Instruction: Generate impression based on medical findings.

Input: 52 year-old female with chest pain shortness of breath. Evaluate for PE. PULMONARY ARTERY: In this technically adequate study, no evidence of pulmonary emboli.LUNGS AND PLEURA: The reference right apical nodule is approximately similar in size measuring 13 x 14 mm (image 19/141). The right upper lobe lobulated nodules are unchanged measuring 8 mm and 9 mm (image 29/141, image 30/141) since 6/12/08 but have increased since 2/6/08. Additional nonspecific micronodules are stable. The left upper lobe opacity is unchanged. No pleural effusions.MEDIASTINUM AND HILA: Normal cardiac size. Mild anterior pericardial wall thickening. Right greater than left hilar adenopathy which has increased since 2/6/08 but stable since 6/12/08. The adjacent bronchus intermedius is within normal limits.CHEST WALL: Stable right supraclavicular lymph node. No significant axillary lymphadenopathy.UPPER ABDOMEN: No significant abnormality noted..

Output: 1. No PE2. Stable reference measurements since 6/12/08 but increased significantly since 2/6/08.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: progression of LUL consolidation/effusions History: progression of LUL consolidation/effusions Severe cardiomegaly, unchanged.New left lower lobe consolidation with underlying edema and pleural effusions.Left jugular catheter, tip at right atrial level.

Output: Severe cardiomegaly with new left lower lobe consolidation and persistent pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female; 45 years old. Reason: r/o pneumonia, pneumothorax History: chest pain, SOB Mild cardiomegaly. Left basilar scarring/atelectasis. No specific evidence of acute infection or edema. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: ? Fever History: ? PNA Cardiac silhouette is at the upper limits of normal in size.Bilateral low lung volumes. Minimal bibasilar atelectasis. Blunting of the posterior costophrenic angles likely pleural thickening and/or trace pleural fluid. No pneumothorax.

Output: Low lung volumes with posterior costophrenic angles pleural thickening and/or trace pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: DKA, leukocytosis, rule out infection History: see above Mediastinal silhouette is normal. No focal pulmonary opacity. No pleural effusion or pneumothorax. No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 48 years, Male. Reason: abdominal discomfort / shortness of breath History: distended abd with nausea / shortness of breath Dilated loops of small bowel measuring up to 5 cm. No evidence of pneumoperitoneum. Small lung volumes with nonspecific bibasilar pulmonary opacities. Left internal jugular central venous catheter tip is in the superior vena cava and is unchanged.

Output: Dilated loops of small bowel measuring up to 5 cm concerning for a high-grade small bowel obstruction.The above findings were communicated via telephone to Dej Micic, MD at 3:55 PM on 3/9/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.RIJ catheter Coarse bilateral interstitial opacities with architectural distortion consistent with fibrosis.Small left pleural effusion versus pleural thickening/scarring. No new airspace disease. Interval placement of right neck central venous catheter with tip in SVC. No pneumothorax.

Output: Cardiopulmonary findings grossly unchanged. New right IJ central venous catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Right thoracotomy, RML wedge resection (necrotizing and nonnecrotizing granulomas). Small pleural effusions with associated atelectasis.Scarring and architectural distortion near the right middle lobe wedge resection site appears worse.On the lateral radiograph, there is a space-occupying contour abnormality is inseparable from the anterior right hilum which is of indeterminate etiology but most likely due to atelectatic lung.

Output: Worsening opacity in the right lung which may be the result of atelectasis related to mucoid impaction. Although the contour abnormality at the level of the hilum is most likely atelectatic lung, lymphadenopathy cannot be entirely excluded. Correlate for signs of infection. Conservative short-term follow-up PA and lateral chest radiographs are recommended when feasible to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with history of liver cancer, renal cancer and lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Multiple small, nonenlarged mediastinal lymph nodes. There is prevascular node measures 9 x 9 mm image number 30, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post resection of previously seen hepatocellular carcinoma. No evidence of recurrent disease. No new focal lesions in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post excision of the right cell carcinoma. A focal area of hypodensity measuring 9 x 11 mm in the midpole of the right kidney may represent postsurgical changes. Follow-up imaging is recommended.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postsurgical changes in the liver and kidney. No definite CT finding to suggest recurrence or new lesions.Small mediastinal lymph nodes.Triple phase CT of the liver with delayed images through the kidneys is recommended for follow-up of this lesion for better evaluation of recurrence in the liver and kidney. Alternatively, given the young age of the patient, MR may also be considered for the follow-up imaging modality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: neutropenic fever History: neutropenic fever Small lung volumes with new right basilar subsegmental atelectasis possibly from aspirated secretions or mucous plugging.No specific evidence of infection.Right jugular catheter, tip in SVC/RA junction level.

Output: Nonspecific atelectasis with no reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Evaluate ET tube. Interval retraction of the endotracheal tube, in good position. Bibasilar subsegmental atelectasis. Unchanged small left pleural effusion. No pneumothorax. Unchanged mildly enlarged cardiomediastinal silhouette.

Output: Interval adjustment of ET tube, in good position. Remaining findings unchanged.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, 53 years old.Reason: fever, eval for pneumonia History: fever Marked improvement in right pleural effusion. No significant pneumothorax. Right IJ line terminates just below the cavoatrial junction. A vascular stent overlies the upper right hemithorax. Mild scarring or atelectasis at the left lung base again noted. Unchanged cardiomegaly. Surgical clips again noted within the upper abdomen.

Output: No acute cardiopulmonary process on radiography.Marked improvement in right pleural effusion. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: assess for new infection, aspiration History: AMS Enlarging left pleural effusion with left basilar consolidation, suggestive of pneumonia.Heart size normal.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Evolving left lower lobe pneumonia with a left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: ? Volume Central venous catheter tip in the SVC.There is stable, mild cardiomegaly.No focal pulmonary opacities or pleural effusions.

Output: Cardiomegaly without evidence of edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: incr O2 requirement History: as above Right pulmonic chest tube and a right pleural effusion, slightly larger than before.Improved retrocardiac atelectasis.An NG tube terminates in the stomach.

Output: Right pleural effusion with right chest tube, slightly larger.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: interval exam History: new crackles at bases Cardiomegaly with worsening air space and interstitial opacities consistent with pulmonary edema.Very small pleural effusions are present.

Output: Significant worsening of CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: advanced ET tube History: advanced ET Tube ET tube tip approximately 4 cm above the carina.Venous catheters unchanged.Extensive atelectasis and consolidation in the right lower and middle lobes, compatible with aspiration, unchanged.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 48 years old Male. Reason: r/o right PTX History: s/p thoracotomy. There is no significant change as compared with prior study. Stable consolidation in the left lower lobe with small left pleural effusion and mild cardiomegaly are again identified.

Output: Stable consolidation in the left lower lobe with small left pleural effusion and mild cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: lung infiltrate History: generalized weakness Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: ETT placement History: ETT No significant cardiopulmonary abnormality.ET tube tip approximately 5 cm above the carina.

Output: No significant abnormality. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: ICU History: Dyspnea. Normal heart size with a right-sided ectatic aorta.Port catheter with its tip in the SVC.No sign of pulmonary edema or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: free air? perforation? pna? History: abdominal pain and distention Cardiomegaly.Left pleural effusion compressing the left lung, gradually increasing in size.Right base subsegmental atelectasis stable.Left PICC, tip in the SVC.No free intraperitoneal air.

Output: Enlarging left pleural effusion. No obvious free air.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: dyspnea History: see above No change in cardiomegaly, small pleural effusions and retrocardiac consolidation.ICD leads unchanged in position.

Output: No change in left basilar consolidation with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusions, mesothelioma History: sob Small lung volumes with diffuse opacity compatible with edema and atelectasis, and bilateral pleural effusions, not significantly changed.No specific evidence of pneumonia or other acute change.

Output: Nonspecific pulmonary opacity and pleural effusions without significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: Check Pulmonary Status History: Check Pulmonary Status Mild cardiomegaly with nonspecific interstitial opacity compatible with edema.Moderate left pleural effusion.Venous catheters in the SVC and pigtail catheter in the right lower pleural space.No new findings.

