Instruction: Generate impression based on medical findings.

Input: 58-year-old male with recent diagnosis bladder cancer CHEST:LUNGS AND PLEURA: Calcified plaque in the right lower lobe. Noncalcified subcentimeter, nonspecific nodule in the left upper lobe measuring 3-mm image number 10, series number 6.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Peripherally calcified hypodense lesion near the dome of the liver measuring 15 x 15 mm on image number 90, series number 4 cannot the optimally characterize on this single phase CT.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: Significantly enlarged prostate gland. Prostate gland is also very heterogeneous.BLADDER: Asymmetric wall thickening of the bladder involving the left side concerning for patient's known bladder carcinoma.LYMPH NODES: Nonenlarged bilateral external iliac and obturator lymph nodes. An index right external iliac lymph node measures 9 x 6 minutes on image number 183, series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Asymmetric wall thickening of the bladder suspicious for bladder cancer.Enlarged heterogeneous prostate gland.Bilateral nonenlarged pelvic lymph nodes.Nonspecific hypodense lesion in the dome of the liver which cannot show to characterize in this single phase CT. if further evaluation of this lesion is clinically indicated, MRI of the liver may be helpful.Nonspecific subcentimeter nodule in the left upper lobe of the lung. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: concern for volume overload, cough, hx of heart failure, worsening lower ext edema History: cough, cough Moderate cardiomegaly.Equivocal edema.No substantial pleural effusions.No specific evidence of infection.

Output: Moderate cardiomegaly with equivocal pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: r/o cat p History: cough fever A pulmonary nodule projects over the posterior right fifth rib. Previous left upper lobe mass-like consolidation has resolved. On the lateral radiograph, nodular opacity at the central trachea may represent overlap of vessels or lymphadenopathy, increased from prior reference lateral from 2011. Heart size is within limits of normal. Pleural spaces clear without evidence of infection.

Output: No evidence of infection. Right upper lobe pulmonary nodule again noted. Overlap of vessels versus lymphadenopathy noted on the lateral radiograph. This can be further characterized with a CT thorax, if clinically appropriate.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: donation History: donation Basilar atelectasis left greater than right with a left pleural effusion.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: Basilar opacities left greater than right with a small left pleural effusion. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: neutropenic fever, r/o occult infection History: neutropenic fever Central venous catheter terminates near the cavoatrial junction. Probable mild bibasilar subsegmental atelectasis or scarring. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Heart size at the upper limit of normal, as before. Aortic atherosclerosis again noted.

Output: No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: r/o PTX History: s/p chest tube Postsurgical changes of the right hemithorax. No significant pneumothorax. No other interval changes.

Output: Removal of right-sided chest tube with no significant pneumothorax. Postsurgical changes the right hemithorax.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Shortness of breath. Normal heart size. Pulmonary vascular redistribution and mild bronchial wall thickening but no signs of interstitial edema. Small focal opacity in the left retrocardiac region, nonspecific.

Output: Signs of mild hypervolemia, but no specific evidence of interstitial edema. Very small focal opacity near the left base, nonspecific. Follow-up films may be obtained if patient remains symptomatic to exclude development of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 56 year old female status post right hepatic lobectomy diagnosed with adenocarcinoma of the colon CHEST:LUNGS AND PLEURA: A few subcentimeter nodular opacities are again identified, unchanged, including the specified nodule along the right minor fissure (series 5; image 56).MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fluid collection in the postsurgical bed of the segment 7 lesion has mildly decreased in size. No new hepatic lesions have developed.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: Sutures are noted along the cecum.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: Examination with unchanged punctate, indeterminate pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Female 3 months old Reason: increase wob and oxygen support VIEW: Chest AP (one view) 3/2/15 at 1902 hrs. NG tube, central line and left-sided chest tube unchanged. Cardiac silhouette size is normal. No change in bilateral hazy lung. Improvement in left upper lower lobe opacities.

Output: Interval improvement in multifocal opacities as described


Instruction: Generate impression based on medical findings.

Input: Female, 97 years old.Syncope and collapse. Fall. Metallic fragments project over the right posterior chest wall.Moderate cardiomegaly with tortuosity of the thoracic aorta.Low normal lung volumes with flattening of the diaphragm. No focal airspace opacities, pleural fluid or pneumothorax.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Within this limitation, there appears to be mild to moderate loss of vertebral body height in the lower thoracic spine, of unclear chronicity. There is also deformity of posterior lower ribs seen on the lateral radiograph, one of which may be expansile, this area is not adequately visualized on the frontal film for assessment. Osteopenia. The right shoulder is inadequately visualized to exclude fracture.

Output: No signs of pneumonia. Compression fractures at T11 and T12 of unclear chronicity. Near the same level, there is rib deformity posteriorly; the rib cortices appear irregular with possible bony expansion. Due to limitations of technique and osteopenia, this is incompletely characterized and underlying pathology including myeloma or a metastasis cannot be excluded, though it could be posttraumatic. Unable to exclude right scapular fracture. Correlate with dedicated bone-technique radiographs if the patient is experiencing pain in these areas.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Productive cough and chest pain. Rule out congestion. Normal heart size. Tortuous thoracic aorta. Linear scarring or atelectasis in the lateral segment of the right middle lobe. No focal air space opacities, pleural fluid or signs of pulmonary edema.

Output: No acute cardiopulmonary abnormalities. Specifically, no signs of pneumonia or CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: repositioned ETT History: repositioned ETT Unchanged large right lung mass. ET tube tip approximately 4 cm above the carina.

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


Instruction: Generate impression based on medical findings.

Input: 85-year-old female with history of altered mental status. Heart size is at the upper limits of normal. Atherosclerotic calcification of the aortic arch.Ill-defined, patchy retrocardiac opacification may represent consolidation or atelectasis. No pleural effusion or pneumothorax.

Output: Ill-defined, patchy retrocardiac opacification may represent consolidation or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old. Complaining of shortness of breath during summer months. History of Ewing's sarcoma. Left upper lobe mass continuous with the superior mediastinum, new from prior.Normal heart size.No evidence of infection or edema.

Output: Left upper lobe mass continuous with the superior mediastinum, suspicious for metastatic disease given history, recommend CT chest w/ contrast for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with peritoneal mesothelioma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Subcentimeter thyroid nodules, unchanged. Previously described subcarinal lymph node is unchanged with a short axis measuring 7-mm image number 43.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter fat density lesion in the liver is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No measurable tumor in the chest abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: eval s/p pacemaker, had SOB earlier today associated with LUE paresthesias, poss hematoma? History: as above Left-sided pacemaker and tracheostomy tube unchanged.Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Shortness of breath History: Shortness of breath No significant cardiopulmonary abnormality.Moderate thoracolumbar scoliosis.Skeletal abnormalities of sickle cell disease noted.Bullet fragment projected over the mid chest posteriorly unchanged. Right jugular catheter tip at right atrial level.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Traumatic subcutaneous emphysema. Lung cancer history. Large left pneumothorax with maximal pleural separation from the chest wall inferiorly of approximately 4 cm, unchanged. The collapsed left infrahilar lung is nodular in appearance. The right lung is clear. Diffuse subcutaneous emphysema continues to slightly increase, consistent with airleak.

Output: No significant change in 4 cm left pneumothorax, however subcutaneous emphysema is progressively increasing, compatible with air leak.


Instruction: Generate impression based on medical findings.

Input: Male 9 months old; Surgical repair of Complete AV canal.VIEW: Chest AP (one view) 8/16/2016, 0508 Endotracheal tube tip is above carina. Bilateral chest tubes and right chest drain are unchanged. Two atrial lines, left internal mammary arterial catheter, temporary and permanent epicardial pacer leads are unchanged. Surgical clips in the mediastinum and neck and two surgical sponges overlying the upper chest are unchanged. The pacemaker battery pack is again seen in the epigastrium. Gastrostomy tube is present and unchanged. The cardiac silhouette is within normal limits. There are no focal opacities. The left lung base is hyperlucent and a pleural edge can be seen.

