Instruction: Generate impression based on medical findings.

Input: 27-year-old female with history of rectal cancer CHEST:LUNGS AND PLEURA: Reference left lower lobe pulmonary nodule measures 11 x 11 mm image number 49, series number 4, smaller in size. All of the other multiple bilateral lung nodules are also smaller.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterine fibroid is unchanged. A previously measured left adnexal mass now measures 6.6 x 2 .4 cm, smaller.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: Small amount of fluid in the pelvis.

Output: Interval decrease in the size of the pulmonary nodules and left adnexal mass.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: eval for acute process History: cough for several months The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. Mild interstitial markings which may reflect small airways disease.

Output: Mild interstitial markings which may reflect small airways disease.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: pneumothorax History: pneumo on CXR Prior small right pneumothorax resolved.Unchanged pulmonary opacities and pleural effusions.

Output: Resolution prior small right pneumothorax, unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ETT check, change in lung field opacities? History: as above No significant interval change in the diffuse reticular nodular interstitial opacities seen bilaterally. No pneumothorax.

Output: No significant radiographic change in the bilateral reticular nodular opacities.


Instruction: Generate impression based on medical findings.

Input: Headache and vision changes SHUNT DEVICE: A left-sided shunt device exits a left frontal burr hole and courses down along the left neck, anterior chest, anterior abdomen and pelvis, and terminates within the anterior pelvis overlying the left sacroiliac joint. Portions of the shunt overlying the calvarium are lucent which limits evaluation however the remaining shunt appears intact without evidence of kinking or discontinuity.The notch appears to project over the 9:00 position. SKULL: No significant abnormality noted.CERVICAL SPINE: Mild degenerative disc disease affects the cervical spine.CHEST: The lungs are clear. There is orthopedic fixation T7-T8.ABDOMEN: The bowel gas pattern is nonobstructive. There is orthopedic fixation of L4-S1 with intervertebral disc spacers placed in the intervening disc spaces.

Output: Left VP shunt without evidence of kinking or discontinuity.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with malignant mesothelioma. CHEST:LUNGS AND PLEURA: Stable right upper lobe with calcified micro-nodule. Fluid density collection along the right major fissure has slightly decreased in size, compatible with loculated fluid.The following are findings at the levels of prior reference measurements: 1. At the level of the aortic arch (series 3; image 35), no measurable disease.2. At the level of the superior pulmonary veins ( series 3; image 54), no measurable disease3. At the level of the right lung base below the inferior pulmonary veins (series 3; image 72), there is pleural thickening anteriorly measuring 6 mm, unchanged.MEDIASTINUM AND HILA: The superiorly located paratracheal lymph node measures 13 x 10 mm (series 3; image 9), previously 17 x 11 mm when remeasured. The reference precarinal lymph node measures 13 x 11 mm (series 3; image 39), unchangedCHEST WALL: The left-sided port terminates in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Sutures are noted along the right hemidiaphragm. Left lobe hepatic cysts. Trace perihepatic ascites.Heterogeneous perfusion is seen along the lateral aspect of the liver right lobe of the liver without a suspicious lesion.SPLEEN: No significant abnormality notedPANCREAS: Subcentimeter hypodensity connecting to the main pancreatic duct (series 3; image 112), is unchanged, representing a dilated side branch versus branch type IPMN. Pancreas divisum is identified.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cysts are seenRETROPERITONEUM, LYMPH NODES: Retrocrural surgical clip.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change. Right anterior pleural thickening below the level of the inferior pulmonary veins.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: r/o infiltrate, effusion, cause of chest pain History: hx of Alzheimer's, unclear history, chest pain 4 radiating to the back x4 days No interval consolidation or significant pleural effusion. Tortuosity of the descending thoracic aorta with mid thoracic degenerative endplate disease. Heart size is normal.

Output: No evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Reason: pain and weakness History: pain and weakness No significant cardiopulmonary abnormalities.Port catheter with its tip in the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: infection? History: shortness of breath, pleuritic chest pain Mild left sided subsegmental atelectasis with volume loss.Right lung unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Nonspecific left lower lung zone subsegmental atelectasis, which could be from mucous plugging. No reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: ett adjustment History: intubated ET tube tip approximately 2.5 cm above the carina.Patchy bilateral airspace opacity without significant change.A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Cough and wheezing Persistent mild nonspecific cardiomegaly with chronic interstitial changes and scarring. No discrete superimposed discrete new focal airspace abnormality.Unchanged 2-lead left subclavian ICD

Output: No acute abnormality superimposed upon old chronic changes


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: history of HI History: none Basilar atelectasis with pleural effusions.Left PICC, tip in the SVC. A Dobbhoff tube extends below the lower margin of the image.

Output: Basilar opacities consistent with atelectasis and pleural effusions, not significantly changed given differences in inflation.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Dyspnea with new oxygen requirement Bilateral large pleural effusions with adjacent atelectasis/consolidation appears similar to that seen on the prior exam. Multiple nodular airspace opacities in bilateral lungs compatible with metastatic disease. No pneumothorax.Partially imaged IVC filter and left nephroureterostomy stent.

Output: No significant change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: as above Cardiopulmonary monitoring and support devices, unchanged.Marked cardiomegaly with basilar opacities compatible with atelectasis and nonspecific consolidation.Feeding tube tip in the gastric fundus.No new findings.

Output: Nonspecific basilar airspace opacity with no acute change.


Instruction: Generate impression based on medical findings.

Input: Non-Hodgkin's lymphoma. Reevaluate and compare previous. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. Minimal bibasilar atelectasis or scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Subcentimeter subcarinal lymph node Heart size normal without pericardial effusion. Coronary artery calcifications as noted previously.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: Hypoattenuating left renal cyst. Nonobstructing bilateral renal stones.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta and iliac arteries. Numerous small retroperitoneal lymph nodes appearing similar to prior study. Reference aortocaval lymph node (series 3; image 142) measures 0.8 x 1 cm (stable). Subtle infiltration of the fat along the origins of the celiac and superior mesenteric arteries as noted previously.BOWEL, MESENTERY: Sigmoid diverticulosis. Unchanged reference mesenteric lymph node with punctate calcifications (series 3; image 117) measures 1.5 x 1.9 cm.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Sigmoid diverticulosis.BONES, SOFT TISSUES: Lumbar spine fusion.

Output: Stable exam with reference measurements given above.


Instruction: Generate impression based on medical findings.

Input: Prematurity with history of pneumothorax.VIEW: Chest AP (one view) 5/3/2016 at 0139 hours. ET tube tip is below thoracic inlet. Umbilical lines are unchanged. Interval placement of a second left-sided chest tube.Cardiac silhouette size is normal. Bilateral diffuse lung haziness and large lung volumes are unchanged. Pattern of PIE is still present. Interval improvement in left-sided pneumothorax.

Output: Interval improvement in left-sided pneumothorax after a additional chest tube placement.


Instruction: Generate impression based on medical findings.

Input: New cough in immunocompromised patient rule out infection. Right subclavian chest port tip at the SVC. Left jugular catheter also terminates at the SVC level. No pneumothorax. Interstitial markings are coarse centrally, with minimal subsegmental atelectasis and bronchial wall thickening. No pleural fluid.

Output: Subtle interstitial abnormality suspicious for early atypical infection such as viral or pneumocystis pneumonia. This can be confirmed with unenhanced thoracic CT if required.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: pt s/p thoracentesis - right pleural effusion History: SOB Heart size upper normal.Lower lung zone opacities are suggestive of edema as well as infection or aspiration, particularly in the left lower lobe.Small pleural effusions left larger than right.No pneumothorax following right thoracentesis.Left subclavian pacemaker, leads unchanged in position.

