Instruction: Generate impression based on medical findings.

Input: 33-year-old male with lymphoma status post stem cell transplant. The lack of intravenous contrast limits the exam for detection of lesions of the solid organs and bowel. With those limitations, the findings are as follows,CHEST:LUNGS AND PLEURA: Interval increase in bilateral pleural effusions. Basilar atelectasis.MEDIASTINUM AND HILA: Redemonstration of a hyperdense calcified dominant nodule within the right thyroid lobe.CHEST WALL: Right Port-A-Cath with distal tip in the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: There is a high-density focus in the right hepatic lobe, which is unchanged. The liver and gallbladder appear normal.SPLEEN: The spleen appears smaller compared to previous examination and has multiple areas of hypoattenuation compatible with infarction. There is high density embolization material within the left upper quadrant which causes streak artifact limiting the evaluation of the spleen. There is a stent in the splenic vein which is in unchanged position.There is confluent abnormal soft tissue within the lesser sac and splenic hilum. The lack of intravenous contrast, nearby streak artifact contribute to soft tissue margins that are indistinct and thus difficult to measure. PANCREAS: Abnormal confluent soft tissue abutting the pancreatic tail.ADRENAL GLANDS: Left adrenal is not well visualized given overlying streak artifact.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy.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: Small amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Left upper quadrant soft tissue mass, characterized on same day PET. Mass is compatible with tumor.2. Retroperitoneal lymphadenopathy, characterized with PET.3. Right thyroid nodule with calcifications.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with lung cancer. CHEST:LUNGS AND PLEURA: Partially calcified right paramediastinal mass measures 4.5 x 2.9 cm on axial image 41/140, increased from 1.7 x 1.8 cm when remeasured on the prior exam. Numerous scattered pulmonary nodules are new on the right (axial images 33, 39, 45, 71/105) as well as one new nodule on the left (axial image 37/105).MEDIASTINUM AND HILA: Reference right paratracheal lymph node measures 3.0 x 4.3 cm in axial image 27/140, increased from 1.7 x 1.9 cm. Subcarinal lymph node measures 5.7 x 4.3 cm on axial image 44/140, increased from 4.6 x 3.2 cm. Right hilar lymphoid tissue measures 1.7 x 1.7 cm on axial image 53/140 and has not significantly changed. Additional mediastinal lymph nodes have increased in size as well.CHEST WALL: Right chest wall port catheter, tip in the SVC. Ossification within the posterior aspect of the spinal canal (axial image 40/140) has not significantly changed.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia, unchanged. The gallbladder is not visualized.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal hypoattenuating lesions, unchanged and probably benign.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered, shotty mesenteric and retroperitoneal lymph nodes, not pathologically enlarged, have not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Progression of disease in the chest. Stable abdominal examination.


Instruction: Generate impression based on medical findings.

Input: Male, 92 years old.Reason: eval for pulm edema, cardiomegaly History: abd distention, LE edema, ? Basilar crackles on exam Cardiac leads terminating within the right atrial appendage and right ventricular apex. Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild basilar atelectasis or scarring. Probable small pleural effusions. No pneumothorax. Heart size, likely unchanged at the upper limit of normal.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval ETT, lung fields History: s/p CABG, AVR, MVR Interval aortic valve placement with sternotomy hardware well aligned. Lucency projecting over the manubrium compatible with 1 to 2 mm skin separation. Endotracheal tube terminates 6 cm above the carina. Right IJ Swan-Ganz catheter terminates in the distal right pulmonary artery. Two subxiphoid mediastinal drains and a left basilar chest tube are in place.Interval decreased lung volumes with retrocardiac atelectasis. Right infrahilar opacities likely aspirated secretions. Lucency at the level of the esophageal hiatus and base of the heart suspicious for pneumomediastinum. No pneumothorax. Postoperative mediastinal widening likely from fluid and/or hematoma.

Output: Postoperative radiograph with retrocardiac atelectasis in this intubated patient. Lucency at the base of the heart is suspicious for minimal pneumomediastinum. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: s/p BL lung transplant History: CT ICU patient Tubes and lines are unchanged.Pleural effusions and diffuse pulmonary opacities not significantly changed.No evidence of pneumothorax.No new pulmonary opacities.

Output: Support devices unchanged. Stable chronic pulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: History of Hurthle cell cancer status post radiotherapy to chest wall mass and left lung mass. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules again identified. Reference right upper lobe nodule and left lower lobe nodule are reidentified on image 36 /109 and 43/109 respectively, slightly increased in size. No new nodules are seen.MEDIASTINUM AND HILA: Previous noted large mass adjacent to the aortic arch superior to the AP window is stable in size, measuring 49 x 58 mm (image 22/160); previously measuring 49 x 58 mm. However, a right paratracheal lymph node has increased in size, now measuring 34 x 20 mm (image 20/160), previously 25 x 14 mm. Other small mediastinal lymph nodes unchanged. Stable large calcified right hilar lymph nodes.Stable fat containing hiatal hernia. Surgical clips in the mediastinum and the expected location of thyroid. Median sternotomy wires unchanged.CHEST WALL: Previously noted, poorly marginated chest wall mass at the level of the aortic arch has slightly decreased in size, measuring 60 x 34 mm (image 23/160); previously 62 x 40 mm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholelithiasis.SPLEEN: Stable calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys. Left peripelvic cysts. Retroaortic left renal vein.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative changes of the spine.

Output: New target mediastinal lymph node increased in size. Previously referenced pulmonary nodules also slightly enlarged but unchanged in number.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Preoperative Unremarkable cardiomediastinal silhouette.No specific evidence of infection or edema. No pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 71-year-old man with history of bladder cancer status post resection recently diagnosed lung cancer and partial colon resection with colostomy who presents with hypertension and one syncopal episode. Abdomen pelvis CT with oral contrast only. Evaluate for presence of colovesicular by CT. CHEST:LUNGS AND PLEURA: There is a large mass in the superior segment of the right lower lobe with adjacent areas of atelectasis and consolidation. The mass is estimated on series 3 image 66/223 to measure 6.5 x 6.4 cm. There is loss of plane to the right lower lobe bronchus with debris in the right lower lobe bronchus suggesting erosion of the mass through the right lower lobe bronchus.Extensive area of consolidation is seen in the right lower lobe. Rule out aspiration pneumonia.Some micronodules are seen elsewhere.Emphysematous changes are seen diffusely.MEDIASTINUM AND HILA: Small clusters of nodes in the paratracheal AP window precarinal and subcarinal area. The mass involves the right hilum and separate adenopathy cannot be measured distinct from the mass. No nodes are seen in the left common.Coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Fat stranding symmetrically around both kidneys. Bilateral renal cysts with thick of a large exophytic cyst off the left lower pole. Air seen in the collecting system of the left kidney and left ureter probably due to large amount of air in the neobladder. This probably iatrogenic as a Foley catheter is seen in the neobladder. There is no evidence of hydronephrosis. The left ureter is prominent.RETROPERITONEUM, LYMPH NODES: Shotty nodes. Nonpathologic by size criteria. Atherosclerotic calcification aorta without aorta tapeworms taper and some areas with double rim of calcification suggesting chronic dissection. Periaortic fat however is intact with no evidence of fibrosis of fluid.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Punctate high density focus in the lower thoracic vertebral bodies on the right may be a bone island. No definite evidence of lytic or blastic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Surgically resected. Foley catheter in the neobladder. Fluid in the neobladder has a somewhat high density measuring about 60 Hounsfield units. It is uncertain as this is from some previous examination at the outside hospital or if this could represent high density fluid due to fistulization of the neobladder to bowel however I see no definite fistula. Oral contrast has reached the rectum and no high density oral contrast can be discerned in the neobladder. If there is strong clinical concern this can be evaluated further by direct injection of the neobladder or alternatively by proctogram.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left lower quadrant ostomy.OTHER: No significant abnormality noted

Output: Large lung mass with associated atelectasis and consolidation and probable erosion into the right lower lobe bronchus. Small mediastinal nodes. Postsurgical changes consistent with cystectomy and neobladder. Fluid in the neobladder is higher than fluid density. I cannot exclude a fistula to bowel. Ectasia distal abdominal aorta with areas suggestive of chronic dissection.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: infection History: SOB The cardiac mediastinal silhouette is unremarkable.Basilar chronic appearing interstitial opacities.No focal areas of consolidation.Possible right pleural effusion.

