Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.New right IJ CVC, ETT, tachycardia. Endotracheal tube tip 5-cm above the level of the carina.Right jugular catheter tip at the SVC.Nasogastric tube in the neoesophagus. Right chest tube unchanged in position. Diffuse interstitial and air space opacities about the same. Subcutaneous emphysema.

Output: ETT 5-cm above carina. Right jugular catheter tip in SVC, no significant sized pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: improvement of known right pneumothorax? History: chest pain and SOB Minimal residual right apical pneumothorax with a margin of the lung a few millimeters from the chest wall, decreased from previous.Airspace opacity in both lower lobes, greater on the left with small pleural effusions, recently characterized by CT scan.

Output: Decreased right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 9 days old. Status post CDH repairVIEW: Chest and abdomen AP (two views) 10/29/2015, 2253 hrs. ET tube tip below the thoracic inlet and above the carina. Enteric tube tip in the stomach. Left chest tube tip near the left apex. UAC tip at the level of T8. UVC tip at the level of the left portal vein. Lower extremity central line tip in the retrohepatic IVC. Urinary bladder catheter in place.Cardiac silhouette size is normal.Continued interval expansion of the lungs, with decreased diffuse hazy opacities. No significant pleural effusions or pneumothorax.Disorganized nonspecific bowel gas pattern.No pneumatosis, portal venous gas, or significant free air.Soft tissue edema.

Output: Continued lung re-expansion status post repair of diaphragmatic hernia.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Worsening left pneumothorax? Retrocardiac opacity likely atelectasis and effusion is stable. Previously seen left upper pneumothorax has resolved. Lungs are otherwise clear. NG tube below the diaphragm.

Output: Pneumothorax has resolved. Retrocardiac opacity is stable.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt with asthma and cough x 3-4 days--assess for PNA History: cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with metastatic colon cancer status post resection x 2, status post chemotherapy CHEST:LUNGS AND PLEURA: Right middle lobe scarlike opacityMEDIASTINUM AND HILA: The tip of the right, port catheter is in the right atrium.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severe left hydronephrosis and hydroureter has progressed despite the double-J stent. Left renal pelvis, now measures 10-cm in diameter.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal adenopathy is slightly increased in size. A reference, aortocaval lymph nodes on image number 143, series number 4, now measures 12 by 8mm. Previously, it was, measuring 6 x 5 mm on image number 141, series number 3.BOWEL, MESENTERY: Previously referenced left lower pelvic mass encasing the left ureter and causing left hydronephrosis measures 3 x 2.1 cm on image number 158, series number 4, slightly smaller compared to previous study. However, there is progression in the significant wall thickening involving the sigmoid colon suspicious for recurrent disease. This mass also invades and displaces the uterus.Right lower quadrant ostomy, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Previous described tubular, cystic structure in the left adnexa has resolved. Uterus cannot be differentiated from the soft tissue mass arising from the residual sigmoid colon.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 progression of left hydronephrosis. Although measurements of the index lesion is slightly smaller, infiltrative Pelvic mass arising from sigmoid colon has increased in size.Retroperitoneal adenopathy has slightly increased in size.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with history of follicular non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Emphysematous changes with pleural plaques in both lungs likely secondary to asbestos exposure is unchanged. Bibasilar scarring. Right lower lobe nodule measures 8mm image number 62, series number 3, not significantly changed. Bilateral minimal pleural effusions, unchanged.MEDIASTINUM AND HILA: Reference prevascular node is smaller measuring 15 x 9 mm image number 32, series number 3. Large precarinal lymph node is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Gallbladder has nodular and significant the thick walls. Gallbladder carcinoma cannot be excluded. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive mesenteric and retroperitoneal adenopathy is significantly smaller. At the level of the left renal vein conglomerate adenopathy enhances less and measures 4.8 x 2.7 cm image number 109, series number 3. Mesenteric adenopathy is also significantly smaller.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate ascites is unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Pelvic lymph nodes are significantly smaller. Reference right hypogastric lymph node now measures 13 x 11 mm on image number 171, series number 3..BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER:

Output: Interval decrease in the size of the retroperitoneal, mediastinal mesenteric and pelvic adenopathy.Right lung nodule, pleural plaques and emphysematous changes are unchanged.Ascites unchanged. There wall thickening of the gallbladder. Gallbladder carcinoma or involvement of the gallbladder with lymphoma cannot be excluded. This is not significantly changed compared to previous study. Further evaluation of the gallbladder with ultrasound is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: ETT tip location, s/p cardiac arrest and intubation History: as above Interval placement of endotracheal tube with tip approximately 6 cm above the carina. Interval placement of enteric tube which extends beyond the inferior margin of the image.Stable cardiac and mediastinal silhouettes allowing for differences in technique.Chronic elevation of the right hemidiaphragm. Low lung volumes. Increasing left perihilar and retrocardiac opacity likely representing atelectasis.

Output: Increasing left perihilar and retrocardiac opacity likely representing atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: transcript. History: asymptomatic Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with refractory follicular non-Hodgkin's lymphoma status post 3 cycles of chemotherapy. Restaging exam. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: A right paratracheal lymph node measures 1.7 x 1.1 cm on axial image 33/224. Cardiac size is normal. No pericardial fluid. Coronary artery calcifications are evident.CHEST WALL: Skin defect and subcutaneous infiltration within the right chest wall on axial image 78/224 is evident. Correlate with history of biopsy.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are evident.BOWEL, MESENTERY: Misty infiltration of the mesentery is compatible with lymphoma.BONES, SOFT TISSUES: Multiple subcutaneous nodules and masses are evident within the right abdominal wall. The largest of these masses measures 6.4 x 2.5 cm on axial image 144/224. As these abnormalities correspond with hypermetabolic activity on the accompanying PET study, they most likely represent tumor.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted

Output: 1.Subcutaneous nodules and masses within the lower right abdominal wall compatible with tumor.2.Suspicious paratracheal lymph node as described above.3.4.


Instruction: Generate impression based on medical findings.

Input: Age: 37 yearsGender: MaleReason for Study: Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Decreased lung volumes with stable cardiac mediastinal silhouette.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: post op History: post op Chest tubes on the right with no significant pneumothorax.Gastric interposition extending to the right of the mediastinum with an NG tube in place.Basilar atelectasis and nonspecific consolidation, without significant change.

Output: Atelectasis and consolidation with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: eval tube placement History: previous dobhoff tube placed at OSH, tube broken, unknown location Heart size is normal. Tortuous aorta. Atherosclerotic calcifications are noted at the aortic arch.Chronic-appearing interstitial disease. The left heart border is poorly visualized. No pneumothorax or large pleural effusion.Dobbhoff is not visualized. Left-sided port with tip at the SVC. Left neck surgical clips, sternotomy wires and mediastinal clips are unchanged.Scoliosis.

Output: Dobbhoff is not visualized. Poor visualization of the left heart border. If there is clinical concern for infection, serial imaging may be obtained.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: infection History: AMS Small pleural effusions and basilar subsegmental atelectasis.No specific evidence of infection.Left axillary to subclavian vascular stent.

Output: Small pleural effusions. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pulm, edema History: chest pain Marked cardiomegaly with a tortuous aorta. Moderately large right pleural effusion with underlying atelectasis that may be organized or loculated.No reliable evidence of pulmonary edema. Vascular stent and sternotomy closure devices, unchanged.

Output: Cardiomegaly and right pleural effusion with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Chest pain and SOB evaluate for cardiomegaly. Normal heart size and mediastinal width. Opacity cranial to the aortic arch level may reflect summation artifact with the manubrium and vascular structures and is not visualized on the lateral radiograph. No focal airspace opacities, pleural fluid or pneumothorax.

