Instruction: Generate impression based on medical findings.

Input: Status post hyperthermic intraperitoneal chemotherapy, evaluate for pneumothorax or effusion. Decreased lung volumes with diffuse interstitial opacities compatible with moderate pulmonary edema. Blunting of left hemidiaphragm suggestive of small pleural effusion. No pneumothorax.

Output: Previously mild and now moderate congestive heart failure.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, 61 years old. Wheezing, SOB. Small pleural effusions with mild basilar atelectasis, new from prior.Stable cardiomediastinal silhouette.Interval removal of central line.

Output: Mild basilar atelectasis with small pleural effusions, new from prior.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: CP History: CP The cardiomediastinal silhouette is normal in size.No focal airspace opacity, pleural effusion or pneumothorax.Mild wedge compression deformity of a midthoracic vertebral body, age indeterminate.

Output: No acute cardiopulmonary findings. Mild wedge compression deformity of a midthoracic vertebral body, age indeterminate.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with history of respiratory failure and endotracheal tube placement. Endotracheal tube tip 6 cm above the carina. NG tube tip outside the field of view. Large lung volumes suggestive of COPD. Multiple healing rib fractures again noted.

Output: Endotracheal tube tip 6 cm above the carina. Otherwise stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female presenting with metastatic renal cell carcinoma. The lack of IV contrast limits evaluation of solid organ lesions.CHEST:LUNGS AND PLEURA: There are patchy areas of dense opacities in bilateral lower lobes. Given that air bronchograms can be identified through these opacities, an infectious process is favored over metastatic involvement.Previously identified right base metastatic lesion is larger compared to the prior study and measures 17 x 17 mm (series 5, image 94), previously 11 x 15 mm.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. There are multiple hypodense hepatic lesions, which have increased in size and number, consistent with worsening metastatic disease. Reference lesion measures 3.6 x 3.4 cm (series 4, image 114).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy.KIDNEYS, URETERS: Status post right nephrectomy. Left upper pole cyst is unchanged compared to the prior study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is an expansile and lytic lesion involving the lateral aspect of the right third rib, consistent with metastasis. Postoperative changes of a right hip arthroplasty are completely visualized on this study.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left external iliac node measures 12 x 7 mm, unchanged compared to the prior study (series 4, image 153).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Total right hip arthroplasty is incompletely visualized on this study. Degenerative disease affects the lumbar spine and left hip.OTHER: No significant abnormality noted.

Output: 1.Multiple hepatic lesions increasing in size and number and right base pulmonary nodule increasing in size, consistent with worsening metastatic disease.2.Bilateral lung bases with patchy consolidations and air bronchograms, new since the prior study. These findings likely represent an infectious process as opposed to metastatic involvement. Close interval followup is suggested.3.Expansile and lytic lesion of the lateral aspect of the right third rib, consistent with new metastasis.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p stent placement History: s/p stent placement Additional stent segment placed in the esophagus superior to the previous one extending almost up to the level of the carina.Right subpulmonic effusion with adjacent atelectasis stable.

Output: New stent segment placement, otherwise unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: night sweats History: night sweats The lungs and pleural spaces are clear. The heart size is normal.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Annual testing, lung transplant Postsurgical changes without evidence of new acute or subacute abnormalities. Asymmetric lung volumes with hyperexpansion of the left lung is again observed without significant change. Specifically no new focal airspace processes on either side.Cardiac and mediastinal contours of the minimal shift are within limits

Output: Postsurgical changes secondary to a right lung transplant yet without superimposed acute or subacute abnormality


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with shortness of breath. ET tube placement. ET tube tip unchanged.Unchanged left pleural effusion and basilar consolidation. Right upper lobe nodule presumably known lung cancer. No new focal airspace opacities.Cardiac mediastinal silhouette is unremarkable.

Output: ET tube unchanged. Unchanged left basilar consolidation and pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: evaluate for infiltrate History: cough, SOB, hypoxia Moderate cardiomegaly.Extensive interstitial opacities consistent with scarring/atelectasis and signs of pulmonary arterial and venous hypertension without significant interval change since the prior exam given differences in technique and lung hypoinflation.No pleural effusion or pneumothorax.Skeletal sequelae from sickle cell disease.

Output: No significant interval change in vascular crowding and scarring given differences in technique and lung hypoinflation. Repeat PA/lateral chest radiographs at full inspiration are recommended when clinically feasible.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: 51F intubated in MICU post-spinal surgery, ?ETT placement History: 51F intubated in MICU post-spinal surgery, ?ETT placement New basilar opacities and left pleural effusion, suggestive of atelectasis from aspirated secretions or mucous plugging.ET tube tip approximately 5 cm above the carina.

Output: ET tube tip 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p intubation History: rising wbc Feeding tube tip in the gastric antrum.Tracheostomy tube in place with its tip about 6 cm above the carina.No significant pulmonary abnormalities.

Output: No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: sciatic nerve pain, chronic back pain. R/o arthritis History: scoliosis of right side Prominent first right costochondral junction, but no obvious underlying pulmonary abnormality when reviewed on energy subtraction images.Small lung volumes, otherwise unremarkable.Unremarkable mediastinal contours and cardiac silhouette.Mild thoracic scoliosis.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 57 y/o with endocarditis, eval for CHF History: none Cardiomegaly with an ICD device in place, unchanged from previous.Small lung volumes with no specific evidence of pulmonary edema or infection.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: smoker History: stroke signs No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: assess lung white out Lines and tubes are unchanged. Study limited by leftward patient rotation. Gradual improvement in left lung aeration. Diffuse left-sided pleural-parenchymal opacities again noted. No new focal pleural parenchymal opacity in the right hemithorax. Unchanged heart size. No pneumothorax. Left pleural effusion again noted.

Output: Gradual improvement in left lung aeration. Diffuse left-sided pleural-parenchymal opacities again noted. No new focal pleural parenchymal opacity in the right hemithorax.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female status post chemotherapy for uroepithelial cancer CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal calcification which represents AtheroCath a chores stone. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Borderline enlarged lymph nodes are unremarkable. 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: Status post cystectomy. Ileal conduit is unremarkable.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 47 years old Female. Reason: r/o acute process History: dyspnea. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. The patchy opacity in the right lower lung appears similar as compared with prior study.

Output: Mild cardiomegaly and infiltrative change in the right lower lung, which may represent pneumonia. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: Swan placement History: Swan Tip of Swan-Ganz catheter in main pulmonary artery.Lungs clear.Cardiomegaly stable.No pleural effusion. No pneumothorax.

Output: Stable line position.Stable cardiomegaly with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Asthma exacerbation. Evaluate for pneumonia. Shortness of breath and wheezing. No focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with hepatic resection for colon cancer. Evaluate for interval change. CHEST:LUNGS AND PLEURA: Faint micro-nodule in the right lung is stable (image 33; series 4).MEDIASTINUM AND HILA: Subcentimeter mediastinal and right hilar lymph nodes are stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post right lobectomy. No focal lesions in the left lobe.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral, hypodense lesions in the kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: A an enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of fluid in the left lower quadrant adjacent to the left inguinal canal, stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: hx of Bone marrow transplant 9 months ago now with recurrent fevers and cough History: fever There is a poorly defined left basilar opacity which can represent atelectasis or infection.Heart size normal.Lungs otherwise clear of pleural or other pulmonary abnormalities.No effusion. No pneumothorax.

Output: Poorly defined left basilar opacity which can represent atelectasis or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Ventricular tachycardia arrest. Cardiopulmonary monitoring and support devices are unchanged in position. No pneumothorax. Worsening hazy ground glass opacities in the lower lung fields which may reflect acute edema or less likely aspiration pneumonitis.