Output: Left small to moderate subpulmonic pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: sob History: sob ET tube is in place with its tip 5 cm above the carina.NG tube with its tip in the margin of the image.Left PICC line with its tip in the left axilla.Right sided chest tube noted at the right lung base.No change in aeration in the right lung with right pleural effusion and diffuse air space and interstitial opacities noted.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Neck pain and chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with history of anal 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: Punctate hypodense lesions in the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, 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: Unremarkable CT.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval for infiltrates History: dyspnea, elevated wbc count Large lung volumes consistent with emphysema.Nonspecific basilar opacities could be infection presenting atypically because of the emphysema, or edema.Minimal pleural effusions are present.Left subclavian pacemaker, leads unchanged in position.

Output: Severe emphysema with basilar opacities consistent with infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.History of liver transplant now with one month of shortness of breath question infiltrates. No cough or fever. Unchanged cardiomediastinal silhouette. No focal airspace opacities, pleural fluid or pneumothorax. Upper abdominal surgical clips.

Output: No acute pulmonary abnormality. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: cough, SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate ETT placement History: intubated ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC and NG tube tip in the stomach.Diffuse lateral nonspecific airspace opacities suggestive of edema, greater on the left.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Status post biopsy of mediastinal mass. Heart size is normal. Bulky mediastinal lymphadenopathy/mass. No focal consolidation, pleural effusion, or pneumothorax.

Output: Bulky mediastinal mass. No evidence of pneumothorax status post biopsy.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: Patient s/p R IJ TLC placment and repositioning, please evaluate interval change History: As above Right central venous catheter has been withdrawn and is in good position at the right atrial caval junction.No pneumothorax. Lines otherwise in stable and good position.Soft tissue fullness in the right neck again demonstrated likely hematoma from central line placement.Low lung volumes with basilar atelectasis.Heart size normal. No pneumothorax. No pleural effusion.

Output: Good position following repositioning of central venous catheter. No pneumothorax.Basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: r/o acute chest History: sickle pain, chest pain, sob Mild cardiomegaly.No significant pulmonary or pleural abnormality.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: Asthma Exacerbation History: SOB Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: eval acute process History: lightheaded, arrhythmias The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: s/p intubation History: intubation Interval adjustment of ET tube, now with tip 2 - 3 cm above the carina.Stable cardiomediastinal silhouette.Linear interstitial opacities, compatible with atelectasis/scarring. No new focal air space abnormality. No significant pleural effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Pleural effusion/edema History: SOB Small lung volumes, and a heart size upper normal.

Output: Heart size upper normal with small lung volumes. No reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval heart failure History: heart failure Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Prominent osteophytes on the right side of the thoracic spine.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.ET tube placement. ETT tip 5 cm above the level of the carina. NGT tip beyond the caudal margin of the film.Low lung volumes with patchy atelectasis and small pleural fluid collections about the same. No pneumothorax. Questionable minimal edema.

Output: ETT tip 5 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: eval for edeMA History: SOB Bilateral thickened septal lines compatible with mild edema. Cardiomegaly which is eccentric weighted by portable technique. No significant pleural effusion or pneumothorax. Recommend a dedicated PA radiograph when the patient can tolerate for further evaluation of the heart.

Output: Mild pulmonary edema with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: s/p MVR History: s/p MVR No significant change in nonspecific right basilar opacities and pleural fluid. Other findings also stable.

Output: No significant change in nonspecific right basilar opacities and pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: assess for change in pleural effusion History: dyspnea Nasogastric tube is unchanged in position. Metallic opacities favoring staples are noted in the left upper abdomen.Lucency at the right hemidiaphragm may represent small pneumoperitoneum versus artifact related to pulmonary opacity. Repeat upright radiograph recommended when the patient can tolerate. Diffuse pulmonary opacities throughout the left lung and right base with large left pleural effusion not significantly changed. Opacity at the aortopulmonary window of uncertain etiology, possibly lymphadenopathy. This can be further evaluated on subsequent upright radiograph.

Output: Lucency at the right base may be artifact versus small pneumoperitoneum. Aorta pulmonary opacities suspicious for lymphadenopathy. Both can be better visualized on upright radiograph. Pulmonary opacities and large left pleural effusion unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 102 years old.Shortness of breath in patient with COPD and heart failure preserved ejection fraction, no lower extremity edema. Large bilateral pleural effusions, increased in volume. Mild cardiomegaly, about the same.Coarse interstitial opacities suggestive of moderate pulmonary edema.Scattered small nonspecific parenchymal opacities incompletely characterized by plain film, similar to recent previous.

Output: Moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Resolving perihilar pulmonary edema with mild cardiomegaly. No definite effusions. No new superimposed focal airspace process

Output: Improving diffuse perihilar edema pattern


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Status post chest tube cramping, evaluate for pneumothorax. Interval development of a small left apical pneumothorax.Unchanged basilar atelectasis and cardiomegaly. Questionable left-sided pleural effusion.Interval removal of right jugular sheath and Swan-Ganz. Left chest tube projects towards the hila.

Output: New small left apical pneumothorax, after clamping of left chest tube.Findings were discussed with the service on 8/31/2016 at 11:20 AM.


Instruction: Generate impression based on medical findings.

Input: Check ETT ETT remains 2 cm above the carina. NG extends. An inferior edge of the image. Right jugular catheter is also well-positioned terminating in the mid SVCUnderlying cardiopulmonary appearance is also similar without new superimposed focal abnormality. Low lung volumes with the diffuse coarse interstitial opacities and effusions again suggest questionable mild ARDS superimposed upon extensive chronic findings

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with metastatic prostate cancer and pulmonary nodules CHEST:LUNGS AND PLEURA: Diffuse emphysematous changes are again identified with scattered scarring and diffuse bronchial wall thickening.Diffuse scattered bilateral pulmonary nodules are unchanged in size. The reference right lower lobe nodule measures 10 x 8 mm, stable (series 5; image 63.MEDIASTINUM AND HILA: The reference left paratracheal node measures 14 x 8 mm, slightly decreased in size, previously measuring 17 x 10 mm. However, the other prominent mediastinal and right hilar lymph nodes have not significantly changedCHEST WALL: Diffuse osseous metastases. A lipoma in the right serratus anterior muscle is seen.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Mild bilateral adrenal thickening is stable.KIDNEYS, URETERS: 9 mm stone in the midpole of the right kidney, increased in size. A punctate calculus is seen in the lower pole the right kidney. No evidence of obstruction is seen.Bilateral renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osseous metastasesOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis. Small left inguinal hernia and left hydrocele.BONES, SOFT TISSUES: Diffuse osseous metastases.OTHER: No significant abnormality noted

Output: Overall stable pulmonary nodules, thoracic adenopathy and osseous metastases.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with metastatic adenocarcinoma of unknown primary. History of pancreatitis 7 days ago. CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules.MEDIASTINUM AND HILA: Extensive mediastinal and hilar adenopathy. There referenced subcarinal adenopathy measures 4 x 2.5 cm image number 40/221. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Minimal intrahepatic biliary dilatation. Common bile duct is slightly dilated proximally. Peripancreatic ill-defined soft tissue likely representing metastatic adenopathy measuring 2.7 x 2.1 cm compresses the distal common bile duct.SPLEEN: No significant abnormality notedPANCREAS: Diffusely images pancreas without evidence of ductal dilatation. These findings are compatible with patient's recent history of pancreatitis.ADRENAL GLANDS: Right adrenal metastatic mass measuring 2.1 x 1.8 cm.KIDNEYS, URETERS: Subcentimeter lesions, too small to clearly characterize with atelectasis.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal and mesenteric adenopathy. There referenced left para-aortic node measures 2.1 x 2.7 cm in image number 123/221.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: Small amount of free fluid in the pelvis.