Output: No significant pneumothorax. Persistent pulmonary opacities left greater than right.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: surveillance History: BiVAD awaiting txp Unchanged support devices.Stable bilateral pleural effusions and retrocardiac atelectasis.

Output: Unchanged pulmonary opacities in pleural effusions as well a support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: Evaluate for pneumonia History: severe sepsis The heart size is normal. Unremarkable cardiomediastinal silhouette. No focal pulmonary opacities, pleural effusion, or pneumothorax. The bones and soft tissues appear unremarkable.

Output: No acute cardiopulmonary abnormality. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Low grade chondrosarcoma right femur, s/p curettage, evaluate for local recurrence/healing History: above No evidence of metastatic disease.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: testicular mass- probable testicular cancer History: testicular mass- probable testicular cancer Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules unchanged. No new nodules or pleural effusion.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Metastatic lesion in the left lobe of the liver is very difficult to measure on noncontrast CT. within this limitations, Reference lesion in the left lobe measures 6.5 x 7.6 cm image number 92, series number 3, increased from previous study. Second reference lesion in the right lobe measures 19 x 22 millimeter image number 92, series number 3, not significantly changed from previous study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Mass in the medial aspect of the left kidney measures 4.4 x 2.9 cm on image number 104, series number 3, not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Patent gastroduodenal stent.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: Generalized osteopenia.OTHER: No significant abnormality noted

Output: Interval increase in the size of the left lobe metastatic lesion. No other significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Atypical rash, evaluate for acute process. Unremarkable cardiomediastinal silhouette.No focal pulmonary opacities, pneumothorax, or pleural effusions.

Output: No significant abnormality by radiography. Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: sob, cough History: sob Opacity projecting over the anterior right sixth rib which may represent overlapping structures. A small nodule cannot be excluded. Clarification with a CT thorax is recommended.No consolidation, pleural effusion or pneumothorax. The heart size is normal. Multilevel degenerative changes of the thoracic spine are again identified.

Output: No specific evidence of infection. There is a nodular opacity projecting over the anterior right sixth rib which may be artifact. Clarification with a CT thorax is recommended. This was discussed with Dr. Walter in the ER at the time of image interpretation.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old Reason: eval for sbp, free air, constipation History: abdominal pain Cardio mediastinal silhouette is normal. Lungs are clear.There is gaseous distention of the colon. There is gas within nondistended small bowel loops. No definite free intra-abdominal air.There are postsurgical changes with multiple clips in the upper abdomen. Linear tracks of gas projects over the liver and may represent biliary air.

Output: Mild gaseous distention of the colon suggestive of an ileus. if symptoms persist consider CT.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: r/o ptx/infection History: acute SOB Large lung volumes compatible with COPD. No interval evidence of edema or infection. The cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: multiple myeloma with cough and shortness of breath History: multiple myeloma with cough and shortness of breath. Large air-filled retrocardiac hiatal hernia, unchanged.Otherwise unremarkable examination with no evidence of pneumonia or other acute disease.

Output: Large hiatal hernia and no acute change.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: post op, eval lung fields History: s/p CABG Interval extubation and removal of a Swan-Ganz catheter.Small lung volumes with nonspecific basilar opacities compatible with edema, atelectasis and pleural effusions.No pneumothorax or other acute change.

Output: Mild residual edema with basilar atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: CT in place History: CT in place Right chest tubes unchanged in position.Basilar subsegmental atelectasis and cardiomegaly stable. Small pleural effusions.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: r/o pneumothorax History: r/o pneumothorax 2 right-sided apically directed chest tubes unchanged.Right apical pneumothorax, right pleural thickening/effusion, and right-sided pulmonary opacities similar in appearance to the prior exam.Left lung is clear.Small amount of subcutaneous emphysema noted along the right lateral chest wall.Stable cardiomediastinal silhouette.

Output: Persistent right apical pneumothorax with right pleural thickening/effusion and interstitial/airspace opacities in the right lung similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.PPD or QFT positive Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: No specific evidence of pulmonary tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Evaluate lung fields status post VATS wedge, left chest tube in place. Left chest tube with tip near the apex. No significant sized pneumothorax. Low lung volumes with basal atelectasis. New masslike opacity at the left base most likely reflects hematoma surrounding the resection site. Small volume of pleural fluid on the left. Interval removal of right pigtail catheter. Minimal subcutaneous emphysema left chest wall.

Output: Left chest tube tip near the apex, no significant sized pneumothorax. Probable postoperative hematoma.


Instruction: Generate impression based on medical findings.

Input: Pneumothoraces Bilateral chest tubes with underlying possibly loculated pneumothoraces are unchanged in position and appearance.Extensive underlying lung disease and fibrotic scarring also similar with probable small to moderate effusions. Cardiac and mediastinal contours are otherwise within limits and unchanged

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: Please r/o acute chest History: 30 yo F with MICU admission for acute chest now on floor off abx, spiking fevers Central dense interstitial and airspace opacities are unchanged consistent with edema or aspiration, or hemorrhage.Heart size normal.Cholecystectomy clips.

Output: Unchanged dense interstitial and airspace opacities consistent with edema, aspiration or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: URI s/s with hx asthma- breath sounds diminished on exam History: URI s/s with hx asthma- breath sounds diminished on exam Although there is bronchial wall thickening consistent with history of asthma, the heart is mildly enlarged and there are small pleural effusions.Thickening of the fissures may indicate evolving edema.Spina bifida occulta T1.

Output: Cardiomegaly and small pleural effusions may be cardiogenic. Bronchial wall thickening is consistent with the provided history of asthma.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: chest pain History: chest pain Lungs hypoinflated. Otherwise, no acute cardiopulmonary abnormality.

Output: Lungs hypoinflated. Otherwise, no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: PneumothoraxVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right chest tube in place. There is a moderate size right pneumothorax decreased from prior exam. Large left pneumothorax decreased from prior exam with placement of a left chest tube. There is subcutaneous emphysema in the left lateral chest wall.

Output: Left pneumothorax decreased in size with placement of a left chest tube.


Instruction: Generate impression based on medical findings.

Input: Reason: confirm line position History: intubated patient ET tube tip approximately 3 cm above the carina.NG tube tip in the stomach.No significant pulmonary abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Stable, partially calcified old lobe opacity in the right upper lobe on image number 30, series number 5, measuring 14 x 12 mm,. Calcified right upper lobe granuloma.MEDIASTINUM AND HILA: Anterior mediastinal soft tissue density is stable measuring 29 right on millimeter image number 37, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: 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: Stable CT findings.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer No acute cardiopulmonary abnormality. Mild tortuosity of the aorta with atherosclerotic changes.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Evaluate disease status prior to new treatment initiation History: Stage IV melanoma The known nodule in the lingula was better seen on recent CT. No acute cardiopulmonary abnormality.

Output: The known nodule in the lingula was better seen on recent CT. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: Patient with right-sided chest pain for 2 weeks. Please evaluate for etiologies of chest pain. History: Right-sided chest pain Cardiomediastinal silhouette is within normal limits. No focal air space abnormality. No pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: LVAD malfunction History: LVAD Left subclavian ICD, LVAD, sternotomy fixation unchanged.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Stable cardiomegaly.

Output: LVAD is unchanged radiographically. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: tachypnea, SOB, upper airway rhonchorous breath sound s/p EVAR 10/7 History: tachypnea, SOB, upper airway rhonchorous breath sounds Moderate cardiomegaly with evidence of previous median sternotomy.Airspace opacity and volume loss in the left lower lung and chronic appearing interstitial opacity at the right base.A CT scan has been performed and provides more detailed evaluation.