Output: Normal heart size. No acute pulmonary abnormality. Opacity projecting over the superior mediastinum is most likely summation artifact. If the patient's pain correlates to this region, follow-up PA and lateral chest radiographs may be obtained for confirmation.


Instruction: Generate impression based on medical findings.

Input: Reason: bladder cancer f/u History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: metastatic head and neck cancer, pre treatment scan History: as above Port catheter terminates near the cavoatrial junction. Poorly defined mass again noted within the right lower lobe. No large pleural effusion or pneumothorax. Normal heart size. Moderate severe wedging of a lower thoracic vertebral body again noted.

Output: Poorly defined mass again noted within the right lower lobe.Moderate severe wedging of a lower thoracic vertebral body again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old. Reason: s/p surgery Left central venous catheter terminates in the suprahepatic IVC, unchanged. The remaining support devices are unchanged.Cardiomediastinal silhouette is unchanged.Unchanged bilateral pulmonary opacities compatible with atelectasis and effusions.

Output: Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: assess for fluid overload vs reactive airway History: SOB, history of CHF and asthma Cardiomegaly with vascular redistribution and pulmonary opacities of mild edema. No interval pneumothorax or pleural effusion.

Output: Stable cardiomegaly with mild edema.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Eval for infiltrate History: rising WBC Interval removal of the enteric tube.Cardiomegaly with nonspecific basilar subsegmental atelectasis, unchanged.Left subclavian catheter tip in left brachiocephalic vein at the midline.

Output: Nonspecific basilar subsegmental atelectasis, stable. No new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 95 years old.Reason: check pulmonary status History: check pulmonary status Unchanged pleural effusions and basilar opacities suggestive of atelectasis.Small lung volumes.No new findings.Status post TIPS.

Output: Unchanged pleural effusions and basilar opacities likely atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: cardiomegaly, pna, effusion History: stroke activation, tongue deviation, slurred speech Borderline heart size. No evidence of pneumonia or significant pleural effusion.

Output: Borderline heart size. No evidence of pneumonia or significant pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: is there pulmonary edema or infiltrate History: chest pain, mild sob. Unremarkable cardiomediastinal silhouette. Unchanged eventration of the right hemidiaphragm. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: et tube placement History: et tube placement Worsening left lower lobe consolidation accompanied by pleural effusions and right basilar subsegmental atelectasis.ET tube cannulates the right main bronchus.An NG tube extends below the lower margin of the image.

Output: ET tube tip in right main bronchus with increasing left basilar consolidation. The service was text paged regarding this.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: syncopal episode History: as above Left subclavian dual lead AICD, mitral valve prosthesis and sternotomy noted.Scattered calcified granulomas.No focal pulmonary opacity, pleural effusion, or pneumothorax.Moderate cardiomegaly.

Output: Cardiomegaly without evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: increased hypoxia, concern for aspiration History: increased hypoxia, concern for aspiration Interval removal of central venous catheter. No pneumothorax.Essentially stable cardiomegaly and pleural effusion.Basilar opacities likely represent atelectasis though superimposed aspiration cannot be excluded.

Output: Cardiomegaly with basilar opacities, which likely represent atelectasis with the possibility of superimposed aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval for cardiomegaly, volume overload History: palpitations, SOB, BLE edema Low lung volumes with basilar atelectasis. No focal pulmonary opacity, effusion or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Chest pain question heart failure. CAD. Moderate cardiomegaly. Unsharpness of the pulmonary vasculature suggests mild edema. Subsegmental atelectasis or scarring in the right lower lung on. Retrocardiac atelectasis. No pneumothorax. No pleural fluid. Mild scoliosis.

Output: Cardiomegaly and possible mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: assess ETT position, changes in pulmonary opacities/effusions History: s/p intubation, T2RF Iatrogenic devices are unchanged. Mild pulmonary edema, pleural effusions, and dense left lower lobe opacity, unchanged. Unchanged heart size. No pneumothorax.

Output: No substantial difference.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with chest pain and elevated d-dimer. PULMONARY ARTERIES: Exam is diagnostic quality. No evidence of pulmonary embolus.LUNGS AND PLEURA: Lungs are clear no focal air space opacity, pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of pulmonary embolus. No specific findings to explain patient's symptoms


Instruction: Generate impression based on medical findings.

Input: Reason: assess for aspiration PNA History: fever Basilar airspace opacities, unchanged from previous, compatible with atelectasis and nonspecific consolidation, not significantly changed from previous.The differential diagnosis includes aspiration.NG tube tip in the area of the gastric antrum.

Output: Basilar atelectasis and nonspecific consolidation, compatible with aspiration.


Instruction: Generate impression based on medical findings.

Input: Tender nodule near Hickman site No evidence for loculated fluid collection or abscess

Output: No evidence for loculated fluid collection or abscess associated with Hickman catheter or surrounding subcutaneous tissues right chest wall.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Hypothermic with S.O.B. Multifocal air space opacities suspicious for pneumonia. Upper normal heart size. Right paratracheal stripe widening may be secondary to goiter or vascular ectasia.

Output: Multifocal pulmonary opacities suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: tobacco history History: dyspnea Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: chest pain History: chest pain No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: chronic cough History: SOB Patient is rotated. Asymmetric and prominent right first costochondral cartilage with persistent underlying opacity on and a subtraction image Partially visualized orthopedic fixation in the right humerus.Moderate cardiomegaly with enlarged central pulmonary vasculature compatible with pulmonary hypertension..No pleural effusion or pneumothorax.Mild thoracic kyphosis.Chronic right anterior rib deformity. Metallic hardware in the right humerus.

Output: Asymmetric masslike opacity in the right upper lobe may be the result of summation artifact from costochondral cartilage however an intrapulmonary lesion cannot be entirely ruled out. A follow up study is recommended when feasible and if the abnormality persists on the follow-up examination, a CT of the thorax may be warranted for further evaluation. Cardiomegaly and signs of pulmonary hypertension..


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old postop day 20 from esophagectomy with cervical anastomosis and postop day 1 status post tracheostomy. Evaluate subcutaneous emphysema. Tracheostomy tube tip approximately 5 cm above the carina. Right IJ central venous catheter and enteric tube are unchanged in position.Stable cardiomediastinal silhouette.Extensive left greater than right interstitial and airspace opacities are not significantly changed. Stable small bilateral pleural effusions. No evidence of subcutaneous emphysema.

Output: Stable cardiopulmonary appearance. No evidence of subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: CHF vs COPD exacerbation History: shortness of breath, crackles \T\ wheezes on auscultation No significant cardiopulmonary abnormality.Unchanged coronary stent.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: CTICU History: Daily CXR Support devices unchanged. Swan-Ganz terminates in the main pulmonary artery. Sternotomy hardware intact. Small left pleural effusion. Low lung volumes and atelectasis.

Output: No significant change in support devices or cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Patient fell, right rib pain Exam limited due to demineralization. No discrete rib abnormality, specifically no right rib fracture is observed however dedicated imaging including obliques may be indicated if suspicion remains high.Lungs otherwise remain clear other than minimal basilar atelectasis. Cardiac and mediastinal contours are within limits of the tortuosity of the aorta and calcified AP window nodes consistent with old healed granulomatous disease exposure.

Output: Old healed granulomatous disease exposure that without superimposed acute cardiopulmonary abnormality; specifically no discrete rib fractures, however see recommendation above.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: check for ptx History: check for ptx s/p lung biopsy on right Marginally decreased small right apex pneumothorax. Known pulmonary nodules were better seen on prior CT.

Output: Marginally decreased small right apex pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 84 yearsGender: MaleReason for Study: Reason: eval for mets, history of bladder ucc History: eval for mets, history of bladder ucc Stable cardiomediastinal silhouette.Marked elevation left hemidiaphragm similar to the prior exam. No new pulmonary opacities identified.Pleural plaques unchanged.Left shoulder arthroplasty redemonstrated.

