Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: pna? History: admission screen and rule out pna Cardiomediastinal silhouette is unremarkable.No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: shortness of breath, copd exacerbation Unremarkable cardiac and mediastinal silhouette. Perihilar bronchial thickening compatible with chronic bronchitis.No sign of pneumonia or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: hx of L-sided empyema. Abx stopped yesterday and with leukocytosis today History: above Left Port-A-Cath with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Decreased lung volumes with scattered areas of scarring/discoid atelectasis.No focal airspace opacities.Mild blunting of the left costophrenic angle may represent pleural thickening.No large pleural effusions.

Output: No change in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: Right sided crackles, hypoxia, fever History: right sided crackles, hypoxia, fever Unremarkable cardiac and mediastinal silhouette. Streaky lower zone opacities consistent with atelectasis and consolidation with partial atelectasis of the right middle lobe.These findings may be related to recurrent aspiration and/or infection.

Output: Partial right middle lobe atelectasis and multiple areas of basilar subsegmental atelectasis compatible with infection, bronchial mucous plugging and possibly recurrent aspiration.


Instruction: Generate impression based on medical findings.

Input: 78 year old female with abdominal tenderness status post mechanical fall. INR of 8. Rule-out intra-abdominal/retroperitoneal bleeding. CHEST: The visualized portion of the heart is enlarged.LUNG BASES: A left pleural effusion is present. Patchy bibasilar ground glass opacities are also noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly is noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating round lesion in the lower pole of the left kidney is again seen, likely renal cyst. Circular lesion of fat attenuation in the lower pole of the right kidney is again visualized, consistent with an angiomyolipoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. There is no evidence of retroperitoneal hematoma.BOWEL, MESENTERY: Diverticulosis of the sigmoid colon is present. A round metallic foreign body measuring 1.8 x 1.8 cm of uncertain significance is visualized in the cecum. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Extensive atherosclerosis of the aorta and its branches is again seen. A saccular aneurysm measuring 2.7 cm x 2.5 cm of the infrarenal aorta is noted (image number 50, series 3).PELVIS:UTERUS, ADNEXAE: The uterus is atrophic or has been surgically removed.BLADDER: The bladder is distended otherwise no significant abnormality is 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.No evidence of intra-abdominal bleed.2.Small saccular aneurysm of the infrarenal aorta as described above.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: cardiomegaly, effusion, PNA History: hyperglycemia, DKA vs. HHS The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusion. Multiple surgical clips in the mid abdomen.

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


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with Langerhan's cell histiocytosis. Reevaluate disease compare the previous CHEST:LUNGS AND PLEURA: Suggestion of some mild paraseptal emphysematous changes. There are a few punctate noncalcified nodules in the right lung nonspecific for example see image 42/83. No effusions.MEDIASTINUM AND HILA: A pathologic size nodes.CHEST WALL: Lytic areas in the lower thoracic spine consistent with history of histiocytosis.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal lytic lesions in the lumbar spine.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: Small groin lymph nodes unchanged question significance. Since the right groin node was measured at remeasured on image 184 as 1.6 x 1.4 cm. No new nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal lytic lesions are seen throughout the osseous structures multiple areas of high density centrally. Some have sclerotic margins on the knot. This would be consistent with involvement of histiocytosis.OTHER: Lipoma right groin.

Output: Multifocal osseous lytic lesions consistent with histiocytosis. Small groin nodes bilaterally unchanged questionable significance. No new adenopathy. Punctate nonspecific lung nodules.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male complains of abdominal distention x2 weeks. Evaluate gas pattern. Chest radiograph demonstrates bibasilar atelectasis or scarring. No pleural effusion. No pneumothorax. The barium contrast extends throughout the lumen of the large bowel. Correlate with history of prior contrast administration. Nonobstructive bowel gas pattern. A few air-fluid loops are seen on the erect views. Greater than average stool burden. No free air.

Output: Streaky bibasilar opacities consistent with atelectasis or scarring. Greater than average stool burden and nonobstructive bowel gas pattern. No free air.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.History of heart failure, evaluate PICC placement Left PICC has been placed with tip in the SVC. IABP marker is in the descending aorta. Swan-Ganz catheter removed and sheath remains in place.Residual contrast seen in the colon.Heart and mediastinal silhouette is enlarged but stable.Bilateral pleural effusions are unchanged allowing for difference in positioning. Adjacent basilar and perihilar opacities again noted.

Output: 1.PICC tip in the SVC.2.Stable pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: tachypnea , R/o pleural effusion or fluid overload History: SOB Chronic appearing elevation left hemidiaphragm with overlying subsegmental atelectasis.Otherwise, the lungs are unremarkable.The heart is mildly enlarged.Left jugular catheter, tip in SVC.

Output: No significant abnormality. Chronic left hemidiaphragm elevation unchanged.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male 5 years status post right upper lobectomy for large cell lung cancer. CHEST:LUNGS AND PLEURA: Right upper lobectomy. Scattered micronodules, unchanged. No suspicious nodules, masses, or pleural effusion.Apical centrilobular emphysema. Stable left apical scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Stable enlarged, nodular thyroid, nonspecific by CT but most compatible with goiter.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Stable hepatic cysts. Cholelithiasis without acute inflammation. Intrahepatic biliary ductal dilatation is unchanged as well.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal nodules are grossly unchanged accounting for differences in technique. Right adrenal nodule measures 25 x 19 mm; previously measuring 24 x 21 mm. Left adrenal nodule measures 26 x 15 mm; previously measuring 23 x 15 mm.There is been no significant change in these nodules since prior study from 2/18/2005.KIDNEYS: Right renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: abnormality? History: sob and chest pain Port catheter, unchanged. No substantial change in right basilar pleural parenchymal opacity. No new focal pleural parenchymal opacity in the left hemithorax. Unchanged heart size. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female presenting with abdominal pain and sepsis CHEST:LUNGS AND PLEURA: Multiplemicronodules in the right upper lobe this was shielded with ill-defined irregular density in the right apex measuring 16 x 10 mm. This density may represent scarring, however, follow-up imaging is recommended to exclude a mass. Another ill-defined air space opacity measures 16 x 9 mm in the right upper lobe. The nodules in the right upper lobe R. atrium but fashion and suspicious for infectious etiology. Bilateral pleural effusions, more on the right side.In the right lower lobe are multiple airspace opacities associated with more 3 in bud type small nodules. This is again suspicious for infection.Left lower lobe pneumonia. Bilateral dependent atelectasis. Multiple nodules around the fissure on the left side may be secondary to patient's known sarcoidosis.MEDIASTINUM AND HILA: Mediastinal, bilateral hilar adenopathy which may be compatible with patient's known history of sarcoidosis. Reference prevascular adenopathy measures 26 x 13 mm image number 35, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:The study is limited due to lack of IV contrast.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of fluid in the pelvis.

Output: Left lower lobe pneumonia. Bilateral small pleural effusions, more prominent on the right.Small micro-nodules in the right lung suspicious for infection.Mediastinal adenopathy and interstitial nodules compatible with patient's known history of sarcoidosis.Ill-defined opacities in the right upper lobe which may represent scarring, however, follow-up chest CT is recommended to exclude a neoplasm.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: ? stroke History: AMS Stable cardiac mediastinal silhouette.Minimal basilar atelectasis unchanged.No new pulmonary opacities.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 65 years old Male. Reason: evaluate lead position and for pneumothorax History: left sided lead ICD. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. The tip of the cardiac pacemaker/defibrillator electrode projects over the right ventricular apex.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: Evaluate for signs of infection History: Extremity weakness Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: r/o infiltrate History: chest discomfort Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Chronic elevation or eventration left hemidiaphragm.Cholecystectomy clips.