Output: Extensive mediastinal , retroperitoneal, mesenteric and hilar adenopathy. Scattered bilateral micronodules.Peripancreatic adenopathy likely compresses the distal common bile duct and causes mild intrahepatic biliary dilatation.Acute pancreatitis.Right adrenal metastatic lesion.Small amount of ascites.


Instruction: Generate impression based on medical findings.

Input: Left pleural effusion status post thoracentesis. Moderate to large left pleural fluid collection not significantly changed. Associated atelectasis is also similar. Chronic right sixth rib fracture deformity. Mid thoracic vertebral body loss of height also appears chronic. Surgical clips near the GE junction.No pneumothorax. Left lower lobe is collapsed.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: R/o power port flipping/misplacement History: bleeding from port site Left port is no longer accessed. The catheter remains in stable position, terminating within the right atrium, close to the tricuspid valve. Pleurx catheter is looped at the right apex, directed cranially at the right perihilar location.Nodular right pleural thickening and or fluid with associated mid to lower zone opacities are stable. Pleural-based pulmonary nodule projects over the anterior first rib and clavicle. The left lung remains clear. Heart size is normal.

Output: The left port catheter is no longer accessed but remains in stable position. No significant change in the nodular pleural thickening, pulmonary nodularity and airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval for PTX; cardiac arrest s/p ROSC and R femoral line placement History: multiple central line attempts in R neck, eval for PTX Improving interstitial and airspace opacities and unchanged cardiomegaly.ET tube tip approximately 3 cm above the carina.NG tube in place the tip at or above the GE junction.

Output: Improving pulmonary opacities. High NG tube.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Worsening tachypnea, evaluate pulmonary edema. Central lines similar in position. Unchanged cardiomegaly. Diffuse edema-like opacities without significant change. Right base atelectasis.

Output: Moderate CHF pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: h/o bladder cancer History: see above Heart size normal, the mediastinum unremarkable except for a small hiatal hernia.No significant pulmonary or pleural abnormality.No evidence of metastases.

Output: Small hiatal hernia, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 59 years old Male. Reason: s/p avr with removal of CTs x2 History: s/p avr. There is no evidence for infiltrate in both lung, or pneumothorax. Cardiac silhouette is stable. Lower lung volume with basilar atelectasis and small bilateral pleural effusions unchanged. Poststernotomy changes are noted.

Output: Lower lung volumes with basilar atelectasis and small bilateral pleural effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Lower extremity edema and concern for ILD. Shortness breath. Mitraclip device and Amplatz occluder device are again noted. Low lung volumes. Streaky bibasilar opacities are noted, compatible with patient's basilar predominant interstitial lung disease. Stable mild cardiomegaly. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: Streaky bibasilar opacities compatible with patient's basilar predominant interstitial lung disease, which was described on the recent CT chest.


Instruction: Generate impression based on medical findings.

Input: Resected gist tumor. Follow-up. 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: Subcentimeter well-defined hyperdense lesion near the dome is unchanged on image number 95/225. Another hypodense lesion likely representing a cyst in the right posterior segment inferiorly on image number 121 is also unchanged. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable presumed right renal cyst. No new findings.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.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 evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated History: Intubated Cardiomegaly with interstitial edema, slightly improved compared to previous.ET tube tip approximately 3 cm above the carina.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Why acutely SOB History: SOB x 1 week, h/o lung CA, reported 16% lung capacity Left mid lung scarring, but no evidence of edema or pneumonia.No evidence of recurrent tumor.Heart size normal.

Output: Left mid lung scarring, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Reason: patient with decreased breath sounds on rml and rll rule out pneumonia History: Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o pulm edema History: SOB Stable cardiomegaly.Diffuse bilateral fine reticular opacities, septal lines and bronchial wall thickening, associated with new small bilateral pleural effusions, consistent with pulmonary edema.Signs of pulmonary venous hypertension, new from prior.

Output: Signs of interstitial edema associated with new small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Large right pleural effusion, not significantly changed, with underlying atelectasis.Diffuse reticulonodular interstitial opacity, compatible with metastatic disease, unchanged or improved compared to the previous radiograph.Port catheter extending to the SVC.

Output: Persistent large right pleural effusion and diffuse pulmonary metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: S/P CABG History: S/P CABG` Resolution of prior right basilar opacity, but persistent left pleural effusion with overlying atelectasis.Unremarkable mediastinal contours and cardiac silhouette.

Output: Improvement in right lung base, but persistent left pleural effusion with overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: ESRD, Pulm Edema, LLL atelectasis. S/p TV repair , AVR and CABG History: SOB Large left pleural effusion occupying most of the left hemithorax with moderate mediastinal shift and depression of the left hemidiaphragm, increased from the previous day. Underlying atelectasis.Mild right perihilar and basilar opacity compatible with atelectasis.

Output: Increasing left pleural effusion of uncertain etiology. The differential diagnosis includes hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: r/o PNA History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: s/p lvad, asses for effusions History: course lung sounds Global cardiomegaly. Status post median sternotomy and mitral valve replacement. ICD/pacemaker and LVAD in place.Persistent signs of pulmonary venous hypertension and interstitial pulmonary edema, stable from prior.The right pleural effusion has decreased in size, now small. No pneumothorax.

Output: Persistent signs of pulmonary venous hypertension and interstitial pulmonary edema, slightly improved. Small right pleural effusion, decreased in size when compared to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: r/o pneumothorax / hemothorax / fluid collection History: SOB; Post-PROCEDURE Pleuroscopy / Thoracoscopy (0400 following procedure) Stable cardiomediastinal silhouette.Two left chest tubes, unchanged in position. Small left pneumothorax with additional component of subpulmonic air.Persistent left airspace opacities/consolidation, which may reflect hemorrhage given recent surgery.Subcutaneous emphysema in the left lateral chest wall is minimally improved.The right lung is clear.Partially imaged distended stomach and bowel in the upper abdomen.

Output: Postsurgical changes in the left lung with dense airspace consolidation and pneumothorax, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Question pneumothorax post device placement in electrophysiology lab. Right subclavian ICD with lead projecting over the right ventricle, not in the apex. An additional lead projects over a left ventricular vein. Mitral ring. Sternotomy hardware appears in alignment.A portion of the right upper lobe is obscured by the pulse generator and cannot be assessed.No significant pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Status post right extended pleurectomy and decortication. Note is made of postsurgical changes compatible with stated history of right-sided pleurectomy and decortication. Small right pleural effusion with underlying atelectasis/consolidation. Right-sided nodular opacities. 2 right-sided chest tubes in place with the tips projecting in the upper lung field. Small right apical pneumothorax. There is subcutaneous emphysema in the soft tissues along the right lateral hemithorax.

Output: Small right apical pneumothorax. Small right pleural effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: ET tube History: intubated ET tube approximately 5 cm from the carina. Enteric tube tip below the diaphragm outside the field-of-view. Bilateral patchy airspace and interstitial opacities compatible with edema and small right pleural effusion.

Output: Pulmonary edema without significant change from prior study.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with mycosis fungoides. Pain, skin lesions. CHEST:LUNGS AND PLEURA: Moderate-sized loculated right pleural effusion with pleural thickening is identified with mild associated atelectasis. Calcifications of changes from pleurodesis in the right pleura.Tubular lesions which appear to branch are identified in the right apex (series 6; image 23). Additional subcentimeter ill-defined nodule is seen in the right upper lobe (series 6; image 40).Right apical pleural parenchymal scarring is also noted.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Bilateral axillary adenopathy is identified. A reference lymph node measures 26 x 11 mm in the right axilla (series 4; image 39).Scattered subcutaneous/skin-based lesions are identified. One lesion which overlies the sternum measures approximate 41 x 7 mm (series 4; image 58).ABDOMEN: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: Scattered subcutaneous/skin-based lesions are identified. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Numerous mildly enlarged inguinal and external iliac lymph nodes are identified bilaterally, similar in size. Reference left external iliac node measures 17 x 10 mm (series 4; image 174).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scattered subcutaneous/skin-based lesions are identified. OTHER: No significant abnormality noted

Output: Scattered subcutaneous/skin-based lesions with axillary and pelvic adenopathy.Tubular, branching lesions noted within the right upper lobe, indeterminate. Follow up can be obtained at scheduled interval or by chest CT in 3-6 months.Loculated moderate-sized right pleural effusion, likely status post pleurodesis.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: R sided thoracentesis performed History: r sided thoracentesis Improvement in right pleural effusion following thoracentesis, with no pneumothorax.Improvement in right basilar consolidation.Tubes and catheters are unchanged.

