Instruction: Generate impression based on medical findings.

Input: 8-year-old female with shortness of breath. Evaluate for pneumothorax.VIEWS: Chest AP/lateral (two views) 2/21/2015 Cardiothymic silhouette is normal. Peribronchial thickening with right middle lobe and retrocardiac opacities. No pleural effusion or pneumothorax.

Output: Findings consistent with multifocal pneumonia in the right middle lobe and left lower lobe superimposed on background of reactive airway disease or bronchiolitis pattern.Findings were discussed with Dr. Katie Burke on 2/11/2015 at 10:45 AM.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: Prior to V/Q scan History: Chest pain, shortness of breath Normal cardiac and mediastinal contours.No pleural or parenchymal abnormalities.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: empyema s/p pigtail, COPD exacerbation History: SOB, tachypnea Stable position of left pigtail catheter.No change in appearance of left lung opacity.Endotracheal valves unchanged position.Severe bullous emphysematous changes are stable.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: s/p MV annuloplasty and maze History: routine post op Median sternotomy, with mild to moderate cardiomegaly status post valve repair.Increased basilar atelectasis with small pleural effusions and edema are consistent with CHF.

Output: Increased basilar opacities and pleural effusions. Chest tubes removed with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: 76yo M with mesothelioma s/p left thoracotomy, left chest tubes x 2 History: left chest tubes x 2 Left apical chest tubes are noted. Right port catheter terminates at the cavoatrial junction. There is a small to moderate-sized left pneumothorax.Asbestos related pleural disease noted bilaterally. Heart is at the upper limit of normal.

Output: Small to moderate sized left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: acute desaturation History: as above Partially visualized feeding tube and left subclavian dual-chamber ICD are unchanged.Stable cardiomegaly.Stable minimal interstitial edema and bibasilar trace effusions. No pneumothorax.

Output: No significant change in cardiomegaly, minimal interstitial edema and trace bibasilar effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: swan placement History: swan placement Iatrogenic devices are unchanged. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: swan ganz catheter in place, ADHF History: ADHF Swan-Ganz catheter tip in the right main pulmonary artery.Marked cardiomegaly with mild basilar scarring or atelectasis, unchanged.No new findings.

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


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: 54 woman with hx of R pneumonia and ARDS. Please evaluate for resolution of opacities. History: Shortness of breath Cardiomegaly unchanged from prior. Infrahilar opacities of mild edema. No pleural effusion or pneumothorax. Multilevel degenerative changes of the thoracic spine.

Output: Cardiomegaly with infrahilar opacities favoring mild edema.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.With shortness of breath and hypoxia. History of tracheostomy, but is unused at this time. Low lung volumes. Mild edema. Small right pleural effusion. No pneumothorax. Streaky bibasilar opacities most consistent with atelectasis, slightly increased from prior. Unchanged VP shunt.

Output: Low lung volumes with possible mild edema, small right pleural effusion, and bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: assess for consolidation History: Lt axillary to posterior pleuritic chest pain Basilar subsegmental atelectasis gradually worsening suggestive of aspirated secretions.Heart size normal.Jugular catheter tip at SVC/RA junction level.

Output: Worsening basilar subsegmental atelectasis which may be the result of aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA, fluid overload, pulmonary edema? History: self extubated, heart failure patient, CCU Interval extubation.Cardiomegaly with diffuse bilateral opacity compatible with edema, atelectasis and layered out pleural effusions. Multiple screws have withdrawn from a sternal fixation plate and several have migrated.

Output: Interval extubation and CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Cervical lymphadenopathy. Rule out lymphadenopathy or malignancy. Normal heart size. The pulmonary hila are upper normal in size relative to the heart size. Questionable lymphadenopathy in the right inferior interlobar region. The lungs are clear.

Output: Unable to exclude lymphadenopathy in the chest. This may be further characterized by CT if required. No focal pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Left-sided chest pain, SOB and palpitations for 3 to 4 months rule out structural abnormality. Normal cardiomediastinal silhouette. The lungs are clear. No focal airspace opacities, pleural fluid or pneumothorax.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: evaluate lung fields History: new desaturations and hypoxia Line position stable.Heart size within normal limits.Basilar opacities are unchanged.

Output: No change in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Chest Pain Normal cardiomediastinal mediastinal contour. No focal consolidation, effusion or pneumothorax. No bony or soft tissue abnormalities.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male with fatigue. LVAD, supratherapeutic INR, routine. Partially imaged LVAD in place. Mitral valvuloplasty ring unchanged Sternotomy wires and fixation device intact.No focal airspace opacities, pleural effusions or pneumothorax. Cardiomediastinal silhouette is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: Mild basilar scarring.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: Compression deformity at T12.UPPER ABDOMEN: Findings in the abdomen have been described in a separate report from the same day.

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


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: r/o fluid overload History: CHF exacerbation Basilar interstitial opacities consistent with mild pulmonary edema. No large pleural effusion or pneumothorax is evident. Marked cardiomegaly unchanged from the prior examination, the asymmetric enlargement of the right heart.

Output: Cardiomegaly and mild pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with AML status post transplant now with worsening cough and sputum production. CHEST:LUNGS AND PLEURA: Scattered micronodules some of which are calcified, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal with small pericardial effusion. Moderate coronary artery calcifications. Calcified left hilar nodes.Right jugular central venous catheter with tip near SVC/RA junction.CHEST WALL: Degenerative changes of the spine. UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of active infection.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: 68yo F s/p BMT now with fever, crackles on exam History: as above New basilar opacities suggestive of edema although atypical infection are in the differential diagnosis. Small pleural effusions are present.At least mild cardiomegaly is noted.Right jugular catheter, tip in SVC.

Output: Basilar opacities, cardiomegaly and small pleural effusions are most suggestive of hypervolemia, atypical infection lower the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: pna History: cough Cardiac size is normal. Tortuous thoracic aorta, correlate for systemic hypertension, though this may be exaggerated by patient positioning.Low lung volumes. No focal pulmonary opacity, pneumothorax, or pleural effusion is identified.

Output: Low lung volumes likely related to patient's bodily habitus. The thoracic aorta appears tortuous though this may be exaggerated by lordotic positioning. No visible signs of pneumonia.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: 83-year-old female with new rectal cancer; evaluate extent of cancer/metastases CHEST:LUNGS AND PLEURA: Multiple micronodules are noted bilaterally of indeterminate etiology. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: Degenerative changes of the spine. ABDOMEN:LIVER, BILIARY TRACT: No abnormally enhancing hepatic lesions. There are mildly enlarged porta hepatis and portacaval lymph nodes also of indeterminate etiology.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is scarred/atrophic. Left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Regional lymphadenopathy surrounding the rectal mass is identified as following:An enlarged perirectal lymph node measures 11 x 8 mm (series 4, image 150).Enlarged lymph node is noted in the ischioanal fossa, measuring 11 x 10 mm (series 4, image 180).An enlarged obturator lymph node measures 14 x 14 mm (series 4, image 157).Bilateral inguinal lymphadenopathy is also identified (series 4, image 168).BOWEL, MESENTERY: An abnormally enhancing rectal mass is seen with areas of necrosis and with regional lymphadenopathy as mentioned above.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: Abnormally enhancing rectal mass with regional lymphadenopathy as detailed above


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: 61 yo female with sob, h/o asthma and cough History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male status post prostatectomy with rising PSA. CHEST:LUNGS AND PLEURA: Mild right lower lobe bronchiectasis. Bilateral emphysematous changes, more prominent in the upper lobes.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: Small left adrenal nodule is unchanged.KIDNEYS, URETERS: Left renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy with herniation of the nonobstructing bowel loops through the ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. BLADDER: .Suprapubic catheter in the bladder. Bladder wall is thickenedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Status post prostatectomy. No CT evidence of recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: Evaluate for cardiopulmonary disease. History: Chest pain. Low lung volumes. Status post sternotomy. The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: Low lung volumes without specific evidence of infection or failure.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: eval for acute chest History: chest pain, sob, Hb SS Unchanged mild cardiomegaly and vascular distribution compatible with sickle cell disease.No focal pulmonary opacities, pneumothorax, or pleural effusions.Right upper quadrant cholecystectomy clips.