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


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: assess for pulmonary edema History: status post fluid resuscitation, now with increased work of breathing Mild interval increase in cardiac size as well as development of mild pulmonary edema.No specific evidence of infection. No pneumothorax. Probable small pleural effusions.

Output: Mild cardiomegaly with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#1 Line position stable.Pulmonary opacities unchanged.No pneumothorax. No pleural effusion.

Output: Stable lung opacities. Stable line position.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with pancreatic cancer CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous metastatic lesions in the liver are again seen. Reference lesion in the dome measures 7.5 by 7.7 cm, image number 72, series number 71, increased from previous study. SPLEEN: No significant abnormality notedPANCREAS: Resection of the pancake head. Visualized body and tail again demonstrates marked dilatation of the pancreatic duct. There is some enhancing soft tissue near the pancreatic anastomosis which represent recurrent tumor.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference lymph nodes in the portacaval space measures 13 by 12-mm image number 102, series number 7 to one, not significantly changed. Other retroperitoneal lymph nodes , most prominently along the SMA, are also both unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the hepatic metastatic lesions. Retroperitoneal adenopathy is grossly unchanged.Ill-defined soft tissue in the region of the pancreatic anastomosis may represent recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: ETT placement History: ETT placement Support devices unchanged. ET tube tip approximately 5 cm above the carina.NG tube with its tip in the stomach.Stable cardiomediastinal silhouette with marked atherosclerotic changes of the aorta and mediastinal widening related to known aneurysm of the aberrant right subclavian artery.Pleural effusions and basilar atelectasis similar to the prior exam.

Output: Support devices unchanged the ET tube tip 5 cm above the carina. Stable cardiopulmonary appearance with pleural effusions and basilar atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Daily CXR History: R sided HF Swan-Ganz catheter terminates in the right pulmonary artery. Low lung volumes. Left basilar pleural parenchymal opacity, unchanged. No pneumothorax. Unchanged cardiomegaly.

Output: Left basilar pleural parenchymal opacity, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Worsening pulmonary edema? History: Hypoxemia Small lung volumes with patchy basilar opacities, improved but still suggestive of edema and atelectasis.Mild cardiomegaly noted.Right PICC, tip in the SVC.

Output: Improving basilar opacities still consistent with edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old. ET tube tip approximately 3 cm above the carina.Bilateral mainly perihilar opacities suggestive of edema with a moderate right pleural effusion and probable smaller left effusion.Underlying partial consolidation of the right lower lobe, obscured by overlying edema and effusion.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: mediastium History: chest pain that radiating to the back The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p intubation History: ILD, hx respiratory failure ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.Bilateral symmetrical mainly lower zone airspace opacity, improved compared to previous.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: r/o pna History: cough Status post median sternotomy. Non-alignment of the lower sternal wires correlates with nonunion at the lower sternum as seen on chest CT dated 04/2014. Left chest pacer device, unchanged in position.Stable cardiomegaly.Low lung volumes. Basilar opacities, compatible with atelectasis/scarring, unchanged. No new focal air space abnormality.

Output: Cardiomegaly without acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 74-year-old with lung cancer to undergo chemotherapy soon. CHEST:LUNGS AND PLEURA: Paramediastinal lung mass in the left upper lobe on axial image 37/88 demonstrates at least a partial fat plane between the adjacent bulky mediastinal adenopathy probably represents the patient's lung cancer. However, this mass is not completely distinct from the adjacent adenopathy making accurate measurements difficult.Scattered additional micronodules and scarlike opacities are noted. Bibasilar atelectasis. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Large heterogeneous goiter as seen on the prior exam has been resected in the interval. Surgical clips are noted in the thyroid bed.Extensive, bulky mediastinal lymphadenopathy noted. A prevascular node on axial image 27/236 indents the left brachiocephalic vein and measures 3.3 x 2.0 cm. Multiple additional aggregates of pre-vascular and pretracheal lymph nodes are evident as well. These findings are stable compared to the prior exam.Cardiac size is normal. No pericardial effusion. Mild aortic atherosclerosis.CHEST WALL: Degenerative disease affects the spine. No evidence of bony metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions in the liver are nonspecific.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Cystic lesions in left kidney are noted.RETROPERITONEUM, LYMPH NODES: Small mesenteric and retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disease. No bony metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged and indents the posterior wall of the bladder.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative disease.OTHER: No significant abnormality noted

Output: 1.Left upper lobe mass and associated bulky mediastinal lymphadenopathy compatible with stated history of lung cancer.2.Interval resection of a thyroid goiter.3.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: Lung nodule History: Lung nodule Mild cardiomegaly.Improvement in basilar opacities with residual pleural effusions.No nodule identified.Right jugular catheter, tip in SVC.

Output: No nodule identified, but that seen on prior CT would be difficult to detect by conventional radiography. For reassessment a CT would be required.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: pna v ards History: sob Interval progression of bilateral consolidative opacities involving both lungs, with worsening consolidation of the left midlung, left base and right apex, concerning for progression of multilobar pneumonia although possibly also secondary to superimposed noncardiogenic pulmonary edema.Moderate right pleural effusion, worsened from prior. Small left pleural fluid also noted.The drop-off catheter has been advanced in the interval and the tip overlies the left upper quadrant.

Output: Worsening bilateral consolidative opacities may represent a combination of progressing multilobar pneumonia and noncardiogenic pulmonary edema.Interval increase in size of the now moderate right pleural effusion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: pna Small lung volumes with no gross cardiopulmonary abnormalities.

Output: No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: r/o acute process History: ams Severe cardiomegaly and/or pericardial effusion are present.No specific evidence of infection or edema tall there may be a small right pleural effusion.Left subclavian biventricular pacemaker, without an atrial lead visible, leads intact.

Output: Cardiomegaly and/or a pericardial effusion, without edema. Possible small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Mild to moderate cardiomegaly and/or pericardial effusion.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: evaluate effusion History: as above Pleural effusion occupying majority of the right hemithorax unchanged since the prior radiograph but larger compared to a CT 4/13/2016.The right lung is predominantly decompressed.Mild left base subsegmental atelectasis.Right subclavian catheter, tip low in the right atrium.

Output: Enlarging right pleural effusion near completely compressing the right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: recent ptx with chest tube, eval for interval change History: see above Left chest tube in place. Lung remains fully expanded. Interval increase in left subcutaneous emphysema.Linear opacities at the right lung base represent atelectasis.Cardiomediastinal silhouette within normal limits.

Output: 1. Complete expansion of left lung with chest tube in stable position. Increased subcutaneous emphysema2. Right basilar atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: changed pa catheter position History: changed wave form Complete left hemithorax opacification with rightward shift of the mediastinum.Patchy right base opacity stable with a right Pleurx catheter and pleural effusion.Right jugular Swan-Ganz catheter tip unchanged, the tip still in the right main pulmonary artery.Right jugular catheter to the SVC/RA junction level.

Output: No change in lung appearance or device locations.


Instruction: Generate impression based on medical findings.

Input: Female 36 years old Reason: ?chf, sob History: sob, cp Sternotomy wires intact. Large left pleural effusion and associated atelectasis/consolidation, increased from the prior examination. Unchanged cardiomegaly. No pneumothorax.

Output: Left pleural effusion with associated atelectasis/consolidation, increased from the prior examination.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male on dialysis presents with shortness of breath on exertion. Evaluate for pulmonary congestion. The cardiomediastinal silhouette is normal. No focal pulmonary opacity, pneumothorax, or pleural effusion.