Output: Edema, atelectasis and effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: pulmonary edema History: intubated Slight worsening of basilar opacities suggestive of edema and atelectasis with pleural effusions.Retrocardiac consolidation is worse than before.ET tube tip approximately 5 cm above the carina.

Output: Slight worsening of basilar opacities consistent with edema and atelectasis, with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Heart size upper normal with left basilar atelectasis or aspiration.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC. New left basilar opacity suggestive of aspiration or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: 78 years, Female. Reason: hx of c diff with megacolon History: diarrhea There is persistent dilatation of the colon, which appears slightly improved as compared to the prior study. There is no definite evidence of pneumoperitoneum. Mild bibasilar atelectasis is noted at the lung bases. Degenerative changes affect the lower lumbar spine.

Output: 1.Persistent diffuse dilatation of the colon, slightly improved postoperative study.2.There is no definite evidence of pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: assess for pulm edema History: sob Improving airspace opacities with persistent pleural effusions.Heart size normal.Right jugular catheter tip at cavoatrial junction level.An NG tube terminates in the stomach.

Output: Improving pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Chest pain and shortness of breath. Normal heart size. Mild elevation of the right hemidiaphragm with associated atelectasis.Hiatal hernia with adjacent atelectatic lung in the paramediastinal left lower lobe. The remainder of the lungs are clear.

Output: Hiatal hernia. Mild basal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: intubated History: Respiratory failure Endotracheal tube tip approximately 1 cm from the carina. Enteric tube tip in the gastric cardia directed toward the GE junction. Central venous catheter with tip in the right atrium.Diffuse right pulmonary opacity and moderate right pleural effusion are unchanged compared to the prior exam. Left pulmonary opacity not changed. No pneumothorax.

Output: Diffuse right pulmonary opacity and moderate pleural effusion are unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: chest pain History: chest pain The cardiac mediastinal silhouette is unremarkable.Right pleural effusion and right basilar consolidation/atelectasis may be related to infection or infarction.The left lung is clear.Moderate degenerative changes in thoracic spine.

Output: Right pleural effusion and basilar consolidation/atelectasis compatible with infection or possibly infarction.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cabg History: removal of chest tubes Interval removal of chest tubes with no significant residual pneumothorax.Mild basilar atelectasis and small effusions.

Output: No pneumothorax following chest tube removal. Resolving basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lung transplant, chest congestion History: as noted above Unremarkable cardiac and mediastinal silhouette. Large lung volumes.Faint opacity in the right upper lateral lung field which may correspond to an area of thickening of the major fissures seen on the lateral view.No reliable evidence of pneumonia.

Output: Mild nonspecific opacity in the area of the upper right major fissure, but no specific evidence of pneumonia. If symptoms persist a follow-up chest radiograph or CT scan is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pulmonary infiltrate, infection History: shortness of breath, concern for asthma exacerbation Normal heart size and mediastinum.Perihilar bronchial thickening compatible with asthma.No sign of pneumonia.

Output: Bronchial thickening with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Cough, tachycardia and fevers question pneumonia. Extensive right lower lobe air space opacities consistent with pneumonia. Normal heart size.

Output: Right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest pain NG coiled in the proximal stomach.Mildly decreased lung volumes, however changes in appearances may be partially due to semiupright portable technique. Vascular redistribution and a questionable focal retrocardiac opacity in the left lung base. Serial imaging is needed to confirm

Output: Questionable left lower lobe focal opacity, concerning for aspiration versus infection


Instruction: Generate impression based on medical findings.

Input: 68-year-old male status post right upper lobe resection, chest tubes placed. Two right-sided apical chest tubes are unchanged.Stable cardiomediastinal silhouette.Moderate right pleural effusion without evidence of significant pneumothorax.Left lung is clear.Subcutaneous emphysema of the right lateral chest wall is decreased.

Output: Moderate right pleural effusion without evidence of a significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: PICC placement History: PICC placement Right PICC with tip in the SVC.Cardiomediastinal silhouette appears unremarkable.Postoperative changes again noted in the left hemithorax.No pleural effusion or pneumothorax.

Output: Right PICC with tip in the SVC. No interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: ng History: ng The lower pelvis is excluded from view. The NG tube has been replaced with a Dobbhoff tube. The tip terminates in the region of the mid gastric body. There is a generalized ileus pattern of bowel gas without small or large bowel dilation. The lung bases are clear.

Output: 1. Dobbhoff tube terminates in the region of the mid gastric body.2. Generalized ileus pattern without signs of obstruction.


Instruction: Generate impression based on medical findings.

Input: 51 year old male with shortness of breath. Rule out pneumothorax. Cardiomediastinal silhouette is within normal limits.Redemonstration of dense left apical opacity. No new opacities. No pleural effusion or pneumothorax.

Output: No pneumothorax or interval change. Recommend CT with IV contrast for further evaluation of left apical opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: sob History: sob Linear scarring or subsegmental atelectasis both lung bases.No specific evidence of infection or edema.Large lung volumes consistent with COPD.Mild cardiomegaly is present.A large goiter deviates the trachea to the left at the thoracic inlet level.

Output: No acute abnormality. Large goiter.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for worsening PTX History: SOB Large right pneumothorax, with pleural adhesions at the apex, slightly increased compared to previous with a pleural drain in place.Moderate right pleural effusion with an air-fluid level.Severe emphysema.

Output: Persistent large right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval for infiltrate, edema; hx of cholangiocarcinoma on active chemo History: fever, cough Cardiac mediastinal silhouette is within normal limits. Lungs clear of airspace and interstitial opacities. Stable position of dual-lumen chest port. There are 2 Radiopacities seen medial to the chest port line which may be outside of the patient.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath eval for effusion, infiltrate History: shortness of breath Heart size about upper normal or mildly enlarged. Moderate bilateral pleural effusions with underlying atelectasis, increased considerably from previous.

Output: Increased bilateral effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: ro widened mediastinum - upright for ro perf viscus History: abdominal pain No significant cardiopulmonary abnormality.

Output: No significant abnormality. Normal-appearing mediastinum.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: r/o acute infection History: shaking chills 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: Shortness of breath Persistent decreased lung volumes with associated motion diminishing sensitivity. Basilar edema and/or aspiration or even infection cannot be excluded. Small suspected effusions.Right chest tube again projects towards the apex, minimally retracted.NG tube is unchanged with tip projected into the distal esophagus. An associated Dobbhoff tube is otherwise projected just beyond the GE junction. The right jugular sheath is kinked at the skin entry point, new since prior study

Output: Right chest tube repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: consolidation, infiltration History: wheezing, sob Bronchial wall thickening slightly worse, consistent with asthma or chronic bronchitis.Slightly large lung volumes.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: Bronchial wall thickening consistent with asthma or chronic bronchitis, without infection.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: intubated History: ams Cardiomegaly with basilar atelectasis left greater than right.No specific evidence of edema or pneumonia.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.

Output: Cardiomegaly with basilar atelectasis. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Right atrial appendage and right ventricular leads are as expected. The cardiac venous lead has changed orientation slightly compared to the portable radiograph. No pneumothorax. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged cardiomegaly and enlarged central pulmonary arteries.

Output: The cardiac venous lead has changed orientation slightly compared to the portable radiograph. Consider assessment to ensure proper function of the cardiac pacer/fibrillator if clinically indicated. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: PTX History: PTX Persistent large left hydropneumothorax with a chest tube projected over the left lung base.Focal opacity at the right base consistent with atelectasis and consolidation.A more recent radiograph has been interpreted.

Output: Persistent large left hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: mass History: sz The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Acute myeloid ischemia. Whooping cough Interval resolution of the bilateral pleural effusions, currently lungs are clear and well visualized. The cardiac and mediastinal contours are within normal limits. Unchanged right jugular catheter terminating in the SVC just beyond at the confluence with the left system.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: ETT History: ETT Tracheostomy tube tip at the level of the clavicular heads. Left jugular catheter unchanged in position. Lung volumes remain low with diffuse airspace opacities similar to recent previous, suggestive of ARDS.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: Swan placement via LIJ History: as above Interval replacement of left internal jugular central venous catheter with Swan-Ganz catheter terminating in the right interlobar artery. Minimal right pleural effusion with interval decrease in right greater than left airspace and interstitial opacities. Unchanged cardiomegaly.