Output: No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: daily cxr History: n/a Swan-Ganz catheter and aortic balloon catheter unchanged.Chest tubes, venous catheter and LVAD also unchanged.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: No change in basilar opacities or line position.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: +parainfluenza, s/p lung transplant, re-eval for possible PNA History: see above Status post lung transplant.Large lung volumes unchanged.Left apical fibrotic abnormality, unchanged.No evidence of acute infection.

Output: Large lung volumes, but no evidence of acute infection. Stable left apical fibrotic opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: dysphagia History: dysphagia Large lung volumes and flattening of diaphragms consistent with history of tobacco use. Small right-sided Bochdalek hernia. Mild basilar bronchial wall thickening, probably chronic.Unremarkable cardiomediastinal silhouette. No visible posterior mediastinal mass.

Output: No acute abnormalities.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, 78 years old.Reason: rule out pneumonia vs CHF History: hx of CHF, appears volume overloaded Cardiomegaly, status post sternotomy with lower lung zone edema and enlarging right pleural effusion.Right basilar atelectasis has increased. Left subclavian ICD, leads unchanged in position.

Output: Enlarging right pleural effusion and increased overlying atelectasis, suggestive of CHF/hypervolemia. There is no specific evidence of pneumonia, however.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval for elevated BNP History: intractable headache, BNP >150,000 Median sternotomy, heart moderately enlarged.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: Moderate cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: s/p lvad, fluid over load assess for effusion or pna History: sob Support devices are unchanged in position.Cardiomegaly unchanged. Mild edema. No pneumothorax.

Output: Cardiomegaly with mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: r/o acute process History: cough, chest pain, congestion Unremarkable cardiomediastinal silhouette.Bilateral multifocal, patchy opacities. No pneumothorax or pleural effusions.

Output: Multifocal pneumonia. Differential considerations include bacterial (such as mycoplasma) and viral etiologies. If the patient is immunocompromised, additional atypical etiologies should also be considered.


Instruction: Generate impression based on medical findings.

Input: Low ejection fraction. Concern for ADH F Unchanged 3-lead left subclavian ICD with a new right jugular dialysis catheter terminating in the mid SVC. No immediate postprocedural complications if recently placed.Persistent moderate nonspecific cardiomegaly with diffuse minimal interstitial changes greater both bases, possibly chronic in nature. No effusions.

Output: Right jugular dialysis catheter placed


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Status post cardiac surgery. The Swan-Ganz catheter has been removed and a right internal jugular vascular sheath remains in place. Remaining support devices are unchanged. Near complete opacification of the left hemithorax is again seen indicating redistributed large pleural effusion and atelectasis. The mediastinal contours are obscured.

Output: Near complete opacification of the left hemithorax indicating large pleural effusion with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old. Reason: evaluate for metastasis History: angiosarcoma Cardiomediastinal silhouette is unremarkable. Well-circumscribed nodular opacity in the left lung base likely represents a nipple shadow.No additional focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: Nodular opacity in the left lung base which may represent a nipple shadow. Recommend repeat chest radiograph with nipple markers for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Dobbhoff tube location Interval retraction of Dobbhoff tube, now located at level of gastric antrum. Compared to prior imaging, improved colonic dilatation and mildly prominent small bowel loops seen diffusely, may reflect ileus. Persistent stippled appearing radiodensities in left upper quadrant may be related to pancreatic calcifications in setting of chronic calcific pancreatitis but nonspecific.

Output: Enteric tube as above.Improved colonic dilatation. Mild diffuse ileus. Additional findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Chest pain. No focal airspace opacities, pleural fluid or pneumothorax. Cardiothoracic ratio appears within normal limits.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Shortness of breath question pneumonia. Interval extubation. Left jugular catheter unchanged in position.New large right subpulmonic fluid collection. Extensive consolidation in the posterior right upper lobe and lung bases about the same, now obscured at the right base.Marked gaseous distention of the stomach.Right VP shunt tubing incompletely visualized.

Output: Bilateral consolidation compatible with pneumonia, not significantly changed. Significant increase in right pleural fluid collection. Gaseous distention of the stomach.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.History of OSA and Legionairre's disease requiring intubation. Patient status post surgery with new oxygen requirement. Evaluate. Cardiomediastinal silhouette is unchanged. Interval improvement in right lung airspace opacities. Bilateral basilar streaky opacities likely represent subsegmental atelectasis. No large pleural effusions or pneumothorax.Left supraclavicular subcutaneous emphysema.

Output: 1.Subsegmental bilateral basilar atelectasis with interval improvement in right lung airspace opacities. 2.Left supraclavicular subcutaneous emphysema; clinical correlation recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Lung nodule History: Lung nodule Prior right lung resection, the lungs better inflated than on the prior study.Left lung unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Continued improvement in aeration following recent right lung nodule resection. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 16 years old.Reason: rule out tb History: none The cardiac and mediastinal contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities.The pleural spaces and visualized bones are within normal limits.

Output: Chest radiograph within normal limits.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: worsening sob History: inc O2 requirement Worsening right-sided opacity, improved on the left.Stable pleural effusions but worsening basilar consolidation.Right jugular Swan-Ganz catheter removed leaving the introducer.Mild cardiomegaly.

Output: Pulmonary opacities worse on the right but improved on the left, with increasing basilar consolidation and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male history of RCC status post lung resection and cryoablation left upper lobe lesion. Assess disease progression. CHEST:LUNGS AND PLEURA: Pleural-based left apical lesion series 4 image 16 measures 1.5 x 1.3 cm. Other postsurgical changes demonstrated. No new sites of disease. No effusions. MEDIASTINUM AND HILA: Irregular shape anterior mediastinal mass redemonstrated measured on series 2 image 27, 2.3 x 1.6 cm. Other small mediastinal nodes diffusely, unchanged.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 evidence of recurrence in the right nephrectomy bed. Left kidney is normal.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small common and external iliac lymph nodes seen bilaterally. A clustering of nodes is abnormal although each node is quite small. Overall appearance is unchanged. None of these were measured previously.BOWEL, MESENTERY: Diverticulosis. Otherwise normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No new sites of disease. Extent in measurements as above.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Concern for pneumothorax] fracture. Cortical discontinuity along the lateral aspect of the left sixth and seventh ribs consistent with acute slightly displaced rib fractures.No additional acute fractures are noted in the visualized bones.No evidence of pneumothorax in this single AP projection.Left basilar discoid atelectasis.

Output: Acute slightly displaced fractures of the lateral aspect of the left sixth and seventh ribs. No radiographic evidence of pneumothorax, considering limitations of a single AP projection.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: evaluate for pneumothorax History: s/p thoracic spine surgery Small left pneumothorax seen laterally.Bilateral peripheral pulmonary opacities are noted as well as mild interstitial edema.