Output: Persistent elevation of the left hemidiaphragm. No acute cardiopulmonary abnormalites identified without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Heart failure and ventricular tachycardia evaluate for pulmonary edema. Mild cardiomegaly, about the same. Patient is rotated on the lateral radiograph. Retrosternal soft tissue opacity on the lateral radiograph present on a film from 9/2008 and presumably reflects fat pad.Basal atelectasis, but no convincing evidence of pulmonary edema.

Output: Cardiomegaly, but no specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient self pulled ETT History: pulled ETT ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Large lung volumes consistent with COPD with mild basilar interstitial opacities, unchanged compared to previous.No new findings.

Output: Severe COPD with unchanged basilar opacities suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: balloon History: balloon Mild cardiomegaly without acute edema. Minimal retrocardiac atelectasis is present.IABP catheter proximal marker 5 cm below the top of the aortic arch.Left jugular Swan-Ganz catheter, tip in proximal right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: IABP catheter, proximal marker 5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT minimally advanced, currently terminating 2 cm from the carina. Underlying cardiopulmonary appearance otherwise similar with mild retrocardiac opacities representing nonspecific changes, probable atelectasis however aspiration or infection cannot be excluded

Output: ETT minimally advanced


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Patient with history of pulmonary sarcoid, status post PICC placement. A left PICC is seen with tip in the right atrium.The cardiomediastinal silhouette is partially obscured but does not appear enlarged.Lung volumes are low and coarse, bilateral interstitial opacities are again noted, worst at the left lung base. There is no pneumothorax.Marked degenerative change is seen affecting the right humeral head.

Output: Left PICC tip in the right atrium without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Dyspnea. Evaluate for infection, concern for heart transplant rejection. Bibasilar subsegmental atelectasis. No focal pulmonary opacities suggest infection. Small left pleural effusion, not significant changed since previous study. No pneumothorax.Unchanged cardiomediastinal silhouette. Status post median sternotomy.

Output: Bibasilar subsegmental atelectasis with unchanged small left pleural effusion. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: s/p OHT. Eval CVC History: s/p OHT Left sided central venous catheter loops on itself over the superior mediastinum with its tip oriented retrograde. Mild left basilar subsegmental atelectasis. No new focal lung consolidation. No large pleural effusion. No pneumothorax.

Output: Left sided central venous catheter loops on itself over the superior mediastinum with its tip oriented retrograde. Findings were verbally discussed with the clinical team at 835am on 11/5/2015.


Instruction: Generate impression based on medical findings.

Input: Line placement New left jugular catheter extends into the mid SVC without immediate postprocedural complication. ICD is unchanged. Small IV in the external right jugular is also similarNo underlying cardiopulmonary abnormality of the persistent minimal retrocardiac atelectasis.

Output: Left jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Chest pain rule out infection versus CHF. Cardiac history. Unchanged cardiomediastinal silhouette. Scoliosis and highly tortuous descending thoracic aorta. Subsegmental atelectasis at the lung bases but no specific signs of pulmonary edema or pneumonia.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Interval change in setting of new onset CP History: New onset CP There is interval near complete opacification left hemithorax with small right effusion.There is no change in the right paratracheal soft tissue opacity. Right lung remains essentially clear.Stable position of surgically placed left subclavian chest port.

Output: Interval near complete opacification of the left hemithorax, likely pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: Pt with positive TB screen; please evaluate for active disease History: Heart size normal. Lungs clear.No pneumothorax. No pleural effusion.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: History of AML, hemoptysis, evaluate for infiltrate Left PICC with its tip in the cavoatrial junction. The heart size is at the upper limit of normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. The lateral view is obscured by overlying anatomy. Orthopedic rods and screws overlie the cervicothoracic spine. Severe osteoarthritis affects the right shoulder.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: S/P AVR Assess R Pleural effusion History: R Pleural effusion Bilateral pleural effusions, right greater than left, with adjacent atelectasis, not significantly changed.Status post aortic valve replacement. Median sternotomy hardware/wires appear intact.

Output: Pleural effusions and adjacent atelectasis, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.History of hypoxia, previous loculated right pleural effusion Large right pleural effusion/pleural thickening with extensive right airspace opacity does not appear acutely changed compared with outside hospital radiograph 6/2/2015. No pneumothorax.

Output: No significant interval change in large right pleural effusion/thickening and extensive right airspace opacities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: Evaluate for pulmonary edema, PNA History: Chest pain, tachypnea, crackles midway up b/l lungs Interval increase in cardiac size as well as bilateral interstitial and left lower lobe airspace opacities with small effusion. Findings likely represent pulmonary edema however superimposed of lower lobe infection cannot be excluded.

Output: Pulmonary edema with possible superimposed left lower lobe infection.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: lung nodule History: lung nodule Increased lung volumes compatible with COPD. Stable cardiomediastinal silhouette.Right upper lobe nodular and scarlike opacities similar to prior exams.No new pulmonary opacities identified.

Output: No significant interval change in the right upper lobe nodular opacities noted on recent CT and prior CXR.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: pt with hx of testicular of cancer History: none The cardiomediastinal silhouette is normal. The lungs are clear of airspace and interstitial opacities. No pneumothorax. No pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Shortness of breath and chest pain. Medical clearance. No visible pleural fluid or pneumothorax. Apparent vascular redistribution could be secondary to semisupine patient positioning as there are no specific signs of CHF. Mild bronchial wall thickening and atelectasis in the right cardiophrenic angle region.

Output: No pneumothorax or convincing evidence of interstitial edema. There is very mild, subtle bronchial wall thickening and atelectasis in the region of the right middle lobe which is a nonspecific finding. Consider follow-up PA and lateral chest radiographs if the patient remains symptomatic.


Instruction: Generate impression based on medical findings.

Input: Coronary disease. Cardiac surgery patient Mildly improving aeration with only minimal change observed in the diffuse pulmonary edema and left lower lobe suspected compression atelectasis from marked cardiomegaly. Bilateral moderate effusionsChest tubes removed

Output: Chest tubes removed


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Please eval for consolidation History: 80 yo F with undifferentiated ssx feeling "off" Heart size normal.No significant pulmonary or pleural abnormalities.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: is there pul edema History: chest pain and sob Mild cardiomegaly.Small left pleural effusion with left basilar atelectasis, and subsegmental atelectasis at the periphery of the right lung base.No reliable evidence of edema.

Output: Findings suggestive of mild hypervolemia without acute edema. Small left pleural effusion and basilar atelectasis are present.


Instruction: Generate impression based on medical findings.

Input: Reason: post-op cardiac surgery History: post-op cardiac surgery Mild cardiomegaly with valvular rings in the tricuspid and mitral locations.2 venous catheters extending to the area of the right brachiocephalic vein.Chest tubes in place with no pneumothorax.Mild interstitial opacity compatible with edema with probable small effusions.No pneumothorax.

Output: Postoperative findings with mild edema and small effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval for aspiration/pna History: trach, cough No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Stable postsurgical changes and/or scarring within the left lung with elevated hilar tissues and focal extension along the fissure to the pleural surface. Bilateral basilar scarring also unchanged. No suspicious new focal airspace abnormalitiesThe cardiac and mediastinal contours are grossly within limits given distortion

Output: Postsurgical changes and scarring without evidence of superimposed new acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Pleural effusion. Status-post chest tube placement.VIEW: Chest AP (one view) 2/17/15 at 618 hours. Central line tip is at the RA. NG tube terminates in the stomach. ET tube tip is below the thoracic inlet. Left-sided chest tube unchanged. Cardiac silhouette size is normal. Persistent diffuse lung haziness with no focal opacities, effusions or pneumothorax.

