Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: FemaleReason for Study: Reason: posto p, eval ETT, lung fields History: s/p AVR, MVR, Maze ET tube with its tip extending into the proximal right mainstem bronchus.Right IJ Swan-Ganz catheter with its tip in the pulmonary artery.Chest/mediastinal tubes in place without evidence of pneumothorax.Marked cardiac enlargement with mild perihilar edema and pleural effusions.Left retrocardiac opacity compatible with consolidation/atelectasis.New median sternotomy.

Output: Postoperative chest. ET tube in low position and should be readjusted.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Exposed AICD, wound dehiscence. Check AICD lead placement. Left subclavian AICD terminates in the projection of the RV apex. Proximal coil projects over the left brachiocephalic vein/SVC and distal projects over the right ventricle.Cardiomegaly is similar to previous. Minimal pleural fluid, about the same. Mild signs of hypervolemia. Interval clearance of previously seen right upper lobe opacity, with new faint opacity at the right middle lobe. Mild bronchial wall thickening.

Output: AICD projects in expected position, no pneumothorax. Suggest short-term follow-up of right pulmonary opacities to exclude development of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: Evaluate for acute cardiopulmonary process History: Chest pain, left sided 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: Age: 75 yearsGender: MaleReason for Study: Reason: desaturations History: desaturations The cardiac mediastinal silhouette is unremarkable.Marked elevation of the left hemidiaphragm may represent phrenic nerve paralysis.The lungs are clear.No pleural effusions.Right PICC line with its tip in the right axilla.Multiple surgical clips in the left axilla.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with newly diagnosed left breast intraductal carcinoma CHEST:LUNGS AND PLEURA: Previously described lung nodules have nearly completely resolved and now replaced by faint groundglass opacities. Ill-defined groundglass opacity replacing the right upper lobe, index nodule measures 1.3 x 0.8 cm on image number 24, series number 11. New right lower lobe nodule, measuring 6 mm in diameter image number 56 on series number 11.MEDIASTINUM AND HILA: Hypodense, well defined lesion in the left severe mediastinum is unchanged, measuring 3.9 by 3.3 cm, image number 12, series number 11, likely represents a benign duplication cyst. Index prevascular lymph node in the AP window measures 1.3 x 1 .2 cm on image number 26, series number 11, grossly stable. Other mediastinal lymph nodes are also grossly stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Patient's known large infiltrative mass replacing most of the left lobe is grossly unchanged, measuring 11 .2 x 7.3 cm in image number 85, series number 11. The mass invades the left portal vein and its branches. The mass also likely invades the stomach and causes distention of the stomach. No focal lesions are noted in the right lobe. CT appearance of this mass is more characteristic of a primary carcinoma of the liver, such as cholangiocarcinoma or hepatocellular carcinoma.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: Index portacaval lymph node measures 10 x 9 mm in image number 85, series number 11. Other smaller retroperitoneal lymph nodes, also unchanged.BOWEL, MESENTERY: Right lower quadrant ileostomy. Borderline enlarged mesenteric lymph nodes are stable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged uterus with calcifications and heterogeneous, hypodense lesions within its myometrium, likely representing fibroids.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: Interval near complete resolution of the lung nodules. Mediastinal adenopathy is stable. Large left infiltrating mass involving the left lobe of the liver invading the antrum of the stomach causing gastric outlet obstruction. This infiltrating mass is suspicious for a primary carcinoma such as cholangiocarcinoma or hepatocellular carcinoma, rather than metastatic disease.


Instruction: Generate impression based on medical findings.

Input: PICC line removed in this sickle cell patient Interval removal of the previously observed partially radiopaque catheter overlying the left upper chest. No current abnormalities are observed.Cardiopulmonary appearance is also similar with vascular redistribution likely due to semiupright technique with superimposed marked nonspecific cardiomegaly similar to prior studies

Output: Cardiomegaly without distinct additional new abnormality


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: MaleReason for Study: Reason: acute process? History: n/v, postop Left-sided ICD unchanged.Stable cardiac enlargement.The lungs are clear.No pleural effusions.Median sternotomy is intact.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with renal cancer CHEST:LUNGS AND PLEURA: New moderate right-sided pleural effusion. Small left-sided pleural effusion is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Large soft tissue mass centered on the right fourth rib measures 6.9 by 5.8-cm image number 48 on series number 4, not significantly changed from previous study.ABDOMEN:LIVER, BILIARY TRACT: Large, predominantly hypodense, heterogeneous mass in the dome of the liver measures 10 .2 x 8 .3 cm, image number 72, series number 4, grossly stable. Other liver lesions are also stable. Second index lesion measures 3.4 x 3.4 cm on image number 85, series number 4.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Unremarkable.KIDNEYS, URETERS: Status post right nephrectomy. Multiple soft tissue mass lesions are noted throughout the nephrectomy bed. Index lesion to the right of duodenum measures 3.3 by 2.8-cm image number 106, series number 4. Second index lesion more inferiorly located measures 2.5 x 2 .3 cm, image number 120, series number 4.Large soft tissue mass adjacent to right iliac is muscle measures 6.7 by 4.3 cm, slightly enlarged on image number 149, series number 4. Loop, benign left renal cyst.RETROPERITONEUM, LYMPH NODES: Paracaval adenopathy measures 3 .3 by 2.8 cm on image number 137, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: Soft tissue nodules posterior to the bladder, unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Fat-containing left-sided inguinal hernia.

Output: Grossly stable disease with the reference measurements above.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.SOB, history of lung transplant, pneumonia? Improved right basilar opacities with persistent right hemidiaphragm elevation. Small bilateral pleural effusions. The lungs are clear. No pneumothorax. The heart size is normal. The cardiomediastinal silhouette is unremarkable. Surgical clips overlie the right hemithorax.

Output: Improved right basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: s/p extubation and postoperative mediastinal fluid drainage, eval for interval changes History: above Patient has been extubated. Other degenerative devices are unchanged. Slight increase in diffuse pulmonary opacities. Stable bibasilar opacities and pleural effusions again noted. Unchanged heart size. No pneumothorax.

Output: Interval extubation with development of mild pulmonary edema. Otherwise, no substantial change.


Instruction: Generate impression based on medical findings.

Input: Reason: 82 yod female with CLL on ibrutinib had cough with sputum for weeks History: cough Moderate cardiomegaly with a tortuous calcified aorta compatible with age. Port catheter with its tip in the area of the SVC.Large lung volumes suggestive of COPD.No sign of pneumonia.

Output: Cardiomegaly with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: s/p thoracic cavity washout History: assess for post pyloric dobhoff placement Support devices unchanged with enteric tube tip beyond the margin of the image.Stable cardiomediastinal silhouette.Significant interval clearing and improvement in bilateral extrapulmonary fluid collections and right-sided predominant pulmonary opacities.Question of small amount of right subpulmonic pneumothorax.

Output: Interval improvement in bilateral extrapulmonary fluid collections.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: hx of asthma and bronchiectasis p/w productive cough, mild hemoptysis History: productive cough, mild hemoptysis A complete mitral annuloplasty ring is in place. Epicardial pacing wires remain in place.Mild biatrial chamber dilatation. There is evidence of prior granulomatous disease. Near complete interval resolution of previous right upper lobe opacities with minimal reticulation in this location, likely scar. Additional scarlike opacity at the left peripheral lung. No evidence of edema or infection. The pleural spaces remain clear.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Fever, erythema and swelling around shunt site.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 09/08/16 Cephalic shunt tip is to the left of midline in the middle cranial fossa. The valve reservoir is in the right occiput and the shunt tubing versus along the right neck and chest. The caudal tip is in the upper mid abdomen. No discontinuity is identified. Bowel loops are not displaced from the distal shunt tip.The skull is large relative to the size of the face. Lung volumes are large. Cardiothymic silhouette is upper limits of normal in size.Mildly dilated bowel loops are present in the disorganized pattern.