Output: No pneumothorax following right thoracentesis.


Instruction: Generate impression based on medical findings.

Input: 76 year old female with the right upper lung mass, compare with previous LUNGS AND PLEURA: Right upper lobe nodule now measures 12 mm x 16.4 mm (image 26 series 5) previously measured 12.5 mm x 19.4 mm. Air bronchograms are noted within the nodule. There has been no significant interval change in comparison with exam dated 11/11/08. There is associated scarring towards the major fissure.Small right upper lobe micronodule is stable (image 31 series 5) it again noticed calcified granuloma left upper lobeMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative changes in the dorsal spineUPPER ABDOMEN: Stable left renal cyst

Output: 1. Right upper lobe nodule is unchanged or minimally smaller compared to exams dated 5/19/09 and 11/11/08. Would favor this representing a benign lesion however PET scanning is recommended for further evaluation.2. Stable right upper lobe micronodule. Evidence of a previous granulomatous infection.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval for infiltrate History: cough, sob Cardiomediastinal silhouette is unremarkable. Increased lung volume compatible with COPD . No pleural effusions or pneumothorax. Redemonstration of nonspecific faint opacity along the right costophrenic angle consistent with scarring or atelectasis.

Output: No specific findings of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: eval lung fields History: CHF s/p LVAD, worsening oxygenation Iatrogenic devices are unchanged. Dense left lower lobe opacity again noted. Small left pleural effusion, improved. Unchanged cardiomegaly. No definite pneumothorax.

Output: Dense left lower lobe opacity persists consistent with atelectasis and/or consolidated lung. Improvement in left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Afib, prior effusion History: a-fib No significant change in bilateral pleural effusions with basilar edema and atelectasis.

Output: No significant change in bilateral pleural effusions with basilar edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: edema? pna? History: shortness of breath Moderate cardiomegaly.Aneurysm of the ascending aorta, previously confirmed by CT scan, not appreciably changed.No sign of pulmonary edema or pneumonia.

Output: Cardiomegaly and aortic aneurysm with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Intubated patient, bilateral pleural effusion, PNA History: Respiratory failure, SOB Gradual worsening of pleural effusions and lower lung zone opacities consistent with edema.Right jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.ET tube tip 7 cm above the carina.

Output: Unchanged pleural effusions and pulmonary opacities. High ET tube.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with history of aortic stenosis presenting with syncope. Assess for presence of dissection. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Aortic annulus calcifications with poststenotic dilatation of the ascending aorta, measuring approximately 3.5 cm in AP dimension (series 9, image 59). No pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesions in the liver (series 9, images 133 and 159) are nonspecific; favor benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Aortic annulus calcifications with poststenotic dilatation of the ascending aorta as above without evidence of dissection


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Assess Swan placement. Congestive heart failure. Swan-Ganz catheter has been advanced slightly and now terminates in the central right hilar region. Left PICC is unchanged. No new focal lung consolidation. No evidence of overt left-sided heart failure. Moderate cardiomegaly again noted.

Output: Swan-Ganz catheter has been advanced slightly and now terminates in the central right hilar region.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: intubated History: same Support devices stable. Bilateral perihilar basilar opacities with small effusions are essentially unchanged.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Unexplained leukocytosis. Shortness of breath Mild rightward patient rotation. Mild subsegmental atelectasis in the lower aspects of the lungs.Likely normal for size given the AP projection. No pleural effusion or pneumothorax.

Output: Mild rightward patient rotation. No focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: Is there a pneumothorax? Eval pleural effusion History: S/p thoracentesis Left Port-A-Cath unchanged. Stable cardiac enlargement.Bilateral pleural effusions, left greater than right, slightly decreased on the left post thoracentesis.No evidence of a pneumothorax.Pulmonary nodules again noted.

Output: Mild interval decrease in left-sided pleural effusion following thoracentesis. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: aboce Small lung volumes with diffuse interstitial opacity consistent with chronic interstitial disease, not significantly changed.Right jugular catheter tip projected in the area of the right atrium.No new findings.

Output: 1. Chronic interstitial disease with no acute change.2. Catheter tip in the right atrium adjacent to the tricuspid valve.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: ETT position; OG position; lung parenchyma History: see above The patient is rotated.ET tube and NG tube unchanged.Significant volume loss in the left lung with a increasing opacity and cut off the left mainstem bronchus which may represent bronchial plugging as well as other etiologies of bronchial obstruction.Small right pleural effusion.

Output: Increasing left-sided atelectasis compatible with left bronchial obstruction. Support devices unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: f/u on left apical ptx History: f/u left apical ptx Left hemithorax postsurgical volume loss with mild edema.Small pleural effusions.Stable cardiomegaly.Improvement in left apical pneumothorax.

Output: Improvement in left apical pneumothorax, otherwise unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: FemaleReason for Study: Reason: Evaluate for effusion, infection, aspiration History: Altered mental status, seizure There are decreased lung volumes with mild elevation right hemidiaphragm.The cardiomediastinal silhouette is unremarkable.Mild basilar atelectasis similar to the prior exam.No new new pulmonary opacities noted.

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


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: right sided CP worse of the last 2 days, chills but no fever, assess for PNA History: right sided CP Heart size upper normal with large lungs suggestive of COPD.No specific evidence of infection or edema.No significant change.

Output: Heart size upper normal and possible COPD, but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: OHT, fatigue. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Sternotomy hardware appears intact. Surgical clips project over the left upper thorax. Bilateral humeral prostheses. Calcified lung nodule suggestive of granulomas. No focal airspace opacities, pleural fluid or pneumothorax. No signs of CHF.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Evaluate ETT placement History: Endotracheally intubated ET tube tip 5-6 cm above carina. NG tube in stomach.Improved aeration of lung bases. No new opacity.

Output: ET tube tip 5-6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: Myxoid liposarcoma of the knee, evaluate for metastatic disease History: above No evidence of pulmonary metastases. Borderline heart size. Degenerative change involving thoracic spine.

Output: No evidence of pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval for pneumothorax, eval for pulmonary effusion History: acute respiratory failure (preceding) attempt to place IJ line that was aborted due to clot/inability to thread wire with subsequent placement of R femoral trialysis Endotracheal tube terminates approximately 4 cm from the carina. Pulmonary edema pattern, slightly improved. Small pleural effusions. No pneumothorax. Unchanged cardiomegaly.

Output: Improvement in pulmonary edema. Endotracheal tube, as above. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: intubation History: cardiac arresdt ET tube tip about 1.5 cm above the carina. This has been adjusted on subsequent radiographs.NG tube coiled in the stomach.Mild left basilar opacity compatible with atelectasis and aspirated secretions.

Output: Slightly low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: intubated History: intubated Cardiomegaly, with either a very prominent left atrial appendage or a soft tissue mass contiguous with the left heart border such as a pericardial cyst.Left pleural effusion.No specific evidence of infection or edema.ET tube tip approximately 3 cm above the carina.Right subclavian catheter, tip in SVC.Left subclavian single chamber pacemaker lead in appropriate position.An NG tube terminates in the stomach.

