Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Dyspnea evaluate for right pleural effusion. Large loculated right pleural fluid collection with minimal decrease in volume. Compressive atelectasis of the adjacent lung. Postsurgical changes on the right. Left lung is clear. Upper normal heart size. Sternotomy hardware and mitral ring noted.

Output: Large loculated right pleural fluid collection with minimal decrease in volume.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: eval lung fields History: s/p AVR Cardiomegaly, open sternotomy wound with surgical sponges still in place.Prosthetic aortic and mitral valves.Minimal left basilar edema. ET tube tip 6 cm above the carina.Surgical drains overlie the mediastinum.Right jugular Swan-Ganz catheter tip in main pulmonary artery region.Unchanged chest tubes.

Output: No change in lung appearance, with minimal left basilar edema. Unchanged support devices, the ET tube high.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval ETT tube placement History: ETT tube adjusted Cardiomegaly with small lung volumes and basilar opacities suggestive of infection or aspiration, unchanged.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 3 cm above the carina, repositioned.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: eval ng tube, aspiration History: ng tube pulled back Interval placement of Dobbhoff tube.Lines otherwise stable.Stable cardiac silhouette and basilar opacities.No pneumothorax.

Output: Stable cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.With asthma and history of multiple intubations presenting with fever. Limited lateral view secondary to body habitus. No pleural effusion or pneumothorax. Previously described left basilar opacity is not visualized on this PA/lateral film, indicative that it likely represented atelectasis. No other focal pulmonary opacities visualized. The cardia mediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality. The previously described left basilar opacity is not visualized on this exam and likely represented atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: weakness History: weakness Mild/moderate cardiac enlargement.Left retrocardiac subsegmental atelectasisMild increased interstitial opacities and bronchial wall thickening.No focal areas of consolidation.The large pleural effusions.

Output: Cardiac enlargement with left retrocardiac subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: Lethargy ET tube tip approximately 5 cm above the carina.Interval resolution of lower zone opacities suggestive of aspiration.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female 21 years old with traumatic chest tube removal and dyspnea Esophageal stent stable in position. Right port catheter with tip in the SVC. Bilateral chest tubes stable in position. Stable cardiomegaly. Bilateral pleural effusions, left greater than right, appearing similar to prior exam. Right basilar and left retrocardiac opacities appear similar to prior exam. No evidence of pneumothorax.

Output: Stable bilateral pleural effusions/consolidation, left greater than right.


Instruction: Generate impression based on medical findings.

Input: Right upper lobe resection for squamous cell carcinoma Persistent moderate right pleural effusion with fluid tracking to the apex, however no associated pneumothorax, gas is resolved. Right lower lung atelectasisLeft lung is clearCardiac and mediastinal contours are within limits. Midline sternotomy.

Output: Persistent moderate right pleural effusion without an underlying pneumothorax


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Recurrent malignant pleural effusion. Right chest wall port tip at the cavoatrial junction.Stable positioning of right pleural drain, tip projects over the right mid thorax.Large right pleural effusion with compressive atelectasis, not significantly changed.

Output: Large right pleural effusion with compressive atelectasis, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: is there an infiltrate History: right upper back pain, previous history pneumonia Unremarkable cardiac and mediastinal silhouette.Moderate dextroscoliosis.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Cough Borderline mild cardiomegaly exaggerated with scoliosis. No definite overt changes to suggest aspiration given patient history, however exam limited due to extensive overlying structures, specifically left lower lung. Left subclavian ICD appears grossly unchanged.

Output: Borderline cardiomegaly without definite superimposed acute abnormality. See limitations described


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with stage II rectal cancer CHEST:LUNGS AND PLEURA: Biapical scarring, unchanged.n MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Small cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: cardiac History: SOB There is increased left retrocardiac consolidation/atelectasis. Persistent left effusion. No pneumothorax.

Output: Persistence of left retrocardiac opacity and effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p sternotomy Left lower zone nonspecific airspace opacity in the small left pleural effusion without significant change.Chest tubes in place with no significant pneumothorax.Venous catheters extending to the SVC.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male; 76 years old. Reason: vtach, weakness r/o sepsis c/f PNA History: vtach, weakness 3cm masslike opacity at the right apex, suspicious for a pulmonary neoplasm.Mild cardiac enlargement. No specific evidence of edema.Mild nonspecific streaky bibasilar opacities, left greater than right, are most likely due to subsegmental atelectasis and/or scarring. No specific evidence of pneumonia.Thickening of the right paratracheal stripe, nonspecific.

Output: Right apical mass suspicious for neoplasm, for which CT chest with contrast is recommended.Findings discussed with and acknowledged by Dr. Miedema at 11:07AM at 1/21/15 by telephone.


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma Moderately decreased overall lung volumes mildly greater on the right with an elevated hemidiaphragm. Minimal pleural thickening and changes superimpose the right apex and both lung bases, presumably chronic in scarring. Without prior exams for comparison confirmation is difficult. Cardiac and mediastinal contours are significant for moderate tortuosity of the aorta.Right jugular single port, tip projects into the SVCNo discrete acute osseous abnormalities, however dedicated imaging may be indicated due to greater sensitivity. Old rib deformities and healed fractures involving the lateral left seventh and eighth ribs are associated with an additional mild wedge deformity of what appears to be T7 is observed and of uncertain significance in light of patient's historyCholecystectomy clips

Output: Suspected basilar and right apical scarring without discrete superimposed acute intrapulmonary abnormality however serial imaging and/or comparisons would be helpful. Old rib deformities largely involving the mid left ribs laterally and a mild wedge deformity of a mid thoracic vertebrae may be associated with known multiple myeloma


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval lung fields and line placement History: chest tube in place Support hardware unchanged in position. Right chest tubes with no evidence of significant pneumothorax. Nonspecific patchy right-sided interstitial and airspace opacities are unchanged.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: sob, concern for fluid overload History: sob. Large lung volumes compatible with emphysema.No focal airspace opacity.Small bilateral pleural effusions.Bilateral basilar atelectasis/scarring.Normal cardiomediastinal silhouette.

Output: Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Cough, pain with deep breathing. Evaluate for pneumonia. No focal pulmonary opacities, pleural effusions, or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval Post pigtail catheter placement History: s/p pigtail catheter placement Pigtail catheter projected over the left lung base. Persistent left lower zone opacity compatible with effusion and atelectasis.Other findings unchanged.

Output: Pigtail catheter projected over the left lung base with no pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above The cardiomediastinal silhouette is normal in size. Tortuous aorta.Calcific density projecting over the right lower lobe correlates with an anterior rib bone island identified on the prior CT. There are no suspicious pulmonary nodules or masses. There is no pneumothorax.Mild degenerative changes affect the thoracic spine.

Output: No evidence of pulmonary metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 66 year old with weight loss, history of laryngeal Ca now with left perihilar mass with multiple nodules on CXR. CHEST:LUNGS AND PLEURA: Large confluent hilar and infrahilar necrotic central mass with associated left lower lobe atelectasis.Numerous well-circumscribed, predominantly peripheral nodules are present throughout the lungs with a reference nodule in the right upper lobe measuring 1.2 cm (Series 5, Image 37).MEDIASTINUM AND HILA: An enlarged lymph node at the left thoracic inlet below the clavicle measures 1.2 x 1.5 cm (Series 3, Image 8).An aortopulmonary window lymph node measures 2.5 x 1.4 cm (series 3, image 35). Multiple pretracheal and subcarinal lymph nodes are also enlarged. Aortic arch and coronary artery atherosclerotic calcifications.Heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple liver lesions in the right lobe are noted. A representative lesion in segment 5, a low-attenuation lesion measures 1.0 x 1.0 cm (series 3, image 95).There is no intrahepatic biliary ductal dilatation. The gallbladder is not visualized.SPLEEN:No significant abnormality noted PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal scarring is noted. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: Abdominal aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disc disease throughout thoracic and lumbar spine.OTHER: No significant abnormality notedUTERUS, ADNEXA: No significant abnormality noted.BLADDER: 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: Significant progression of metastatic disease with a large necrotic hilar and infrahilar mass, multiple pulmonary nodules, mediastinal lymphadenopathy, and liver lesions, compatible with metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: r/o pneumothorax History: SOB Multifocal nodular opacities have decreased in conspicuity compared to previous study. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. No pneumothorax.

