Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: evaluate for pneumonia History: right sided crackles, rales, hypoxemia Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Cough Mild chronic appearing scarring in both bases without superimposed acute cardiopulmonary abnormality. Marked tortuosity of the aorta also stable in appearance

Output: Chronic appearing scarring without superimposed acute abnormalities


Instruction: Generate impression based on medical findings.

Input: Age: 38 yearsGender: FemaleReason for Study: Reason: Consolidation, atlectasis History: R chest pain, cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Dextroscoliosis 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: Male, 72 years old.Severe sepsis with septic shock. Right IJ TLC. Right jugular catheter tip in the right atrium. Mild edema-like opacity. Patchy opacities consistent with atelectasis bilaterally. Probable very small pleural effusions.

Output: Right jugular catheter tip at the level of the right atrium, no pneumothorax. Mild hypervolemia and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: r/o pneumonia History: SOB, fever Left basilar subsegmental atelectasis or scarring.Heart size normal.No specific evidence of infection or edema.

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


Instruction: Generate impression based on medical findings.

Input: Positive TB test No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: new hypoxic episode History: new hypoxic epidosde Stable position of endotracheal tube and other port devices. No pneumothorax.No significant interval change in the diffuse bilateral interstitial and alveolar opacities.

Output: No change in the bilateral lung opacities. Support devices stable in position.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: 47 yo M w C diff and legionella PNA c/b ARDS on ECMO with ileus, symptomatically stable, eval ECMO cannulae History: na No change in ECMO cannula and enteric tube.No change in patchy bilateral airspace and interstitial opacities.

Output: Stable pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female status post right modified radical mastectomy for IDC grade 3 with lymph node involvement. CT scan for metastatic workup. CHEST:LUNGS AND PLEURA: Few subpleural micronodules bilaterally and a punctate calcified granuloma in the right lower lobe. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Left chest port catheter with catheter tip in distal SVC. Right axillary surgical clips. Right chest wall drain.ABDOMEN: LIVER, BILIARY TRACT: Punctate hepatic hypodensities too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Circumaortic left renal vein, normal anatomic variant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Punctate sclerotic focus in the left humeral head (series 3, image 8) and as well as a 5 mm sclerotic focus in the right glenoid are compatible with benign bone islands.Punctate sclerotic focus in the left transverse process of the T9 vertebral body (series 3, image 65) is also favored to be a benign bone island.Minimal degenerative changes of the spine.

Output: No definitive evidence of distant metastases. Few probable benign bone islands as above.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: aspiration pneumonia Right IJ tip terminates in the SVC. Enteric feeding tube tip terminates in the proximal gastric body. Gastric LAP-BAND position unchanged.Streaky bibasilar opacity consistent with atelectasis slightly improved form the prior. Mild cardiomegaly persists.

Output: Mild bibasilar atelectasis improved from the prior.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: hypoxia. pneumothorax? pulm edema? History: hypoxia No focal lung consolidation. No large pleural effusion or pneumothorax. Heart size at the upper limit of normal.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: OG tube advanced, monitor placement History: OG advance Interval development of small right pleural effusion. No other interval changes.

Output: Interval development of small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Cardiomegaly with redistribution of the pulmonary blood flow and atelectasis in the right mid lung versus fluid in the minor fissure.Minimal streaky opacities left lung base.No reliable evidence of infection.

Output: Cardiomegaly with foci of subsegmental atelectasis, but no reliable evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: chest pain, fever, chills Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.History of spontaneous pneumothorax. Left anterior air lucency at the level of the aortopulmonary window may contain internal vascular markings on the lateral radiograph, favoring paramediastinal emphysema over a pneumothorax. Left hemithorax volume loss with apical and basal pleural and parenchymal scarring, correlate for history of pleurodesis. Left anterior lung scarring has increased from the prior study. Scoliosis. Right lung is without acute abnormality.

Output: Anterior air lucency in the left lung is favored to represent paraseptal/paramediastinal emphysema over pneumothorax. Follow-up inspiration and expiration technique chest radiographs would be more sensitive for detection and confirmation of pneumothorax if required.


Instruction: Generate impression based on medical findings.

Input: Reason: please evaluate for pneumonia History: cough Mild scarring at both lung bases but no sign of pneumonia.Feeding tube coiled in the stomach.Bullet projected over the left axilla.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain Status post right lung transplant with severe emphysema in the left native lung.Bilateral skin folds but no pneumothorax.Unremarkable cardiac and mediastinal silhouette.

Output: Status post right lung transplant with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: Pna History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: s/p PICC, pulled back 5cm Left-sided PICC has been pulled back now terminating within the most inferior aspect of the left internal jugular vein. No substantial change in bibasilar pleural-parenchymal opacities. Left pleural effusion again noted. Unchanged heart size. Aortic stent, unchanged.

Output: Left-sided PICC has been pulled back now terminating within the most inferior aspect of the left internal jugular vein.


Instruction: Generate impression based on medical findings.

Input: 14-year-old male with history of NF1, autism, and gynecomastia. No history of fever or trauma. Please evaluate axillary mass. Left shoulder: Focal lesion in the left axilla along the median and ulnar nerve distribution has increased peripheral STIR signal and a stellate, low signal centrally. This lesion measures 3.1 x 2.6 x 4.1 cm (series 501, image 41) and has a somewhat atypical appearance for a plexiform neurofibroma. Multiple additional small plexiform neurofibromas are present distally along the medial aspect of the left arm in the median and ulnar nerve distribution.Chest: Multiple neurofibromas are present in the mediastinum including the right paratracheal and prevascular spaces. Numerous additional neurofibromas are present along the inferior surface of the ribs, paraspinal region, and brachial plexus bilaterally. Multiple small plexiform neurofibromas are present in the subcutaneous tissues.

Output: 1. Probable large plexiform neurofibroma in the left axilla which is somewhat atypical in appearance. 2. Multiple additional small neurofibromas throughout the chest.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: eval tube placement History: sob, hypoxia, intubated ET tube and NG tube unchanged.Stable cardiac mediastinal silhouette.Increasing interstitial/airspace opacities, more prominent on the right, compatible with edema.Small pleural effusions.

Output: Support devices unchanged. Increasing predominantly right-sided pulmonary edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: AMS s/p intubation tube placement History: ET tube placement Endotracheal tube is seen with tip approximately 1 cm above carina.Low lung volumes. Left basilar opacity representing effusion and/or atelectasis. Mid-upper lung zones are essentially clear. The mediastinal silhouette is within normal limits.Tip of nasogastric tube in the projection of the gastric pylorus.

Output: Interval intubation. Hypoinflation persists. Progression of left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: S/p chest tube removal History: S/p chest tube removal for PTX Interval removal of left chest tube.No significant interval change in the appearance of pulmonary opacities and pleural effusions. No pneumothorax.

Output: Interval removal left chest tube with no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval lung fields, atelectasis History: trached Portable semierect radiograph demonstrates support devices unchanged in position. Persistent low lung volumes with basilar opacities of subsegmental atelectasis. No interval pneumothorax.

Output: Stable position of support devices with persistent low lung volumes.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: evaluate lungs and mediastinum History: sob Right-sided pleural thickening and pulmonary parenchymal scarring appear similar to the prior; however, there is a new superimposed bibasilar interstitial opacity suggestive of pulmonary edema. Possible small left pleural effusion versus pleural thickening unchanged. Sternotomy hardware intact. Cardiomegaly unchanged.

Output: Persistent right-sided pleural-parenchymal scarring, but with probable new superimposed mild pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: cough for one month History: as above The cardiac and mediastinal contours are within normal limits.The lung volumes are normal. No abnormal focal lung parenchymal opacities.The pleural spaces are within normal limits.No osseous lesions are present.

Output: Chest radiograph within normal limits.


Instruction: Generate impression based on medical findings.

Input: Reason: worsening SOB in pt with EF 30%, evaluate for worsening pulmonary edema History: SOB Bilateral streaky perihilar opacities compatible with edema and possibly aspiration, slightly increased. Catheter tip in the SVC.