Output: No evidence of extracranial shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: pneumonia f/u History: as above The endotracheal tube tip terminates approximately 7 cm above the carina. The NG tube tip terminates out of the field of view inferiorly. The left upper extremity PICC tip terminates at the cavoatrial junction.Stable cardiomediastinal silhouette. Minimal small right pleural effusion. Bilateral perihilar and bibasilar atelectasis, slightly improved from prior exam. There is no pneumonia.

Output: (1) Endotracheal tube tip approximately 7 cm above the carina(2) Slight improvement in perihilar and bibasilar opacities, suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: trached History: trached Edema, pleural effusions and basilar consolidation, worse than on the prior study.A Dobbhoff tube terminates in the stomach.Tracheostomy tube tip approximately 3 cm above the carina.DP shunt tubing courses over the right side of the chest.

Output: Worsening basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval aspiration pna, picc line placement History: hypoxia PICC line tip in the area of the SVC, directed laterally. Moderate bilateral pleural effusions and basilar atelectasis.

Output: Improved pulmonary inflation with partial resolution of atelectasis, but persistent diffuse interstitial edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Single lead pacemakerWith its tip projected in the area of the apex of the right ventricle.No pneumothorax or complications. Streaky basilar opacities compatible with subsegmental atelectasis.

Output: New pacemaker with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: r/o ff History: h/o splenomegaly with LUQ pain Normal cardiac and mediastinal silhouette.No focal airspace opacity, pleural effusions, or pneumothorax.Five sternotomy wires are identified, the inferior-most one of which appears fractured.

Output: No significant cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with CHF, pericardial effusion status post pericardiocentesis now with left lower lobe consolidation and effusion. Assess mobility of left-sided effusion and loculation. LUNGS AND PLEURA: Small left pleural effusion is mobile, demonstrating layering along gravity dependent structures, with patient repositioning. Scattered pulmonary micronodules. Minimal radiation reaction along the anterior aspect of the right upper lobe.Mild interstitial edema. Compressive atelectasis of the anterior left lower lobe, superimposed infection cannot be ruled out.MEDIASTINUM AND HILA: Cardiomegaly. Large pericardial effusion. AICD.CHEST WALL: Left chest wall pacemaker device. Right axillary surgical clips status post mastectomy. Multilevel thoracolumbar degenerative changes.UPPER ABDOMEN: Hydropic gallbladder. Well defined exophytic mass extending from the upper pole of the right kidney is incompletely evaluated but most likely represents a simple cyst.

Output: 1. Free flowing small left pleural effusion.2. Large pericardial effusion.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Coarse breath sounds in the setting of recent stroke rule out pneumonia. Dobbhoff tube tip beyond the caudal margin of the film. Stent projects over the right upper quadrant. Surgical staples project over the upper abdomen.Interval development of pleural fluid, atelectasis and airspace opacity at the left lung base suspicious for aspiration and infection. Mild patchy atelectasis or scarring near the right base.Cluster of small nodular opacities projecting over the right upper lobe new from CT of 7/12/2016 and may be postinflammatory.

Output: Pleural fluid, atelectasis and airspace opacity within the left base suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: 4-year-old male intubated, sounds wet on exam.VIEW: Chest AP (one view) 9/9/2015 ET tube tip is at the carina. Feeding tube tip is not visualized on this image.Cardiothymic silhouette is normal. The right minor fissure is elevated and there are right upper lobe, left upper lobe and left lower lobe opacities. No pleural effusion.Multiple skin staples of the chest and abdomen are noted.

Output: Right upper lobe, left upper lobe and left lower lobe opacities likely due to atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: concern for aspiration event, new hypoxia History: as above Bilateral airspace opacity compatible with aspiration, greater in the right upper lobe, slightly improved compared to recent previous radiographs.Port catheter and PICC line extending to the SVC.Mild mediastinal widening compatible with lymphadenopathy.

Output: Slightly improved airspace opacities compatible with aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: eval for acute cardiopulm abnormality History: pt sweaty, diaphoretic Small lung volumes, otherwise unremarkable.

Output: No significant abnormality. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: pna? Edema? History: heart failure, copd, wheezing, diminished breath sounds, shortness of breath Increased basilar opacities and pleural effusion suggestive of edema/CHF.Heart size upper normal, partially secured by the effusions.

Output: Worsening basilar opacities suggestive of CHF with edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: Musculoskeletal abnormalities History: left breast pain/musculoskeletal chest pain, worse with palpation or movement Small lung volumes with nonspecific left basilar atelectasis.A less than 1 cm nodule is present in the right midlung.Heart size upper normal.

Output: Left basilar atelectasis which may be from aspirated secretions or mucous plugging. Right midlung nodule could be followed on a PA and lateral but is well-circumscribed and probably benign.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: 55 yom w/ APL and new small volume hemoptysis History: hemoptysis Nonspecific right mid to lower lung zone interstitial opacities could in part be artifact although could represent a site of hemorrhage.Elsewhere, mild interstitial opacities in the left lung base with septal lines are subtle but could indicate edema and there is a small left pleural effusion.Heart size upper normal.

Output: Nonspecific opacities, CT follow-up recommended to assess for pulmonary hemorrhage or its cause.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Right IJ trialysis placement. Right jugular introducer tip projects over the right brachiocephalic vein near the SVC, approximately 2 cm above the level of the azygos arch. No pneumothorax. Cardiomegaly with prominence of the central pulmonary vasculature unchanged. Minimal lower zone vascular unsharpness suggesting hypervolemia, but no specific evidence of pulmonary edema.

Output: Right jugular catheter tip projects over a central vein without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Complaints of L-chest pain, shortness of breath, rule out infiltrates, effusion, no significant medical history The heart size is normal. The lungs are clear. No pleural effusion or pneumothorax. No specific radiographic evidence of infection.

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


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p left thoracotomy \T\ LLL lobectomy History: none Right upper lobe predominant severe emphysema.Left pleural effusion and basilar atelectasis persists.

Output: Severe emphysema. Stable left pleural effusion and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: tachypnea History: above Low lung volumes makes detailed cardiopulmonary assessment difficult. Patchy basilar opacities with mild nodularity in the right lung. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Patchy basilar opacities, likely atelectasis.Mild diffuse nodularity in the right lung. Consider correlation with chest CT if clinically indicated. This finding was text paged to the primary team.


Instruction: Generate impression based on medical findings.

Input: Kidney donor No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.History of POEMS syndrome and CHF. Getting diuresed status post extubation. Moderate to large right pleural effusion with associated atelectasis. Left subpulmonic effusion, small to moderate, also with overlying compressive atelectasis, unchanged. Mild cardiomegaly, about the same. Mild thickening of the fissures, but otherwise no convincing evidence of pulmonary edema.

Output: Moderate to large pleural effusions and atelectasis. Cardiomegaly unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath New patchy right base opacity suggestive of infection or aspiration.No significant pneumothorax.Heart size normal.

Output: New patchy right base opacities suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: intubated/sedated History: above Readjusted endotracheal tube is now approximately 2 cm above the carina.Right central venous catheter with tip at the cavoatrial junction.No change in the extensive bilateral airspace opacities.No pneumothorax.

Output: Successful repositioning of endotracheal tube. No significant change in the extensive bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: dysphagia liquid and solid; 25 pound weight loss. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus revealed no mucosal or mural abnormalities. No hiatal hernia was identified.  Fluoroscopic examination of esophageal motility revealed early termination of the primary peristaltic wave with proximal escape and temporary retention of contrast, which subsequently clears spontaneously (series 19).No gastroesophageal reflux was identified. Visualized portions of the stomach and proximal duodenum are within normal limits.Total fluoroscopy time: 2:57DAP (uGy*m^2): 1134.6

Output: Mild esophageal dysmotility. Otherwise, normal esophagram.