Output: Interval replacement of left internal jugular central venous catheter with Swan-Ganz catheter terminating in the right interlobar artery. Improving right pleural effusion and interstitial/airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: metastatic breast cancer, concern for pericardial effusion History: passing out, chest pain Mild basilar reticulation. No large pleural effusion or pneumothorax. Focal area of convexity noted along the inferior margin of the left breast which is not well correlated on abnormality on the lateral. This lesion could conceivably be within the lung.Mild to moderate cardiomegaly again noted. Aortic and coronary calcification, as before. Patient status post left mastectomy.

Output: Questionable focal left lung lesion centrally. Correlation with recent chest CT is suggested if clinically indicated. Probable mild interstitial pulmonary edema. Patient is status post left mastectomy.Mild-to-moderate cardiomegaly again noted. Correlation with echocardiography is suggested if not recently performed.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: worsening productive cough History: cough Increased bibasilar opacity, worse on the left, which may be due to aspirate or pneumonia.

Output: Increased bibasilar opacity, worse on the left, which may be due to aspirate or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Shortness of breath Unremarkable cardiomediastinal silhouette.Upper lobe predominant bronchiectasis and mucoid impaction, compatible with cystic fibrosis and similar to prior.No new focal lung opacities identified.No pleural effusions.

Output: Findings compatible with cystic fibrosis, similar to prior.Please see subsequent CT report from the same day for additional findings.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ARDS History: see above Slight worsening of pulmonary opacities especially in the right lower lung zone, with small pleural effusions.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Slight worsening of pulmonary opacities in the right lower lung zone, with small pleural effusions. ET tube repositioned, the tip now 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: History of head and neck cancer. CHEST:LUNGS AND PLEURA: Scattered 2 to 3 mm micronodules unchanged. Several small nodules are present in the right costophrenic angle region, possibly related to aspiration or inflammation given the clustering and the basilar location; most conspicuous approximately 6 by 8 mm image 85/105 which be followed on subsequent studies. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Coarse right breast calcifications unchanged. Neck dissection and tracheostomy.UPPER ABDOMEN: No significant abnormality noted.

Output: Right basilar nodules described above, indeterminate for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: fever w/u History: tachy, febrile, leukopenia Mild nonspecific left base subsegmental atelectasis.No other significant abnormality.

Output: Mild left base subsegmental atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: swan History: swan Left IJ Swan-Ganz catheter tip in the right pulmonary artery. Stable cardiomegaly and low lung volumes. Left-sided ICD is unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval ETT position History: hypoxia ET tube tip now located 5 cm above the level of the carina.Mediastinal mass is demonstrated. No new lung opacities.Right PICC line is again noted in the cavoatrial junction.

Output: ET tube slightly retracted 5 cm above the level of the carina. No interval change in the cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Pneumothorax. Post device placement. Interval removal of right IJ catheter. Left chest wall pacer with leads unchanged in position. Small bilateral pleural effusions and interstitial opacities are unchanged. Unchanged cardiomegaly. No pneumothorax

Output: No pneumothorax. Unchanged mild pulmonary edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: heart failure History: as above Worsening mid to lower lung zone interstitial and airspace opacities with moderate sized pleural effusions.Heart size normal.Very small right apical pneumothorax noted.

Output: Worsening pulmonary opacities and pleural effusions suggestive of CHF/hypervolemia. Superimposed aspiration or infection are in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: evaluate line placement History: malnutrition need for PN No significant cardiopulmonary abnormality.Left PICC, tip in the SVC.GE junction clips.

Output: Left PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Pulmonary fibrosis/s/p lung resection History: Pulmonary fibrosis/s/p lung resection No pneumothorax following right chest tube removal.Unchanged interstitial opacities present.

Output: No significant pneumothorax following right chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: s/p TECAB, CT removal History: s/p TECAB, CT removal Chest tubes removed with no pneumothorax.Mild increase in basilar atelectasis with pleural effusions. Heart mildly enlarged.Left subclavian pacemaker, leads unchanged in position.Status post extubation and right jugular catheter removal.

Output: No pneumothorax following chest tube removal. Increased basilar atelectasis with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: SOB evaluate for worsening pulmonary edema. Unchanged cardiomegaly.Extensive pulmonary opacities have not resolved and appear static in distribution and extent. Patchy atelectasis or scarring on the left.Right hilar lymphadenopathy unchanged.

Output: Static appearance of extensive pulmonary opacities atypical for edema and is now suspicious for an atypical infection including but not limited to pneumocystis or mycoplasma pneumonia. Diffuse alveolar hemorrhage is considered less likely.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with sarcoid. History of colon cancer obtained from prior radiology requisition. LUNGS AND PLEURA: Numerous, predominantly upper lobe bilateral pulmonary nodules are identified. Some of these are calcified and thus compatible with granulomatous disease. The background lung demonstrates several well-circumscribed, geographic regions of relative hypoattenuation which persist on expiration views likely representing air trapping. Although these findings are most compatible with the patient's stated history of sarcoid, given her history of colon cancer, comparison with prior exams is recommended if available. Surgical suture lines are evident in the right upper and right middle lobes. MEDIASTINUM AND HILA: Numerous enlarged superior mediastinal, prevascular, pretracheal, subcarinal and hilar lymph nodes are evident. Most of these are calcified compatible with prior granulomatous disease.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Prominent gastrohepatic and porta hepatic lymph nodes are identified.A subtle focus of hyperattenuation within the liver (axial image 94/105) is of uncertain significance, but given the patient's history of colon cancer, further evaluation with dedicated liver imaging (triple phase liver CT) is requested.

Output: 1.Constellation of findings including predominantly upper lobe pulmonary nodules and mediastinal/hilar lymphadenopathy most compatible with the patient's stated history of sarcoid. 2.A subtle liver lesion is incompletely evaluated on this noncontrast examination. Dedicated liver imaging is requested as above.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: rulr out pneumonia History: cough and cold symptoms Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: ? infection History: ? infection/ AMS Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: FemaleReason for Study: Reason: eval for PTX History: s/p MVC The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Sepsis, cough noted on exam patient with HIV not taking meds. IV drug use. With abscess. Basilar scarring and bronchiectasis on the right. Volume loss in the left mid lung associated with some faint opacity nonspecific and is of unclear chronicity. Although this could be due to scarring/atelectasis, acute infectious process may have a similar radiographic appearance.Presumed nipple shadow artifact on the right.Asymmetric left chest wall soft tissue swelling, correlate with site of cellulitis.Nonspecific blunting of the costophrenic angles. No pneumothorax.

Output: Opacities in the left lung of unclear chronicity and may reflect atelectasis/scarring or infection. Consider a baseline CT unless the referring clinical service is able to obtain and submit remote outside prior films for comparison. Left chest wall soft tissue swelling.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Congestive heart failure. Swan-Ganz catheter tip is pulled back upon itself within the main pulmonary artery.IABP marker at the level of the top of the aortic arch, grossly unchanged. Cardiomegaly with diffuse interstitial opacity compatible with edema; slight improvement in edema.

Output: Swan-Ganz catheter tip folded back upon itself within the main pulmonary artery. CHF with slight improvement in edema.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: chest pain History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 91 years old.Fever and productive cough question pneumonia. Patchy faint airspace opacities bilaterally suspicious for pneumonia. New retrocardiac atelectasis on the lateral radiograph. Blunting of the posterior costophrenic angles is unchanged. Upper normal heart size. Tortuous thoracic aorta, unchanged.

Output: Multifocal opacities suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: as above Tracheostomy tube and venous catheter unchanged.Mild basilar atelectasis.No new findings.