Output: Slightly increased perihilar opacity compatible with edema and possibly aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Difficulty swallowing, prior history of esophageal rupture now with esophageal strictures evaluate for pneumomediastinum. No visible pneumomediastinum. Unchanged cardiomediastinal silhouette.No pneumothorax or other acute pulmonary process. Mild basal scarring on the left. Atherosclerotic calcifications of the thoracic aorta.

Output: No visible pneumomediastinum, though please note that pneumomediastinum is often not visible by plain film until large and if there is continued clinical suspicion, CT would be suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: fluid balance History: NICM A fib, AICD fired Small lung volumes with equivocal edema as there is thickening of the fissures on the lateral view.No large pleural effusions.Mild cardiomegaly.

Output: Mild cardiomegaly, equivocal evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: PICC line placed a prior admission, check position History: PICC line, placed at prior admission, check position Stable cardiomediastinal silhouette.Low lung volumes with no focal airspace opacity, pleural effusion, or pneumothorax.Interval placement of right PICC line with tip in the SVC.Stable positioning of IVC filter.

Output: Interval placement of right PICC line with tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: intubated History: intubated ET tube tip 4 cm from the carina.Other support devices unchanged.Basilar edema, atelectasis, and layering effusions.Moderate cardiomegaly.Wide mediastinum likely accounted for by rotation.

Output: Line position stable. No change in basilar opacities and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: ETT History: ETT placement Interval placement endotracheal tube with tip approximately 4 cm above the carina. Right chest port is present with tip at the cavoatrial junction.Again seen are multiple bilateral pulmonary nodules and masses consistent with metastases appearing similar to the prior exam. No large pleural effusion or pneumothorax.

Output: Interval placement of endotracheal tube with tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: asthma exacerbation Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Mild nonspecific bronchial thickening.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval lung fields, cardiac size History: s/p AV canal repair Small residual pneumopericardium, but no pneumothorax.Mild basilar edema.Stable heart size.Chest tubes and right jugular catheter unchanged.

Output: No pneumothorax. Stable heart size with mild basal edema.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with history of head and neck cancer, unknown primary. Status post CRT. Evaluate for disease, compare to previous. CHEST:LUNGS AND PLEURA: Interval resolution of ground glass opacities in the right lower lobe. Few pleural based nodules posteriorly, likely postinflammatory in etiology. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Possible anomalous origin of the right coronary artery from the left coronary cusp; however this is a non-gated examination with motion artifact limiting evaluation. Prior studies are equivocal to this regard. CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Stable juxta-caval hypoattenuating lesion in the caudate lobe (series 3, image 97); it was seen on initial CT from 6/2010. Unchanged hemangioma adjacent to the gallbladder fossa (series 3, image 125).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No evidence of metastatic disease.2. Possible anomalous origin of the right coronary artery from the left coronary cusp; however this is a non-gated examination with motion artifact. Prior studies are equivocal to this regard. If this requires further work up a dedicated gated cardiac CT or MR would be diagnostic.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p MVR, CABG Interval extubation. Swan-Ganz catheter tip in the main pulmonary artery.Cardiomegaly with basilar opacity compatible with atelectasis and effusion.Mediastinal drains in place with no pneumothorax.

Output: Interval extubation and no other acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: hypoxia, fever History: eval for worsening pulm opacities Unchanged airspace opacities and very small pleural effusions.Heart size normal.Right jugular catheter tip at cavoatrial junction.A Dobbhoff tube terminates in the stomach.

Output: Unchanged airspace opacities suggestive of infection or atypical edema.


Instruction: Generate impression based on medical findings.

Input: 90 year-old female with right lower quadrant pain, low-grade fever. Evaluate for perforated appendix. CHEST:LUNGS AND PLEURA: Again noted are numerous bilateral round pulmonary nodules, greatest in the lower lobes, the largest measuring 2.2 x 2.0 cm in the left lower lobe (series 5; image 73). Several of the right upper lobe nodules demonstrate cavitation.Minimal bilateral pleural effusions are identified.MEDIASTINUM AND HILA: Small right supraclavicular and paratracheal lymph nodes are identified, the largest measuring 13 x 11 mm (series 3; image 39) in the paratracheal region.Dense coronary artery calcifications. Calcification of the aortic arch.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous hypodense, ring enhancing lesions are present throughout all lobes, unchangedSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large cecal lesion is again identified, which extends into a dilated appendix which measures 1.7 cm. Mild adjacent fat stranding is again noted. However, a small amount of fluid adjacent to the lesion which extends into the pelvis is now visualized. No free air is identified.A small omental lesion (series 3; image 105) is compatible with metastasis. Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diffuse atherosclerotic disease.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter is noted in the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal ascites layers in the pelvis.

Output: Diffuse metastatic lesions, described above.Mildly increased amount of fluid adjacent to the cecal lesion which layers in the pelvis without free air. Findings can be due to inflammation, although microperforation cannot be excluded


Instruction: Generate impression based on medical findings.

Input: History of splenomegaly, retroperitoneal adenopathy and pulmonary nodules CHEST:LUNGS AND PLEURA: Bilateral scattered subcentimeter nodules are unchanged from previous study. An index nodule in the right upper lobe measures 6 mm in diameter image number 18, series number 12.MEDIASTINUM AND HILA: Partially calcified mediastinal and hilar adenopathy, unchanged from previous study. Index precarinal node measures 1.3 by 1.1-cm on image number 36 nausea is normal in level and.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenomegaly, mild, unchanged from previous study. Spleen measures 12 .4 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. Index precaval node measures 1 x 1 cm image number 126 of series number 11.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic lymph nodes. Index left external iliac node measures 1.3 x 0.9 cm in image number 171, series number 11.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral, nonspecific are scattered lung nodules.Calcified mediastinal and hilar lymph nodes.Borderline enlarged retroperitoneal and pelvic lymph nodes. Mild splenomegaly. No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: sob, hypoxia History: hypoxia Nasogastric tube has been advanced and is coiled in the gastric body, directed cranially. Right IJ catheter unchanged in position.Decreased lung volumes with progressive pulmonary edema. Small pleural effusions. A skinfold projects over the left thoracic inlet; no pneumothorax is present.

Output: Progressive pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of transitional cell carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Benign adrenal lesions are unchanged. Right adrenal lesion measures 2.4 x 2.9 cm. left adrenal lesion measures 3.4 x 2.6 cm. KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The patient is status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral adrenal lesions are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: hx of cough, pulm edema Moderate cardiomegaly with pacemaker leads and an aortic valve prosthesis, unchanged.Interstitial pulmonary opacity compatible with edema with moderate effusions and basilar atelectasis.Slightly improved pulmonary inflation and no other significant change.

Output: CHF with slightly improved pulmonary inflation.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate pneumothorax History: pneumothorax Left chest tube in place with a small residual pneumothorax and small pleural effusion.No new findings.

Output: Small left pneumothorax, possibly slightly increased, and effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: FemaleReason for Study: Reason: cardiomegaly, pulm edema History: DOE, LE edema new x 1 week Portable and cardiac enlargementThe lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with history of cervical cancer and rectal mass and history of partial small bowel obstruction. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Unchanged hypodense lesions in the liver. Largest is in the left lobe and measures 2.3 x 1.8 cm, not significantly changed from previous CT.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodularity of the left adrenal gland is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Interval increase in the dilatation of the small bowel segments with decompressed distal ileal segments with a transition point in the pelvis on image number 111, series number 3. Presence of oral contrast in the distal ileum likely suggest partial obstruction. At the level of the transition point. There is intussusception of the small bowel segments likely secondary to a lead point formed by a metastatic/recurrent focus or an effusion. No free air to suggest perforation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Right vulvar mass measures 2.2 x 2.4 cm, not significantly changed from previous study. This may represent recurrent tumor.