Output: Multifocal nodular opacities have decreased in conspicuity compared to previous study. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: r/o acute process History: abd pain Left-sided pacemaker unchanged.Right PICC line with its tip in the SVC.The cardiac mediastinal silhouette is unremarkable.Decreased lung volumes with elevation left hemidiaphragm.Minimal basilar atelectasis without focal areas of consolidation.Multiple surgical clips noted within the upper abdomen.

Output: Elevation of the left hemidiaphragm unchanged. No acute abnormalities noted. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Device placement Persistent mild cardiomegaly with a 2-lead left subclavian ICD unchanged in position. No immediate postprocedural complications.

Output: ICD placed without and immediate complication


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: PNA? AMS, psych history History: confusion Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild spinal curvature.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old. Aortic balloon catheter with its tip at the level of the top of the aortic arch.Swan-Ganz catheter tip in the right descending pulmonary artery.ICD leads unchanged.Perihilar opacity suggestive of edema, with marked cardiomegaly.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: 4 day old female with pneumothoraxVIEW: Chest and Abdomen AP (two views) 4/4/15, 0520 ET tube tip at the thoracic inlet. Enteric tube tip in the gastric body with proximal sideholes in the esophagus. UVC in the right atrium. The UAC at T8. Two right chest tubes unchanged.Cardiac silhouette size is normal. Increase in size of right tension pneumothorax with persistent diffuse, coarse lung haziness with pattern of PIE. Complete paucity of bowel gas. No pneumatosis, free air, or portal venous gas.

Output: Increased right tension pneumothorax with leftward mediastinal shift. No bowel gas.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with diffuse large B-cell lymphoma presents with cough and shortness of breath, found to have left pleural effusion. Evaluate size of left pleural effusion. LUNGS AND PLEURA: Left upper lobe bronchovascular opacity extends from the hilum to the apex most compatible with pulmonary lymphoma. A pleural effusion occupies approximately one third of the left hemithorax. A small amount of fluid or pleural thickening is evident on the right as well. Nodularity of the left pleura suggests involvement with lymphoma. The airways are impacted on the left.MEDIASTINUM AND HILA: Marked, diffuse adenopathy in the neck and mediastinum. Nodes surround the SVC, but without IV contrast enhancement, extrinsic compression of the SVC cannot be evaluated. The pericardium is nodular and may also be involved with lymphoma.CHEST WALL: Left axillary adenopathy. A right Port-A-Cath is in place.UPPER ABDOMEN: Diffuse abdominal and retroperitoneal adenopathy. Lack of IV contrast limits the evaluation of solid organ pathology.

Output: 1.Large left pleural effusion.2.Left upper lobe opacity which favors pulmonary lymphoma but an infectious process is also possible and should be excluded based on clinical findings.3.Marked, diffuse lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Abusive head trauma with retinal hemorrhage.EXAMINATION: Skeletal survey 07/13/16 Bone mineralization and modeling are normal. No fracture is seen.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: AMS Severe cardiomegaly and possible pericardial effusion, with vascular redistribution.Interstitial opacity suggestive of edema. No specific evidence of pneumonia.

Output: CHF with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Altered mental status. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary vasculature are also within normal limits. No airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary process. No ET tube identified.


Instruction: Generate impression based on medical findings.

Input: 51 years, Male. Reason: r/o PNA, free air under diaphragm History: epigastric pain, chills Cardiomediastinal silhouette is unremarkable without focal airspace or interstitial opacity. No pleural effusion.Nonobstructive bowel gas pattern with average stool burden. No evidence of intraperitoneal free air.

Output: No evidence of pneumonia. Nonobstructive bowel gas pattern without evidence of intraperitoneal free air.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infection History: febrile, hypoxic Mediastinal widening with an SVC stent in place, unchanged.No sign of pneumonia or other significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: 48 year old male with legionella pnumononia and bilateral effsuions, eval effusion size and ? small apical PTX seen on last CXR History: SOB Resolution of right-sided pneumothorax. Basilar pulmonary opacities with left greater than right pleural effusions again noted. No pneumothorax. Unchanged heart size. Iatrogenic devices are unchanged.

Output: Resolution of right-sided pneumothorax. Otherwise, no substantial change.


Instruction: Generate impression based on medical findings.

Input: Pectus excavatum.EXAMINATION: CT chest 01/10/11 Pectus excavatum is present. The Haller index is 4.0.

Output: Pectus excavatum.


Instruction: Generate impression based on medical findings.

Input: 60 year old female with history of colorectal cancer. Evaluate disease status. CHEST CT

Output: The previously described pelvic fluid collection anterior and superior to the bladder persists without interval change, and this may represent a postoperative lymphocele. No measurable metastatic disease. No acute abnormality was found.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: r/o pna, edema History: lightheadedness Moderate to severe COPD.Heart size normal.No specific evidence of infection or edema.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Reason: eval for infiltrate History: chest pain COPD and mild cardiomegaly status post sternotomy for CABG.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.Degenerative abnormalities affect both shoulders.

Output: COPD and cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: bilat lung transplant now with coughing/wheezing History: cough Status post clamshell sternotomy for bilateral lung transplant.The transplanted lungs are unremarkable without evidence of infection or other abnormality.Heart size normal.Bridging of the anterolateral aspect of the left fourth and fifth ribs could be developmental or related to trauma during surgery.

Output: Status post bilateral lung transplant, without acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: s/p L subclavian line placement and L IJ line exchange History: evaluate position ET tube has been basilar is now 3 cm above carina.Left subclavian catheter tip in SVC. The apparent kink in the axillary region is not evident on follow-up radiographs. Left jugular catheter tip in right atrium. Other support hardware is stable.Nonspecific basilar opacities are unchanged.

Output: ET tube has been basilar is now 3 cm above carina.Left subclavian catheter tip in SVC. Left jugular catheter tip in right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.History of COPD. The cardiac and mediastinal contours are within normal limits.Increased lung volumes and signs of upper lobe predominant emphysema again noted. No abnormal focal lung parenchymal opacities.Healed fractures of the posterolateral aspect of the left seventh rib again noted.

Output: Increased lung volumes and signs of emphysema, stable from prior.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: preop AVR, root History: aortic valve disorder, AI Heart size is normal. Calcified and ectatic ascending aorta. Midline sternotomy hardware with fracture of the most inferior wire, unchanged, and mediastinal clips. No pulmonary or pleural abnormality.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: FemaleReason for Study: Reason: sickle cell History: CP, cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: GI perforation History: abdominal pain post colonoscopy No evidence of intraperitoneal free air. The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormalities. No evidence of intraperitoneal free air.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: fever, R/o pneumonia History: fever Prominent epicardial fat pads. Streaky bibasilar opacities, likely representative of atelectasis. There may be a small left pleural effusion. Right central venous catheter terminates in the distal SVC . No focal pulmonary opacities. Cardiomediastinal silhouette is within normal limits.