Instruction: Generate impression based on medical findings.

Input: Male 10 months old Reason: Lung volume expansion, line placements History: INtubated pt w/ pulmonary hypoplasia and pulm HTN, omphaloceleVIEW: Abdomen and chest AP (2 views 6/27/2015 at 0323 hours. Tracheostomy tube, and NG tube as well as right IJ venous access are unchanged. Left lower extremity venous access its anterior at the right atrium through a left IVC or there is a chance of being an arterial line.Cardiac silhouette size is enlarged but stable. Large lung volumes with left lower lobe opacity.Giant omphalocele with complete paucity of abdominal gas.

Output: Large lung volumes and left lower lobe atelectasis as described.Complete paucity of abdominal gas.


Instruction: Generate impression based on medical findings.

Input: Chest pain ICD and cardiopulmonary exam is otherwise unchanged, again demonstrating mild nonspecific cardiomegaly otherwise grossly clear lungs. Probable patchy atelectasis observed in the mid left lung, however again serial imaging will be important to mixture clearance

Output: No definite new superimposed airspace abnormalities to suggest pneumonia, however minimal atelectasis suspected in mid left lung. Serial imaging will ensure clearance and/or shifting position.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Prior pneumonia in November, evaluate for resolution. Cough. Resolution of basal air space opacity since the previous study. Lung volumes remain low normal. No focal air space opacities, pleural fluid or pneumothorax. Normal heart size.

Output: No acute cardiopulmonary abnormality; right lower lobe pneumonia has resolved.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: abnormality, pleural effusion on ct scan for stone History: back pain, pleural effusion Severe enlargement of the cardiac silhouette, corresponding to a pericardial effusion seen on an earlier CT of the abdomen.No specific evidence of infection or failure.

Output: Large pericardial effusion. No significant pleural effusions, or significant pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: r/o infection History: Febrile, tachycardic The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 53 year old male with cough for 1 week, decreased breath sound right base. No focal airspace opacities. Mild blunting of the costophrenic angles bilaterally consistent with pleural effusions more marked on the right with basilar consolidation/atelectasis. Cardiomediastinal silhouette unremarkable.

Output: Pleural effusions, right greater than left, with right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval position of tubes and lines History: as above ET tube tip approximately 2 cm above the carina. Catheter tip in the SVC.Diffuse nonspecific airspace opacity suggestive of edema.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male status post transhiatal esophagectomy one year follow-up. CHEST:LUNGS AND PLEURA: Calcific granulomata are redemonstrated. One or two noncalcified lung nodules unchanged, for example left apex image 22. Minimal emphysematous changes in the upper lobes.MEDIASTINUM AND HILA: Calcific granulomata unchanged. No new nodes.Postsurgical changes consistent with esophagectomy and gastric pull-up.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted . Gallbladder surgically absent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: small peripancreatic nodes, unchanged. Bowel normal.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 consistent with esophagectomy with gastric pull-up and cholecystectomy. Small peripancreatic nodes stable. Granulomatous disease mediastinum and lungs. Few noncalcified nodules unchanged. No definite evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: pneumonia History: cough Normal cardiomediastinal silhouette.Basilar linear atelectasis and/or scarring.No evidence of infection or edema. No pleural effusion.

Output: Basilar linear atelectasis and/or scarring. No evidence of infection. No interval change.


Instruction: Generate impression based on medical findings.

Input: CHF Given differences in patient positioning and rotation, no significant change in the severe cardiomegaly and underlying moderate to severe pulmonary edema greater in both lung bases. Superimposed atelectasis

Output: Largely unchanged moderate to severe pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: new onset SOB, flu-like Sx r/o PNA History: new onset SOB, flu-like Sx r/o PNA No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: evaluate for infiltrate History: cough/fever The cardiomediastinal silhouette is unremarkable.Mildly decreased lung volumes.Scattered areas of scarring/discoid atelectasis.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: R/O PTX post L thoracentesis History: None Bilateral pleural effusions and basilar consolidation, improving on the left.Heart size normal. Status post sternotomy. No significant pneumothorax.

Output: Improving left basilar consolidation following thoracentesis, with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: ett position History: ett adjusted The endotracheal tube has been advanced, now close to the ostium of the right mainstem bronchus. Interval placement of a nasogastric tube with the sidehole in the stomach. Right IJ central catheter remains in stable position.Progressive bilateral airspace and interstitial opacities. No interval pneumothorax. Persistent gaseous distention of the stomach.

Output: The endotracheal tube approaches the ostium of the right mainstem bronchus. This has been repositioned on subsequent radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: s/p chest tube to water seal History: s/p chest tube to water seal Bilateral chest tubes are present with no pneumothorax.Small right pleural effusion and adjacent atelectasis, and mild retrocardiac atelectasis, unchanged.NG tube tip is at the hemidiaphragm level, unchanged.Right subclavian catheter, tip in SVC.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval for ptx/atelectasis History: sob, chest tightness Linear scarring or subsegmental atelectasis left lower lobe, the lungs otherwise unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: daily am cxr History: n/a Small lung volumes with basilar opacities suggestive of edema and/or aspiration.Heart size upper normal.

Output: Basilar opacities suggestive of edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval for acute process History: SOB Cardiomegaly with mild pulmonary vascular redistribution but no evidence of edema or pneumonia.Linear atelectasis left lower lung zone.

Output: Unchanged cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: check VNS placement History: RUE weakness; s/p fall seizure Pulse generator remains in stable position, at the posterior superior left chest wall. The electrode terminates at the base of the left neck, likely vagal nerve stimulator.Relatively low lung volumes. Linear opacity favoring scar is noted in the right lower lobe. No evidence of pneumonia or edema. The pleural spaces are clear. The heart size remains upper limits normal. No displaced rib fracture.

Output: No evidence of pneumonia or displaced rib fracture following fall.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: SOB History: above No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate lead positioning History: pt needs MRI The heart size about upper normal with a tortuous calcified aorta.Dual chamber pacemaker with leads in the area of the right atrial appendage and right ventricular apex.No pneumothorax or other complications.

Output: Pacemaker leads in expected locations with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: trauma History: trauma Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No traumatic abnormality identified.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 57 years old Male. Reason: check new central line placement History: new central line. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. Small amount of bilateral pleural effusions are noted.There is a new tube overlying right mediastinal silhouette is of normal clinical significance.

Output: The above findings are consistent with severe congestive heart failure, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Chest pain. The cardiomediastinal silhouette is within normal limits. No focal airspace opacity, significant pleural effusion, rib fracture, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: worsening sob. COPD History: as above Cardiomegaly with basilar opacities and chronic appearing right hemidiaphragm elevation, unchanged.

Output: No change in cardiomegaly and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 23 yearsGender: FemaleReason for Study: Reason: Pna History: productive cough, fever The cardiomediastinal silhouette is unremarkable.Patchy airspace opacities in the upper lobes and left lower lobe are compatible with multifocal pneumonia.No pleural effusions.

Output: Multifocal pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Evaluate for change in pneumothorax. Left pneumothorax with maximal pleural separation at the apex of 2.5 cm. Diffuse subcutaneous emphysema. A drain or tube is partially visualized projecting over the left upper quadrant. Low lung volumes with dependent and basal atelectasis. Possible small right pleural effusion.

Output: 2.5 cm left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: hypoxia to 90%, eval for PNA History: hypoxia to 90%, eval for PNA Large lung volumes with emphysema most pronounced in the right upper lobe.Unremarkable mediastinal contours and cardiac silhouette.No specific evidence of infection or edema.

Output: Moderate to severe emphysema, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: SOB and CP. Effusion versus pneumonia. Surgical clip in the right paratracheal region. Normal heart size. No focal airspace opacities. Unchanged mediastinal appearance. No visible pleural fluid or pneumothorax.

