccumulation of effusion History: SOB, new oxygen requirements 8823 Stable cardiomediastinal silhouette. Calcified aortic arch.Redemonstration of perihilar congestion and interstitial edema in the setting of chronic lung changes. Small to moderate right side partially loculated effusion and atelectasis. Right upper paratracheal masslike opacity is unchanged. Previously identified bilateral nodules on recent CT chest 11/12/2016 are poorly demonstrated on this study. No pneumothorax.

Output: No significant interval changes with redemonstration of interstitial edema pattern and a right basilar partially loculated effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: swan catheter placement History: swan catheter placement Cardiomegaly with small pleural effusions and improving left basilar opacity.Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery, slightly pulled back.Second right jugular catheter tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Metastatic renal cancer to lungs and liver. CHEST:LUNGS AND PLEURA: Scattered pulmonary metastatic nodules are not significantly changed in size and number, see reference measurement below. No new nodule is identified.No focal consolidation, pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No supraclavicular, mediastinal or hilar lymphadenopathy. Normal cardiac size without pericardial effusion.CORONARY ARTERY CALCIFICATION: Mild. CHEST WALL: No axillary lymphadenopathy. Degenerative changes of the thoracic spine. Congenital/post-traumatic appearing left posterior rib deformity.ABDOMEN: Lack of intravenous contrast limits evaluation for solid organ, bowel and vascular pathology. LIVER, BILIARY TRACT: Bilobar hepatic metastases are again noted, see reference measurements before. No new lesion is evident. Normally distended gallbladder without radiopaque gallstones. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Mildly prominent periaortic lymph nodes are not changed, see reference measurements below.CALCIFICATIONS IN ABDOMINAL AORTA AND ITS BRANCHES: MildBOWEL, MESENTERY: Very small hiatal hernia. The small and large bowel is normal in appearance.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small bilateral fat-containing inguinal hernias. Partially imaged right-sided hydrocele. Nonspecific scattered sclerotic foci are not changed.OTHER: No significant abnormality noted

Output: No new sites of metastatic disease with no significant change in pulmonary and hepatic metastases.INDEX LESION MEASUREMENTS (Current exam date/time: 12/18/2015 09:29:12)LEFT LOWER LOBE NODULE: 2.8 x 2.0 cm (Image 67, Series 4); 3.2 x 1.9 cm on prior (7/17/2015) (Image 69, Series 5).RIGHT LOWER LOBE NODULE: 1.0 x 0.9 cm (Image 73, Series 4); 0.7 x 0.8 cm on prior (7/17/2015) (Image 75, Series 5).SEGMENT 7 LIVER MASS: 3.8 x 2.5 cm (Image 92, Series 3); 4.0 x 2.5 cm on prior (7/17/2015) (Image 88, Series 3).SEGMENT 3 LIVER MASS: 1.6 x 1.3 cm (Image 104, Series 3); 1.4 x 1.8 cm on prior (7/17/2015) (Image 101, Series 3).LEFT PARA AORTIC LYMPH NODE: 0.6 cm (Image 116, Series 3); 0.7 cm on prior (7/17/2015) (Image 114, Series 3).


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: fever Unremarkable cardiac and mediastinal silhouette. Mild streaky basilar opacities compatible with scarring, unchanged.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: R/o pna History: cough No pleural effusion or pneumothorax. Calcified and noncalcified hilar lymph nodes, not significantly changed. No focal pulmonary abnormality. The silhouetting of the left heart border is unchanged from prior examinations. The cardiomediastinal silhouette is within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.History of asthma exacerbation with cough, fever, and chest pain. Evaluate for pneumonia. The cardiomediastinal silhouette is normal.There is a right lower lobe opacity and small right pleural effusion.

Output: Right lower lobe pneumonia with small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old, with left upper quadrant pain. Evaluate for bowel, solid organ injury. (Per ER report, patient was punched in the left upper quadrant.) CHEST:LUNGS AND PLEURA: Dependent atelectasis. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: The cardiac size is normal. No pleural fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Nonspecific subcentimeter nodules are evident in both breasts. Mammography is recommended if the patient has not already had a mammogram with the prior 12 months.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted

Output: No specific finding to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: chest pain, shortness of breath, cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: Eval for cardiopulmonary disease History: SOB No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Code, cardiac arrest. Diffuse pulmonary opacities with relative sparing of the upper aspect the left lung, not substantially changed. Unchanged heart size. Pleural effusions again noted. No definite pneumothorax.

Output: Diffuse pulmonary opacities with relative sparing of the upper aspect the left lung, not substantially changed. Pleural effusions again noted. No definite pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for pneumothorax, comparison with previous History: s/p CABG, Subcutaneous emphysema, pneumomediastinum Moderate left pleural effusion with underlying atelectasis.Extensive subcutaneous emphysema and pneumomediastinum, unchanged.No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.LVAD insertion. Visualized hardware and devices unchanged in position. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.Moderate to large layering pleural fluid collections with associated atelectasis slightly worse. Mild superimposed pulmonary edema.

Output: Slight worsening of CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: sob History: sob Open sternotomy with overlying cervical sponges.Small lung volumes with central and basilar atelectasis, and mild cardiomegaly.Unchanged support devices.

Output: Unchanged support devices and pulmonary opacities with an open sternotomy wound.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old Reason: 48F with CHF, iabp History: chf, iabp IABP marker projects over the aortic arch, slightly larger compared to prior examination, 4 cm below the aortic arch. ICD with leads unchanged. No focal airspace opacity, pleural effusion or pneumothorax.

Output: IABP marker, slightly lower compared to prior examination.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: cp History: cp Large lung volumes compatible with COPD. Deformity of the right humeral neck and several right inferolateral ribs are again identified. Biapical pleural thickening, right greater than left, possible pleural plaque. If chest pain is in the right superior thorax, consider CT for further evaluation. Nodular opacity at the right base is most compatible with a nipple shadow. Stable cardiomegaly.

Output: Biapical pleural thickening, greater on the right. If there is pain in this location, consider CT for further evaluation. Otherwise, no evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: 89 year old male with worsening shortness of breath after device upgrade, please eval for pneumothorax or effusion History: shortness of breath No specific evidence of infection or edema.Heart size normal, the aorta tortuous.Left subclavian pacemaker, leads unchanged in position.

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


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with metastatic melanoma status post treatment, compare to previous. CHEST:LUNGS AND PLEURA: Subpleural micronodule in the right apex (series 5 and image 27), unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable postoperative appearance of right hepatic lobe resection. The hypoattenuating lesion adjacent to the resection margins (series 4, image 81) measures 1.8 x 1.4 cm (previously 1.7 x 1.1 cm)- likely representing technical/sampling variation. Gallbladder is absent. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Few subcentimeter retroperitoneal nodes are similar to prior. Previously identified cavoatrial node (series 4 image 128) measures 9 x 8 mm, unchanged.BOWEL, MESENTERY: Small periumbilical hernia containing a bowel loop, similar to prior. No evidence of strangulation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Interval decrease in size of pelvic mass adjacent to the left external iliac artery (series 4 image 177) now measuring 2.9 x 1.9 cm (previously 4.4 x 3.4 cm). Interval decrease in size of adjacent obturator mass/lymphadenopathy (series 4, image 181) now measuring 1.3 x 2.4 cm (previously 2.3 x 3.2 cm). No new lesions are identified.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in size of left pelvic/obturator nodes. No new lesions identified. Non- obstructed bowel-containing periumbilical hernia, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: cough History: cough Focal cavitary/cystic lesion again noted within the left lower lobe. The walls of this lesion appears slightly thicker. No new focal lung consolidation. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Large patient body habitus.