Output: Diffuse lung haziness with no focal opacities. No effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: primary lung cancer of unknown cell type History: primary lung cancer of unknown cell type Volume loss in the left hemithorax consistent with previous left upper lobectomy.Residual blunting of the left costophrenic angle compatible with scarring and probably a small residual pleural effusion.No new findings.

Output: Postsurgical volume loss and small residual left effusion.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of carcinoid tumor CHEST:LUNGS AND PLEURA: Nonspecific micronodules unchanged.MEDIASTINUM AND HILA: Precarinal index lymph node is unchanged measuring 1.3 by 1.1-cm image number 52, series number 10. Other small mediastinal lymph nodes are also unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. No focal liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Lobulated mesenteric soft tissue mass with spiculated margins measures 3.3 by 1.9 cm on image number 140, series number 10, unchanged. Surrounding small mesenteric lymph nodes, thick walled and dilated small bowel loops are also unchanged.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: Again noted effusion formation of the rectosigmoid colon. Unchanged from previous study. Etiology is unknown.BONES, SOFT TISSUES: Sclerotic lesion in the right iliac bone is unchanged.OTHER: No significant abnormality noted

Output: No significant change from previous study. Spiculated mesenteric mass, inflammation of the rectosigmoid, cholelithiasis, sclerotic right iliac bone lesion are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: lung infiltrate History: SOB Moderately severe cardiomegaly with mild interstitial opacity compatible with edema and small pleural effusions.Marked hilar lymphadenopathy, unchanged.

Output: CHF, and lymphadenopathy possibly due to sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Reason: swan in place, evaluate position History: swan in place Swan-Ganz catheter tip in the right main pulmonary artery.ICD lead unchanged and right jugular catheter extending to the SVC.Moderately severe cardiomegaly with no sign of CHF.

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


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Eval for Hydrothorax History: HCV cirrhosis Complete opacification of the right lung, most consistent with large pleural fluid collection.Nonvisualization of right upper lobe airway and airways beyond the bronchus intermedius, consistent with total right lung collapsePatchy interstitial opacities of the left lung, may be due to pulmonary edema.Small left pleural effusion.No pneumothorax.

Output: Large right pleural fluid collection with total right lung collapse and small left pleural effusion with interstitial opacities, likely representing pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: trauma, eval for ptx or rib fx History: l anterior rib pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No obvious rib fractures.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: chest pain History: chest pain Chronic left hemithorax volume loss with apical fibrosis unchanged.Heart size normal.Right lung unremarkable.

Output: No significant abnormality. Unchanged left-sided scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: please evaluate for recurrent pleural effusion, pulmonary edema, pneumothorax History: shortness of breath and increasing O2 requirement Left-sided chest tubes/drains are unchanged. Small left pleural effusion has improved. Stable small right effusion. Unchanged basilar opacities. Unchanged cardiomegaly. Very small left apical pneumothorax.

Output: Unchanged basilar opacities with slight improvement in left pleural effusion. Small left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: assess for infiltrate, infection History: Hx of Diabetes, reports cough for 1 week, generalized weakness worsening related to demylination Port catheter terminates in the RA. Low lung volumes. Bibasilar atelectasis or scarring, as before. No new focal lung consolidation. No large pneumothorax.

Output: Low lung volumes with bibasilar opacities, likely atelectasis or scar. No focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: eval for position of chest tube History: s/p R chest tube Endotracheal tube terminates 5 cm above the carina. Interval placement right chest tube. The remaining support devices are unchanged in position.Increasing right pleural effusion, extending into the major fissure. Multifocal regions of subsegmental atelectasis. Postoperative mediastinal widening is unchanged. Lucency at the left ventricular apex may represent small pneumomediastinum.

Output: Increasing right pleural effusion with interval placement of right chest tube.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: lung transplant with cough History: persistent cough The heart is normal in size.Status post bilateral lung transplant. Lung volumes are normal.The pleural spaces are within normal limits.Small osseous bridge is noted between the right fourth and fifth ribs. Small cortical chronic deformity along the anterior aspect of the left fourth rib also noted. No signs of sternal dehiscence. The sternal wires are intact.

Output: Stable status post bilateral lung transplant. No abnormal radiographic findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: h/o multiple myeloma; new onset fever and myalgias; mild URI symptoms. Please r/o pneumonia History: h/o multiple myeloma; new onset fever and myalgias; mild URI symptoms. Please r/o pneumonia Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Unchanged lower thoracic vertebral compression fracture.

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


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: ETT readjusted evaluate placement History: above Endotracheal tube 1 cm above carina.No significant change in bilateral pulmonary opacities.

Output: Endotracheal tube now seen 1 cm above carina. No change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: reactive airway disease, signs of pneumonia, pleural effusions History: shortness of breath, cough Possible subsegmental atelectasis left retrocardiac region, otherwise unremarkable.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.With a history of CHF presenting with edema and shortness of breath. Extremely low lung volumes limits evaluation. Questionable small bilateral pleural effusions. Heart size is not easily evaluated. Bibasilar interstitial and airspace opacities may represent pulmonary edema or may be sequelae of low lung volumes.

Output: Exam is limited secondary to low lung volumes. Bibasilar interstitial and airspace opacities may represent pulmonary edema or may be sequelae of low lung volumes. If high clinical suspicion remains recommend repeat examination.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: assess for edema/infection History: acutely paniced and hypoxic, increased O2 requirement Stable mild cardiac enlargement.Increasing bilateral perihilar airspace and interstitial opacities suggestive of edema, although infection and hemorrhage cannot be excluded.Increasing left retrocardiac consolidation/atelectasis.Possible small pleural effusions.

Output: Increasing perihilar airspace and interstitial opacities compatible with edema. Infection and hemorrhage cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Talc pleurodesis question pneumothorax. Right pneumothorax with maximal pleural separation from the chest wall of 8 mm, slightly larger post chest tube removal, previously 5 mm.Pleural fluid, atelectasis and right basal opacity unchanged.Left upper lobe mass unchanged.High density layering within the fissures on the right unchanged, presumably postprocedural.

Output: Interval removal of right chest tube. Small right pneumothorax minimally larger, now 8mm.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: hypoxia, h/o interstitial lung disease History: hypoxia There is cardiomegaly. Coarse interstitial pattern with more patchy peripheral opacities suggestive of interstitial disease. Superimposed infection cannot be excluded from this radiograph.

Output: Coarse interstitial opacities suggestive interstitial lung disease with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: assess lungs History: none. pre liver transplant evaluation Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.With respiratory distress. Persistent mild cardiomegaly. Bibasilar interstitial opacities are compatible with interstitial edema/atelectasis. Small left pleural effusion. AICD is unchanged. Right central venous catheter tip in the SVC.

Output: Persistent cardiomegaly with effusion/edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: lung cancer History: lung cancer LLL s/p LLL superior segmentectomy Interval removal of left-sided chest tubes. No large pneumothorax. Right lung remains clear. Unchanged heart size.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: assess et position History: moved it ET tube repositioned, the tip now 2 cm above the carina.Unchanged pulmonary opacities and other abnormalities.

Output: ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: History of empyema status post left VATS decortication and PICC placement.VIEW: Chest AP (one view) 12/31/2015 05:11 Left chest tube with tip now at the left apex. Right upper extremity PICC tip in the right atrium.Cardiothymic silhouette normal in size. Mild rightward mediastinal shift persists.A moderate left pneumothorax is present, slightly increased. Soft tissue swelling is present along the left chest wall related to surgery with persistent subcutaneous emphysema in the left chest wall, left supraclavicular, and right supraclavicular regions. A small amount of pneumomediastinum is present. Small left apical pleural effusion is unchanged. Left mid and lower lung zone opacities appear similar to prior. Right retrocardiac opacities slightly increased.