Output: Worsening pulmonary opacities, most likely acute pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Acute on chronic heart failure. Pericardial drain appears to have been slightly retracted relative to the position of the IABP when comparing to earlier radiographs with similar patient positioning.Retrocardiac opacity unchanged. Linear atelectasis at the right base. No pneumothorax. Diffuse opacities seen previously have resolved.A right sided peripheral catheter projects over the axilla and is not in a central vein.

Output: No specific signs of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: SOB History: SOB Chronic lung disease consistent with fibrosis and a prior left wedge resection, unchanged.No sign of superimposed edema or pneumonia.Heart size normal.

Output: Small lung volumes with chronic pulmonary fibrosis, but no active process seen.


Instruction: Generate impression based on medical findings.

Input: 44 years old Male. Reason: r/o worsening RLL complicated cavitary lesion History: SOB. Right small pleural effusion with overlying consolidation and atelectasis is stable. Cardiomediastinal silhouette is stable.

Output: Small right pleural effusion with overlying consolidation and atelectasis, unchanged. Stable mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: 87F with Hx of fall \T\ pelvic fracture eval for PNA, atelectasis History: new O2 requirement, rhonchi in RLL Large lung volumes with bronchial thickening, suggestive of COPD with small pleural effusions.No specific evidence of pneumonia or CHF.

Output: COPD and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male status post lung transplant Bilateral chest tubes with interval decrease in size of left-sided pneumothorax.No interval change in bilateral opacities and pleural effusions.

Output: Improving left sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.History of intracerebral hemorrhage, endotracheal tube advanced. ET tube is been advanced and now is approximately 4 cm above the carina. Enteric tube tip is beyond the field of view.The cardiac silhouette is stable.Streaky bilateral basilar opacities are stable.

Output: ET tube advanced, still in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: r/o lung pathology for shortness of breath, vs diaphram perf History: short of breath unable to lie supine 2/2 to pain Low lung volumes.No focal pulmonary opacity, pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.Tunneled right IJ catheter tip in the central SVC.

Output: No specific evidence of infection or edema.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, 68 years old.History: COPD, MAI infection with worsening shortness of breath, productive cough. Stable cardiomediastinal silhouette.No focal airspace opacity.Pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality, no interval change.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, 58 years old.Reason: Lines placement, no new pathology History: Lines Iatrogenic devices are unchanged. Nodular opacities at the lung bases again noted. Unchanged cardiomegaly. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: r/o acute process History: gib, sob The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Cardiomegaly. Widened mediastinum. Syncope. Lungs are clear. Heart size within normal limits. No pneumothorax. No abnormal mediastinal widening is seen.

Output: No significant cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: eval lung fields History: s/p LVAD Intra-aortic balloon pump projects 3 cm below the top of the aortic arch. Swan-Ganz catheter has its tip overlying the main pulmonary artery. LVAD in place. Surgical changes of prior median sternotomy and cardiac valvular surgery are noted. Apparent new enteric tube with tip overlying the distal esophagus.Cardiomediastinal silhouette is apparently magnified and may be enlarged. No focal pulmonary opacity suggestive of pneumonia. Left basilar opacity likely pleural effusion and atelectasis. No pneumothorax.

Output: 1.Intra-aortic balloon pump projects approximately 3 cm below the top of the aortic arch. Swan-Ganz catheter has tip overlying the main pulmonary artery. 2.Apparent new enteric tube with tip overlying the distal esophagus. Recommend further advancement.3.The remainder of the chest is stable.Text paged Roy Tulsi (p1593) with findings @ the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.4 days of SOB and chest pain. Evaluate for fluid overload, infection or widened mediastinum. Cardiothoracic ratio appears moderately enlarged. Mild widening of the superior mediastinum.Enlargement of the central pulmonary vasculature consistent with pulmonary hypertension.Vascular unsharpness most consistent with moderate acute pulmonary edema. No visible pleural fluid. There is relative sparing of edema within the left apex which may be the result of hypoperfusion.

Output: Cardiomegaly with signs of pulmonary hypertension and moderate acute pulmonary edema pattern. Focal sparing of edema in the left apicoposterior segment could indicate hypoperfusion from acute or chronic PE.Mild superior mediastinal widening is present and acute aortic pathology cannot be excluded.This was verbally communicated to the ED resident at extension 4-5481 at 10:39 AM on 6/1/2016 (patient had been discharged).


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.CHF. Edema? Bibasilar opacities, small pleural effusions, and cardiomegaly suggestive of pulmonary edema, appearing similar to the prior study. No evidence of pneumothorax. Again seen is pericardial calcification and probable mediastinal lymphadenopathy. Persistent bronchial wall thickening, appearing similar to the prior study.

Output: Persistent pulmonary edema.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, 56 years old.Reason: Check ETT placement History: intubated Moderate to severe cardiomegaly status post LVAD placement.Mild lower lung zone edema is unchanged.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly and edema, unchanged following intubation.


Instruction: Generate impression based on medical findings.

Input: HypocarbiaVIEW: Chest AP 2/23/15 NG tube tip in the stomach. The umbilical venous catheter tip in the IVC. Cardiothymic silhouette normal. There is a small right-sided pneumothorax unchanged. The right chest tube has been removed in the interval.

Output: Right small pneumothorax unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Pulmonary edema? History of SOB. Low lung volumes. Heart size is at least upper normal. Basal atelectasis 2 200 inflation, limiting assessment of abnormality in the lung bases. There appears to be a partially circumscribed 3 cm masslike opacity projecting over the right lower lobe.Left lower lobe and lingular opacity nonspecific and may reflect atelectatic lung however infection or other pathology cannot be excluded. No pneumothorax. Consolidation in the right costophrenic angle also noted.

Output: Bilateral basal atelectasis and consolidation, infection is not excluded. A rounded masslike focus is also noted in the projection of the right lower lobe, which is incompletely assessed. It is unclear whether this is artifact of summation or an intraparenchymal abnormality. Further evaluation with PA and lateral chest radiographs is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: hx esophageal ca metastic to lung/brain, hx malignant pleural effusion History: chest pain/shoulder pain Right port is currently accessed. There is a stent within the distal esophagus it extends into the stomach, unchanged in position compared to prior radiograph.Moderate right pleural effusion with atelectasis and consolidation unchanged. Apical scarring unchanged. The heart size is normal.

Output: Persistent moderate right pleural effusion, atelectasis and consolidation. Stable position of gastroesophageal stent.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: chest pain History: chest pain Stable cardiomegaly with evidence of prior CABG. No evidence of infection or edema. No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Positive TB skin test. No significant cardiopulmonary abnormality.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for pulm edema vs. atelectasis History: SOB on bipap Severe cardiomegaly with no specific evidence of pulmonary edema or infection.ICD leads in place, unchanged. Large mass at the thoracic inlet deviating the trachea to the right, compatible with a goiterImproved pulmonary inflation with clearing of basilar atelectasis.Small calcified nodules compatible with previous infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: RIJ Cordis placement History: none Increase in interstitial pulmonary edema. No large pleural effusion or pneumothorax. Cardiomegaly, unchanged. Cardiac leads are unchanged. Right IJ sheath in place. Electronic device overlies the right aspect of the heart. No large pleural effusion or pneumothorax.

Output: Increase in interstitial pulmonary edema. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: r/o pneumonia History: fever, hx lymphoma on chemo Patchy, streaky opacity medial segment of right lower lobe has progressed somewhat since the prior study. This could represent infection or atelectasis.Cardiomediastinal silhouette is otherwise unremarkable. Line position stable. No pneumothorax.

Output: Slight progression of streaky opacity medial segment right lower lobe which can represent infection or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: aspiration? History: coughing? Small lung volumes with eventration of right hemidiaphragm.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: chest pain since 10A History: as above Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Prosthetic heart valve. Sternotomy now with pain, serosanguineous drainage rule out sternal dehiscence. By plain film technique, sternal hardware alignment appears similar, but CT would be much more sensitive for the detection sternal dehiscence.Valves prostheses unchanged. Cardiothoracic ratio similar to previous. No pneumothorax, pleural fluid or focal pulmonary opacities.