Output: Normal chest radiograph.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with newly diagnosed gastric cancer. Evaluate extent of disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: The bladder is decompressed around a Foley catheter.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of regional or distant metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Cough, fever. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary vasculature are also within normal limits. There is no airspace disease, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: as above Marked cardiomegaly with a tortuous aorta, unchanged from previous.Status post median sternotomy and probableMitral valve prosthesis. Mild basilar interstitial opacities compatible with scarring and atelectasis.No evidence of pulmonary edema or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: respiratory distress post bronch History: respiratory failure Interval intubation with tip at the thoracic inlet. Surgical clips are unchanged. Surgical suture material in the right apex.Right chest port tip is at the superior cavoatrial junction. Interval mid esophageal stent placement. Cardiomediastinal silhouette is normal.Large lung volumes suggestive of COPD. No pleural effusion or pneumothorax.Diffuse airspace opacities are slightly increased in size. Left basilar atelectasis/consolidation better evaluated on recent CT.

Output: Increasing diffuse airspace opacities may reflect edema superimposed on chronic interstitial changes. Retrocardiac atelectasis/consolidation better evaluated on recent CT.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female history of cholangiocarcinoma CHEST:LUNGS AND PLEURA: Again noted multiple pulmonary metastatic lesions. Index lesion in the right middle lobe now measures two . 2 x 1.7 cm on image number 49, series number 7, increased in size compared to previous study. Second index lesion in the right lower lobe now measures 7-mm in diameter in image number 54, series number 7, increased in size compared the previous study. Biapical scarring.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Again noted biloba or numerous metastatic lesions. Index lesion in the left lobe measures 6.6 x 4 .7 cm on image number 95, series number 7, not significantly changed in size. However, all of the other metastatic lesions have significantly increased in size. For comparison an index lesion on image number 113, series number 7 now measures 3 x 2.7 cm. Previously it was measuring 1.3 x 1.3 cm on image number 109, series number 3. There are also new metastatic liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference peripancreatic lymph node now measures one .2 x 1.3 cm image number 106, series number 7, increased in size compared to previous study. Other peripancreatic and retroperitoneal nodes also significantly increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified fibroid is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: Interval progression of disease with interval increase in the size and number of hepatic metastases, size of lung metastases and retroperitoneal metastatic adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: vomiting, hemoptysis History: vomiting, hemoptysis Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Increasing O2 requirement Overall mild improvement and decreased bibasilar atelectasis with diminished interstitial changes in both bases. Moderate nonspecific cardiomegaly unchanged. Marked tortuosity aorta and atherosclerotic changes. No new superimposed focal airspace abnormality

Output: Mild improvement in diminishing suspected edema with mildly improving lung volumes


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: r/o infection, asthma exacerbation History: dyspnea No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Line placement correct? History: line placement Enteric tube terminates within the proximal aspect of stomach. Port catheter terminates near the cavoatrial junction. Ureteral stents noted. Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable mild basilar atelectasis. No focal lung consolidation or evidence of overt left-sided heart failure. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Lines and tubes, as above. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Interval near complete resolution of previously described CHF with persistent mild small effusions greater on the left with mild borderline cardiomegaly. Hardware unchanged

Output: Resolving CHF


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: hypoxia History: see above Right IJ venous catheter with its tip in the SVC.Dobbhoff tube with its tip in the stomach.There decreased lung volumes with basilar opacities compatible with atelectasis, edema, and pleural effusions similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: No significant interval change in the basilar edema/atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: post op, eval lung fields History: s/p TAVR Interval placement of percutaneous aortic valve. An external defibrillator pad is placed over the left anterior chest. Right IJ sheath terminates at the level of the carina. A left chest tube is looped over the inferior hemithorax, directed toward the midline.Small right pneumothorax. Skin folds are present on the left along with circumferential pleural thickening and or fluid. There is evidence of prior granulomatous disease. Heart size remains stable.

Output: Small right pneumothorax following percutaneous aortic valve placement.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Support devices are unchanged.No pneumothorax.Nonspecific basilar opacities, right greater than left, not significantly changed.Stable cardiomediastinal silhouette.

Output: Stable nonspecific basilar opacities, right greater than left, may represent aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: 75 years, Female. Reason: Patient s/p new ileal conduit urinary diversion. Distension and nausea. Also high drain output of clear yellow fluid. Concern for urinary leak and ileus. would like to confirm that bilateral stents are up to kidneys. History: As above Slightly hypoinflated chest with basilar atelectasis and small pleural effusions. Heart size normal. Osseous structures normal.Abdomen shows postsurgical ileus. No intramural air or free air. Suture lines. Skin staple line and JP drain pelvis. Surgical clips, vascular calcifications, and bilateral ureteral stents are seen. Stents are in expected position with the left in the distribution of the mid left ureter and the right looped in the distribution of the renal pelvis and proximal ureter.

Output: Postop ileus. Stents positioned as above.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with history of renal cell cancer, status post 14 cycles of therapy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Mild pericardial thickening has increased. No other significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Severe fatty infiltration and postsurgical changes in the liver. Numerous metastatic lesions throughout the liver are again identified. Reference lesion in segment 4 now measures 11 x 11 mm in image number 71, series number 3, not significantly changed. Other numerous metastatic lesions are also grossly stable. Hepatomegaly, stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Left renal cyst is stable.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: Status post hysterectomy. 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.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: ETT, ARDS, Pneumonia History: intubated, ARDS ETT 5 cm above the carina. Right internal jugular catheter tip in the right brachiocephalic vein. Enteric tube tip extends distal to the field of view.Patchy diffuse airspace opacities and pleural effusions consistent with edema/ARDS. No pneumothorax. The cardiomediastinal silhouette is stable.

Output: Stable findings consistent with clinical diagnosis of ARDS.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with bodyaches, chest wall pain, cough. Evaluate for acute process. Cardiomediastinal silhouette is within normal limits.Mild obscuration of the right and left heart borders corresponds to areas of subsegmental atelectasis and scarring as seen on prior CT.Bronchial wall thickening, suggestive of bronchitis or asthma.No pneumothorax or obvious rib fractures.

Output: Bronchial wall thickening, suggestive of bronchitis or asthma in a patient of this age group.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: FemaleReason for Study: Reason: s/p CIED upgrade to a biventricular ICD (CRT-D) --> r/o pneumothorax and evaluate lead positions History: as above New right-sided ICD with lead wires in the right atrial appendage, right ventricle, and coronary sinus. Additionally an epicardial lead is noted.Stable cardiac enlargement.The lungs are clear.No pleural effusions.No evidence of a pneumothorax.

Output: Interval placement of aright-sided ICD without complication.


Instruction: Generate impression based on medical findings.

Input: Clinical status-post PEA arrest. Evaluate for PE PULMONARY ARTERIES: There is no filling defect within the visualized pulmonary arterial system to suggest a pulmonary embolism.LUNGS AND PLEURA: Tree in bud opacities are noted in the right middle lobe on image 86 of series 9.There are additional centrilobular groundglass and tree in bud opacities in both lower lobes with areas of more focal consolidation. Given the symmetric appearance of these findings in the lower lobes, the possibility of pneumonitis from aspiration is raised.There are larger areas of consolidation/volume loss in the dependent posterior lower lobes.MEDIASTINUM AND HILA: There are no enlarged mediastinal lymph nodes. The patient has an endotracheal and nasogastric tubes.CHEST WALL: Heart size is enlarged with coronary arterial calcifications. There is hypertrophy of the left ventricle. There is diffuse atherosclerosis of the aorta. There are no enlarged axillary lymph nodes.UPPER ABDOMEN: The visualized upper abdominal contents are unremarkable.

Output: 1.No evidence of pulmonary embolism.2.Bilateral lower lobe tree in bud and centrilobular opacities with larger areas of lung consolidation as described above. Findings likely reflect aspiration pneumonitis with possible superimposed infection given the symmetric appearance of these findings and the history of cardiac arrest. Additional tree in bud opacities in the right middle lobe may be either infectious or inflammatory in etiology.3.Cardiomegaly with left ventricular hypertrophy.


Instruction: Generate impression based on medical findings.