Output: 1. Left pneumothorax, stable on a follow-up study.2. Peripheral pulmonary opacities which appeared worse on a follow-up study, consistent with infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: pna History: sore throat fever, immunosuppressed 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: 56-year-old male with history of colon cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Nonspecific, borderline enlarged mediastinal lymph nodes. Index pretracheal lymph node measures 14 x 11 mm image number 35, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Nonspecific punctate hypodense center which number 79, series number 3 is unchanged. No other focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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: Nonspecific, borderline enlarged mediastinal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of post transplant lymphoproliferative disorder CHEST:LUNGS AND PLEURA: Previously described ground glass opacity in the right middle lobe is stable to slightly progressed. Stable micronodules. Subsegmental atelectasis in left lung base, stable.MEDIASTINUM AND HILA: Nonocclusive thrombi in the left internal jugular vein SVC and azygous vein, not significantly changed from previous study. Interval removal of the left port catheter and placement of a right subclavian catheter with its tip in the SVC. Trace pericardial effusion is unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measuring 1.5 x 1.2 cm image number 99, series number 3 stable.KIDNEYS, URETERS: Atrophic native kidneys and renal cysts are stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again noted a large low density mass within the right side of the small bowel mesentery. There is significant amount of air within this low density area which may indicate infection, fistulization with the bowel lumen or necrosis. Measurement of this mass is not accurate, however, small and measures 11.6 x 13.6 cm in image number 114, series number 3. In the other hand, more inferior and solid appearing component of this mass is overall stable to minimally increased in size.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fluid density lesion which may represent ovarian cyst, stable.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: Transplant kidney in the right iliac fossa is unchanged.

Output: Minimal progression of the groundglass opacity in the right middle lobe.Large necrotic mesenteric mass containing air and invading small bowel loops is minimally decreased in its transverse dimension superiorly, however, stable to minimally increased in size in its axial dimension inferiorly. Air in the mass may be secondary to fistulization to bowel lumen, abscess or necrosis.Thrombi within the SVC, left internal jugular vein, left common iliac vein and left common femoral vein are stable.Dr. Cavanaugh was notified and acknowledged about the above findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: s/p thoracocentesis R/o pneumothorax History: shortness of breath with large left pleural effusion Right Port-A-Cath with its tip in the SVC.Almost complete opacification left hemithorax compatible with atelectasis and effusion.Diffuse interstitial and nodular opacities in the right lung.No evidence of pneumothorax.

Output: Complete opacification of the left hemithorax compatible with increasing large left pleural effusion and accompanying atelectasis. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 82 years old Female. Reason: r/o infiltrate History: new hypoxia. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. Small amount of bilateral pleural effusions are noted. The support devices are stable in position.

Output: The above findings are consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: pna History: cough. No focal air space opacity.No pneumothorax, pulmonary edema, or significant pleural effusion.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: infection History: stroke like sx Lungs and pleural spaces are clear. The heart size is normal.

Output: No evidence of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: s/p thoracentesis History: s/p thoracentesis Persistent complete left hemithorax and opacification, presumably due to pleural effusion and tumor. Right lung unchanged. A skin fold is noted on the right. No evidence of pneumothorax.

Output: Persistent complete left hemithorax and opacification, presumably due to pleural effusion and tumor. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old. ET tube is in place with its tip approximately 3 cm above the carina.Patient is rotated limiting evaluation.Stable cardiomediastinal silhouette mild left retrocardiac subsegmental atelectasis.

Output: Interval intubation with the ET tube in satisfactory position.


Instruction: Generate impression based on medical findings.

Input: 56 years old Female. Reason: lung eval History: lung eval. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Stable bilateral interstitial changes and airspace opacities. Small right pleural effusion.The ET tube has been removed. Remaining tubes and lines are stable in position. There is no evidence of the thorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Sepsis History: As above Dobbhoff tube has been removed. The cardiomediastinal silhouette is normal.Subsegmental atelectasis noted at the lung bases. Otherwise, there are no focal pulmonary opacities or pleural effusions.

Output: Subsegmental atelectasis without additional acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.History of right shoulder pain and twitching of right first and second digits. Cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Status post tracheostomy Tracheostomy tube tip above the carina. Left ICD device and LVAD components unchanged in position. Scattered mediastinal clips. Mitral valve prosthesis unchanged.Cardiomegaly stable. Calcification of the aortic arch. Retrocardiac consolidation as well as bilateral airspace and interstitial opacities, left greater than right, not significantly changed. Small right pleural effusion, slightly increased, and moderate left pleural effusion, stable.

Output: Stable bilateral pleural effusions, left greater than right. Persistent bilateral interstitial and airspace opacities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for positioning of new balloon pump History: femoral IABP replaced with subclavian IABP this morning. Swan-Ganz catheter tip located in the right descending pulmonary artery.Balloon catheter, PICC line and ICD leads unchanged.Left lower lobe atelectasis and left pleural effusion unchanged.

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


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of metastatic non-small cell lung cancer CHEST:LUNGS AND PLEURA: Right upper lobe spiculated mass has slightly increased in size now measures 4.5 x 2.5 cm image number 27, series number 8. Right upper lobe mass superior to this ill-defined mass is also significantly increased in size now measures 2.5 x 2.5 cm in image number 20, series number 8. Previously it was measuring 14 x 11 mm on image number 28, series number 4. Left lower lobe referenced nodule is unchanged measuring 13 x 12-mm on image number 45, series number 8.MEDIASTINUM AND HILA: Reference right paratracheal lymph node is unchanged measuring 12 by 8mm image number 33, series number 6. Conglomerate of subcarinal lymph nodes are also unchanged.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 change in the small infrarenal abdominal aortic aneurysm. Left common iliac arteries aneurysm is also unchanged and measures 2.7-cm in greatest AP dimension.BOWEL, MESENTERY: Patient has a neobladder. New wall thickening involves the distal ileal segment. Etiology is unknown.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder is not visualized. Multiple, round soft tissue densities in the right lower quadrant largest measuring 16 x 14 mm on image number 168, series number 6. These are all smaller compared to previous study. They may represent adenopathy versus resolving hematoma which was present on CT dated 2/6/2009.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 right upper lobe mass with no significant increase in the size of the right apical nodule.Ileal wall thickening in the right lower quadrant. The etiology is unknown.Multiple round soft tissue densities in the right lower quadrant which represent adenopathy versus resolving hematoma. There are smaller compared to previous CTs.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: Daily CXR History: Intubated Pleural effusions and basilar opacities improved.Chest tubes and surgical drains unchanged in position with no pneumothorax.ET tube tip approximately 1 cm above the carina.

Output: ET tube tip approximately 1 cm above the carina. Improved basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: eval pneumonia History: R sided chest pain, cough Mild to moderate cardiomegaly. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: Cardiomegaly without additional acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: pneumonia History: cough/weight loss Innumerable pulmonary nodular opacities. Diffuse opacities in the right lung with patchy left basilar opacity superimposed on nodular opacities. Right peritracheal lymphadenopathy. Small pleural effusions. No pneumothorax. Normal heart size.

Output: Innumerable nodular opacities throughout the lungs with right paratracheal lymphadenopathy consistent with metastatic disease.Diffuse right lung opacities and patchy left basilar opacities which may represent superimposed pneumonia or aspiration or extension of tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Pleural effusion History: dyspnea Improvement in lung volumes. Apparent improvement in diffuse pulmonary opacities. Underlying pleural-parenchymal opacities, unchanged. Unchanged cardiomegaly. No pneumothorax. Lines and tubes are unchanged other than slight shifting of position of right basilar pigtail drain.

Output: Apparent improvement in diffuse pulmonary opacities consistent with edema.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: picc line placement History: picc line placement Left-sided PICC extends superiorly to level of the mouth. This is been subsequently repositioned. Worsening pulmonary edema.

Output: Left-sided PICC extends superiorly to level of the mouth. This is been subsequently repositioned. Worsening pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: eval PICC History: PICC placed Median sternotomy with cardiomegaly and stable pleural effusions.Right PICC, tip in the SVC.Right jugular Swan-Ganz catheter tip in main pulmonary artery. Left subclavian ICD, leads unchanged in position.

Output: Right PICC, tip in the SVC. Stable pleural effusions and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: FemaleReason for Study: Reason: cough, hx sickle cell disease History: cough Port-A-Cath with its tip in the SVC.Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.Osseous changes compatible with sickle cell disease.