Output: Atelectasis and nonspecific airspace opacity in the left lower lung.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.History of cough, crackles. Linear basilar opacities consistent with atelectasis/scarring without acute interval change. No pneumothorax.Cardiac silhouette unchanged in size.Right chest port unchanged in position. Interval removal of NG tube.

Output: Basilar scarring/atelectasis without acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: rule out infection History: cough, dysnpea Stable cardiomediastinal silhouette.New left basilar opacity compatible with consolidation/atelectasis and may be secondary to aspiration.The right lung is clear.No pleural effusions.Metallic densities overlying left chest and lower thoracic spine unchanged.G-tube in place.

Output: Left basilar atelectasis/consolidation, possibly related to aspiration. Infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Status post OHT. Surveillance. Low lung volumes. Mild bibasilar subsegmental atelectasis, unchanged. No pleural effusions or pneumothorax.Cardiomediastinal silhouette is within normal limits.Hardware unchanged. Right IJ Swan-Ganz with tip in the right main pulmonary artery.

Output: Mild bibasilar subsegmental atelectasis, unchanged. Right IJ Swan-Ganz with tip in the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: 64yoM septic shock, SOB History: SOB Right jugular catheter with its tip in the SVC.No pneumothorax or other complications.Small lung volumes with mild perihilar opacity compatible with atelectasis and edema.

Output: Mild perihilar opacity compatible with atelectasis and possibly edema.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: r/o pneumonia History: sob Patchy lower lung zone predominant interstitial opacities with basilar atelectasis and pleural effusions are present.Heart size relatively normal.

Output: New pulmonary opacities and pleural effusion suggestive of CHF more likely than pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: evaluate for infection, PNA History: Abnormal lung sounds, cough, poor air exchange rt lung Stable cardiomediastinal silhouette with atherosclerotic changes of the aorta.Apical scarring and scattered granulomata unchanged.No new pulmonary opacities identified.No pleural effusions.Scoliosis of the thoracolumbar spine redemonstrated.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Chills \T\ tachypnea in immuocompromised patient. r/o infection or pleural effusion History: Chills \T\ tachypnea Mild cardiomegaly with a small right pleural effusion, not significantly changed.Catheter tip in the SVC.No evidence of pneumonia.

Output: Small right pleural effusion and no new findings.


Instruction: Generate impression based on medical findings.

Input: 56 yo F s/p colonoscopy on 7/6 with worsening abdominal pain, nausea/vomiting, evaluate for perforation or other complication. Mild stable cardiomegaly. No focal pulmonary opacities. No pleural effusions.Cholecystectomy clips in place. Mild small bowel gaseous distention without evidence of obstruction. Stool noted within the right colon. No definite free intraperitoneal air identified.

Output: No definite free intraperitoneal air identified.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: previous smoker, elevated white count, rigors, r/o infection History: smoker, elevated WBCs Coarsened bronchopulmonary markings with no specific evidence of infection or edema.Heart size normal. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: eval for infiltrate History: cough for 3 days Cardiac size is within normal limits. No large pleural effusions, pneumothorax, pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Status post CABG and IABP evaluate ETT and lung fields. Postoperative pneumopericardium. No pneumothorax.ETT tip 3.5 cm above the level of the carina.IABP marker at the level of the T8/T9 vertebrae. Right jugular Swan-Ganz catheter the level of the right main pulmonary artery. Mediastinal drains and a right basal chest tube are in place. Right subclavian ICD unchanged in position with unusual course from the SVC though it appears to terminate in the region of the right ventricle.Subsegmental atelectasis and patchy nodular opacities suspicious for aspiration of secretions. Minimal pleural fluid.

Output: Low position of intra-aortic balloon pump marker, at the level of the T8/T9 vertebral interspace. Mild aspiration of secretions.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with bladder cancer and prostate cancer. Lung nodule. CHEST:LUNGS AND PLEURA: 19 x 15 mm left lower lobe nodule has not significantly changed (series 5; image 75). The smaller right lower lobe nodule is unchanged.MEDIASTINUM AND HILA: No adenopathy. Calcified lymph nodes are again identified.Status post CABG with coronary artery calcifications. Hypodense thyroid nodules, stableCHEST WALL: Pacemaker.ABDOMEN:LIVER, BILIARY TRACT: No hepatic lesions are seen.Cholelithiasis.Small cystic focus at the gallbladder fundus may represent adenomyomatosis, stable.SPLEEN: No significant abnormality.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts with scattered scarring is stable.RETROPERITONEUM, LYMPH NODES: 17 x 9 mm pericaval lymph node (series 3; image 108), unchanged.BOWEL, MESENTERY: Small hiatal hernia.17 x 17 millimeters soft tissue density is noted between the gastric fundus and spleen is unchanged from 1/08 and would be unusual for a metastatic lesion. It could potentially represent a gastric diverticulum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Diffuse atherosclerotic disease.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatectomy.BLADDER: Cystectomy with ileal conduit.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left inguinal hernia containing nonobstructed small bowel, unchanged.BONES, SOFT TISSUES: Multiple surgical clips in the pelvis. The bones are osteopenic. OTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval lung fields History: s/p CABG Cardiomegaly status post sternotomy with chest tubes but no pneumothorax.Lower lung zone edema and atelectasis is gradually worsening.Right jugular Swan-Ganz catheter tip in right pulmonary artery.IABP catheter distal marker 6 cm below the top of the aortic arch.Severe gaseous distention of stomach is present and an NG tube may be advisable.

Output: Gradually worsening pulmonary opacities. Markedly distended stomach.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o PNA History: CP, cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Follow up pneumonia. Look for worsening opacities, abscess, new pleural effusion. Uptrending WBC despite appropriate antibiotics for HCAP. Stable cardiomediastinal silhouette.Chronic bilateral interstitial opacities with a more focal left lower lobe opacity. No large pleural effusion or pneumothorax.Gastrostomy tube is in place. Pneumoperitoneum has improved and possibly resolved.

Output: Development of left lower lobe opacity on a background of pulmonary fibrosis is not significantly changed. This may be secondary to infection or exacerbation of interstitial lung disease and could be further evaluated with ILD CT. Unable to assess for abdominal pathology.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p left apical lesion biopsy and chest tube placement History: None Left pigtail pleural catheter unchanged with no pneumothorax.Minimal left chest wall soft tissue emphysema is noted.Unchanged left upper lobe mass, and apical emphysema.

Output: No significant pneumothorax, left pleural drain in place.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: Pre-operative evaluation History: None The cardiomediastinal silhouette is within normal limits. Cavitary retrocardiac lesion with apparent thick walls and adjacent calcification is again seen.No focal consolidation, pleural effusion, or pneumothorax is identified.

Output: Stable retrocardiac cavitary-like lesion, which is favored to represent a postinfectious bronchocele related to a previously obstructed bronchus.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: Elevated white blood cell count in a immunosuppressed patient. The cardiomediastinal silhouette is normal. There is no focal opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: reevaluate right pleural effusion History: reevaluate right plerual effusin Right pleural catheter unchanged.Stable cardiomediastinal silhouette.Bilateral pleural effusions similar to the prior exam.Septal thickening suggestive of edema redemonstrated.Innumerable pulmonary nodules and right perihilar mass again identified.No new pulmonary opacity noted.

Output: Stable cardiopulmonary appearance with bilateral pleural effusions and innumerable pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: lung eval History: lung eval Right chest tubes with no pneumothorax.Unchanged right subpulmonic pleural effusion with overlying atelectasis.Right jugular catheter, tip in main pulmonary artery region.