Output: Moderate left pneumothorax, slightly increased. Persistent subcutaneous emphysema related to chest tube.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval change History: intubated ET tube tip approximately 4cm above the carina. Nasogastric tube coiled within the stomach.Stable cardiomediastinal silhouette.No focal airspace opacity or signs of edema. No pleural effusions.

Output: Stable cardiopulmonary appearance. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: 34 y/o with hx of SLE, chronic/recurrent pericarditis, c/o chest pain History: chest pain Enlarged cardiac silhouette, not significantly changed versus 2011, which could be due to cardiomegaly or pericardial effusion. No new pulmonary opacity.

Output: Enlarged cardiac silhouette, not significantly changed versus 2011, which could be due to cardiomegaly or pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with splenomegaly and enlarged lymph nodes 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: Cirrhotic appearing liver. No focal lesions. Status post cholecystectomy. Varices around the distal esophagus.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nephrolithiasisRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: CT findings compatible with cirrhosis and portal hypertension causing splenomegaly and portosystemic varices.


Instruction: Generate impression based on medical findings.

Input: LVAD check Bilateral and mediastinal chest tubes are unchanged, no appreciable associated significant pneumothoraces.Decreased lung volumes, marked nonspecific artery megaly with patchy nonspecific opacities in both lung bases with left lower lung partial consolidation are suspected collapse similar to prior.Swan-Ganz, Dobbhoff are unchanged

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: 26-year-old female with right lower quadrant pain and history of appendectomy. Evaluate for abscess. CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips. No evidence of intra-or extrahepatic biliary duct dilatation.SPLEEN: Not visualized.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged nodes. For reference, a gastric node (series 4, image 48) measures 1.6 x 1.7 cm.BOWEL, MESENTERY: Normal bowel. Numerous enlarged mesenteric nodes, predominantly in the right lower quadrant (series 4, image 94). For reference, a right mesenteric node (series 4, image 91) measures 2 x 1.7 cm.Surgical suture line in the cecum consistent with history of appendectomy. No abnormal fluid collections to suggest abscess.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent inguinal lymph nodes. For example, conglomerate of nodes in the right groin (series 4, image 153) measures 2.1 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Diffuse lymphadenopathy as above with a dense cluster of enlarged mesenteric nodes in the right lower quadrant. Findings may represent mesenteric adenitis.2. No discrete fluid collections to suggest abscess as clinically questioned.3. Absent spleen.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Stroke, evaluate for pneumonia Mild cardiomegaly. Tortuous aorta.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: lung eval History: lung eval Cardiomegaly unchanged status post sternotomy.Right upper quadrant drain removed.Chronic elevation right hemidiaphragm stable.No significant pulmonary or pleural abnormality.Right jugular catheter, tip in SVC.

Output: No significant pulmonary or pleural abnormality. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: eval for pulm edema or infection History: nausea, diaphoresis Mild cardiomegaly with retrocardiac atelectasis or scarring.No specific evidence of infection or edema.Left axillary vascular stent.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Chest pain Old healed rib deformities on the right without additional cardiopulmonary abnormality or change. Minimal right basilar scarring

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Chronic dry cough for 3 months rule out mass or pneumonia. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Unsharpness of the right heart border may be accounted for by anterior chest wall asymmetry.

Output: No visible signs of pneumonia or a mass.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Swan positioning History: as above No significant cardiopulmonary abnormality.IVC Swan-Ganz catheter slightly looped in the right atrium before terminating in the proximal right main pulmonary artery.Right PICC, tip in the SVC.

Output: Swan-Ganz catheter, slightly looped in the right atrium before terminating in the proximal right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Bilateral cervical ribs incidentally noted.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: PNA History: AMS No specific evidence of infection or edema. Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Hypotensive Decreased lung volumes with minimal mixed interstitial airspace opacities with small effusions greater on the left are observed. Overall appearance is nonspecific and difficult to discern a more focal process, however serial imaging may improve sensitivity.The cardiac and mediastinal contours are grossly within normal limits.The right subclavian dual port terminates in the mid SVC

Output: Nonspecific mixed interstitial and patchy opacities suggesting possible early edema. Serial imaging may be needed to confirm


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.On chemotherapy, known pleural effusion with a pleural catheter. Question pneumonia or effusion. Near complete resolution of left pleural fluid collection. The Pleurx catheter has been advanced with tip now in the left cardiophrenic angle.Right chest port unchanged in position.Wedge-shaped opacity in the retrocardiac region is newly visible, but most likely reflects a pleural lesion with adjacent atelectasis seen on recent PET scan.Moderate volume of pleural fluid on the right with compressive atelectasis extending adjacent to the fluid-filled pull-up similar to appearance on recent PET CT scout image dated 7/1/2016.

Output: Moderate right pleural fluid collection unchanged. Near complete resolution of left pleural fluid, with newly visible pleural metastases.


Instruction: Generate impression based on medical findings.

Input: 35 years, Female. Reason: constipation, bowel gas?, History: acute abdominal pain There is nonobstructive bowel gas pattern. There is no evidence of free air. There is average stool burden. Radiopaque object is noted projecting over the pelvis, which has a somewhat atypical appearance for IUD.

Output: 1.Nonobstructive bowel gas pattern.2.No evidence of free air.3.Radiopaque object projecting over the pelvis, which has a somewhat atypical appearance for IUD. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female history of diabetes and past history of ovarian cancer. Presented with left flank pain 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: Fatty infiltration of the liver. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Presumed parapelvic cysts bilaterally.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: Enlarged left ovary, measuring 4.2 x 2.0 cm. Further evaluation with pelvic ultrasound may be helpful. Large fibroid, measuring 4.5-cm.BLADDER: No significant abnormality noted.LYMPH NODES: Right external borderline enlarged lymph node measuring 10 x 9 mm on image number 151, series number 5.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Borderline enlarged. Left ovary. Further evaluation with pelvic ultrasound recommended. Single large lesion fibroid.Cholelithiasis. Fatty infiltration. Nonspecific right external iliac lymph node.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: eval for cardiomegaly or effusion History: heart transplant, SOB Patient is status post sternotomy and heart transplant. No pleural effusions or pneumothorax. Mild interstitial opacity, nonspecific but may represent mild pulmonary edema.

Output: No pleural effusions or pneumothorax. Probable mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: r/o infection/edema History: cough, COPD Left pacemaker leads are unchanged. Right central catheter with tip at the cavoatrial junction. Multiple surgical clips overlie the mediastinum. Severe cardiomegaly is unchanged. Bibasilar scarring and pleural thickening. No specific evidence of infection or edema.

Output: Cardiomegaly and chronic basilar scarring without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Evaluate pacer leads. Left chest wall biventricular pacer with one lead in the right atrial appendage and the other directed in the right ventricle. Severe coronary calcifications. Surgical changes post CABG. Small right pleural effusion. Left lower lobe subsegmental atelectasis. No focal consolidation or pneumothorax. Prominent costochondral cartilage.

Output: 1.Left chest wall biventricular pacer with one lead in the right atrial appendage and the other in the right ventricle. 2.Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 88 yearsGender: FemaleReason for Study: Reason: s/p fall with right rib pain History: right rib pain Stable cardiac enlargement with interval placement of an Amplatz device..Mild chronic interstitial opacities without focal areas of consolidation.No pleural effusions.No pneumothorax.No obvious rib fracture.Partial collapse of several thoracic vertebrae slightly progressed since the prior exam.

Output: Stable cardiac enlargement without acute abnormalities. Interval placement of an Amplatz device.


Instruction: Generate impression based on medical findings.

Input: Status post pericardial window. Bilateral paramediastinal consolidation previously described as post radiation fibrosis. Known mediastinal lymphadenopathy.Interval development of opacification of the left cardiophrenic angle. Right chest port and a pericardial drain are similar in position.

Output: Interval opacification of the left lower lobe, which may be due to atelectasis given rapid development..


Instruction: Generate impression based on medical findings.