Input: Lung resection wedge, VATS, bronchoscopy conversion to open surgery. All objects accounted for. No missing objects. Two left side down decubitus images taken portably in the CCD operating room.A right chest tube is in place with tip at terminating at the medial aspect of the right apex. Moderate right pneumothorax. Small volume of layering pleural fluid on the left. No unexpected radiopaque foreign objects are identified.Endotracheal tube terminates about 3-4 cm above the expected level of the carina.

Output: No unexpected radiopaque foreign objects. Results verbally communicated to the OR team/Drs. Ferguson and Patino at 10:06 AM on 12/6/2016. Moderate right pneumothorax with chest tube in place.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: s/p 3/5 right middle lobectomy History: follow up Right pleural effusion/thickening and volume loss in the right lung similar to the prior exam.Perihilar and basilar interstitial opacities have increased since the prior exam compatible with edema.Small left pleural effusion.Stable cardiomediastinal silhouette.

Output: Perihilar/basilar interstitial opacities and left pleural effusion increased from the prior exam suggesting CHF. Volume loss and right pleural effusion/thickening unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: interval exam History: interval exam Median sternotomy, heart size normal.No specific evidence of infection or edema.Unchanged support devices.Swan-Ganz catheter tip in right pulmonary artery.

Output: No acute abnormality. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old Reason: 62 yo male with history of MDS; pre-allo SCT evaluation No focal airspace opacity.Normal cardiomediastinal silhouette.No pleural effusion or pneumothorax.

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, 72 years old.Reason: chest pain History: chest pain LVAD in ICD unchanged.Stable cardiomegaly with bibasilar atelectasis and small stable right pleural effusion.

Output: Stable cardiomegaly with bibasilar atelectasis and small stable right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: weakness History: same No pulmonary effusion or pneumothorax. Unchanged pacemaker, left chest port, tracheostomy. Interval improvement in bilateral right greater than left interstitial opacities. Bilateral apical opacities are favored to represent costochondral calcifications.

Output: Interval improvement in bilateral interstitial opacities


Instruction: Generate impression based on medical findings.

Input: 63-year-old male status post CABG. Evaluate for effusion status post chest tube removal. Multiple surgical clips and sternotomy wires are again seen. Unchanged position of prosthetic tricuspid valve.Persistent bilateral lower lobe subsegmental atelectasis and small effusions. No pneumothorax.

Output: Persistent bilateral lower lobe subsegmental atelectasis and small effusions. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Hypotension Mild COPD changes with minimal scarring in the mid right lung and lung bases. No discrete additional superimposed focal air space process. Extensive coronary and aortic calcification with suspected partial stenting of the LAD. Mediastinal and cardiac silhouette otherwise unremarkable

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Cough, wheezing and shortness of breath. Evaluate for pneumonia or mass. Patient with persistent cough wheezing SOB. Right-sided diffuse wheezes. Normal heart size. Central pulmonary vasculature upper normal for the patient's age. No focal airspace opacities, pneumothorax or pleural fluid.

Output: No acute parenchymal lung abnormality is appreciated. The central pulmonary vasculature is upper normal for age which could be an early sign of pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: patient coded postop History: unresponsive postop, intubated ET tube with its tip 3 cm above the carina.Right IJ venous catheter and chest/mediastinal tubes unchanged.No evidence of a pneumothorax.Stable cardiac enlargement with some widening of the mediastinum.Focal right midlung opacity similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: chest tube placement History: n/a Retrocardiac consolidation.ET tube tip approximately 4 cm above the carina.Left supraclavicular surgical drain.

Output: Retrocardiac consolidation, suggestive of infection or mucus plugging. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: assess balloon pump positioning History: dyspnea, tachycardia to 130s Balloon catheter in the proximal descending aorta with the marker about 2 cm below the top of the aortic arch.ICD leads unchanged.PICC line from the right with its tip in the right subclavian vein.Mild chronic interstitial opacity with no acute change.

Output: Balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Hypoxia status post intubation, ETT positioning and pulmonary edema. Endotracheal tube tip 6-cm above the level of the carina. Other tubes and lines unchanged in position. Large layering pleural effusions with associated atelectasis about the same. There is probable pulmonary edema at the right lung base, unchanged.

Output: No significant change in pleural effusions, atelectasis or edema. Endotracheal tube 6-cm above carina.


Instruction: Generate impression based on medical findings.

Input: Reason: sp CABG, removal of CTs History: - No sign of pneumothorax or other acute change. Small lung volumes with basilar opacities compatible with atelectasis and pleural effusions.No pneumothorax.

Output: Basilar atelectasis and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: central picc line placement History: central picc line placement No significant cardiopulmonary abnormality.Left PICC, tip in SVC.Residual contrast is seen in the colon.Cholecystectomy clips are present.

Output: PICC placement. No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: History of gastric cancer status post total gastrectomy. N3 disease with likely recurrence. No adjuvant chemotherapy. Please evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Fibrotic changes in the periphery of the lungs, more severe on the right side and in the lung bases is roughly stable. No nodules or pleural effusions.MEDIASTINUM AND HILA: Stable precarinal lymph node measures 1.4 x 0.9 cm (image 31; series 3). Stable subcarinal lymph node measures 1.5 x 2.6 cm (image 58; series 3).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter hypodensity in the left lobe of the liver is unchanged.SPLEEN: Splenic vein has become infiltrated by tumor and is now occluded.PANCREAS: No significant abnormality noted. 3 x 1.7 cm (image 89; series 3) heterogeneous hypodense soft tissue mass superior to the pancreatic tail is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy has progressed since the prior exam. The reference left para-aortic lymph node (image 124; series 3) measures 2.2 x 1.5 cm. Additional periceliac periportal adenopathy is also present. Hazy, ill-defined increased density around the hepatic hilum and in the paraceliac region has been described previously and likely represents tumoral infiltration. Compression of the portal vein is now noted.BOWEL, MESENTERY: Status post gastrectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The wall of the bladder slightly thickened suggestive of cystitis.LYMPH NODES: Bilateral pelvic adenopathy is roughly stable.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Disease progression since the prior exam with measurements given above. New vascular invasion.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: eval line placement, followup ETT History: intubated The endotracheal tube tip is approximately 4 cm above the carina. The enteric tube tip is within the gastric body. Right chest port catheter tip is at the SVC/RA junction.Bilateral interstitial opacities, pleural effusions and basilar consolidation appear similar to the prior exam.

Output: Endotracheal tube and enteric tube are in appropriate position. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: 56 M with mesothelioma and history of pleural effusions. Now with worsening DOE, please eval for recurrent effusion. History: none Bilateral pleural thickening/tumor unchanged.Stable cardiomediastinal silhouette with left paramediastinal fibrosis.No new pulmonary opacities identified.

Output: Stable appearance of bilateral pleural thickening/tumor. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Reason: post op, eval lung fields History: s/p CABG, MVR Small lung volumes with interstitial opacity compatible with edema and atelectasis.Cardiopulmonary monitoring and support devices, unchanged.No pneumothorax or other acute change.

Output: Edema and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: is there any chf History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: right chest tube to Atrium device, waterseal History: eval with CXR Right apically directed chest tube and right-sided endobronchial valves are unchanged in position.Right hydropneumothorax is stable. Bilateral pulmonary opacities with evidence of biapical bullous disease unchanged. Left greater than right pleural effusions.

Output: Persistent right hydropneumothorax in the setting of a chest tube. Bilateral pulmonary opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Laryngectomy with SOB. Surgical drain overlies the neck. Right jugular chest port unchanged in position.Small pleural fluid collections, left greater than right.Patchy opacities in the dependent lung fields most consistent with aspiration bronchiolitis and pneumonitis, slowly increasing over the last 2 days which may indicate developing infection. Retrocardiac atelectasis on the left is also worse.