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


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: sepsis, hypoxia, crackles on exam Unremarkable cardiac and mediastinal silhouette. Small lung volumes with mild basilar atelectasis or scarring.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: short of breath, chest pain History: short of breath Left-sided ICD unchanged.The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female history of hypoxia. Left-sided chest tubes are unchanged. Right IJ central venous catheter tip in the right atrium.Unchanged small bilateral pleural effusions, partially loculated on the right. Stable mild pulmonary edema pattern. Dense left retrocardiac opacities secondary to aspiration, however superimposed infection cannot be entirely excluded.

Output: Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with new lung opacity noted in a chronic smoker. LUNGS AND PLEURA: No suspicious masses, or nodules. Mild scarring at the lung bases.Centrilobular emphysema.MEDIASTINUM AND HILA: Moderate-sized sliding hiatal hernia.Anomalous origin of the left vertebral artery from the aorta, considered a normal variant.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Paget disease noted of the second ribs bilaterally, as well as in the sternum.UPPER ABDOMEN: Small hepatic hypodensities, most likely benign.

Output: No significant pulmonary or pleural abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval lung fields History: eval lung fields Support devices are unchanged.Stable cardiomegaly with basilar opacities and effusions.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: aspiration pna History: 1040 Little interval change in the findings of cardiomegaly with pulmonary edema and small effusions. No pneumothorax.

Output: Little interval change in the findings of congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Lateral radiograph is limited by poor inspiration and a large degree of motion artifact. Cardiac leads, unchanged. No pneumothorax. Moderate cardiomegaly again noted. Patchy bibasilar opacities, slightly increased.

Output: Patchy bibasilar atelectasis, increased from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: CT ICU post-op patient History: CT ICU post-op patient The support devices are unchanged in position.The patient is rotated to the left. Persistent cardiomegaly with retrocardiac atelectasis and patchy consolidation. Associated small pleural effusions are suspected.

Output: No significant change in the retrocardiac consolidation and atelectasis. Small pleural effusions are suspected.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Neutropenic fever. Right-sided chest port tip at the lower SVC.Stable cardiomediastinal silhouette.Minimal basilar atelectasis/scarring with no new focal airspace opacity, pleural effusions or pneumothorax.

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: 67-year-old male with shortness of breath. Evaluate for pulmonary edema. Right-sided central venous catheter with tip in the SVC which appears to be pointed towards the lateral wall. According mediastinal silhouette is unchanged. No focal pulmonary consolidation, large pleural effusions, or pneumothorax. Bilateral basilar streaky opacities likely subsegmental atelectasis. Cental mass as on priors.

Output: Minimal bilateral basilar subsegmental atelectasis without specific evidence of volume overload.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: FemaleReason for Study: Reason: rule out pneumonia History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Acute cor pulmonale Motion degrades sensitivity. IABP pump remains unchanged, tip projects just beyond the aortic archInferior Swan-Ganz terminates in the right lower lobe pulmonary artery. NG and ETT are otherwise similar. Right jugular catheter extends into the mid SVCModerate nonspecific cardiomegaly with small lung volumes and questionable mild edema persists, the latter difficult to confirm due to motion

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: Infiltrates History: fever No significant cardiopulmonary abnormality.No specific evidence of infection or edema.Left PICC, tip in the SVC.Right subclavian or EJ port catheter tip at right atrial level.Gastrostomy tube.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: SOB, DOE, history of CHF. Cardiomegaly but are appreciated on this exam and is at least moderate. Central pulmonary vasculature appears enlarged, suspicious for pulmonary hypertension.Left subclavian ICD unchanged with lead terminating in the projection of the right ventricle directed towards the apex.Signs of hypervolemia with thickening of the fissures and vascular unsharpness. Minimal pleural fluid. No pulmonary edema.

Output: Cardiomegaly with signs of pulmonary hypertension and hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Rib Fx? History: Fall, chest pain The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.No displaced rib fracture is evident.

Output: No acute cardiopulmonary process is identified. No displaced rib fracture is evident.


Instruction: Generate impression based on medical findings.

Input: Reason: stem cell pt w/ vomiting History: 64Yrs male w/ hx of CLL progressed to DLBCL s/p stem cell transplant in November 2014 who presents to ED for vomiting x 1 day with fevers at home of 99.9. Streaky opacity at the left base with blunting of the left costophrenic angle, not significantly changed, suggestive of scarring, possibly related to recurrent aspiration. Mild blunting of the right costophrenic angle, also unchanged.PICC line tip in the left axilla.Unremarkable cardiac and mediastinal silhouette.

Output: Chronic basilar opacities, possibly related to recurrent aspiration. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Check IABP The IABP marker remains in the aortic arch. Swan-Ganz projects into the right upper lobe artery, advanced approximately 3 cm. I CD unchangedModerate nonspecific cardiomegaly with underlying retrocardiac opacities concerning for atelectasis versus partial consolidation. Lungs otherwise unchanged

Output: Swan-Ganz repositioned


Instruction: Generate impression based on medical findings.

Input: 23-year-old female with history of chest pain, evaluate for pneumothorax Normal cardiomediastinal silhouette. Lungs and pleura are unremarkable.

Output: No cardiopulmonary abnormalities. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: rule out pneumonia History: hypotension, WBC Right IJ central venous catheter unchanged. Pacer device, leads in unchanged position.Stable cardiomediastinal silhouette.Left greater than right effusions, with underlying subsegmental atelectasis.

Output: Cardiomegaly and effusions, likely secondary to CHF.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with pain. Evaluate for injury. Minimal displaced fracture of the left posterolateral ninth rib.No focal airspace opacities. There is a small left pleural effusion with adjacent atelectasis. No pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: Minimally displaced fracture of the left posterolateral ninth rib with a left pleural effusion. Please refer to subsequent CT study for additional findings.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p pericardial stripping, robotic History: s/p pericardial stripping, robotic Postoperative radiograph demonstrates bilateral chest tubes, apically directed on the left and terminating at the right peripheral lung on the right. There is a curvilinear opaque structure that projects over the mid thoracic inlet, possibly external to the patient. This was discussed with the floor nurse caring for the patient and a follow-up PA and lateral radiograph will be obtained.Low lung volumes with basilar opacities of subsegmental atelectasis. No significant pneumothorax. Heart size is within limits of normal. Mild mediastinal widening, likely due to underinflation and possible postoperative fluid or blood. Small amount of subcutaneous emphysema left infralateral chest wall.

Output: Postoperative lower lobe subsegmental atelectasis. Repeat PA and lateral radiograph recommended to confirm artifact, as above.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Postop cardiac surgery. Line evaluation. Interval removal of bilateral chest tubes. Sternotomy hardware and other tubes/ lines are unchanged. Small apical pneumothoraces bilaterally, 7 mm on the right and about 1 cm on the left. Basilar atelectasis, left greater than right.

Output: Small bilateral apical pneumothoraces post chest tube removal. No new central lines are identified; the right jugular Swan-Ganz catheter tip remains in the right main pulmonary artery projection.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval lung fields, ETT, chest tubes History: s/p AVR/MVR/TVR Endotracheal tube terminates 4 cm from the carina. Swan-Ganz catheter terminates within the left pulmonary artery. Mediastinal drain/chest tubes are noted. Low lung volumes makes detailed cardiopulmonary assessment difficult. Increased basilar opacities, likely atelectasis. Small left pleural effusion. No significant pneumothorax. Unchanged heart size.

Output: Expected postoperative appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: ro PNA History: cough, recent CEA Central area of right lung consolidation has resolved. No new focal pleural parenchymal opacity. Mild basilar subsegmental atelectasis or scarring. Unchanged heart size. No large pleural effusion or pneumothorax. Surgical staples overlie the lower aspect of the right neck, as before.