Output: Mild basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval ETT, lung fields History: s/p LVAD Median sternotomy for LVAD placement with chest tubes and no pneumothorax.Nonspecific basilar subsegmental atelectasis postop.Left subclavian ICD, leads unchanged in position.Right jugular Swan-Ganz catheter, tip in main pulmonary artery.ET tube tip 7 cm above the carina.New LVAD. Right PICC removed.

Output: No complication following LVAD placement. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: ro fxs, ptx History: trauma + pain The heart is somewhat in size. Moderate tortuosity of the thoracic aorta.Lung volumes are normal. Signs of upper lobe predominant emphysema.No abnormal lung parenchymal opacities.No pleural effusion or pneumothorax.No displaced rib fractures are noted, considering limitations for the assessment of the inferior most ribs.

Output: No displaced rib fractures or pneumothorax, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: fever, hx of cancer, eval for PNA History: fever, hx of cancer, eval for PNA Mild basilar subsegmental atelectasis and very small pleural effusions, unchanged.Heart size normal, although the azygos vein is quite distended.No evidence of pneumonia. No sign of metastases.

Output: Very small effusions and basilar subsegmental atelectasis, unchanged with no other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval for widened mediastinum History: chest pain, left hand numbness The cardiomediastinal silhouette is normal in size.No focal pulmonary opacity, pleural effusion or pneumothorax.Status post mitral valve replacement with medial sternotomy wires intact.

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


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: ETT placement History: respiratory failure The heart is normal in size.The ET tube has been advanced and overlies the mid trachea, localized approximately 3.3 cm above the carina.Right IJ central venous catheter in place overlies the proximal right atrium. Enteric tube courses below the diaphragm.Very low lung volumes and vascular crowding.Possible small left pleural effusion. No pneumothorax.

Output: Interval repositioning of ET tube, now localized approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: r/o PTX History: post procedure Left-sided pacemaker removed.New right subclavian biventricular dual-chamber ICD in place, leads appropriate in position with no pneumothorax.

Output: ICD placement with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male complaining of choking on food, prior to lung transplant evaluation. Scout radiograph of the chest showed large lung volumes suggestive of COPD. Mild scarring at the lung apices. No mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Please note that the costophrenic angles are excluded from the field-of-view.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. Fluoroscopic evaluation of the hypopharynx and upper esophagus demonstrate no evidence of aspiration. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.During the exam, no spontaneous or provoked gastroesophageal reflux was observed. A swallowed 13mm barium tablet was held briefly in a physiologic location and passed readily into the stomach with sips of waterTOTAL FLUOROSCOPY TIME: 3:57 minutesAIR KERMA: 92.00 mGy

Output: Normal examination of the esophagus. No evidence of aspiration during this study.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: chest tube History: chest tube Left chest tube, tip in apex, with a small amount of pleural air at the periphery at the left base, otherwise no evidence of pneumothorax.Nonspecific basilar subsegmental atelectasis and small pleural effusions are present.

Output: Small pleural air collection possible, chest tube in place with no large pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: ?pulm edema History: sob, h/o valve replacement at OSH, patient unsure which valves Moderate cardiomegaly, status post sternotomy for mitral replacement and tricuspid annuloplasty.Pulmonary vascular redistribution is present without reliable evidence of edema or pleural effusions.No specific evidence of infection.

Output: Cardiomegaly status post mitral valve replacement and tricuspid valve annuloplasty. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old. Reason: evaluate rib cartilage for ear reconstruction. History: traumatic ear amputation Cardiomediastinal is unremarkable.No focal airspace opacity, pleural effusion or pneumothorax.No evidence of displaced rib fracture.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with ocular lymphoma. Restaging. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Few subcentimeter mediastinal lymph nodes are noted, including a borderline enlarged pretracheal lymph node with a fatty hilum. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense lesion in the lower pole of the right kidney, likely represents a cyst. A right renal artery aneurysm with calcification of the arterial wall is noted.RETROPERITONEUM, LYMPH NODES: Few subcentimeter lymph nodes are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes affect the lower lumbar spine.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple subcentimeter mesenteric lymph nodes are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.Minimal mediastinal, retroperitoneal, and mediastinal lymphadenopathy that is not enlarged by CT criteria.2.Right renal artery aneurysm with calcification of the arterial wall


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Chest pain, evaluate for pneumonia. Sternotomy hardware intact.Low lung volumes.Streaky bibasilar opacities, increased in the right lower lobe.The cardiac and mediastinal contours are within normal limits for size.

Output: Nonspecific streaky bibasilar opacities possibly representing CHF or pneumonia. Further evaluation with an upright PA and lateral chest radiograph is suggested.


Instruction: Generate impression based on medical findings.

Input: Bilateral basilar crackles. Sarcoidosis No definite superimposed acute cardiopulmonary amalgam. Persistent moderate and predominantly interstitial changes are observed in all 4 quadrants and essentially unchanged from prior studies. No definite effusions.Cardiac and mediastinal contours are grossly within limitsRight jugular catheter extends into the upper SVC

Output: Underlying chronic appearing changes consistent patient's known sarcoidosis. No superimposed distinct acute abnormality within this limited exam. Consider serial imaging to increase sensitivity


Instruction: Generate impression based on medical findings.

Input: 82-year-old male status post right hemicolectomy for colon cancer. CHEST:LUNGS AND PLEURA: Mild emphysema. Pleural based plaque in the right middle lobe is unchanged from previous CT dated 3/13/2009. Focal areas of atelectasis in the left lung base.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hemangiomas and benign cysts in the liver are unchanged. Some of the lesions are too small to accurate characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Minimal wall thickening of the bladder, more prominent anteriorly.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Coarse trabeculation of the pelvic bones, most prominent in the left iliac bone is unchanged and may represent changes secondary to Paget's disease.OTHER: No significant abnormality noted

Output: No significant change from previous study. Mild wall thickening of the bladder anteriorly. If there is a clinical concern for bladder tumor cystoscopy may be helpful.


Instruction: Generate impression based on medical findings.

Input: Cough Mild COPD changes without superimposed acute cardiopulmonary abnormalitySurgical sternotomy fixation and vascular clips projected over the upper mediastinum

Output: COPD without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Cough and chest pain. History of sickle cell disease. Stable cardiomegaly and basilar interstitial opacities. No new focal airspace opacity, pleural effusions or pneumothorax.

Output: Stable cardiomegaly and basilar interstitial opacities.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, 49 years old.Reason: ett History: ett distance? The endotracheal tube terminates 6 cm above the carina. The remaining support devices are unchanged in position. Of note, the nasogastric tube side hole terminates in the distal esophagus.Blunting of the right costophrenic angle likely from a combination of scarring and small right pleural effusion. Opacities in the right base not significantly changed, suspected atelectasis and aspirated secretions. Cardiomegaly is unchanged. No pneumothorax.

Output: Nasogastric tube advancement recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: s/p PICC, evaluate. Left PICC loops within the left internal jugular vein, with the tip extending inferiorly. An enteric tube coils within the stomach. Multiple surgical clips overlie the upper abdomen. Right abdominal drainage catheter is partially visualized.Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: 1.Left PICC loops within the left internal jugular vein, with the tip extending inferiorly.2.Enteric tube coils within the stomach.3.No acute cardiopulmonary abnormalities.These findings were discussed with Dr. Noelle Kakuk at 11:38 AM on 5/12/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: chest pain, dyspnea History: chest pain, dyspnea Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of leukemia, 30 days post stem cell transplant CHEST:Bilateral new moderate-sized pleural effusions. Bilateral dependent atelectasis.Index prevascular node measures 1.4 by 0.8 cm on image number 34, series number 3, slightly increased compared to previous study. Other mediastinal lymph nodes are also slightly increased in size.Trace pericardial effusion.Index left axillary node measures 1.7 x 0.5 cm on image number 28, series number 3, significantly decreased in size compared to previous CT. Other axillary nodes have also decreased in size within the internal.Small amount of fluid around the right shoulder joint which may indicate degenerative changes versus fluid collection the bursa is unchanged. The tip of the right-sided port catheter is in the SVC.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Subcentimeter cyst in the pancreatic tail and body are unchanged. No evidence of pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter minimally complex cysts in the upper pole of the right kidney is unchanged from previous study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening involving the cecum and proximal ascending colon which may represent mild colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace amount of ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index right femoral node measures 8 x 8 mm image number 185, series number 3, unchanged from previous study. Other small pelvic lymph nodes are also unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal interval increase in the size of the mediastinal lymph nodes. Significant interval decrease in the size of the axillary lymph nodes.Pelvic lymph nodes are unchanged.New bilateral moderate pleural effusions and small pericardial effusion.Mild wall thickening involving the cecum and proximal ascending colon suspicious for mild colitis.