Output: Partial small bowel obstruction with interval worsening compared to previous CT. The transition point is at the pelvis with a focal area of intussusception.Right vulvar mass has not significant changed. These findings were communicated with and acknowledged by Dr. Theodesis on 2/22/2009 at 9:15 a.m.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Chest pain. Elevation of the right hemidiaphragm. Basal atelectasis. No focal airspace opacities or pneumothorax. Cervical spine hardware partially visualized. The costophrenic angles are excluded from the image and cannot be assessed.

Output: No acute pulmonary abnormality, the lateral costophrenic angle regions are not included on the image and cannot be assessed.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: mechanical obstruction, mass History: dysphagia Cervical immobilization hardware is again visualized.The right costophrenic angle is excluded from the field-of-view. Fine detail is limited by technique. No evidence of edema, infection or significant pleural effusion. The heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Recent colon cancer resection now with bleeding per rectum. Evaluate for pouchitis also evaluate for progression of metastatic disease. Abdominal pain and anemia. CHEST:LUNGS AND PLEURA: Emphysematous changes in both lung apices. Scarring and faint ground glass and opacity noted at both lung bases. No definite pulmonary metastases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly as noted previously with no focal liver lesions suspicious for metastatic disease.SPLEEN: Mild splenomegaly as noted previously.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: New left hydronephrosis and hydroureter secondary to a new enhancing lesion anterior to the left psoas muscle (image 119; series 4) which measures 2.4 x 2.0 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ostomy. 1.5 x 1.5 cm omental implant (image 105; series 4) inferior the gastric body in the left midabdomen. Probable additional metastatic implant identified in the right midabdomen (image 118; series 4 and image 63; series 80348) invading small bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Ill-defined presumed residual or recurrent mass adjacent to multiple surgical clips in the left hemipelvis which measures 3.2 x 4.9 cm (image 140; series 4). Additional metastatic implant noted on the left lateral pelvic side wall anterior to the external iliac artery and vein (image 51; series 80348).BONES, SOFT TISSUES: No significant abnormality notedOTHER: Free fluid in the pelvic cul-de-sac.

Output: 1. Peritoneal spread of tumor with multiple sites of disease as measured above. 2. New left hydronephrosis and hydroureter secondary to metastatic lesion anterior and contiguous with the left iliopsoas muscle. 3. Residual or recurrent disease in the left hemipelvis adjacent to surgical site.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: Acute chest? History: chest pain Small lung volumes.No significant abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with metastatic renal cell cancer CHEST:LUNGS AND PLEURA: New centrilobular subcentimeter nodules in the right lower lobe and right middle lobe. The etiology is more likely to be infectious, however, possible to metastatic disease cannot be entirely excluded. Postsurgical changes in the right middle lobe is unchanged.MEDIASTINUM AND HILA: Reference subcarinal lymph node measures 12 x 11 mm image number 30 cyst on series number 8, unchanged. Reference anterior diaphragmatic lymph node is smaller measuring 9 x 7 mm on image number 74, series number 6.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: Left adrenal nodule measuring 11 x 13 mm unchanged on image number 88, series number 6. KIDNEYS, URETERS: Right kidney is absent. Left kidney has multiple hypodensities which are unchanged from previous CT likely representing simple cyst. Cortical scarring in the lower pole of the left kidney is also unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metastatic left pubic bone lesion, slightly more prominent compared to previous CT. OTHER: No significant abnormality noted.

Output: Expansile metastatic lesion in the left pubic bone. Adrenal lesion is unchanged.New subcentimeter nodules in the right lower lobe as well as in the right middle lobe. The etiology of these nodules is not certain however their distribution suggests an infectious etiology, however, metastatic disease cannot be entirely excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: sob History: SOB Chronic elevation of the right hemidiaphragm with no change in small bilateral pleural effusions. No specific signs of infection or interval change.No evidence of pneumothorax.

Output: Chronic elevation right hemidiaphragm with no change in small bilateral pleural effusions but no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: Assess trach placement History: as above Tracheostomy tube and right central venous catheter unchanged.Moderate/marked cardiac enlargement with evidence of pulmonic valve prosthesis.Decreased lung volumes with elevation of the right hemidiaphragm and basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.Median sternotomy with fractured inferior sternal wire again identified.

Output: Cardiomegaly and basilar atelectasis without acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: post op resp failure History: resp failure Unchanged patchy airspace opacities with pleural effusions.Stable cardiomegaly.ET tube tip approximately 4 cm above the carina.NG and Dobbhoff tubes extend below the lower margin of the image.Right jugular catheter, tip at cavoatrial junction.Bilateral chest tubes with no pneumothorax.

Output: Unchanged pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: assess for infiltrate History: productive cough Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No specific findings of pneumonia. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Traumatic injury. Fall. Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Probable aspirated secretions left lower lobe. No evidence of pulmonary edema or specific signs of pneumonia. No pneumothorax. Upper normal heart size. Atherosclerotic calcification of the thoracic aorta at the level of the arch. Calcified right hilar region and mediastinal lymph nodes. Degenerative changes of the glenohumeral joint space and spine.

Output: No pneumothorax. Probable aspiration of secretions into the left lower lobe may be followed on a nonemergent chest radiograph given patient's age to assess for clearance. Please note that fracture may not be visible by chest technique and if the patient is experiencing any localized pain then dedicated bone-technique radiographs of the area would be recommended.


Instruction: Generate impression based on medical findings.

Input: SOB. Enteric tube projects over the distal stomach.Presternal ICD in place.Main pulmonary artery appears slightly prominent which is suggestive of pulmonary hypertension.Left costophrenic angle blunting unchanged and may be due to small volume of pleural fluid or scarring.No specific signs of pulmonary edema or pneumonia.Left upper lobe hazy opacity overlying the lateral margin of inferior scapula.Basal and retrocardiac atelectasis, left greater than right.

Output: Atelectasis and hazy opacity in the left lung along with minimal pleural fluid nonspecific and could be due to aspiration however PE may be considered in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: 58 year-old female with left-sided pleuritic chest pain, history of submassive PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic the level of the subsegmental pulmonary arteries.Mild basilar atelectasis and/or scarring.LUNGS AND PLEURA: Calcified granuloma in the right lower lobe. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.The esophagus is fluid-filled in the mid thoracic level, with an air-fluid level seen on series 11, image 38. Please correlate for reflux disease.CHEST WALL: Stable left breast calcifications. Right chest wall Port-A-Cath with tip in in the SVC. The bones are demineralized with mottled appearance as seen on prior study. Deformity and erosions of the left posterolateral sixth rib (series 11, image 119) is again compatible with myeloma and also appear similar to prior study from 2008.UPPER ABDOMEN: Cholelithiasis without acute inflammation.

Output: 1. No PE. Study is diagnostic the level of the subsegmental pulmonary arteries.2. Fluid-filled esophagus. Please correlate for gastroesophageal reflux disease.3. Deformity and erosions of the left posterolateral sixth rib (series 11, image 119) is again compatible with myeloma and also appear similar to prior study from 2008.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.History of elevated alkaline phosphatase, evaluate for lymphadenopathy. The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality. No significant lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: ARDS Persistent decreased lung volumes without significant interval change in the diffuse and largely interstitial opacities an appearance suggesting ARDS. No new superimposed focal process.Tracheostomy tube unchanged

Output: ARDS without acute new change


Instruction: Generate impression based on medical findings.

Input: 65 year with history of pain status post fall. Cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax. No evidence of displaced rib fracture.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Bladder cancer, evaluate for metastatic disease. Low normal lung volumes with flattening of the diaphragm unchanged. No visible pulmonary nodules or masses. No pneumothorax or pleural fluid. Atherosclerotic calcification in the distribution of the carotid vasculature in the neck.