Output: Interstitial opacities may be chronic in origin. Small right pleural effusion. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male 23 years old Reason: evaluate for obstruction History: severe abdominal pain; known fibrostenotic Crohns disease. Cardiomediastinal silhouette is unremarkable. Note is made of an azygos pseudolobe. Visualized lung fields clear. There is no free air under the hemidiaphragms. Nonobstructive bowel gas pattern. Postsurgical anastomotic suture material is seen in the right lower quadrant.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: 35 year old female with history of myxoid liposarcoma status post chemotherapy. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary micronodules are identified and are not significantly changed in size. No new nodules or masses. No pleural fluid. Small bibasilar atelectasis/scarring.MEDIASTINUM AND HILA: The main pulmonary artery remains enlarged compatible with pulmonary artery hypertension. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. Stones in the gallbladder with no evidence of cholecystitis. No evidence of focal liver lesions. The portal and hepatic vasculature is patent.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: A right lower quadrant mesenteric mass has not significantly changed in size when accounting for differences in its location and variability of measurement now measuring 4.3 x 2.5 cm on image 117 series 3 (this is in comparison to 3.9 x 3.4 cm on axial image 124/205 on prior study). Midline mesenteric mass measuring 3.3 x 2.8 cm on image 148 series 3 has also not significantly changed when accounting for differences in the location of the mass and measurement variability as this mass was retrospectively identified near the small hernia sac (measured 3.8 x 2.1 cm on image 154 series 4 on CT of 10/29/2008). A ventral abdominal wall hernia is unchanged containing non-obstructed bowel loops.BONES, SOFT TISSUES: Asymmetric soft tissue density within the left anterior abdominal wall is grossly unchanged and may be postoperative in etiology.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: Stable examination without evidence of disease progression.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: r/o pneumonia History: productive cough, SOB, tachypnea Cardiomegaly.Minimal pleural effusions and scattered septal lines suggestive of edema.No specific evidence of infection.Left subclavian dual-chamber ICD unchanged.

Output: Cardiomegaly, and minimal effusions with septal lines suggestive of edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 43 years old Male. Reason: impella placement History: impella placement. There is new patchy opacity in the right lung with the interval worsening of basilar atelectasis. Stable cardiomegaly and consolidation in the retrocardiac area. The Swan-Ganz catheter, and cardiac pacemaker/defibrillator are stable in position.

Output: Interval worsening of the right lung opacity with basilar atelectasis. Otherwise no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Shock, evaluate for infection. Low lung volumes with small pleural effusions. Chronic volume loss right upper lobe. No specific signs of pneumonia.

Output: Small pleural effusions, no specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: Evaluate for PNA History: Fevers and chills x2 days 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, 71 years old.Reason: SOB History: SOB Low lung volumes with left basilar opacity. Right lower lobe basilar opacity likely represents infection and/or aspiration.No pleural effusion. No pneumothorax.

Output: Right lower lobe infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: swan placement? History: see above ET tube with its tip 4 cm above the carina.NG tube with its tip in the margin of the image.Right IJ venous catheter with tip in the SVC.IABP marker in the aortic arch.IVC Swan-Ganz now positioned with its tip directed inferiorly in the right ventricle.Stable cardiac enlargement with perihilar/basilar opacities compatible with edema and atelectasis.

Output: IVC Swan-Ganz repositioned with its tip now directed inferiorly in the right ventricle.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: pneumonia History: cough Bronchial wall thickening consistent with asthma or chronic bronchitis.No specific evidence of infection or edema.Heart size normal.

Output: Bronchial wall thickening consistent with asthma or bronchitis. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old. Reason: eval lung fields History: s/p epicardial lead placement Study is limited by interesting repeating linear artifact overlying the upper abdomen and left side of the hemithorax. Right internal jugular venous sheath is noted. Cardiac leads terminating in expected location of the right atrium and right ventricle as well as a cardiac vein. Epicardial pacemaker leads are also noted. Marked cardiomegaly. Patchy bibasilar opacities likely representing atelectasis. No definite pleural effusion or pneumothorax.

Output: Limited study, as above. Iatrogenic devices, as above. Marked cardiomegaly. Patchy bibasilar opacities, likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old. ET tube and NG tube unchanged.New right IJ venous catheter placed with its tip in the SVC.No evidence of a pneumothorax.Stable cardiomediastinal silhouette.Mild left basilar atelectasis similar to the prior exam.

Output: Triple placement of a right IJ venous catheter without complication.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: fevers in patient receiving chemotherapy History: fever Right IJ port catheter with tip overlying the SVC.Cardiac size is normal in size.Low lung volumes with streaky left basilar atelectasis and prominent interstitial markings bilaterally.

Output: Bilateral interstitial prominence may relate to edema, although the possibility of atypical viral-like infection remains a differential considerations. Correlate with fluid status.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Evaluate for cause of chest pain History: chest pain Low lung volumes. Probable atelectasis at the lung bases. No large pleural effusion or pneumothorax. Heart size at the upper limits of normal given low lung volumes.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: heart/lung pathology History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old. Reason: post-intubation History: post intubation ET tube tip in the right mainstem bronchus with atelectasis of the left lower lobe.ICD with leads unchanged in position.Right central venous catheter with tip in the SVC. Cardiomegaly with pulmonary edema and small pleural effusions, unchanged.

Output: Right mainstem intubation with atelectasis of the left lung .Findings were discussed by telephone with the emergency department physician, Dr. Bickley, at 4:30 PM on 5/16/2016


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with metastatic breast cancer. Recent increase in low back pain. CHEST:LUNGS AND PLEURA: An irregular 10 x 10 mm nodule is seen in the right apex with subpleural extension (series 4; image 17) and spiculated margins. 2-mm left lower lobe micronodule remains (series 4; image 43). A few other scattered punctate nodules are identified, not significantly changed (for example, left upper lobe series 4; image 39)MEDIASTINUM AND HILA: A large heterogeneous thyroid nodule/left lobe with substernal extension, not significantly changed.No mediastinal or axillary adenopathy. Status post left axillary node dissection.CHEST WALL: A few lytic lesions in the thoracic spine are seen new at T7 on the right and increasing at T10 on the left (series 3; images 45 and 70). Unchanged sclerotic metastasis involving the right first rib.ABDOMEN:LIVER, BILIARY TRACT: Post radiation fatty changes at the dome of the liver are less pronounced. This may obscure the lesion which was previously described on MRI.Ill-defined 8 x 8 mm hypodense lesion is seen in segment 7 of the liver, previously measuring approximate 5 mm (series 2; image 86), but not definitively changed given lack of definition.Cholelithiasis.SPLEEN: The spleen is unremarkable. A partially calcified splenic artery aneurysm is again seen.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, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: Sclerotic lesions in the iliac bones, right ischium and sacrum are grossly unchanged, consistent with metastases. A nondisplaced fracture fracture the L3 spinous process, new (series 3; image 121). Small lytic lesion in the L2 vertebral body on the right is also suggestive of metastatic disease, increased in size.OTHER: No significant abnormality noted.

Output: New right upper lobe pulmonary nodule, worrisome for primary versus metastatic disease.Subcentimeter hypodensity in the liver, not definitively changed. The lesion described at the dome of the liver on prior MRI is not well visualized, and it may be obscured by postradiation fatty infiltration.Mild increase in size of the few of the bony lesions, described above.New L3 spinous process fracture, which could be the cause of the patient's low back pain.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: r/o granulomatous nodules History: right orbital inflammation Stable cardiomediastinal silhouette with calcified aortic arch.Bilateral hilar contours are unremarkable. Posterior costophrenic angle pleural thickening with or without trace effusions. Otherwise, lungs are clear.

Output: Stable appearance of the chest with no gross evidence of hilar adenopathy or definite calcified granulomas on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: assess for infiltrate History: cough Bibasilar atelectasis or scarring. Mild pulmonary edema. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Bibasilar atelectasis or scarring. Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath No significant cardiopulmonary abnormality.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: chest tube placement History: s/p RLL lobectomy Unchanged right chest tube with no pneumothorax.Increased basilar interstitial opacities since the prior study suggestive of aspirated secretions.Marked gaseous distention of the stomach.