Instruction: Generate impression based on medical findings.

Input: Male; 63 years old. Reason: am cxr History: am cxr A right-sided chest tube appears unkinked. Otherwise, stable multiple tubes and lines. Stable esophageal stent.Stable cardiomediastinal silhouette.Low lung volumes. Stable small pleural effusions with underlying atelectasis. No pneumothorax.

Output: Stable cardiopulmonary appearance with small effusions and atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 43 years old Female. Reason: lines ok? History: blast crisis. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Diffuse groundglass opacities is seen in the right middle and lower lung fields as well as in the left lower lung field.

Output: The above findings are consistent with mild congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male, advanced IABP, ? placement ET tube, left jugular catheter tip, cardiac assist cannulae and enteric tube tip unchanged. IABP marker unchanged in the distal descending thoracic aorta. Right IJ Swan-Ganz catheter tip unchanged overlying the right main pulmonary artery. Bilateral pleural effusions and perihilar interstitial opacities with cardiomegaly unchanged.

Output: IABP marker unchanged in the distal descending thoracic aorta. No interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: s/p MVR History: s/p MVR Status post mitral valve repair.Partial resolution of right lower lung zone subsegmental atelectasis, but persistent right hemidiaphragm elevation and very small pleural effusions.Heart size normal.

Output: Improving basilar atelectasis with persistent small pleural effusions after recent mitral valve repair.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: first NP fever, eval for pna History: as above Right port tip in SVC. Left jugular catheter tip in SVC.Minimal streaky basilar opacity likely due to atelectasis. No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma No discrete osseous focal abnormalities, however please correlate with pending dedicated imaging. Healing left third rib fracture with additional questionable fracture involving the rib end of the left second rib.No underlying cardiopulmonary abnormality, specifically lungs are clear

Output: Old healing rib fractures, please correlate with dedicated rib imaging due to greater sensitivity


Instruction: Generate impression based on medical findings.

Input: Reason: New edema in the legs bilaterally with increased SOB. R/O fluid History: Peripheral edema, obese, urinary incontinence, stress, female, mild, bilateral knee OA, Rouine health exam; adenocarcinoma, breast -r-breast mastectomy Marked biapical pulmonary and pleural scarring with cysts or cavities, and bronchiectasis, unchanged.Normal heart size and no sign of pulmonary edema or pleural effusions.

Output: Chronic apical abnormalities compatible with previous infection. No sign of CHF or other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: ETT History: ETT No significant cardiopulmonary abnormality.ET tube tip 5 cm above the carina.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval for IABP placement, edema History: CHF, cardiogenic shock Moderate to severe cardiomegaly.No evidence of edema although there is mild retrocardiac subsegmental atelectasis.IABP catheter marker 4 cm below the top of the aortic arch.Right PICC, tip at RA level.

Output: IABP marker 4 cm below the top of the aorta. Moderate to severe cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Evaluate lung nodule status post left upper lobe VATS Status post removal of left pleural drain without significant pneumothorax. A pulmonary nodule projects over the right middle lobe compatible with nodule seen on recent CT. No acute cardiopulmonary abnormality.

Output: Interval removal of left pleural catheter without significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: s/p bronch History: postop atelectasis The endotracheal tube terminates 5 cm from the carina. Swan-Ganz catheter terminates within the RPA. Chest tube/mediastinal drains noted. Cardiac leads, unchanged. LVAD device again noted. Intra-aortic balloon pump again noted terminating approximately 7.9 cm from the top of the aortic arch. Left effusion and left basilar opacity, as before. Improvement in right upper lobe atelectasis. No pneumothorax.

Output: Expected postoperative appearance with left pleural effusion and probable left basilar atelectasis. Improvement in right upper lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: s/p vats History: chest tube Two right chest tubes no pneumothorax.Right hemithorax postsurgical volume loss.No new findings.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: assess for rib fracture, s/p fall History: s/p fall with rib pain Median sternotomy, heart size normal.No obvious displaced rib fracture or pneumothorax.Healed or healing fracture of the lateral aspect of the left fourth and possibly fifth rib identified.Right jugular catheter, tip at cavoatrial junction level.

Output: Healed left-sided rib fractures, but nothing acute and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: pneumonia, cardiomegaly, effusion History: acute onset substernal chest pain, also presenting with DKA 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: 53-year-old female with endometrial carcinoma CHEST:LUNGS AND PLEURA: Subcentimeter, nonspecific nodule in the right lower lobe on image number 41, series number 5.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left border in the lateral soft tissues of the chest extending two an expandable balloon of the left breast is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Subcapsular hypodensity in the liver on image number 89, series number 3 is unchanged. No new lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Hazy stranding around the aorta and IVC at the level of bifurcation may represent postsurgical changes. There are small retroperitoneal lymph nodes, however, no evidence of lymph node enlarged by CT criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No CT evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: eval pacemaker placement History: intermittent pacemaker not capturing No focal lung consolidation or evidence of overt left-sided heart failure. Moderate cardiomegaly again noted. Cardiac leads, unchanged. Cardiac valve prosthesis, unchanged. Aortic atherosclerosis, as before. Sternotomy wires at midline.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: eval for worsening infection, heart failure History: respiratory distress Stable enlarged cardiac silhouette. Stable to slight improvement in bilateral interstitial and airspace opacities most suggestive of edema. Small pleural effusions remain grossly unchanged. No pneumothorax.

Output: Stable to slight interval improvement in bilateral pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: assess for change in pulmonary status History: intubated post-operatively Interval repositioning of endotracheal tube, now 4 cm superior to carina. Right IJ central catheter is unchanged in position.Moderate layering pleural effusions with atelectasis. Persistent retrocardiac consolidation. No interval pneumothorax. Heart size remains mildly enlarged raising the question of a pericardial effusion.

Output: Successful repositioning endotracheal tube, now 4 cm above carina. Stable pleural effusions and atelectasis. Pericardial effusion suspected.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with metastatic colon cancer. Evaluate for PE. Check for lung metastasis. CHEST:PULMONARY VASCULATURE: No evidence of pulmonary embolus. Technically adequate study.LUNGS AND PLEURA: Micronodule is seen at the right costophrenic sulcus (series 11, image 62), appearing similar to prior study. New micronodule seen in the left lower lobe; which may represent inflammatory sequela versus metastatic disease. Note is made of paraseptal emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal with minimal pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Numerous hepatic metastases are noted in the visualized upper abdomen. Please refer to report for CT abdomen/pelvis performed on the same date for further details.LOWER EXTREMITY DVT EXAMINATION:Suboptimal opacification especially lower thighs makes this portion of the exam nondiagnostic.

Output: 1. No PE. Study is nondiagnostic for evaluation of DVT.2. Stable right lower lobe micronodule. New left basilar micronodule, which may represent inflammatory sequela versus metastatic disease.3. Numerous hepatic metastases. Please refer to report for CT abdomen/pelvis performed on the same date for further details.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old with history of chest pain and shortness of breath, evaluate for infection Stable cardiomediastinal silhouette. No focal consolidation. No pleural effusions. Leadless pacemaker noted in the left chest.

Output: Stable exam without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: pleural effusion, s/p pleurx placement History: malignant pleural effusion There is been interval placement of a right pleural drainage, with the tip terminating at the right lung apex.Interval decrease in size of the right pleural effusion with improvement of the right perihilar atelectasis, with residual patchy consolidation. Left lower lobe atelectasis and left basilar effusion similar to prior. There is no pneumothorax.The cardiac and mediastinal contours are unchanged.