Output: Streaky bibasilar opacities, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male 1 day former a 30 week gestation old; Patient with hydrops and bilateral pneumothoraces.VIEW: Chest AP (one view) 8/23/2016, 1831 hours The endotracheal tube is between the thoracic inlet and the carina. Bilateral chest tubes are in place unchanged. The umbilical venous catheter is high in the right atrium. The umbilical arterial line is between T7/T6. The enteric tube is seen with the tip out of the field-of-view.The cardiothymic silhouette is within normal limits. There are small residual bilateral pneumothoraces, left greater than right. There is bilateral lung haziness not significantly changed from previous exams. There is a right-sided pleural effusion.

Output: Small bilateral pneumothoraces, left greater than right.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: eval lung fields History: cough, cp Right port catheter tip in the SVC.Persistent upper lung zone predominant interstitial fibrosis and cystic bronchiectasis and architectural distortion of the hila.Multiple sites of embolization, including bronchial and internal mammary arteries.Stable cardiac mediastinal silhouette.No new focal pulmonary opacities.

Output: Stable findings consistent with cystic fibrosis without radiographic evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 98 years old.Aspiration. Patchy opacities with bronchial wall thickening suggestive of aspirated secretions, slightly improved in the left lower lobe but similar elsewhere. No new opacities are identified.

Output: Partial clearing of pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p trach change Tracheostomy tube in place with its tip about 5 cm above the carina.Right jugular catheter tip in the upper right atrium. ICD lead and LVAD unchanged.Partial right lower lobe atelectasis with interstitial basilar opacity compatible with edema with small pleural effusions.

Output: Tracheostomy tube in appropriate position.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: chest tube interval History: above Right basilar chest tube again noted. Postoperative changes in right hemithorax. No pneumothorax. Left lung remains essentially clear. Normal heart size. Prominent loops of bowel in the upper abdomen. Clinical correlation suggested.

Output: Right-sided chest tube without pneumothorax.Prominent loops of bowel in the upper abdomen. Clinical correlation suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval for interval change History: R PTX, persistent Right chest tubes unchanged with a minimal right apical pneumothorax.Severe emphysema.Stable endobronchial valves.

Output: Unchanged minimal right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.ETT. ETT tip 3.5 cm above the level of the carina.Dobbhoff tube tip in the proximal gastric body projection.Probable cardiomegaly, unchanged.Improving subsegmental atelectasis with suggestion of debris in the airways consistent with aspirated or retained secretions.

Output: ETT tip 3.5 cm above carina. Improved lung inflation with partial resolution of atelectasis. Dobbhoff tube may be advanced.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: COPD History: SOB There is borderline cardiac enlargement.No focal areas of consolidation.Mild scarring/discoid atelectasis in the right middle lobe.No pleural effusions.Degenerative changes in the thoracic spine.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: pleural effusion History: f/u--compare with previous Left Pleurx catheter with no pneumothorax.Small pleural effusions right larger than left basilar atelectasis unchanged.Right jugular catheter, tip in SVC.

Output: No change in pleural effusions right greater than left, with a left Pleurx catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: s/p cardiac arrest History: s/p cardiac arrest Moderate cardiomegaly.Minimal interstitial edema and a small right pleural effusion are noted.

Output: Cardiomegaly with mild edema and a small right pleural effusion consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: assess for infiltrates History: cough The overall enlargement of the cardiac silhouette.The right IJ port catheter overlies the proximal right atrium.No signs of pulmonary edema.Limited assessment for pleural effusions. No pneumothorax.

Output: Stable global cardiomegaly. No signs of pulmonary edema. No findings to suggest pneumonia, considering the limitations of a single AP projection.


Instruction: Generate impression based on medical findings.

Input: Metastatic colorectal cancer. CHEST:LUNGS AND PLEURA: Index left upper lobe spiculated lesion measures 3 x 1.9 cm on image number 26/92, series number 5. Posterior segment right upper lobe lesion measures 19 x 15 mm on image number 36. Other multiple smaller metastases are unchanged. No new nodules are seen.MEDIASTINUM AND HILA: Mild cardiomegaly, unchanged. Calcified lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver metastases are again very ill-defined and poorly delineated as before. Within this limitation, the index lesion measures 3.4 x 2.0 cm on image number 106/219. No new metastatic 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: Stable postsurgical presacral changes.

Output: Stable liver metastases. Lung metastases have also not significantly changed except for slight decrease in the size of the left upper lobe nodule.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with chest pain. Cardiomediastinal silhouette is unremarkable.Upper lobe scarring is again seen, similar to prior. No consolidation, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality and no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Chest pain Mild COPD changes without additional superimposed acute cardiopulmonary abnormalities

Output: Mild COPD


Instruction: Generate impression based on medical findings.

Input: ETT placed ETT terminates 3 cm above the carina. NG is also new extending beyond the inferior edge of the image. Left jugular catheter extends into the innominate without postprocedural complications. Right subclavian port similar to prior and unchangedUnderlying cardiopulmonary appearance is similar grossly with questionable improving aeration the right lower lung, see the subsequent report given extensive limitation in motion artifact on the current study

Output: ETT placed


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Swan. Line placement. New right jugular transvenous pacer terminates in the projection of the cranial aspect of the right ventricle.No specific signs of pulmonary edema and no pneumothorax.Linear radiopaque clip or marker projecting over the aortic arch may reflect an IABP marker.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: heart failure History: heart failure Mild cardiomegaly status post sternotomy, with stable circulatory assist catheters.Small pleural effusions are noted with left basilar consolidation.No significant pneumothorax.Right jugular catheter tip at cavoatrial junction.Left jugular catheter tip in left brachiocephalic.

Output: No change in small pleural effusions and left basilar consolidation. Stable devices.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Bipap. Evaluate for edema/pneumonia. Peripheral focal opacity in the right lower zone may represent pneumonia or infarct.Retrocardiac atelectasis. Probable small pleural effusions and mild basilar opacity suggestive of edema.Median sternotomy and posterior changes of CABG. ICD leads in the distribution of the right atrial appendage, right ventricle, and coronary sinus.Cardiomegaly.Left rib deformities.

Output: Peripheral focal opacity in the right lower zone may represent pneumonia or infarct; follow up to resolution recommended to exclude a mass.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: neuro request History: weakness No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: assess picc placement History: as above Cardiomegaly with mild basilar opacities which have improved, suggestive of resolving edema and atelectasis.Right chest wall and left neckSurgical clips. Left PICC, tip still in the left upper extremity.

Output: Left PICC, tip in the left upper extremity. Improving basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old. ET tube tip in right main bronchus. This has been corrected on subsequent radiographs.Complete atelectasis and consolidation in the left lung, likely related to ET tube placement.A more recent radiograph has been interpreted.

Output: ET tube in right main bronchus with resulting left lung atelectasis.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: 5-mm nodule in the left lower lobe (series 6, image 64), not significantly changed. Stable right upper lobe nodular opacity (series 6, image 22).Minimal biapical scarring and paraseptal emphysematous changes.MEDIASTINUM AND HILA: Stable nodule in the left lobe of the thyroid gland. Calcified right hilar lymph nodes. No adenopathy is identified.Coronary artery calcifications are identifiedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Calcified hepatic granuloma.SPLEEN: The spleen is normal in sizePANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate nonobstructive right nephrolithiasis, unchanged. Focal scarring of the mid pole of the left kidney, unchanged.RETROPERITONEUM, LYMPH NODES: 12 x 8mm reference lymph node just inferior to the aortic bifurcation (series 4, image 137), unchanged.Stable haziness of the mesenteric fat with associated numerous mesenteric lymph nodes.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: Scattered diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: PNA History: cough, sob, wheezing Support devices including LVAD, ICD, and median sternotomy hardware are unchanged. Interval removal of skin staples. No large pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No focal airspace opacity to suggest pneumonia as clinically questioned.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: monitor hardware History: s/p ET tube and chest tube Enlarging left pneumothorax despite a left chest tube, with a new pneumomediastinum.Diffuse interstitial opacities are consistent with edema, unchanged.ET tube tip 4 cm above the carina.NG tube and side port below the GE junction an IVC filter in place.Right subclavian catheter tip in SVC.