Output: Chest tube with no pneumothorax. Increasing basilar opacities suggestive of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Reason: ? pna History: lethargy Unremarkable cardiac and mediastinal silhouette. Pacemaker lead extending to the area of the apex the right ventricle.No sign of pneumonia or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Chronic airway obstruction evaluate lung fields. Shortness of breath and cough. Right paramediastinal contour abnormality just above the diaphragm. No specific signs of pulmonary edema or pneumonia. Cardiothoracic ratio appears at least upper normal. Central pulmonary vasculature is enlarged, suggestive of pulmonary hypertension.

Output: Possible cardiomegaly with signs of pulmonary hypertension. Contour abnormality abutting or within the right posterior mediastinum near the cardiophrenic angle region of unclear etiology. Differential considerations include collapsed or less likely infarcted lung or a soft tissue abnormality in the posterior mediastinum. Correlation with direct PA and lateral chest radiographs is suggested as an initial step in further characterization. This may occur and are near a site of previously reported discitis from 2013. Dr. Babcock of the ED verbally notified and will alert the admitting service.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Hypotension evaluate lung fields. Hardware and devices are similar and position allowing for lordotic position and were previously discussed with the clinical service.No significant sized pneumothorax.Unchanged cardiomegaly.No specific signs of pulmonary edema.

Output: No acute change in cardiopulmonary appearance. Left pneumothorax nearly resolved.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Pacemaker leads projected in the area of the right atrium and right ventricle, unchanged from previous.One of the atrial leads is directed laterally towards the atrial free wall.No pneumothorax or other complications.

Output: New pacemaker leads as described with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Post thoracentesis left side. Chest pain. Evaluate for pneumothorax. Right regular dual lumen catheter distal tip low in the right atrium.Decreased volume of pleural fluid on the left, now small to moderate bilaterally.Dependent atelectasis and hazy opacity improving. No visible pneumothorax.

Output: Decreased volume of pleural fluid on the left. No visible pneumothorax. Low position of right jugular catheter.


Instruction: Generate impression based on medical findings.

Input: Metastatic disease The ventricles and cortical sulci are normal. There is no acute hemorrhage, mass or extra-axial fluid collection identified. Images of the vascular enhancement pattern and are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: Essentially unremarkable CT head as discussed above.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: cough, subjective fever, eval for pneumonia History: see above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with non-Hodgkin lymphoma. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Bilateral thyroid nodules are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in appearance. The gallbladder is absent with cholecystectomy clips in place. No intrahepatic biliary ductal dilatation.SPLEEN: A previously described, ill-defined, mass in the spleen measures 2.1 x 1.5 cm (series 3, image 87). This mass appears smaller, but the mass is likely unchanged from previous examination due to differences in technique of scan. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: There is soft tissue prominence around the IVC and aorta which appears unchanged from previous examinations.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterine fibroids are again 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: 1. No significant change in splenic lesion.2. Stable retroperitoneal soft tissue prominence.3. No new lymphadenopathy or new sites of disease.4. Uterine fibroids.


Instruction: Generate impression based on medical findings.

Input: Thymoma Interval removal of the right chest tube without evidence of underlying residual complication. Improved overall expansion with elevated left hemidiaphragm unchanged. No superimposed acute cardiopulmonary abnormality

Output: Chest tube removed


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Eval lung fields History: Intubated Tracheostomy tube is in place. Left subclavian line is looped on itself at the level of the brachiocephalic vein. Focal 1.5 cm nodule in the lateral aspect of the right lung base again noted. Mild pulmonary edema again noted. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Stable radiographic findings. Follow-up of pulmonary nodule again necessary.No acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old. New right PICC line with its tip in the RA.NG tube with its tip in the stomach.Stable cardiac enlargement with widening of the mediastinum.Pleural effusions and perihilar/basilar opacities similar in appearance to the prior exam.

Output: Right PICC line in place with its tip in the R8. Pleural effusions and perihilar/basilar opacities without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: MaleReason for Study: Reason: eval effusions History: as above Stable cardiac enlargement.Interstitial opacities, basilar atelectasis, and all pleural effusions are similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with cardiomegaly, pleural effusions, basilar atelectasis, and interstitial opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval worsening infection vs edema History: SOB Diffuse pulmonary edema pattern slightly increased. Unchanged bibasilar opacities and small effusions. Unchanged cardiomegaly. No pneumothorax. Iatrogenic devices are unchanged.

Output: Increase in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male evaluate status post thoracentesis. No interval change in left pleural effusion with adjacent atelectasis/consolidation. No new focal airspace opacity. No pneumothorax. Normal cardiomediastinal silhouette.

Output: Left pleural effusion grossly stable with no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Evaluate for pneumonia. History: Fever, history of small cell lung cancer, right bronchus intermedius tumor, breast cancer, on XRT The lateral view is limited due to overlying anatomy. Diffuse coarse reticular opacities are likely related to edema and atelectasis superimposed upon radiation therapy changes. Moderate subpulmonic right pleural fluid collection with adjacent atelectasis and consolidation. Small left pleural effusion.Right PICC catheter tip projects over the right axillary vein. Status post left mastectomy. Severe degenerative osteoarthritis of the shoulders.

Output: 1. Moderate right subpulmonic fluid collection.2. Increased edema and atelectasis likely superimposed upon radiation changes. Infection not entirely excluded, especially in the right lung base.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: RIJ central line placement History: RIJ central line placement ET tube and left venous catheter unchanged. Right venous catheter tip at RA/SVC junction. ET tube extends beyond the field-of-view of study.Stable to slight increase in diffuse interstitial and airspace opacities though a focal area of the left base is slightly better aerated.

Output: Right venous catheter tip at RA/SVC junction.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with shortness of breath and fever. Evaluate for left lower lobe pneumonia, pleural effusion Moderately large right and small left, freely layering pleural effusions with underlying basilar atelectasis, similar to CT chest performed on 11/24/2015.

Output: Bilateral, freely layering pleural effusions with underlying basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Fever Asymmetric hazy opacity overlying the right upper lung without clear delineation. There is a large soft tissue mass projected off the posterior aspect is observed on the lateral projection, presumably related to this right upper lobe described opacity, thus representing superimposed structures. Small faint calcifications within this soft tissue finding cannot be excluded. Please correlate with physical exam and although lung appearance is atypical for infection, an early pneumonia cannot entirely be excluded and serial imaging is indicated given patient history. Left lung and right lung base are otherwise clearThe cardiac and mediastinal contours are within limits. No effusions

Output: Questionable right posterior soft tissue shoulder mass representing a suspected nonspecific opacity involving the right upper lung. Correlation with physical exam and possibly follow-up imaging is needed


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: ett placement History: intubated ET tube with its tip 3 cm above the carina.Decreased lung volumes with stable cardiomediastinal silhouette.No new pulmonary opacities noted.

Output: ET tube tip in satisfactory position. Stable cardiopulmonary appearance without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: ARDS s/p trach, eval trach positioning History: as above Unchanged pulmonary opacities consistent with ARDS.Tracheostomy tube tip approximately 1 cm above the carina.Left jugular catheter, tip in SVC.Dobbhoff tube, tip in descending portion of the duodenum.

Output: Unchanged pulmonary opacities consistent with ARDS.


Instruction: Generate impression based on medical findings.

Input: Female 20 years old Reason: ileus v obstruction History: pain Lungs are clear. Heart size is normal. Nonobstructive bowel gas pattern. No free air.

Output: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: 82 year-old female with shortness of breath, cough. Evaluate for infiltrate or CHF. Surgical clips in the left mid to upper long. Perihilar interstitial opacities and probable small effusions. Cardiomegaly.

Output: CHF without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval for any possible cause of pain History: back pain radiating to chest Sternal wires remain well aligned. There is evidence of previous coronary arterial bypass and stent placement.The lungs and pleural spaces are clear. Cardiomegaly with evidence of mild increased left atrial chamber size. The mediastinal width remain stable. If there is high clinical suspicion for acute aortic syndrome, gated CTA thorax is recommended.

Output: Cardiomegaly with evidence of mild increase size of the left atrium. The mediastinal width remain stable. If there is high clinical suspicion for acute aortic syndrome, gated CTA thorax is recommended.


Instruction: Generate impression based on medical findings.