Output: Worsening pulmonary opacities suspicious for aspiration pneumonitis and possibly infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Evaluate Swan-Ganz placement. Right IJ Swan-Ganz catheter tip projects over the right main pulmonary artery. Cardiomegaly again noted. ICD leads are unchanged. No significant pleural effusion, focal airspace opacity, or pneumothorax. Left upper lobe bronchial wall thickening without specific evidence of pulmonary edema.

Output: Swan-Ganz catheter tip projects at the right main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: CF exacerbation eval interval change History: dyspnea Right chest wall port catheter tip at superior cavoatrial junction.Chronic bronchiectasis and bronchial impaction reflecting known cystic fibrosis.No definite new airspace opacity to suggest acute infection.Unremarkable cardiomediastinal silhouette.

Output: Findings of cystic fibrosis without new focal findings to suggest acute infection.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: ET tube. Basilar airspace opacities, dependent atelectasis, tubes and lines unchanged.

Output: ETT tip 4.5 cm above the level of the carina. No acute change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Chest pain and SOB rule out pneumonia. Postsurgical changes of a left mastectomy with axillary dissection clips.No focal airspace opacities, pleural fluid or pneumothorax. No visible pulmonary nodules or masses.

Output: No evidence of pneumonia or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: History of renal cell carcinoma. CHEST:LUNGS AND PLEURA: Punctate, nonspecific pulmonary nodules , one in each lower lobe are unchanged. The lungs are otherwise clear with no additional nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Heterogeneous enhancing mass in the left lateral lobe of the liver measures 2.9 x 2.2 cm in image number 19, series number 4. Another subcentimeter enhancing lesion in the dome of the liver is also unchanged. No new hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Surgical defect in the lateral aspect of the left kidney. No focal lesions to suggest metastatic disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bowel containing left flank 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: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT. A MRI of the liver may be helpful if further characterization of the liver lesions is clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: eval change in right lung field History: s/p esophagectomy, c/b esophageal leak sp stent placement Support devices unchanged with esophageal stent stable.Right pleural effusion and underlying interstitial opacities in the right lung compatible with edema.No significant pneumothorax.Left basilar atelectasis redemonstrated.

Output: Support devices unchanged. Right lung opacities similar in appearance to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Eval for pneumo History: Known pneumo No change in small right-sided pneumothorax. Other findings also stable in short interval. The stylette has been removed from the Dobbhoff catheter.

Output: No change in small right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: tachy, increased work of breathing History: increased work of breathing New right upper extremity PICC tip projects over the right brachiocephalic vein. Unchanged cardiomediastinal silhouette with mild cardiomegaly. Low lung volumes. Near complete resolution of basilar opacities compatible with atelectasis and mild edema. No new focal opacity to suggest pneumonia. Likely small left pleural effusion.

Output: Near complete resolution of basilar opacities compatible with atelectasis and mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old. Shortness of breath. Unremarkable cardiac and mediastinal silhouette.Left basilar subsegmental atelectasis. No evidence of infection or edema.Focal eventration of the left hemidiaphragm, unchanged.

Output: Left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: removal of right pleural drain, right pleural fluid collection History: right pleural fluid collection Interval removal of right sided drain. Minimal residual right pleural effusion and basilar atelectasis but no significant pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: Eval for PTX vs. other History: Newly SOB Enteric tube, unchanged. Left-sided PICC terminates in the left subclavian vein. Trend toward increasing left basilar opacity. Unchanged heart size. Dilated loops of bowel within the upper abdomen again noted.

Output: Trend toward increase in left basilar opacity consistent with aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: h/o empyema, now with intermittent confusion - assess for interval worsening of infection History: see above Loculated right hydropneumothorax with a pigtail catheter, unchanged.Patchy opacity throughout the right lung is stable.Minimal subsegmental atelectasis left lung base and a small left pleural effusion are still present.Esophageal stent unchanged in position.Right jugular catheter, tip in SVC.

Output: No change in loculated right hydropneumothorax. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: 67 yo F w/ pancreatic cancer, s/p intubation assess for ETT position History: as above Interval intubation with endotracheal tube tip 1 cm above the carina. Enteric tube tip courses below the field-of-view.Increased aeration of the left lung base compared to prior.Persistent bibasilar opacities compatible with pleural effusions, atelectasis and/or consolidation.

Output: 1. Interval intubation with tip of endotracheal tube at 1 cm above carina.2. Improved aeration left lung base.3. Persistent basilar opacities


Instruction: Generate impression based on medical findings.

Input: 77-year-old male presenting with non-Hodgkin's lymphoma. Evaluate disease status. Lack of oral contrast limits evaluation of bowel.CHEST:LUNGS AND PLEURA: A small bulla at the right apex is unchanged. MEDIASTINUM AND HILA: Small pericardial effusion is unchanged. Central venous catheter is seen in the distal superior vena cava. Coronary artery calcifications are noted. CHEST WALL: Port-A-Cath is seen in the subcutaneous tissues overlying the right chest. Enlarged thyroid with heterogenous left thyroid nodule is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Patient is status post cholecystectomy. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and its branches are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted

Output: 1.No evidence of lymphadenopathy.2.Stable small pericardial effusion.3.Unchanged left thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p bilateral lung transplant History: fungal pneumonia Cardiopulmonary monitoring and support devices, unchanged.Bilateral nonspecific airspace opacity and pleural effusions, unchanged or slightly improved.Possible small left apical pneumothorax.No new findings.

Output: Airspace opacity and pleural effusions without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.History of lung cancer. Assess for interval changes. Intubated. Endotracheal tube tip approximately 3 cm above the carina. Right upper extremity PICC tip at the cavoatrial junction. Enteric tube tip extends beyond the inferior margin of the image.The cardiomediastinal silhouette with large mediastinal mass is unchanged.Persistent bibasilar pulmonary opacities and pleural effusions, slightly increased on the left.

Output: Persistent bibasilar pulmonary opacities and pleural effusions, slightly increased on the left.


Instruction: Generate impression based on medical findings.

Input: Reason: resolution of PTX History: PTX Right chest tube in place with a very small residual right pneumothorax, slightly unchanged from previous.Moderate right pleural effusion and atelectasis in the right lower lobe with multiple bronchial valves in place.Calcified nodule at the left apex compatible with healed granuloma.

Output: Unchanged right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Rectal cancer Mildly improved exam with an overall improved aeration, however underlying cardiopulmonary appearance is similar with an unchanged right chest tube with tip projected towards the midline and upper lung. Remaining hardware including an NG tube, Dobbhoff and both a right jugular and right subclavian catheters unchangedTIPS and upper abdominal drainage catheters including a biliary tube and sterilization coils projected over the right lower lung and/or lower chest are all unchanged

Output: Right chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: ARDS ETT remains 3 cm above the carina. NG projects into the proximal stomach.Right jugular catheter terminates in the proximal SVC without interval alterationBilateral pulmonary opacities with retrocardiac consolidation and/or atelectasis with moderate effusions similar to prior exam.

Output: Unchanged cardiopulmonary appearance with findings consistent with known moderate ARDS


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Cough and chest pain question pneumonia. Moderate bilateral pleural fluid collections, similar to previous. Opacity in the adjacent lung is disproportionate on the left, which may indicate a superimposed process such as infection. Thickening of the fissures consistent with hypervolemia. Cardiothoracic ratio similar to previous. No pneumothorax.

Output: Hypervolemia with moderate bilateral pleural effusions. Consolidation in the left lower lobe is disproportionate to the volume of pleural fluid; this may indicate a superimposed process such as infection. Suggest follow-up PA and lateral chest radiographs after management of the patient's volume status to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: eval lung fields History: s/p CABG Moderate cardiomegaly with moderate postoperative mediastinal widening. Basilar subsegmental atelectasis, unchanged.No new findings.