Input: Kidney transplant Persistent or recurrent mixed interstitial airspace opacities greater in both bases and mildly on the right. Appearance however has mildly improved since 6/1/2015 and no new discrete focal superimposed process is otherwise observed. Suspected small right effusion. Mild cardiomegaly.Left jugular catheter continues to extend into the SVC just beyond the confluence, unchanged

Output: Essentially unchanged persistent pulmonary opacities again supporting aspiration versus mild residual edema


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Index pretracheal lymph node is unchanged measuring 8 x 11 mm on image number 34, series number 4.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Heterogeneous enhancing mass in the right kidney measures 4 x 2.5 cm on image number 137, series number 4, not significantly changed from previous study.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Soft tissue mass encasing the L3 vertebra now measures 7.8 x 6.2 cm on image number 133, series number 4, slightly smaller compared to previous study. The mass enters the spinal canal. Again noted, lytic destruction of L3 vertebral body. The lesion also extends into L4 transverse process and posterior elements.Right sacral asymmetric soft tissue density suspicious for metastatic disease.OTHER: No significant abnormality noted

Output: Interval decrease in the size of the bone metastasis.Right sacral metastatic disease is seen on today's study.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Heart size upper normal and the aorta tortuous but consistent with age.No specific evidence of infection or edema.Healed granulomatous disease.Cervicothoracic stabilization hardware.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Dyspnea History: dypsnea Unremarkable cardiac and mediastinal silhouette. Catheter tip in the SVC.Mild nonspecific streaky lower zone opacities compatible with bronchial thickening and subsegmental atelectasis.No new findings.

Output: Mild nonspecific basilar opacities that may be related to chronic aspiration, not significantly changed from previous.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: trach, interval change s/p bilat lung transplant History: as above Support devices unchanged.Bilateral apical pneumothoraces decreased from the prior exam.Perihilar / basilar opacities and pleural effusions similar to the prior exam.No new pulmonary opacities identified.

Output: Small bilateral apical pneumothoraces slightly decreased from the prior exam. Persistent extensive airspace opacities and pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.IABP IABP marker projects 4-cm below the top of the aortic arch. Left subclavian ICD unchanged in position. No focal pulmonary opacities.

Output: Unchanged position of IABP marker.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Female; 102 years old. Reason: NG tube placement History: hypernatremia NG tube courses through stomach though the tip is below field of view . Normal cardiac silhouette with tortuous aorta. Calcified hilar lymph nodes. No pleural effusions or focal areas of consolidation.

Output: NG tube courses through stomach though the tip is below field of view


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for Pleural effusions / Atelectasis / Stability of sternal hardware History: S/P Emergent Sternotomy for Cardiac Tamponade Status post median sternotomy with sternal hardware intact.Normal heart size with a tortuous aorta.Interval clearing of basilar atelectasis and small effusions with minimal residual.

Output: Resolving atelectasis and effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval for pna, pulm edema History: shortness of breath Unchanged upper lobe scarlike opacities.No specific evidence of infection or edema.Heart size normal.

Output: Unchanged upper lung zone scar like opacities, with no new findings. No evidence of acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: FemaleReason for Study: Reason: SOB History: SOB Stable cardiomediastinal silhouette with pulmonary vascular redistribution.Pleural effusions, right greater than left , and basilar atelectasis similar to the prior exam.No new opacities identified.Right PICC line with its tip in the right axilla.

Output: No interval change in the pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: daily am cxr History: daily am cxr Lines and tubes are unchanged. Patchy bibasilar opacities, left greater than right, again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged patchy bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Chest tube placementVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip not visualized. Left PICC tip at the left subclavian vein. Right chest tube again noted with tip at the right apex. There is a large right-sided pneumothorax with mild mediastinal shift from right to left. Cardiothymic silhouette normal. Diffuse pulmonary interstitial emphysema bilaterally.

Output: Large right-sided pneumothorax increased from prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Cardiac arrest, assess ET tube History: cardiac arrest with ROSC Severe cardiomegaly with small lung volumes and perihilar opacities possibly edema and atelectasis.Large central pulmonary arteries suggestive of PA hypertension.ET tube low, at the level of the carina.An NG tube extends below the lower margin of the image.

Output: Low ET tube.


Instruction: Generate impression based on medical findings.

Input: Line placement Bilateral to jugular catheters, ICD, Dobbhoff and LVAD tubes all unchanged.Moderate nonspecific cardiomegaly with mild patchy basilar changes with small effusion suggesting minimal edema

Output: Right jugular catheter is unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: R/o PNA in patient p/w cough History: cough, crackles on examination Unremarkable cardiac and mediastinal silhouette. Nodular opacity in the right apex described in the preliminary report is most likely due to superimposition of normal structures but this could be confirmed on a follow-up radiograph.No specific evidence of pneumonia.

Output: Questionable opacity at the right apex which could be clarified by a follow-up chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA History: fever Left lower lobe atelectasis, and opacity, decreased in extent compared to previous, though atelectasis may be more complete.Mild blunting of left costophrenic angle is compatible with atelectasis and possibly small effusion.No specific evidence of pneumonia.

Output: Persistent left lower lobe atelectasis, which could be better characterized by CT scan. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 80 year-old male with known pulmonary fibrosis with worsening dyspnea. Evaluate for pulmonary embolism. PULMONARY ARTERIES: Contrast infusion is of diagnostic quality. No PE. Pulmonary artery measures 33 mm in diameter, compatible with pulmonary arterial hypertension. LUNGS AND PLEURA: Low lung volumes. Diffuse interlobular septal thickening with traction bronchiectasis and basilar-predominant honeycombing, compatible with known idiopathic pulmonary fibrosis. Mild centrilobular emphysema of upper lung zones. No air trapping on expiratory views. No pleural effusions. MEDIASTINUM AND HILA: Few scattered slightly prominent mediastinal lymph nodes, nonspecific. Contrast refluxing into the hepatic veins with slight right sided cardiac enlargement, suggestive of right heart strain. Moderate coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Left renal cyst is incompletely evaluated.

Output: 1) No PE.2) Findings compatible with IPF and UIP pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Shortness of breath with productive cough. Low lung volumes. Severe upper lobe fibrosis and volume loss. Degree of fibrosis elsewhere may be slightly worse, though this could be the result of differences in technique. Faint groundglass opacity right midlung nonspecific and favored to represent overlying soft tissue summation; in the appropriate clinical setting acute exacerbation of interstitial lung disease could not be excluded and further evaluation with erect PA and lateral chest radiographs would be recommended. Normal heart size.

Output: Apparent groundglass opacity in the periphery of the right lung is favored to represent soft tissue summation artifact however if there is clinical concern for acute exacerbation of interstitial lung disease a reduced dose unenhanced thoracic CT would be suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Status post tracheostomy. Tracheostomy tube and enteric tube unchanged. AVR, sternotomy wires and plates in place, unchangedStable cardiomediastinal silhouette.Retrocardiac consolidation/atelectasis and small effusions redemonstrated.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with persistent retrocardiac consolidation/atelectasis and small effusions.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, 61 years old.JP drain inflated question pneumothorax or displaced lung drain. Anterior left pneumothorax not visible but suspected based on asymmetric lucency of the lung apex and pattern of layering pleural fluid in the semierect position.Pigtail catheter projecting over the left apex from an anterior approach has slightly changed in orientation. As the drain marker is seen on-end, I cannot comment on whether this is within the cavity/pleural space or within the chest wall or extrapleural space. This would require a lateral radiograph. On the CT dated 11/5/2015, the marker appeared to straddle the visceral pleura.Left hilar mass with complete atelectasis of the upper lobe unchanged. Minimal pleural fluid on the right. Otherwise, the right lung is clear.A left Midline-type catheter projects over the left subclavian vein in the mid clavicular line.