Input: 54 years, Male. Reason: r/o free air History: abdominal distention Diffuse gaseous distention of the stomach, small and large bowel, suggestive of ileus type pattern. No evidence of pneumoperitoneum.Please refer to same-day chest radiograph report for chest findings.

Output: 1. Diffuse gaseous distention of the stomach, small and large bowel, favoring ileus type pattern. Continued follow-up is recommended to exclude developing partial small bowel obstruction.2. No evidence of pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: osh picc assess location History: osh picc Right PICC, tip in SVC.No acute abnormality.

Output: Left PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with metastatic bladder cancer. Back pain. Skin nodules? 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: Multiple new ill-defined, hypodense lesions in the liver. An index lesion is near the dome of the liver measuring 18 x 18 mm on image number 78, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Specific, small hypodense lesions in both kidneys are unchanged.RETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node has increased in size and now measures 19 x 18 mm in image number 115, series number 3. Other lymph nodes are also slightly increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post bladder resection. Ill-defined enhancing mass adjacent to the right pelvic bowl measures 3.5 by 1.7-cm image number 182, series number 3. Previously it was measuring 2.3 x 1.6 cm image number 185, series number 4. Similar enhancing focus is also likely present on the left side.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thickening of the skin in the right lower quadrant with small subcentimeter soft tissue density foci, some of them are new from previous study. An index lesion measures 6 x 5 mm image number 151, series number 3.OTHER: Small amount of ascites.

Output: Interval progression of disease with interval development of new liver metastases, increase in the size of the retroperitoneal lymph nodes and pelvic mass.Subcentimeter skin nodules in the lower pelvis may also represent metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: SOB in patient with hx of asthma and smoking. History: SOB No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality. If there is concern for malignancy or more detailed assessment of the airways is necessary, CT is recommended, especially in a high risk patient/smoker.


Instruction: Generate impression based on medical findings.

Input: 28 years, Male. Reason: Crohn's eval for obstruction History: deceased passage flatus Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Scattered loops of gas distended small and large bowel. Stool is present within the sigmoid colon. No specific evidence for obstruction.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Upper lobe predominant fibrosis with bronchiectasis consistent with known sarcoidosis, similar to the recent CT but improvement in the right upper lobe since the 728/2016 chest radiograph.Heart size normal.No evidence of superimposed infection or edema.Unchanged mediastinal/hilar lymphadenopathy.

Output: Upper lobe fibrosis and bronchiectasis consistent with known sarcoidosis. No evidence of superimposed edema or pneumonia, and no significant pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: shortness of breath History: shortness of breath Right PICC terminates at the superior caval atrial junction. The right lung is hyperinflated with evidence of emphysema. Mid to lower zone subsegmental atelectasis and patchy regions of consolidation raising the question of infection. There is a small left pleural effusion, decreased from prior. There is a pulmonary nodule at the right posterior 8/9 rib interspace.

Output: Interval volume loss with small left pleural effusion and basilar opacities that may represent infection. Right pulmonary nodule has been better characterized on recent CT thorax.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female kidney donor. Evaluate for cardiopulmonary abnormalities. No focal airspace opacity, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with history of lymphoma CHEST:LUNGS AND PLEURA: Bilateral multiple nodules have decreased in size and number.MEDIASTINUM AND HILA: Mediastinal adenopathy has also decreased in size and number. Reference anterior mediastinal lymph node now measures 11 by 8mm image number 22, series number 3.CHEST WALL: Bilateral significantly enlarged axillary adenopathy. Left axillary reference node measures 20 x 18 mm. Significant increase in the size of the right axillary adenopathy. Reference right axillary adenopathy measures 2.5 x 3 cm. This adenopathy is new from previous study.ABDOMEN:LIVER, BILIARY TRACT: New ill-defined, hypodense lesion in the right lobe of the liver, measuring 2.1 x 1 .7 cm, image number 66, suspicious for metastatic disease. Other smaller subcentimeter hypodense lesions are also noted in both lobes.SPLEEN: Spleen is slightly heterogeneous and mildly enlarged, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule has increased in size, now measures 2.5 x 1.7 cm. Previously present measuring 1.7 x 1.2 cm. Right adrenal gland is unremarkable.KIDNEYS, URETERS: Mass at the lower pole of the left kidney measures 2.2 x 1 .9 cm, not significantly changed and is suspicious for renal cell carcinoma. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy is slightly increased in size. Reference aortocaval lymph node now measures 2.2 x 1 .7 cm, image number 101, series number 3.BOWEL, MESENTERY: Peripancreatic, periceliac nodes are unchanged. Reference lymph node measures 18 x 14 mm, on image number 89, series number 3. Multiple mesenteric lymph nodes are slightly smaller. Small amount of ascites is slightly increased in size.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: New bilateral inguinal and pelvic adenopathy. Reference right obturator lymph node measures 2.4 x 2 cm, image number 177, series number 3. Reference left inguinal adenopathy measures 2.9 x 1.9 cm on image number 197, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mixed interval changes. New pelvic, inguinal, right axillary adenopathy and hepatic metastases. Increase in size of the left adrenal mass.Mediastinal, mesenteric lymph nodes are decreased in size. Please see the above report for the other details


Instruction: Generate impression based on medical findings.

Input: 41 year old female undergoing treatment for right-sided endocarditis. Evaluate for evidence of septic emboli to lungs. CHEST:LUNGS AND PLEURA: Small right pneumothorax as seen on recent chest radiograph. Bibasilar scarring and atelectasis. Small pleural effusions bilaterally with trace fluid tracking along the minor fissure.Round 9-mm nodule in the right lung base (series 80332, coronal image 37); finding is nonspecific but differential consideration includes septic embolus. No areas of cavitation identified.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Patulous esophagus containing debris with air-fluid level. Please correlate for aspiration.CHEST WALL: Subcutaneous air tracking along the right lateral chest likely from previous chest tube placement. Probable bone island in left fifth rib laterally.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Nonspecific right lower lobe nodule. Differential consideration includes septic embolus.2. Small right pneumothorax with bibasilar scarring/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: question of perforated viscus History: sudden onset of left chest and abdominal pain Left basilar opacities, suggestive of subsegmental atelectasis.Right lung is clear.Unremarkable cardiomediastinal silhouette.Lucency beneath the diaphragm about the midline is suspicious for free intra-abdominal air, accounting for limitation in evaluation by patient positioning. Biliary stent and pneumobilia noted.

Output: Lucency beneath the diaphragm about the midline suspicious for free intra-abdominal air.Findings discussed via telephone with Alaine Kamm, APN, at 10:15 AM on 7/14/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: E/o volume overload, PNA History: Chest pain, SOB Low lung volumes with basilar atelectasis. Stable postoperative changes.No pleural effusion. No pneumothorax.

Output: Low lung volumes with basilar atelectasis but no evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: assess for infection History: neutropenic fever No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: ILD, pneumonia History: hypoxia Moderate cardiomegaly with a fibrotic native left lung.Mild basilar opacities suggestive of edema on the right are unchanged.Left jugular catheter, tip in left brachiocephalic vein near its junction with the SVC.A Dobbhoff tube extends below the lower margin of the image.Status post cholecystectomy.

Output: Mild basilar edema pattern in the transplanted lung, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: infiltrate History: hypoxia Right PICC is unchanged in position.Predominantly upper to mid zone opacities are stable. Multiple left-sided rib deformities compatible with chronic fractures. Likely trace pleural effusions. Heart size remains stable.

Output: Bilateral upper to mid zone opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: 83 yo F with new AMS, ?aspiration or pneumonia History: AMS Mild cardiomegaly.Left lower lobe scarring or subsegmental atelectasis, the lungs otherwise unremarkable.

Output: Mild cardiomegaly, otherwise unremarkable. No reliable evidence of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: iabp History: iabp No acute abnormality.IABP catheter proximal markers projected over the aortic arch.Left subclavian ICD, leads unchanged in position.Right PICC, tip in right innominate vein.

Output: IABP catheter marker projects over the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Fever. Low lung volumes. Motion artifact. Patchy atelectasis or scarring bilaterally. No visible airspace opacities or pneumothorax. No signs of pulmonary edema.