Output: Persistent left pneumothorax and a new pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: 39-year-old man with history of type B aortic dissection and thoracic aortic aneurysm status post left thoracotomy and thoracic aneurysm repair on 4/4/2016. Numerous staples and surgical clips overlying the chest. ET tube tip is approximately 4 cm above the carina. 3 left sided surgical drains are seen. There is a small amount of subcutaneous emphysema at the left neck. Atelectasis of the anterior segment of the right upper lobe. Bilateral pleural effusions, left greater than right. No large pneumothorax.

Output: Postoperative changes of aortic aneurysm repair with bilateral pleural effusions, left greater than right, and no large pneumothorax. Right upper lobe segmental atelectasis. ET tube is in appropriate position.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: post-cardiac surg History: post-cardiac surg Interval increase in bilateral pleural effusions and basilar opacities. No pneumothorax. Swan-Ganz catheter removed. Lines otherwise stable.

Output: Interval progression of basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Congestive heart failure and atelectasis. Exam limited by patient rotation and body habitus. Also, the right lung apex is not well visualized on this study. Endotracheal tube tip 4 cm above the carina. Feeding tube tip is beyond the field of view but courses toward the stomach. Metallic vascular stents are seen in the left upper extremity. Mild cardiomegaly. Low lung volumes. Bilateral pleural effusions and associated basilar opacities compatible with atelectasis and edema. The pleural effusions demonstrate mild interval decrease in size.

Output: Limited exam demonstrates improving bilateral pleural effusions with associated basilar atelectasis and edema.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.ETT removed 2 cm. ETT tip is now 2.5 cm above the level of the carina.Bilateral lower lobe collapse/consolidation with associated pleural fluid similar in appearance. Edema and atelectasis in the posterior lung fields has nearly resolved. Scoliosis.

Output: ETT tip 2.5 seen above the level of the carina. Bilateral basal atelectasis/consolidation which may be the result of aspiration and/or mucus plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old with fever and cough. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Dyspnea on exertion. Crackles Nonspecific mild basilar interstitial changes largely peripheral. Specifically appearance raises concern for possible pulmonary embolus and infarct in the appropriate clinical setting. Decreased lung volumes are associated with a mild diffuse interstitial and nodular pattern partially visualized on prior outside abdomen CT 8/11/2014. Please correlate.Borderline cardiomegaly. Mild tortuosity of the aorta with moderate atherosclerotic changes of the aortic archCholecystectomy clips

Output: Nonspecific more patchy changes in both bases superimposed upon a nodular interstitial abnormality, possibly chronic in nature. Serial imaging and/or correlation with prior outside images would be helpful for confirmation and further delineation/characterization. Please see detail providedService contacted pager 2712


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: s/p right lung transplant, new onset of dyspnea on exertion. Cardiomediastinal silhouette is unremarkable. Surgical clips are noted within the mediastinum. Left lung is again hyperinflated. No focal airspace opacities, pleural effusion, or pneumothorax.

Output: Marked hyperinflation of the left lung, similar to prior exam, with no acute cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with tachycardia 140-150s. Evaluate for PE. CHEST:PULMONARY VASCULATURE: Given suboptimal opacification of the pulmonary arteries, this study is only diagnostic to the level of the main pulmonary arteries. No central PE identified.LUNGS AND PLEURA: Bibasilar atelectasis and small pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Enteric tube tip abuts the stomach wall.CHEST WALL: Right chest Port-A-Cath with tip in in the right atrium near its junction with the IVC.UPPER ABDOMEN: Stranding in the mesentery of the upper abdomen and free intra-peritoneal air reflect recent surgery.

Output: Given suboptimal opacification of the pulmonary arteries, this study is only diagnostic to the level of the main pulmonary arteries. No central PE identified.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: intubation and bronch History: desaturation requiring intubation and bronch Reexpansion of the right lung which probably was the result of mucous plugging and atelectasis.Small right pleural effusion.ET tube tip approximately 4 cm above the carina.Right jugular catheter, tip in SVC.NG tube unchanged, the tip near the diaphragm.

Output: Reexpansion of the right lung following intubation.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with tachycardia and dyspnea. History of breast cancer and lung nodule, new treatment-related AML. Suprarenal aneurysm seen on prior scan. PULMONARY ARTERIES: Technically adequate exam with no evidence of pulmonary embolus.LUNGS AND PLEURA: Centrilobular emphysema unchanged. Right paramediastinal fibrosis and scarring likely reflects prior radiation therapy. Left upper lobe calcified granuloma unchanged. Right lower lobe atelectasis/scarring unchanged. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Referenced right pretracheal lymph node measures 1.4 x 1.0 cm on axial image 88/431 and is unchanged. Calcified AP window lymph node likely reflects prior granulomatous disease and is unchanged.Cardiac size is normal. No pericardial effusion. Coronary artery calcifications or stents noted. Lipomatous hypertrophy of the inter-atrial septum noted.CHEST WALL: Right-sided Port-A-Cath in place. Status post right mastectomy.UPPER ABDOMEN: Punctate splenic calcifications likely reflect prior granulomatous disease. Gallbladder sludge noted.Focal dilatation of the suprarenal abdominal aorta measures 3.5 x 3.6 cm on axial image 348/431 and is unchanged.

Output: No pulmonary embolus. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: s/p thora History: n/a Marked interval improvement of the left pleural effusion, with development of a small hydropneumothorax. There is persistent left basilar atelectasis and consolidation. The right lung remains well aerated. Cardiomegaly unchanged.

Output: Decreased left pleural effusion, but with development of a small hydropneumothorax.These findings were relayed to Dr. Roy via telephone at 12/1/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: post-mitral valve leak repair History: post MVR leak repair Median sternotomy with a mitral valve per stasis.Small right pleural effusion with overlying subsegmental atelectasis and possible edema.No specific evidence of infection.Left subclavian pacemaker, leads in appropriate position.

Output: Median sternotomy with a right pleural effusion and the suggestion of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: ro pneumonia History: altered mental status, cough, poor historian Scattered scarlike opacities, the lungs otherwise unremarkable.No specific evidence of infection or edema.Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: aspiration History: as above Slightly increased left lower lobe opacity with associated volume loss which may be related to aspiration.Interval removal of a left subclavian catheter.

Output: Nonspecific left lower lobe opacity and volume loss, possibly related to aspiration.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with chest pain and lightheadedness. History of CAD with stent. Cardiomediastinal silhouette is within normal limits.No focal pulmonary consolidation or pleural effusion.

Output: No evidence of acute cardiopulmonary abnormality without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath rule out pneumothorax. Left chest tube tip projects over the costophrenic angle. Large left pleural fluid collection increased in volume. Elevation of the left hemidiaphragm with atelectasis/consolidation of the left lower lobe and lingula. Aortic knob appears enlarged, unchanged. Right lung is clear. No pneumothorax.