Output: No visible pulmonary metastases by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent decreased lung volumes greater on the left with what is now currently an elevated left hemidiaphragm. The visualized lungs are otherwise clear other than minimal basilar atelectasis.Cardiac and mediastinal contours are within limits.Right jugular port and left PICC line appear unchanged

Output: Unchanged left PICC line


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: Abnormal Uptake? History: Thyroid cancer with tracheal invasion There is increased paratracheal activity consistent with functioning thyroid tissue most likely representing tumor. Otherwise no evidence of functioning thyroid tissue in the remainder of the scan with expected I-131 activity in the salivary glands, stomach, colon and urinary bladder.

Output: Increased paratracheal activity consistent with functioning thyroid tissue, most likely representing tumor. Otherwise no evidence of functioning thyroid tissue.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Status post lung biopsy. Evaluate for pneumothorax. Low lung volumes. Right apical nodules better appreciated on recent CT. No pleural abnormalities. No evidence of pneumothorax.Cardiomediastinal silhouette is within normal limits.Right IJ port with tip at cavoatrial junction. Right upper quadrant gastrostomy tube.

Output: No pneumothorax.. Right apical nodules better appreciated on recent CT.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: new ETT History: A-a gradient, new ETT Unchanged pleural effusions and left basilar consolidation.IVC or percutaneous right atrial catheter.ET tube tip approximately 3 cm above the carina.

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


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Is there pneumothorax? History: chest tube placement Partially visualized feeding tube and left-sided PICC remain unchanged.Cardiac silhouette is obscure. Stable moderate left pleural effusion and atelectatic changes. Minimal right basilar atelectasis. No pneumothorax.

Output: No significant interval changes. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: s/p bilat lung tx, eval CT position, pneumos History: as above Iatrogenic devices are unchanged. Diffuse pulmonary opacities again noted. Small left-sided pneumothorax, as before. Subcutaneous emphysema again noted. Unchanged heart size.

Output: Small left-sided pneumothorax, as before. Diffuse pulmonary opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: S/p thoracentesis Left-sided PICC, unchanged. Small right-sided pleural effusion slightly improved. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. No pneumothorax.

Output: Decrease in size of right-sided pleural effusion without evidence of significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: S/p dual-chamber ICD History: None Small lung volumes.No acute abnormality.New left subclavian dual chamber ICD, leads in appropriate positions.

Output: ICD placement without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: 65yr old male with history of MM; pre-auto sct evaluation History: evaluate Elevation of left hemidiaphragm, likely chronic. No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: f/u pleural effusion History: f/u pleural effusion Bilateral pleural effusions and basilar opacities consistent with edema, unchanged.A Dobbhoff tube extends below the lower margin of the image.

Output: Unchanged pleural effusions and basilar opacities consistent with edema.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: S/p CABG with IABP History: CT in place, Dyspnea on 6L No change in IABP, chest tubes, or Swan-Ganz catheter. Lungs hypoinflated with nonspecific basilar opacities.

Output: No change in IABP, chest tubes, or Swan-Ganz catheter. Lungs hypoinflated with nonspecific basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: rule out pneumonia, lymphoma History: chest pain w/ inspiration No change in elevation of left hemidiaphragm with blunting of costophrenic angle.Stable scarring left upper lobe with nodularity right lung base.No acute cardiopulmonary abnormality. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: r/o pna, pleural infiltrates History: fever, weakness Resolution of prior left lower lobe consolidation with a small left pleural effusion or pleural scarring.Heart size upper normal.Extensively calcified lymphadenopathy consistent with healed granulomatous disease.Cervicothoracic spine stabilization hardware unchanged.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: malignant pleural effusion History: s/p left VATS pleurodesis Multiloculated left hydropneumothorax unchanged. Small right pleural effusion stable. Patchy airspace opacities are unchanged. Right port tip in SVC.

Output: Multiloculated left hydropneumothorax unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Prekidney transplant rule out cardiomegaly or infiltrates. Heart size is at least upper normal, unchanged. Left subclavian ICD unchanged in position, with tip in the projection of the RV apex. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.No focal airspace opacities, pleural fluid or signs of CHF.

Output: No acute pulmonary abnormality. Heart size is upper normal.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: evaluate for recurrence of right pleural effusion History: pleural effusion Cardiomediastinal silhouette is unchanged. Small right pleural effusion is not significantly changed compared to the prior exam. No focal pulmonary opacity. Bibasilar scarring is similar to the prior exam.

Output: Unchanged small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: s/p esophagectomy History: elevated wbc count Status post esophagectomy and gastric pull-up.Small right pleural effusion and mild basilar subsegmental atelectasis.No reliable evidence of infection.

Output: Status post gastric pull-up. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Rule out acute cardiopulmonary process. History: epigastric/chest pain, status post stem cell transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Left jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: eval for PNA, PJP History: hx HIV, pancytopenia, CP Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Chest tube removal.VIEW: Chest AP (one view) 01/17/16, 1118 Right chest tube has been removed. Very small subpulmonic pneumothorax is identified.Bilateral lung opacities continue right worse than left. No pleural effusion is identified. Cardiac silhouette size is normal.Right upper extremity PICC has its tip in superior vena cava. Right thoracolumbar curve is noted.

Output: Right chest tube removal and very small subpulmonic pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.History of neck cancer, new onset wheezing in the right lung base. Evaluate for aspiration/pneumonia. Postoperative surgical clips in the right neck. Left chest single lumen Port-A-Cath with tip in the SVC. Mediastinal silhouette within normal limits. No consolidation or pneumothorax. No large pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 72 year-old female with lung cancer and altered mental status. Evaluate for pathology Heart size upper limits of normal. Bilateral interstitial opacities predominantly in the lower lungs with multiple septal lines on the right suggestive of edema. There maybe a component of aspiration in the left lung base. Right perihilar opacity correlates with right perihilar mass noted on recent CT. No pleural effusion or pneumothorax.

Output: Findings suggestive of CHF and possible aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Cough. The cardiac size within normal limits with mildly tortuous aorta. Basilar subsegmental atelectasis without focal airspace opacity, significant pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Evaluate for obstruction, history of vomiting Nonobstructive bowel gas pattern. Gas containing bowel in left upper quadrant may be related to portion of stomach. Low-lying rectum, suggestive of prolapse. Left abdominal postsurgical suture material. Left-sided femoral subcapital/neck fracture, better evaluated on earlier dedicated radiography. Small basilar atelectasis. Partially imaged electronic device overlying left chest laterally. Spinal degenerative disease.

Output: Nonobstructive bowel gas pattern. Low-lying rectum, suggestive of prolapse. Left femoral fracture.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.History of testicular cancer. Evaluate for metastatic disease. No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: 82yo M y/o HTN, CVA, with sob. History: sob Upper normal heart size and prominent central pulmonary vasculature unchanged.Hazy opacity in the region of the lingula. Mild thickening fissures. Probable emphysema. Patchy airspace opacity at the right base.

Output: Interval development of hazy opacity in the lingula and patchy opacity at the right lung base, probably the result of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Device placement Left subclavian ICD appears similar without evidence of interval change or complication.Persistent borderline mild cardiomegaly. Decreased lung volumes are otherwise associated with clear lungs

Output: ICD unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Chest tube Left chest tube appears to been slightly repositioned. Small to moderate bilateral pneumothoraces, about 3 cm each at the apices, slightly improved inferiorly. Extensive subcutaneous emphysema. Air surrounding the sternotomy hardware is new and could be in the chest wall.Lung volumes remain low with worsening bronchial wall thickening and atelectasis.

Output: Persistent bilateral pneumothoraces, probably not significantly changed. Worsening bronchial opacities consistent with acute rejection. Worsening subcutaneous emphysema suggests an air leak. Unable to adequately assess for residual intra-abdominal air due to patient position.


Instruction: Generate impression based on medical findings.

Input: Reason: fever, transplant pt History: fever, transplant pt Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: r/o infiltrate History: cough, sob Moderate cardiomegaly with mild edema and fluid in the fissures.No specific evidence of infection.