Output: Motion artifact degrades image quality. Areas of subsegmental atelectasis but no visible signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Pt with ARDS, eval for interval change in diffuse opacities History: ARDS Small lung volumes with diffuse airspace and interstitial opacity, not significantly changed from the previous day but new since 7/12/2016.Feeding tube tip in the stomach.

Output: Diffuse severe pulmonary opacity suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: 69 year-old female with thyroid cancer. Status post 8 cycles of therapy. CHEST:LUNGS AND PLEURA: Scan is impaired by respiratory motion.Multiple pulmonary nodules are present consistent with metastases. The reference nodule in the superior segment of the left lower lobe measures approximately 14 x 11 mm, not significantly changed from previous.A large confluent lesion or lesions in the right lower lobe measures 28 x 50 8 mm, not significantly changed from 25 x 58 mm previously. As previously noted there is evidence of invasion of the inferior pulmonary vein with extension of tumor into the left atrium.MEDIASTINUM AND HILA: No evidence of pericardial effusion or lymphadenopathy.Left atrial invasion the mass described above.CHEST WALL: Lytic lesion of the inferior portion of the sternum without significant change.ABDOMEN: Considerable motion artifact degrades diagnostic detail.LIVER, BILIARY TRACT: Subcentimeter hypodensities, most likely due to cysts but too small to characterize.SPLEEN: No significant abnormality notedADRENAL GLANDS: Left adrenal mass, 28 x 27 mm, unchangedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: The previously described punctate hypodensity in the tail of the pancreas is not visible on the current scan.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable disease.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Check ETT placement. Endotracheal tube tip 12 mm above the level of the carina. Small pleural effusions. Mild residual edema and atelectasis.

Output: Low endotracheal tube, suggest repositioning. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: IABP placement History: IABP Heart size near upper normal, the lungs are unremarkable.IABP catheter proximal marker projects over the aortic arch.Left subclavian ICD, leads unchanged in position.Prior left jugular Swan-Ganz catheter removed.Right jugular catheter, tip in SVC.

Output: IABP catheter marker projects over the aortic arch. Unremarkable appearing lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval for R sided PTX History: SOB s/p endoscopy Right chest wall port catheter tip near the confluence of the brachiocephalic veins.Right perihilar mass and left mid lung nodule are redemonstrated from recent CT.No new focal pulmonary opacity, pleural effusion, or pneumothorax.Stable cardiac mediastinal silhouette.Right axillary clips again noted.

Output: No pneumothorax. Right perihilar mass and left mid lung nodule are redemonstrated.


Instruction: Generate impression based on medical findings.

Input: 30 -year-old male with history of testicular carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No change in patient's known hypodense lesionsSPLEEN: 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: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right inguinal partially calcified adenopathy is unchanged measuring 14 x 12 mm image number 230, series number 3BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.ETT evaluation. Cardiac arrest. ETT tip approximately 6 cm above the level of the carina. Airspace opacity in the right lung, about the same, obscured by an overlying pad. Faint perihilar airspace opacity on the left. Normal heart size. NGT sidehole above the GE junction and may be advanced.

Output: ETT 6 cm above carina. NGT may be slightly advanced. Perihilar distribution airspace opacities most likely reflect acute pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with history of multiple lytic lesions found on CT of chest abdomen September 2011 This study is severely limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Bilateral large pleural effusions, increased in size compared to previous study.Bilateral patchy airspace opacities which may represent pneumonia. Bilateral lower lobe subsegmental atelectasis.MEDIASTINUM AND HILA: Calcified hilar and mediastinal granuloma. There is also noncalcified hyperdense adenopathy in the mediastinum. Index pretracheal lymph node measures 3 x 2.2 cm in image number 15, series number 3.CHEST WALL: Bilateral axillary adenopathy. Index left axillary lymph node measures 1.7-cm in image number 9, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Nodular contours of the liver, 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: Mixed lytic and sclerotic lesions involving the left iliac bone, stable.OTHER: Generalized anasarca.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: Please see discussion aboveOTHER: No significant abnormality noted.

Output: Generalized anasarca. Extremely limited study due to lack of IV contrast.Extensive mediastinal calcified and noncalcified adenopathy, etiology unknown.Interval increase in the size of the bilateral pleural effusions.Bilateral patchy airspace opacities, suspicious for pneumonia.No significant change in the mixed lytic and sclerotic lesions involving the left iliac wing.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female status post Whipple surgery for pancreatic ductal adenocarcinoma CHEST:LUNGS AND PLEURA: 6-mm nodule in the apical segment of the left lower lobe adjacent to the aortic arch. No other nodules in the lungs. No pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Previously described lesion in segment 4 has now increased in size and now measures 19 x 16 mm image number 101, series number 61. Second index lesion in the right lobe has also increased in size and now measures 15 x 14 mm on image number 113, series number 61. New metastatic lesions are also seen in the liver.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple surgery. Residual pancreas is unremarkable.ADRENAL GLANDS: Stable left adrenal nodule measuring 14 x 9 mm image number 87, series number 61.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small nodes in the mesentery, unchanged.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: Interval increase in the size and number of hepatic metastatic lesions. Solitary nodule in the left lung.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: S/p thoracocentesis, R/o pneumothorax History: shortness of breath No pneumothorax following right thoracentesis.Minimal residual right pleural effusion.Chronic left hemithorax volume loss.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: SOB, known metastatic melanoma, question etiology for SOB. Interval development of a large left pleural fluid collection occupying greater than one half of the left hemithorax. The left hemidiaphragm may be elevated and the left lower lobe and lingula are collapsed/consolidated. Diffuse pulmonary nodules compatible with metastases increased in size and number, not visible previously by plain film.Destructive skeletal metastasis at the tip of the right scapula with pathologic fracture.

Output: Large left pleural fluid collection, diffuse pulmonary metastases and a right scapular metastasis.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Hepatic hydrothorax, increased oxygen requirements. Large pleural effusions, right greater than left. Extensive airspace opacities bilaterally without significant change.

Output: No significant change in pleural fluid or pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: 26 y/o F with PTCL s/p haplocord HSCT, Day +275. H/o bronchopneumonia seen on CT. Occasional chills with new cough. Eval for pneumonia. History: Chills, cough Right Port-A-Cath with its tip in the SVC.Cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: s/p esophagectomy History: s/p esophagectomy Small persistent right apical pneumothorax despite a right chest tube.Left lower lobe consolidation and left pleural effusion unchanged.An NG tube in place tip above the hemidiaphragm level.Right jugular catheter tip in SVC.

Output: Small right apical pneumothorax unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: 63 F s/p ex lap now w SOB, nausea r/o aspiration, PNA, obstruction History: SOB Mild streaky basilar opacities compatible with subsegmental atelectasis, unchanged or slightly improved.Catheter tip in the SVC.No specific evidence of aspiration or infection.

Output: Mild basilar atelectasis with no sign of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: intubated, interval exam History: intubated, interval exam Tracheostomy, bilateral central lines and partially visualized enteric tube remain unchanged.Stable cardiomediastinal silhouette.Low lung volumes. Increased scattered hazy airspace opacities with new consolidations/atelectasis within the right upper lobe. Small left pleural effusion, unchanged.

Output: Scattered airspace and interstitial opacities, increased within the right upper lobe, likely pneumonia in background of pulmonary edema. Stable small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: history of treated testicular cancer (NED) needs annual cxr to evaluate for adenopathy - imaging reports in care everywhere History: history of testicular cancer Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of lymphadenopathy.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Interval central line placement now with respiratory distress. Interval placement of right IJ central venous catheter with tip in SVC. No pneumothorax.Stable cardiomediastinal silhouette including mild cardiomegaly.Right basilar opacity comprised of atelectasis/consolidation and small effusion, unchanged. Slightly increased nonspecific opacity in the right upper lobe.

Output: Central venous catheter placement without pneumothorax. Slightly increased opacity in the right upper lobe which could be related to aspiration and/or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: tubed History: tubed Marked increase in size of left-sided pneumothorax. This is subsequently decreased in size on follow-up radiograph. Iatrogenic devices, unchanged. Diffuse pulmonary opacities, unchanged. Unchanged heart size.

Output: Marked increase in size of left-sided pneumothorax which subsequently has decreased in size on follow-up radiograph.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: fever History: fever Persistent elevation of the right hemidiaphragm with basilar atelectasis. No visualized pulmonary nodules.No specific evidence of infection or edema.