Output: No acute cardiopulmonary abnormality. Sternal hardware appears similar in alignment, but please note that CT would be much more sensitive.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: evaluate for PNA History: fever and cough, long term smoker Dense right middle lobe atelectasis. Focal mass lesion overlying the left lower lobe which may be extrapulmonary given its sharp margination on PA view measuring 7 x 6.3 cm on lateral image. Normal heart size. Markedly tortuous thoracic aorta. Aortic atherosclerosis. Diffuse osteopenia with midthoracic kyphosis and multilevel compression deformity at this level.

Output: Unexpected focal mass lesion overlying the left lower lobe which may be extrapulmonary. Further evaluation with chest CT is suggested.Dense right middle lobe atelectasis. Superimposed pneumonia or aspiration may be present. Unexpected finding was verbally discussed with Dr. Lisa Mailliard at 4:00 PM on day of study.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Altered mental status. Evaluate for possible pneumonia. No pulmonary or pleural abnormalities. No evidence of infection. Prominent nipple shadows.Cardiomediastinal silhouette is within normal limits.Interval placement of enteric tube, coursing below the diaphragm with tip off the field of view.

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


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: intubation, daily routine History: intubated Tip of Dobbhoff tube within the gastric fundus.Support devices stable.No change in bilateral pulmonary opacities. No pneumothorax.

Output: 1. Stable pulmonary opacities2. Support devices stable3. Dobbhoff tube in gastric fundus


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: dyspnea History: sudden onset dyspnea Heart size upper normal.Basilar interstitial opacities with septal thickening is consistent with edema.Minimal pleural effusions may be present.There is no evidence of infection.

Output: CHF, with mild cardiomegaly and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old. Chest pain. Evaluate for cardiomegaly. Unremarkable cardiac silhouette. No evidence of infection or edema.Lower cervical spine plate and screws.

Output: Unremarkable cardiac silhouette with no significant acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: R/O constricting mass in lungs History: Recent RLL and RML pneumonia with respiratory failure New complete right upper lobe atelectasis, which could be due to mucous plugging or even an endobronchial/central tumor. Minimal basilar atelectasis.Previous right basilar opacities have resolved.Heart size normal.Healed left rib fractures.

Output: New complete right upper lobe atelectasis, which could be due to mucous plugging but a CT is recommended to exclude a obstructing tumor.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female post MVR r/o effusion/CT pull r/o ptx. Left sided PICC has been advanced with tip in the distal left innominate vein. Status post sternotomy.No focal opacities. No pleural effusion or pneumothorax.Stable cardiomediastinal silhouette.

Output: No pleural effusion or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with shortness of breath. Unchanged cardiomediastinal silhouette.Interval increase of innumerable pulmonary metastases as seen on same day CT. No pneumothorax or large pleural effusion.Right chest port with tip in the SVC.

Output: Interval increase of innumerable pulmonary metastases as seen on same day CT.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: Evaluate for pneumonia. History: Fever and cough for 2 days. No past medical history. The heart size is normal. The lungs are clear. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: assess for pneumonia History: leukocytosis, s/s of aspiration Normal cardiac and mediastinal silhouette.Low lung volumes with no focal airspace opacity, pleural effusions, or pneumothorax.

Output: No significant cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: STEMI History: STEMI Small lung volumes with nonspecific left base subsegmental atelectasis and gas distended stomach.NG tube, tip above the GE junction level.ET tube tip approximately 2 cm above the carina.

Output: High NG tube. Nonspecific basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: IABP, swan placement History: ADHF s/p IABP, swan awaiting transplant eval Cardiomegaly. No focal airspace opacities, pleural effusion, or pneumothorax.IABP marker proximal descending thoracic aorta. Swan-Ganz catheter tip remains in right interlobar pulmonary artery. ICD leads unchanged position.

Output: IABP marker proximal descending thoracic aorta. Swan-Ganz catheter tip remains in right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: rule out chest metastasis History: renal cell ca, sp partial nephrectomy The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: swan placement, O2 requirement, distributive shock History: swan No change in left basilar opacity. Support hardware is unchanged.

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


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with chronic lymphocytic leukemia CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Bilateral enlarged lymph nodes in the neck will be better evaluated on the same day CT of the neck.Enlarged mediastinal lymph nodes. Index right paratracheal lymph node measures 14 by 8mm image number 34, series number 4.CHEST WALL: Bilateral enlarged axillary lymph nodes. Index left axillary lymph node measures 18 x 11 mm image number 23, series number 4.ABDOMEN:LIVER, BILIARY TRACT: Hemangioma in the left lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy. Index left para-aortic lymph node measures 5.8 x 4.6 cm on image number 121, series number 4.BOWEL, MESENTERY: Extensive mesenteric adenopathy. Index mesenteric lymph node measures 18 x 12 mm image number 127, series number 4.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Extensive pelvic lymphadenopathy. Index left obturator adenopathy measures 4 x 2.2 cm on image number 170, series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Axillary, mediastinal, hilar, retroperitoneal, mesenteric adenopathy


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: s/p pacemaker r/o pneumothorax History: s/p pacemaker r/o pneumothorax Pleural effusion still present with adjacent atelectasis.Right basilar atelectasis may have improved.No pneumothorax following recent pacemaker placement, a single lead ICD with the tip in expected location of the RV apex although redundant in the right atrium.

Output: No pneumothorax following recent pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: is there a pleural effusion History: history lung cancer with sob, previous thoracentesis about one month ago Persistent dense left perihilar opacity compatible with radiation reaction and possibly residual tumor.Blunting of left costophrenic angle compatible with pleural effusion, increased compared to previous. No sign of pneumothorax or other acute change.

Output: 1. Increased left pleural effusion2. Stable appearance of the left perihilar opacity compatible with radiation reaction and possibly residual tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: 46 y/o here for GI bleed, eval for anemia History: SOB A right port catheter in the axillary location is accessed. This terminates at the superior caval atrial junction.Right middle lobe atelectasis with elevation of the right hemidiaphragm is present. No specific evidence of infection. The pleural spaces are clear. Heart size is magnified. Recommend a straight PA and lateral radiograph when the patient can tolerate.

Output: Elevation of the right hemidiaphragm with suggestion of right middle middle lobe atelectasis. PA and lateral radiograph with full inspiration is recommended when the patient can tolerate.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: eval lung fields History: s/p MVR Tubes and lines unchanged with right IJ Swan-Ganz tip in the pulmonary artery.ET tube with its tip approximately 5 cm above the carina.Stable cardiac enlargement with prominence of the pulmonary artery.No new opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: CM s/p OHT, annual evaluation History: CM s/p OHT, annual evaluation Median sternotomy.Heart size normal.Chronic elevation right hemidiaphragm.No significant pulmonary or pleural abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p 3/16 PleurX catheter placement, History: follow up Pleurx catheter projected over the right lung base with a small residual effusion.Large right lower lobe mass compatible with known primary lung carcinoma.Nodular opacity along the right pleural surface consistent with metastatic disease.

Output: Pleurx catheter directed medially at the right base with a small residual pleural effusion and underlying tumor.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pleural effusion History: anemia, hx pleural effusion Normal heart size with markedly distention of the azygos vein, consistent with azygos continuation of the IVC, previously confirmed by CT scan.No significant pulmonary abnormalities and no visible pleural effusions.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female; 55 years old. Reason: 55 yo w septic shock now s/p dobbhoff placement. Pelvis excluded from field of view. Dobbhoff tip in antropyloric region. Paucity of visualized bowel gas. Small left pleural effusion and associated left basilar opacity, please see dedicated chest radiograph report for further details.

Output: Dobbhoff tip in antropyloric region.


Instruction: Generate impression based on medical findings.