Output: No signs of pneumonia. No visible pleural fluid though a small volume of fluid would not be visible on portable technique.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of weight loss decreased oral intake. Please evaluate for malignancy versus infection. CHEST:LUNGS AND PLEURA: Calcified right upper lobe nodule.MEDIASTINUM AND HILA: Multiple nonenlarged and borderline enlarged mediastinal lymph nodes. Precarinal lymph node measures 15 x 7 mm image number 44, series number 3. Right hilar and subcarinal lymph nodes are also present.Heart is enlarged with hypertrophy of the left ventricle. Small amount of pericardial effusion is present. Thrombus is present in the left atrial appendage.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver has nodular contours with hypertrophied left lobe. Its enlarged measuring 15.6 cm in craniocaudal dimension. No focal lesions. Small amount of periappendicitis.SPLEEN: Focal splenic infarcts.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Bilateral focal infarcts are seen in the lower pole of the kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of ascites in the pelvis. Bilateral inguinal hernias. The right inguinal hernia sac contains fat and fluid left inguinal hernia sac contains fat only.

Output: Cardiomegaly with severe left ventricular hypertrophy and thrombus in the left atrial appendage causing bilateral renal infarcts and splenic infarcts.Hypertrophic left lobe with nodular contours of the liver which may be secondary to heart failure.Referring physician was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: line placement/pna History: AMS The heart is normal in size.Interval intubation. ET tube overlies the mid trachea.The lungs and pleural spaces are within normal limits.

Output: Adequate position of ET tube overlying the mid trachea.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of rectal adenocarcinoma. CHEST:LUNGS AND PLEURA: Scattered micronodules in the right middle lobe, nonspecific. Subsegmental atelectasis in lung bases.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: 17 x 19 mm hypodense lesion in the right lobe the liver as seen on image number 104, series number 4, metastatic disease cannot be excluded. Subcentimeter lesion in the right lobe of the liver image number 119, series number 4.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign-appearing 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: 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: Hypodense liver lesion in the right lobe of the liver. This lesion cannot be optimally characterized on this single phase CT, however, metastatic disease cannot be excluded. Further evaluation with MRI may be helpful if characterization is clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval for IABP placement History: IABP Swan-Ganz catheter has been removed with placement of right IJ sheath. Other lines and tubes, unchanged. Mild left basilar subsegmental atelectasis or scarring again noted. No new focal lung consolidation. Marked cardiomegaly again noted. No pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Hypoxemia. Hemoptysis. Endobronchial occlusion device projects over the expected location of the left main bronchus, difficult to visualize given patient rotation.ETT tip 4 cm above the level of the carina. Bronchial embolization coils.Pleural fluid and extensive basal atelectasis and consolidation bilaterally with interval worsening on the right.Right lower lobe nodule is obscured.Groundglass opacities unchanged..

Output: Worsening airspace opacity at the right base could reflect aspirated blood products or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Fever question infiltrate. Right perihilar consolidation with basilar atelectasis and a moderate volume of pleural fluid. Small left pleural fluid collection. Unchanged cardiomegaly and mediastinal widening. Central lines have been removed in the interim, but there is a new left PICC which terminates in the lateral aspect of the subclavian vein on the left.

Output: New right perihilar opacity suspicious for pneumonia. Other findings without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: eval for pathology History: fall Left linear scarring or subsegmental atelectasis.No specific evidence of infection or edema.No evidence of a displaced rib fracture.Cholecystectomy clips and IVC filter are identified.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.History of intubation. Endotracheal tube 4 cm above the carina. Right IJ central venous catheter unchanged.Basilar subsegmental atelectasis/scarring. No new air space opacities or pneumothorax.Cardiac silhouette unchanged.

Output: No acute abnormalities or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Asthma exacerbation No cardiopulmonary abnormality

Output: Normal large posterior


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: r/o infection, edema, effusion History: cough, nasal congestion The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: End stage renal disease Improved and decreased ili-defined groundglass focus in the right upper lung without additional new pulmonary abnormality. Cardiac and mediastinal contours are otherwise intact.Anterior ICD lead is unchanged and generator appears similar.

Output: Resolving right upper lobe focal opacity


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with locally advanced bladder cancer CHEST:LUNGS AND PLEURA: Stable apical bulla. Emphysema. Right lower lobe. Calcified granuloma.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable cholelithiasis without cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Status post cystectomy. Neobladder is unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with vomiting and abdominal distention. Rule out small bowel obstruction. ABDOMEN:LUNG BASES: Marked emphysema. Right-sided subcentimeter nodule image number 9, series number 4 is unchanged. Mild scarring in the right lung base.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign-appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic changes involving the abdominal aorta. Ectatic abdominal aorta. On image number 52, series number 3 abdominal aorta measures 35-mm (AP) by 38-mm (transverse. At this level. There is also focal bulging in the abdominal aorta.BOWEL, MESENTERY: Proximal small bowel loops are dilated, measuring up to 2.5-cm. Distal small bowel loops are completely decompressed consistent with a small bowel obstruction. Transition point appears to be in the midline around the umbilicus around image number 75, series number 3. Contrast material in the colon suggests a partial obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: Bladder is distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Partial proximal small bowel obstruction.Severe atherosclerotic changes with infrarenal abdominal aortic aneurysm. Abdominal aorta cannot be optimally evaluated due to lack of IV contrast. Focal posterior bulging of the aorta at the level of the renal arteries may represent a small saccular aneurysm.


Instruction: Generate impression based on medical findings.

Input: Reason: icu History: Primary pulmonary hypertension. Tracheostomy tube, right jugular catheter and pigtail catheter in the right pleural space, unchanged.Nonspecific diffuse pulmonary opacities and moderately large pleural effusions, with some increase in airspace opacity in the right upper lobe.No pneumothorax or other acute change.

Output: Extensive pulmonary opacity and pleural effusions with increased right upper lobe consolidation compatible with infection.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: assess line, ETT placement History: shock, respiratory failure, need for swan ET tube tip 6 cm above carina, NG tube tip in stomach, Swan-Ganz catheter in right pulmonary artery. Right PICC tip in SVC. ICD unchanged.Stable cardiomegaly with basilar edema and atelectasis, unchanged.

Output: Swan-Ganz catheter in right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: vent patient History: vent patient Lines and tubes are unchanged. No focal lung consolidation or evidence of overt left-sided heart failure. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: worsening SOB, cause History: as above, history of heart failure Cardiomegaly with moderate pulmonary edema and pleural effusions, unchanged.Left jugular catheter, tip in SVC.

Output: Stable CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: NGT position History: NGT pulled back NG tube tip in upper esophagus. Venous catheter tip at RA/SVC junction.Persistent pulmonary edema and pleural effusions.

Output: NG tube tip in upper esophagus.


Instruction: Generate impression based on medical findings.

Input: 51 year-old female with Hodgkin's 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: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter cysts in the upper pole of the left kidney.Wedge-shaped hypoattenuating focus in the mid pole of the left kidney has slightly decreased in size, compatible with an infarctRETROPERITONEUM, LYMPH NODES: Left para-aortic adenopathy is decreased in size, measuring 14 x 7 mm (series 3; image 110), previously 2.3 x 2.0 cm. 9 x 4 mm left periaortic lymph node (series 3; image 109), previously 20 x 15 mm. Surgical clips are noted within the retroperitoneumBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free fluid layers in the pelvis, likely physiologic

Output: Decreased size of adenopathy as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.History of renal cell carcinoma status post partial nephrectomy rule out chest metastases. No suspicious pulmonary nodules or masses. The lungs appear clear. Normal heart size. No pleural fluid.