Output: No new focal pleural parenchymal opacity. Focal cavitary/cystic lesion again noted within the left lower lobe with slightly thicker walls which may represent superimposed inflammation. This would be better evaluated with chest CT.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Evaluate R sided chest tube History: None Chest tubes unchanged in position. At least one coronary stent projects over the left ventricle.Blunting of the right costophrenic angle from trace right pleural effusion is unchanged. No significant pneumothorax is present. Heart size is stable.

Output: Right chest tube remains in stable position, terminating at the apex. Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: History: cp Normal heart size.Tracheal deviation in the neck consistent with a goiter, unchanged.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Cough and blood-tinged sputum. Normal heart size. Atherosclerotic calcification of the thoracic aorta. Pulse generator appears the majority of the right middle lung which cannot be assessed. No visible pulmonary opacities. No pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality. Please note that a portion of the right lung is obscured on the frontal radiograph due to positioning of the chest wall pulse generator.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with duodenal Gist tumor, status post resection CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Exophytic lesion arising from the upper pole of the right kidney is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason pneumothorax/pneumonia, radical esophageal surgery for esophageal cancer. 1 cm right apical pneumothorax.Moderate right pleural fluid collection which appears to be partially loculated in the fissures. There appears to be a suture line in the paramediastinal right lower lobe.Right basal opacities consistent with atelectasis but are nonspecific in the setting of recent esophagectomy and presence of pneumothorax; a dehiscence with leak into the pleural space could present in such a manner.A peripheral catheter from the right terminates in the right atrial projection. Long segment stent projects over the midesophagus at the level of the carina to the proximal stomach.

Output: 1 cm right apical pneumothorax. Moderate, partially loculated right pleural fluid collection and nonspecific right basal atelectasis. Constellation of findings is nonspecific in the absence of comparison to prior studies. This should be closely monitored for worsening to exclude dehiscence/leak. CT may be obtained if patient has clinical signs of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.History of shortness of breath and hypoxia. The cardiomediastinal silhouette is obscured.Diffuse bilateral pulmonary opacities have progressed from the prior examination.Cholecystectomy clips noted. There are osseous stigmata of sickle cell disease.

Output: Interval worsening of diffuse bilateral pulmonary opacities/acute chest.


Instruction: Generate impression based on medical findings.

Input: Male 50 years old Reason: chest pain History: chest pain. Cardiomediastinal silhouette is within normal limits and unchanged.No focal opacity, pneumothorax, or significant pleural effusion is identified.Bibasilar streaky opacities compatible with subsegmental atelectasis.No evidence of displaced rib fracture. Dextroscoliosis of the thoracic spine is noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: eval for pna History: cough Heart size is normal with tortuous aortic contour, greater than expected for age, which may relate to systemic hypertension.No focal consolidation, pleural effusion, or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: CT UPPER ABD AND PELVIS W, 8/25/2009 9:08 AM CHEST:LUNG BASES: There is a right basilar pulmonary nodule, which is unchanged from the prior CT exam.ABDOMEN:LIVER, BILIARY TRACT: Punctate, hypoattenuating nonspecific foci are seen within the liver.SPLEEN: There is a calcific, thrombosed splenic artery aneurysm, which is unchanged from the prior exam.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small portal caval nodes are noted and are unchanged from the prior study.BOWEL, MESENTERY: A midline, ventral hernia with a neck measuring 2.6 cm contains a loop of bowel without obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is moderate atherosclerosis of the abdominal aorta and proximal renal arteries.PELVIS:PROSTATE, SEMINAL VESICLES: There is hypertrophy of the prostate, measuring 7.5 cm in diameter and is unchanged from the prior exam.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Prior right hemicolectomyBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.Tiny right basilar pulmonary nodule, unchanged from the prior study.2.Status post right hemicolectomy without evidence of recurrence in the abdomen and pelvis.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with metastatic prostate cancer CHEST:LUNGS AND PLEURA: 6-mm subpleural nodular density in the left lower lobe image number 50, series number 3.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Severe right hydronephrosis and hydroureter down to the obstructing right UVJ junction mass mentioned below is unchanged.RETROPERITONEUM, LYMPH NODES: Index pericaval adenopathy is significantly smaller now measuring 6 mm in diameter image number 111, series number 3. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Enhancing mass in the bladder causing right hydronephrosis is slightly smaller measuring 3.9 x 3 .4 cm on image number 170, series number 3.LYMPH NODES: Index right common iliac lymph node measures 10 by 13-mm image number 120, series number 3. Index right external iliac lymph node measures 2.2 x 1.6 cm in image number 154, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the bladder mass and abdominal and pelvic adenopathy. Moderate to severe right hydronephrosis is unchanged.Subcentimeter nonspecific subpleural nodule in the left lung.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with history of metastatic melanoma. Please evaluate extent disease. CHEST:LUNGS AND PLEURA: Interval worsening of nodular pleural thickening throughout right hemithorax. Previously referenced right posterior lung base soft tissue mass does not represent extent of the entire lesion, which is best seen on axial image 75/199. In entirety, it measures 7.4 cm x 2.3 cm, while on the comparison study it measured 6.5 cm x 1.5 cm.Previously referenced pleural plaque anterior in right lung has increased in size, now measuring 3.5 cm x 8.5 cm (axial image 67/199).Reference pleural-based mass at the right anterior lung base adjacent to the pericardium has also increased in size, now measuring 3.2 cm x 4.3 cm (axial image 61/199). MEDIASTINUM AND HILA: Previously noted aortic root dilatation remains stable.CHEST WALL: Stable right-sided thyroid nodule.ABDOMEN:LIVER, BILIARY TRACT: Stable calcified granuloma in the liver.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: Stable sclerotic changes in contiguous left lower anterolateral ribs.OTHER: Stable aneurysmal dilatation of the right common iliac artery, which measures 18 mm x 17 mm (axial image 118/199).PELVIS: The images of the pelvis are degraded by beam hardening artifact secondary to patient prosthetic hip therePROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right total hip prosthesis.OTHER: Bilateral inguinal hernias, stable in comparison to previous exam.

Output: Interval progression of metastatic disease in right hemithorax as detailed above. The remaining previously noted findings remain stable.


Instruction: Generate impression based on medical findings.

Input: 51 year-old female with progression of ILD, history of scleroderma, coronary artery disease, and increasing dyspnea LUNGS AND PLEURA: Mild interval increase in the lower zone subpleural reticulation, as well as pleural and subpleural calcifications . No pleural effusion can be identified. Mild air trapping is noted in the left apex.MEDIASTINUM AND HILA: Prominent mediastinal lymph nodes are stable. No pericardial effusion can be identified. There is a small hiatal hernia. Asymmetry of the thyroid gland with a prominent left lobeCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Mild interval progression in the lower zone subpleural reticulation and pleural/ subpleural calcifications


Instruction: Generate impression based on medical findings.

Input: Follow-up rectal cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver is unchanged. Left lobe hemangioma is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst is unchanged. Left renal stones are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small ventral hernias, stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Cough and history of sarcoidosis Interval increasing mediastinal and hilar lymphadenopathy without ulna abnormality

Output: Lymphadenopathy compatible with patient's underlying sarcoidosis without additional pulmonary involvement


Instruction: Generate impression based on medical findings.