Output: Enlarging left pleural fluid collection. No pneumothorax post chest tube placement.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of non-Hodgkin lymphoma status post stem cell transplant CHEST:LUNGS AND PLEURA: Stable punctate bilateral nodules, not changed.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered nonenlarged mesentery lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable study.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: sob, hypoxia eval for mucus plugging or other change History: sob, hypoxia Dense basilar pulmonary opacities and pleural effusions unchanged.Left PICC, tip in the SVC.

Output: No change in pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with increased work of breathing in the setting of IV fluid resuscitation. Cardiomediastinal silhouette is unchanged.Persistent elevation of the right hemidiaphragm. New patchy ill-defined opacities are seen within the right lung greater than left. Small pleural effusions.

Output: Probable pulmonary edema, mild.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: post op, eval ETT, lung fields History: s/p AVR Small lung volumes post op, with chest tubes but no pneumothorax.Basilar opacities are suggestive of edema although atelectasis may indicate superimposed aspirated secretions.ET tube tip approximately 2 cm above the carina.Two right jugular catheters terminate in the right brachiocephalic vein.

Output: No significant pneumothorax. Postop basilar opacities suggestive of edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: hx lung transplant History: hypoxia Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.Surgical clips secondary to prior bilateral lung transplant.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Hx of tonsillar cancer on IV fluids for hypercalcemia with incresaed oxygen requirement check for fluid overloload History: SOB Right side predominant lobulated pleural effusions and/or tumor are unchanged, compressing the right lower lobe.Left-sided lower chest pleural base lesion is unchanged in appearance.No evidence of edema or left pleural effusion.Heart size normal. No evidence of fluid overload.Right jugular catheter, tip in SVC.

Output: Radiographically unchanged pleural masses.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: PNA/Bronchitis History: Shortness of breath There are new patchy opacities at the right lung base. Hyperinflation of the lungs again noted. Probable diffuse lung emphysema with prominent involvement of lower lobes again noted. Stigmata of previous granulomatous disease, as before. Focal nodule in the left lower lobe, unchanged compared to 6/2014.

Output: New right basilar opacities consistent with aspiration or pneumonia. COPD.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for L anterior rib fx. History: rib pain s/p altercation with girlfiriend. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.No displaced rib fractures.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Adenocarcinoma the right lung The whole removal of the 2 right chest tubes without subsequent abnormality. Minimal right basilar changes representing atelectasis with overall mild volume loss. Right upper lobe and left lung are clearCardiac and mediastinal contours are within limits

Output: Interval removal of 2 right chest tubes


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: intubation History: intubation ET tube is been placed with its tip 4 cm above the carina.Left IJ Swan-Ganz has been mildly retracted with its tip in the main pulmonary artery.Right IJ venous catheter unchanged.Impella device slightly advanced.Stable cardiomediastinal silhouette.No new pulmonary opacities.

Output: Interval intubation with ET tube in satisfactory position. Mild retraction of the Swan-Ganz with its tip now in the main pulmonary artery. Mild advancement of the impella device. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: chest pain History: chest pain, left sided, a.fib patient No significant cardiopulmonary abnormality.Chronic eventration right hemidiaphragm.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT repositioned, tip currently projects 2 cm above the carina. No additional cardiopulmonary changes observed

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Cardiomediastinal silhouette is within normal limits. No pulmonary opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval for PNA History: sob No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: fever; eval for infiltrate History: cough; fever Small lung volumes with basilar subsegmental atelectasis.No specific evidence of infection or edema.Right subclavian catheter, tip in SVC.Left jugular catheter, tip in SVC.

Output: Small lung volumes with basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: s/p cardiac surgery History: continued o2 requirements Right IJ catheter has been removed.Enteric tube with its tip beyond the margin image.Right basilar chest tube unchanged.Stable cardiac enlargement with widening of the mediastinum compatible with known aortic dissection similar to prior exams.Interval improvement in the right upper lobe airspace opacity.Small pleural effusions and basilar atelectasis stable.

Output: Some interval improvement in right upper lobe peripheral airspace opacity. Basilar atelectasis and pleural effusions similar to the prior exam..


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: r/o infection History: cough/trach Low lung volumes makes detailed cardiopulmonary assessment difficult. Tracheostomy tube is in place. Cervicothoracic spinal fusion hardware overlies the lower neck and upper mediastinum. Patchy basilar opacities, right greater than left. Probable small right pleural effusion. Normal heart size. No pneumothorax. Shunt catheter overlies the right hemithorax and upper abdomen. Old right clavicular fracture. Postoperative changes of the proximal right humerus noted.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Patchy bibasilar opacities which may represent aspiration, pneumonia, and/or atelectasis. Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Chest pain Patient is status post sternotomy. Surgical clips overlie the left mediastinum.Cardiac size is within normal limits. Faint retrocardiac pulmonary opacity. No pleural effusions or pneumothorax.

Output: Faint retrocardiac pulmonary opacity, which may represent developing 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: Reason: Evaluate ETT position History: ETT position ET tube tip approximately 3 cm above the carina.Bilateral nonspecific airspace opacities greater on the right, suggestive of infection.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: HIV positive patient with T cell count >900 now with 2 weeks offever, upper abdominal pain and now cough. Labs and cultures unremarkable. Evaluate for source of fever History: Fever, cough, abdominal discomfort Chronic appearing blunting left costophrenic angle with basilar scar like opacities.No evidence of infection or edema. Unremarkable mediastinal contours and cardiac silhouette.Probably healed right rib fractures.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: effusion, edema, cardiomegaly History: SOB, LE edema Cardiomegaly with increasing pulmonary opacities suggestive of edema.Confluence in the right base could be superimposed infection or simple atelectasis.Left upper quadrant bullet fragment.

Output: Increasing pulmonary opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: Infiltrates? rales noted on the right History: fever, recent post op for breast reconstruction and lymph node transplant Probable drain overlies the right breast. Multiple surgical clips overlie the right hemithorax. There is a spacer overlying the inferior aspect of the left hemithorax. Probable linearly oriented iatrogenic device overlies the mid aspect the left hemithorax and may be within the soft tissues. Mild basilar atelectasis or scarring. No large pleural effusion or pneumothorax. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: IABP check Circular radiopaque marker projects in the aortic arch unchanged. Swan-Ganz and ICD are also similar positionModerate nonspecific hernia measuring with persistent mildly decreased lung volumes and basilar atelectasis. No superimposed new airspace abnormalities

Output: Suspected IABP marker unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: s/p impella placement change, eval coils etc in aorta History: impella repositioned Mild cardiomegaly and mild pulmonary edema with a small right pleural effusion.Impella device unchanged in position. IVC Swan-Ganz catheter tip in right main pulmonary artery. Right jugular catheter, tip in SVC.

Output: Mild edema and small right pleural effusion. Impella in appropriate position as are other support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Intubated. The endotracheal tube tip is 3 cm above the carina. Enteric tube IVC filter and a left IJ central venous catheter tip are unchanged.The cardiomediastinal silhouette is unchanged.Improved retrocardiac and right lower lung atelectasis/opacity and interval improvement in interstitial and hazy airspace opacities bilaterally.

Output: Improved aeration in the left lower lobe and improving pulmonary 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: Female, 62 years old.Reason: evaluate lung fields History: s/p right thoracotomy 2 right-sided chest tubes directed towards the apex. Subcentimeter right pneumothorax seen at the apex, the subpulmonic region and extending into the lateral costophrenic sulcus. Right chest wall subcutaneous emphysema and right chest wall surgical drains.Moderate volume of pleural fluid on the right loculated in the fissure and laterally in the upper thorax. Mild edema and atelectasis in the right lung. Scarring near the left hilum and in the left lower lobe. Unable to assess for surgical rib fractures.