Output: No evidence of acute pulmonary abnormality. No signs of pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with shortness of breath, evaluate for pleural effusion and worsening cancer lesions. CHEST:LUNGS AND PLEURA: A small right pleural effusion is noted. There is no evidence of consolidation or other focal processes. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged and cirrhotic in morphology. There are numerous confluent bilobar masses within the liver parenchyma, consistent with the patient's known diagnosis of HCC. These findings are unchanged when compared to the prior exam. Again seen is enhancing tumor thrombus within the portal venous system. SPLEEN: Splenomegaly is again noted. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild upper abdominal adenopathy is again noted.BOWEL, MESENTERY: Extensive varices are seen adjacent to spleen and about the distal esophagus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is been an increase in the amount of abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.Increased amount of abdominal ascites.2.New small right pleural effusion.3.Stable liver lesions and portal venous tumor thrombus


Instruction: Generate impression based on medical findings.

Input: 70-year-old female status post pacemaker placement. Left subclavian pacemaker with leads positioned over the right atrial appendage and right ventricular outflow tract.Cardiomegaly. Interstitial opacities compatible with atelectasis and small effusions, not significantly changed.No pneumothorax.Sternotomy hardware appears intact.

Output: Left subclavian pacemaker with leads in expected positions. No pneumothorax. Unchanged lower lung zone atelectasis since pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old. Right IJ venous catheter with its tip in the SVC.Left IJ venous catheter with its tip at the SVC/left innominate junction.The cardiomediastinal silhouette is unremarkable.Nonspecific basilar opacities compatible with atelectasis.No new pulmonary opacities.No evidence of a pneumothorax.

Output: Interval placement of IJ venous catheters without complication. Basilar atelectasis increased from the prior exam.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female presents with nausea and obstipation, evaluate for obstruction. Contrast material is present in the colon. Ileus bowel gas pattern. Average amount of stool burden. Surgical clips and anastomotic sutures in the abdomen are noted. No evidence of pneumoperitoneum. Phleboliths are seen projecting over the pelvis.No focal pulmonary opacities, pneumothorax, or large pleural effusions.

Output: No specific evidence of obstruction or free air. Ileus bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Reason: fever, eval for infiltrate History: fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: evaluate lung fields History: cardiogenic shock, balloon pump in place There is an inferior approach aortic balloon pump catheter in place, with the tip terminating in proximal aortic arch. There is a left upper extremity PICC, with the tip terminating in the superior vena cava.Streaky perihilar and basilar interstitial and airspace opacities suggest pulmonary edema. No pleural effusion or pneumothorax is evident. There is a focal area of consolidation in the right middle lobe with associated air bronchograms.There is moderate/severe enlargement of the cardiac silhouette.The imaged upper abdomen and skeleton are unremarkable.

Output: 1.IABP tip in the proximal aortic arch.2.Probable mild pulmonary edema secondary to CHF.3.Focal consolidation in the right middle lobe may reflect infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Cough productive of sputum, fever, decreased appetite. Severe scoliosis with paraspinal compressive atelectasis or scarring.Elevation of the left hemidiaphragm with adjacent compressive atelectasis.No signs of pneumonia.

Output: Limited exam. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: assess s/p RUL History: see above 2 chest tubes extends to the right apex with a small residual pneumothorax and extensive subcutaneous emphysema.Right apical opacity possibly due to contusion and/or hematoma.Mild subsegmental atelectasis at the left base.

Output: Extensive postoperative findings on the right with a small right apical pneumothorax and subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: chest pain History: chest pain Cardiac silhouette and vasculature are normal. Lungs clear of airspace and interstitial opacities. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female history of cough. Cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.History: chest pain Cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity. No specific evidence of infection or edema. No mass as clinically questioned.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: cp History: cp The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: trach History: trach Tracheostomy tube and right central venous catheter unchanged.Stable cardiomediastinal silhouette.Basilar opacities are compatible with pleural effusions and atelectasis, similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Persistent pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Dyspnea. History of COPD and hypertension. Left ventricular enlargement. Tortuosity and atherosclerotic calcification of the thoracic aorta.Increased lung volumes. Diffuse bilateral symmetric reticular nodular opacities symmetrically involving both lungs, age indeterminate in the absence of comparison images. There is discrete bilateral subpleural sparing. No focal areas of volume loss or asymmetric involvement. Suggestion of underlying emphysema.The pleural spaces are within normal limits.Moderate degenerative changes of the thoracic spine.

Output: 1. Diffuse bilateral reticular opacities symmetrically involve both lungs, superimposed on underlying emphysema. In the acute setting, this may represent viral pneumonia, although in the chronic setting differential diagnosis includes a smoking associated interstitial lung disease such as diffuse interstitial pneumonia (DIP) and Langerhans cells histocytosis (LCH), among others. No prior images available to establish chronicity of these findings. Recommend further assessment with high-resolution chest CT for characterization.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: r/o lung path History: diabetes with wheezing The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.s/p pacemaker placement. Interval placement of a single lead left subclavian pacemaker, with lead tip projecting in the right ventricular apex.Previously seen orphaned pacemaker lead is again seen in the left subclavian vein and cut off at the mid SVC.No pneumothorax.Increased retrocardiac opacity, suggestive of atelectasis and small left effusion.

Output: No pneumothorax. Increased retrocardiac atelectasis/effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.S.O.B. status post left single lung transplant. The native right lung unchanged in appearance. NoLeft lung volumes slightly larger compared to previous with improved aeration at the lung base. Linear scarring in the anterior left lower lobe and lingula. No focal air space opacities in the left lung. No pleural fluid. Focal lucency anteriorly on the lateral radiograph at the level of the hilum may represents a small focal herniation of lung parenchyma through an intercostal space but is poorly assessed by this technique.Nodular opacity anterior to the pulmonary hila on the lateral radiograph not identified on the frontal film and may correlate to lymphadenopathy identified on prior CT scans however an intraparenchymal process cannot be entirely excluded as there is no prior comparison post transplant lateral film.

Output: Nodular opacity seen only on the lateral radiograph of unclear etiology and may be further characterized by reduced-dose thoracic CT when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: cough, sob, cp with cough History: chest pain with cough Cardiac silhouette is mildly enlarged.Relatively lung volumes with mild focal right midlung and bibasilar opacities may represent atelectasis. No sizable pleural effusion or pneumothorax.No acute osseous abnormalities.

Output: Mild focal right midlung and bibasilar opacities may represent atelectasis but correlate with any concern for developing infection.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: sepsis History: sepsis Mild left basilar subsegmental atelectasis or scarring. No focal lung consolidation. No pleural effusion or pneumothorax. No acute bony abnormality. Status post sternotomy and CABG, as before. Heart size and the upper limit of normal. Dense aortic and coronary calcification again noted. Mild diffuse osteopenia.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Sick sinus syndrome, lead less pacemaker insertion Interval placement of a device projected over the left lung base without apparent significant additional change. Bilateral diaphragmatic eventration with small lung volumes and vascular redistribution with mild changes suggesting questionable edema again observed. Mild cardiac magnet cannot be excluded it contours are exaggerated due to extensive scoliosis. Small right effusion also cannot be excluded

Output: Pacemaker insertion


Instruction: Generate impression based on medical findings.

Input: IABP placement IABP marker remains projected into the aortic arch. No additional cardiopulmonary changes

Output: IABP remains projected into the aortic arch


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with history of lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Thyroid nodules are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study. Borderline enlarged retroperitoneal lymph nodes are stable.


Instruction: Generate impression based on medical findings.

Input: 70 year old male. Resected right lobe of the liver in 11/07 for stage IV colorectal cancer. Status post chemotherapy. Now NED. Evaluate for disease recurrence. CHEST: LUNGS AND PLEURA: Previous identified subcentimeter scattered nodules in both lungs are unchanged. MEDIASTINUM AND HILA: No significant abnormality noted CHEST WALL: A right-sided venous access device is in expected position.ABDOMEN: LIVER, BILIARY TRACT: Postsurgical changes in the liver. Fluid collection in the hepatectomy bed has nearly resolved since the prior exam. This fluid collection now measures 1.9 x 6.4. Status post right lobectomy. SPLEEN: No significant abnormality noted PANCREAS: No significant abnormality noted ADRENAL GLANDS: No significant abnormality noted KIDNEYS, URETERS: Bilateral nonobstructing renal calculi, unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted OTHER: There is postop laxity of the anterior abdominal wall especially near the midline surgical scar without associated entrapment of bowel. This finding is stable since the prior examinations.PELVIS: PROSTATE, SEMINAL VESICLES: Status post prostatectomy. 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: Bilateral fat-containing inguinal hernias.