Input: Dyspnea Persistent unchanged right chest tube with large underlying effusion and underlying compression of the lung. Left lung remains clear.No acute cardiopulmonary mediastinal change. Right jugular dual port similar to prior studies

Output: Large right pleural effusion and chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: concern for VT post EGD, eval for cardiomegaly History: suspect VT post procedure No significant cardiopulmonary abnormality.Small lung volumes.Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: ?thoracic pathology, weight loss of unknown etiology History: weight loss Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of lung cancer with diarrhea, fevers. Immunosuppressed. Evaluate for presence of pulmonary source of infection or presence of colitis. CHEST:LUNGS AND PLEURA: There is increased cavitation to the mass seen in the superior segment of the left lower lobe (series 5, image 51), measuring 6.3 x 4.5 cm in the axial plane.Focal clusters of tree- and-bud and nodular opacities are seen in the right upper lobe (series 5, images 38-41), new since prior study.MEDIASTINUM AND HILA: Interval decrease in size of reference AP window lymph node (series 3, image 36), measuring 0.6 x 2.3 cm; previously measuring 1 x 2.8 cm. Other reference hilar and subcarinal lymph nodes are not clearly delineated on this noncontrast examination.Heart size normal without pericardial effusion. Coronary artery calcifications.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts bilaterally are again seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of wall thickening or mesenteric stranding. No obstruction.BONES, SOFT TISSUES: Degenerative changes of the spine.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No evidence of wall thickening or mesenteric stranding. No obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic free fluid is seen just superior to the bladder.

Output: Intervally increased cavitation in the lower lobe mass compatible patient's history of lung cancer. Focal clusters of tree-and-bud and nodular opacities in the right upper lobe are new since prior study. This finding may be seen in patients with aspiration or infection (such as viral). However, continued surveillance should be considered to confirm benignity.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: lvad History: same Cardiomegaly status-post sternotomy and LVAD placement, unchanged.Pleural fluid and left lower lobe consolidation are unchanged.Right lung unremarkable.Tubes and devices are stable.

Output: No change in left effusion and left base consolidation. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: evaluate for mass, rib fx.,metastatic dx. History: hx of rt lower lung pain and rt lateral rib pain, hx of breast cancer Left thoracotomy with postsurgical volume loss.No specific evidence of infection or edema.Heart size normal.No evidence of metastases.

Output: No significant abnormality. No evidence of metastases or other causes for rib pain. A bone scan might be more sensitive if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: lung fields History: sob Small lung volumes with basilar opacity suggestive of edema, atelectasis and pleural effusions, unchanged. Right jugular Swan-Ganz catheter tip in right pulmonary artery.A Dobbhoff tube extends below the lower margin of the image.Cardiac assist cannulae unchanged.

Output: No change in lower lung zone opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with cough, DIE, SLE. Right calcified chest node, old. Decreased DLCO. LUNGS AND PLEURA: 4-mm right middle lobe micronodule on axial image 50/94. 3-mm left upper lobe micronodule on axial image 36/94. In a low-risk patient, no follow-up is required. With a history of smoking or other high clinical suspicion, a 12 month CT follow-up is recommended.No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Large right paratracheal calcified lymph node is grossly unchanged when compared to the prior chest radiograph. No other pathologically enlarged hilar or mediastinal lymph nodes.Cardiac size is normal. Small pericardial effusion.CHEST WALL: Prominent right axillary lymph node of uncertain clinical significance on axial image 22/94.UPPER ABDOMEN: Limited examination given the lack of IV contrast enhancement. Splenic and liver calcifications likely represent prior granulomatous disease.A low attenuation lesion in the upper pole of the right kidney is incompletely evaluated.

Output: 1.Nonspecific micronodules. For a low-risk patient, no follow-up required. Otherwise, 12 month CT follow-up is recommended.2.Stable calcified right paratracheal lymph node.3.Enlarged right axillary lymph node of uncertain clinical significance.4.A low attenuation right renal lesion is incompletely evaluated.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Tachycardia and low BP. Metastatic ERCP. Sepsis. Pulmonary nodules unchanged. Interval development of a moderate right pleural effusion and moderate to severe edema-like opacities. Right chest port unchanged in position.

Output: Right pleural effusion with moderate to severe pulmonary edema pattern and atelectasis. Pulmonary nodules without visible signs of cavitation.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: MaleReason for Study: Reason: 77 y/o m with COPD; worsening SOB; please eval for pna, aspiration History: worsening SOB Port-A-Cath with its tip in the SVC.Cardiomediastinal silhouette is unremarkable.Bronchial wall thickening and mild chronic appearing interstitial opacities at the lung bases.No focal areas of consolidation.No pleural effusions.

Output: ] Bronchial wall thickening at the lung bases, more prominent on the right. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Lung CA post right upper lobectomy question pneumothorax. Left subclavian chest port tip at the SVC/RA junction. Two right apical chest tubes. Postoperative volume loss on the right with at least a small to moderate anterior pneumothorax, not measurable due to position. Opacity caudal to the suture line may reflect postoperative contusion however is nonspecific and should be followed to complete radiographic resolution on subsequent studies.

Output: Small to moderate right pneumothorax, not measurable due to its location.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: 67 year old female with relapsing lymphoma with pancreatic mass and recurrent ascites CHEST:LUNGS AND PLEURA: Left-sided pleural effusion and resolved. Subcentimeter calcified granulomas are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 17 x 13 mm hypodense lesion in the right lobe of the liver on image number 109, series number 11. Mild intrahepatic biliary dilatation despite the metallic stent in the distal common bile duct.SPLEEN: Splenomegaly, unchanged. Peripherally calcified splenic cyst is unchanged.PANCREAS: Patient's known retroperitoneal mass invading the body and the tail of the pancreas is unchanged from previous study now measures 9 x 6.4 cm in image number 99, series number 11. This mass also invades retroperitoneum. Splenic vein is chronically thrombosed. SMV, celiac and SMA are also encased by the mass. The mass encases the portal vein at the level of the confluence but the rest of the portal vein is patent.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: Moderate amount of ascites.PELVIS:UTERUS, ADNEXA: Right adnexal cystic lesion is unchanged measuring 4.4 x 2.4 centimeter. A second cyst measures 4 x 2.8 cm. Further evaluation of these cystic lesions by pelvic ultrasound may be helpful.Multiple fibroids in the uterus. Enhancement within the endometrial cavity is suspicious for endometrial cancer.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: Thrombosis of the left common femoral vein. Significant ascites.

Output: Interval resolution of the left-sided pleural effusion.Significant ascites. Hepatic and pancreatic mass invading the retroperitoneum are unchanged.Left common femoral vein DVT.Findings suspicious for endometrial cancer and right adnexal mass. Pelvic ultrasound may be helpful for further evaluation.Dr. Ramsdale was notified and acknowledge of the emergent finding at the time of the dictation.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: missed HD, vomiting History: missed HD There is moderate cardiac enlargement.Lungs are clear.No pleural effusions.