Input: Device placement Interval unchanged left subclavian 2-lead ICD. No immediate postprocedural complications observed other than persistent small effusions, moderate cardiomegaly and basilar minimal atelectasis mixed with probable edema

Output: ICD unchanged with suspected mild CHF


Instruction: Generate impression based on medical findings.

Input: COPD, check for pneumonia. Now shortness of breath Prominent central pulmonary vessels suggesting hypertension without definite superimposed acute focal air space abnormality. Minimal reticular changes greater both bases should be considered which may be chronic. Comparison with prior imaging would be helpful as well as serial imaging if there is concern for early edema. Borderline cardiomegaly.

Output: Nonspecific appearance with suspected chronic appearing interstitial changes however early edema cannot be excluded. Serial imaging should be considered


Instruction: Generate impression based on medical findings.

Input: Reason: s pneumo pneumonia, hypoxia History: 1154 Moderate cardiomegaly with bilateral atelectasis and consolidation, not significantly changed.Catheter tip in the SVC.

Output: Bilateral lower zone atelectasis and consolidation, better demonstrated on a recent CT scan, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left-sided pacemaker unchanged.Mild cardiac enlargement with pulmonary vascular redistribution.Blunting the right costophrenic angle compatible with small effusion.No evidence of pneumothorax..

Output: No evidence of a pneumothorax. Mild cardiomegaly with pulmonary vascular redistribution and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: shortness of breath History: shortness of breath Mild cardiomegaly status post sternotomy.Unchanged pleural effusions and basilar opacities.Right PICC, tip in right subclavian.

Output: Unchanged pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: rule out pneumonia History: respiratory distress Unchanged basilar opacities suggestive of edema and atelectasis with pleural effusions.Heart size upper normal.

Output: Unchanged basilar opacities and pleural effusions most likely edema and aspirated secretions rather than pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: To be performed 3/23 AM History: eval PNA Right IJ venous catheter unchanged. Large area of right upper and middle lobe consolidation similar in appearance to the prior exam.Redemonstration of multiple pulmonary nodules and mediastinal lymphadenopathy.

Output: Right upper and middle lobe consolidation with numerous pulmonary metastases unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval lung fields History: s/p aortic arch replacement Median sternotomy status post aorta repair, with basilar atelectasis and pleural effusions.Multiple chest tubes with no pneumothorax.Although abnormal, mediastinal width is stable postop.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter tip in pulmonary outflow tract.

Output: No change in pulmonary opacities or mediastinal width.


Instruction: Generate impression based on medical findings.

Input: Reason: R/o PNA History: CP, SOB Unremarkable cardiac and mediastinal silhouette. Small lung volumes with perihilar bronchial thickening compatible with bronchitis, unchanged.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Pulmonary edema. Evaluate hardware. Dyspnea. Cardiomegaly with basilar atelectasis, stable. Right jugular line tip over the right atrium. Left jugular line tip over the innominate. No pneumothorax. Other devices stable.

Output: Stable exam. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pressure Minimal atelectasis without additional cardiopulmonary abnormality

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: ETT check ETT has been advanced, currently terminating 3 cm above the carina. Underlying cardiopulmonary appearance is however similar, please see subsequent report

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with CLL/SLL; compare with CT from 11/08. CHEST:LUNGS AND PLEURA: Bibasilar atelectasis is noted.MEDIASTINUM AND HILA: Extensive mediastinal adenopathy. Reference left paratracheal lymph node has decreased in size and measures 1.1 cm x 1.6 cm on image 15/188, series 4, compared to 2.2 x 1.5 cm on the prior study.CHEST WALL: Bilateral axillary adenopathy. Reference right axillary node has decreased in size and now measures 0.9 cm by 0.6 cm (image 18/188, series 4) compared to 1.8 x 1.2 cm on the previous study.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: Stable multiple hypodense lesions in the kidneys bilaterally, likely represent cysts.RETROPERITONEUM, LYMPH NODES: The retroperitoneal lymph nodes are decreased in size with the reference portacaval lymph node measuring 2.1 cm by 1.9 cm ( image 94/188, series 4), compared to 2.9 x 2.0 cm on the prior study.BOWEL, MESENTERY: Decrease in size of extensive mesenteric adenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: There is also been decrease in size of the pelvic lymphadenopathy. Right obturator lymph node now measures 1 cm x 2.5 cm (image 152/188, series 4), compared to 3.8 x 1.6 cm on the prior. BOWEL, MESENTERY: Wall thickening, and fat stranding the cecum, previously described, appears stable and likely represents prior infection. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval improvement of mediastinal, axillary, retroperitoneal, mesenteric, and pelvic lymphadenopathy


Instruction: Generate impression based on medical findings.

Input: Reason: interval change? History: swan, chf, impella Cardiopulmonary monitoring and support devices, unchanged.Impella device extending to the area of the left ventricle.Left lower lobe opacity compatible with atelectasis and aspirated secretions.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: h/o COPD on home O2 complaints of cough, sputum and desats at home History: cough, green sputum, The cardiomediastinal silhouette is unremarkable.Increased lung volumes compatible with COPD.No focal airspace opacities.No pleural effusions.Degenerative changes and kyphosis of the thoracic spine.

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


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: pulmonary edema History: A-flutter after ablation 3/7 Moderate cardiomegaly. Low lung volumes with bibasilar subsegmental atelectasis. No specific evidence of infection or edema.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Intubation. Mild diffuse interstitial opacities appear new from recent PET/CT and are likely edema. Heart size upper normal. Endotracheal tube is 4 cm above the carina.

Output: Mild interstitial edema pattern. ET tube 4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: r/o acute process History: weakness Unchanged cardiomediastinal silhouette. Persistent complete right upper lobe atelectasis, related to known mass with postobstructive atelectasis/consolidation.Unchanged right small effusion/scarring. The left lung is clear.

Output: No significant interval change in complete right upper lobe collapse related to central mass. No new pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: 87yo M w/ leukocytosis, assess for infiltrate History: as above Diffuse hazy opacities with areas of scarring again noted within the right lung. Mild left basilar subsegmental atelectasis or scarring, as before. Heart size, normal, as before. Tortuous thoracic aorta again noted. No pneumothorax.

Output: No new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval for acute cardiopulmonary abnormality History: cough, sob, wheezing Diffuse bronchial wall thickening and bronchiectasis, greatest in the middle and lower lobes. Reticulonodular opacities within the right upper lobe, immediately superior to the fissure. While this may be inflammatory, a nodule cannot be excluded. Continued observation with radiographs recommended. In the absence of resolution, consider CT thorax. Heart size is normal. No significant pleural effusion or associated pulmonary edema.

Output: Bronchiectasis with bronchial wall thickening and emphysema. Right upper lobe nodular opacities may represent impacted bronchi. Continued follow-up to resolution recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: FemaleReason for Study: Reason: serial assessment given worsening O2 requirement, possible aspiration History: increasing O2 requirement The mediastinal silhouette is unremarkable.Left lower lobe opacity unchanged from prior exams.No new pulmonary opacities identified.Multiple surgical clips within the neck and mediastinum unchanged.

Output: Chronic left basilar opacity compatible with known bronchiectasis and mucous plugging. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: interval exam History: interval, new lvad Status post median sternotomy and valve repair.Small lung volumes with retrocardiac atelectasis and possible minimal edema in the right lung base.Pleural and mediastinal drains are unchanged in position with no pneumothorax.IABP catheter distal tip projects over the aortic arch, unchanged.Left jugular Swan-Ganz catheter tip directed towards the right pulmonary artery.Unchanged ICD in LVAD.Right jugular catheter, tip in SVC.

Output: No significant pneumothorax. Unchanged coronary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: evaluate for pneumothorax s/p thoracentesis History: ams Lateral pleural effusion slightly decreased from the prior exam critically on the left.No evidence of a pneumothorax post thoracentesis.Stable cardiomediastinal silhouette.Perihilar interstitial opacities compatible with edema.