Output: Interval placement of a right pleural drainage catheter with improvement of the right pleural effusion and right perihilar atelectasis, but with residual patchy bilateral opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: SOB Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Surgical clips again noted in the left hemithorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: s/p SC-ICD implantation --> r/o pneumothorax and evaluate lead position History: as above Single lead left ICD is in place with a lead directed towards the right ventricular apex.No focal air space opacity. No large pleural effusion or pneumothorax is seen.No change in severe cardiomegaly.

Output: Single lead left ICD in place without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: ETT placement, perform 1/4/16 History: none ET tube tip 6 cm above carina. Venous catheter tip at RA/SVC junction. NG extends beyond the field-of-view of study.Persistent bibasilar edema with bilateral pleural effusions.

Output: ET tube tip 6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: 69 year-old male history of shortness of breath. Evaluate for pulmonary edema. Left chest wall AICD/pacemaker is incompletely imaged on this study. Again seen are extensive chronic appearing interstitial opacities compatible with chronic interstitial lung disease. There is volume loss particularly on the left. There may be slight interval increase in focal fibrosis in the right upper lobe.

Output: Chronic interstitial lung disease as above. There may be slight interval increase in size of probable nodular fibrosis within the right upper lobe. Follow-up PA/lateral chest radiograph is recommended to exclude alternate pathology in 2-3 months.


Instruction: Generate impression based on medical findings.

Input: 50 years, Female. Reason: lateral view to eval shunt setting History: adjustment of shunt setting Codman Hakim valve has been reset to approximately 130-140 mm of water.

Output: As above.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: Evaluate for pneumonia History: Seen on OSH imaging Mild left basilar subsegmental atelectasis or scarring. No large pleural effusion or pneumothorax. Mild cardiomegaly again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with chest pain. Cardiomediastinal silhouette is unchanged. Tortuous aorta, similar to prior.No consolidation, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: intubation History: intubation Endotracheal tube in the projection of the trachea with tip approximately 2 cm above carina.Cardiomegaly with basilar opacities, right greater than left. Findings are nonspecific which can represent edema or infection.

Output: Cardiomegaly with basilar opacities, right greater than left. Edema versus infection.


Instruction: Generate impression based on medical findings.

Input: Reason: AMS, ?Infectious source History: AMS Normal cardiac and mediastinal contours.Biapical scarring and calcified granulomas compatible with previous infection.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p MVR Swan-Ganz catheter tip in the right main pulmonary artery.Cardiomegaly with perihilar and basilar streaky opacities compatible with atelectasis and aspirated secretions.

Output: Perihilar and basilar opacity compatible with atelectasis and aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Pacer placement. Motion degrades sensitivity.Persistent mixed mild-to-moderate CHF changes with moderate bilateral pleural effusions and cardiomegaly. No immediate postprocedural additional new complicationsUnchanged right subclavian ICD, however lead tips are poorly visualized due to motion

Output: ICD grossly unchanged and suspected CHF


Instruction: Generate impression based on medical findings.

Input: 87-year-old male with history of prostate cancer status post 6 cycles of docetaxel. CHEST:LUNGS AND PLEURA: Stable slight pleural thickening at left lung base. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Interval decrease in size of axillary lymph nodes I laterally. Reference left axillary lymph node (series 7, image 39) measures 1.4 x 1 cm; previously measured 1.4 x 2 cm. Diffuse osseous metastases are again seen.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Possible very small left adrenal nodule.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Significant interval decrease in the size of retroperitoneal adenopathy. Reference aortocaval node (series 7, image 224) measures 1 x 0.8 cm; previously measuring 1.9 x 1.7 cm. Reference para-aortic and lymph node (series 7 and image 121) measures 0.8 x 0.7 cm; previously measuring 1.3 x 1.8 cm.BOWEL, MESENTERY: Scattered colonic diverticulosis.Midline ventral hernia containing mesenteric fat and nonobstructed small bowel loops. No evidence of bowel obstruction.BONES, SOFT TISSUES: Numerous sclerotic foci compatible with metastases again seen in the scapulae, clavicular heads, sternum, vertebrae, ribs, and pelvis.PELVIS:PROSTATE, SEMINAL VESICLES: Eccentric soft tissue extending from the left prostatic lobe, extending cephalad, appear similar prior study.BLADDER: No significant abnormality noted.LYMPH NODES: Interval decrease in size of pelvic adenopathy. Reference right common iliac node is now subcentimeter in size and too small to accurately measure; previously measuring 1.3 x 1.9 cm.BOWEL, MESENTERY: Ventral wall hernia as above. No evidence of bowel obstruction.BONES, SOFT TISSUES: Numerous sclerotic foci compatible with metastases again seen in the scapulae, clavicular heads, sternum, vertebrae, ribs, and pelvis, and femora.

Output: 1. Marked interval decrease in retroperitoneal and pelvic adenopathy with reference measurements as above.2. Extensive bony metastatic disease.3. Stable asymmetric enlargement of the prostate gland.


Instruction: Generate impression based on medical findings.

Input: ECMO patient ETT, mediastinal and bilateral basilar chest tubes, vascular catheters are all unchanged in position. Specifically and additionally observed are 2 radiopaque sponge markers one projected over the mid trachea and another over the left ventricle unchanged in position.IABP marker mildly blurred projects within 2 cm of the aortic archModerate cardiomegaly with underlying suspected compression atelectasis of the left lower lobe with an associated marked to large layering left pleural effusion.

Output: Chest tubes and postsurgical hardware unchanged including a well-positioned ETT. Particular note is made of radiopaque packing within the mediastinal incision


Instruction: Generate impression based on medical findings.

Input: Assess lung white out. Near complete reexpansion of the left lung with residual atelectasis in the left lower lobe. Persistent left apical loculated pleural fluid with adjacent architectural distortion extending towards the hilum, possibly reflecting an unusual pattern of atelectasis due to pleural adhesions.Moderate pleural fluid on the right with unchanged dependent atelectasis and basilar nodular opacities which could be neoplastic or infectious.

Output: Persistent loculated left apical pleural fluid with possible pleural adhesions in the left upper lobe. Left lower lobe atelectasis has improved but not resolved. Nodular densities at the right lung base similar to recent prior and may be neoplastic or infectious.


Instruction: Generate impression based on medical findings.

Input: Reason: recurrent pleural effusion? History: SOB, confusion Large right pleural effusion with moderate shift of the mediastinum to the left.Mild nonspecific interstitial opacity in the left lung which may be chronic.

Output: Large right pleural effusion with underlying partial atelectasis.


Instruction: Generate impression based on medical findings.

Input: Pulmonary edema Motion degrades sensitivity.ETT removed. NG grossly unchanged and bilateral basilar chest tubes similar position.Cardiomegaly with bilateral nonspecific opacities greater in both bases with moderate layered effusions. No definite new findings

Output: Chest tubes unchanged and ETT removed


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: stat TLC History: TLC Cardiomegaly status post sternotomy.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter removed. A new right jugular catheter terminates in the SVC.LVAD and ICD unchanged.

Output: Catheter exchange without complication.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: s/p intubation. pls assess ETT placement. History: s/p intubation. The endotracheal tube tip terminates 2 cm above the carina.Patchy basilar predominant interstitial and airspace opacities appear similar to the prior. Possible layering small left pleural effusions. No pneumothorax. Low lung volumes.Unchanged moderate enlargement of the cardiac silhouette.The imaged upper abdomen and skeleton unremarkable.

Output: Stable interstitial and airspace opacities associated cardiomegaly suggests pulmonary edema secondary to CHF, although superimposition on a systemic process is not excluded. Possible small left layering pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old."Question OSA" . Lung volumes. Acute respiratory failure. Interval placement of a nasogastric tube with tip off the caudal margin of the film. Right jugular catheter and visualized portion of the Dobbhoff tube unchanged.Lung volumes remain low. Layering pleural fluid and atelectasis on the left. Compressive atelectasis right lung base. No specific signs of pulmonary edema.