Output: Cardiomegaly, with either a marked enlargement of the left atrial appendage or a soft tissue mass contiguous with left heart border.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: CHF, CABG Small lung volumes with bilateral opacity compatible with edema and pleural effusions, greater on the left.Swan-Ganz catheter tip in the main pulmonary artery.No significant change allowing for decreased pulmonary inflation and motion artifact.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: 85-year-old male with CHF presents with wheezing. Evaluate for pneumonia, stigmata CHF. Changes of a prior median sternotomy are noted. ICD overlies the left chest with leads at the right atrial appendage and right ventricular apex. Surgical clips project over the mediastinum.There is been interval resolution of a previously noted right basilar opacity. The cardiomediastinal silhouette is normal. No new focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: Interval resolution of previously noted right basilar opacity. No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: is there an infiltrate or effusion History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pulmonary edema, widened mediastinum History: chest pain while shoveling snow Unremarkable cardiac and mediastinal silhouette. Healed fractures of the right fifth and sixth ribs and pleural scarring at the right base laterally, unchanged.No sign of pulmonary edema or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: ETT placement History: above ET tube tip 5 cm above carina. NG tube tip in stomach. Venous catheter tip in SVC.Persistent bilateral pleural effusions with underlying consolidation.

Output: ET tube tip 5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Rule out pneumothorax status post lung biopsy. Small right pneumothorax with maximal pleural separation from the chest wall of 17 mm at the apex.Right upper lobe mass. Mild basal atelectasis and small volume of pleural fluid on the right.

Output: 17 mm right apical pneumothorax. Right upper lobe mass.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: please assess lung fields History: s/p ECMO decannulation Median sternotomy with pleural and mediastinal drains but no pneumothorax.Small lung volumes with minimal basilar subsegmental atelectasis.Status post extubation.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter, tip at cavoatrial junction level.Left jugular Swan-Ganz catheter, tip in main pulmonary artery.

Output: No significant change in minimal basilar atelectasis following extubation. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with metastatic sarcoma status post two cycles of chemotherapy. CHEST:LUNGS AND PLEURA: The right lower right lower lobe pulmonary nodule measures 10 x 9 mm, previously 12 x 11 mm (series 5, image 54). The few other subcentimeter nodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: The right-sided port terminates in the distal SVCStable right thyroid nodule.ABDOMEN:LIVER, BILIARY TRACT: Hyperenhancing lesion in segment two of the liver (series 3, image 84) is unchanged from 3/09, likely benign.Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are identified. Left hydronephrosis has resolved.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left-sided Spigelian hernia containing loops of nonobstructed small bowel, increased in sizeBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left inguinal lymph node has decreased in size, measuring 11 x 11 mm (previously 18 x 13 mm).BOWEL, MESENTERY: Scattered diverticulosis. The left spigelian hernia extends to the left inguinal region.BONES, SOFT TISSUES: The left heterogeneous iliopsoas mass which encases the left external iliac artery and vein has decreased in size, measuring 9.0 x 7.0 cm (previously 10.3 x 8.7 cm).OTHER: No significant abnormality noted

Output: Decrease in size of the left iliopsoas mass with resolution of left hydronephrosis. Slight decrease in the reference pulmonary nodule and inguinal adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: Evaluate for pulmonary edema History: shortness of breath, hx CHF Globular cardiomegaly and/or pericardial effusion.No evidence of edema.Left midlung subsegmental atelectasis.

Output: Severe cardiomegaly and/or pericardial effusion, but no evidence of edema/CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: infection History: r/o PNA Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: LIJ trialysis insertion History: LIJ trialysis insertion Improving left basilar opacity.Right upper lobe nodular opacity unchanged.Heart size upper normal.Left jugular catheter, tip in SVC.

Output: Left jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Cough, asthma exacerbation. Partial reexpansion of the right upper lobe though there is persistent discoid atelectasis and thickening of the minor fissure. Linear atelectasis at the lung bases bilaterally, left greater than right, new from prior. Airspace opacity left midlung has improved, probably reflecting atelectasis seen on end previously. No pneumothorax.

Output: Migratory atelectasis, now bilateral and most pronounced at the left lung base.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: check ET tube History: check ET tube Endotracheal tube 4 cm above carina.No evidence of infection or edema. Left basilar atelectasis.Nasogastric tube seen with tip in projection of the gastric body.No pleural effusion. No pneumothorax.

Output: Endotracheal tube and nasogastric tube in acceptable position. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Patient with swan, eval placement History: see above Cardiomegaly with minimal basilar edema.No specific evidence of infection.Right jugular Swan-Ganz catheter tip in right pulmonary artery.Right subclavian ICD unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval effusions History: as above Worsening pulmonary opacities suggestive of edema or aspiration, with pleural effusions.Moderate cardiomegaly status post sternotomy.

Output: Worsening CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.ICM status post LVAD assess effect of diuretics. Large layering pleural fluid collections, about the same. Low lung volumes with significant compressive atelectasis at the bases and along the dependent lung fields. Probable reduction in pulmonary edema, though difficult to assess. Cardiopulmonary monitoring and support devices similar in position.

Output: Large pleural effusions with significant atelectasis about the same. Perhaps slight improvement in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: s/p GIST tumor resection, laparoscopic thoracic esophagectomy History: none The cardiac mediastinal silhouette is unremarkable.There are decreased lung volumes.Mild right pleural thickening/small effusion.Nonspecific basilar opacities are compatible with atelectasis/scarring.No focal areas of consolidation.IVC filter noted.

Output: Interval improvement in the basilar atelectasis with mild residual changes noted at the right lung base. Right pleural thickening/small effusion redemonstrated. No new pulmonary opacities noted.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: s/p chest tube placement History: s/p chest tube placement Interval exchange of previous two right pigtail pleural catheters for a right chest tube. Right endobronchial valves and left port are unchanged in position.Persistent right subcutaneous emphysema. Decreased size of right hydropneumothorax, now small. Rounded nodular opacity at the right base with small right pleural effusion. Left lung is fully inflated with blunting at the left costophrenic angle, possibly trace effusion or atelectasis. Heart size is normal.

Output: Small right hydropneumothorax, decreased since interval placement of chest tube. Rounded pulmonary opacities at the right base compatible with known metastases.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of lung cancer, on chemotherapy. Severe pain at left chest wall. Follow up scan. CHEST:LUNGS AND PLEURA: Complete consolidation of the left lung, likely from bronchial obstruction as described previously with continued pleural thickening. Increased prominence of multiple right pulmonary nodules is also noted (series 5, image 57).Interval development of right pleural effusion with associated compressive atelectasis.MEDIASTINUM AND HILA: Stable mediastinal extension of tumor (series 3, image 36). Stable mediastinal lymphadenopathy. For reference, a right paratracheal lymph node measures 1.8 x 1.8 cm (stable).CHEST WALL: Left lateral chest wall mass measures 4.2 x 2.6 cm (series 3, image 68); previously measuring 4.5 x 2.7 cm. Left axillary lymphadenopathy (series 3, image 46) measures 3.2 x 1.7 cm; previously measuring 2.8 x 1.5 cm.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: Scattered lymphadenopathy in the mesentery and retroperitoneum as well as in the portacaval region. For reference, a para-aortic node measures 1.7 x 1 cm (series 3, image 114).BOWEL, MESENTERY: Ill-defined thickening of the peritoneum (series 3, image 136 for example) suspicious for peritoneal carcinomatosis.BONES, SOFT TISSUES: Soft tissue infiltration in the mid abdomen with few foci of subcutaneous air of uncertain etiology. Upon discussion with Dr. Hoffman, the patient takes Lovenox injections.

Output: Complete consolidation of the left lung as seen previously with progression of metastatic disease, including increasing lymphadenopathy and new peritoneal carcinomatosis. Increased prominence of multiple right pulmonary nodules as above.Findings were discussed via telephone with ordering physician, Dr. Philip Hoffman.


Instruction: Generate impression based on medical findings.