Output: Pulmonary edema and bilateral pleural effusions. No evidence of pneumothorax post thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: pna History: pna The lungs are clear. Heart normal in size. No significant cardiopulmonary abnormality identified. No pneumothorax.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 57 years old Female. Reason: neutropenic fever History: neutropenic fever. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. The tip of the right IJ catheter projects over the SVC. There is no evidence of pneumothorax.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with pulmonary hypertension and a right middle lobe pulmonary nodule LUNGS AND PLEURA: Stable well defined right middle lobe nodule (image 51 series 5) measures 18 x 18 mm previously measuring 15 x 17 mm.Scattered pulmonary cysts as well as patchy ground glass opacities and mosaic attenuation are stable.Bronchial and bronchiolar wall thickening more prominent at the lung bases.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Marked cardiac enlargement with a small pericardial effusion.Marked coronary calcifications.Enlarged pulmonary arteryCHEST WALL: Stable mildly enlarged axillary lymph nodes .UPPER ABDOMEN: Stable left adrenal nodule.Splenic calcifications consistent with previous granulomatous disease.Minimal amount of perihepatic ascites.

Output: 1. Continued mild interval growth of the smoothly well marginated right middle lobe nodule.2.Large pulmonary artery compatible pulmonary arterial hypertension.3.Patchy groundglass opacities and mosaic attenuation pattern with bronchial/bronchiolar wall thickening compatible with small airways disease.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with metastatic colon cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Small mediastinal nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous metastatic lesions are again noted. Reference lesion in the left lobe measures 2.8 x 2 cm on image number 80, series number 4, unchanged. The other lesions are also unchanged. Cholelithiasis is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule measuring 1.8 x 1.3 cm is unchanged on image number 90, series number 4.KIDNEYS, URETERS: Nephrolithiasis left lower pole and several renal cysts unchanged. Right kidney is not visualized. Small cystic lesion with punctate calcification in its wall in the right renal bed is unchanged measuring 20 by 16mm on image number 103, series number 4.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal carcinomatosis, amount of ascites is increased. Reference lesion in the right lower quadrant is unchanged measuring 4.9 x 2.5 cm image number 125, series number 4.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: Carcinomatosis and ascites unchanged.

Output: No significant change in the liver metastases. Ascites is increased in size. Other findings also unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval for recurrence of R pneumo History: na Right-sided venous catheter unchanged.Left basilar atelectasis. No evidence of pneumothorax. Right chest tube has been removed.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: Tachycardia. Assess for left lung lower lobe consolidation as cause. History: Tachycardia. Assess for left lung lower lobe consolidation as cause. Left basilar airspace opacity gradually resolving consistent with prior infection or aspiration.Small lung volumes.Drainage catheter and NG tube removed.

Output: Improving left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: evaluate lungs History: trach Small lung volumes with improving consolidation especially in the left base.Tracheostomy tube, the tip at the level of the thoracic inlet.An NG tube extends below the lower margin of the image.Left subclavian ICD, leads unchanged in position.

Output: Improving basilar consolidation with no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p lung transplant History: lung transplant Left lower lobe consolidation and left pleural effusion unchanged.Stable right basilar subsegmental atelectasis or scarring.Heart size upper normal.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: SOB History: above Slight worsening of edema and left upper lobe opacity, with stable pleural effusions.Mild cardiomegaly.IVC filter.

Output: Worsening CHF with pulmonary edema but stable pleural effusions. Increased opacity left upper lobe. This could represent a site of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: eval for pulmonary edema History: dyspnea, flail MR New central lung opacities bilaterally with small pleural effusions. Moderate cardiomegaly, slightly increased from last study.

Output: Congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Runny nose and dry cough. Mild fibrosis post stem cell transplant. Normal heart size. Scarring at the left lung base. No specific signs of pneumonia. No pleural fluid.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Shortness of breath. Mild persistent cardiomegaly. Mediastinal silhouette is unremarkable. No pulmonary opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p TECAB Low lung volumes. Stable small right pleural effusion and moderate left pleural effusion. Left retrocardiac, perihilar, and right basilar airspace opacities have progressed compared to earlier exam and may represent progressive pulmonary edema, atelectasis, or pneumonia. No pneumothorax.The cardiomediastinal mediastinal silhouette appears enlarged but stable.Calcified subcarinal lymph node.

Output: Increased bilateral airspace opacities, consistent with progressive pulmonary edema, however cannot rule out infection.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: concern for broken rib (patient is splinting s/p code). Concern for aspiration pneumonia History: patient with increased respiratory rate ET tube and NG tube removed.Right IJ venous catheter with its tip in the SVC. Stable cardiomediastinal silhouette with bilateral pleural effusions and basilar consolidation/atelectasis.No new pulmonary opacities identified.No obvious rib fracture identified.

Output: Interval extubation. Stable cardiopulmonary appearance with basilar atelectasis/consolidation and bilateral pleural effusions. No obvious rib fractures identified.


Instruction: Generate impression based on medical findings.

Input: Cough. Unchanged cardiomegaly. Left jugular ICD unchanged in position and traverses a left-sided superior vena cava. Within the limitations of motion artifact and bodily habitus, no large pleural effusions or conclusive evidence of pulmonary edema. The central pulmonary vasculature may be enlarged.

Output: Cardiomegaly with signs of pulmonary hypertension. Assessment of the lung parenchyma is limited by artifact of motion and bodily habitus, but no specific signs of edema or pneumonia are appreciated.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: assess for cause of chest pressure (PNA), CP x 4 days History: Chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate known pleural effusions, and for edema or consolidation History: Metastatic urothelial ca, shortness of breath and hypoxia Persistent large right pleural effusion and smaller left effusion.Multiple bilateral pulmonary nodules compatible with metastases, not significantly changed.No specific evidence of infection or other complication.

Output: Extensive metastatic disease with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: Evaluate Lines/Drains/Devices History: Evaluate Lines/Drains/Devices ET tube has been removed.Right IJ Swan-Ganz in chest/mediastinal tubes unchanged.Stable cardiac enlargement.Mild perihilar and basilar opacities are compatible with atelectasis and edema.Small pleural effusions.No significant pneumothorax.

Output: Interval extubation. Remaining support devices unchanged. Stable cardiopulmonary appearance with basilar atelectasis/edema and small effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Altered mental status evaluate for pneumonia. History of bladder cancer. Normal heart size. Calcified hilar lymph nodes and scattered nodules consistent with old, healed granulomatous disease. Nodular opacity in the right lower lobe, nonspecific. Mild basal atelectasis.Nodular opacity at the confluence of the clavicle with anterior left first rib and posterior left fifth ribs, possibly reflecting summation artifact however further evaluation is recommended to exclude the possibility of a nodule.

Output: No convincing evidence of bacterial pneumonia however nodular opacities are seen at the right base and possibly the left upper lobe for which correlation with erect PA and lateral chest radiographs are recommended when feasible, especially given history of malignancy.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval pulmonary edema History: hypoxia Cardiomegaly with moderate pulmonary edema and pleural effusions consistent with CHF.Left axillary vascular stent.

Output: No change in CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Evaluate for IABP location Left subclavian ICD leads and generator in place. Right IJ Swan-Ganz catheter tip in the right descending pulmonary artery. IABP marker in the proximal descending aorta. Right upper extremity PICC tip in the SVC.Cardiomegaly unchanged.No large pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: Unchanged support devices. No acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: bilateral CN VII LMN paresis, evaluate mediastinum for hilar lymphadenopathy History: as above No evidence of mediastinal/hilar mass or adenopathy. No acute cardiopulmonary abnormality.