Output: Central area of right lung consolidation has resolved. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Weakness. Unremarkable cardiomediastinal silhouette.No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: verify swan position History: verify swan position Swan-Ganz catheter terminates within the interlobar pulmonary artery. Other iatrogenic devices, not substantially changed. Unchanged basilar opacities and pleural effusions as well as unchanged cardiomegaly. No pneumothorax.

Output: Swan-Ganz catheter terminates within the interlobar pulmonary artery and could be pulled back if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: LVAD check Interval retraction of the Swan-Ganz catheter, however the right jugular sheath remains projected into the distal SVC. No additional cardiopulmonary abnormalities or new findings. Mild nonspecific cardiomegaly with nonspecific interstitial changes greater in the right lung base are again observed. Questionable small right effusion

Output: No interval change in suspected mild atelectasis and questionable mild edema


Instruction: Generate impression based on medical findings.

Input: 81 year-old female with lung carcinoma. Status post chemotherapy. Please compare to previous study, and evaluate disease status. CHEST:LUNGS AND PLEURA: Interval increase in size of multiple bilateral pulmonary masses, compatible with the patient's diagnosis of bronchoalveolar carcinoma. The right middle lobe index lesion measures 2.3 x 1.7 cm (image 63, series 4) compared to 1.8 x 1.3 cm previously. The left upper lobe index lesion measures 2.0 x 1.7 cm (image 39, series 4) compared 1.3 x 1.1 cm. Mild paraseptal emphysema. Left lower lobe wedge-shaped consolidation is unchanged.  Left lower lobe scarring/subsegmental atelectasis is noted. Stable left lower lobe hamartoma. MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Low attenuating lesion in the spleen is nonspecific and unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Coronary artery calcifications and atherosclerosis of the abdominal aorta and its branches are evident. There is mild aneurysmal dilatation of the infrarenal aorta measuring up to approximately 3.2 cm (image 131, series 3).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: Degenerative changes affect the lumbosacral spine and hips. OTHER: No significant abnormality noted.

Output: 1. Interval increase in size of the index lung masses compatible with patient's history of bronchioloalveolar carcinoma.2. No evidence of extrathoracic metastases or new sites of disease.2. Stable mild infrarenal aneurysmal dilatation of the abdominal aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: shortness of breath, eval for PNA History: shortness of breath Bibasilar opacities and pleural effusions increased from last study. Central venous catheter terminates in the RA. No pneumothorax. Heart size is likely unchanged but difficult to assess due to pleural effusions.

Output: Increase in basilar atelectasis and/or consolidated lung as well as increase in pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Shortness of breath, intermittent chest pain. There are increased bilateral pleural effusions, now moderate. There are low lung volumes with new atelectasis in the right cardiophrenic angle. Median sternotomy hardware and left apical surgical clips are unchanged.

Output: Low lung volumes with moderate bilateral pleural effusions. New atelectasis in the right cardiophrenic angle.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: patient s/p lobectomy, patient still hypoxic, want to eval for status/infection/effusions History: SOB Right chest tube removed with no pneumothorax.Unchanged lower lung zone opacities with atelectasis and pleural effusions.Right jugular introducer sheath, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: Right chest tube removed with no pneumothorax. Right jugular catheter removed leaving the introducer sheath.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.End-stage renal disease. Status post bronchoscopy. The left midlung opacity appears slightly increase in extent, likely iatrogenic. Otherwise no new focal opacities.Stable left hilar prominence.Otherwise unremarkable cardiomediastinal silhouette.No pneumomediastinum or pneumothorax.

Output: The left midlung opacity appears slightly increase in extent, likely iatrogenic


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: post thora History: hemothorax Interval reduction in size of the large right pleural effusion/hemothorax with associated atelectasis involving the right middle and lower lobes. Streaky left infrahilar opacities may represent retained secretions or atelectasis. No significant pneumothorax is identified.

Output: Reduction in size of the right hemothorax/pleural effusion without significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval aspiration pna History: hypoxia and increase wob requiring bipap New left hemithorax opacification presumably from atelectasis, the result of aspiration or mucus plugging. Patchy right-sided opacities could also be result of aspiration or edema.Left PICC, tip in the SVC.

Output: New complete opacification of the left hemithorax presumably from aspiration or mucus plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath No pneumothorax. Increased patchy left basilar opacity. Chronic appearing left sided volume loss again noted. No new focal pleural parenchymal opacity in the right hemithorax. Unchanged heart size.

Output: No pneumothorax. Increased patchy left basilar opacity consistent with atelectasis, aspiration, and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male with DKA. Evaluate for pneumonia. Cardiomediastinal silhouette is normal. No focal pulmonary opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: dobhoff tube placement History: dobhoff placement Dobbhoff tube placed, the tip in the right bronchus intermedius. A subcutaneous radiograph showed this was removed with no pneumothorax.Nodular pulmonary opacities are unchanged consistent with infection.

Output: Dobbhoff tube placed in the right bronchus intermedius, subsequently removed. Unchanged pulmonary opacities which should be followed to resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: balloon pump positioning History: balloon pump positioning Mild basilar opacity suggestive of atelectasis and pleural effusions versus artifact.Left subclavian IABP, proximal marker 4 cm below the top of the aortic arch.Left jugular Swan-Ganz catheter tip in right pulmonary artery.Presternal ICD unchanged.

Output: No change in support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: assess for metastatic disease History: none Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old. Reason: r/o PTX History: SOB Cardiomediastinal silhouette is unremarkable.No focal airspace opacity, pleural effusion or pneumothorax.The osseous structures are unremarkable.

Output: No acute cardiopulmonary abnormality, specifically no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Hazy opacity in the mid aspect of the left lung again noted. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Prominent azygos vein again noted consistent with azygos continuation of the IVC.

Output: Probable lung cancer again noted in the mid aspect of the left lung. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: 69 y/o GI bleed, eval for edema History: SOB A pulse generator occupies the left superior thorax. One electrode terminates in the left axilla. The proximal electrode is directed cranially, toward the left atrial appendage. The second terminates at the left costophrenic angle, in the expected apex of the right ventricle. Of note, one of the electrodes demonstrates focal lucency approximately 7 cm from the pulse generator. There is evidence of a coronary arterial stent.Moderate to severe cardiomegaly. Basilar opacities favor comminution of edema and subsegmental atelectasis. No pneumothorax or significant pleural effusion.

Output: Cardiomegaly with right lower zone opacities suggestive of mild edema with subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: ETT placement s/p OR History: s/p OR ET tube tip 4 cm above carina. Nonspecific basilar opacities are unchanged. Lungs are hypoinflated.

Output: ET tube tip 4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p endoscopy after esophagectomy History: as above, r/o changes ET tube tip approximately 3 cm above the carina. NG tube tip projected over lower mediastinum consistent with gastric interposition.Catheter tip in the SVC.Right chest are in place with no significant pneumothorax.Diffuse bilateral interstitial opacity with no significant interval change.

Output: Diffuse interstitial disease with no acute change.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female s/p OHT. Annual exam. Surgical clips project over the peripheral right upper lobe. Median sternotomy.No focal airspace opacity, pleural effusion or pneumothorax. Mild cardiomegaly.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: MaleReason for Study: Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: FemaleReason for Study: Reason: ? PNA History: sepsis 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: Female, 79 years old.Reason: 79 yo F with cough, weakness - eval pneumonia, opacity, effusion, other History: cough Cardiomediastinal silhouette is within normal limits.No focal airspace abnormality. No significant pleural effusions.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old history of shortness of breath. Interval removal of left-sided PICC line. Stable mild scarring at the right costophrenic angle.No significant acute pulmonary or pleural disease. The heart size is within normal limits.

Output: No significant acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: pna? History: SOB Lower lung zone opacities are suggestive of edema or aspiration.Upper abdominal lucency could be an artifact although pneumoperitoneum is possible.