Input: 63 year old female with cough. Follow-up on right lower lobe nodule noted on 1/2007. LUNGS AND PLEURA: Previously noted right lower lobe pulmonary nodule measures approximately 6 mm - series 5, image 49 - (stable). Calcified right middle lobe nodule also unchanged.MEDIASTINUM AND HILA: No lymphadenopathy. Coronary calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Stable cholelithiasis.

Output: Right lower lobe pulmonary nodule remains stable since 4/23/2007, indicating benignity. Follow up is no longer necessary for this benign nodule.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: eval for acute chest History: chest pain, hx of HbSS No focal lung consolidation or evidence of overt left-sided heart failure. Marked cardiomegaly again noted. No large pleural effusion or pneumothorax.

Output: Marked cardiomegaly, as before. No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: 21-year-old female with leukocytosis. Stable cardiomediastinal silhouette.Bibasilar atelectasis/scarring. No pleural effusion.Osseous changes compatible with sickle cell disease are again noted.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: chest pain/sob, eval for PNA History: chest pain/sob, eval for PNA Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.SOB and chest pain evaluate for fluid overload Low lung volumes with moderate cardiomegaly. No pleural fluid or specific signs of pulmonary edema. No focal airspace opacities.

Output: Moderate cardiomegaly but no specific signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: eval of lung fields History: BL lung transplant Bilateral chest tubes in place with no pneumothorax.Nonspecific pulmonary opacity compatible with edema, atelectasis and effusions.No significant pneumothorax or other acute change.

Output: Bilateral nonspecific pulmonary opacity with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 84 yearsGender: FemaleReason for Study: Reason: eval for pulm edema, infiltrate History: pt w SOB, hx of HFpEF Decreased lung volumes with stable cardiomediastinal silhouette.Mild perihilar/basilar interstitial opacities compatible with edema and/or atelectasis.No focal areas of consolidation.No pleural effusions.

Output: Mild increased perihilar/basilar interstitial opacities compatible with edema and/or atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: pneumothorax; post-device placement in EP Lab History: s/p device placement in EP lab New cardiac leads terminating in the right atrial appendage and over the lower aspect of the heart. Previous defibrillator lead is unchanged. No pneumothorax. Mild rightward patient rotation. Low lung volumes makes detailed cardiopulmonary assessment difficult. Moderate elevation of the right hemidiaphragm again noted. Increased right basilar atelectasis. Persistent left basilar opacities, likely atelectasis or scarring. Unchanged cardiomegaly. Prominent azygos vein again noted.

Output: New cardiac leads terminating in the right atrial appendage and over the lower aspect of the heart. Previous defibrillator lead is unchanged. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Cough for 4 weeks, evaluate for infectious process. Normal heart size. Severe central bronchial wall thickening and perihilar lymph node enlargement. Atelectasis in the left lung base has a somewhat nodular contour.

Output: Severe central bronchial wall thickening with mild associated lymphadenopathy. Given the patient's age this is most likely infectious such as viral pneumonia. Follow-up PA and lateral chest radiographs may be obtained in 4-6 weeks to assess for clearance. If this abnormality persists at that time then further evaluation with CT may be warranted.Ashley Martin (4480) verbally notified via telephone at 10:25a.m. on 11/6/2015.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: mediastium History: CP to back Stable cardiomediastinal silhouette.Left pleural thickening and pleural calcification similar in appearance to the prior exam.Scattered calcified granulomas.No new pulmonary opacities identified.No pleural effusions.

Output: No evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p AVR Interval extubation. Swan-Ganz catheter tip in the right main pulmonary artery.Small lung volumes with nonspecific basilar opacity compatible with atelectasis and small effusions.No pneumothorax.

Output: Interval extubation with no other acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: FemaleReason for Study: Reason: pna History: weight loss, nausea There is cardiac enlargement with marked prominence of the pulmonary artery similar to the prior exam.Bilateral moderate-sized pleural effusions are present.Basilar opacities compatible with atelectasis.Median sternotomy is intact with evidence of a prior CABG.Mildly dilated air-filled loops of small bowel in the upper abdomen.

Output: Bilateral pleural effusions and underlying basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female status post gunshot transplant now with worsening hypoxia. CHEST:LUNGS AND PLEURA: Bilateral small pleural effusions and dependent atelectasis. Bilateral patchy ground glass opacities, most prominent in the lingula and the right middle lobe suspicious for infection. Drug reaction may also present with a similar appearance.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes have slightly increased in size from previous study. A reference precarinal lymph node measures 19 x 11 mm on image number 31/213.Small pericardial effusion.CHEST WALL: Bilateral axillary adenopathy a significantly increased in size. In reference right axillary adenopathy measures 18 x 10 mm image number 22/213. This same lymph node was measuring 11 x 7 mm on the previous study.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly. Contracted gallbladder. This study is limited for evaluation of focal liver lesions.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy. A reference lymph nodes in the left para-aortic space measures 14 x 13 mm image number 127/213. Additional mesenteric borderline enlarged lymph nodes are also present.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: Multiple enlarged pelvic lymph nodes. In reference right operator node measures 27 x 11 mm which number 175/213.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: Bilateral groundglass opacities suspicious for infection or drug reaction. Intraparenchymal hemorrhage is another possibility.Interval increase in the bilateral axillary and mediastinal adenopathy. Additional retroperitoneal , mesenteric and pelvic adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: interval change History: . Improved inflation but persistent left lower lobe consolidation and mild basilar edema.Tracheostomy tube, the tip at the level of the thoracic inlet.

Output: Improved inflation but persistent basilar opacities.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with history of bladder cancer. CHEST:LUNGS AND PLEURA: Bibasilar atelectasis, unchanged.MEDIASTINUM AND HILA: Index mediastinal node is unchanged, measuring 9 x 6 mm image number 10, series number 4. Other small mediastinal lymph nodes are also 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: Left renal hydronephrosis, hydroureter, cortical thinning, unchanged. Calcified density in the left lower pole, representing a stone.17 x 16 mm, round, high density exophytic lesion in the anterior aspect ofthe lower pole of the right kidney on image number 125, series number 4 is minimally increased compared to previous study where it was measuring 16 x 12 mm. However, this lesion has significantly increased from previous study dated 2/12/2007 where it was measuring 8 x 7 mm. this lesion may still represent a hyperdense cyst, however, a slow growing renal cell carcinoma cannot be excluded.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged retroperitoneal lymph nodes are not significantly changed. Index left para-aortic lymph node measures 14 by 11-mm image number 107, series number 4. This lymph node was measuring 12 x 11 mm image number 105, series number 5.BOWEL, MESENTERY: Ventral hernia containing nonobstructing bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Herniating, nonobstructing, small bowel loops. Right lower quadrant ileostomy. Ileal pouch in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Persistent fluid density collection in the left side of the pelvis is unchanged measuring 5.6 x 5 .5 cm, image number 163, series number 4.

Output: Left-sided hydronephrosis is unchanged. New stone in the lower pole left kidney.Growing high density lesion in the inferior pole of the right kidney. Further evaluation with renal MR or ultrasound is recommended to exclude a renal cell carcinoma.Borderline enlarged retroperitoneal lymph nodes. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: 44 years old Male. Reason: Dyspnea History: Dyspnea. Lower lung volumes. Scattered bilateral linear opacities. Left side AICD is unchanged. Stable cardiomediastinal silhouette. No evidence of acute infiltrate pleural effusion or pneumothorax.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Evaluate for PNA History: fever, unknown source An ICD and tips appear stable. There is been interval placement of a right-sided subclavian central venous catheter has its tip at the superior cavoatrial junction.The cardiomediastinal silhouette is normal. Bilateral interstitial opacities consistent with mild pulmonary edema. No focal pulmonary opacity suggestive of pneumonia. Bilateral streaky opacities, left greater than right, consistent with atelectasis. No pleural effusion or pneumothorax.