Output: Assessment limited for both pneumothorax and position of JP drain due to its anterior entrance into the chest wall. Drain position may be confirmed with a lateral radiograph which may be done at bedside. This would also assist in confirmation or exclusion of an anterior pneumothorax component.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: eval infiltrate History: as above Tracheostomy is in place. Low lung volumes and patient motion makes detailed cardiopulmonary assessment difficult. Basilar opacities again noted. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Low lung volumes and patient motion makes detailed cardiopulmonary assessment difficult. Basilar opacities again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Screening for respiratory tuberculosis 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: Postprocedural cardiogenic shock. SOB. Hardware monitoring and support devices unchanged in position. No significant change in size of left pneumothorax. The majority of the air collection projecting over the mediastinum reflects medial pneumothorax component however there is also likely a small volume of residual pneumopericardium and air related to the sternotomy. Diffuse interstitial opacities, left greater than right, about the same. Minimal pleural fluid and basal atelectasis on the right.

Output: Left pneumothorax slightly larger, now with about 13 mm maximal pleural separation from the chest wall laterally. No substantial change in additional edema and pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: cough, fever per pt at home (afebrile here), hx esophageal cancer History: cough, fever Subtle pulmonary metastases are unchanged compared to recent CT.Erosion of several left-sided ribs are stable.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: No specific evidence of infection or edema. Unchanged metastases.


Instruction: Generate impression based on medical findings.

Input: Female 38 years old Reason: 38F with hemoptysis, neutropenic from chemotherapy, ?pneumonia, ?aspiration History: 38F with hemoptysis, neutropenic from chemotherapy, ?pneumonia, ?aspiration Right distal Port-A-Cath tip terminates in the SVC.Unchanged mild basilar interstitial opacities, no new focal airspace opacity.No pleural effusion or pneumothorax.The cardiac mediastinal silhouette is normal.

Output: Unchanged mild basilar interstitial opacities suggestive of atelectasis/aspiration, but no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: hypercarbic resp failure History: ams, hypercarbia Interval extubation. Bilateral basal atelectasis without significant change, right greater than left.Right subclavian vein stent is severely narrowed as it passes over the first rib, chronic.Heavily calcified thoracic aorta at the level of the arch and severe vascular calcifications in the chest wall noted.

Output: Interval extubation with no change in bilateral basilar atelectasis or scarring


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Eval for pneumothorax History: S/P CT removal Chest tubes have been removed and there is only a minimal right apical pneumothorax. Basilar atelectasis has improved.No new findings.

Output: Chest tube removal with only a minimal right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old, with history of tonsil cancer status post chemo/RT/surgery. CHEST:LUNGS AND PLEURA: Medial right middle and lower lobe glass opacities are consistent with aspiration. Scattered micronodules unchanged. No new nodules or pleural fluid.MEDIASTINUM AND HILA: Postop change status post right neck dissection.No significant hilar or mediastinal lymphadenopathy.The cardiac size is normal. No pericardial fluid.CHEST WALL: Right chest wall deformity, unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cystic lesions, unchanged and too small characterize.PANCREAS: Cystic lesion in the tail of the pancreas is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval G-tube removal.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Left lateral chest wall mass. Clinical concern is accessory breast tissue versus lipoma. A targeted left ultrasound was performed for the palpable area of concern. A uniform density mass measuring up to 10 cm is seen in the left lateral chest wall, with echogenicity similar to adjacent fat lobules. There is no suspicious solid or cystic mass identified.

Output: Findings compatible with a lipoma. The patient will be following up with plastic surgery for consideration of lesion removal.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: r/o pna, pulm edema History: CP, SOB, cough No significant cardiopulmonary abnormality.Left jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 77 year old female with parathyroid cancer/paratracheal mass LUNGS AND PLEURA: Stable apical pleural thickening and apical and basilar scarring. Stable right upper lobe. Micronodule (image 44, series 5). No new suspicious nodules identified.MEDIASTINUM AND HILA: Soft tissue posterior to the trachea in the upper mediastinum ( image 10, series 3) is difficult to accurately measure without the use of intravenous contrast. It appears to be stable in size.Anterior mediastinal retrosternal soft tissue density anterior to the left innominate vein appears unchanged. However, accurate measurement cannot be obtained without the use of intravenous contrast.The soft tissue adjacent to the left thyroid cartilage, measured on exam dated 10/3/09 is not imaged on this study. CHEST WALL: Degenerative changes throughout the thoracic and visualized lumbar spine with demineralization.UPPER ABDOMEN: Left adrenal thickening, compatible with hyperplasia. Hypodense lesions in the liver, stable.

Output: No significant interval change. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Eval for pneumonia History: neutropenic fever Right upper extremity PICC tip in the cavoatrial junction. Nonspecific bibasilar interstitial opacities without significant change from prior study. Mild increase in the reticular opacities at the right lung base, compatible with edema. Slightly nodular appearance of the right right lung zone suggestive of bronchiolitis.

Output: Pulmonary edema without conclusive evidence of pneumonia. Follow-up recommended.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: 54-year-old male with Hodgkin's disease. CHEST:LUNGS AND PLEURA: Several scattered punctate nodules are unchanged from prior exam.MEDIASTINUM AND HILA: Small mediastinal and hilar lymph nodes are unchanged.CHEST WALL: Small axillary lymph nodes are unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference portacaval lymph node is unchanged measuring 19 x 14 mm in image number 130/236. Several other para-aortic borderline enlarged lymph nodes are also unchanged.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: Borderline enlarged inguinal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable disease with no new sites of involvement.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: re-expanding tension pneumothorax despite 2 chest tubes, ?progression History: re-expanding tension pneumothorax despite 2 chest tubes, ?progression Two left pleural drains with a small left apical and left subpulmonic pneumothorax.Stable left chest wall soft tissue emphysema.Unchanged basilar atelectasis.

Output: Residual left pneumothorax, equivocally larger but not to the extent seen before the second chest tube was placed.


Instruction: Generate impression based on medical findings.

Input: Reason: interval IABP History: IABP Balloon catheter marker at the level of the aortic arch with the balloon in the descending aorta.ICD leads unchanged.No significant pulmonary abnormalities.

Output: Balloon catheter in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusion improvement? History: CHF Markedly enlarged cardiac silhouette with ICD leads unchanged from previous. Pulmonary vascular redistribution and mild basilar interstitial opacity compatible with atelectasis and possibly edema.Catheter tip in the SVC.Small pleural effusions and retrocardiac opacity, consistent with compressive atelectasis.

Output: Pleural effusions and atelectasis with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: Evaluate for pneumonia and other acute abnormalities History: SOB The cardiac mediastinal silhouette is unremarkable.Interval improvement in the left retrocardiac consolidation/atelectasis.New patchy airspace opacity in the right upper lobe may represent infection.Moderate/marked dextroscoliosis of the thoracic spine.

Output: New right upper lobe opacity may represent acute infection or aspiration. Interval improvement in the left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: pna, traumatic injury History: cough, chest pain, recent fall Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Large patient body habitus.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Retained ICD wire seen on CXR yesterday. Repeat inspiration and expiration CXR to rule out pneumothorax. History: Neck pain Fractured wire in the left innominate vein again noted. No convincing evidence of pneumothorax. Mild left basilar scarring again noted. Unchanged heart size. No large pleural effusion or pneumothorax. Patient is status post sternotomy.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: swan placement History: swan placement Cardiomegaly without acute edema.Right jugular Swan-Ganz catheter pulled back to the proximal right main pulmonary artery.IABP catheter distal tip 2 cm below the top of the aortic arch.Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter repositioned. No other change.


Instruction: Generate impression based on medical findings.

Input: 69 years old Male. Reason: eval for cardiac enlargement History: hx CHF. The cardiac and mediastinal silhouette is enlarged. There is interval improvement of the interstitial edema. The cardiac pacemaker/defibrillator electrodes are stable in position.