Output: Cardiomegaly without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: sharp pain under ribs on left side; S/P AVR April 2015 History: sharp pain elicited with pressing Left Port-A-Cath with its tip in the SVC.Cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Median sternotomy intact.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: The 75-year-old female with shortness of breath. Metastatic non-small cell lung cancer with T12 metastasis status post chemo and XRT. Restaging. CHEST:LUNGS AND PLEURA: Left lower lobe mass is not clearly visualized and therefore not accurately measurable due to new adjacent atelectasis and new moderate left pleural effusion.There appears been increased mediastinal component in this location when compared to prior study (for example, series 4, image 67).MEDIASTINUM AND HILA: Small precarinal lymph nodes, unchanged. Enlarged, heterogeneously enhancing subcarinal lymph node (series 4, image 53) measures 18 x 12 mm (not significantly changed).Necrotic paraesophageal lymph node is inseparable from the esophagus and therefore not accurately measurable (series 4, image 9); however it appears grossly increased in size since prior study.Heart size normal without pericardial effusion.CHEST WALL: New necrotic lesion at the left fifth costochondral junction (series 4, image 50), compatible with metastasis.New right sixth rib metastasis posteriorly (series 4, image 41).New peripherally enhancing lesion in the left breast (series 4, image 47) measures 10 mm and is suspicious for metastasis.Nodular thyroid gland, unchanged.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Hypoattenuating lesion in the spleen, unchanged. Additional smaller lesion more superiorly (series 4, image 89) also was present previously.PANCREAS: No significant abnormality notedADRENAL GLANDS: New left adrenal metastasis (series 4, image 98), measuring 27 x 18 mm.KIDNEYS, URETERS: Small cysts bilaterally, too small to characterize.RETROPERITONEUM, LYMPH NODES: Mild aortic and iliac artery atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic foci in the T12 vertebral body and the left L1 vertebral body and pedicle, unchanged.

Output: 1. New left pleural effusion and adjacent atelectasis, which obscures reference left lower lobe mass. However, there appears to be increased mediastinal invasion by this mass.2. New multifocal metastases, including bilateral ribs/adjacent soft tissues and left adrenal gland as above. New left breast mass is also suspicious for metastasis.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: evalaute line placement History: line placement New left-sided venous catheter with tip likely near confluence of brachiocephalic veins though it is partially obscured by overlying leads. No pneumothorax. Femoral Swan-Ganz catheter is been removed. Dialysis catheter unchanged. ICD unchanged. Balloon pump no longer visualized.Stable cardiomegaly with basilar atelectasis.

Output: New left-sided venous catheter with tip likely near confluence of brachiocephalic veins though it is partially obscured by overlying leads. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old. Nausea and vomiting. The lungs are clear. The heart mediastinum appear satisfactory. Bony structures are intact.Gas pattern is within normal limits. Bubbly lucencies overlie the low pelvis, possibly within the urinary bladder representing gas. There are not significant gas/fluid levels on upright view and no evidence for free intraperitoneal gas. Bony structures are intact.

Output: No evidence for obstruction or free gas. Presumed gas within the urinary bladder although could also potentially reside within the uterus or other pelvic locations.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: et tube placement History: as above Right chest tube and left central catheter unchanged. Endotracheal tube tip approximately 4 cm above the carina. Persistent left pleural effusion and associated atelectasis. No pneumothorax.

Output: Persistent left pleural effusion and associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: intubated History: intubated Support devices unchanged.Subcutaneous emphysema noted on the right lateral chest wall.No obvious pneumothorax.Stable cardiomediastinal silhouette.Pleural effusions, basilar opacities and atelectasis similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: ett placement History: as above Unchanged interstitial and airspace opacities.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Spinal stabilization hardware.

Output: Stable pulmonary opacities. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: history of gastric perforation History: asymptomatic Interval extubation.Right sided ICD unchanged.Decreased lung volumes with basilar opacities compatible with atelectasis, edema, and pleural effusions similar to the prior exam.

Output: Interval extubation. No other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Status post CABG evaluate lung fields. Tubes and lines unchanged.Persistent mild basal and dependent atelectasis. No pneumothorax.Unchanged left paratracheal soft tissue opacity which may reflect a postoperative hematoma, and adjacent parenchymal opacity, possibly contusion. Findings are nonspecific and should be followed to complete radiographic resolution to exclude alternate pathology.

Output: Mild postoperative atelectasis. Possible left paratracheal mediastinal hematoma, follow-up to complete resolution to exclude alternate pathology.


Instruction: Generate impression based on medical findings.

Input: Reason: swan ganz placement History: as above Swan-Ganz catheter advanced to the right descending pulmonary artery.ICD leads unchanged.Underinflated lungs with no gross abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.SOB question pneumonia Patient is rotated. The mediastinum is partially obscured by spinal fixation hardware.No pleural fluid or pneumothorax. Apparent hypervascularity suspicious for hypervolemia or mild atypical edema.

Output: Increased vascular markings suspicious for hypervolemia. Limited film. Short-term follow-up suggested if there is persistent clinical concern for infection.


Instruction: Generate impression based on medical findings.

Input: Reason: post op cardiac surgery History: post op cardiac surgery Left jugular catheter and left chest tube unchanged.Small lung volumes with mainly basilar opacities consistent with atelectasis and effusions.No new findings.

Output: Postoperative findings with effusion and atelectasis but no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Cough productive of yellow sputum. Subjective fevers. Normal heart size. No pleural fluid. Bronchial wall thickening at and minimal atelectasis in the lower lungs, right greater than left.

Output: Lower lobe bronchitis, but no specific signs of pneumonia at this time. If patient's symptoms worsen, follow-up films may be obtained to exclude development of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: pneumonia History: hypoxia Moderate cardiomegaly with unchanged lower lung zone opacities and pleural effusions.ET tube tip approximately 4 cm above the carina.An NG tube is only partially visualized.

Output: Unchanged basilar opacities and pleural effusions. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 93 years old.Reason: Concern for aspiration given weak cough History: SOB The heart is normal in size.Increased lung volumes and signs of upper lobe predominant emphysema. Persistent bilateral basilar coarse reticular opacities, suggestion of left basilar bronchiectasis and interval progression of left lower lobe volume loss, which may represent developing aspiration pneumonia in the appropriate clinical setting. Attention on follow-up.No signs of pleural effusion or pneumothorax in this single AP projection.

Output: Progressive left lower lobe volume loss and consolidation may represent atelectasis or developing aspiration pneumonia. Close attention on follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Hypoxia. Prostate neoplasm. Left jugular catheter has been slightly retracted, now at the confluence of the brachiocephalic veins.Elevation of the right hemidiaphragm.Small to moderate pleural effusions with basal atelectasis.No pneumothorax.

Output: Low lung volumes with basal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: pna? History: URI symptoms, fever, cough Cardiomegaly with no specific evidence of infection or edema. Low lung volumes.No pleural effusion. No pneumothorax.

Output: Cardiomegaly without evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: evaluate for infiltrate History: cough/sob No new focal lung consolidation. Right greater than left upper lung predominant pulmonary fibrosis, as before. Unchanged heart size.

Output: No new focal lung consolidation. Right greater than left upper lung predominant pulmonary fibrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: Evaluate for PTX, effusion History: Post op day 5 from R VATS Unchanged interstitial opacities.Right chest tube removed with no pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with renal cell carcinoma CHEST:LUNGS AND PLEURA: Scarring in the right apex is unchanged. Multilocular right apical cavitary lesion is also unchanged. Additional scattered micronodules including right middle lobe nodular scar like opacity are stable.MEDIASTINUM AND HILA: Previously described precarinal lymph node measures 21 x 15 mm image number 30, series number 4, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of tumor recurrence. Exophytic mass arising from the midpole of the right kidney is unchanged measuring 13 x 11 mm in image number 118, series number 4. Two additional indeterminant hypoattenuating lesion is arising from the upper pole of the right kidney are also unchanged. Punctate stone in the upper pole of the right kidney is unchanged.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: No significant change from previous study. Small mass arising from the midpole of the right kidney, mediastinal adenopathy and scattered micronodules are unchanged.