Output: Expected postoperative findings including small right hydropneumothorax and edema in the right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: is there evidence of rib fracture or pleural effusion History: sp mva, co pain to right mid lateral back area Unremarkable cardiac and mediastinal silhouette.Stable linear scarring/atelectasis left lung base. Remaining lungs are clear.No pleural effusion. No pneumothorax.Heart size normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 42 years old Male. Shortness of breath. LUNGS AND PLEURA: Few nodular ground glass opacities are noted in the right middle lobe. Bronchial wall thickening and debris in the bronchi are noted. Differential includes aspiration, asthma, or less likely an indolent infection such as atypical mycobacteria. Micronodule along the left major fissure may represent an intrapulmonary lymph node.MEDIASTINUM AND HILA: Small scattered mediastinal lymph nodes are noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Limited views of the upper abdomen demonstrate a left renal hypodensity not completely visualized on this study

Output: Right middle lobe groundglass opacities and diffuse mild bronchial wall thickening and debris. These findings are nonspecific by may be due to aspiration, asthma, or less likely an indolent infection such as atypical mycobacteria.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: assess pna History: sob Enlarging right pleural effusion and basilar opacity. Mild cardiomegaly.

Output: Enlarging right pleural effusion and right basilar opacity, more likely CHF than pneumonia although the latter is possible.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with history of Crohn disease and anemia presented to the ED 4/11/2016 with sudden onset chest pain/pressure and dyspnea. Cardiomediastinal silhouette is within normal limits. No pulmonary opacities, pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality, without interval change. Specifically, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Chest pain. Interval placement of thoracic fixation hardware and midline upper thoracic skin staples. Cervical fixation hardware is unchanged. Interval placement of IVC filter. A nonspecific curvilinear wire overlies the left mediastinum, presumably outside of the patientNew scattered nonspecific airspace opacities and bibasilar subsegmental atelectasis.

Output: 1.New nonspecific bilateral airspace opacities, may represent aspiration, edema or hemorrhage.2.Interval postsurgical changes including IVC filter and thoracic fixation hardware.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: PNA? pleural effusion, edema? History: shortness of breath, chest pain Right hilar mass and mediastinal widening unchanged.Stable right basilar opacity and right pleural effusion.Left hemithorax unremarkable.

Output: No change in known lung cancer.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: r/o CHF History: shortness of breath, ankle swelling about 6mo Large lung volumes, with chronic appearing right apical scarring probably from prior granulomatous disease.Patchy left base opacity has an appearance suggestive of pneumonia or aspiration.Heart size normal.No reliable evidence of CHF.

Output: Patchy left base opacity suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: 66M trach-dependent, COPD, dyspnea, eval for volume overload History: dyspnea Large lung volumes with streaky bilateral focal opacities compatible with atelectasis scarring and infection, unchanged from previous.Tracheostomy tube and port catheter unchanged.

Output: Bilateral patchy opacities compatible with atelectasis and possibly infection, unchanged. No specific evidence of pulmonary edema or visible effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: 25F hx of AI sp valve repair here w syncopal episode, eval for heart size/fluid overload History: as above No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: r/o PNA History: SOB, CP, leukocytosis Low lung volumes. Essential resolution of diffuse pulmonary opacities noted on previous study. Persistent bibasilar opacities, likely atelectasis or scar. Focal nodular lesion noted in the mid aspect the left lung. No evidence of overt left-sided heart failure. Normal heart size. Aortic tortuosity and calcification again noted.

Output: Focal nodular lesion in the mid aspect of the left lung, consistent with known malignancy. No new focal lung consolidation.Resolution of diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male status post hepatic cyst resection now with acute shortness of breath and desaturations. PULMONARY VASCULATURE: No PE. Technically adequate study.LUNGS AND PLEURA: Bilateral pleural effusions and underlying consolidation/atelectasis with air bronchograms predominantly at the bases. Region of poorly opacified lung is seen in the posterior right lung (series 11013, image 129; also seen on series 81024, coronal image 26); nonspecific but may represent a bulla. Likely of little clinical significance.MEDIASTINUM AND HILA: No significant abnormality noted. ET tube. NG tube terminates in distal esophagus.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Intraperitoneal free air and pneumobilia compatible with patient's history of recent surgery. Ascites.

Output: 1.No PE.2.Bilateral pleural effusions with predominant bibasilar consolidation/atelectasis; likely the cause of patient's clinical signs and symptoms. Nonspecific region of poorly opacified lung as detailed above.3.Likely postoperative intraperitoneal free air and pneumobilia.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Emphysema, unchanged. Previously measured right lower lobe nodule is unchanged measuring 7 mm on image number 64, series number 4. Other smaller scattered nodules are also unchanged.MEDIASTINUM AND HILA: Index prevascular lymph node measures 1.2 by 0.9 cm on image number 33, series number 3, stable. Other mediastinal lymph nodes are also stable.CHEST WALL: Postsurgical changes involving the sternum are stable. Sclerotic lesions involving the vertebral bodies and some of the ribs are unchanged.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesions in the liver unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Previously described hypodense lesion in the upper pole of the left kidney is minimally increased in size measuring 3.6 x 2 .1 cm image number 106, series number 3. Right lower pole exophytic lesion is unchanged. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Interval increase in the size of retroperitoneal adenopathy. At the level of the aortic bifurcation left paraortic node now measures 1.8 x 1.4 cm in image number 133, series number 3. Previously it was measuring 1.3 by 1 cm on image number 131, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive bone metastases are stable.Multilevel vertebral body collapse is again noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post radical prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Index right external iliac lymphadenopathy is increased in size and now measures 2.4 x 1.9 cm on image number 165, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive bone metastases are stable.OTHER: Right common iliac aneurysm is unchanged.

Output: Minimal interval increase in the size of the retroperitoneal and pelvic adenopathy.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer status post chemotherapy. CHEST:LUNGS AND PLEURA: No significant change in extensive interstitial thickening and nodular opacities in both lungs. The etiology is unknown. Lymphangitic carcinomatosis cannot be excluded.MEDIASTINUM AND HILA: Mediastinal adenopathy is unchanged. Reference subcarinal adenopathy measures 2 x 1.4 cm image number 34, series number 3.CHEST WALL: Multiple sclerotic foci within the bones of the chest wall and left clavicular head and thoracic vertebral bodies are unchanged.ABDOMEN:LIVER, BILIARY TRACT: Extensive metastatic disease throughout the liver with numerous mixed character lesions are reidentified in the liver. The referenced lesion within the right lobe measures 2.6 x 2.3 cm on image number 79, series number 3. Extensive hepatic lesions are relatively unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule is unchanged.KIDNEYS, URETERS: Severe right-sided hydronephrosis and hydroureter up to the soft tissue density at the level where the ureter is adjacent to the right external iliac vessels is unchanged. The soft tissue nodule measures 13 x 9 mm and may represent adenopathy versus less likely an primary transitional cell carcinoma.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Brachytherapy seeds are in place.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive bone metastases in the pelvis and vertebral bodies are unchanged.OTHER: No significant abnormality noted

Output: No significant change in the hepatic and bone metastases.Nodular interstitial disease in the lungs is also unchanged and suspicious for lymphangitic carcinomatosis.Severe right hydronephrosis with an enhancing nodule in the distal right ureter which may represent metastatic adenopathy versus a primary transitional cell carcinoma is unchanged.Small retroperitoneal lymph nodes are unchanged.Mediastinal adenopathy is also unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: New cough, sputum History: New cough, sputum Cardiomegaly. Low lung volumes with basilar opacities. The basilar opacities likely represent atelectasis.Recommend repeat study of PA and lateral views on deep inspiration for further evaluation. Mid and upper lung zones are clear.Sternotomy wires intact.No pneumothorax.