Output: No evidence of mediastinal/hilar mass or adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.History of cough. Degenerative change noted in the thoracic spine.Cardiomediastinal silhouette is normal.No focal pulmonary opacity or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 61 year old female with history of DCIS on tamoxifen with shortness of breath. Evaluate for PE. IMAGE ACQUISITIONS: Contrast enhanced CT of the chest was performed following administration of 120 mL of IV contrast given at 4 mL/sec. PULMONARY ARTERIES: Technically adequate study with no evidence of PE. The main pulmonary artery is enlarged measuring 3.4 cm in diameter suggestive of chronic pulmonary arterial hypertension.LUNGS AND PLEURA: Multifocal patchy geographic airspace and ground glass with associated bilateral pleural effusions, right greater than left. Distribution is atypical for cardiogenic edema as the opacities are primarily non-dependent. MEDIASTINUM AND HILA: Moderate cardiomegaly. Mild coronary artery calcifications. No pericardial effusion. Multiple mildly enlarged mediastinal lymph nodes are noted; reference pretracheal lymph node measures 9 mm as seen on image 72 of series 5.CHEST WALL: Ill defined spiculated mass in the left breast with multiple adjacent surgical clips (image 65 of series 5) is noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Technically adequate study with no evidence of PE.2. Nonspecific multifocal patchy geographic airspace and ground glass opacities which may be secondary to drug toxicity, acute noncardiogenic pulmonary edema, pulmonary hemorrhage, or atypical infection. Noncardiogenic edema secondary to Tamoxifen may be considered in the appropriate clinical context.3. Cardiomegaly and pleural fluid with enlarged SVC, most suggestive of hypervolemia.Differential diagnosis discussed with the clinical service at the time of interpretation.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: ETT placement ET tube tip approximately 3 cm above the carina.Right jugular catheter tip in the area of the junction of the right jugular and subclavian veins.Moderate cardiomegaly with bilateral nonspecific patchy perihilar airspace opacity, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Evaluate for pneumothorax History: s/p bronchoscopy with biopsy of RML Right middle lobe mass with increasing adjacent opacity favoring atelectasis. Trace bilateral pleural effusions. Smaller left upper lobe nodule noted on the CT and left pleural plaque noted on the CT not well visualized. Opacity at the distal transverse arch extending beyond lumenal calcification compatible with advanced atherosclerotic disease and shallow ulcerations, better characterized on cross-sectional imaging. No interval pneumothorax.

Output: Right middle lobe mass with increasing adjacent opacity favoring atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: submassive PE History: SOB, CP Heart size is upper limits of normal.Patchy bilateral perihilar and basilar airspace opacities and possible small effusions.

Output: Patchy bilateral opacities may represent atelectasis/hemorrhage. Suggestion of enlargement of the pulmonary arterial system may be related to recent PE.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: new consolidation History: fever Right internal jugular chest catheter terminates in the SVC. An enteric tube terminates in the stomach.Diffuse pulmonary opacities appear similar to the prior exam. Small pleural effusions are unchanged. No pneumothorax. The heart size is normal.

Output: Unchanged diffuse pulmonary opacities; the differential diagnosis includes Langerhans cell histiocytosis in addition to disseminated infection.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: PULM EDEMA History: SOB Moderate to large left pleural effusion and very small right.Mild basilar interstitial edema.Left basilar consolidation.A Dobbhoff tube extends below the lower margin of the image.

Output: Pulmonary opacities and pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval ETT, pleural effusions History: intubated, known effusion Unchanged pleural effusions and basilar opacities.ET tube tip 7 cm above the carina.Left subclavian catheter removed.

Output: ET tube tip 7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with ALL, follow up for previous lung opacities LUNGS AND PLEURA: There has been clearing of the left upper lobe ground glass and tree in bud opacities . No new pulmonary opacities are identified.MEDIASTINUM AND HILA: Left PICC line with its tip in the SVC.There is no hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Low attenuation of the blood pool compatible with anemia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Interval clearing of the left upper lobe pneumonia. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Status post robotic-assisted left lower lobectomy and mediastinal lymph node dissection Suture material reflecting left lower lobectomy. Moderate left pleural and small right pleural effusion with adjacent atelectasis.No pneumothorax.Cardiomediastinal silhouette is normal.

Output: Moderate left pleural and small right pleural effusion with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: pre-op, eval for PTX/effusion History: pre-op, eval for PTX/effusion Status post bilateral lung transplant.Left basilar chest tube unchanged.Subcutaneous emphysema is redemonstrated.Moderate bilateral pneumothoraces are stable.No new focal airspace opacities or pleural effusion.Stable cardiomediastinal silhouette.

Output: Stable moderate bilateral pneumothoraces and subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Positive blood cultures No acute cardiopulmonary abnormality other than persistent mildly decreased lung volumes

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: s/p central line placement History: s/p central line placement Interval placement of a right IJ central catheter terminating at the level of the azygos vein. Right PICC remains in stable position. Percutaneous gastrostomy tube projects over the left upper abdomen.Partial resolution of the right lower zone opacities suspicious for infection. Minimal opacities at the left base, stable. No interval pneumothorax. The heart size is stable.

Output: Right lower zone opacities suspicious for aspiration pneumonia decreased. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: ET placement History: intubated Mild cardiomegaly with persistent retrocardiac consolidation.Small left pleural effusion.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the duodenal cap region. Left subclavian pacemaker, leads unchanged in position. Right PICC, tip in right subclavian.

Output: ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: effusion? overload? pna? History: atrial fibrillation, being admitted, light headedness Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 61 years old Male. Reason: Shortness of breath, orthopnea Stable cardiomediastinal silhouette. Basilar atelectasis and chronic elevation of the left hemidiaphragm. Small bilateral lung volume. No specific evidence of infection or edema. The aorta tortuous.

Output: Small lung volume with basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Evaluate for pneumonia versus CHF. Shortness of breath. Stable mild cardiomegaly. Mild vascular congestion. No airspace opacity, pleural effusion, or pneumothorax.

Output: Mild vascular congestion.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: Acute chest vs. infiltrate History: SOB, CP, persistent tachycardia New bibasilar atelectasis or scar. No large pleural effusion or pneumothorax. Typical findings of sickle cell disease within the bones and spleen.

Output: New bibasilar atelectasis or scar.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Intubated, ARDS. ETT tip 4.5 cm above the carina. Right jugular catheter projects over the right atrium. Enteric tube tip off the caudal margin of the film.Worsening pulmonary opacities and atelectasis. Moderate layering pleural fluid, left greater than right

Output: Worsening pleural fluid and edema-like pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Reason for imaging: +Tb quant. R/o active TB History: Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: intubation History: intubation Endotracheal tube terminates 4 cm above the carina. The right IJ central catheter terminates in the superior right atrium. Enteric tube terminates at the abdominal midline.Elevation of the right hemidiaphragm is stable. Extensive bilateral pulmonary opacities still sparing the periphery of the right lung.

Output: Stable, extensive bilateral pulmonary opacities in this intubated patient.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Left subclavian catheter placement. Left subclavian central line tip can be followed to the level of the brachiocephalic venous confluence, the tip is obscured by overlying hardware. Increasing basal airspace opacities. Extensive vascular calcification in the upper abdomen. No pneumothorax.

Output: Basal opacities suggestive of aspirate. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: rule out pneumonia History: reports purulent sputum, febrile overnight Cardiomegaly status post sternotomy and mitral valve repair.Unchanged small pleural effusions.LVAD and ICD stable in position. Right PICC, tip in axillary region.

Output: Cardiomegaly and small pleural effusions. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female 46 years old Reason: is there an infiltrate History: chest pain. Cardiomediastinal silhouette is within normal limits.No focal airspace opacity, pneumothorax, or significant pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: rij line placement History: rij line placement Right internal jugular catheter has its tip at the in the proximal superior vena cava.Interval development of a large right-sided pleural collection in light of recent line placement recent question possibility of a hemothorax. Left-sided basilar scarring appears stable. No pneumothorax. Cardiomediastinal silhouette is stable.