Output: Scattered bilateral lung nodules are unchanged. Perihepatic seroma has nearlyresolved since the prior exam. Nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Status post Cobra MAZE. Small to moderate volume of pleural fluid.Left basal/retrocardiac atelectasis.No convincing evidence of pulmonary edema.No pneumothorax.

Output: Small pleural effusions with mild associated atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Chest pain Considerable motion degrades sensitivity.Interval increasing cardiac size with suspected myocardium likely despite decreased lung volumes. Streaky patchy densities are observed in both bases greater in a retrocardiac position concerning for probable atelectasis however partial consolidation must also be excluded with serial imaging.

Output: Limited exam with suspicious retrocardiac left lower lobe questionable partial consolidation. Serial imaging is needed to confirm and demonstrate clearance given patient history and possibility of marked aspiration versus infection


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: patient w hx of thora with increased wob History: SOB Bilateral pleural effusions and basilar atelectasis, not significantly changed.Stable right lung nodule.No pneumothorax.

Output: Persistent pleural effusions, not significantly changed with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT placement History: ETT pulled back 5.5 cm ET tube tip approximately 4 cm above the carina.Venous catheters unchanged.Nonspecific basilar opacities compatible with edema, atelectasis and small effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Evaluate PICC line placement centrally. Low lung volumes. No pulmonary or pleural abnormalities.Cardiomegaly.Left upper extremity PICC with tip in SVC.

Output: Left upper extremity PICC with tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: resp failure History: intubated ET tube, left jugular cannula and NG tube, unchanged. Basilar opacity, greater on the left, compatible with small effusions and atelectasis.

Output: Pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: R pleural effusion on exam History: recent pneumonia Cardiomegaly with a presternal ICD lead and dual-lumen catheter extending to the SVC.Large right pleural effusion, markedly increased, with underlying atelectasis and consolidation.

Output: Large right pleural effusion and marked cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: r/o tension pneumothorax History: decreased BP, urine output, high peak airway pressures, ARDS Interstitial/airspace opacities have improved.Stable small pleural effusions.Right jugular ECMO cannula courses towards the RV rather than inferiorly into the IVC; the side port is at the cavoatrial junction. Tracheostomy tube tip approximately 4 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: Improved pulmonary opacities consistent with ARDS. ECMO cannula still courses towards the RV, unchanged since the prior study, when the service was notified via text by the attending radiologist pager 7228.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: worsening SOB \T\ fatigue, history of AFib History: SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Chest pain Persistent mild basilar patchy densities representing minimal scarring and/or probable atelectasis over aspiration in both lung bases. Mild cardiomegaly unchanged. No new superimposed focal air space process observed.Unchanged right jugular single port

Output: Cardiomegaly with suspected basilar minimal atelectasis and/or scarring


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval for effusions History: rales, shortness of breath Hazy opacities in the central aspect the lungs with left greater than right basilar opacities and septal thickening. Calcified granuloma at the right lung base. Heart size at the upper limit of normal. Aortic atherosclerosis. Small pleural effusions.

Output: Probable congestive heart failure. Stigmata of previous granulomatous disease.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: hypoxia History: see above Stable cardiomegaly with pulmonary edema.Left subclavian ICD, leads unchanged in position.

Output: Stable cardiomegaly with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: eval for unfection History: eval forinfection Stable mild cardiomegaly. Tip of the Swan-Ganz catheter is now advanced into the left pulmonary artery more distally. There is no pneumothorax. No other interval changes.

Output: Swan-Ganz catheter with its tip now in the distal left pulmonary artery. No pneumothorax or other interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval for infiltrate or edema History: shortness of breath Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size at the upper limit of normal, as before.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusion? History: vol overload. diuresing Interval extubation.Bilateral perihilar and lower zone opacity compatible with atelectasis and pleural effusions.No new findings.

Output: Atelectasis and pleural effusions which have probably slightly increased.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval for pneumonia. copd here with subjective sob History: sob Extensive lower lung zone bronchial wall thickening and bronchiectasis consistent with MAI.No evidence of superimposed infection or edema, nor pleural effusions.Unremarkable mediastinal contours and cardiac silhouette.

Output: Extensive lower lung zone bronchiectasis and bronchial wall thickening consistent with MAI or other form of chronic bronchiectasis and bronchiolectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: s/p VATS, cabg and avr History: s/p VATS, cabg \T\ avr One right chest tube remains in place, barely projected over the pleural space, with a persistent right subpulmonic pneumothorax, unchanged.Right basilar atelectasis and right sided pleural thickening or loculated fluid is stable.Mild basilar subsegmental atelectasis unchanged.Median sternotomy, tortuous aorta and coronary stent identified. Left subclavian catheter, tip in SVC.

Output: Persistent right subpulmonic pneumothorax, the right chest tube barely projected over the pleural space.


Instruction: Generate impression based on medical findings.

Input: Age: 38 yearsGender: MaleReason for Study: Reason: ETT placement History: cough ET tube is been advanced with its tip now 2 to 3 cm above the carina.Remaining support devices are unchanged.Diffuse pulmonary opacity similar in appearance to prior exam.

Output: Interval advancement of the ET tube with its tip 2 to 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p chest tube removal, PTX stable/resolved? History: see above No significant change in cardiopulmonary status with interstitial and nodular opacities bilaterally as well as small to moderate pleural effusions, left greater than right. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: evaluate progress of R pleurodesed lung History: none Pleural effusion decreased from the prior exam.The cardiac mediastinal silhouette is unremarkable.No new pulmonary opacities.

Output: Interval decrease in right pleural effusion/thickening.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of metastatic melanoma. Restaging prior to chemotherapy treatment. CHEST:LUNGS AND PLEURA: Stable right upper lobe nodule measuring 1.4 cm in diameter on image number 27/104. No new nodules.MEDIASTINUM AND HILA: Previous described nonenlarged multiple mediastinal nodes are smaller and have decreased in size. Previously mentioned borderline enlarged subcarinal lymph node now measures 9 x 7 mm on image number 46/230.CHEST WALL: Previously described multiple axillary lymph nodes are smaller in size.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Subtle hypoattenuating lesion in the spleen is unchanged. The spleen is enlarged measuring 14.1 cm craniocaudally.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Small bowel masses difficult to evaluate but is likely unchanged measuring 4 x 4.1 cm on axial image number 132/230.Vague stranding of the fat in the mesentery in the midabdomen and borderline enlarged lymph nodes are unchanged.BONES, SOFT TISSUES: Symmetric lytic lesions within the sacrum and pelvis are unchanged and likely due to osteopenia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the mediastinal lymph nodes. Lung nodule, small bowel mass, hazy increase in the density of the mesentery fat, retroperitoneal and mesenteric lymph nodes are stable to minimally increased..


Instruction: Generate impression based on medical findings.

Input: Reason: ?PNA History: oxygen requirement Small lung volumes with streaky basilar opacities compatible with subsegmental atelectasis.Probable small pleural effusions in the posterior costophrenic angles.No specific evidence of pneumonia.