Output: 1. Basilar opacities suggestive of edema or aspiration.2. Questionable pneumoperitoneum versus gastric distention discussed with the clinical service, and a left down decubitus view of the abdomen recommend depending on the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with pleuritic chest pain, shortness of breath, and cough. Evaluate for consolidation. Cardiomediastinal silhouette is normal. No focal pulmonary consolidation, pleural effusions, or pneumothorax.Subcentimeter faint right upper lobe pulmonary nodule noted on subtracted image which may represent artifact from overlying hypertrophic degenerative changes involving the sternocostal junction.

Output: 1.No acute cardiopulmonary abnormality.2.Subcentimeter faint right upper lobe pulmonary nodule noted on subtracted image which may represent artifact from overlying hypertrophic degenerative changes involving the sternocostal junction. Findings communicated to referring physician by Dr. Kromrey at the time of exam.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female with cholangiocarcinoma. Now with new ascites. Please assess. Combs positive hemolytic anemia. Please evaluate for LAD or masses. CHEST:LUNGS AND PLEURA: Benign-appearing calcification right upper lobe series 5 image 22. Moderate size right pleural effusion. Small left pleural effusion. Associated bibasilar atelectasis or consolidation. No lung nodules.MEDIASTINUM AND HILA: Scattered mediastinal nodes some pathologic by size criteria. Cluster of high paratracheal nodes on series 2 image 23 measure 1.8 x 1.5 cm. Small nodes in the anterior mediastinum prevascular area subcarinal area. Calcific granuloma right hilum. Small left axillary nodes can be followed.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The there is streak artifact from surgical clips or coils in the right lobe of the liver. There is moderate intrahepatic biliary dilatation with a transition zone in the porta hepatis. This is presumably due to the patient's known cholangiocarcinoma although tumor cannot be measured.There is cysts stent in the main portal vein. High density consistent with flow is seen throughout most of the stent but there is some thrombus at its caudal aspect near the confluence.SPLEEN: Upper normal in size. No focal lesions.PANCREAS: Fluid or soft tissue density abuts the cephalic aspect of the pancreas likely related to the surgery and ascites. The pancreatic parenchyma per se is normal. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney is atrophic or extensively infarcted. It does have a symmetric nephrogram with the normal sized left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is markedly distended with fluid and debris and a gastro-jejunal anastomosis is identified and is patent as seen on coronal image 48/85.Distal to the anastomosis small bowel is a tortuous contour and there is a focally markedly dilated loop of jejunum in the right upper quadrant measuring 4.5 cm in diameter is seen on coronal image 55/85. This may be due to adhesions. The small bowel more distally is collapsed but has a diffusely markedly thickened folds consistent with hypoproteinemia or other causes of diffuse thick folds. No intramural air or free air. Sutures are seen along the SMV but it is patent.Varices in the EG junction.Massive generalized ascites. Some varices in the omentum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Marked generalized ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Biliary dilatation the porta hepatis likely due the patient's known cholangiocarcinoma although tumor cannot be measured. Partial thrombus in the portal vein stent at the confluence but flow is seen within the stent and in the intrahepatic portal venous system. Massive generalized ascites. Focally dilated loop of jejunum right upper quadrant likely due to adhesions. Diffuse small bowel thickening likely due to hypoproteinemia. (Infection much less likely) Massive generalized ascites. Varices. Atrophic or partially infarcted right kidney. Mediastinal nodes. Bilateral pleural effusions right greater than left. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: increased pulm edema from previous cxr History: pulm edema Worsening pulmonary edema especially compared to early morning 10/30/2015. Persistent left lower lobe consolidation with a left pleural effusion.Tracheostomy tube tip 7 cm above the carina. A Dobbhoff tube extends below the lower margin of the image.Right subclavian catheter, tip in SVC.

Output: Gradual worsening pulmonary edema with left lower lobe consolidation and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: desaturation post op History: none The heart size about upper normal with small lung volumes.Streaky basilar opacities compatible with subsegmental atelectasis uncertain etiology, possibly related to mild aspiration.

Output: Basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Sharp right-sided chest pain for 3 days. No pneumothorax or pleural fluid. Normal heart size. No focal airspace opacity. T1 spina bifida occulta.

Output: No pneumothorax or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Eval pul edema History: cough Enteric tube terminates out of the field of view, likely within the stomach. Stable position of left single lead subclavian pacemaker, with tip in the right ventricular apex. Surgical clips in the right neck.Stable mild cardiomegaly. Minimal basilar atelectasis. No pleural effusions or pneumothorax.

Output: Mild basilar atelectasis without specific evidence of infection or edema. NG tube is likely within the stomach.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: post-op cardiac surgery History: post-op cardiac surgery Increasing left-sided airspace opacity consistent with atypical edema or hemorrhage, or pneumonia.Mild airspace opacity right lung base periphery.Median sternotomy with chest tubes.No significant pneumothorax.ET tube tip approximately 5 cm above the carina.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.

Output: Increasing left-sided airspace opacity consistent with atypical edema or hemorrhage reason infection postop. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: pneumonia, bronchitis, effusion, cardiomegaly History: 34yoF 2 weeks of productive cough, intermittent chills, mild wheezing Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Chest pain. Normal heart size. No mediastinal widening. No pneumothorax.No focal airspace opacities or signs of pulmonary edema. No pleural fluid.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ARDS 2/2 sepsis w unknown primary, intubated and paralyzed s/p proning, eval for interval change and ETT location History: see above. Unchanged position of support devices. ETT tip 3 cm by the carina.Stable cardiac silhouette.Partial redistribution of multifocal hazy opacities to dependent areas, but grossly stable accounting for differences in technique.Small right pleural effusion and probable trace left pleural effusion.

Output: Grossly stable appearance of the chest with multifocal hazy opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: assess for infection, edema History: intubated Iatrogenic devices are unchanged. Dense left lower lobe opacity and small left pleural effusion again noted. No acute bony abnormality. Unchanged heart size.

Output: Persistent dense left lower lobe atelectasis or consolidation small left pleural effusion. Iatrogenic devices are unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: check swan placement History: swan placement Left IJ Swan-Ganz retracted with catheter tip now in the pulmonary artery.Right IJ venous catheter with its tip in the SVC.Complete opacification left hemithorax with shift of mediastinum from right to left unchanged.Surgical clips identified in left hilar region.Median sternotomy intact with evidence of a mitral valve repair.

Output: Interval repositioning of the Swan-Ganz catheter with its tip now in the pulmonary artery. Opacification of the left hemithorax and shift of the mediastinum from right to left suggestive of a prior pneumonectomy. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: FemaleReason for Study: Reason: Eval for metastatic lesions History: Prior Left forearm alveolar sarcoma The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: 85F with elevated WBC, tachycardia c/f infection with unclear source. r/o PNA History: leukocytosis, pain Mild cardiomegaly with a tortuous aorta, unchanged.No significant pulmonary or pleural abnormality.

Output: Mild cardiomegaly. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: verify ET tube placement History: respiratory failure New basilar opacities suggestive of atelectasis from aspirated secretions.ET tube tip approximately 4 cm above the carina.Right jugular catheter, tip in SVC.