Output: Mild CHF with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: evaluate for pna - 70 yo w cad, copd w leukocytosis and likely dehydration c/f flowerinfg pna w rehydration History: hypotension, leukocytosis Motion limits sensitivity.Stable cardiac enlargement.The lungs are clear.No pleural effusions.Median sternotomy is intact with evidence of prior CABG.

Output: Stable cardiomegaly. No acute abnormality identified. No specific evidence of an infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: s/p lvad, possible aspiration History: sob Motion artifact makes evaluation of lungs difficult. No new focal lung consolidation. Moderate cardiomegaly again noted. Iatrogenic devices are unchanged. No large pleural effusion or pneumothorax.

Output: Motion artifact makes evaluation of lungs difficult. No new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: Chest pain History: chest pain Heart size upper normal, otherwise unremarkable.No specific evidence of infection or edema.Bilateral shoulder prostheses and upper abdominal surgical artifact.

Output: Heart size upper normal, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: ro foreign body (tooth) History: altercation with avulsed tooth Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: sob History: sob Two left chest tubes unchanged in position as well as a new left pleural pigtail drain with its tip where there had previously been a small air collection, posterior and medially.No significant pneumothorax.Unchanged pulmonary opacities.Tracheostomy tube, the tip at the level of the thoracic inlet.An NG tube terminates in the stomach.Right PICC, tip in the SVC.

Output: New left pigtail pleural drain, with resolution of a small pleural air collection.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Swan-Ganz catheter placement. Distal position of right jugular Swan-Ganz catheter, which remains overlying a right middle lobe branch artery.No pneumothorax.Left subclavian ICD unchanged. Aortic stent graft partially visualized.Small pleural effusions and mild to moderate pulmonary edema unchanged.

Output: Swan-Ganz catheter appears unchanged in position and may be pulled back slightly.


Instruction: Generate impression based on medical findings.

Input: Male 56 years old Reason: pre op evaluation History: Cough Nonspecific diffuse basilar predominant reticulonodular interstitial opacities are likely chronic.There are dense calcifications of the abdominal aorta, but otherwise the cardiomediastinal silhouette is unremarkable.No pleural effusion or pneumothorax is evident.Surgical clips are present within the neck and upper abdomen.

Output: Chronic appearing nonspecific diffuse reticulonodular interstitial opacities, without superimposed acute disease.


Instruction: Generate impression based on medical findings.

Input: 31 year old female with a history of lupus, APS, DVT, PE, MI with a previously abnormal CT LUNGS AND PLEURA: Patchy mild ground glass opacities are identified in both lungs. There has however, been significant interval improvement in comparison to the exam dated 7/2/09. Scarring is identified at the right lung base. There is no evidence of significant air trapping or interstitial fibrosis. No pleural effusion is notedMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Minimally prominent lymph nodes in both axillary regions without evidence of lymphadenopathyUPPER ABDOMEN: No significant abnormality noted.

Output: Significant interval improvement in the multiple patchy, ground glass opacities in both lungs. There are scattered residual groundglass opacities present in the upper lobes. Most likely represents resolving atypical infection


Instruction: Generate impression based on medical findings.

Input: Reason: icu patient, tracheostomy History: icu patient, tracheostomy, on ventilator Tracheostomy tube, PICC line and right jugular catheter unchanged.New pleural drain projected over the right upper lobe area.Hazy opacity on the right consistent with a layered out pleural effusion. Subsegmental atelectasis on the small effusion on the left.

Output: New right pleural drain and no other significant change.


Instruction: Generate impression based on medical findings.

Input: ARDS.VIEW: Chest AP (one view) 03/29/15, 0443 Endotracheal tube tip is between thoracic inlet and carina. Feeding tube tip is in gastric body. Left upper extremity PICC has its tip in superior vena cava. A chest tube is present in each hemithorax.Cardiothymic silhouette is upper limits of normal in size. Airspace disease in the lower lobes continues. No pneumothorax or pleural effusion is present.

Output: Unchanged opacities in the lung bases.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: 62yo M w/ fever, assess for pulm source, history of non-small cell lung cancer The cardiomediastinal silhouette is stable. Persistent low lung volumes with bibasilar atelectasis/consolidation. Multiple pulmonary nodules and mediastinal lymphadenopathy better seen on recent CT scan. No new focal consolidation. Probable pleural effusions.Cortical destruction of the right sixth and seventh ribs with overlying soft tissue mass, consistent with osseous metastasis as seen on CT scan 12/29/2015. Numerous osseous lytic lesions and sclerosis are unchanged.

Output: Persistent low lung volumes with bibasilar atelectasis/consolidation and probable pleural effusions. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: trauma History: fall No significant cardiopulmonary abnormality.

Output: No significant abnormality. No displaced rib fracture or pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Evaluate lung fields History: s/p LVAD Pulmonary artery catheter tip directed toward the right main pulmonary artery. Left ICD with leads in similar position. Right pleural and mediastinal drains unchanged. LVAD at the cardiac apex. Enteric tube has been removed.Stable obscuration of the right heart border, representing right middle lobe atelectasis with probable pleural effusion. Left basilar atelectasis/consolidation unchanged.No pneumothorax.Stable cardiomediastinal silhouette.

Output: Stable right middle lobe atelectasis and probable pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Attempted line placement and left IJ and right IJ. Evaluate for pneumothorax. Stable positioning of endotracheal tube and nasogastric tube. Stable cardiomediastinal silhouette. Mild to moderate vascular congestion. Patchy alveolar opacities in the right upper lung and right lower lung fields. Retrocardiac airspace disease cannot be excluded. No pneumothorax.

Output: Multifocal patchy alveolar opacities throughout the right lung and left base may represent bone edema or infection. Mild to moderate pulmonary vessel congestion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Left-sided chest wall pain and left upper back pain. Evaluate for lung abnormality. Normal heart size. No mediastinal widening is evident however please note that acute vascular pathology cannot be accurately assessed by plain film.No pleural fluid or pneumothorax. No focal pulmonary opacities.Mild scoliosis.

Output: No acute cardiopulmonary abnormality by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: pna? CHF? History: LVAD, AMS Stable position of support devices with redundancy of the ICD electrode within the right atrium. Complete mitral annuloplasty ring is present. Inflow cannula of the left ventricular assist device is directed cranially toward the trachea.Persistent right mid zone reticulation compatible with atelectasis. Likely small pleural effusions, unchanged. No interval pneumothorax. Cardiomegaly is unchanged.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: chest pain Normal heart size with a tortuous aorta.No significant pulmonary abnormalities.Mild elevation of the left hemidiaphragm, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female; 49 years old. Reason: History of large B cell NHL History: Evaluate for continued remission Evaluation of solid organs is limited by lack of intravenous contrast.CHEST:LUNGS AND PLEURA: MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Two punctate non-obstructing left renal stones identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical clips at the GE junction and gastric pylorus noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. Previously identified cystic left adnexal lesion is not apparent on current exam.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Superior end plate deformity of L3, similar to prior.OTHER: No significant abnormality noted.

Output: No evidence of recurrent disease or acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: SOB History: ? CHF Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: s/p ICD History: S/P ICD Interval placement of a left chest wall ICD with single lead in the right ventricle. Interval removal of Swan-Ganz catheter.Mild cardiomegaly.No pleural effusion or pneumothorax.No focal pulmonary opacity.

Output: Interval placement of an ICD without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Marked COPD without focal new acute abnormality. Both apical and basilar scarring is observed, mildly greater on the right, and unchangedPartially observed lower cervical spine fixation

Output: Marked COPD without superimposed new acute abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: s/p R CT removal History: s/p R CT removal Interval removal of right chest tube. No significant pneumothorax.Extensive chest wall subcutaneous emphysema, unchanged.Severe emphysema and fibrotic changes, unchanged.