Output: No significant pneumothorax. Unchanged right pleural effusion and overlying basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: 29 F with hx of kidney/pancreas Txp on immunosuppressive, p/w chest pain, SOB, "PNA" at OSH History: CP, SOB Small pleural effusions and basilar opacity suggestive of infection or aspiration.Mild cardiomegaly.

Output: Basilar opacities consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with history of AML. Pre-transplant evaluation. LUNGS AND PLEURA: Few scattered micronodules bilaterally are nonspecific, likely represent intrapulmonary lymph nodes.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant findings.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 3 cm above the carina.Venous catheter tip in the right atrium.Mild streaky basilar opacities compatible with atelectasis and aspirated secretions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: cause of fever History: fever No significant cardiopulmonary abnormality.Right subclavian catheter, tip in SVC.A moderate amount of gas-filled bowel is present, none particularly dilated however.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: s/p TECAB History: s/p TECAB The right central venous line has been removed. There is no pneumothorax.Stable bibasilar opacities and pleural effusions.

Output: Right internal jugular venous sheath has been removed. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: evaluate for opacities or effusions History: shortness of breath, history of COPD and CHF Pacemaker with leads in the right atrium and ventricle.The heart size is normal. Large lung volumes. Blunting of the left costophrenic angle is consistent with scarring and/or small pleural effusion. No radiographic evidence of infection.

Output: Left basilar scarring and/or small pleural effusion without radiographic evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: 74 y/o M hx of aspiration PNA, admitted for PNA History: SOB Interval increase in patchy peripheral, right greater than left, airspace opacity likely aspirate or pneumonia.

Output: Interval increase in patchy peripheral, right greater than left, airspace opacity likely aspirate or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Zero female NSCLC with brain METs and recent UTI with mental status changes leukocytosis. CHEST:LUNGS AND PLEURA: There is a large right perihilar mass measured on series 3 image 35 is 4 x 3.6 cm the component compressing the growing into the right pulmonary artery and markedly compressing and occluding adjacent bronchi with near complete collapse of the right lung and some sparing of the right upper lobe. There is associated pleural fluid. There are no axillary middle mediastinal or left hilar nodes. No diaphragmatic or retrocrural nodes. The left lung demonstrates ground glass appearance with some fibrotic changes. Fibrotic changes are also seen in the right upper lobe.MEDIASTINUM AND HILA: As above.CHEST WALL: Port-A-Cath right chest wall. Possible lipoma anterior chest wall on the first image. NG tube.ABDOMEN:LIVER, BILIARY TRACT: Numerous scattered hypodense lesions in the liver consistent with cysts, unchanged from the prior exam.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There are two nodules in the left adrenal gland. Previously measured lesion is stable and sixth imaging one measured 1.7 x 1.2 cm. A second nodule just cephalad to it on image 79 measures 1.4 x 1.1 cm.The right adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Caval filter. Hypodense irregularly-shaped somewhat tubular structure abutting the inferior vena cava may represent a thrombosed gonadal vein. The I do not think it represents a node. It is unchanged from prior exam.BOWEL, MESENTERY: No significant abnormality noted.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: Irregular shaped hypodense lesion in the dependent portion of the left hemipelvis redemonstrated consistent with a cystic metastasis. It measures 5 x 4.6 cm, unchanged. There is loss of fat plane to the pelvic wall musculature and to the region of the cervix.BOWEL, MESENTERY: Colonic diverticulosis. Otherwise unremarkable. No evidence of ascites.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Marked increase in size of mass in the right lung marked increase in involvement of the right pulmonary artery. Stable left adrenal nodules and cysts hypervascular mass in the dependent portion of the left hemipelvis. This distribution of the pelvis is unusual for lung cancer. Correlate clinically. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with history of Hodgkin lymphoma and SVC syndrome. Please reevaluate disease and clot. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. Biapical scarring unchanged. MEDIASTINUM AND HILA: Reference prevascular lymph node stably measures 1.3 x 1 cm (series 3, image 39). Heart size normal without pericardial effusion. No definite thrombus is seen in the SVC; evaluation is limited by mixing artifact in the vasculature at this level.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Stable cholelithiasis without evidence of acute inflammation or ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Stable left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable examination


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: Eval change in lung parenchyma History: Intubated Endotracheal tube unchanged terminating approximately 4 cm from the carina. NG tube terminates inferiorly off the field-of-view. Intra-aortic balloon pump metallic component terminates approximately 6.3 cm the top aortic arch. PICC line, unchanged. Diffuse pulmonary opacities, more confluent basilar opacities, and pleural effusions again noted, not substantially different. Unchanged heart size. No pneumothorax.

Output: Lines and tubes, as above. Diffuse pulmonary opacities and pleural effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: Hypoxia - evaluate for improvement of lung whiteout History: Hypoxia Continued increase in right pleural effusion. No change in the appearance of the left lung mass and nodules. No pneumothorax.

Output: Continued progression of right lung effusion and atelectasis associated with the mass. No change in the metastatic masses and nodules involving the left lung.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval RIJ line placement History: line placed Internal jugular venous catheter with tip in the projection of the right brachiocephalic vein. There is no pneumothorax. Cardiac mediastinal silhouette is within normal limits. No lung opacities. No pleural effusions.

Output: New right internal jugular catheter. No evidence of pneumothorax, infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PTX, reaccumulating effusion History: Momentary desaturation to 60's during Pleurx drainage. Left pleural drain extending to the apical area with a small residual pleural effusion but no significant pneumothorax.Underlying left basilar opacity consistent with atelectasis.No other significant change.

Output: Markedly decreased left pleural effusion and no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: r/o pneumothorax History: s/p chest tube removal Moderate cardiomegaly.No pneumothorax following recent chest tube removal. Stable basilar atelectasis left greater than right.Left PICC, tip in the SVC.

Output: No pneumothorax following chest tube removal, and no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: PRE Lung or Heart-Lung Transplant Evaluation History: PRE Lung or Heart-Lung Transplant Severe emphysema right more extensive than left.Heart size normal.No specific evidence of infection or edema.

Output: Severe emphysema. No new abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64 yo M with swan catheter in place, confirm position History: see above Mild cardiomegaly.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter tip in right ventricular outflow tract, subsequently advanced.Remnants of a left subclavian ICD remain in the chest wall.

Output: Mild cardiomegaly. Swan-Ganz catheter in right ventricular outflow tract.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: abdominal pain, fever History: above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Male 50 years old with history of hypoxia, tachycardia, concern for pulmonary embolism Right IJ catheter and right subclavian catheter stable in position.Decreased lung volumes. Stable cardiomediastinal silhouette. Bibasilar atelectasis as well as bilateral airspace and interstitial opacities grossly stable.

Output: Stable nonspecific bilateral airspace and interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Severe COPD and dyspnea with cough. Preop. Sternotomy wires and surgical clips suggestive of prior CABG, some of the wires are discontinuous and is seen previously. Normal heart size.Probable calcified granuloma in in the left lung. Hazy opacity at the lung bases nonspecific but most suggestive of bronchiolitis or pneumonitis.

Output: Hazy basilar opacity suspicious for bronchiolitis or possibly pneumonitis. This finding is nonspecific but most commonly seen as the result of of aspirated secretions or gastric contents absent clinical signs of infection. Suggest conservative imaging follow-up with chest radiograph in 1-2 weeks to assess for clearance.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for etiology of chest pain/abnormal EKG History: Chest pain, SVT Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: AMCXR History: AMCXR Right PICC line, left-sided chest tube, and upper abdominal drainage catheters unchanged. Decreased lung volumes with basilar atelectasis and small left pleural effusion similar appearance the prior exam.No new pulmonary opacities identified.No pneumothorax.