Output: Large right-sided pleural collection concerning for hemothorax.Paged 2457 at the time of dictation to discuss findings.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: ETT pulled back/ hypoxia History: resp failure ET tube tip 4 cm above carina. Other findings stable in short interval.

Output: ET tube tip 4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with metastatic RCC CHEST:LUNGS AND PLEURA: Indexed left suprahilar mass and slight increase in size and now measures 2.1 x 2.8 cm on image number 41, series number 5. Stable micronodules.MEDIASTINUM AND HILA: Index prevascular lymph node has increased in size and now measures 1.6 x 1.7 cm on image number 38, series number 3. Other mediastinal lymph nodes have also increased in size. Second reference node measures 1.3 by 1.1 cm in the AP window on image number 39, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence in the nephrectomy bed. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the hilar and mediastinal index metastases..


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: SOB, Pneumonia History: Aspiration Stable cardiomegaly and vascular congestion however interval development of left basilar opacity with small effusion. This can represent infection/aspiration. No pneumothorax.

Output: Cardiac megaly with interval development of left basilar opacity which can represent infection/aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: IJ placement History: IJ placement Right jugular catheter tip now in the SVC. Other findings stable.

Output: Catheter tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Complicated recent surgery. Fever. Source of infection. CHEST:LUNGS AND PLEURA: A metallic stent is placed in the esophagus within the interval. The esophagus is still dilated.The study is limited due to lack of oral contrast. Previously described loculated pleural fluid collection at the right base laterally has completely resolved. However, at the right lung base medially the collection measuring 9.2 x 2.9-cm communicating with the pulled up stomach containing air fluid levels still persists. Pleural calcifications and right-sided small pleural effusion is unchanged. New trace pneumothorax. Bilateral emphysema and bullous changes in the apices are unchanged.MEDIASTINUM AND HILA: Status post partial esophageal resection with gastric pull-up. Please refer to above discussion. Small mediastinal lymph nodes noted incidentally.CHEST WALL: No significant abnormality notedABDOMEN:eLIVER, BILIARY TRACT: Liver is slightly enlarged, otherwise unremarkable.SPLEEN: No significant abnormality notedPANCREAS: Punctate calcification in the uncinate process, mild pancreatic ductal dilatation in the body and tail and ill-defined hypodensity in the pancreatic head are unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous jejunostomy catheter is in place.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral enlarged common femoral nodes are unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval resolution of the localized pleural fluid collection in the right lung laterally and persistence of the pleural fluid collection communicating with the proximal stomach on the right side medially.Trace right pneumothorax.No change in the pancreatic ductal dilatation with punctate calcification and ill-defined hypodensity. These changes are more likely to secondary to chronic pancreatitis however M.R.C.P. may be helpful for further evaluation. medially.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: r/o edema History: SOB Stable cardiomediastinal silhouette with atherosclerotic changes of the aorta.Lungs are clear.No pleural effusions.Marked degenerative changes of the glenohumeral joints.

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


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Cath alert History: shortness of breath, chest pain x24 hours Borderline enlarged heart size. Subtle basilar interstitial opacities are nonspecific. No effusions. No focal consolidation. Right axillary surgical clips.

Output: Basilar interstitial opacities are nonspecific. No effusions or focal consolidation.


Instruction: Generate impression based on medical findings.

Input: Back pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: evaluate lung fields History: s/p R thoracotomy Right chest tubes, unchanged, with no pneumothorax.Low lung volumes with new mild atelectasis.

Output: No significant pneumothorax. Increased pulmonary opacities.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Cough x 3 months History: Cough The lungs and pleural spaces are clear. Partially air-filled hiatal hernia. Heart size is normal. Atherosclerotic disease of the distal transverse arch. Multiple vascular clips again noted at the base of the neck at the midline and lateral left breast.

Output: No evidence of edema or infection. Moderately sized hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Evaluate for pneumothorax and effusion on right side. History: Status-post thoracentesis on right side this morning. There is interval improvement of the right pleural effusion status-post thoracentesis today. The left pleural effusion appears stable in size with underlying compressive atelectasis. Tiny right apical pneumothorax. The cardiomediastinal silhouette is stable and there is improved pulmonary edema.Two right internal jugular central venous catheters appear stable position terminating in the distal SVC/cavoatrial junction.

Output: Interval improvement of the right pleural effusion status post thoracentesis with tiny right apical pneumothorax, likely not clinically significant. Stable left pleural effusion with interval improvement of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: pt with recent syncopal episode and fall, r/o infection History: no resp The cardiomediastinal silhouette is unremarkable.No focal areas of consolidation.Increased reticular nodular predominantly basilar interstitial opacities most likely chronic in origin.There are no pleural effusions.

Output: Chronic appearing reticulonodular interstitial opacities without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with prostate cancer. End stage renal disease. Evaluate disease status. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Heterogeneous left lobe of the thyroid extending retrosternally. Extensive coronary artery calcifications. Mild cardiomegaly.CHEST WALL: Gynecomastia. Left-sided venous access device is in expected position. There are venous collaterals at the right chest wall. The superior vena cava appears narrowed, probably due to partial occlusion.ABDOMEN:LIVER, BILIARY TRACT: Several hepatic cysts are again noted. The cyst in the left lobe is unchanged. Scattered hepatic calcifications, probably due to old granulomatous disease.SPLEEN: Multiple punctate calcifications, probably due to old granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral thick and nodular adrenal glands, unchanged.KIDNEYS, URETERS: Atrophic kidneys with multiple cysts, unchanged. Changes are compatible with history of end stage renal disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse duodenal wall thickening, especially in the second and third parts, suggests duodenitis. The appendix is diffusely enlarged measuring up to 1.8 cm in diameter seen best on axial images 126 -- 141/204. This appendiceal enlargement was present on the prior examination and appears unchanged.BONES, SOFT TISSUES: Sclerotic lesion in T11 vertebral body is unchanged. Punctate sclerotic focus in the left femoral neck and left ischium are unchanged.OTHER: Nonobstructive umbilical hernia contains nondilated small bowel loops.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder is small and has a thick wall, which may be secondary to radiation therapy or cystitis or chronic disuse.LYMPH NODES: Left inguinal adenopathy measures 3 x 4.2 cm on image number 192 is not significantly changed. Right inguinal adenopathy is larger.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of lumbosacral spine and pelvis.OTHER: Fat-containing inguinal hernias.

Output: Increased bilateral inguinal adenopathy and stable T11 vertebral body lesion.Duodenal wall thickening is new. Enlarged appendix is stable.No other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval lung fields History: s/p CABG The endotracheal tube tip terminates 3 cm above the carina. The right IJ tip terminates at the confluence of the right brachiocephalic and internal jugular vein. The sternotomy hardware is intact. There are two left-sided chest tubes in place.Low lung volumes. Small left pleural effusion and bihilar/left basilar atelectasis similar to prior. No pneumothorax.The cardiac and mediastinal contours are within normal limits for size. Subcutaneous emphysema along the left chest wall improved from the prior.

Output: Small left pleural effusion and associated atelectasis similar to prior.


Instruction: Generate impression based on medical findings.

Input: ETT placement ETT remains 4 cm above the carina. NG extends beyond the inferior edge of the imageLarge lung volumes with marked COPD changes with associated minimal patchy airspace opacities minimally greater in the right with small effusions are new superimposed upon mild interstitial chronic changes. Aspiration and/or possible infection must be considered, again more likely on the right. Serial imaging will be important to help differentiate. Old granulomatous disease exposure

Output: Unchanged ETT with persistent nonspecific mixed patchy opacities greater in the mid right lung. Concern for possible infection and/or aspiration requiring serial imaging


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: diagnosed with pna, on azithro with continued sob History: above Increased consolidation within the lungs, left greater than right. Query small pleural effusions. Unchanged heart size. No pneumothorax.