Output: Cardiomegaly with basilar opacities. With low lung volumes is likely represents atelectasis however recommend follow-up PA and lateral views of the chest is possible for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Improvement in pleural effusion, vascular congestion History: SOB Small lung volumes with diffuse coarse interstitial opacities suggestive of fibrosis, unknown etiology.Cardiomegaly with large central pulmonary arteries consistent with pulmonary arterial hypertension..Superimposed edema cannot be determined.Right pleural thickening or small effusion.

Output: Severe pulmonary fibrosis, ILD thoracic CT recommended for further characterization. No reliable evidence of superimposed edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for edema, infection History: hypoxic, cough Catheter tip in the SVC.Small lung volumes with streaky bilateral mainly lower zone opacities compatible with subsegmental atelectasis and scarring, not significantly changed allowing for inflation. No specific evidence of pulmonary edema or pneumonia.

Output: Atelectasis and scarring with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Mild cardiomegaly, unchanged. Extensive scarring at the right lung base with multiple bullet fragments, unchanged from previous.Catheter tip in the SVC.No significant interval change.

Output: Cardiomegaly and scarring with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: FemaleReason for Study: Reason: ICD placement History: ICD fired \R\1:40pm today Left-sided ICD unchanged. Stable moderate cardiac enlargement.The lungs are clear.No pleural effusions.

Output: ICD unchanged. Stable cardiac enlargement. No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: shortness of breath History: shortness of breath Stable cardiomediastinal silhouette.Increased lung volumes compatible with COPD.No focal areas of consolidation.Pulmonary nodules noted on recent CT are not well visualized on this chest radiograph.Mild basilar bronchial wall thickening.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of esophageal cancer status post resection and chemo RT. Now with brain metastases. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: Small right pleural effusion and compressive atelectasis in the right lower lobe, unchanged. No suspicious nodules or masses.MEDIASTINUM AND HILA: Reference superior mediastinal lymph node (series 3, image 24) measures 7 x 6 mm (stable). Enlarged subcarinal lymph node remains unchanged as well. Heart size normal without pericardial effusion.Patient is status post esophagectomy with gastric pull up. Overall findings are similar to prior study from May 2011.CHEST WALL: Right chest port catheter with catheter tip near the SVC/RA junction. ABDOMEN: LIVER, BILIARY TRACT: Scattered hypoattenuating foci in the liver are too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts bilaterally, unchanged.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta and iliac arteries.BOWEL, MESENTERY: Hazy stranding is seen in the mesentery in the midabdomen (series 3, image 146), which is of uncertain etiology but may be related to prior intervention as a linear tract of subcutaneous air is seen in the anterior abdominal wall in this region.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No evidence of tumor recurrence or distant metastases.2. Stranding in the mesentery of the mid abdomen, possibly from a prior intervention if the clinical history is appropriate.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.ETT placement, after repositioning 3cm Left port catheter tip projects over the cavoatrial junction. Right port catheter tip projects superiorly in the right internal jugular vein. Mild cardiomegaly. No large pleural effusion or pneumothorax. The ET tube projects approximately 4 cm above the carina. No focal pulmonary consolidation. Faint perihilar opacities may reflect aspiration of secretions or perhaps mild edema.

Output: Repositioning of ETT tube as above.


Instruction: Generate impression based on medical findings.

Input: 71 year-old male with laryngeal cancer. Patient admitted for pneumothorax, status post chest tube. CXR shows multifocal atelectasis. Mild tachycardia yesterday, need to rule out PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the subsegmental level.LUNGS AND PLEURA: Previously noted right lower lobe nodule is stable, again measuring 9 mm (series 5, image 124). The scarlike nodule more medially in the right lower lobe (series 5, image 124) is also stable, again measuring 6 mm. Two probable intrapulmonary lymph nodes are reidentified in the right upper lobe (series 5, images 90 and 109). No new suspicious nodules or masses.Focal atelectasis is seen in the right lung base medially with debris seen in an inferior bronchiole (series 5, images 107-124). There is also in linear atelectasis/scarring more peripherally in the left lower lobe as well.Central bronchial wall thickening.Mild centrilobular emphysema, predominantly upper lobes.No pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Atherosclerotic calcification seen in the LAD.CHEST WALL: Extensive subcutaneous emphysema in the right axilla and along the right chest wall.Right chest port catheter with tip in near the SVC/RA junction. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No PE.2. Focal atelectasis in the left lower lobe, likely from aspiration.3. Extensive subcutaneous emphysema in the right axilla and along the right chest wall.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: hypoxia History: hypoxia, SOB Stable cardiomegaly. Signs of pulmonary arterial hypertension.Limited assessment of the left base and cardiophrenic angle, excluded from the field-of-view. Persistent left pleural effusion and trace right pleural fluid. No supine evidence of pneumothorax.Persistent signs of interstitial pulmonary edema. Left retrocardiac consolidation possibly represents left lower lobe atelectasis.Stable position of right IJ central venous catheter overlying the distal SVC.

Output: Persistent signs of interstitial pulmonary edema and bilateral pleural effusions, partially assessed on the left.


Instruction: Generate impression based on medical findings.

Input: 79 years old Female. Reason: acute tachycardia History: as above. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Stable basilar subsegmental atelectasis. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: part of study for clinical research History: uveitis Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pacemaker lead placement History: palpitations Pacemaker leads in expected position with no significant change.No significant cardiopulmonary abnormalities.

Output: Normal lead placement and no significant change.


Instruction: Generate impression based on medical findings.

Input: CHF Moderate nonspecific cardiomegaly with diffuse fibrotic changes similar to prior exam. No discrete superimposed focal airspace process.New Swan-Ganz catheter extends into the right pulmonary outflow tract. ICD unchanged. CABG clips

Output: Cardiomegaly with diffuse fibrotic changes and no distinct definite acute superimposed focal abnormality


Instruction: Generate impression based on medical findings.

Input: Reason: to see if the esophogeal stent is patent History: n \T\ v Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Right chest wall port tip in the SVC. Gastroesophageal stent noted. The stent was patent.TOTAL FLUOROSCOPY TIME: 1 minute 4 secondsEntrance dose: 27.90 mGy

Output: Patent gastroesophageal stent.


Instruction: Generate impression based on medical findings.

Input: Male; 81 years old. Reason: Eval for effusion , pulmonary edema History: S/P AVR CABG in patient with low EF The cardiomediastinal silhouette is unremarkable.No pulmonary opacity to suggest infection. No pleural effusion or pneumothorax.

Output: No pleural effusion or evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: assess pulmonary edema History: CTICU Bilateral chest tubes and mediastinal drains, with no pneumothorax.Unchanged mild basilar opacities and small pleural effusions.A Dobbhoff tube extends below the lower margin of the image.ECMO cannulae unchanged.Left PICC, tip in left subclavian.

Output: No change in pulmonary opacities suggestive of edema, without reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: rpossible pna History: possible pna Interval progression of the right upper lobe pneumonia.No pneumothorax. No pleural effusion.Normal cardiomediastinal silhouette.

Output: Interval progression of right upper lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Sepsis Interval new retrocardiac focal opacity in the left lower lobe with an associated moderate effusion. Although this may partially represent collapse, partial consolidation most also be considered in this limited semiupright projection. Marked scoliosis.