Output: Nasogastric tube tip off the caudal margin of the film. Persistent left pleural fluid collection with associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: assess for infiltrates History: cough Left subclavian port catheter with tip overlying the cavoatrial junction.Cardiac silhouette is normal in size.Low lung volumes. There is mild prominence of the perihilar interstitial markings suggesting chronic lung changes. No focal consolidation, sizable effusion or pneumothorax. There is retained barium contrast material within a few colonic diverticula.No acute osseous abnormality.

Output: Low lung volumes with mild prominence of perihilar interstitial markings suggesting chronic lung changes. No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with esophageal cancer and chronic lymphocytic leukemia CHEST:LUNGS AND PLEURA: Postoperative changes in the left lower lobe are again noted. Pleural thickening and scar are unchanged.MEDIASTINUM AND HILA: Postoperative changes secondary to esophagectomy. Mediastinal adenopathy is increased in size and number compared to previous study. An index precarinal lymph node now measures 17 by 15-mm image number 33, series number 3. This node was, measuring 7 by 8mm image number 32, series number 3. (Seven slice 2007CHEST WALL: Interval increase in the size and number of axillary lymph nodes. Index right axillary node measures 3.1 x 1.6 centimeter. Previously this was measuring 1.5 by 2.6 cm on image number 21, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Mild splenomegaly, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Significant retroperitoneal and peripancreatic adenopathy. An index aortocaval lymph node measures 19 by 14 mm on image number 97, series number 3, new from previous study.BOWEL, MESENTERY: Soft tissue density lymph nodes adjacent to the stomach. An index node measures 17 x 13 mm image number 88, series number 3. Other scattered small mesenteric lymph nodes.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: Extensive bilateral pelvic adenopathy. Left obturator index lymph node measures 3 .1 x 1.6 cm on image number 155, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval development of mediastinal, retroperitoneal, and pelvic adenopathy.


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: CT ICU Daily Cxray LVAD in place, position unchanged. Orphaned left AICD leads unchanged. Right chest wall AICD unchanged. Dobbhoff tube tip in the body of stomach. Embolization coils noted in the right upper quadrant. Sternotomy wires intact.Bilateral interstitial opacities, right greater than left, not substantially changed from the prior examination. Small bilateral pleural effusions, left greater than right unchanged. Cardiomegaly.

Output: Bilateral interstitial opacities are unchanged, with small pleural effusions and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: eval hemorrhage History: hemoptysis No focal lung consolidation. Moderate cardiomegaly again noted. Cardiac leads, unchanged. No large pleural effusion or pneumothorax. Rightward deviation of the superior aspect of the trachea again noted suggestive of thyroid nodule/goiter. Consider correlation with ultrasound.

Output: Clear lungs.Rightward deviation of the superior aspect of the trachea again noted suggestive of thyroid nodule/goiter. Consider correlation with ultrasound.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Right upper lobe cavitary lesion and surrounding opacity, increased compared to previous, possibly due to hemorrhage or lavage fluid. There has been recent bronchoscopy.No pneumothorax.

Output: Increased right upper lobe opacity compatible with hemorrhage or lavage fluid but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Dialysis patient History: ? Volume Extensive hilar lymphadenopathy consistent with known sarcoidosis. Moderate cardiomegaly.No specific evidence of infection or edema.Left upper extremity vascular stent partially imaged.

Output: No specific evidence of infection or edema. Hilar lymphadenopathy consistent with known sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: 48 years old Female. Reason: assess lines History: RIJ; ?asp pneumonitis. Severe chronic interstitial disease, unchanged.Catheter tip in the SVC.Decreased volume in the right lung and no other significant interval change.

Output: Severe chronic interstitial disease with decreased lung volume, unchanged.


Instruction: Generate impression based on medical findings.

Input: Syncope and lower extremity edema question CHF. Upper normal heart size. No specific signs of pulmonary edema. No pneumothorax. No signs of aspiration. No pleural fluid.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: RO PNA History: FEVER The endotracheal tube tip terminates proximal to 4 cm above the carina. The left PICC has been removed. The NG tube tip terminates out of the field-of-view.There are persistent basilar predominant patchy interstitial and airspace opacities suggestive of aspiration or possibly infection. No pleural effusion or pneumothorax is evident.The cardiomediastinal contours are within normal limits for size.The imaged skeleton and upper abdomen are unremarkable.

Output: Stable basilar predominant patchy interstitial and airspace opacities suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: SOB History: SOB Diffuse pulmonary opacities suggestive of edema or atypical infection are unchanged, but now there are small pleural effusions.Heart size normal.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary opacities, now with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 57 years, Female. Reason: abdominal distention, fever, recent SBO History: abdominal pain Dilated loops of small bowel, measuring up to 4.3 cm, with air seen in the descending colon. There is a paucity of gas in the pelvis. IVC filter is noted. Pelvic surgical clips are also noted.Please refer to same-day chest radiograph report for chest findings.

Output: Dilated loops of small bowel with air in the descending colon, favored to represent an ileus type pattern. Follow-up radiograph is recommended to exclude a developing obstruction.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with history of shortness of breath. There are diffuse bilateral patchy groundglass opacities. Probable small bilateral pleural effusions. Mild cardiomegaly. Mild dextroscoliosis.

Output: Mild cardiomegaly with diffuse bilateral patchy groundglass opacities. Please see same day chest CT for further details.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of metastatic rectal cancer and PE. CHEST:LUNGS AND PLEURA: Stable bilateral micronodules. Reference right lower lobe nodule measures 4 mm, unchanged (series 5; image 70).Wedge-shaped consolidation in the right lower lobe has greatly decreased in size.MEDIASTINUM AND HILA: Small mediastinal nodes are identified, slightly increased in size. A precarinal lymph node measures 1.4 x 9 mm (series 3; image 39, previously 10 x 7 mm).Coronary artery calcifications.CHEST WALL: A right port terminates in the SVC. No thrombus is seen adjacent to the catheter.ABDOMEN:LIVER, BILIARY TRACT: 4-mm hypodensity at the dome of the liver in the left lobe (series 2; 35) is unchanged from 3/09.SPLEEN: The distal splenic vein thrombosis with the confluence has decreased in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous bilateral renal hypodensities are too small to definitely characterize, unchanged from 3/09, most likely cysts.RETROPERITONEUM, LYMPH NODES: Numerous mildly prominent mesenteric lymph nodes and retroperitoneal lymph nodes are identified, mildly increased in sizeBOWEL, MESENTERY: Stable mesenteric haziness and mildly enlarged mesenteric lymph nodes. A reference node in the left mesentery measures 1.4 x 0.8 cm (series 2; image 119), previously 11 x 8 mm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mild enlarged pelvic lymph nodes are seen, increased in size. A left external iliac node (series 3; image 184) measures 1.3 x 1.1 cm, previously 8 x 6 mm.BOWEL, MESENTERY: Left lower quadrant colostomy. Proctectomy with small amount of fluid in the presacral space with out abscess, unchangedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate infrarenal atherosclerotic disease.

Output: Mildly increased adenopathy, described above.No evidence of thrombosis along the right port catheter.Decrease in the wedge-shaped right lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: assess tubes position History: advanced og Advancement of the nasogastric tube with the sidehole at the gastric fundus. Interval intubation with the endotracheal tube terminating 5 cm above the carina. Right dual lumen port is accessed with the catheter likely terminating in the central left brachiocephalic vein. Left IJ central catheter is unchanged in position.Increasing right lower lobe consolidation compatible with pneumonia. Slight interval reduction of previous left lower lobe opacities. Stable small pleural effusions.

Output: Successful advancement of nasogastric tube. Interval intubation. Progressive pneumonia right lower lobe.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: 55 year old female intubated, 4 AM CXR History: intubated Tracheostomy tube and NG tube unchanged.Stable cardiac enlargement.Persistent left retrocardiac opacity compatible with consolidation/atelectasis.No new pulmonary opacities identified.