Output: Basilar atelectasis and probable small pleural effusions of uncertain etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: s/p Ruptured AAA , Hemothorax History: s/p Ruptured AAA , Hemothorax The contour of the aortic arch is better defined than before but is dilated, and nearly the entire thoracic aorta stented.Small left apical pneumothorax. Left basilar consolidation unchanged.ET tube tip 7 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Small left apical pneumothorax. Dilated stented aorta, the margins better defined than on the prior study.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with metastatic sarcoma. Evaluate for progression of metastatic disease. CHEST:LUNGS AND PLEURA: Multiple nodules in both lungs consistent with metastatic disease given patient's indicated history of sarcoma. For reference, a right upper lobe nodule measures 1.7 x 1.5 cm (series 5, image 46). Left lower lobe nodule measures 1.3 x 1.2 cm (series 5, image 70). MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Low-attenuation mediastinal mass on series 3, image 75 may represent a duplication cyst.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Diffuse metastatic disease to the liver is also identified exhibiting areas of central necrosis. The majority of the lesions are confluent, thereby making objective measurements difficult. Prominent portacaval and porta hepatis lymph nodes are also seen. The central portal venous and hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland calcifications. Normal left adrenal gland.KIDNEYS, URETERS: Left renal cyst, incompletely evaluated on this study.RETROPERITONEUM, LYMPH NODES: Large heterogeneous retroperitoneal mass on the left measures 11 x 9.2 x 11 cm (series 3, image 127; series 80232, coronal image 65), displacing the left kidney posteriorly, the stomach and pancreas anteriorly, and abutting the left hepatic lobe. Prominent left periaortic lymph nodes are also seen adjacent to this mass.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osseous metastatic lesions are also seen. For example, on series 3, image 193 at the left ilium.Small, well-corticated lesion at right femoral neck may be of benign etiology.

Output: Multifocal metastatic disease with diffuse liver involvement, bone and lung metastases, and large retroperitoneal mass as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Left IJ placement. Interval placement of left central venous catheter with tip in the right atrium. No pneumothorax. Right-sided central venous catheter tip in the right atrium. Enteric feeding tube tip extends beyond the inferior margin of the image. Bilateral pleural effusions, retrocardiac opacity, pulmonary edema, and linear opacities are not significantly changed compared to prior examination.

Output: Left central venous catheter tip in the right atrium without pneumothorax. Stable bilateral pleural effusions, pulmonary edema, retrocardiac opacity, and linear opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval for acute pathology History: chest pain Left lung base scarring or subsegmental atelectasis, unchanged.Heart size normal.No specific evidence of infection or edema.Cholecystectomy clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Weak, dizzy status post bronchus and biopsy evaluate for pneumothorax. Elevation of the left hemidiaphragm unchanged. Left basal airspace opacities better seen due to interval resolution or shift of pleural fluid and resolution of atelectasis, though some of these opacities are likely postprocedural. Severe emphysema with basilar fibrosis in the native right lung. Left mediastinal and hilar surgical clips.

Output: Apparent increase in left basal opacities may be due to bronchial washings or postprocedural hemorrhage. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: chest pain, eval for fluid overload/pna History: chest pain, eval for fluid overload/pna New right middle lobe atelectasis and small right pleural effusion. Subsegmental atelectasis or scarring again noted at the left lung base. Normal heart size. No pneumothorax.

Output: New right middle lobe atelectasis and small right pleural effusion. Findings could represent right lung pneumonia/aspiration. Chest radiographic follow-up in 8-12 weeks is suggested to ensure resolution. However, if the clinical presentation is atypical for pneumonia, malignancy should be considered and further evaluation with chest CT is suggested.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with pleuritic chest pain and history of PE. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the segmental level.LUNGS AND PLEURA: Mild central bronchial wall thickening, improved since prior study from January 2011. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No PE. 2. Mild central bronchial wall thickening, which can be seen in reactive airway disease, improved since prior study from January 2011.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Tachypnea, increased work of breathing. Evaluate lung fields. Interval extubation. Retrocardiac consolidation about the same. Left perihilar consolidation has improved. New interstitial and airspace opacities in the right lung consistent with a combination of edema and aspiration or infection. Moderate right pleural fluid collection.

Output: Interval development of extensive opacities in the right lung most consistent with aspiration and possible infection. Mild superimposed pulmonary edema. Persistent left basal consolidation suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: s/p tunneled dialysis catheter placement History: s/p tunneled dialysis catheter placement Interval removal of nasogastric tube. The Dobbhoff tube remains unchanged in position. Left central catheter and right PICC are unchanged. There is a catheter projecting over the upper abdomen which terminates at the level of the GE junction, possibly external to the patient. Multiple skin staples at the abdominal midline. Apex of the inferior vena caval filter noted.Improved aeration left lower lobe with residual retrocardiac atelectasis and consolidation. Trace pleural effusions. No interval pneumothorax.

Output: Improved aeration left lower lobe with residual retrocardiac atelectasis and consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: pna? History: sob Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: ptx post bx History: none No pneumothorax. Bilateral pulmonary nodules and masses compatible with metastases appear similar to the prior. There is a small right pleural effusion. The cardiac contours are within normal limits for size. There is moderate gaseous distention of the stomach.

Output: No pneumothorax. Small right pleural effusion and bilateral pulmonary nodules and masses unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: eval for pulm edema vs pna History: sob, wheeze x3 days, stopped lasix 6 days ago Moderate cardiomegaly/pericardial effusion unchanged. No large pleural effusions. No evidence of pneumothorax. No definite evidence of edema.

Output: No definite evidence of pneumonia or edema. Cardiomegaly unchanged.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with abdominal pain. Evaluate for perforation. CHEST:LUNG BASES: No significant abnormality noted.Right breast nodule (series 3, image 11); correlate with mammographic findings.ABDOMEN:LIVER, BILIARY TRACT: Stable cystic lesion in left hepatic lobe. Mild central biliary ductal prominence status post cholecystectomy as seen previously.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Developing inflammatory changes about the hepatic flexure are again seen without evidence of a discretely organized fluid collection. No evidence of free air.Duodenal diverticulum (third portion).BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Heterogeneously enhancing uterus as seen previously, likely secondary to leiomyomata.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: Degenerative changes of the hips.

Output: 1. Probable diverticulitis with developing peridiverticular fluid collection about the hepatic flexure not yet amenable to percutaneous drainage.2. Right breast nodule; correlate with mammographic findings.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Dyspnea with effusions. Decreased moderate right and unchanged small left pleural effusions with adjacent subsegmental atelectasis. No new focal consolidation or pneumothorax. Sternotomy and surgical clips unchanged. Interval removal of the Swan-Ganz catheter. Normal cardiomediastinal silhouette. Degenerative changes of the thoracic spine.

Output: Decreased moderate right and unchanged small left pleural effusions with adjacent subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Status post AVR/MVR/TVR/Maze. There is been interval removal of the right internal jugular sheath as well as midline mediastinal chest tube. Two mediastinal drains remain. Stable appearance of a mitral, aortic, and tricuspid valve repairs. There is been interval improvement of the right pleural effusion and now only small bilateral pleural effusions remain. Left basilar atelectasis is relatively stable. No evidence of pneumothorax.

Output: Interval improvement in the right pleural effusion with stable left effusion and underlying atelectasis. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: hypoxia History: hypoxia Enteric tube terminates inferior to the caudal aspect of the image. Right PICC terminates within the right atrium.Interval improved aeration at the left lower lobe. New upper zone opacities may represent aspiration or infection. Progressive blunting of the right costophrenic angle from additional focus of consolidation with atelectasis. Small bilateral pleural effusions.