Instruction: Generate impression based on medical findings.

Input: Status post cardiac surgery for atrial septal defect.VIEW: Chest AP (one view) 1/12/2016 at 2234 hours. Misplaced right IJ venous axis, epicardial pacer leads and bilateral chest tubes are again noted.Cardiac silhouette size is top normal but stable. Persistent, although improved I basilar opacities. No effusions or pneumothorax.

Output: Interval improvement in bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: s/p lung transplant History: lung transplant Decreased lung lines are stable cardiomediastinal silhouette.  Basilar predominant opacities, right greater than left, are similar in appearance to prior exam.Probable small pleural effusions.No new pulmonary opacities identified.Bilateral rib fractures redemonstrated.

Output: Stable cardiopulmonary appearance with basilar predominant opacities and pleural effusions, right greater than left.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old. Right IJ venous catheter has been placed with its tip in the SVC.No evidence of pneumothorax.Decreased lung volumes and stable cardiomediastinal silhouette.Nonspecific basilar basilar opacities are compatible with atelectasis/edema.

Output: Placement of a right IJ venous catheter without complications.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: SOB, cough History: eval for infection, Hx of PNA recently Cardiomegaly status post sternotomy.Mild basilar interstitial edema but no sign of infection.Minimal pleural effusions noted.

Output: Cardiomegaly and mild edema but no sign of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: pna? History: new hypoxia The heart is normal in size. Tortuosity of the thoracic aorta.Improved lung volumes. Persistent left lower lobe bandlike opacities representing discoid atelectasis. No imaging findings to suggest pneumonia.No pleural effusion or pneumothorax.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Low lung volumes. No focal pulmonary nodule, mass, or consolidation. Normal heart size. No pleural effusion or pneumothorax.

Output: No evidence of metastatic disease on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: Febrile to 38.9 History: as above Catheter tip in the SVC.NG tube tip projected over the lower mediastinum.Interval removal of right chest tubes with no significant residual pneumothorax.Hazy opacity on the left compatible with layered pleural effusion and underlying atelectasis.Pleural calcification at the left apex, unchanged.Right paratracheal mediastinal widening, compatible with esophagectomy.

Output: Pleural effusion and underlying atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: eval lung fields History: stridor, sob Tracheostomy and right Port-A-Cath unchanged.Elevation of the left hemidiaphragm with small left pleural effusion similar to the prior exam.The right lung is clear.No new pulmonary opacities identified.The cardiac mediastinal silhouette is unremarkable.

Output: Stable cardiopulmonary appearance with elevation of the left hemidiaphragm, small left pleural effusion, and left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: eval pleural effusion History: pt with pleural shunt with pleural effusion, s/p thoracentesis ET tube has been removed.Ventriculopleural shunt tubing noted overlying the right upper chest.Small right pleural effusion with basilar atelectasis.Stable cardiomediastinal silhouette.Left lung is clear.Multiple surgical staples in the upper abdomen.

Output: Interval extubation. Small right pleural effusion decreased from the prior exam. No pneumothorax identified post thoracentesis. Interval improvement in right basilar aeration.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Cough and shortness of breath. History of sickle cell disease. Stable enlargement of the left ventricle and main pulmonary artery.Right subclavian and SVC stents are again noted. The right IJ port catheter terminates in the superior cavoatrial junction.Lung volumes are normal. Bilateral peripheral predominant fine reticular opacities are again noted, possibly representing sequelae of chronic pulmonary arterial hypertension and subpleural scarring.The right lower lobe subpleural focal heterogeneous opacity possibly representing scarring is again noted. No signs of acute pulmonary edema.No pleural effusions or pneumothorax.Fishmouth deformity of a few upper lumbar vertebral bodies and mild sclerosis of bilateral humeral heads, in keeping with history of sickle cell disease.

Output: No radiographic findings to suggest acute chest syndrome or acute infectious process.Focal right lower lobe subpleural scarring is unchanged from prior chest CT.Signs of chronic pulmonary arterial hypertension again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Hypotension, tachycardia. Interval development of a partially loculated right pleural fluid collection in the right midlung laterally. Diffuse interstitial and airspace opacities not significantly changed in extent, though they now appear somewhat nodular in some areas on the right.Right PICC tip in the right atrium. Tracheostomy tube tip at the level of the clavicular heads.

Output: New partially loculated right pleural fluid collection. New patchy opacities in the right lung. Differential considerations include aspiration, infection and blood products. Diffuse opacities elsewhere about the same.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: shortness of breath History: shortness of breath Moderate cardiomegaly.Small lung volumes but no reliable evidence of edema or pneumonia.

Output: Moderate cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Preoperative evaluation. Left basilar scarring. No pleural abnormalities.Cardiomediastinal silhouette is within normal limits.Healed left rib fractures.

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


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: neutropenic fever, eval for pneumonia History: neutropenic dever Heart size normal. Lungs clear.No pneumothorax.Single lumen chest port with tip in superior vena cava. A second internal jugular venous catheter seen with tip in superior vena cava.

Output: 2 central venous lines with no pneumothorax. No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Evaluate for pulmonary edema vs aspiration History: DOE Probably alveolar pulmonary edema with persistent pleural effusions, left greater than right. Persistent retrocardiac opacities. Unchanged cardiomegaly. No pneumothorax. Pacer lead again noted terminating in the expected location of the RV.

Output: Increase in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval for chest tube placement, pneumothorax History: sepsis, pneumothorax, chest tube Very low lung volumes and basilar predominant consolidative opacities and atelectasis again noted.The right chest tube is partially visualized, stable in position.There is a trace residual right apical pneumothorax.Limited assessment of the left pleural space.Assessment of the cardiac mediastinum is very limited by rotation.

Output: Small right apical residual pneumothorax. Stable position of right chest tube.


Instruction: Generate impression based on medical findings.

Input: Osteomyelitis check left 10th rib excision Interval removal of left chest tube and overlying surgical staples and drain. No appreciable underlying pulmonary abnormality. Lungs are mildly decrease in lung volume without new superimposed acute cardiopulmonary abdomen theUnchanged right jugular dual portInterval resolution of previously observed intra-abdominal free air.

Output: Left chest tube and postsurgical hardware removed


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with gastrointestinal stromal tumor CHEST:LUNGS AND PLEURA: Stable right lower lobe micro-nodule (series 9; image 52)MEDIASTINUM AND HILA: Stable right thyroid nodule. Coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fluid density lesion in segment IVB of the liver is unchanged, measuring 2.6 x 2.2 cm (series 7; image 89), previously 2.7 x 2.0 cm. Three other subcentimeter hypoattenuating lesions are also seen in the liver, unchanged.Cholelithiasis.SPLEEN: Scattered subcentimeter hypodensities in the spleen are unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral nephrolithiasis and scarring has not significantly changed. Nor has numerous hypoattenuating lesions in both kidneys, which are too small to definitively characterize.One of the two renal veins demonstrates a retroaortic course.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrojejunostomy. Small fat-containing periumbilical hernia. Diastasis of the rectus muscles remains.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small bilateral fat-containing inguinal hernias.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable cystic hepatic lesions and nonspecific right lower lobe micro-nodule.