Output: Postoperative atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Left VATS wedge resection with chest tube. Left chest tube projects over the mid thorax. Minimal ipsilateral subcutaneous emphysema and a trace 1 to 2 mm left pneumothorax.Low lung volumes with elevation of the right hemidiaphragm. Basal atelectasis about the same. Right upper lobe nodule better seen on today's study, refer to recent CT.

Output: Trace left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Infiltrates History: fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Shortness of breath. Normal heart size. Tortuous thoracic aorta. Patchy basal opacities bilaterally nonspecific, most pronounced in the anterior lung. No pleural fluid or pneumothorax.

Output: Faint nonspecific patchy basal opacities, not specific for acute infection. Additional differential considerations include areas of atelectasis due to prior aspiration or scarring. Based on the distribution, query clinical history of risk factors for MAI.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Febrile and tachycardic question pneumonia. Moderate to large left pleural fluid collection increased in volume. Mild basal atelectasis on the right. I jugular catheter unchanged in position. Cardiomegaly. Apparent mediastinal shift exaggerated by patient rotation.

Output: Large left pleural fluid collection with associated atelectasis. No other signs of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old. New right subclavian catheter with its tip in the area of the SVC.Right paramediastinal opacity is compatible with a skin fold.Interval improvement in pulmonary edema with persistent left lower lobe atelectasis and small effusions.NG tube tip at the GE junction.

Output: Catheter tip in the SVC with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Thoracentesis check for pneumo. Pigtail catheter projects over the right hemithorax just above the level of the hilum. No pneumothorax on the right. Right jugular catheter projects over the right atrium. Dobbhoff tube tip off the caudal margin of the film. Tracheostomy tube tip 3.5 cm above the level of the carina.Large right pleural fluid collection.Moderate volume of pleural fluid on the left.Diffuse edema and atelectasis on a background of emphysema.Airspace opacities in the left upper lobe may also reflect edema and atelectasis, superimposed infection cannot be excluded.A peripheral catheter from the left projects over the left axillary vein.

Output: Interval placement of right-sided pigtail catheter. No pneumothorax on the right. Difficult to assess for pneumothorax on the left due to overlying devices.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: FemaleReason for Study: Reason: Evaluate for PNA History: transient desaturation down to 86 Markedly decreased lung volumes.The cardiomediastinal silhouette is unremarkable.Lungs are clear.The large pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: End-stage renal disease Minimal basilar atelectasis without additional cardiopulmonary abnormality other than questionable mild aspiration.

Output: Questionable mild aspiration greater in left lung base


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Swan placement History: n/a Mild interstitial edema with septal lines and a small right pleural effusion noted.Heart size upper normal status post median sternotomy.Right jugular Swan-Ganz catheter, tip directed towards the right upper lobe.Left jugular catheter, tip in SVC. Left subclavian ICD, leads unchanged in position.

Output: Mild interstitial edema. Right jugular Swan-Ganz catheter unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Hypoxia, left pleural effusion. Chest tube placement. New left chest tube directed inferiorly towards the lung base. Interval decrease in volume of pleural fluid on the left. Other hardware and devices similar in position. Pulmonary edema and airspace opacities about the same.No significant pneumothorax.

Output: Decreased volume of pleural fluid on the left post chest tube placement.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: hx COPD, p/w SOB, eval for pna, edema History: sob The heart is normal in size.Lung volumes are normal. No abnormal focal lung parenchymal opacities.The pleural spaces are within normal limits.

Output: No abnormal radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male history metastatic squamous cell carcinoma with measurable right axillary lymphadenopathy, history of pelvic RT and chronic edema sequelae. Lower extremity and pudendal edema, chronic. CHEST:LUNGS AND PLEURA: Calcified granuloma right lobe. No new lung nodules.MEDIASTINUM AND HILA: Conglomerative nodes in the right axilla measures 2.8 x 2.5 cm series 3 image 29. Previously 3 x 2.4 cm. fat stranding in other nodes in the right fellow visually stable. Large calcified subcarinal granuloma. No pathologic sized mediastinal nodes or left axillary nodes.CHEST WALL: Adenopathy as above.ABDOMEN: The exam is not sensitivity lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: The scattered hepatic cysts and lobulated larger fluid density lesion in the right lobe are all unchanged. Scattered calcific granulomata.SPLEEN: Calcific granulomataPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule estimated at 2 x 1.1 cm series 3 image 31. Previously 2.1 x 1. Right adrenal gland normal.KIDNEYS, URETERS: Status post right nephrectomy. Left kidney normal size and contour.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously seen jejunal obstruction is diminished. One loop of proximal jejunum continues to be slightly dilated with effect of coins appearance but with no obvious area of narrowing or transition zone. This findings is nonspecific. There is no evidence of intramural air or free air. No free or loculated intraperitoneal fluid. The all contrast progresses past this loop into a normal-appearing mid and distal jejunum and ileum..BONES, SOFT TISSUES: Anasarca. Thickening skin anterior abdominal wall particular.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small pelvic lymph nodes probably not pathologic in size and unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted

Output: Stable adenopathy in anasarca. Persistent stack of coins appearance one loop of proximal jejunum but decreased in extent. No evidence of mechanical obstruction. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Hypercapnia Persistent mild CHF with marked cardiomegaly and moderate pleural effusions again greater on the right.Right jugular catheter extends into the SVC near the RA junction

Output: CHF without new interval change


Instruction: Generate impression based on medical findings.

Input: Evaluate for possible pneumonia. History: Patient with known interstitial lung disease, new coughVIEWS: Chest AP/lateral No significant interval change in lung opacities from previous films. No evidence for new pneumonia. Cardiothymic silhouette normal.

Output: Chronic lung disease without evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia, cardiomegaly, effusion, acute chest syndrome History: Hx of HgbSS, PHTN, PE on xarelto, c/o 4 days worsening right sided chest pain. Moderate cardiomegaly with marked enlargement of the main pulmonary artery consistent with pulmonary hypertension. No evidence of pneumonia or other acute change.

Output: Pulmonary hypertension and no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: 39F p/w pleuritic CP. C/f cardiac vs PE History: CP No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Heart size upper limits of normal.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: pleural effusion s/p removal of pigtail drain History: as above Unchanged small to moderate size right pleural effusion. Probable right basilar atelectasis again noted. Very small loculated pneumothorax at the base of the right hemithorax again noted.Left hemithorax is unchanged. Unchanged cardiomegaly.

Output: Persistent very small loculated right basilar pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with weakness. Further evaluate mass seen on chest x-ray. CHEST:LUNGS AND PLEURA: Dense consolidation in the left upper lobe along the oblique fissure in a peribronchovascular distribution with a large cavitary component as well (series 5, image 34). A separate, focal area of consolidation is also noted in the left upper lobe anteriorly (series 5, image 55).Diffuse micronodules bilaterally also raise the possibility of miliary spread of infection.Bibasilar scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy on this noncontrast exam. Note is made of a calcified subcarinal lymph node. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Left renal cysts.

Output: Dense left upper lobe opacities, one of which appears to be cavitating. Diffuse micronodules bilaterally. TB is a strong consideration. A less likely consideration includes a cavitating malignancy with diffuse lung metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval ET tube placement History: ET tube reposition Interstitial opacities consistent with edema, with left lower lobe consolidation and a left pleural effusion, unchanged.ET tube tip 9 cm above the carina.Right jugular catheter, tip in SVC.An NG tube terminates in the stomach.

Output: High ET tube. Unchanged pulmonary opacities and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: ETT History: ETT Support devices unchanged with ET tube tip approximately 3 cm above the carina.Stable cardiac enlargement with prominence of left atrial appendage.Lungs are clear.No large pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: r/o acute process History: shortness of breath Left lung and hilar mass unchanged.No evidence of superimposed edema or pneumonia.Mild to moderate cardiomegaly present.