Output: Interval removal of right chest tube. No pneumothorax. Persistent extensive subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of left upper lobe nodule, biopsy from 11/2008 nondiagnostic. 3 month follow-up. LUNGS AND PLEURA: Right apical mass with lobular margin is again noted abutting the pleura, measuring 3.3 cm in longest axial dimension on series 6, image 14. No other suspicious nodules or masses; no pleural effusions.Calcified nodule in the right upper lung and calcified lymph node along left major fissure likely of benign etiology such as prior granulomatous infection.MEDIASTINUM AND HILA: Moderate hiatal hernia (series 4, image 74). Unenlarged mediastinal lymph nodes.CHEST WALL: Enlarged, multinodular thyroid gland. Degenerative changes of the spine.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Right apical mass stable in size. Differential considerations included focal organizing pneumonia versus infarct. Malignancy is considered less likely due to lack of interval change, however 6 month follow-up study is recommended to confirm stability or decrease in size. If clinically warranted, further correlation with a PET scan may be considered.2. Enlarged, multinodular thyroid gland.3. Moderately-sized hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: 8/27/15 Thoracoscopic wedge resection of left lower lobe nodule History: none The cardiomediastinal silhouette is unremarkable.Left-sided chest tube has been removed with surgical sutures noted in the left upper lobe.No evidence of a pneumothorax.Persistent right suprahilar nodule unchanged.No pleural effusion.

Output: Interval removal of left-sided chest tube without evidence of a pneumothorax. Right suprahilar nodule unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: assess for pulmonary edema History: sob Improvement in pulmonary edema. Cardiomegaly again noted. No pneumothorax or large pleural effusion. Pacer leads, unchanged.

Output: Improvement in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Evaluate extent of disease. 60 year old woman with breast cancerstatus post lumpectomy in 2007. Cervical cancer status post radical TAH with chemo andRT. Third cancer, illegible. Finished chemo. CHEST:LUNGS AND PLEURA: . Scarring in the right lung base, unchanged. 7-mm pleural-based nodulein the left lung base, unchanged (image 92; series 9). MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Segments 4 portal vein thrombosis with associated hypoattenuation onvenous images (image 13; series 80776). No focal hepatic lesions. Biliary stent in placewith the distal tip in the third segment of duodenum. Mild intrahepatic biliary ductaldilatation, stable with prominent enhancement of bile duct walls. Contractedgallbladder. 3-mm soft tissue density nodule in the fundus of the gallbladder isnonspecific and may represent a stone or polyp as described previously.SPLEEN: No significant abnormality notedPANCREAS: As noted previously, there is diffuse dilatation of the proximal pancreatic ductwith abrupt termination of the duct at the pancreatic head. No discrete mass isidentified and ill-defined soft tissue density in the pancreatic head is unchangedmeasuring 27 x 18 mm (image 41; series 8). There is associated soft tissue densityinfiltration in the porta hepatis and around the portal vein as noted previously withnarrowing/mass effect on the SMV at the confluence. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nodules in the left kidney are again noted with a hyperdense nodule atthe midpole medially. This measures 60HU and pre-enhanced images (image 48; series 3),51HU on arterial weighted images (image 51; series 8), and an approximately 71HU on venousimages (image 117; series 11) suggesting that this represents a hyperdense cyst. Continued surveillance is recommended. RETROPERITONEUM, LYMPH NODES: Reference peripancreatic lymph node measures 14 x 11 mm butis difficult to evaluate on today's exam due to slight motion artifact (image 104; series11).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Uterus not visualized.BLADDER: Bladder is collapsed and difficult to evaluate.LYMPH NODES: Few small lymph nodes are not enlarged using CT size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites.

Output: New segment 4 portal vein thrombosis. Stable ill-defined pancreatic headmass. Stable subcentimeter left basilar pulmonary nodule. Trace pelvic ascites. Probable left complex cyst also unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: CT daily CXR History: CT daily CXR Heart failure LVAD and ICD leads unchanged. Left lower lobe opacity with probable small left pleural effusion, unchanged. No evidence of pneumothorax. Stable cardiomegaly.

Output: Left lower lobe opacity with probable small left pleural effusion, unchanged. No evidence of pneumothorax. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

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

Output: Continued progression of left lung opacity and edema.


Instruction: Generate impression based on medical findings.

Input: 6-year-old male with history of trauma from fall out of a 3-story window with previous pneumomediastinum, persistent fever and increased LFTs. LUNGS AND PLEURA: There is bibasilar dependent atelectasis, right greater than left. MEDIASTINUM AND HILA: The previously described pneumopericardium and pneumomediastinum are no longer identified.CHEST WALL: Posterior subcutaneous emphysema and air in the spinal canal at the level of T2/T3 are no longer identified.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedKIDNEYS, URETERS: There is a well-defined, round, hypodense lesion in the upper pole of the right kidney which may represent a calyceal diverticulum or cyst.ADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Residual contrast from prior examinations is noted in the sigmoid colon and rectum.BONES, SOFT TISSUES: The proximal aspect of the right comminuted diaphyseal femoral fracture is noted. There is a new sideplate and multiple screw device which is incompletely imaged on this examination.OTHER: A spica cast is noted which encompasses both upper thighs and extends to the level of the lower ribs.

Output: 1. Interval resolution of pneumopericardium, pneumomediastinum and subcutaneous emphysema.2. Interval placement of a spica cast and proximal femoral orthopedic hardware.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: hypoxia, history of breast cancer with metastasis, radiation, chemotherapy, malignant pericardial effusion, status-post subxiphoid pericardiotomy with drainage Left port catheter tip overlies the distal SVC. Pericardial drain overlies the inferior heart border. Defibrillator pads partially obscure underlying right lung parenchyma.Stable moderate to severe cardiomegaly. Moderate right and large left pleural effusions. Stable perihilar and retrocardiac airspace opacities. No pneumothorax. The right breast is surgically absent.

Output: Stable findings consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: new onset productive cough, pain with inspiration--> currently getting chemotherapy History: new onset productive cough, pain with inspiration- Subtle left basilar opacity consistent with infection or aspiration. This could be confirmed by CT if clinically indicated.Heart size normal.No substantial pleural effusions.

Output: Subtle nonspecific left basilar opacity suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: fever on chemotherapy. History: fever. Normal heart size. Moderately ectatic and tortuous thoracic aorta.No acute focal airspace opacity.No pneumothorax or pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: s/p AVR/CABG History: SOB Cardiomegaly status post sternotomy for aortic valve replacement.Moderate lower lung zone edema slightly worse with pleural effusions.No specific evidence of infection.

Output: Persistent, possibly worsening, pulmonary edema consistent with CHF following recent surgery.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for infection History: fevers, ?e coli bacteremia New right lower lung airspace opacity may represent developing infection. Stable cardiomediastinal silhouette.Spinal fixation hardware again noted.

Output: New right lower lung airspace opacity may represent developing infection.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out PNA History: fever, increased O2 Small lung volumes with streaky lower zone opacities suggestive of atelectasis, possibly related to aspirated secretions.NG tube tip in the stomach with the sidehole in the distal esophagus.No specific evidence of pneumonia.

Output: Small lung volumes with lower zone atelectasis but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Hypotension evaluate for edema Sternotomy wires and mediastinal surgical clips. Patient is rotated leftward, limiting evaluation. Left paramediastinal retrocardiac opacity may reflect scarring or atelectasis, nonspecific. Small volume of pleural fluid or scarring in the costophrenic angle region. No specific signs of pulmonary edema. Poorly visualized left glenohumeral fusion.

Output: No convincing evidence of pulmonary edema. Possible small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of metastatic head and neck cancer CHEST:LUNGS AND PLEURA: Pulmonary nodules have minimally increased in size. Index right middle lobe nodule measures 9 mm in image number 50, series number 5. Other pulmonary nodules have also slightly increased in size. No new nodules. Right lower lobe subsegmental atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large hepatic lesion in segment 4 now measures 6.5 by 5.1-cm on image number 80, series number 3, not significantly changed in size. Other smaller hepatic lesions are also stable. Mild left-sided intrahepatic ductal dilatation, stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged peripancreatic round hypodensity, stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic and lytic lesions through the thoracic and lumber vertebral body with compression fracture of L2 vertebral body, stable. Destructive the left iliac bone lesion, stable.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive pelvic metastases disease and destruction of the left ilium, stable.OTHER: No significant abnormality noted

Output: Pulmonary nodules and minimal increase in size. Bone and hepatic metastases are grossly stable.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: h/o COPD, pulmonary htn, worsening sob please evaluate Diffuse reticular opacities, greatest at the bases, suggestive of edema superimposed on emphysema. Nodular opacity at the left costophrenic angle visualized on multiple exams and most compatible with scarring. Heart size is mildly enlarged. Several segmentation anomalies (butterfly vertebrae) are again noted.