Instruction: Generate impression based on medical findings.

Input: 77 year old female with mesothelioma on chemotherapy. CHEST:LUNGS AND PLEURA: Volume loss and mild pleural thickening on the right consistent with mesothelioma.Reference measurements:1. At the level of the left pulmonary artery (image 45/113): Two o'clock position 4 mm, 5 o'clock position 5 mm, 10 o'clock position 5 mm, unchanged.2. At the level of the left atrium (image 64/113): Four o'clock position 5 mm, 7 o'clock position 6 mm, 11 o'clock position 4 mm, unchanged.3. At the level of the coronary sinus (image 79/113): Four o'clock position 6 mm, 7 o'clock position 6 mm, 9 o'clock position 3 mm.Additional calcified pleural plaques are seen laterally at the base. Nodular pleural thickening extends to the fissures. No pleural effusions. Suture line identified near the right middle lobe at the base.Nonspecific right pulmonary micronodules unchanged.MEDIASTINUM AND HILA: Cardiomegaly. Coronary artery calcifications. Calcifications of the mitral annulus. No pericardial effusions. Small mediastinal nodes. No significant hilar lymphadenopathy. CHEST WALL: No suspicious axillary lymphadenopathy. Degenerative changes of the thoracic spine. Stable right lateral rib deformities with associated pleural thickening (image 51/113). Left thyroid enlargement and heterogeneity unchanged. Degenerative changes in the spine.UPPER ABDOMEN: Several hypodense lesions in both lobes of the liver are unchanged. Splenic calcified granulomas. Atherosclerotic calcifications of the abdominal aorta.

Output: Stable disease with reference measurements as given above.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p lung transplant History: cough New right basilar opacities suggestive of infection or aspiration and less the patient is recently undergone bronchioloalveolar lavage.Elsewhere, the lungs are unremarkable.Status post bilateral lung transplant.Large lung volumes.Heart size normal.

Output: Right basilar aspiration or pneumonia, unless the patient has undergone recent bronchioloalveolar lavage. Large lung volumes could indicate obstructive airway disease.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: eval mediastinal width, cause of CP History: L shoulder and CP, known TAA s/p TEVAR Status post endograft placement in a large aortic aneurysm.The embolization coil pack initially placed into the aneurysm sac has migrated inferiorly, presumably still in the false lumen.Mild retrocardiac atelectasis post procedure, with a small effusion.Heart size normal.Right jugular catheter, tip in SVC.

Output: Large aortic aneurysm treated with endograft and embolization clinical pack, the coil pack migrated inferiorly. This was discussed with the service, pager 2567, at 12:42 PM on 3/20/2016 by the radiology resident on call, Dr. Masse.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with large cell neuroendocrine tumor of the pancreas CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Pretracheal lymph node is grossly stable measuring 12 by 15-mm in image number 39, series number 9.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Index lesion adjacent to middle hepatic vein measures 22 by 24-mm image number 97, series number 9, not significantly changed from previous study. Numerous new small hypodense lesions have in the interval developed in the liver consistent with metastatic disease.SPLEEN: Status post splenectomy. Previous described enhancing lesion in the splenectomy bed is smaller measuring 16 x 14 mm and demonstrates less enhancement.PANCREAS: Postsurgical changes. Main pancreatic duct is dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left para-aortic mass is smaller in size and demonstrates less enhancement. It measures 2.2 by 2-cm image number 131, series number 9.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: Left adnexal/nodal mass measures 5 by 3.4 cm on image number 154, series number 9, smaller compared to previous study. The lesion also enhances less compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid is unchanged.

Output: Interval development of numerous metastatic hepatic lesions.Index lesions in the chest abdomen and pelvis are either stable or slightly decreased.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: r/o infiltrate History: weakness No change in right pleural thickening and/or fluidWith adjacent consolidation. Increasing opacity left perihilar region.Stable support devices.

Output: Pulmonary opacities suggestive of infection or aspiration, new in the left perihilar region.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Tachypnea question pneumonia. Interval extubation. Right jugular catheter tip at the SVC. Peripheral catheter tip at the superior cavoatrial junction.No pneumothorax.Lung volumes remain low.Layering pleural fluid and atelectasis/consolidation at the left lung base.Diffuse interstitial opacity with lesser involvement of the right upper lobe, unchanged compared to recent prior radiographs.Focal nodular opacity just above the right hemidiaphragm new from earlier studies, likely infectious.

Output: Left basal opacity and right basal nodule consistent with infection. Diffuse opacities elsewhere are relatively static since the patient's admission film of 9/16/2016, inconsistent with edema and suspicious for atypical infection including but not limited to pneumocystis pneumonia.Findings and recommendations discussed with the referring clinical service (intern) at 10:16 a.m. on 9/27/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: intubated OSH transfer; eval for pulm edema, PTX, ET placement, central line placement History: see above Moderate to severe cardiomegaly with mild basilar edema pattern as well as pleural effusions and left lower lobe consolidation, unchanged.Right jugular catheter, tip in SVC.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Left subclavian ICD, leads unchanged in position.

Output: Persistent findings suggestive of CHF as well as left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: s/p PICC line placement History: PICC line placement Interval removal of right internal jugular central venous catheter and placement of a right upper extremity PICC which terminates at the cavoatrial junction.Mild cardiomegaly.No focal opacity, pneumothorax, or significant pleural effusions identified.

Output: Interval placement of a right upper extremity PICC in appropriate position. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: pre op, infection and inflammatory reaction due to unspecified internal joint prosthesis, history of sickle cell disease Mild cardiomegaly. Bibasilar scarring. No pleural effusion or pneumothorax. Cholecystectomy clips and other surgical clips in the left and right upper quadrants. Skeletal abnormalities consistent with history of sickle cell disease.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: fever, h/o MS eval PNA History: fever Low lung volumes. Streaky bibasilar opacities consistent with atelectasis/scarring. Multiple calcified mediastinal and hilar lymph nodes again evident. The cardiac and mediastinal contours are within normal limits for size.

Output: Low lung volumes and mild basilar atelectasis/scarring.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with hypoxia, pleural effusion. Status post thoracentesis. Monitoring given ongoing oxygen requirement. Right IJ venous catheter tip in the right atrium.Large right pleural effusion with adjacent compressive atelectasis not significantly changed. No new focal focal airspace opacities. No pneumothorax. Unchanged cardiomediastinal silhouette.

Output: Large right pleural effusion and compressive atelectasis without significant interval change. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: 61yr old male with history of amyloidosis; pre-auto sct evaluation History: evaluate The cardiomediastinal silhouette is normal. Left basilar opacity atelectasis or scarring. Trace pleural effusions and/or pleural thickening. No pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Reason: sternal fracture History: pain Fracture of the mid sternum with moderate displacement, best shown on the lateral view, new since 9/13/2016.Moderate cardiomegaly with bilateral pleural effusions, unchanged.Severe diffuse chronic interstitial disease.

Output: Pathological fracture of the sternum.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: cabg work up History: recent nstemi Heart size within normal limits.Mediastinal clips. Sternotomy wires intact.Lungs clear.No pleural effusion.

Output: Postsurgical change with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: R pneumothorax s/p R chest tube placement History: eval for pneumothorax No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Hypertension Interval near complete opacification of left lower lobe with mild volume loss suggesting atelectasis, however partial consolidation cannot be excluded. Mild cardiomegaly and a possible small minimal left pleural effusion. Right lung and left upper lobes are clear.