Output: Mild pulmonary edema.Discussed findings with Dr. Anupama Joseph at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with history of chronic lymphocytic leukemia and pneumonia CHEST:LUNGS AND PLEURA: Previously described although nodular opacities in the lung bases a result.MEDIASTINUM AND HILA: Index prevascular lymph node measures 17 x 8 mm on image number 27, series number 3, grossly unchanged. Other borderline enlarged mediastinal lymph nodes are also stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Small hypodense lesions in the liver are unchanged. Some of the more to small to accurate characterize.SPLEEN: Splenomegaly, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy. An index left para-aortic lymph node measures 2 x 1.3 cm on image number 113, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval resolution of confluent airspace opacities in lung bases.Splenomegaly.Retroperitoneal adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male 75 years old Reason: s/p left nephro-urothelial carcinoma- now with intermittent hematuria History: hematuria- s/p left nephro u Interval removal of a right central venous catheter and improvement of perihilar airspace and interstitial opacities.Redemonstration of cardiomegaly with tortuosity and aneurysmal dilation of the proximal descending aorta, not substantially changed from prior examination.Linear retrocardiac opacity likely represents atelectasis.No pneumothorax or pleural effusion is identified.IVC filter is partially visualized.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: r/o pneumothorax History: SVT Cardiomegaly with pleural effusions and the suggestion of basilar edema and atelectasis, not significantly changed.Chest tubes been removed with no pneumothorax.Right jugular catheter, tip in SVC.

Output: No pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Diarrhea, abdominal pain Chest: No focal pulmonary opacities, pleural effusion, or pneumothorax. The lungs are clear. The heart size is normal.Abdomen: Nonobstructive bowel gas pattern. No evidence of pneumoperitoneum. Cholecystectomy clips.

Output: Nonobstructive bowel gas pattern. No evidence of pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with history of epiglottic cancer. Please evaluate. CHEST:LUNGS AND PLEURA: Paramediastinal pulmonary fibrosis and scarring likely reflect sequela of prior radiation therapy. No suspicious nodules, masses, or pleural effusion.Debris in trachea compatible with aspiration.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild coronary calcifications.Interval increase in asymmetric thrombus just distal to the origin of the left subclavian artery with near total occlusion (series 3, image 24).CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Right renal cyst is partially visualized. Several subcentimeter hypodensities in the liver are too small to characterize but stable.

Output: 1. No evidence of metastatic disease.2. Near-total occlusion of the left subclavian artery just distal to its origin.3. Aspirate debris in trachea.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: ptx? and reduction in effusion History: s/p thora Increasing left lung consolidation with a stable left pleural effusion.Small right lung volume.

Output: Increasing left-sided consolidation consistent with infection or aspiration, with a pleural effusion. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Prekidney transplant evaluation, end-stage renal disease. Right jugular catheter tip projects over the cranial aspect of the right atrium. Normal heart size. No focal airspace opacities. Unchanged mild apical scarring. Right upper quadrant surgical clips.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with right renal mass and IVC thrombus with new onset murmur today in preop. Assess for extension of IVC thrombus and right renal mass. CHEST:LUNGS AND PLEURA: Round soft tissue nodule in the right apex (series 6, image 21) measures 10 x 8 mm, cannot exclude metastatic disease. Few additional subcentimeter, subpleural nodules (including nodule on series 6, image 41) are nonspecific, but cannot exclude metastatic disease.MEDIASTINUM AND HILA: Heterogeneously enlarged left thyroid lobe with multiple cystic nodules, the largest measuring 1.9 x 1.2 cm (series 8 image 13) causing rightward deviation of the trachea and esophagus. Pretracheal enlarged lymph node (series 8, image 24) measures 2.2 x 1 .3 cm, Scattered aortic arch calcifications.CHEST WALL: Median sternotomy wires are noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic calcifications, similar to prior, suggestive of chronic pancreatitis. Stones in the pancreatic body (series 3 and image 58) with upstream pancreatic ductal dilatation of the body/tail suggest possible obstructing intraductal calculi.ADRENAL GLANDS: Persistent prominence of the left adrenal gland is indeterminate.KIDNEYS, URETERS: Heterogeneous, enhancing mass in the right mid/inferior pole is similar in size to prior, measuring 4.4 x 7.1 cm in coronal dimension (coronal image 67), suspicious for renal cell carcinoma. The right renal vein is enlarged, suggesting tumor invasion. There is fat stranding surrounding the right kidney, suggesting perinephric infiltration.Right-sided nephroureteral stent, unchanged in position.RETROPERITONEUM, LYMPH NODES: Numerous subcentimeter retroperitoneal lymph nodes, similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: IVC tumor thrombus extends superiorly to just below the hepatic vein/IVC junction. Numerous collateral vessels are seen in the right renal fossa, suggesting chronicity.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1) Pulmonary and mediastinal masses, concerning for metastatic disease2) Right renal mass, suspicious for renal cell carcinoma with renal vein extension.3) IVC tumor thrombus extends superiorly to just below the hepatic vein/IVC junction4) Heterogenous thyroid enlargement with multiple cysts. Recommend follow-up ultrasound5) Pancreatic calculi with possible obstructing intraductal calculi.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: DOE History: DOE The left port is now accessed. Lower sternotomy hardware is unchanged in appearance.Postsurgical changes reflecting prior right middle lobectomy and lung transplant. Small bilateral pleural effusions, left greater than right. Right perihilar and bilateral lower lobe opacities of subsegmental atelectasis. Persistent opacification of the left apex from fluid or pleural thickening. Heart size is normal.

Output: No significant change in the left greater than right small pleural effusions and postsurgical changes from prior transplant and right middle lobectomy.


Instruction: Generate impression based on medical findings.

Input: History of MAI. Cough. Check for COPD Marked COPD changes with flat diaphragms. Lungs are otherwise clear of the minimal scarring and/or atelectasis.Cardiac and mediastinal contours are significant for mild tortuosity of the aorta and atherosclerotic disease.Mild kyphosis centered in lower thoracic spine

Output: Marked COPD without superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Patient with history of squamous cell carcinoma of the larynx treated with radiation. Now has hoarseness and right vocal cord stiffness LUNGS AND PLEURA: Severe centrilobular emphysema. A 5-mm nodule is identified in the right upper lobe. This was not clearly seen on the prior examination but may have been missed due to slice thickness. This is nonspecific at this size. Other calcified nodules are also identified.MEDIASTINUM AND HILA: No pathologically enlarged mediastinal lymph nodes or mediastinal masses. Coronary artery calcifications. Trace pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No findings to account for the patient's hoarseness or vocal cord stiffness.2. 5-mm micronodule in the right upper lobe which is nonspecific at this size, 6-12 month follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: please evaluate for new lung pathology History: desaturation Chest tubes extending to the right apex with no significant pneumothorax.Bilateral basilar opacity consistent with pleural effusions with underlying atelectasis and possibly edema.Slightly decreased gastric distention.