Output: Known lung cancer, but no acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male 2 years old , intubated, evaluate tube placementVIEW: Chest AP (one view) 4/1/2016, 2149 Endotracheal tube tip is at thoracic inlet. Nasogastric tube tip is in the midesophagus.Cardiothymic silhouette is normal. Mild bronchial wall thickening is noted. Focal left lower lobe opacities are present. No pleural effusion or pneumothorax is evident.

Output: Left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: eval pna, mass History: cough, n/v, fever/chills, malaise, wt loss The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.A degenerative changes in the thoracic spine with mild interval wedging of several midthoracic vertebrae.

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


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: post-rosc after losing pulse Endotracheal tube terminates 2 to 3 cm from the carina. Endobronchial blocker tube terminates in what is likely a left lower lobe bronchus. Right IJ line terminates near the cavoatrial junction. Improvement in right pleural effusion. No significant pneumothorax. Batwing pulmonary edema again noted. Unchanged cardiomegaly.

Output: Endotracheal tube terminates 2 to 3 cm from the carina. Endobronchial blocker tube terminates in what is likely a left lower lobe bronchus. Right IJ line terminates near the cavoatrial junction. Improvement in right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: evaluate for infiltrate, worsened infiltrate History: new cough The right port is now accessed. The tracheostomy tube is unchanged in position.Slight increased size of large left pleural effusion which obscures visualization of the inferior left lung. Associated infection is a consideration. Diffuse opacities of the aerated left upper lobe may represent a combination of atelectasis and aspirated secretions. Trace right pleural effusion.

Output: Slight increased size of large left pleural effusion which may obscure a pneumonia. Opacities in the aerated left upper lobe represent a combination of atelectasis and aspirated secretions. Further evaluation following diuresis is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: atypical chest pain with pain in her left chest History: left chest pain from front to back Heart size about upper normal.Mildly tortuous aorta, unchanged.No sign of CHF or active pulmonary disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Altered mental status and probable aspiration Motion degrade sensitivity. Decreased lung volumes complicate moderate effusions and largely basilar patchy lobe edema with possible cardiomegaly. Overall CHF suspected with scoliosis

Output: Suspected moderate CHF


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Shortness of breath, ET tube placement ET tube tip is 6 cm above the carina. Dobbhoff tube tip projects over the gastric fundus.Cardiomediastinal silhouette is normal.Upper lung zone emphysema.Bibasilar opacities compatible with pleural effusions and adjacent atelectasis and aspiration.No pneumothorax.

Output: Unchanged opacities suggestive of aspiration. ET tube tip is 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: eval for PNA History: hypoxia and SOB Low lung volumes makes detailed cardiopulmonary assessment difficult. Diffuse right greater than left pulmonary opacities with bibasilar subsegmental atelectasis or scarring. Mild cardiomegaly. Tortuous and atherosclerotic aorta. Enlarged central pulmonary arteries suggestive of pulmonary hypertension.

Output: Diffuse right greater than left pulmonary opacities which may represent atypical edema, infection, and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: post-heart transplant History: post-heart transplant Interval intubation with the endotracheal tube terminating 2 cm above the carina. The imaging findings are compatible with interval cardiac transplant, as the left ventricular assist device is no longer visualized. A right IJ Swan-Ganz catheter terminates in the mid right pulmonary artery. The right ICD electrodes have been removed with skin staples in the right subclavicular location. 2 subxiphoid mediastinal drains are now in place. Sternotomy hardware is well aligned.Small amount of postoperative pneumomediastinum. Postoperative mid to lower zone subsegmental atelectasis with low lung volumes. No pneumothorax.

Output: Postoperative findings compatible with interval heart transplant. Appropriate position of support devices with minimal postoperative pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: Male, 98 years old.Altered mental status. Intubated. Low endotracheal tube with tip approximately 1 cm above the expected level of the carina. Enteric tube looped in the stomach with tip near the gastric fundus. Patchy basal airspace opacities, greater on the left than the right may reflect aspiration and/or infection however should be followed to complete radiographic resolution to exclude underlying nonbenign pathology.

Output: Low endotracheal tube. Nonspecific basal opacities which may be the result of aspiration or infection but should be followed to radiographic resolution.


Instruction: Generate impression based on medical findings.

Input: Reason: daily cxr History: Hypoxemia. Cardiopulmonary monitoring and support devices, unchanged.Diffuse nonspecific airspace opacity suggestive of edema with pleural effusions, unchanged.Loculated right apical pneumothorax with a pleural drain in place.No new findings.

Output: Loculated pneumothorax and pulmonary edema with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: eval for lung pathology History: decreased breath sounds Mild cardiac enlargement with tortuosity of aorta.Lungs are clear.No pleural effusions.Surgical clip noted in the right upper abdomen.Degenerative changes throughout the thoracic spine.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: r/o infection History: fever Mild bronchial wall thickening which could indicate asthma or chronic bronchitis.No other significant abnormality.Heart size normal.

Output: Nonspecific bronchial wall thickening, otherwise unremarkable. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Scattered micronodules are stable. Index right lower lobe nodule measures 6 mm in diameter image number 70, series number 5, stable. Previously described ground glass opacity in the right lobe has resolved.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: Right adrenal nodule measures 2.1 by 1.5 cm on image number 98, series number 3.KIDNEYS, URETERS: Bilateral renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: Distal abdominal aortic aneurysm measures 5.1-cm in its greatest AP dimension image number 147, series number 3, slightly increased in size compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval resolution of groundglass opacity in the right lung.Interval minimal increase in the size of the abdominal aortic aneurysm.These findings were discussed by Dr. Smith at the time of the dictation


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Evaluate left pleural effusion History: Confusion Small left pleural effusion layering on a left decubitus view. Pulmonary edema pattern with atelectasis are unchanged.

Output: Left pleural effusion layering freely.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.ETT position, assess for change in pleural effusion. Aspiration pneumonia status post intubation. No significant change in right pleural fluid collection layering into the fissures. Partial clearance of right middle lobe lateral segment opacity. Mild patchy groundglass opacities persist. Resolving edema in the right lung. Tubes and lines unchanged with tip of the endotracheal tube projecting 4 cm above the level of the carina.

Output: ETT 4 cm above the carina. No significant change in pleural fluid volume though the lateral segment of the right middle lobe has now partially reexpanded.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: PA catheter adjusted History: as above Lines and tubes are not substantially changed. Mild pulmonary edema, as before. Increased basilar opacities. Small pleural effusions. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged mild pulmonary edema. Increase in basilar opacities, particularly on the left, likely atelectasis. Small pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: eval infection, edema, effusion History: hypoxia The heart is normal in size.Lung volumes are normal. No abnormal focal lung parenchymal opacities. Mild bilateral bronchial thickening.The pleural spaces are within normal limits.Diffuse osseous sclerosis and endplate deformity, in keeping with history of sickle cell disease.

Output: No abnormal radiographic findings to suggest pneumonia.Abnormal osseous sclerosis and deformity of vertebral bodies, in keeping with history of sickle cell disease.


Instruction: Generate impression based on medical findings.

Input: . Kidney transplant No cardiopulmonary abnormality. Midline sternotomy and fractured inferior wire unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: eval lung fields, device placement History: s/p LVAD placement Support devices unchanged.Stable cardiac enlargement.No evidence of a pneumothorax.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: Evidence of infection History: Increased white count in immunocompromised patient Moderate cardiomegaly but no sign of edema or infection.Interval removal of the Swan-Ganz catheter.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: s/p C/S 2/28, with postoperative fevers, OSA, supermorbid obesity concern for atelectasis versus pneumonia History: Fevers Cardiomediastinal silhouette is within normal limits.No focal airspace abnormality. No pleural effusions.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Tachypnea. ET tube placement. Low endotracheal tube with tip less than 1 cm above the level of the carina.Left jugular catheter looped, probably in a collateral vessel.A peripherally placed catheter from the right terminates in the subclavian vein.Interval development of multifocal airspace opacities and worsening of basal atelectasis. Probable small pleural effusions. No pneumothorax.