Output: Suspected left lower lobe atelectasis, however partial consolidation cannot be excluded including aspiration. Serial imaging will be helpful to confirm and clear


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.IABP placement. Cardiogenic shock. IABP marker projects one 9-cm below the aortic arch. New right jugular catheter can be followed to the SVC level. ICD unchanged in position. A catheter terminates in the right upper extremity, peripheral to the axillary vein. No acute pulmonary abnormality.

Output: IABP marker projects over the aortic arch. Appropriate position of right jugular catheter without pneumothorax. A peripheral catheter terminates in the right upper extremity.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: infiltrate History: sickle cell chest pain Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. Unchanged heart size. Bony changes consistent with sickle cell disease.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: 48-year-old man with history of COPD, CHF, morbid obesity who presents with chest pain and shortness of breath. Stable cardiomediastinal silhouette. Decreased lung volumes with unchanged elevation of the right hemidiaphragm and associated atelectasis. No evidence of pulmonary edema or definite pleural effusion. No focal pulmonary consolidation. Cardiac loop recorder again noted.

Output: No evidence of pulmonary edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Prekidney transplant evaluation. No focal airspace opacity, pleural effusion, or pneumothorax. Streaky left basilar opacity most consistent with subsegmental atelectasis.The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval for cardiomegaly, effusion History: CP Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Patient status post sternotomy and CABG. Vascular stents noted over the right heart.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: eval for focal consolidation or pneumothorax History: chest pain No significant cardiopulmonary abnormality.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: new consolidation History: fever in sickle cell patient with chest pain Stable mild cardiomegaly.Signs of pulmonary venous hypertension again noted. No signs of overt pulmonary edema. Azygos lobe is incidentally noted. Persistent trace right pleural effusion and minimal subpulmonic left pleural fluid, stable from recent comparison although improved from 6/10/2016. No pneumothorax.Fishmouth deformity of thoracolumbar vertebral bodies, in keeping with history of sickle cell disease.

Output: Stable cardiomegaly, signs of pulmonary venous hypertension and chronic trace bilateral pleural effusions.Fishmouth deformity of thoracolumbar vertebral bodies, in keeping with history of sickle cell disease.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval for pna History: weakness, hypothermic, tachypneic, recent chemo for known LLE lung mass Left lower lobe superior segment mass invading the infrahilar region consistent with known neoplasm. Left eighth rib expansile metastasis is again demonstrated. No pleural effusion. No pneumothorax. The cardiomediastinal silhouette is within normal limits.

Output: No interval change in left lower lobe superior segmental mass with left eighth rib expansile metastasis. These findings are best seen on the prior CT study of 5/18/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Ovarian cancer patient on chemotherapy. Chest pain. Shortness of breath. Unremarkable cardiomediastinal silhouette.Blunting of the left costophrenic angle may represent a small residual effusion or scarring. Nodular opacity in the left lower lobe corresponds to a scar like opacity seen on the CT from 7/20/2015.No specific evidence of infection or interstitial edema. No pneumothorax.Right chest port with catheter tip at the superior cavoatrial junction.

Output: 1. No acute cardiopulmonary abnormality evident.2. Nodular opacity in the left lower lobe corresponds to a scar-like opacity seen on the CT from 7/20/2015. Given the history of malignancy, surveillance with follow-up PA radiograph is recommended in 3-6 months.


Instruction: Generate impression based on medical findings.

Input: Continued hypoxia status post HD. Right upper extremity and subclavian vascular stents.Low lung volumes, edema and atelectasis, fairly similar to previous with the exception of a rounded opacity overlying the left hemidiaphragm which is new. The central pulmonary vasculature is enlarged however this is unchanged compared to earlier films this year. Aorta is widely awaiting adjacent to the dialysis unit. Millimeters of no cellulitis or mediastinal malignancy as

Output: New opacity overlying the left hemidiaphragm which is somewhat atypical in configuration for atelectasis and could potentially reflect an infarct. Dr.Degesys verbally notified at approximately 8:10 AM on 11/5/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: evaluate PA catheter positioning History: Vtach/Vfib on monitor. PA catheter wedged Open sternotomy wound packed with surgical sponges with overlying surgical drains.Moderate cardiomegaly.Unchanged pleural effusions and left lower lobe consolidation.Small right apical pneumothorax.LVAD and ICD are unchanged.ET tube tip approximately 6 cm above the carina.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.

Output: Small right apical pneumothorax. Open history sternotomy wound with surgical packing material.


Instruction: Generate impression based on medical findings.

Input: 68 year old with right parotid malignancy. Rule out metastases. CHEST:LUNGS AND PLEURA: Mild paraseptal emphysema, mainly in the upper lobes.Mild basilar scarring.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative disease in the spine, compatible with age.UPPER ABDOMEN: No significant abnormalities.

Output: No sign of metastatic disease in the chest.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Shortness of breath. Large lung volumes without pleural effusion or pneumothorax. The cardiac mediastinal silhouette is unremarkable. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Interval change History: Oxygen desaturation There is interval progression of the right upper lobe airspace opacity previously described. If improvement is not seen following treatment, CT of the chest should be obtained for further evaluation.No change in right basilar opacity. Left lung remains clear. Cardiomediastinal silhouette is unremarkable.

Output: Progression of right perihilar and upper lobe opacity. No change in right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: intubated patient - assess et placement History: see above Persistent right pleural effusion with right basilar consolidation.Nonspecific left basilar opacity either edema or aspiration.ET tube tip within 1 cm of the carina on one of two views.NG tube extends into the proximal duodenum.

Output: Unchanged pulmonary opacities and pleural effusions. Low ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: swan placement after adjustment History: above Moderate cardiomegaly with questionable edema and persistent retrocardiac subsegmental atelectasis.IVC Swan-Ganz catheter tip still peripherally in the right lower lung zone, which can lead to arterial damage.Left subclavian ICD unchanged.Right sided IABP introducer, the proximal marker projects over the aortic arch.

Output: Swan-Ganz catheter tip still peripherally in the right lower lung zone.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o dissection History: CP, abd pain, SOB Moderate cardiomegaly with mildly tortuous aorta, unchanged.Diffuse interstitial opacity with multiple septal lines consistent with edema, similar to previous.

Output: CHF with interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Chest pain malignant neoplasm of the esophagus. SOB. Tubes and lines unchanged in position. Volume of pleural fluid on the right has slightly increased. Diffuse opacities are improving, suggestive of edema and atelectasis with superimposed bronchiolitis, likely the result of aspiration. Possible anterior pneumothorax on the left near the costophrenic angle where there is a focal area of lucency.

Output: Slight increase in right pleural fluid however the pulmonary opacities appear to be improving. Possible anterior pneumothorax on the left, suggest short-term follow-up.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with shortness of breath. Patient is rotated.Cardiomediastinal silhouette is unremarkable.Hyperinflated lungs and flattening of the diaphragm is compatible with history of COPD. Left basilar atelectasis. Bilateral pleural effusions or scarring. No pneumothorax.

Output: Left basilar atelectasis/scarring and bilateral pleural effusions of scarring. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: MaleReason for Study: Reason: cough for 2 months with hemoptysis History: as above There is moderate cardiac enlargement with pulmonary vascular redistribution.Questionable thickening of the left paratracheal stripe may represent lymphadenopathy.Mild perihilar interstitial opacities compatible with edema.No focal airspace opacities.No pleural effusions.