Output: Interval improvement of the interstitial edema. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female newly diagnosed SLL/CLL. Evaluate extent of disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: There clusters of nodes in the middle mediastinum and AP window. The cluster are size are suspicious but the patient has had sternotomy and these could be inflammatory in nature. For baseline purposes noted anterior to the right main bronchus on series 6 image 34/106 measures 2.2 x 1.5 cm.Small clusters of axillary nodes nonpathologic by size criteria.Postsurgical changes consistent with coronary artery bypass surgery.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There is mild to moderate intra-and extrahepatic biliary dilatation with no discrete transition zone seen in the common bile duct being tortuous and tapering to the ampulla. Largest diameter is seen in the region of the mid common duct supra-pancreatic on coronal image 67/111 where it measures 1.3 cm in diameter. By CT, no gallstones or masses are evident however. A few punctate hypodensities are seen in the liver likely cysts. The hepatic and portal veins enhance normally.SPLEEN: Normal size with no focal lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few small likely cysts bilaterally. Normal collecting system on delayed images no hydronephrosis.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal nodes. Cluster of nodes in the left periaortic area on series 6 image 113 measured 2.2 x 1.6 cm. nodes continue with clusters of nodes in the right and left common iliac distribution. These are pathologic in size and clustering.Atherosclerosis diffusely but no evidence of aneurysm.BOWEL, MESENTERY: Scattered nodes in the mesentery that are pathologic by size criteria. Largest node is in the right lower quadrant and pelvic dysplasia pelvic inlet on series 6 image 136 and measures 3.1 x 2 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: Nodes are seen along the common, and bilateral external iliac distributions as well as internal iliac distributions. There also nodes bilateral obturator and proximal femoral and small inguinal nodes.For baseline purposes a left proximal femoral noted seen on series 6 image 165 measures 2.9 x 2.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Midline scar. Surgical clips both groin.OTHER: No significant abnormality noted.

Output: Scattered pathologic size lymph nodes in the mediastinum retroperitoneum and pelvis. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Shortness of breath. Hypoxemia. Bibasilar opacities with effusions have progressed slightly on the left. This may reflect progression of aspiration/infection. Cardiomegaly again noted. No pneumothorax.

Output: Small effusions and basilar opacities, slightly progressed, which may reflect progression of aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: r/o pneumonia, bronchitis History: fever, cough x 6 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: 34-year-old female with cystic pancreatic lesion on outside CT scan. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Precontrast images demonstrate no evidence of calcification or hemorrhage. Postcontrast images demonstrate a 1.4 x 1.3 cm low attenuation lesion in the tail of the pancreas on axial image 82/201. This lesion measures fluid density and shows no significant enhancement on postcontrast images. No evidence of pancreatic ductal dilatation.A focal bulge of pancreatic parenchyma in the region of the pancreatic neck (axial image 89/201) demonstrates slightly lower attenuation than adjacent pancreas and may represent a normal variant of anatomy with fatty infiltration and less likely a mass lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A gastric band is in adequate position.BONES, SOFT TISSUES: Postoperative changes status post gastric banding with a reservoir in the left mid abdominal wall.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Nonspecific pancreatic tail cyst which may represent a simple cyst or a pseudocyst. There are no specific findings to suggest an intraductal papillary mucinous neoplasm. A bulge of pancreatic parenchyma at the pancreatic neck probably represents fatty infiltration and normal variant anatomy.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Status post lung biopsy, please rule out pneumothorax or hemorrhage. No pleural effusion or pneumothorax. Air lucency is visualized in the subcarinal space which could represent pneumomediastinum although based on the CT guided biopsy images no intervention was performed in this region and this is more likely to represent artifact. Post biopsy changes surrounding the right middle lobe lesion.

Output: No pneumothorax. Apparent air lucency in the projection of the subcarinal space of unclear etiology, recommend repeat radiograph. Dr.N. Singh verbally notified and agreed to order a follow-up radiograph after ensuring patient stability.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Assess for aspiration given hypoxia and copious amounts of output from NG History: Hypoxia, Tachycardia, Hypotension Unchanged basilar opacities and pleural effusions.Heart size normal. An NG tube terminates in the stomach.

Output: Unchanged basilar opacities and pleural effusions, which may be the result of aspiration or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Near complete resolution of previously described mild edema with marked nonspecific cardiomegaly otherwise unchanged. Mildly decreased lung volumes

Output: Near complete resolution of mild edema with persistent cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Soft tissue sarcoma, right elbow No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Hypertensive. Cardiac arrest ETT terminates 2 cm above the carina. NG and left jugular catheter similar to prior studies.Moderate nonspecific cardiomegaly with underlying mixed minimal interstitial and nonspecific airspace changes greater both bases and on the left, suggest questionable mild edema. Small left effusion suspected. Serial imaging is needed to confirm clearance

Output: ETT unchanged and questionable mild minimal probable edema


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: as above Unremarkable cardiac and mediastinal silhouette. Mild deviation of the trachea to the right at the thoracic inlet suggestive of goiter.Streaky basilar opacities suggestive of scarring with bronchial thickening and possibly subsegmental atelectasis..

Output: Basilar scarring and/or subsegmental atelectasis but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: s/p TECAB History: s/p TECAB The heart is normal in size.Lung volumes are normal. No abnormal focal lung parenchymal opacities. Interval resolution of previously seen left lower lobe partial atelectasis. No signs of pulmonary edema.Persistent small bilateral pleural effusions. No pneumothorax.

Output: Interval resolution of left lower lobe atelectasis previously noted. Persistent small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old. Reason: s/p lung txp History: DOE Mild cardiomegaly, unchanged.Small volume of left apical pleural fluid. Interval development peripheral groundglass opacities. Relative paramediastinal areas of lucency may represent air trapping. There is also a more focal opacity in the left lower lobe. Right basilar subsegmental atelectasis or scarring which appears similar to prior study. Small left pleural effusion.No pneumothorax.Mediastinal surgical clips are unchanged.

Output: New opacities and pleural fluid in the left lung which are suspicious for bronchiolitis obliterans.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: 58F tx from OSH with necrotizing PNA, please eval History: ?necrotizing PNA There may still be residual opacity in the left lung base, better seen on a prior abdomen CT, that might not be well seen by chest radiograph.Elsewhere, the lungs are unremarkable.Heart size normal.

Output: Residual left basilar opacity with no new findings.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with metastatic renal cell carcinoma status post left nephrectomy and biopsy left iliac wing lesion. Status post radiation therapy to pelvis/left iliac crest. CHEST:LUNGS AND PLEURA: A few subcentimeter nodules are seen in the lungs on the largest measuring 8 x 7 mm in the right upper lobe (series 6; image 28). Another nodule seen in the left upper lobe and left lower lobe. Nodular opacity adjacent to the left oblique fissure may represent intrapulmonary lymph node. These are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in segment VIII of the liver is seen. Likely fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Fluid in the postsurgical bed has mildly decreased. In the posterior aspect of the midpole of the right kidney, a 14 x 12 mm hypodense lesion is seen. This lesion demonstrates HU of 66. On prior PETCT, HU was approximately 30.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Expansile lytic lesion in the left iliac wing measures approximately 4.9 x 2.0 cm, increased in size. Right hip degenerative changes are noted.OTHER: No significant abnormality noted

Output: Status post left nephrectomy without evidence of recurrence in the postsurgical bed. Left iliac expansile lesion, increasing in size, compatible with metastatic disease.Lesion in the midpole of the left kidney, not compatible with a simple cyst. It most likely represents an enhancing solid lesion given its appearance on the PET-CT. Findings are worrisome for renal cell carcinoma.Stable nonspecific, subcentimeter pulmonary nodules.