Output: Intubation, with new basilar opacities suggestive of atelectasis from aspirated secretions although infection is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with lung cancer. Evaluate for progression of metastatic disease. CHEST:LUNGS AND PLEURA: Left lower lobe mass (series 5, image 55) measures 29 x 22 mm (unchanged). No new suspicious pulmonary nodules or masses are identified.Left basilar scarring and and mild adjacent pleural scarring, not significantly changed.Paramediastinal fibrosis compatible with sequela of radiation therapy as seen previously.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Opacification of numerous collateral vessels in the right chest may indicate central venous stenosis along the region of patient's chest port catheter.CHEST WALL: Reference left axillary lymph node (series 3, image 29) measures 12 x 8 mm (unchanged). Multiple sclerotic lesions involving the thoracic spine vertebral bodies and posterior elements as well as the right ninth rib, unchanged.Right chest port catheter with catheter tip in distal SVC.Two small sclerotic foci in the right humeral head are similar to prior study from April 2011 and may represent metastases as well.ABDOMEN: LIVER, BILIARY TRACT: Reference hepatic lesion (series 3, image 99) measures 12 x 12 mm (unchanged). No new hepatic lesions identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Large heterogeneous right adrenal mass (series 3, image 118) measures 86 x 87 mm; previously measuring 86 x 94 mm.More smoothly marginated right adrenal nodule is unchanged since study from 8/31/2010.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node (series 3, image 25) measures 8 x 5 mm (unchanged).IVC filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel sclerotic lesions involving the spine and visualized pelvis compatible with metastases are unchanged. No new osseous lesions identified.

Output: 1. No significant change in left lower lobe lung mass.2. Slight interval decrease in size of right adrenal mass, likely from resolving internal hemorrhage.3. Reference hepatic lesion not significantly changed since prior study from June 2011, but decreased in size since initial CT from August 31, 2010.3. No new lesions suspicious for metastases identified.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: fever, unclear source History: as above Interval removal of an enteric tube and pericardial drain. Unchanged cardiomediastinal silhouette with cardiomegaly. Bilateral moderate pleural effusions and bibasilar atelectasis. No pneumothorax. Ill-defined retrocardiac opacity suspicious for pneumonia.

Output: Persistent left basilar opacity suspicious for infection. Unchanged pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with acute onset shortness of breath with diffuse interstitial opacities on x-ray. Evaluate for interstitial lung disease. CHEST:LUNGS AND PLEURA: Moderate-to-severe, upper lobe predominant centrilobular emphysema. Chronic-appearing scarring in the lung bases (left greater than right) with few nodular opacities at the bases as well, likely aspiration-related. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Moderate coronary calcifications.CHEST WALL: Smoothly marginated, subcutaneous lesion seen posteriorly (series 3, image 14) is of uncertain etiology but may represent a sebaceous cyst. UPPER ABDOMEN: Surgical clips near the GE junction with presumed postsurgical changes partially visualized at the gastric antrum.

Output: Findings likely related to aspiration on background of moderate-to-severe emphysema.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for PNA History: Pleuritic chest pain on right side Normal heart size with a tortuous calcified aorta.Linear scar, best seen on the lateral view, but no active disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval for progression of pulm edema History: freq suction, trach Moderate cardiomegaly.Unchanged basilar opacities suggestive of edema with pleural effusions.Tracheostomy tube tip 6 cm above the carina.

Output: Unchanged CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Bilateral lower extremity edema question enlarged cardiac silhouette. Moderate cardiomegaly, unchanged. No specific signs of pulmonary edema. No focal airspace opacities.

Output: Cardiomegaly. No evidence of edema or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: PNA? History: worsening SOB Left chest tube with small left apical pneumothorax.Patchy pulmonary opacities were seen on the left suggestive of infection or aspiration, accompanied by bilateral pleural effusions.Right jugular catheter, tip in SVC.

Output: Left-sided opacity suggestive of aspiration or infection. Small left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval for aspiration History: new fever and leukocytosis Lungs hypoinflated. Left ICD tip in RV apex. No new opacity to suggest pneumonia.

Output: Lungs hypoinflated. No new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Eval for cardiopulmonary disease. History: SOB Venous dialysis catheter tip at RA/SVC junction. Heart size normal. No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: eval mediastinal widening History: am cxr w/ mediastinal widening The patient remains intubated with the endotracheal tube 5 cm above the carina. The remaining support devices are unchanged in position.There is mediastinal widening which has not increased since the study at 0606 hours. There is developing edema in the right mid to lower zone with a small pleural effusion. No interval pneumothorax.

Output: Stable size of the mediastinum. Developing edema.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: ETT ET tube tip approximately 5 cm above the carina.Small lung volumes with streaky basilar atelectasis likely secondary to aspirated secretions.A more recent radiograph has been interpreted.

Output: Slightly high position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: FemaleReason for Study: Reason: lung adeno ca s/p LUL resection with 6/4/15 History: none Mild volume loss in the left lung with pleural scarring noted at the left lung base.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No new pulmonary opacities noted.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT remains 4 cm above the carina. Dobbhoff, right jugular catheter and left subclavian line otherwise similarPersistent decreased lung volumes with unchanged cardiac and mediastinal contours. Suspected mild basilar, greater in the left, atelectasis and small effusion

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: intubated, pulmonary edema, RIJ line History: as above Cardiopulmonary monitoring and support devices, unchanged.Diffuse airspace opacity compatible with edema, unchanged.No new findings.

Output: Pulmonary edema with no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: MaleReason for Study: Reason: evaluate for new infiltrate History: hypoxia Right Port-A-Cath with its tip in the SVC.Left-sided chest tube unchangedStable cardiomediastinal silhouette. Moderate left-sided subpulmonic pneumothorax similar in appearance to the prior exam.

Output: Persistent moderate sized left subpulmonic pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: post-op heart transplant History: cardiogenic shock Swan-Ganz catheter terminates within the proximal aspect of the interlobar pulmonary artery. Low lung volumes makes detailed cardiopulmonary assessment difficult. Improvement in diffuse pulmonary opacities. Left basilar opacity persists, likely atelectasis. No significant pneumothorax. Unchanged heart size.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Improvement in diffuse pulmonary opacities. Left basilar opacity persists, likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female status post tumor debulking in 3/08 for metastatic colon cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right port terminating in the SVC. ABDOMEN:LIVER, BILIARY TRACT: Tubular hypodensity at the inferior margin of the liver (series 3; image 132) is identified, unchanged from 1/14/10 but not present on 10/6/09 it measures 10 x 9 mm in greatest dimension.CholecystectomySPLEEN: 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: 2.0 x 1.6 cm ring enhancing hypodense nodule is identified in the mesentery (series 3; image 154). In retrospect, this lesion has been gradually increasing in size.See belowBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: HysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A vertically oriented soft tissue density in the midline presacral space is unchanged. Given surgical clips at its superior margin and tubular nature, this is compatible with a rectal stumpRight lower quadrant colostomy. Hypodense ring enhancing lesion measuring 2.5 x 1.7 cm is identified immediately posterior to the fascial exit of the colonic loop (series 3; image 141). In retrospect, this lesion has been slowly increasing in sizeEvidence of prior small bowel resection in the left lower pelvis. A few loops are dilated at the anastomotic site, likely secondary to surgery, unchanged from 6/08. No evidence of obstruction is seen. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two hypodense ring enhancing lesions which have been gradually increasing in size, one in the mesentery and the other adjacent to the colostomy, compatible with metastases.Tubular presacral lesion likely represents a rectal stump-please correlate with surgical history.Tubular, hypodense lesion in the inferior margin of the liver is most likely not metastatic in nature given its orientation. However, follow up is suggested to evaluate for change.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.ET tube placement ET tube tip approximately 6 cm above the carina. Left jugular venous catheter tip at the confluence of the brachiocephalic veins. NG tube tip extends below the diaphragm and beyond the field-of-view.Cardiomegaly, unchanged.Moderate sized right pleural effusion and right basilar opacities, similar to the recent prior exams. Small left pleural effusion.

Output: Stable appearance of the pleural effusions and right basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: ECMO History: - Left IJ Swan-Ganz catheter with its tip in the left descending pulmonary artery.Remaining support devices are unchanged.Large left pleural effusion mildly decreased from the prior exam with some aeration noted in the left upper lobe.Marked cardiac enlargement.