Output: Opacities suspicious for aspiration or infection. Left lower lobe. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of mesothelioma CHEST:LUNGS AND PLEURA: Overall, the left pleural thickening has decreased. Reference left pleural measurements are as follows: At the level just superior to the origin of the left subclavian artery (series Number 3 image number 19), one o'clock position measures 7-mm, 6 o'clock position measures 6-mmAt the level of the left pulmonary artery, 5 o'clock position, image number 34, series number 3 measures 7-mm.At the level of the right pulmonary artery, series number 3, image number 41, 5 o'clock position measures 13 -mm . Possible chest wall invasion in that location.MEDIASTINUM AND HILA: Subcarinal lymph node measures 13 by 9-mm image number 38, series number 3, smaller per compared to previous study. Left hilar lymph node measures 15 by 10-mm image number 35, series number 3, stable. Necrotic para-aortic mass measures 3 .2 x 2 .4 cm, image number 41, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: 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: Slight interval decrease in the left pleural thickening and mediastinal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Post bronch. Mediastinal widening with rightward tracheal deviation unchanged, consistent with known mass.Decreased pleural fluid on the left with partial aeration of the left upper lobe, the left lower lobe and majority of the lingula remain atelectatic.Mild interstitial edema.New patchy opacities at the right base suggestive of atelectasis or aspirate but nonspecific.

Output: Partial reexpansion of the left lung. Mild pulmonary edema. Nonspecific basal opacity on the right.


Instruction: Generate impression based on medical findings.

Input: Reason: tb test History: positive ppd history of Unremarkable cardiac and mediastinal silhouette. Small lung volumes with no significant abnormalities.

Output: No sign of infection or other significant findings.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: SOB, eval for pulm edema History: SOB Small lung volumes with basilar atelectasis over elevated diaphragms.Heart size normal.Right jugular catheter at SVC/RA junction level.

Output: Small lung volumes with basilar atelectasis possibly from aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Tobacco use disorder with shortness of breath rule out pneumothorax. Surgical clips or markers in the left upper lobe adjacent to the left first costochondral cartilage. Lateral to this area, there is a focal parenchymal opacity which is similar in size but changed in position, more medial on the current study. Nodules in the right upper lobe are difficult to visualize by this technique.Multifocal atelectasis with diffuse pain air space opacities bilaterally, most pronounced in the right lung base. No pneumothorax.

Output: No pneumothorax. Diffuse pulmonary opacities nonspecific and may reflect acute alveolar edema, infection, diffuse aspiration pneumonitis or blood products in the appropriate clinical context. Left upper lobe lesion changed in position but not in size, query history of RT.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: follow up pleural effusion History: none Interval placement of a right dual-lumen catheter terminating in the mid superior vena cava.No significant change in the multifocal nodular pulmonary opacities, left greater than right partially loculated pleural effusions, atelectasis and scarring. No significant pneumothorax.

Output: Left greater than right partially loculated pleural effusions and diffuse pulmonary opacities. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Swan placement History: None Cardiomegaly status post aortic valve replacement with mild retrocardiac subsegmental atelectasis, unchanged.Right jugular Swan-Ganz catheter, tip directed towards the right main pulmonary artery.Right subclavian ICD unchanged.

Output: Cardiomegaly with retrocardiac subsegmental atelectasis, otherwise unremarkable. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: please r/u PNA or acute cardiopulmonary process History: cough, SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Skin fold projected over the left lung.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: daily am cxr History: n/a Increasing patchy airspace opacities with pleural effusions.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter tip at cavoatrial junction.

Output: Increasing pulmonary opacities. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for pulm edema History: chest pain, leg swelling Heart size upper normal.Questionable basilar edema and small right pleural effusion.Perihilar bronchial wall thickening is present.

Output: Mild CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: 73F p/w CP History: CP Median sternotomy.Heart size normal.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: History of pneumothorax, evaluate chest tubes and interval change.VIEW: Chest AP (one view) 2/23/2016 05:48 Endotracheal tube with tip between thoracic inlet and carina. NG tube with tip beyond inferior margin of image. Right pleural catheter unchanged. Two left-sided chest tubes unchanged.Cardiac silhouette size remains upper normal to mildly enlarged. Trace right pneumothorax, decreased from prior. Small left pneumothorax, slightly increased from prior. Numerous pneumatoceles bilaterally with superimposed focal opacity in the left lower lower lobe on a background of coarse pulmonary opacities. Subcutaneous emphysema on the left has decreased.

Output: Small left pneumothorax, slightly increased from prior. Pneumatoceles which may reflect necrotizing pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Shortness of breath, bilateral pneumothoraces Right chest wall Port-A-Cath tip is in the right atrium. Bilateral chest tubes are noted, unchanged position. Partially visualized cholecystectomy clips, common bile duct, and pancreatic duct drains.Cardiomediastinal silhouette is normal.Small bilateral pleural effusions.No significant improvement in size bilateral large pneumothoraces.

Output: No significant improvement in size bilateral large pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: 1-day-old male with meconium aspiration. Status post ECMO cannulation.VIEW: Abdomen AP (one view) 7/29/2016, 0742 UAC tip is at T7. Right lower extremity PICC is in the intrahepatic IVC. Enteric tube proximal side-port is in the distal esophagus with its tip in the stomach. Urinary bladder catheter tip is in the pelvis. A paucity bowel gas is present. No intraperitoneal free air, pneumatosis or portal venous gas is noted. Diffuse lung haziness is visualized in the lower lung fields.

Output: No evidence of obstruction or pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Status post mediastinal debridement. Shortness breath. Status post removal of median sternotomy hardware. Surgical drain projects over the mediastinum with adjacent foci of air in an open sternotomy. No significant pneumothorax. Valvular prostheses remain in place. Bilateral left greater than right pulmonary edema, pleural effusions overlying atelectasis are mildly increased compared to prior. Rightward curvature of the mid thoracic spine again noted.

Output: Status post removal of median sternotomy hardware with surgical drain projecting over the mediastinum with adjacent foci of air and presumable open sternotomy. Increasing pulmonary edema and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval heart and lung fields History: SOB Cardiomegaly with mid to lower zone opacities which can be edema or infection, greater in the left lower lobe. No pneumothorax.

Output: Cardiomegaly with left greater than right opacities of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: assess pulmonary edema History: as above Unchanged pulmonary opacities suggestive of edema as well as left lower lobe consolidation and a small left pleural effusion. Lucency projected over the right lung base has diminished, and could've been a loculated pneumothorax or other air collection, unlikely to be a pneumoperitoneum.Right jugular temporary pacemaker tip quailed near its tip, still near the right ventricle.ET tube tip approximately 4 cm above the carina. An NG tube terminates in the stomach, the side port at hemidiaphragm level.

Output: Unchanged pulmonary opacities. Improving lucency projected over the right lung base.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Is there pneumonia? History: Fever Feeding tube terminates within the stomach, as before. Stable patchy bibasilar opacities. No large pleural effusion or pneumothorax. Questionable small left pleural effusion. Unchanged cardiomegaly.

Output: No substantial change.


Instruction: Generate impression based on medical findings.

Input: Reason: patient with sob, green sputum, cough, want to r/o pneumonia History: cough, sob Severe perihilar and paramediastinal scarring and volume loss, unchanged from previous, with underlying bronchiectasis as documented by CT scan.No sign of pneumonia or other acute change.

Output: Severe upper zone scarring and bronchiectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female status post bolus with resolution. Evaluate disease status prior to therapy initiation. History of metastatic colon cancer. 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: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple peripherally enhancing hypodense lesions have developed within the omentum. One of them also extends into the anterior abdominal wall in the midline. That lesion measures 5.3 x 4.7 cm image number 119/197. These lesions were at the location of previous fluid collections and most likely represent abscesses.  Soft tissue mass in the midline lower anterior abdominal wall now measures 2.5 x 2.6 cm image number 127/197. Other smaller omental nodules are unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mesenteric soft tissue metastases on image number 155/197 measures 2.4 x 1.8 cm, not significantly changed from previous CT.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval development of pair of early enhancing lesions at the site of the previously described fluid collections adjacent to the bowel. Given the significant interval change in the size of these lesions, they most likely represent abscesses however, necrotic omental masses cannot be excluded.Other nodules in the peritoneum are unchanged.These findings were discussed with Dr. Polite the time of dictation.