Output: Reticular opacities greatest at the bases suggestive of mild edema on severe emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: chest pain, sob, eval for PNA/PTX History: chest pain, sob, eval for PNA/PTX Nonspecific left basilar opacity could be an artifact or early infection.Elsewhere the lungs are unremarkable.No significant pneumothorax.Unremarkable mediastinal contours and cardiac silhouette.

Output: Left basilar airspace opacity versus artifact.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.History: Atrial fibrillation, CKD, COPD. Symptoms: Chest pain, dyspnea after falling off a 15 foot ladder. Query: pneumonia, CHF. Stable cardiomegaly.Interval improvement of bilateral lower and mid lung zone airspace opacities. No pneumothorax. No obvious rib fracture.

Output: Stable cardiomegaly. Interval improvement in the airspace opacities


Instruction: Generate impression based on medical findings.

Input: Reason: daily am cxr History: Soft tissue disorder. Interval removal of a right jugular catheter.Tracheostomy tube and remaining jugular catheter are unchanged.Diffuse bilateral interstitial opacity, nonspecific but possibly due to edema, unchanged.No new findings.

Output: Diffuse interstitial opacity without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: pneumonia? History: shortness of breath No focal consolidation, pleural effusion or pneumothorax. Mediastinal and hilar lymphadenopathy similar to prior. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: ett History: ett ET tube tip at carina. Right jugular catheter and nasogastric tube unchanged.Lungs hypoinflated with nonspecific basilar opacity.

Output: ET tube tip at carina.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Multiple sclerosis flare evaluate for pneumonia. Normal cardiomediastinal silhouette. No focal airspace opacities or pleural fluid. A nodular density projecting over the anterior left third rib is nonspecific and could reflect summation artifact. This is unlikely to represent infection unless the patient is neutropenic and can be conservatively followed with chest radiographs.

Output: No signs of bacterial pneumonia. Probable summation artifact overlying the left third rib can be followed with erect PA and lateral chest radiographs when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval lung fields History: s/p CABG, VATS Unchanged left chest tubes with lucency along the left paraspinous region, likely a small amount of pleural air medially. Mild left basilar subsegmental atelectasis. Increasing left chest wall soft tissue emphysema.Right jugular catheter, tip in SVC.Status post extubation.

Output: Lucency along the left paravertebral region could represent a small pneumothorax, with increasing left chest wall soft tissue emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: please assess lung fields History: s/p avr, mvr Pneumoperitoneum is unchanged.Right pulmonary arterial catheter tip directed towards the right main pulmonary artery. Mediastinal drains are unchanged. Mitral valve prosthesis.Basilar atelectasis and effusions are unchanged. Cardiomegaly with tortuous aorta with superior mediastinal widening.

Output: 1.Superior mediastinal widening, which was present on prior radiographs, and is magnified by portable technique. Short term follow up is recommended to ensure stability.2.Unchanged pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: ET tube placement, assess for pleural effusion/pulmonary edema post op History: see above Small lung volumes with interstitial opacities likely chronic.Mild cardiomegaly.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: Small lung volumes with interstitial opacities likely fibrosis rather than edema, although the latter still possible.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: L lung expansion, chest tubes Extremely small left apical pneumothorax, not unexpected given presence of left apical chest tubes. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or right-sided pneumothorax.

Output: Extremely small left apical pneumothorax, not unexpected given presence of left apical chest tubes.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Chest pain question pneumonia. Mediastinal clips and sternal hardware suggestive of prior CABG.Normal heart size.No signs of CHF or pneumonia. No pleural fluid or focal pulmonary opacities. No pneumothorax.

Output: No acute cardiopulmonary abnormality and no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of cough and sore throat. Cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.Density overlying T12 spinous process and adjacent facet joint, likely skeletal but confirmation with thoracic spine radiographs is requested.

Output: Density overlying T12 spinous process, likely skeletal but confirmation with thoracic spine radiographs is requested.Otherwise, no acute cardiopulmonary abnormality and no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.IABP placement. IABP marker overlies the proximal descending aorta. Other support devices unchanged. Positioning of all devices are thought to be stable when considering differences in projection between the current and prior studies.Cardiomegaly with improvement in right perihilar interstitial opacities. There are no lage pleural effusions. Relatively diminished lung volumes. There is no pneumothorax.

Output: IABP marker overlying the proximal descending aorta, unchanged. Improving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Right IJ dialysis catheter placement. Right jugular catheter tip near the SVC. Right subclavian central line unchanged in position, terminating at the superior cavoatrial junction. Presternal ICD in place.No pneumothorax. Moderate pleural fluid bilaterally. Retrocardiac atelectasis. The right cardiac chambers appear enlarged.

Output: Right jugular catheter tip in a central vein. No pneumothorax. No acute change in pleural fluid volume.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: eval for signs of restrictive/obstructive lung disease History: sob on exertion, progressive, osa Large lung volumes with flat diaphragms more suggestive of obstructive lung disease than restriction.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: Large lung volumes suggestive of COPD. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 73F with ETT adjustment History: ETT ET tube tip approximately 2.5 cm above the carina.Catheter tip at the SVC/RA junction. NG tube tip in the stomach.Bilateral nonspecific airspace opacity compatible with edema and infection.Probable small to moderate pleural effusions.

Output: Airspace opacity and pleural effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: OSH transfer with NICM EF 25% hypoxic on HF NC, eval for effusions/infiltrates History: SOB Heart not particularly enlarged, the aorta tortuous but consistent with age.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Evaluate outside PICC line placement prior to use History: Outside PICC line Mild distention of a gastric pull-up causing apparent increased opacification of the right lower lung zone.Decreased lung volumes with mild interstitial abnormalities right base.Right PICC, tip at SVC/artery junction level.

Output: Fluid distended gastric pull-up. Slight increase in right basilar interstitial opacities possibly edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: ? pna History: tachycardic., Small lung volumes with cardiomegaly, effusions right greater than left, and basilar atelectasis, stable.Right jugular catheter tip in or at level.Prior left jugular catheter removed.

Output: CHF with pleural effusions and compression atelectasis in the bases, but no reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Empyema. Heart transplant. Clinical service reports left jugular catheter produces venous return. Left VAD projects over the expected course of the left SVC, unchanged in position. Unchanged mediastinal widening.No pneumothorax. Large left pleural fluid collection similar in volume. Moderate volume of pleural fluid on the right unchanged. Orphaned ICD with leads in the known obliterated right SVC.

Output: No significant change in pleural fluid or atelectasis.


Instruction: Generate impression based on medical findings.

Input: 70 years, Female. Reason: eval for stool burden History: abd pain, incontinence Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities.Nonobstructive bowel gas pattern. Large amount of amorphous stool throughout the descending and sigmoid colon. Phleboliths are noted.

Output: Moderate stool burden.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: sob History: sob Left pleural pigtail catheter replaced with a smaller bore device.Unchanged moderate to large left pneumothorax with severe soft tissue emphysema.Partial atelectasis left lung with endobronchial valves.

Output: Pleural drain exchange. Persistent left pneumothorax and severe soft tissue emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: LVAD placement History: LVAD Global cardiomegaly.The tip of the Swan-Ganz catheter overlies the distal right pulmonary artery, unchanged in position.LVAD in place.Abandoned pacer/ICD leads are noted.Persistent signs of interstitial pulmonary edema, improved from prior.Trace bilateral pleural effusions.