Output: No interval change in the basilar atelectasis and small left pleural effusion. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with aspergilloma, respiratory failure, hemoptysis. Endotracheal tube tip 6 cm above the carina. Enteric tube extends extends beyond the inferior margin of the study. Left IJ venous catheter tip in the SVC.Emphysema with unchanged bilateral interstitial and airspace opacities, including aspergilloma in the right upper lobe cavity. No pneumothorax. Normal cardiomediastinal silhouette.

Output: No significant interval change in bilateral pulmonary opacities, including right upper lobe aspergilloma, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Check for pulmonary edema in a patient with chest pain Persistent and unchanged mild interstitial changes mildly greater basilar distribution. No discrete superimposed new airspace abnormality, specifically no findings to support edema and/or effusions. Apical scarringModerate nonspecific cardiomegaly with associated moderate tortuosity of the aorta and atherosclerotic disease unchanged

Output: Cardiomegaly with underlying interstitial chronic change yet without superimposed findings to suggest infection


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval for effusion, ptx, History: sp transhiatal esophagectomy and had afib w rvr Interval removal of enteric tube.Low lung volumes.Basilar atelectasis, left greater than right, increasing on the left.No pneumothorax.Stable cardiomediastinal silhouette.Small volume pneumoperitoneum compatible with stated history of recent surgery.

Output: Increasing left basilar atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: LUL rales and URI symptoms, fever, eval for PNA Unremarkable cardiomediastinal silhouette.Mild bronchial wall thickening which can be seen with bronchitis.No focal pulmonary opacities, pneumothorax, or pleural effusions.

Output: Bronchitis without pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: UPRIGHT EXAM; free air? History: abdominal pain No sign of free intraperitoneal air.Heart size about upper normal or mildly enlarged.No significant pulmonary abnormalities.

Output: No sign of free intraperitoneal air on this semierect portable radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.History: Known C1 cervical spinal mass with spinal stenosis. Left neck pain, Shoulder pain Unremarkable cardiomediastinal silhouette.No pulmonary nodule or mass.Chronic basilar interstitial changes compatible with fibrosis.Marked degenerative changes of the thoracic spine.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Immunosuppressed with cough and fevers. Unchanged mild cardiomegaly. There is a tortuous aorta. Surgical clips are seen over the right paratracheal region. No focal opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: intubated History: na Interval removal of the lower left chest tube. Other support hardware is stable.Diffuse bilateral pulmonary opacity compatible with edema.Findings on the right consistent with previous thoracoplasty.ET tube tip approximately 4 cm above the carina.

Output: Interval removal of lower left chest tube with no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Right jugular catheter placed ETT remains 4 cm above the carina. A new left jugular catheter projects below the diaphragm and possibly into the hepatic vein. The previously described left jugular and right jugular catheters are otherwise similar without complication. Left subclavian also terminates just to the confluence with the innominate and SVC.Cardiopulmonary appearance is similar

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: s/p MVR and AVR History: post op Moderate cardiomegaly status post sternotomy.Large lung volumes consistent with COPD.Very small pleural effusions are present, but no edema is identified.Status post valve replacement.Calcified fragments are identified in the left shoulder bursa.

Output: Cardiomegaly and small pleural effusions with underlying COPD.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: concern for aspiration pneumonia History: concern for aspiration pneumonia Small pleural effusions have developed, but there is no other evidence of edema or pneumonia.Heart size normal.Right jugular catheter, tip in SVC.

Output: Small pleural effusions, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: patchy opacities on prior CXR Catheters extending to the SVC.Bilateral patchy and nodular pulmonary airspace opacities, nonspecific but compatible with infection, not significantly changed.No new findings.

Output: Diffuse patchy and nodular pulmonary opacities compatible with infection.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and right effusion Unchanged right basilar chest tube with large effusion. Probable loculation. Underlying compression atelectasis with patchy nonspecific parahilar opacities. Left lung clearProbable mild cardiomegaly.

Output: Unchanged right chest tube and effusion


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of urothelial cancer CHEST:LUNGS AND PLEURA: Nonspecific micronodules in the left lower lobe is not well seen on the current study. No other micronodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST 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: Status post left nephrectomy. No evidence of recurrence.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: Previously described presumed left ureteral remnant has slightly increased in size and has associated fat stranding around it.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the left ureteral remnant with now associated fat stranding. Etiology is unknown. Further evaluation with endoscopy is recommended. No other significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p LVAD Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with pleural effusions and left lower lobe atelectasis, not appreciably changed.No new findings.

Output: CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: MaleReason for Study: Reason: TRNASBRONCHIAL BX History: R/O PNEUMO THORAX There are decreased lung volumes with stable cardiomediastinal silhouette.Focal air space opacity in the right lower lung zone but appreciably related to recent bronchoscopy.No evidence for pneumothorax.Postsurgical changes related to prior bilateral lung transplant.

Output: Focal air space opacity in the right lower lung zone presumably related to recent bronchoscopy and transbronchial biopsy. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT repositioned, tip projects 3 cm above the carina. NG, ICD and right jugular catheter are all otherwise unchanged and well positionedUnderlying cardiopulmonary appearance is also similar with mixed interstitial patchy opacities mildly greater in both bases with moderate effusions. Again suspected moderate CHF given mild borderline cardiomegaly

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Fever Persistent decreased lung volumes with minimal atelectasis and streaky patchy opacities observed in both bases and throughout the left hemithorax. Questionable small right effusion.Unchanged left subclavian catheter, tip projects into the innominateThe cardiac and mediastinal contours remain unchangedNumerous unchanged healing rib fractures and deformities bilaterally

Output: Mildly increasing streaky patchy densities mildly greater on the left, concern for aspiration and less likely infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: 66F hx of COPD, heroine use here w SOB; eval for COPD vs infection History: as above Stable cardiomediastinal silhouette with multiple coronary stents.Lungs are clear with no focal consolidation or sizable effusion. COPD changes again seen.Degenerative changes of the bilateral glenohumeral joint, right greater than left.

Output: Stable appearance of the chest with COPD changes and no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Left-sided 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: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable CT.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.History of systolic heart failure. Stable global cardiomegaly. ICD/pacemaker in place, unchanged in position.The right IJ Swan-Ganz catheter overlies the proximal left pulmonary artery. The right subclavian venous catheter there overlies the SVC, also stable in position.Persistent signs of pulmonary venous hypertension and interstitial pulmonary edema.Moderate right pleural effusion is unchanged from recent comparisons. No pneumothorax.

Output: Stable adequate position of support apparatus.Moderate right pleural effusion is unchanged from priors.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: pre-op History: pre-op Cardiomediastinal silhouette is unremarkable.Diffuse upper lobe predominant emphysematous changes consistent with COPD.No focal opacities.No pleural effusions or pneumothorax.

Output: COPD without acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval for sarcoid and PNA History: eval for sarcoid The cardiomediastinal silhouette is normal. Lungs are clear of airspace and interstitial opacities. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality or specific evidence for pulmonary sarcoid.


Instruction: Generate impression based on medical findings.

Input: Fallopian tube cancer, right pleural effusion Interval extubation and NG tube removed. The right pleural effusion has largely resolved only minimal fluid and/or scarring persists.Right upper and left lungs are clear.Cardiac and mediastinal contours are within limits. Right jugular single port has been placed in good position

Output: Near complete resolution of a right pleural effusion


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: new HD line confirmation History: new HD line confirmation of placement ET tube tip terminates 5 cm above the carina. Left IJ tip terminates at the tubercle junction. Right IJ tip terminates in the right PICC terminates in the right brachiocephalic vein. NG tube tip terminates in the gastric body.Increased retrocardiac opacity consistent with increasing atelectasis. Bibasilar interstitial opacities consistent with edema similar to prior. Low lung volumes. No pneumothorax. Small left and probable small right pleural effusions unchanged. Mild cardiomegaly unchanged.