Output: Worsening bilateral consolidation certainly consistent with pneumonia though bilateral involvement suggests possible component of pulmonary edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: POD 1 right upper lobectomy History: POD 1 Chest tubes extending into the right apex with no significant pneumothorax.Mediastinal widening right upper lobe opacity compatible with postoperative contusion and atelectasis.Port catheter with its tip in the upper right atrium.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: R/o infection in patient with persistent leukocytosis, sickle cell History: R/o infection in patient with persistent leukocytosis Right-sided chest port has its tip at the inferior cavoatrial junction.The cardiomediastinal silhouette is unremarkable. Low lung volumes. No focal pulmonary opacity suggestive of pneumonia or acute chest syndrome. No pleural effusion.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male presents with chest wall tenderness after a fall. Evaluate for fracture. The cardiomediastinal silhouette is normal. No focal pulmonary opacity or pleural effusion.Mild cortical irregularity of right fourth posterior rib and the fifth right posterior rib are consistent with age indeterminate rib fractures. Correlate with point tenderness. No pneumothorax.

Output: Age indeterminate fractures of the posterior right fourth and fifth ribs; correlate with point tenderness. No associated pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Wheezing. Evaluate for pneumonia. The cardiomediastinal silhouette is normal. There is no pleural effusion, pneumothorax, or abnormal pulmonary opacities to suggest infection.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: left thoracentesis, eval for pneumothorax History: loculated pleural effusion in lung transplant and CF patient No pneumothorax or other acute change.Diffuse nonspecific airspace opacity and partly loculated pleural effusions, as previously described. Interval removal of right jugular catheter. An insertion of a new left jugular catheter with its tip at the SVC/R knee junction.

Output: New catheter with no complications. No pneumothorax following thoracocentesis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT, lung fields History: s/p TAH ET tube tip approximately 4 cm above the carina.Venous catheters and mediastinal drains in place.Total artificial heart and multiple surgical sponges projected over the mediastinum and upper abdomen.Cardiomegaly with pulmonary edema and a large layered out right pleural effusion.Basilar opacity compatible with atelectasis and consolidation.No significant pneumothorax.

Output: Status post total artificial heart surgery with edema, atelectasis and a large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Malignant pleural effusion. Low lung volumes. Small pleural effusions. Severe interstitial edema. Atelectasis and airspace opacity at the lung bases nonspecific. Scattered pulmonary nodules.

Output: Severe pulmonary edema with small pleural effusions and atelectasis. Pulmonary nodules or areas of airspace opacity may be due to known metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: CT-ICU patient History: CT-ICU patient Iatrogenic devices are unchanged. Diffuse pulmonary edema pattern, not substantially different. Dense retrocardiac opacity is again noted. Probable left pleural effusion, as before. No pneumothorax. Unchanged cardiac megaly.

Output: Diffuse pulmonary edema, left basilar opacity, and left pleural effusion again noted.


Instruction: Generate impression based on medical findings.

Input: Female; 59 years old. Reason: f/u ground glass appearance pulmonary hemorrhage vs drug reaction History: f/u ground glass appearance pulmonary hemorrhage vs drug reaction LVAD and other support devices unchanged.Severe cardiomegaly and diffuse bilateral interstitial opacities appearing similar to prior. There is relative sparing of the bases.

Output: Unchanged midlung zone interstitial predominant opacities which may represent atypical edema and less likely drug reaction or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male status post renal transplant in 2006 male with likely acute kidney failure with decreased urine output. SOB and hypoxia, and hemoptysis x 3 days. Rule out nephrolithiasis hydronephrosis pulmonary edema pneumonia. Replaces previous request CHEST:LUNGS AND PLEURA: Severe diffuse patchy fluffy airspace disease in a pattern consistent with pulmonary edema. Underlying pneumonia cannot be excluded. There is some focal dense consolidation or atelectasis in the right base. No effusions however. Also consider drug reaction and pulmonary hemorrhage. There does not appear to be vascular redistribution.MEDIASTINUM AND HILA: Multifocal small nodes in the precarinal, AP window and prevascular spaces.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs or bowel due to the lack of IV or oral contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: Contracted gallbladder with gallstones. No obvious biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small consistent with chronic medical renal disease bladder with ex tensive but symmetric bilateral perinephric fat stranding. No obvious hydronephrosis or hydroureter. No pathologic calcifications.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes.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 noted. Minuscule amount of free fluid in dependent portion of pelvis.BONES, SOFT TISSUES: Radiopaque foreign body in the region of the right gluteus muscle possibly bullet fragmentOTHER: Renal allograft right iliac fossa with no hydronephrosis. No perinephric fat stranding. No perinephric fluid collections.

Output: Diffuse fluffy pulmonary airspace disease differential includes edema, hemorrhage, drug reaction, infection.Bilateral small kidneys with perinephric fat stranding marked, but symmetric. Cholelithiasis. Minimal free fluid in the pelvis. Radiopaque foreign body or right gluteus area.


Instruction: Generate impression based on medical findings.

Input: Reason: 58yo M with biV CHF and swan ganz. History: dyspnea, LE edema Cardiomegaly with mild interstitial opacity compatible with edema.Swan-Ganz catheter tip in the main pulmonary artery.ICD leads, unchanged. No new findings.

Output: CHF with interstitial edema and no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Status post CABG/AVR? LV air lucency on prior chest radiograph. Lucency projecting over the mid and lateral aspect of the cardiac silhouette, in addition to air associated with the IABP and the sternotomy, about the same. This is most likely represents postoperative pneumopericardium and air associated with the sternotomy site.Allowing for differences in patient projection, tubes and lines are similar in position. Lung volumes remain low. No specific signs of pulmonary edema.

Output: Lucency projecting over the left heart may be intra-pericardial and/or associated with the sternotomy but appears increased from the most recent postoperative exam of 1/30/15 at 14:47 hours. Findings discussed with Ryan Brunner at 3:35 p.m. on 1/31/2015.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of metastatic bladder cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Small superior mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small hypodensity in the posterior aspect of the spleen is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesions in both kidneys are unchanged.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy. Index left para-aortic lymph node measures 11 mm in diameter image number 123, series number 4. Multiple other smaller retroperitoneal lymph nodes are also present.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatectomy.BLADDER: Status post cystectomy. Ileal pouch with ostomy.LYMPH NODES: Some soft tissue fullness in the right obturator region abutting the right internal iliac vessels is slightly more prominent on this study. Lack of IV contrast limits optimal evaluation of this region. Ill-defined soft tissue density measures 2.9 x 2.2 cm in image number 180, series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval development of retroperitoneal adenopathy. More prominent ill-defined soft tissue density in the right pelvis, again suspicious for metastatic disease. MRI of the pelvis may be helpful for better characterization of this area, if clinically indicated. No other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64yo M s/p intubation, ETT placement History: as above Patient is markedly rotated. Likely little change in the basilar opacities and pleural effusions. Line position stable. The thorax.

Output: Likely will interval change in basilar opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly.

Output: Mild cardiomegaly. Clear lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old. Enteric tube seen with side-port in mid esophagus and further advancing by approximately 18 cm recommended. Nonobstructive bowel gas pattern. Right upper quadrant postsurgical material. Ovoid radiodensity in right upper quadrant likely a colonic diverticulum containing contrast/inspissated material. Presumed posttraumatic sequela involving left iliac wing. Soft tissue density in lateralmost aspect of right lower quadrant may correspond to inflammation adjacent to air and fluid containing collection better seen on prior CT imaging. Low lung volumes.

Output: Further advancing of enteric tube recommended, additional findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: infiltrate, edema History: advanced heart failure with hypercarbic resp failure Worsening right-sided opacities suggestive of aspiration superimposed on edema, with an enlarging right pleural effusion.Heart size upper normal.Right jugular Swan-Ganz catheter removed.An NG tube terminates in the stomach.

Output: Worsening right-sided opacities and pleural effusion suggestive of aspiration or infection.