Output: Stable persistent elevation of the right hemidiaphragm with basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: chest pain 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: Age: 57 yearsGender: MaleReason for Study: Reason: 57yo M h/o cirrhosis c/b hepatic encephalopathy. Eval for pneumonia History: encephalopathy Decreased lung volumes with marked elevation of the right hemidiaphragm and evidence of interposed bowel between the liver and diaphragm.Cardiac size is is normal with marked tortuosity of the aorta.Mild basilar atelectasis.No pleural effusions.

Output: Marked elevation of the right hemidiaphragm with interposed bowel. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old Cough and shortness of breath. Rule out pneumonia. Per EMR: History of COPD on chronic steroids. Hyperinflated lungs, consistent with COPD.Bronchial thickening, consistent with bronchitis.Prominent nipple shadows projecting over bilateral lower lungs.

Output: COPD with no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: s/p MAZE History: s/p MAZE Improving inflation with decreased subsegmental atelectasis.Mild to moderate cardiomegaly unchanged.

Output: Improving atelectasis with no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Status post CABG Interval placement of Swan-Ganz catheter with the tip projecting at the level of the main pulmonary artery. Mediastinal drain in place. Bilateral pleural drains, 2 left and one right in place.Median sternotomy.. IABP marker terminates approximately 8 cm below the level of the aortic arch. ET tube tip terminates in the right mainstem bronchus.Bilateral pleural effusions, left greater than right, with underlying atelectasis/consolidation. Persistent retrocardiac consolidation.

Output: Postsurgical changes with bilateral pleural effusions and retrocardiac consolidation. ET tube tip terminates in the right mainstem bronchus. Subsequent imaging demonstrates appropriate repositioning.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: 49-year-old male with history of CHF and IABP. IABP marker unchanged. Right PICC with tip projecting over the axilla. Left-sided AICD unchanged.Moderate cardiomegaly with no specific evidence of edema or infection.

Output: Stable IABP position.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: interval change History: interval change Right chest tubes with no pneumothorax.Stable edema like opacities with a left pleural effusion and left lower lobe consolidation.An NG tube traverses a gastric pull-up. Right jugular catheter, tip in SVC.

Output: No change in pulmonary opacities and left pleural effusion. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: r/o acute process History: ams The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified. 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: eval for PTX History: PTX, CT in place Unchanged right-sided chest tube. No significant pneumothorax. Scar like opacities again noted in the mid aspect the lungs. No new focal pleural parenchymal opacity. Right-sided subcutaneous emphysema again noted. Unchanged cardiomegaly. No pleural effusions.

Output: Unchanged right-sided chest tube. No significant pneumothorax. Scar like opacities again noted in the mid aspect the lungs.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval lung fields History: ECMO Support devices unchanged including ECMO catheters.Stable marked cardiac enlargement.No new pulmonary opacities identified.No large pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: FemaleReason for Study: Reason: Intubated , Resp Failure History: Intubated , Resp Failure Right IJ venous catheter, ET tube, and aortic stent unchanged.Stable cardiomediastinal silhouette.Bilateral pleural effusions and perihilar opacities similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, pleural effusions, and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.With a history of dyspnea, please rule out pleural effusion. Interval placement of endotracheal tube with tip is about 3 to 4 cm above the carina. Redemonstration of bilateral pleural effusions and right greater than left diffuse opacity. No pneumothorax is visualized. Dobhoff tube terminates in the gastric cardia. Right Port-A-Cath terminates in the SVC.

Output: Interval placement of endotracheal tube with tip 3 to 4 cm above the carina. Dobhoff tube terminates in the gastric cardia. Otherwise, no substantial change.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: Intubated History: as above Endotracheal tube tip 2 cm from the carina. Looping of Dobbhoff tube no longer evident, terminating beyond the field-of-view. Other support devices unchanged.Basilar edema, effusions, atelectasis unchanged.Moderate cardiomegaly.

Output: Line position stable. No change in cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Reason: swan position History: poor waveform Swan-Ganz catheter tip in the right main pulmonary artery.Severe cardiomegaly with bilateral pulmonary opacity compatible with edema and pleural effusions. ICD lead unchanged.No new findings.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of mesothelioma. Acute DVT. Rule out PE. CHEST:PULMONARY ARTERIES: Technically adequate study with multiple left subsegmental small pulmonary emboli.LUNGS AND PLEURA: Diffuse nodular pleural thickening of right sided pleura consistent with the given history. Reference measurements are as follows:At the level of the AP window (image 99/308): 18 mm at 6 o'clock, previously 19. 12mm at 9 o'clock, previously 10 mm.At the level of the azygos/hemiazygos confluence (image 171/308): 10 mm at 3 o'clock, unchanged. 17 mm at 6 o'clock, unchanged.At the level of the inferior pulmonary veins (image 60/164): 14 mm at 7 o'clock, unchanged. 5 mm at 9 o'clock, unchanged.Multiple scattered pulmonary micronodules, the largest approximately 5 mm (image 82/154). Some of these nodules are calcified and likely related to previous granulomatous disease. Nodular visceral pleural involvement on the right. No contralateral disease.MEDIASTINUM AND HILA: Multiple small mediastinal lymph nodes are present. Mediastinal and pericardial invasion on the right, minimal. Pleural deposit compresses the SVC slightly, though it remains grossly patent.CHEST WALL: No significant abnormality.ABDOMEN:Right upper pole renal cyst.Aortic atherosclerotic calcifications noted.

Output: 1. Technically adequate study with multiple subsegmental small pulmonary emboli.2. Right pleural mesothelioma with reference measurements as above. No evidence of chest wall, contralateral pleural or subdiaphragmatic disease, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Shortness of breath rule out pulmonary edema. Unchanged cardiomegaly. Vascular redistribution and unsharpness suggestive of hypervolemia and mild edema. Right basal atelectasis abutting the diaphragm unchanged. Trace pleural fluid.

Output: Mild hypervolemia/edema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: substernal CP History: CP Left upper lobe mass also seen on prior CT consistent with a superior sulcus lung cancer. Underlying bones appear intact.Elsewhere, the lungs are unremarkable by conventional radiography.Unremarkable mediastinal contours and cardiac silhouette.

Output: Large left upper lobe lung cancer.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: fever of unknown origin, patient vomiting, concern for aspiration / pneumonia History: fever The cardiomediastinal silhouette appears enlarged, which may be slightly exaggerated given the low lung volumes and portable technique.Low lung volumes. No dense consolidation or large pleural effusion.

Output: Mild to moderate cardiomegaly. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: Assess Lung fields History: Lung tx patient with increased sputum The cardiac mediastinal silhouette is unremarkable.The lungs are clear.Mild bronchial wall thickening in the right lower lobe.No new pulmonary opacities identified.No pleural effusions.Postsurgical changes related to prior bilateral lung transplant.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab ICD device with a new right ventricular lead, the tip projected superior to the apex of the right ventricle. The pre-existing right ventricular lead is still in place.A chest wall lead is also projected over the left lower hemithorax.Moderate cardiomegaly with no evidence of CHF or other significant cardiopulmonary findings.

Output: New ICD device with no visible complications.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male status post CABG, AVR, MVR Interval removal of endotracheal tube.IABP marker projects over the left mainstem bronchus.Remaining support devices are unchanged.Cardiomediastinal silhouette is unchanged.Perihilar subsegmental atelectasis/edema and retrocardiac consolidation is unchanged.

Output: Interval extubation. Persistent perihilar atelectasis/edema and left retrocardiac consolidation/ atelectasis.


Instruction: Generate impression based on medical findings.

Input: ETT check Repositioning of the right chest tube demonstrates 4 to 5 cm retraction with tip now projected into the apex with less redundancy. Underlying cardiopulmonary appearance otherwise similar. Specifically the ETT projects 5 cm above the carina

Output: Right chest tube repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval PNA History: fever No significant cardiopulmonary abnormality.No specific evidence of infection.Stable mediastinal widening likely due to mediastinal fat deposition.Scoliosis and spinal stabilization hardware noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: eval lung fields History: s/p MVR Right chest tube removed with no significant pneumothorax.Increased right chest wall soft tissue emphysema.Increased right-sided opacity likely edema with unchanged basilar subsegmental atelectasis.