Output: Increased retrocardiac atelectasis. Edema and effusion similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Sickle cell disease with chest pain. The cardiomediastinal silhouette is stable. Right-sided chest port tip at the cavoatrial junction.No focal airspace opacity pleural effusions or pneumothorax. Minimal right basilar scarring.

Output: No acute cardiopulmonary abnormality or significant interval change.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, 58 years old.Intubation. Endotracheal tube tip is approximately 4.9 cm above the carina. A right chest tube, bilateral IJ central venous catheters, and enteric tube appear similar in position to the prior exam.Right chest wall subcutaneous emphysema and left retrocardiac opacity are again noted. The heart size is stable.

Output: Endotracheal tube tip 4.9 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with dyspnea, LE edema. Evaluate for pulmonary edema. Chest wall AICD with leads unchanged. LVAD device in place. Intact sternotomy wires.Retrocardiac and left basilar opacity/pleural effusions similar to prior. No focal airspace opacity or significant pleural effusion on the right. No pneumothorax. Marked cardiomegaly.

Output: Retrocardiac and left basilar opacity/pleural effusions similar to prior.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p AVR Large lung volumes compatible with COPD.Mild basilar opacities compatible with small effusions and atelectasis.Sternal fixation devices, intact, with an aortic valve prosthesis and mediastinal drain in place.

Output: Small pleural effusions and basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with history of uterine cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Borderline enlarged left supraclavicular lymph node measures 12 x 10 minutes and image number 10, series number 4, not significantly changed.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific left para-take lymph node is unchanged measuring 10 x 7 mm image number 121, series number 4.New cystic well-defined lesion in the right pericaval region measuring 5.2 x 6.6 cm image number 115, series number 4. Given the lack of a solid component this more likely represents a lymphocele.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Interval hysterectomy and oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: Interval development of a right retroperitoneal cystic lesion likely representing a lymphocele.Interval hysterectomy and salpingo-oophorectomy.No other significant change from prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: 71F s/p TAVR History: - Mild to moderate cardiomegaly, unchanged.Right greater than left pleural effusions and bilateral interstitial and airspace opacities do not appear significantly changed. No pneumothorax.Post surgical changes secondary to TAVR. Cholecystectomy clips. Left upper extremity PICC tip is at the level of the axillary vein.

Output: 1. Right greater than left pleural effusions and bilateral interstitial and airspace opacities do not appear significantly changed.2. Left upper extremity PICC tip is at the level of the axillary vein.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: Age: 49 yearsGender: MaleReason for Study: Reason: evaluation of R chest wall pain x years , mid thoracic, mid axillary line along rib, poss old rib fx? History: as above Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.Dextroscoliosis of the thoracic spine redemonstrated.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Muscle pain and chest pain No cardiopulmonary abnormality.Sternotomy unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Shortness of breath. Evaluate for infection versus asthma. No pulmonary opacities, pleural effusions, or pneumothorax.Cardiac silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: r/o pneumonia History: cough/fever Low lung volumes makes detailed cardiopulmonary assessment difficult. Lateral radiograph limited by patient motion. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Patient status post cholecystectomy. Large patient body habitus.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.History: Pulmonary hypertension, Chronic iron deficiency anemia secondary to blood loss. Signs and symptoms: Leg swelling, increased exertional dyspnea, and chest pain. Right-sided port with tip in the right atrium, unchanged from prior radiographs.Persistent cardiomegaly with prominent pulmonary arteries, compatible with known pulmonary hypertension. No evidence of acute exacerbation.No focal pulmonary opacity or pleural abnormalities.

Output: No evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Left-sided pneumothorax.VIEW: Chest AP (one view) 5/4/2016 at 1419 hours. ET tube tip is below thoracic inlet. NG tube and umbilical lines unchanged. Interval removal of one of 2 left-sided chest tubes. Cardiac silhouette size is normal. Persistent bilateral diffuse lung haziness, large lung volumes and pattern of PIE. Stable left-sided pneumothorax.

Output: Stable left-sided pneumothorax after chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Acute respiratory failure with hypoxiaVIEW: Chest AP Right upper extremity PICC tip terminates at the right atrium. ET tube tip is at the thoracic inlet. NG tube terminates at the stomach. Gastrostomy tube is in place. Soft tissue edema persist. Cardiothymic silhouette normal. There is a right chest tube in place with improved aeration right lung. No evidence of pneumothorax. Diffuse left lung opacities not significantly changed.

Output: Right lung aeration improved from prior exam.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with right upper quadrant pain. History of cholangiocarcinoma. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Anterior mediastinal triangular shaped soft tissue density may represent thymic tissue.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined, infiltrative hypodensity replaces the entire left lobe of the liver. The extent of the patient's known mass cannot be clearly delineated on this single phase CT study. The liver is enlarged.Paracardiac lymph nodes. There is a node measures 13 x 8 mm number 61, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate left renal stone without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Hepatoduodenal and peripancreatic enlarged lymph nodes. In reference lymph node measures 2.4 by 1.6-cm image number 88, series number 3. Other para-aortic and paracaval lymph nodes are also present. A reference, paracaval lymph node measures 15 by 9- millimeter image number 133, series number 3.BOWEL, MESENTERY: Unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large, infiltrative hypodensity replacing most of the left lobe of the liver. The extent of patient's known cholangiocarcinoma is not clear on this single phase study. Multiple enlarged. Upper abdominal and retroperitoneal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tubes History: chest tubes Interval removal of Swan-Ganz catheter.Other devices unchanged.Small lung volumes with bilateral nonspecific opacity compatible with edema and atelectasis.No pneumothorax or other acute change.

Output: Interval removal of Swan-Ganz catheter and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Intubated. Other mechanical complication of unspecified cardiac device, initial encounter. ETT tip 2.5 cm above the level of the carina. Left subclavian midline catheter terminates at the SVC near its confluence with the brachiocephalic veins. A peripheral catheter from the right terminates at the superior cavoatrial junction. Enteric tube tip off the caudal margin of the film.Low lung volumes with layering pleural fluid and significant compressive atelectasis about the same. Partial clearing of airspace opacities in the upper lung zones since the prior study.

Output: ETT tip 2.5 cm above the level of the carina. Partial clearance of airspace opacities in the lung apices, though significant compressive atelectasis and airspace opacities remain in the lower lung zones and pleural fluid volume appears unchanged.


Instruction: Generate impression based on medical findings.