Output: Improving interstitial pulmonary edema.Stable position of support apparatus.


Instruction: Generate impression based on medical findings.

Input: History of prematurity with right pneumothorax.VIEW: Chest crosstable lateral (one view); abdomen crosstable lateral (one view) 12/21/2015 23:46 Endotracheal tube tip below the thoracic inlet and above the carina. Enteric tube with tip in the stomach. UVC with tip within the intrahepatic IVC. UAC with tip at T10. Two right-sided chest tubes are present.Diffuse bilateral hazy pulmonary opacities are present. Right subpulmonic pneumothorax persists.Previously seen crescentic lucency along the right abdominal wall is not well visualized on this lateral view. No intraperitoneal free air is seen. The bowel gas pattern is disorganized. No pneumatosis or portal venous gas.

Output: Right subpulmonic pneumothorax with chest tubes in place. Diffuse hazy lung opacities and consolidation. No intraperitoneal free air is seen on this lateral view.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old. Reason: chest pain History: as above Cardiomediastinal silhouette is unremarkable.Low lung volumes with nonspecific opacities which likely represent subsegmental atelectasis.No large pleural effusion or pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Syncope and collapse. Mild edema type pattern although improved from prior. Heart size within normal limits. Biapical scarring and pleural thickening stable. No pneumothorax. Right central line tip over the SVC. Left-sided rib resection again noted.

Output: Mild edema type pattern although improved from prior.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: weight loss History: weight loss Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Shortness of breath Interval placement of nasogastric tube with the distal tip looped in the left upper quadrant.Left-sided ICD and LVAD unchanged.Right-sided lead wires redemonstrated.Stable cardiac enlargement.Interstitial opacities throughout both lungs compatible with edema superimposed on residual lung fibrosis, unchanged.No large pleural effusions.

Output: Interstitial opacities compatible with edema superimposed on underlying ILD.


Instruction: Generate impression based on medical findings.

Input: Esophagus cancer. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left apex.MEDIASTINUM AND HILA: Subcentimeter left thyroid cystic nodule.Previous surgery of gastric pull-through and esophagectomy. No evidence of mediastinal or hilar adenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ill-defined large masses replacing most of the liver parenchyma in both lobes.A reference mass in the right lobe measures 4.8 x 4.4 cm on image number 32/65. No evidence of intrahepatic biliary dilatation. Portal vein and its branches are patent. Intrahepatic IVC cannot be differentiated from the surrounding ill-defined mass and is likely invaded.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 2.8 x 2 cm right adrenal metastatic mass. Left adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged upper abdominal retroperitoneal lymph nodes, and reference node measures 1.2 x 1.5 cm on image number 28/65.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. Right inguinal hernia containing ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Extensive metastatic disease involving the liver. Intrahepatic IVC is likely invaded. Upper abdominal adenopathy. Right adrenal metastatic disease. Small amount of ascites and bilateral moderate pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: dyspnea on exertion History: dyspnea on exertion COPD. Heart size normal.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 23-day-old male patient with history of reintubation.VIEW: Chest AP (one view) 11/05/2015 at 12:13 hours. ET tube tip is at the thoracic inlet. Interval removal of inferior right chest tube. Remaining right-sided chest tube is unchanged in position. No pneumothorax. Interval removal of NG tube. Lower extremity central line tip is in the retrohepatic IVC. Cardiothymic silhouette is normal. Stable large lung volumes and diffuse coarse lung haziness with pattern of PIE.

Output: Interval removal of NG tube and one right-sided chest tube. No pneumothorax. Stable large lung volumes and coarse lung opacities compatible with PIE.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: 80 yo F with SOB, ?PNA History: SOB Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mildly tortuous thoracic aorta.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: assess status of known infection, hx: stem cell transplant History: SOB, fevers No change in basilar opacities suggestive of atelectasis or aspiration.Faint nodular opacity in the left midlung is new, and could represent a nidus of infection.Right jugular catheter, tip in SVC.

Output: New nodular opacity left mid lung, consistent with early fungal infection. Stable basilar opacities suggestive of aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval lung fields History: cp Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pain Marked interval improvement, specifically the cardiac and mediastinal contours are now within limits. Lungs remain clear. No effusions

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: MaleReason for Study: Reason: patient s/p bronch with increasing oxygen requirements History: oxygen desat Right Port-A-Cath with its tip in the SVC.Stable cardiomediastinal silhouette.Right perihilar opacity similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Stable appearance of right perihilar masslike opacity. See recent CT report.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Dyspnea Cardiomegaly with small bilateral pleural effusions, basilar opacities and mild diffuse interstitial pattern suggesting mild CHF is stable. Calcified pleural plaques again seen. Right jugular line with tip over the right atrium, stable. No pneumothorax. A left vascular stent is in placed in the subclavian region. The patient is also status post ET tube 4 cm above carina and NG tube over the proximal stomach.

Output: Mild CHF pattern, stable. Status post ETT tube placement 4 cm above carina and NG tube placed over the stomach. Also interval left subclavian vascular stent.


Instruction: Generate impression based on medical findings.

Input: Male, 97 years old.Syncope wu ICD leads unchanged. Cardiomediastinal silhouette is not significantly changed compared to the prior exam. Tortuous aorta is similar in appearance. No large pleural effusion or pneumothorax. Mild interstitial opacity at the bases likely represents mild atelectasis.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Sickle cell. Chest pain, fever, productive cough. The cardiac silhouette is at the upper limits of normal in size the mediastinum and hila are within normal limits nipple shadows noted at lung bases bilaterally. No airspace opacity, pleural effusion, or pneumothorax. Incidental note is made of H-shaped vertebral bodies in the upper thoracic spine consistent with known sickle cell disease.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: ET tube placement adjustment History: see above The endotracheal tube is near the carina and has been repositioned on the subsequent radiograph. Nasogastric tube and right central catheter are unchanged in position.Stable bilateral air space and interstitial opacities. No interval pneumothorax. Gaseous distention of the stomach.

Output: Endotracheal tube within 1 cm of the carina, repositioned on subsequent radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Postop. Liver cell carcinoma. Distention of the SVC and azygos arch suggests hypervolemia, though is likely exaggerated by patient position.Drain in the right upper quadrant with a small amount of pneumoperitoneum, presumably postoperative.Lung volumes are low, but there is no specific evidence of edema or aspiration. No pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: UPRIGHT to r/o free air History: abdominal pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: 30y/o with sickle cell comes in with body pain and SOB History: SOB Port tip at RA/SVC junction. Stable cardiomegaly. No new pulmonary opacity. Cholecystectomy clips.

Output: No new lung opacity


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: failure to thrive, weakness, cervical cancer patient History: weakness Right upper lobe wedge resections.Large lung volumes consistent with COPD.Heart size normal.Right jugular catheter, tip in SVC.

Output: COPD, no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of pancreatic cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Enlarged thyroid gland, unchanged. Borderline enlarged mediastinal lymph nodes are unchanged. The reference lymph node again measures 12 x 7 mm in image number 30, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. No biliary duct dilatation. No focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: Residual pancreas is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Benign renal cyst.RETROPERITONEUM, LYMPH NODES: Stable mildly enlarged retroperitoneal lymph nodes. Reference lymph node measures 8 x 7 mm. (Image number 106, series 3). Mild fat stranding and small amount of fluid in the retroperitoneum between the SMA and aorta is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previous described fluid collection in the anterior abdominal wall as result.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post Whipple procedure with post operative changes without significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: chest pain History: hx of hgbss presenting with voc crisis with chest pain The cardiomediastinal silhouette is mildly enlarged.No focal airspace opacity, pleural effusion or pneumothorax.Osseous changes of sickle cell disease.

Output: No acute cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Epigastric pain/pressure. Rule out widened mediastinum, acute pulmonary pathology. No abnormal lung parenchymal opacities.The pleural spaces are within normal limits.Cardiomegaly without silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.