Output: No pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Labored breathing history of RVR Severe emphysematous changes with associated small to moderate pleural effusions and extensive scarring is again observed. Mild cardiomegaly with no definite new superimposed focal air space abnormalities. Possible right basilar focal nodularity with questionable spiculation again may warrant CT evaluation.Mild cardiomegaly. ICD unchanged

Output: Stable appearing chest radiograph with severe emphysematous changes and scarring with possible spiculated nodule in the right lung base. Again CT evaluation may be indicated for further characterization.Pager 3050 contacted.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: pneumothorax History: s/p right lung biopsy Right port is accessed. Trace right apical pneumothorax following biopsy. Right paramediastinal opacity corresponding to known pulmonary mass again noted. Heart size remains normal. Left lung is fully inflated and clear.

Output: Trace right pneumothorax following biopsy.


Instruction: Generate impression based on medical findings.

Input: Female 11 months old. Follow-up pleural effusions, right IJ position.VIEW: Chest AP (one view) 4/15/2016, 14:26 Right IJ venous catheter tip is in the left innominate vein. Right chest tube and mediastinal clips are unchanged. The right atrial line and epicardial pacer leads have been removed.Cardiothymic silhouette size is normal. Left lower lobe opacity and small to moderate left pleural effusion are unchanged. Persistent small right pleural effusion. No new pulmonary opacities.

Output: Persistent left greater than right pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: post lung biopsy ? ptx History: post lung biopsy Stable cardiomediastinal silhouette.Left basilar opacity, compatible with atelectasis and mass like consolidation as seen on recent CT imaging.No pneumothorax.

Output: Stable cardiopulmonary appearance. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Suspicious and questionable partially calcific 1 cm nodular density in the mid left lung. Although possibly related to granulomatous disease exposure and correlating with calcified lymph nodes and left hilar region, follow-up imaging and/or comparison with prior images if available would be helpful to confirm. No definite spiculation, however again appearances limited. The remaining lungs are otherwise clear. No effusions.The cardiac and mediastinal contours are within limits

Output: Suspicious and questionably partially calcified solitary nodule in the superior segment of the left lower lobe. Serial imaging and/or comparison with prior images is needed to confirm stability and suspected old granulomatous disease exposure


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: 73M s/p urethroplasty now with shortness of breath/cough History: shortness of breath/cough Basilar opacities suggestive of atelectasis, with moderate to severe emphysema.

Output: Emphysema, with basilar atelectasis possibly the result of aspirated secretion or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: MaleReason for Study: Reason: history of thyroid cancer, cough, eval for infection History: cough, hypotension, tachycardia Right Port-A-Cath with its tip in the SVC.Marked elevation of the right hemidiaphragm and right pleural effusion similar in appearance to prior exam.Mediastinal mass and right paramediastinal fibrotic changes with atelectasis redemonstrated.The left lung is clear.Stable cardiac enlargement.

Output: No significant interval change compared to the prior exam with elevation of the right hemidiaphragm, right pleural effusion, and prominent mediastinal mass and right paramediastinal fibrosis/atelectasis.


Instruction: Generate impression based on medical findings.

Input: 93-year-old female with dizziness and lightheadedness. Evaluate for mediastinal mass. Normal heart size with tortuous and heavily calcified aorta. A prominent aortic root is noted.No pleural effusion. Bronchial wall thickening and atelectasis posterior to the left atrium, nonspecific.

Output: 1. Dilated aortic root, ectasia versus aneurysm. CTA of the chest may be of use for further characterization if clinically warranted. Elizabeth Lafontant 5717 notified via text page 1/16/15 10:34am.2. No evidence for mediastinal mass3. Bronchial wall thickening and atelectasis posterior to the left atrium, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.DOE and wheeze. Lung transplant status. Severe hyperinflation of the native left lung consistent with emphysema. No acute pulmonary opacities on the left.Transplanted right lung without focal opacity. Blunting of the costophrenic angles is chronic and unchanged. Postsurgical rib deformities and hardware.

Output: No acute pulmonary abnormality. Severe emphysema and the native left lung.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: rule out chest metastasis History: hx of renal cell carcinoma, sp partial nephrectomy Chronic appearing elevation left hemidiaphragm with overlying subsegmental atelectasis or scarring.No specific evidence of infection or edema.No sign of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: tachypnea History: see above Catheter tip in the SVC.No significant cardiopulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p OLT History: s/p OLT Interval extubation and removal of NG tube.Left jugular catheter and Swan-Ganz catheter are unchanged.Small lung volumes with basilar opacities compatible with atelectasis and small effusions.

Output: Interval extubation and removal of NG tube, and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for infiltrate History: chest pain The cardiomediastinal silhouette is normal in size.No focal pulmonary airspace opacity, pleural effusion or pneumothorax.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with lung cancer CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule measures 4.8 x 3 cm in the axial plane (series 5, image 30), previously measuring 3.4 x 2.9 cm. However, this difference in measurement may be due to the orientation of the lesion in the axial plane; in the coronal plane, it measures 4.2 x 2 cm (series 80268, image 40), previously measuring approximately 4.4 x 2.3 cm.Additional nodular opacities in the right lung (series 5, images 15, 24, and 32) appear similar to prior study.Stable emphysema. Surgical clips in the left hilum.MEDIASTINUM AND HILA: A small right hilar lymph node is stable. Heart size normal without pericardial effusion. Atherosclerotic calcification of the aorta and its branches. Coronary artery calcification.CHEST WALL: Degenerative changes of the spine. Postsurgical left rib deformity laterally.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: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable disease accounting for differences in technique with reference lesion as above; correlate with recent PET/CT performed on the same date.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for appropriate Swann-Ganz catheter placement History: S/p OHT, concern for rejection Swan-Ganz catheter tip in the main pulmonary artery.Aortic balloon catheter unchanged.Cardiomegaly with basilar opacity compatible with edema, slightly improved, and pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Cough, chest pain, sickle cell Mild chronic interstitial opacities likely postinflammatory in etiology without superimposed focal opacity. No pneumothorax or pleural effusion.Cardiac silhouette is normal.Sclerotic H-shaped vertebral bodies consistent with history of sickle cell disease.

Output: Chronic sequela of sickle cell disease without evidence of acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with shortness of breath. Mild cardiomegaly. Bibasilar interstitial pulmonary opacities. Possible small left pleural effusion. No pneumothorax.Degenerative changes affect the shoulders and spine.

Output: Bibasilar interstitial pulmonary opacities with possible small left pleural effusion, compatible with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: 36 year old receiving treatment for aplastic anemia, recently fluid overloaded. Eval for effusion. History: DOE Right upper extremity PICC tip in the superior atriocaval junction.The heart size is normal. Unremarkable cardiomediastinal silhouette. No focal pulmonary opacities, pleural effusion, or pneumothorax.Mild gaseous distention of the stomach.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Assess for etiology of dyspnea - volume vs infection History: DOE Cardiomediastinal silhouette is unchanged. No focal airspace opacity. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary.


Instruction: Generate impression based on medical findings.

Input: New hypoxia, evaluate for infiltrates. Low lung volumes with unchanged elevation of the left hemidiaphragm. Worsening atelectasis at the right base. Small volume of pleural fluid on the left. No convincing evidence of pulmonary edema.Degenerative changes of the spine.Gaseous distention of the stomach has resolved in the interim.Cardiomediastinal silhouette appears similar to prior along for patient rotation.Widened left acromioclavicular space consistent with joint dislocation, new from 2009 but of unknown chronicity.

Output: No specific signs of pneumonia. Worsening basal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Cough and SOB rule out pneumonia. Hazy opacities at the right base. There is some new peribronchial opacity in the medial right lung base. No pleural fluid or pneumothorax. Normal heart size. Mild degenerative changes of the spine.New mass effect upon the carina from known mid esophageal mass new from the prior study.

Output: Interval development of mass effect upon the carina from known mid esophageal mass. This was discussed with Dr. Chaney of the Emergency Room at 9:06 AM on 8/17/2016. Hazy basilar opacity most likely mild aspiration bronchiolitis and pneumonitis.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: 63 F w/ PA catheter - worried that its wedged too far History: see above Cardiomegaly with left lower lung zone predominant airspace opacities suggestive of edema although infection is possible.Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery, unlikely wedged, however.Tracheostomy tube tip approximately 6 above the carina.Unchanged LVAD and ICD.