Output: No significant interval change in left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: OHS/OSA with dyspnea Stable cardiomegaly. Diffuse hazy airspace opacities and suggestion of vascular redistribution, consistent with pulmonary edema. No specific evidence of pneumonia. There is marked narrowing of the trachea in the coronal plane, raising concern for tracheal stenosis. No large pleural effusion or pneumothorax.

Output: 1. Findings consistent with CHF with pulmonary edema.2. Marked narrowing of the trachea in the coronal plane, suggestive of tracheal stenosis, which could be better evaluated by CT scan.Findings communicated to Dr. Palma at pager #3928 at 1:50 PM on 8/17/16.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: eval pna History: cough Small lung volumes.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

Output: No evidence of infection, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: chest pain, post op History: chest pain, post op SOB Small lung volumes with interstitial opacities and pleural effusions. Mild right basilar subsegmental atelectasis.Heart size relatively normal.

Output: Findings suggestive of postoperative edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.COPD and cough. There is mild cardiomegaly with a tortuous aorta. New right basilar opacity compatible with right lower lobe pneumonia. Left basilar subsegmental atelectasis. No pneumothorax.Degenerative changes affecting the right acromioclavicular joint are noted and better seen than recent studies.

Output: New right basilar opacity compatible with right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Cough Persistent large layered pleural effusions with mild questionable edema, cardiomegaly and partial left lower lobe consolidation. No discrete additional new superimposed focal airspace process within the limitations described.ICD and valvular stent are unchangedTracheostomy tube terminates 7 centimeters above the carina

Output: No significant change in large pleural effusions with underlying left lower lobe partial consolidation


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Rule out pneumothorax, check initial tracheostomy placement History: s/p trach Tracheostomy tube is in place. Enteric tube extends inferiorly off the field-of-view. Clear lungs. Normal heart size. No pleural effusion pneumothorax. No acute bony abnormality.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax? pericardial effusion? History: SOB Almost complete opacification of the right hemithorax consistent with known mesothelioma, not significantly changed.Nonspecific airspace opacity in the left lower lobe with a differential diagnosis that includes pneumonia, not significantly changed.No evidence of pneumothorax.The cardiac silhouette is incompletely visualized though it is not appreciably changed. However this does not exclude pericardial effusion.

Output: Extensive bilateral abnormalities without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: pna, cardiomegaly, effusion History: hx of chf, afib, presenting with palpitations, nausea, weakness The cardiomediastinal silhouette is apparently magnified and most likely enlarged based off of prior PA radiograph. Right-sided streaky opacity likely scarring. No new focal pulmonary opacity suggestive of pneumonia. No large pleural effusion. No pneumothorax.

Output: Unchanged cardiomegaly. No superimposed acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with history of low-grade lymphoma. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic cyst adjacent to the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable ill-defined left para-aortic adenopathy measuring 1.5 x 1 cm on image number 112, series number 4.BOWEL, MESENTERY: Ill-defined soft tissue infiltration within the mesentery is less prominent today. An ill-defined area of soft tissue infiltration measures 2.9 x 1 cm, smaller compared to previous study in the left lower quadrant.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: Stable right pelvic adenopathy measuring 10 x 11 mm image number 151, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal interval decrease in the size of the retroperitoneal and mesenteric lymph nodes. Pelvic adenopathy is unchanged.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of recurrent hemoptysis presenting with hemoptysis. Please evaluate for apical lung lesion or endobronchial tumor. LUNGS AND PLEURA: Moderate to severe emphysema. Right apical wedge resection.A spiculated mass lesion in the right upper lobe measures 1.2 x 1.3 cm on axial image 37/112 and is suspicious for neoplasm.Numerous additional nodular and scarlike opacities are scattered throughout both lungs.Diffuse bronchial and bronchiolar wall thickening and bronchiectasis are suggestive of chronic aspiration, bronchitis or asthma. Peribronchial ground glass nodular opacity in the left lower lobe suggests hemorrhage versus aspiration bronchiolitis or early infection.No pleural effusion. No significant airtrapping is seen and expiration views.MEDIASTINUM AND HILA: Evaluation for mediastinal and hilar lymphadenopathy is slightly limited secondary to the noncontrast technique. However, several prominent pretracheal, prevascular and subcarinal nodes are evident. For reference, the subcarinal lymphoid tissue measures 2.8 x 1.4 cm on axial image 46/112.The cardiac size is normal. No pericardial fluid.CHEST WALL: Rib deformities in the right upper thorax are likely postsurgical.UPPER ABDOMEN: Surgical clips in the gallbladder fossa.

Output: 1.Right upper lobe spiculated mass suspicious for malignancy.2.Diffuse bronchial abnormality as described above suggestive of chronic aspiration or bronchitis/asthma.3.Left lower lobe peribronchial nodularity and ground glass opacity may represent aspiration or early infection, or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: 60-year-old man with shortness of breath. Evaluate ET tube placement. Enteric tube projects inferiorly beyond the visualized field-of-view. ET tube tip is approximately 2.5 cm above the carina. Unchanged large lung volumes and cardiomediastinal silhouette. Prominent dilated loops of bowel in the upper abdomen are unchanged from the previous study.

Output: ET tube tip in appropriate position.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Left pneumothorax. Left chest tube unchanged in position. Moderate left pneumothorax with maximal pleural separation from the chest wall of 21-mm near the apex. Irregular cavitary opacities in the upper lobes bilaterally unchanged. Bronchial valves on the left proximal to the an increased area of parenchymal density in the upper lobe and lingula which appears unchanged. Mild hazy opacity is suggestive of bronchial wall thickening elsewhere about the same. Hilar prominence bilaterally unchanged.

Output: Pneumothorax now measures 21-mm.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: r/o infection History: coughing No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.SOB and setting of gastroenteritis, recent EGD. No pneumoperitoneum or pneumothorax.Normal heart size. The lungs are clear.Thoracolumbar scoliosis.

Output: No free intraperitoneal air is appreciated. No acute pulmonary abnormality. Scoliosis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for volume overload History: sob Heart size about upper normal.Bilateral pulmonary opacities, greater on the right, compatible with pulmonary edema, increased from previous exam small pleural effusions.

Output: Pulmonary edema and small effusions, increased from previous consistent with volume overload.


Instruction: Generate impression based on medical findings.

Input: 73 years old Female. Reason: interval changes History: as above. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins, which is stable. The tip of the Swan-Ganz catheter projects over the right pulmonary artery.

Output: The above findings are consistent with mild congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: chronic pneumonia History: chronic cough, Low lung volumes. Probable subsegmental atelectasis or scarring at the left lung base. Query small left pleural effusion versus pleural scarring. Normal heart size. No pneumothorax.

Output: Low lung volumes. Probable subsegmental atelectasis or scarring at the left lung base. Query small left pleural effusion versus pleural scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: intubated History: see above Lines and tubes are unchanged. Stable mild interstitial pulmonary edema. Stable effusion and bibasilar opacities. Marked cardiomegaly again noted. No pneumothorax.

Output: No substantial difference compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: evaluate lungs for aspiration/infiltrates History: desaturation, respiratory distress Mild basilar interstitial edema and right basilar atelectasis unchanged.Mild cardiomegaly.An NG tube terminates in the stomach.

Output: Unchanged basilar opacities suggestive of edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Postop CABG. Small pleural effusions with basal atelectasis bilaterally, slightly improved on the left. Interval removal of right jugular introducer. Bilateral chest tubes unchanged in position. Trace, less than 5-mm, apical pneumothoraces. Subcutaneous emphysema left chest wall.

Output: Decreased atelectasis left base. Trace pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: RIJ central line placement History: RIJ central line placement Mild basilar opacities are suggestive of edema or aspiration.There may be very small pleural effusions.Mild cardiomegaly unchanged.Right jugular catheter, tip at cavoatrial junction.

Output: Mild basilar opacities suggestive of edema. New right jugular catheter.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: 64 yo M with NICM s/p RVAD/ECMO decannulation, needing CXR evaluation by CT ICU History: SOB. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There are small bilateral pleural effusions. The support devices unchanged.

Output: The above findings are consistent with CHF.