Output: Low endotracheal tube. Left jugular catheter extends cranially probably within a collateral vessel but has been repositioned on a subsequent film. The right peripherally placed catheter is not central in location. Development of multifocal edema-like airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Heart transplant Abandoned ICD leads and sternotomy wires are unchanged.Lungs remain clear.Cardiac and mediastinal contours are within limits

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: cough. High family hx of lung cancer History: cough Stable cardiomediastinal silhouette.No focal airspace opacities.No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormalities. No interval change from prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: eval for effusion History: sob/new oxygen requirement Interval increase in size of the left pleural effusion, most of which demonstrates a subpulmonic distribution.No pneumothorax. Trace right pleural fluid is noted. The left upper lobe mass is again visualized, unchanged from prior. No new abnormal lung parenchymal opacities.The cardiac and mediastinal contours are partially obscured.

Output: Slight interval increase in size of the left subpulmonic pleural effusion.Unchanged left upper lobe mass known to represent a primary lung neoplasm.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Bilateral apical scarring. Right upper lobe subpleural cysts, unchanged. Right upper lobe micronodular on image number 23, series number 4 is unchanged measuring 4 mm in diameter. No new nodules. Left lower lobe nodule is also unchanged.MEDIASTINUM AND HILA: Calcified right hilar lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right lower pole renal stone, unchanged. Left nipple small hypodense lesion is unchanged.RETROPERITONEUM, LYMPH NODES: Index aortocaval node is unchanged measuring one by 1.1-cm image number 139, series number 3. Other small retroperitoneal lymph nodes are also stable.BOWEL, MESENTERY: Multiple subcentimeter mesenteric lymph nodes and haziness within the mesentery, 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: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Age: 88 yearsGender: FemaleReason for Study: Reason: Rule out PNA History: AMS Stable cardiomediastinal silhouette with atherosclerotic changes of the aorta. Lung volumes compatible with COPD.No focal airspace opacities.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: r/o pulm edema History: sob Swan-Ganz catheter again terminates in the right pulmonary artery. Unchanged left basilar pleural-parenchymal opacities. No new focal pleural parenchymal opacity. No pneumothorax Unchanged cardiomegaly.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: s/p bronch, Right VATs/Robotic Assisted upper lobe wedge resections (x2), Open Thoracotomy with Wedge resection right upper lobe History: post-op f/u Left chest port with tip in the SVC. Right apical hydropneumothorax is again noted, similar to prior exam. Interval decrease in right pleural effusion. Improved aeration of the left lung.

Output: Moderate right hydropneumothorax, similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: 78 year old male presents for follow-up of left lower lobe mass. CHEST: LUNGS AND PLEURA: Opacity in the left lower lobe with associated air bronchograms, a few punctate calcifications and volume loss, more suggestive of cancer than of cryptogenic organizing pneumonia with increase in size since 5/2008. The opacity measures 3.1 x 5.4cm (series 4, image 53) previously 2.5 x 4.8.Right upper lobe 6mm nodule, unchanged since 10/2008. No new nodules identified.MEDIASTINUM AND HILA: No significant lymphadenopathy. Severe coronary arterial calcifications and stents. Aortic calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small kidneys with arterial calcifications and several cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aorto-iliac stent graft, incompletely imaged but not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Opacity in the left lower lobe more suggestive of cancer than of cryptogenic organizing pneumonia with increase in size since 5/2008. An IR consult could be obtained for biopsy feasibility.2. Other findings as described above, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval ETT, lung fields History: s/p MVR Endotracheal tube terminates approximately 4 to 5 cm from the carina. Swan-Ganz catheter terminates within the central pulmonary artery. Mediastinal drain/chest tubes noted. Mild left basilar opacity, likely atelectasis with possible small pleural effusion. Right lung is clear. No pneumothorax.

Output: Expected appearance status post MVR.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: unexplained weight loss in a smoker History: weight loss The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax. Numerous small calcified granulomas compatible with prior granulomatous disease.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval for improvement in left pleural effusion History: left pleural effusion Persistent small left pleural effusion. No pneumothorax.Stable position of support apparatus.Left lower lobe subsegmental atelectasis again noted.

Output: Persistent small left pleural effusion, unchanged in appearance from prior.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Right lung wedge resection. Fever. Chest tubes. Partial clearing of pulmonary opacities, likely reflecting resolving edema. Numerable poorly defined hazy nodular opacities may be infectious or metastatic. Interval placement of a right apical chest tube without significant pneumothorax. Minimal subcutaneous emphysema at the chest tube insertion site.

Output: Improving edema. Remaining diffuse opacities may be infectious or metastatic, please refer to pathology/culture reports.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: eval for pneumonia History: tachycardia and tachypnea in pt with lung cancer and new trach Stable cardiac silhouette.Bilateral stable pleural effusions. Multifocal pulmonary opacities have worsened on the right and improved on the left. Stable to slight increase in size of right pulmonary mass (the margins of which are obscured due to increasing pulmonary opacities in the right lung).Interval placement of tracheostomy tube with tip seen approximately 6 cm above the carina.Right subclavian chest port with tip projecting over the cavoatrial junction.

Output: (1) Multifocal pulmonary opacities have worsened on the right and improved on the left. (2) Interval placement of tracheostomy tube with tip seen approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: check for blood clots- need xray for V/Q scan History: shortness of breath Sternotomy sutures noted, the inferior most of which is fractured but stable. The cardiomediastinal silhouette is normal.There is bilateral hilar prominence from pulmonary arterial enlargement. No focal pulmonary opacities or pleural effusions identified.

Output: Enlarged pulmonary arteries without focal pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of non-small cell lung cancer. Status post chemoradiation CHEST:LUNGS AND PLEURA: Large right apical mass, measuring 6.9 x 9.2 cm in axial dimension ( Series 10200, image 12) with invasion of the upper thoracic vertebral bodies and encroachment on the central canal. Scattered ill-defined micronodules, greatest in right upper lobe, are too small to characterize. Mild peribronchial wall thickening and mild paraseptal emphysema are also seen. MEDIASTINUM AND HILA: No lymphadenopathy.CHEST WALL: Lateral chest wall invasion by right apical mass. The mass invades the spinal canal with dural thickening.ABDOMEN:LIVER, BILIARY TRACT: Minimal intrahepatic biliary dilatation. Cystic mass in inferior right hepatic lobe is unchanged in size from prior. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal nodules again noted: right adrenal nodule measures 1.6 x 0.9 cm as seen on series 10200, image 101 (previously 1.4 x 1.1 cm); left adrenal nodule measures 2.0 x 1.4cm as seen on series 10200, image 96 (previously 2.0 x 1.4 cm), previously characterized as adrenal adenomas. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1) Large right apical mass with chest wall and spinal canal encroachment.2) Bilateral adrenal nodules, unchanged in size, compatible with benign adrenal adenomas.


Instruction: Generate impression based on medical findings.

Input: Reason: cough, doe History: cough, doe Unremarkable cardiac and mediastinal silhouette. Focal scarring of the left cardiac border, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Cough, shortness of breath, PO2 92%. Left hilum is enlarged, consistent with lymphadenopathy. No associated parenchymal lung abnormality is appreciated. No pleural fluid. Heart size is normal. Mild scoliosis.

Output: Left hilar lymphadenopathy of unclear etiology. As no prior chest radiographs are available, this is of unclear chronicity or clinical significance. Although this is statistically most likely postinflammatory or postinfectious given the patient's young age, follow-up PA and lateral chest radiographs are recommended in 2-3 months to assess for stability, resolution or growth in order to exclude the much less likely possibility of nonbenign pathology.