Input: Evaluate Dobbhoff tube placement Interval retraction of enteric tube, now seen overlying gastric fundus. Nonobstructive bowel gas pattern. Healing right-sided ninth posterior rib fracture.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: pneumonia, cardiomegaly, effusion History: neutropenia, elevated lactic acid Right-sided PICC again terminates in the SVC. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: MaleReason for Study: Reason: fever, cough, r/o pneumonia History: fever, cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with metastatic melanoma now with acute renal failure and severe abdominal pain, recent elevated lactate diffusely. Evaluate for signs of infection, clivus carcinomatosis. Shortness of breath. question of ascites/SBP. CHEST:LUNGS AND PLEURA: Scattered diffuse increased interstitial markings, fibrotic changes, pleural thickening and micronodules redemonstrated. Slight increase and bilateral pleural effusions and now right basilar atelectasis or consolidation. Rule out aspiration or pneumonia. Comparison the maximal intensity projection and retained lung views suggest that there might be new micronodules in the upper lobes.MEDIASTINUM AND HILA: Scattered small mediastinal nodes. Previously measured right pretracheal node is completely fatty replaced and should no longer be followed or measured. This is not pathologic node.Granulomata right hilum. Vascular calcification aorta and pulmonary outflow tract. Correlate for prior surgery.CHEST WALL: Sternotomy.Pathologic size index left axillary node is increased in size and measures 3.5 x 2.8 cm series 4 image 33 previously 2.6 x 2 cm.Mild gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Diffuse intrahepatic hypoattenuating lesions consistent with metastases markedly increased. The appearance of a hypoattenuation along the dome of the liver suggests areas of subcapsular fluid and bleeding or possible areas of infarction. The liver is enlarged at 25 cm cephalocaudad as measured on coronal image 48.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: New right adrenal gland nodule 1.5 x 1.4 cm series 4 image 90.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Noted in the right perirenal space likely a metastatic focus measures 1.6 x 1.3 cm series 4 image 107. On the prior scan it measured 1 x 0.9 cm series 4 image 88.Caval filter. Atherosclerotic changes aorta without aneurysm.BOWEL, MESENTERY: Small amount of free intraperitoneal fluid. No measurable carcinomatosis. No evidence of bowel obstruction. Partial intrathoracic stomach.BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of intraperitoneal fluid in the dependent portions of the pelvis. Some of this is slightly high density but without discrete layering and hemoperitoneum cannot be excluded.BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality noted

Output: Marked progression of hepatic lesions consistent with metastases. Increase in size of some of the lesions. Chronic changes and possibly some new micronodules in the lungs. New right adrenal nodule. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.AML and hypoxia. Left PICC tip at the level of the right atrium.Central venous distention and septal thickening consistent with mild to moderate hypervolemia and interstitial edema. Airspace opacities at the right lung base, nonspecific.

Output: Mild/moderate hypervolemia/CHF. Superimposed airspace process on the right may reflect atypical edema however hemorrhage, drug reaction or infection cannot be excluded in the setting of AML.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male, septic with infected abdominal wall wound. Evaluate for extension. Status post minimally invasive esophagectomy. CHEST:LUNGS AND PLEURA: Tracheostomy tube tip is below the thoracic inlet. Stable position of a tracheal stent is noted. Right internal jugular catheter tip at the SVC\RA junction. Right chest tube is unchanged in position. Interval placement of a pigtail drainage catheter within the low left hemithorax; based on reference measurements, interval decrease in size of left pleural fluid collection, which now measures 5.5 x 4.2 cm (image 60\27). This left pleural fluid collection communicates with a posterior mediastinal air collection, as seen on image 65\207. Interval improvement of bilateral dense pulmonary consolidations. Small residual pneumothorax affects the right hemithorax.MEDIASTINUM AND HILA: Again noted is a posterior mediastinal air collection, which communicates with the dependent left hemithorax drained fluid collection. Postoperative changes of esophagectomy are seen.CHEST WALL: Extensive right chest wall subcutaneous emphysema likely secondary to indwelling right chest tube.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple punctate calcifications are seen within both kidneys. No hydronephrosis or perinephric fat stranding, concerning for an inflammatory process.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Feeding tube in the left lower quadrant is unchanged in position. Postoperative changes of esophagectomy are present. Prominent caliber of the proximal colon is again noted; small bowel is normal in caliber. This maybe due to a focal ileus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Again noted is a infrarenal IVC filter. An open anterior midline abdominal wall defect is seen with dependent debris; multiple small bowel loops closely abut this abdominal wound; however, no loculated intraperitoneal component is present.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder is drained by a Foley catheter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Rectal tube is present. Distal colon is collapsed. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in size of drained left pleural fluid collection, which communicates with a posterior mediastinal air collection, as detailed above.1.Interval decrease in size of dense bilateral pulmonary air space consolidations.2.Postoperative changes of an esophagectomy.3.Open anterior midline abdominal wound with multiple closely associated small bowel loops; however, no loculated intraperitoneal component is present.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: Fever with VOC, evaluate for new opacity/acute chest syndrome New right greater than left lung consolidation with small pleural effusions. Moderate cardiomegaly again noted. Bony changes consistent with sickle cell disease.

Output: New bibasilar consolidation and small pleural effusions consistent with pulmonary edema, pneumonia, aspiration, and/or acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval for chest pain History: chest pain, left sided Improvement in prior bronchial wall thickening but still present.The lungs are otherwise unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Bronchial wall thickening, improved, with no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: eval for cause of sob History: sob No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Pain in right hip after fall. Possible preop. PA and crosstable lateral chest radiographs.Upper normal heart size.Superior mediastinal mass with mild rightward tracheal deviation, statistically most likely the result of substernal goiter and/or tortuous vasculature but nonspecific by plain film. No focal airspace opacities, pleural fluid, pneumothorax or signs of pulmonary edema. Lung volumes appear large with flattening of the diaphragm on the lateral radiograph suggesting COPD/emphysema.Chronic left rib fracture deformities. Degenerative changes of the glenohumeral joints. Mild mid thoracic vertebral body loss of height.

Output: No acute pulmonary abnormality. Trachea is deviated slightly rightward by a large mediastinal mass, most likely a substernal goiter.


Instruction: Generate impression based on medical findings.

Input: Male; 71 years old. Reason: SOB, desats, recent pul edema History: desats Interval removal of endotracheal and enteric tubes.Stable cardiomediastinal silhouette.Interval resolution perihilar air space opacities.

Output: Interval resolution of perihilar opacities, likely due to edema.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: r/o PTX History: syncope Right apical bulla unchanged.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.No significant pneumothorax.

Output: Right apical bulla, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Urostomy with acute chest pain. Wheezing Interval removal of the NG tube. Left PICC line and right subclavian port otherwise unchangedLungs remain moderately decreased in volumes with moderate effusions greater on the right. Underlying atelectasis essentially unchanged

Output: NG removed


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. Reason: IABP History: IABP Right central venous catheter with tip in the SVC, unchanged.IABP marker approximately 4 cm below the aortic arch.Stable marked cardiomegaly with mild residual edema which has gradually improved since 5/6/2016.Again seen is a smoothly marginated left upper lobe nodular opacity which appears unchanged.No large pleural effusion or pneumothorax.

Output: Cardiomegaly with mild residual pulmonary edema. IABP marker in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval for pneumonia History: cough, SOB Interval extubation. No pneumothorax. Increase in left basilar opacity. Large left lung mass as well as innumerable pulmonary nodules are unchanged.

Output: Interval extubation. No pneumothorax.Increasing left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p exploratory thorascopy Extensive opacity and volume loss in the right hemithorax, unchanged, compatible with hydropneumothorax with underlying consolidation and atelectasis.Small left effusion with atelectasis.No new findings.

Output: Bilateral abnormalities, more extensive on the right, with no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: pulmonary edema History: dyspnea Right Port-A-Cath and right basilar chest tube unchanged.Extensive pulmonary metastatic disease with right upper lobe consolidation/atelectasis similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with right upper lobe consolidation/atelectasis and innumerable pulmonary metastatic nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.With recent aortic valve replacement. Redemonstration of large right pleural effusion and underlying atelectasis without additional cardiopulmonary change from earlier film 10/21/2015. Moderate left pleural effusion. Small right apical pneumothorax. No additional focal opacities.