Output: Swan-Ganz catheter discussed above. Unchanged pulmonary opacities including left mid and lower lung zone airspace disease possibly infection rather than simple edema.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for causes of hypoxemia in this AML patient now on leukaphoresis History: hypoxemic respiratory failure ET tube and venous catheters unchanged.Mild left basilar opacity compatible with nonspecific consolidation and atelectasis likely secondary to aspirated secretions.

Output: Focal left lower lobe consolidation and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female, ET tube placement. Endotracheal tube tip 2.5 cm above the carina. Right IJ venous catheter tip SVC. Left IJ venous catheter tip in SVC.Enteric tube sidehole in the stomach.No significant interval change in bilateral pleural effusions and perihilar interstitial/airspace opacities. No pneumothorax. Moderate cardiomegaly.

Output: Endotracheal tube tip 2.5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval swan History: see above Severe cardiomegaly with unchanged left lower lobe consolidation, and bilateral pleural effusions left larger than right.Right PICC, tip in the SVC.Left subclavian ICD, leads unchanged in position.IVC Swan-Ganz catheter tip in main pulmonary artery.

Output: Unchanged support devices. Stable pleural effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Heart failure Left chest tube again projects towards the inferior costophrenic angle with unchanged right chest tube and mediastinal chest tubes. LVAD, ICD and Swan-Ganz are also unchangedMarked cardiomegaly with underlying mild edema and likely compression atelectasis of the left lower lobe

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: f/u pleural effusion History: f/u pleural effusion Large right pleural effusion with underlying atelectasis and focal subsegmental atelectasis in the left perihilar region, unchanged.No significant change allowing for slightly improved inflation on the current radiograph.

Output: Large right pleural effusion and bilateral atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: SOB History: As above Support devices unchanged.Stable cardiac enlargement.Interstitial opacities and small right pleural effusion not significantly changed.No new pulmonary opacities.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, pulmonary edema, right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Respiratory arrest. Position of the ETT after pulled out by 2-cm. Endotracheal tube tip one cm above the carina. Extensive diffuse subcutaneous emphysema. Pneumomediastinum. No pneumothorax.Dependent and basal atelectasis, mild. Possible nondisplaced left lateral rib fracture versus overlying subcutaneous emphysema. Given the extent of subcutaneous emphysema, presents or absence of pneumoperitoneum cannot be assessed in this patient position. Vascular calcifications of thoracic aorta.

Output: Pneumomediastinum. Endotracheal tube remains low, 1 cm above carina.


Instruction: Generate impression based on medical findings.

Input: 73-year-old man with history of prostate cancer post chemotherapy follow-up CHEST:LUNGS AND PLEURA: No change in extensive interstitial thickening and nodular opacities in both lungs. Carcinomatosis cannot be excluded.MEDIASTINUM AND HILA: Left paramediastinal right paratracheal and subcarinal nodes redemonstrated on images 30, and 39. The subcarinal index nodes remeasured on image 39 is 2.4 x 1.5 cm. No new nodes.CHEST WALL: Sclerotic osseous lesions redemonstrated left clavicular head and thoracic vertebral bodies 4, 11 and 12. No new sites of disease.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given that limitation the following observations are made.LIVER, BILIARY TRACT: Extensive metastatic disease throughout the liver reidentified with multifocal areas of increased density consistent with calcification a benign tumor. The index lesion in segment 8 is measured on image 82/208 is 2.4 x 1.7 cm. Recognize limitation of comparing contrast-enhanced scan two and noncontrast enhanced scan.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right-sided hydronephrosis, hydroureter with severe parenchymal atrophy unchanged. Small soft tissue nodules described along the course of the right ureter on the previous exam. It is unchanged and is seen in the upper pelvic inlet most likely representing a small node on image 162/208 measuring 1.1 x 0.7 cm.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes redemonstrated, unchanged. No new nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Brachytherapy seeds redemonstrated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis. No evidence of ascites or carcinomatosis. Small right inguinal hernia with omentum unchanged.BONES, SOFT TISSUES: Sclerotic bony metastases left hemipelvis and L5, unchanged. Some in the right issue pubic ramus. Few scattered sclerotic foci elsewhere.OTHER: No significant abnormality noted

Output: No significant interval change. Details as above. Limited comparison due to lack of IV contrast.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male with odynophagia status post esophageal dilation 3 weeks ago. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Limited volume barium test swallow demonstrated frank aspiration, with contrast outlining the trachea and entering terminal bronchioles in the left lower lobe. Positive cough reflex was demonstrated by the patient and cleared some of the aspirated contrast material. Subsequently, limited water-soluble contrast evaluation of the esophagus and gastric cardia/fundus revealed a small hiatal hernia. No mucosal abnormalities were identified.Frank aspiration with positive cough reflex were then confirmed in the hypopharynx following administration of half teaspoon thin barium (movie loop, series 23).TOTAL FLUOROSCOPY TIME: 5:43 mm:ssAIR KERMA: 118.7 mGy

Output: 1.Frank tracheal aspiration with positive cough reflex on barium test swallow, confirmed in the hypopharynx at the conclusion of the exam. These findings were discussed with the referring physician, Dr. Blair, via telephone immediately following the study. 2.Small hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: cough Unremarkable cardiac and mediastinal silhouette.Small lung volumes likely secondary to body habitus. TheNo significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Swan placement. Cardiomyopathy. Right jugular Swan-Ganz catheter has been retracted with tip now the level of the right interlobar pulmonary artery.Right PICC tip at the SVC. Left subclavian ICD unchanged.Large large loculated appearing pleural fluid collections with subpleural areas of consolidation suspicious for rounded atelectasis, though nonspecific by plain film. Questionable mild basal edema. No pneumothorax.

Output: Interval retraction of Swan-Ganz catheter which now terminates at the level of the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with acral melanoma, unexplained anemia, history of breast cancer status post mastectomy-oophorectomy. Melanoma deeper than 4 mm. CHEST:LUNGS AND PLEURA: Calcified nodule in the lingula compatible with a granuloma. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Scattered prominent mediastinal lymph nodes are noted. For example, a node in the prevascular space measures 1.4 x 1 centimeters (series 3, image 23). Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 13-mm right upper pole renal cyst cannot be definitively characterized as a simple cyst. Continued surveillance is recommended.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left-sided colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically removed.BLADDER: No significant abnormality noted.LYMPH NODES: Several prominent pelvic lymph nodes identified; for example, along the internal iliac chains (series 3, images 141-142). For reference, a right internal obturator lymph node (series 3, image 151) measures 2.5 x 1 cm.Prominent left inguinal node (series 3, image 176) measures 1.1 x 0.9 cm.BOWEL, MESENTERY: Left-sided colonic diverticulosis.BONES, SOFT TISSUES: Subcentimeter sclerotic focus in the left pubic ramus (series 80280, coronal image 49) and left ischium (series 3, axial image 173) likely represent benign bone islands.

Output: 1. Multifocal borderline enlarged lymph nodes involving the mediastinum, pelvis, and left inguinal region as detailed above with the largest, pathologically-enlarged node seen in the right internal obturator chain.2. 13-mm right upper pole renal cyst that cannot be definitively characterized a simple cyst. Continued surveillance is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: pneumonia or TB History: fever, SOB Severe upper lobe fibrosis consistent with healed granulomatous disease or sarcoidosis.Mild apical cavity formation unchanged.No evidence of superimposed edema or pneumonia.No active TB.

Output: Healed granulomatous disease or sarcoidosis, unchanged, without evidence of superimposed acute infection.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old. Right jugular catheter tip in the area of the SVC. Aortic balloon catheter and ICD leads unchanged. Cardiomegaly with no sign of edema or infection.

Output: Right jugular catheter tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infection History: mild fever, post op Mild focal new opacity in the right midlung, compatible with infection or mild aspiration.No other significant change.

Output: New focal right lung opacity compatible with pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: s/p bilateral lung transplant History: annual tests Stable cardiomediastinal silhouette.Postsurgical changes related to prior bilateral lung transplants.Minimal scarring/discoid atelectasis at the left lung base.No new pulmonary opacities identified.No pleural effusions.Left apical pleural thickening unchanged.Cervical fusion hardware and median sternotomy redemonstrated.

Output: No acute cardiopulmonary abnormalities identified without interval change.