Output: Pleural effusions with lower zone airspace airspace opacity with atelectasis, slightly increased over the past 2 days.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for esophageal abnormality History: dysphagia; coughing with oral intake; h/o cerebral palsy 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. There is significant dilatation of the esophagus. Because of this dilatation there is suboptimal opacification of the distal esophagus which does not allow detailed evaluation of the mucosa. There is suggestion of a moderate-sized hiatal hernia, however gastric mucosa is not definitely visualized within the hernia due to the above-mentioned dilatation.  Fluoroscopic examination of esophageal motility revealed no significant esophageal dysmotility. Initially, no tertiary waves were identified, however, upon presentation of spontaneous gastroesophageal reflux, there is diffuse esophageal spasm witnessed.Spontaneous gastroesophageal reflux was identified to the level of the thoracic inlet, followed by diffuse esophageal spasm. The refluxed contrast material subsequently passed upon repeated swallowing and positioning the patient upright.Total fluoroscopy time: 3:21DAP (uGy*m^2): 1754.4

Output: 1.Moderate hiatal hernia.2.Severe spontaneous gastroesophageal reflux to the level of the thoracic inlet which causes subsequent tertiary waves/esophageal spasm.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with resected lung cancer CHEST:LUNGS AND PLEURA: Mild emphysematous changes remain. No masses or nodules are seen. The left lung continues to exhibit the expected volume loss.MEDIASTINUM AND HILA: 12 x 10-mm precarinal lymph node (series 4, image 29), unchanged. Coronary calcifications are identified.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormalityPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Shotty gastrohepatic lymph nodes.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: Diverticulosis.BONES, SOFT TISSUES: Lumbar laminectomies. Chondrocalcinosis affects the pubic symphysis.OTHER: Diffuse atherosclerotic disease

Output: Stable examination without definite evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: chest tubes, s/p bilat transplant History: chest tubes, s/p bilat transplant Improving lower lung zone opacities with no new pulmonary findings.Bilateral chest tubes are present with no pneumothorax.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Improving pulmonary opacities with no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: sob History: sob Interval increase in patchy bilateral airspace opacity suggestive of pneumonia.

Output: Interval increase in patchy bilateral airspace opacity suggestive of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated, eval ET tube History: see above ET tube tip approximately 5 cm above the carina.Aortic balloon catheter tip at the level of the aortic arch.Cardiomegaly with basilar opacities compatible with hemorrhagic infarct and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: L IJ placed History: L IJ Placed Pleural effusions and basilar atelectasis, slightly worse.NG tube is no longer looped in the upper esophagus and hypopharynx, but the side port is at or above the GE junction.ET tube tip approximately 6 cm above the carina.Spinal stabilization hardware is noted as well as paraspinal drains.Left jugular catheter, tip in SVC.

Output: NG tube corrected. Left jugular catheter, tip in SVC. ET tube tip approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with history of esophageal leak. There has been interval removal of a right pleural catheter and right upper extremity PICC. Bear claw endoscopic clip in the region of the mid to distal esophagus is stable in position. Stable bibasilar atelectasis and small bilateral left greater than right pleural effusions.

Output: Interval removal of right pleural catheter and right upper extremity PICC, but otherwise stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: trach History: asx . Acute respiratory failure. Moderate cardiomegaly with a tracheostomy tube in place. Large bilateral pleural effusions with underlying atelectasis, also unchanged.No new findings.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: assess lines, ETT History: ETT, lines Iatrogenic devices are unchanged. Mild interstitial pulmonary edema, as before. Small pleural effusions. Unchanged cardiomegaly. No significant pneumothorax. Mild subcutaneous emphysema again noted.

Output: Stable pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Chest pain and hypertension. Evaluate. Cardiomediastinal silhouette is normal. No pulmonary opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: CHF exacerbation History: PND, LE edema Biventricular ICD electrodes remain in stable position. Sternotomy wires are well aligned.Increasing right pleural effusion which appears partially loculated. Left pleural effusion is small and stable in size. Progressive right mid to lower zone opacities favoring edema. Severe cardiomegaly is unchanged.

Output: Severe cardiomegaly with progressive right mid to lower zone opacities favoring edema. Right pleural effusion is larger, likely partially loculated.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: s/p valvuloplasty concern for AAA History: s/p valvuloplasty Cardiomegaly. Tortuous aorta and calcified arch.Nonspecific basilar opacity and small pleural effusions. Dextroscoliosis of the thoracic spine.

Output: Cardiomegaly and small effusions is nonspecific but suggestive of mild CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Status post internal closure evaluate lung fields. Hardware and devices similar in position.Interval increase in volume of loculated pleural fluid at the right apex which may reflect hemothorax given its density.Groundglass opacities in the right lung are unchanged. Increasing atelectasis on the left compared to the prior study.

Output: Enlarging loculated right apical pleural collection suspicious for hemothorax.


Instruction: Generate impression based on medical findings.

Input: CT CHEST ABDOMEN PELVIS W, 9/4/2009 1:09 PM CHEST:LUNGS AND PLEURA: There is bronchial wall thickening and thickening of the intralobular septa of the bases bilaterally, suggestive of aspiration pneumonia. Additionally, there is nodularity of the septa and along the fissures, which may represent lymphangitic disease.MEDIASTINUM AND HILA: Density in the trachea likely represents fluid.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Multiple gallstones are seen within the gallbladder fossa, without any evidence of cholecystitis. Hypodensity in the right lobe of the liver is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerosis of the abdominal aorta, common iliac arteries, and internal iliac arteries is noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: A Foley catheter drains the bladder. There is thickening of the bladder wall.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse mottled appearance of the bones, consistent with bony metastases.OTHER: No other significant abnormality noted.

Output: 1. Fluid in the trachea and basilar dominance of bronchial wall thickening and thick intralobular septa is consistent with aspiration pneumonia. Additionally, there is a nodular appearance of the septum and the fissures, which could represent lymphangitic disease and a follow-up CT chest is recommended after resolution of the patient's acute process.2. Diffuse bony metastatic disease3. Cholelithiasis


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: PNA, flu, OSH TLC eval position History: see above A left central line has been placed, however the tip is projecting over the aortic knob and is direct and slightly away from the midline. These are findings which are highly suspicious for arterial line placement. Correlation with blood gases and clinical assessment is warranted. Justin Tomal was contacted at the time of the preliminary dictation.Bilateral lower lobe airspace opacities compatible with atelectasis and pneumonia.Cardiomegaly. ICD leads in adequate position.

Output: 1. The location of the left central line is of question, as described above. Service was notified of the findings and follow-up is essential.2. Bilateral lower lobe opacities representing pneumonia and atelectasis.3. Cardiomegaly with stable position of ICD leads.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pulmonary edema History: sob Right jugular catheter tip in the right atrium.Postsurgical findings in the right hemithorax with small pleural effusions, greater on the right. NG tube tip in the stomach.

Output: Small pleural effusions. Interval resolution of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for Sternal Integrity and for Effusions, Atelectasis History: S/P MVR and TV Repair Marked cardiomegaly with a single lead pacemaker unchanged. Diffuse nonspecific pulmonary opacity compatible with edema, atelectasis and possibly infection. Probable moderate pleural effusions. Intact sternal fixation devices.No significant change.

Output: Findings suggestive of CHF and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: tracheal aspirate with pseudomonas History: concern for pna Mild to moderate cardiomegaly.Small pleural effusions have improved and there are no new findings.Tracheostomy tube tip approximately 6 above the carina.Left subclavian catheter, tip in subclavian to the left of midline.

Output: Improvement in pleural effusions with no reliable evidence of acute pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: r/o pneumonia History: chest pain The cardiomediastinal silhouette is normal. Lungs clear of airspace and interstitial opacities. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Advanced heart failure confirm stable swan placement. Primary cardiomyopathy. Left jugular Swan-Ganz catheter tip in the right main pulmonary artery projection. Left subclavian ICD unchanged. Moderate cardiomegaly, similar to recent previous. No pneumothorax or focal air space opacities.

Output: Swan-Ganz catheter tip in the projection of the right main pulmonary artery. No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: 46F s/p ex-lap, check ETT placement History: ETT placement Endotracheal tube terminates approximately 4.5 cm from the carina. Enteric tube is looped in the stomach terminating proximally. Low lung volumes makes detailed cardiopulmonary assessment difficult. Left greater than right basilar opacities. No large pleural effusion. No pneumothorax. Heart size difficult to assess..

Output: Lines and tubes, as above. Left greater than right basilar opacities which may represent atelectasis and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Possbile infectious cause of fatigue History: Fatigue Surgical clips project over the right breast and right axilla.Left basilar opacities likely atelectasis/scarring.No specific evidence of infection or edema.Heart size normal.No effusion. No pneumothorax.

Output: No specific evidence of infection or edema.