Output: Support devices unchanged including Swan-Ganz catheter, ECMO catheters, and tracheostomy tube. Mild interval decrease in the large left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with stage IV non-small cell lung cancer, status post two cycles of chemotherapy. Needs disease evaluation with comparison to prior. CHEST:LUNGS AND PLEURA: Centrilobular emphysema. Mixed interval change of multiple bilateral pulmonary nodules; however, most are stable to slightly increased in size. Reference right upper lobe pulmonary nodule is stable in size measuring 1.5 x 0.8 centimeters (image 22\117); reference right lower lobe nodule is decreased in size measuring 0.8 x 0.6 cm (image 86\117). No new pulmonary nodule.Right paramediastinal volume loss and traction bronchiectasis is consistent with radiation change.MEDIASTINUM AND HILA: Coronary artery and mitral valve calcifications; stable heart size. Small pericardial effusion. Prominent pulmonary arteries likely indicate pulmonary hypertension. No significantly enlarged mediastinal or hilar lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral nephrostomy tubes are incompletely visualized. Stable atrophic kidneys with symmetric mesenteric fat stranding. Unchanged calcification within the lower pole of the left kidney. Stable hypodense left midpole lesion is incompletely characterized on this noncontrast enhanced examination.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple surgical clips and a stapled anastomotic suture line identified within the right hemiabdomen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Right intraperitoneal catheter partially visualized.

Output: 1.Mixed interval change of multiple pulmonary nodules; however, most are stable to slightly increased in size. 2.No new sites of disease.3.Other stable findings as above.


Instruction: Generate impression based on medical findings.

Input: History of endometrial and thyroid cancer CHEST:LUNGS AND PLEURA: Bilateral emphysematous changes, not significantly changed from previous study. Peripheral nodularity in the right upper lobe likely representing atelectasis/scarring is unchanged. Small right-sided pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple the ninth lesions in the liver representing hemangiomas and cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mesenteric lymph nodes in the left lower quadrant are grossly unchanged. Reference lymph node measures 12 x 9 mm on image number 127, series number 3.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not well 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: Stable examination


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: ro pna, widened mediastinum History: chest pain, sob, epigastric pain Linear scarring or subsegmental atelectasis.Nonspecific mediastinal widening most likely is due to mediastinal fat deposition, and is unchanged compared to the prior study allowing for differences in projection and rotation.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.History of productive cough and bodyaches. The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p OLT, check ETT; PA Cath placement History: s/p OLT, check ETT; PA Cath placement Cardiopulmonary monitoring and support devices, unchanged.Moderately large bilateral pleural effusions with underlying atelectasis.Marked interval decrease in the left pleural effusion following chest tube placement.Left chest tube in place with no significant pneumothorax.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: infection History: neutropenic fever Stable cardiomediastinal silhouette with marked tortuosity of aorta.The lungs are clear.No focal areas consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Head pain and fever. VP shunt. Posterior fossa tumor.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 12/26/15 Left ventriculostomy tip is adjacent to midline in middle cranial fossa. The strata valve in the left frontoparietal region is set at a performance level of 1.0. Tubing courses along the left head and neck. It continues along the left chest and enters the peritoneal space adjacent to midline and has its caudal tip in the left upper quadrant. No shunt discontinuity is identified. All loops are not displaced from the distal tip.A cyst drainage catheter has been placed via a right occipital burr hole with its tip to the right of midline, low in the middle cranial fossa. Further postoperative changes are seen in the right occiput.The right Port-A-Cath device has its tip in the right atrium.No focal lung opacity is present. Bowel gas pattern is slightly disorganized.

Output: No evidence of extracranial shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: 3 year-old male status post trauma. ABDOMEN:LUNG BASES: Mild dependent atelectasis is seen in the left lung base. No pulmonary opacity or pleural effusion is noted.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:BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality of the osseous structures is noted.OTHER: The left testis is seen within the inguinal canal.

Output: No significant abnormality of the intraabdominal or pelvic organs. Undescended left testis.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p VATs pleural biopsy History: s/p VATs pleural biopsy Residual pleural effusions right larger than left, but resolution of prior lobulated pleural collections.No significant pneumothorax.Right chest wall soft tissue emphysema.

Output: No significant pneumothorax. Resolution of prior lobulated right pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Reason: daily cxr History: Presence of heart assist device [Z95.811], ET tube tip approximately 5 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.LVAD and presternal ICD lead unchanged.Marked cardiomegaly with nonspecific basilar opacity compatible with edema and atelectasis.Subcutaneous emphysema.

Output: Cardiomegaly and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated s/p cardiac arrest History: intubated s/p cardiac arrest ET tube tip approximately 2 cm above the carina.Focal airspace opacity in the right. Hilar region and left lower lobe, increased from previous, suggestive of aspiration.NG tube coiled in the stomach.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: SOB; missed HD; eval for cause History: see above Question of mild interstitial pulmonary edema. No large pleural effusion or pneumothorax. Marked cardiomegaly slightly increased from last study.

Output: Question of mild interstitial pulmonary edema. Moderate cardiomegaly, slightly increased. No large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 76 year-old female with history of metastatic melanoma status post 2 cycles of chemotherapy. Evaluate extent of disease. CHEST:LUNGS AND PLEURA: Emphysematous changes bilaterally. Left pulmonary nodule (series 4, axial image 30/118) measures 1.2 cm diameter and is larger in comparison to previous exam. MEDIASTINUM AND HILA: Previously noted multiple bilateral cystic foci within the thyroid are stable.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Previously noted multiple, bilobar subcentimeter foci of hypoattenuation remain stable and are too small to be further characterized. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral subcentimeter adrenal nodules are stable when compared to prior exam.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Previously noted large periaortic lymph node (series 3, axial image 117/216) measures 0.8 cm x 0.7 cm, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bulky bilateral common iliac, internal iliac, external iliac, femoral, and left inguinal metastatic adenopathy are increased in size.Reference right common iliac lymph node (series 3, axial image 148/214) has increased in size on comparison to previous exam and now measures 2.4 cm x 2.8 cm.Reference left external iliac lymph node (series 3, axial image 176/214) has increased in size and now measures 3.3 cm x 6.6 cm.Reference right femoral lymph node (series 3, axial image 200/214) has grown to 2,3 cm x 2.3 cm.Reference left inguinal mass (series 3, axial image 192/214) now measures 4.1 cm x 6.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse anasarca has increased.OTHER: No other significant abnormality noted.

Output: 1.Extensive bilateral pelvic metastatic adenopathy with interval progression of disease. Stable left periaortic lymph node.2.Left pulmonary nodule is increased in size on comparison to previous exam.3.Scattered hypoattenuating foci throughout the liver. 4.Stable bilateral adrenal nodules.5.Bilateral cystic foci within the thyroid are stable


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for PNA History: SOB and productive cough x2 weeks, hx COPD, on 3L O2 at home Unremarkable cardiac and mediastinal silhouette. Marked perihilar bronchial thickening especially on the right consistent with bronchitis, but no reliable evidence of pneumonia.

Output: Right perihilar interstitial opacity suggestive of bronchial thickening, likely related to bronchitis and bronchiolitis.


Instruction: Generate impression based on medical findings.

Input: Positive Quantiferon, no symptoms, assess for infiltrates. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. No signs of active intrathoracic tuberculosis.

Output: No evidence of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Cough rule out pneumonia. Cardiomegaly with marked enlargement of the central pulmonary vasculature consistent with pulmonary hypertension. Chronic appearing coarse interstitial abnormality. Faint basilar airspace opacities more likely to reflect edema than infection, though the latter cannot be entirely excluded. No pleural fluid.

Output: Chronic interstitial abnormality likely related to chronic CHF. Cardiomegaly and signs of pulmonary hypertension. Faint basilar airspace opacities more likely to reflect edema than infection, though the latter cannot be entirely excluded.