Output: Cardiomegaly with perihilar interstitial opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: hx of urothelial carcinoma, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No sign of metastases.Left subclavian pacemaker, leads unchanged in position.

Output: No sign of metastases, or other significant abnormality. No significant change.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with renal cell carcinoma, status post left nephrectomy. Evaluate for recurrence of disease. Attention to lungs bilaterally. CHEST:LUNGS AND PLEURA: Biapical scarring and emphysematous changes of the lungs are again seen.Multiple micronodules are again seen in the right lung, with the reference right upper lobe nodule, measuring 4.4 mm in diameter (image 118/301, series 6). There is also multiple micronodules noted in the left lower lobe, which are unchanged from the prior study.MEDIASTINUM AND HILA: Multiple subcentimeter lymph nodes are again noted in the mediastinum. The right hilar lymph node is stable and measures 1.1 cm x 0.9 cm (image 40/228, series 4). Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Again seen is a hypodense lesion superior to the caudate lobe which appears unchanged when compared to the prior study.SPLEEN: A splenule is noted adjacent to the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy with no evidence of local disease recurrence.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 1.3 cm x 1.0 cm (image 118/228, series 4), which is unchanged when compared to prior study. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Status post left nephrectomy without evidence of metastatic disease2. Stable mediastinal and retroperitoneal adenopathy3. Stable bilateral pulmonary micronodules


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: please capture LV apex, assess for LVAD placement History: VT Left subclavian ICD and visualized portion of the LVAD appear similar in position.No focal pulmonary opacities within the visualized lung; a portion of the left upper lobe has appeared by the pulse generator.

Output: No interval change or acute abnormality


Instruction: Generate impression based on medical findings.

Input: 54-year-old male staging of squamous cell cancer and head and neck cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: 76 years, Female. Reason: worsening SBO, s/p G-tube placement, known SBO History: emesis Chest: Right central catheter in the region of the cavoatrial junction. No focal pulmonary opacity. Right pleural effusion. No free air.Abdomen: Percutaneous gastrostomy tube is noted. Interval removal of enteric tube. There is persistent gaseous distention of small bowel with multiple air-fluid levels. The small bowel measures up to 6.6 cm and distention. Air and stool are noted within the colon. Findings are most compatible with a partial small bowel obstruction with increased bowel dilatation compared to prior radiographs.

Output: Partial small bowel obstruction with increasing distention of small bowel loops compared to prior exam.


Instruction: Generate impression based on medical findings.

Input: Intubated. Traumatic brain injury. Diaphragm repair.VIEW: Chest AP (one view) 05/15/15, 1430 Endotracheal tube tip is above carina. Feeding tube tip is in gastric body.Left chest tube has been removed. Left lower lobe opacity persists. No pneumothorax is seen. The pulmonary vascularity on the left is diminishedA small to moderate right pleural effusion has developed. A pulmonary edema pattern is present in the right lung. Cardiac silhouette size is normal.

Output: Right pulmonary edema pattern and pleural effusion. Decreased vascularity and left lung. Pulmonary embolism cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 57 years, Female. Reason: r/o bowel obstruction History: nausea/vomiting Chest:Right chest wall port terminates in the cavoatrial junction. Small left pleural fluid suggested. Bibasilar discoid atelectasis.Abdomen:Multiple dilated loops of small bowel are noted in the left hemiabdomen. There is relative paucity of intraluminal gas beyond the jejunum, concerning for small bowel obstruction. Left-sided suture material and surgical clips seen. Residual barium contrast is noted within the rectum and distal colon, presumably related to patient's reported barium enema at outside institution. No definite pneumoperitoneum seen on upright imaging.

Output: 1.Multiple dilated loops of small bowel in the left hemiabdomen, with paucity of intraluminal gas distal to the jejunum. Given these findings, a small bowel obstruction cannot be ruled out, findings may be further assessed with dedicated contrast-augmented CT as clinically indicated.2.Residual barium contrast in rectum and distal colon, presumably related to patient's reported barium enema at outside institution.These findings were discussed via phone with Dr. Hoppenot at 4:00 PM on 8/12/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: interval assessment of PTX History: see above No significant pneumothorax.Right upper lobe cavity with aspergillomas are unchanged.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath No pneumothorax following bronchoscopy.Basilar interstitial opacities appear worse but this likely is due to differences in inflation and the recent procedure.No new findings.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 72 years, Female. Reason: NG tube position History: s/p NG advancement Enteric tube now coils within the gastric fundus. No significant interval change.

Output: Enteric tube now coils in the gastric fundus.


Instruction: Generate impression based on medical findings.

Input: 68 years, Female. Reason: Abdominal pain, distension, nausea History: As above There is diffuse dilation of small and large bowel in an ileus pattern. There is centralization of bowel loops suggesting mild ascites. Right lower lobe airspace opacities with central lucencies consistent with hydropneumothorax seen on prior studies. A right chest tube is present.

Output: Ileus pattern and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: FemaleReason for Study: Reason: eval for pna, ptx History: wheezing There are decreased lung volumes with mild/moderate cardiac enlargement.Widening of the mediastinum and right paramediastinal opacity most likely related to tortuous/dilated vessels.Perihilar and basilar interstitial opacities compatible with atelectasis and bronchial wall thickening.No focal areas of consolidation.No pleural effusions.No evidence of a pneumothorax.

Output: Mild cardiac enlargement with bronchial wall thickening and basilar atelectasis. No specific evidence of pneumonia or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: mvc, left scapular pain History: mvc, left scapular pain Low lung volumes with bibasilar subsegmental atelectasis or scarring. No large pleural effusion or pneumothorax. Normal heart size given low lung volumes.

Output: Low lung volumes with bibasilar subsegmental atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with chest pain. Left chest wall AICD with leads unchanged. Heart size upper limits of normal. Tortuous thoracic aorta. No focal airspace opacity, pleural effusions or pneumothorax. Persistent scoliosis of the spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 60 Sowell female with history of hemochromatosis, rule out hepatocellular carcinoma CHEST:LUNGS AND PLEURA: Severe emphysema. Nodular areas in the right upper pole may represent scarring, however, follow-up imaging is recommended to exclude neoplasm.MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver. 6.6 x 6.1 cm mass in the right lobe of the liver demonstrates partial enhancement on the arterial phase and partial washout on the delayed phase consistent with hepatocellular carcinoma. The liver parenchyma is extremely heterogeneous which makes evaluation for hepatocellular carcinoma more difficult. There are numerous hypodense nodules throughout the liver. Only a few of these nodules demonstrate arterial enhancement. The largest of the nodules demonstrating arterial enhancement measures less than a centimeter.Extrahepatic and intrahepatic main portal vein is thrombosed. Right portal vein is not visualized and invaded by the mass. Left portal vein is also at least partially thrombosed.SPLEEN: Splenomegaly. Splenic artery aneurysms. Largest measuring 9-mm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple right renal artery aneurysms, largest measuring 14 x 11 mm.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal and peritoneal varices.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.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: No significant abnormality noted.

Output: Cirrhotic liver with a large mass in the right lobe invading the right portal vein. Thrombosis of the main portal vein. Numerous nodules in the liver, only a few subcentimeter ones demonstrate arterial enhancement has been and are suspicious for other foci of hepatocellular carcinoma.Splenomegaly and extensive retroperitoneal and mesenteric varices consistent with portal hypertension.Bilateral right renal artery aneurysms.Extensive emphysema. Follow-up chest CT is recommended to evaluate the nodularity in the right upper lobe.