Output: Large right pleural effusion and small right apical pneumothorax.These findings were discussed with primary team Dr. Wilkey by the radiology resident by telephone at 4:30 PM on 10/21/2015.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable moderate pericardial effusion.CHEST WALL: Expansile and sclerotic right rib lesion, unchanged. T12 hemangioma Again noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous metastatic disease. Again noted. Index lesion in the lateral segment of the left lobe measures 6.4 by 3 .6 cm, slightly enlarged compared to previous study. However its difficult to differentiate from surrounding other lesions. Reference lesion in the right lobe measures 7.8 by 6.3 cm in image number 118, series number 3. This lesion is stable. Other hepatic lesions are also grossly stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small left adrenal nodule is stable.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence in the nephrectomy bed.RETROPERITONEUM, LYMPH NODES: Stable left retroperitoneal soft tissue density anterior to the left psoas muscle, measuring 2.1 x 1 .8 cm, image number 148, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.

Output: Minimal interval increase in the size of the wall. The next hepatic lesions. Please note that its difficult to accurately measure this lesion due to surrounding extensive metastatic disease and lack of IV contrast. Other findings are stable.


Instruction: Generate impression based on medical findings.

Input: Female; 34 years old. Reason: Patient with obstructive pneumonia now with acute SOB, evaluate for interval change History: SOB Persistent right basilar opacity compatible with moderate pleural effusion and atelectasis. Underlying right lower lobe cavitary lesion is less conspicuous. Small left pleural effusion.Stable cardiomegaly.Stable right jugular central venous catheter.

Output: Moderate right and small left pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old. Aortic balloon catheter marker in the descending aorta at the level of T5.ET tube and venous catheter unchanged.Diffuse bilateral opacity compatible with edema without significant change.

Output: Balloon catheter tip in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: fluid status History: near syncope, sob, hx chf Vascular redistribution and suggestion of mild basilar edema, small effusions, and basilar atelectasis.Stable cardiomediastinal silhouette.

Output: Mild pulmonary edema with small effusions.


Instruction: Generate impression based on medical findings.

Input: CHEST: Examination limited by field of view and range of coverage.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality noted in the extracardiovascular portions of the examination.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: hx of +PPD, eval infiltrate concerning for TB History: none Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval History: eval Streaky opacity left basilar opacities suggests atelectasis/scarring. There is no pleural effusion or pneumothorax. The cardiac and mediastinal contours are within normal limits for size. There is a partially imaged right shoulder arthroplasty device in place.

Output: Mild left basilar atelectasis/scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: pneumonia, cardiomegaly, effusion History: productive cough x 2 days, wheezing Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval lungs, R pleural effusion History: s/p heart transplant Moderately large bilateral pleural effusions, greater on the right, not significantly changed.Catheter from the left arm extending to the left subclavian vein and ICD remnants on the right, unchanged.Epicardial pacer wires projected over the lower mediastinum.No new findings.

Output: Pleural effusions with no interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: Eval for Pneumothorax History: S/P Chest tube removal Left-sided chest tube has been removed.Volume loss in left lung with left pleural effusion/thickening and pulmonary opacities similar in appearance to the prior exam.No new pulmonary opacities identified.Right pleural effusion decreased from the prior exam.No large pneumothorax identified.

Output: Interval removal of the left-sided chest tube. No significant pneumothorax identified. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.RFO, 9mm needleSurgical Case Information | Procedure(s): Procedure(s): | CORONARY ARTERY BYPASS WITH ROBOTIC ASSISTANCE | Operating Room: CDOR 04 WEST | Surgeon(s) and Role: | * Husam H Balkhy, M.D. - Primary | ETT 3 cm above the carina.Right internal jugular catheter tip in the SVC.Right pleural/mediastinal drain.Left chest tube.Stable cardiomediastinal silhouette. No large pleural effusion or pneumothorax.No radiopaque foreign object identified.

Output: No radiopaque foreign object identified.Images were not immediately available due to a system wide PACS error. The study was reviewed when it became available. This was relayed to the OR technologist. This final report was attempted to be communicated to attending surgeon Dr. Balkhy at the time of report 5:00 PM on 2/1/2016 by Dr. Altman, however he was not available by page.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: s/p CABG History: s/p CABG Status post median sternotomy. Mediastinal drains in unchanged position. Right IJ Swan-Ganz terminates in the main pulmonary artery.Interval extubation.Status post cholecystectomy.Stable cardiomediastinal silhouette.Nonspecific linear interstitial opacities, compatible with atelectasis and possible small effusions, not significantly changed from the prior exam.

Output: Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: eval for infection History: acute MS exacerbation prior to steroid tx No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: eval for pneumonia History: dyspnea The lungs and pleural spaces are clear. Heart size is normal. There is a increased retrosternal airspace with relative convex curvature of the sternum suggestive of pectus carinatum.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: decompensated systolic heart failure s/p PA catheter placement, eval for interval change History: see above Swan-Ganz catheter in the right descending pulmonary artery. ICD leads unchanged. Moderate cardiomegaly with small lung volumes.No specific evidence of pulmonary edema.

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


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: cause of CP, SOB History: shortness of breath No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Pt is a 65 y/o female with cough, wheezing, fevers, evaluate History: cough, wheezing fevers Airspace opacity with adjacent segmental atelectasis in the right middle lobe.Normal sized heart.No interstitial opacities or pleural effusions.Right chest port with tip in the cavoatrial junction.Degenerative changes of the thoracic spine.

Output: Airspace opacity with adjacent atelectasis in the right middle lobe which may represent mucous plugging or less likely infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Right-sided chest pain Unremarkable cardiomediastinal silhouette.No specific evidence of infection or edema.No pneumothorax.

Output: No acute cardiopulmonary abnormality. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: r/p PNA History: productive cough one week Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Progressive pleural effusions and fluid overload. There are multifocal airspace opacities in the left lung. Cardiomegaly. Probable left effusion. There is near complete opacification of the right lung, which may represent pleural effusion/consolidation.

Output: Near complete opacification of the right lung, which may represent pleural effusion/consolidation. Patchy multifocal opacities in the left lung with small to moderate sized left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: pna? History: cough, chest pain Minimal basilar scar like opacities, the lungs otherwise unremarkable.Previously seen scattered nodular opacities not confirmed on today's study.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality. Basilar scarring.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male. Metastatic renal cell carcinoma. Evaluate disease status. CHEST:LUNGS AND PLEURA: New bilateral small pleural effusions and bibasilar atelectasis. Punctate right middle lobe nodule is unchanged.MEDIASTINUM AND HILA: Previously described mild paratracheal adenopathy has almost completely resolved. Previously measured referenced lymph node now measures 9 x 6 mm on axial image number 35/222 of series 3. Subcarinal adenopathy is decreased in size. Extensive coronary artery calcification. Mild cardiomegaly. CHEST WALL: No change in the expansile right anterolateral rib lesion measuring 4.2 x 2.3-cm at axial image 59/222 of series 3.ABDOMEN:LIVER, BILIARY TRACT: Numerous diffuse hepatic metastases replacing the liver parenchyma are stable. Previously mentioned reference metastases in the right lobe measures 5.8 x 4.4 cm on image number 93/222 of series 3. The second reference mass in the left lobe measures 8.2 x 5.4 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Vertebral body hemangioma at axial image 80/222. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged, but otherwise unremarkable. BLADDER: The bladder wall is thickened, but otherwise unremarkable. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the bilateral pleural effusions and stable to decreased mediastinal adenopathy. Extensive liver metastases and the expansile rib lesions are grossly unchanged.


Instruction: Generate impression based on medical findings.

Input: Visualization of the thorax is limited by the field of view and length of scan, which excludes substantial areas of the lungs.CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant extra cardiovascular abnormalities in the visualized portion of the thorax.