Output: Persistent and enlarging left pleural effusion with cardiomegaly. Underlying probable compression atelectasis however a more acute intrapulmonary process cannot entirely be excluded. Pneumonia must be considered


Instruction: Generate impression based on medical findings.

Input: Reason: check pulmonary status History: check pulmonary status Increased opacity at the left base, suggestive of atelectasis.Heart size about upper normal with a tortuous aorta and evidence of previous median sternotomy.No specific evidence of pulmonary edema or pneumonia.

Output: Increased atelectasis at the left base.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old with fever and cough. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.S.O.B. and anasarca evaluate for acute abnormality. Mild reticulonodular interstitial and airspace opacities with relative sparing of the left upper lobe, the distribution is similar to that seen on prior studies. Bilateral pleural thickening or small effusions with thickening of the fissures consistent with hypervolemia. Cardiothoracic ratio enlarged, similar to previous. Right jugular catheter unchanged in position.

Output: Signs of mild to moderate hypervolemia/edema with superimposed small nodular opacities nonspecific but may reflect superimposed chronic atypical infection.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: please verify line positioning History: s/p IR IJ placement Right pleural effusion and basilar consolidation right greater than left are unchanged.Moderate cardiomegaly.Right jugular catheter, tip at SVC/right atrial junction level.

Output: Unchanged basilar opacities and pleural effusions. New right jugular catheter placed.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for pna or edema History: SOB, cirrhosis, high lactate Small pleural effusions. Hazy opacity at the left lung base, likely atelectasis and pleural fluid. No acute bony abnormality. Normal heart size.

Output: Small pleural effusions. Hazy opacity at the left lung base, likely atelectasis and pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Shortness of breath. On BiPAP. Increased right pleural effusion with adjacent atelectasis/consolidation. Known right lower lobe mass is better evaluated on recent CT chest 2/20/2016. Patient is rotated limiting evaluation. The left lung field is clear, markedly improved from last study.

Output: Increased right pleural effusion with adjacent atelectasis/consolidation. 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, 22 years old.Reason: sickle cell disease, leukocytosis, eval pneumonia History: leukocytosis, atelectasis Cardiomegaly stable. No new opacity to suggest pneumonia. Osseous changes of sickle cell disease.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with metastatic colorectal cancer CHEST:LUNGS AND PLEURA: Emphysematous changes are stable. Reference right apical lesion currently measures 15 x 13 mm previously 19 x 15 mm (image 25, series 5). Right lower lobe nodule currently measures 10 x 6 mm previously 12 x 8 mm (image 49, series 5). Right middle lobe mass currently measures 2.9 x 2.8 cm previously 3.4 x 3.0 cm (image 54, series 5). There is however increase in multiple non-reference lesions as well as multiple new nodules predominantly at the lung base bilaterally (see arrow notations on series 5 images 82 to 86). MEDIASTINUM AND HILA: Reference right hilar adenopathy currently measures 25 x 17 mm previously 27 x 19 mm image number 43, series number 3. Right-sided port terminates in SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis with minimal stable intrahepatic biliary dilatation is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left lower adrenal nodule currently measures 17 x 17 mm previously 17 x 15 mm on image number 104, series number 3. Left upper adrenal nodule currently measures 11 x 26 mm previously 10 x 22 mm on image number 100, series number 3. Mild right adrenal nodularity is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Right retrocrural adenopathy currently measures 14 x 17 mm previously 12 x 13 mm image number 95, series number 3. Substantial increase in retroperitoneal lymphadenopathy. A new reference retrocaval lymph node currently measures 2.0 x 1.4 cm previously 0.9 x 0.8 mm (image 118, series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific punctate scattered lesions in the thoracic and lumber vertebral bodies are grossly stableOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Unchanged mild wall thickening and fat stranding in the mid sigmoid colon region. Pineal soft tissue density posterior to the sigmoid colon currently measures 11 x 10 cm on axial images previously 11 x 11 mm image number 171, series number 3.BONES, SOFT TISSUES: Nonspecific punctate sclerotic lesions in the pelvic bones and vertebral bodies are unchanged. Bilateral fat containing inguinal hernias.OTHER: No significant abnormality noted

Output: 1. Mixed response in the lung. Reference lesions have slightly decreased in size. However multiple non-reference lesions have increased in size. There are multiple new lung nodules.2. Substantial interval increase in retrocrural and retroperitoneal lymphadenopathy.3. Stable adrenal lesions.4. Stable small sclerotic lesions throughout the bones. Bone scan may be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: assess for infiltrate History: hypoglycemia, altered mental status Left-sided ICD unchanged.The lungs are clear.No pleural effusions. Stable cardiac enlargement.

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


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: 57 yo F with trach and vent dependence History: vent dependence The heart is normal in size, considering technique.Diffuse bilateral coarse reticular opacities represent residual interstitial pulmonary edema superimposed on emphysema.Trace bilateral pleural effusions again noted. No pneumothorax.Stable position of support apparatus.

Output: Stable position of tracheostomy cannula and enteric tube.Residual interstitial pulmonary edema superimposed on emphysema is unchanged from multiple priors.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: infection History: SOB and fevers Normal cardiomediastinal silhouette.No focal lung opacities.No pleural effusion.No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: chest pain, sob History: chest pain, sob Stable cardiomediastinal silhouette.No new focal airspace opacities.No pleural effusions.

Output: Borderline cardiac enlargement without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female status post resection of lung with adenocarcinoma and caseating granulomas. Evaluate for miliary tuberculosis. LUNGS AND PLEURA: Severe emphysema is unchanged. Staple lines and postoperative scarring/fibrosis noted in the right lower lobe. Previously seen right lower lobe mass has been resected.Diffuse interstitial opacity within the right lung may represent localized edema, infection, or lymphangitic spread of tumor. Follow-up is recommended.Right upper lobe nodule (axial image 42/101) is new and may reflect postoperative scarring, but follow-up is recommended. Left upper lobe nodule (axial image 28/101) is unchanged.MEDIASTINUM AND HILA: Cardiac size is normal with no pericardial effusion. No significant hilar or mediastinal lymphadenopathy noted. Small prevascular nodes are unchanged.CHEST WALL: Gas within the subcutaneous tissues of the right chest wall just superficial to the pectoralis muscles is of uncertain etiology (axial image 21/101). No evidence of abscess or other inflammatory changes is noted. Has the patient received instrumentation to this region in the recent past?Postoperative rib deformities noted on the right.UPPER ABDOMEN: Limited examination given the lack of IV contrast enhancement. Within this limitation, no gross abnormality noted.

Output: 1.Resection of a right lower lobe mass with expected postoperative changes.2.Diffuse interstitial opacity in the right lung of uncertain etiology which may indicate edema, infection or lymphangitic spread.3.Severe emphysema.4.New right upper lobe nodule.5.Gas within the subcutaneous tissues of the right chest wall.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: r/o pneumonia, lvad problem History: SOB LVAD pt Stable severe cardiomegaly, LVAD unchanged.Respiratory motion degrades the image of the lungs, but they are likely unchanged. No specific evidence of infection.Right subclavian ICD lead stable.

Output: Respiratory motion degrades the image, but there is no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: Pt is a 54 y/o male with h/o urothelial cancer, evaluate for recurrence in lungs History: urothelial cancer, h/o tobacco abuse The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval for cause of chest pain History: chest pain No significant cardiopulmonary abnormality.Lumbar spine stabilization hardware and upper abdominal surgical clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough, check for organizing pneumonia No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: eval swan History: eval swan Swan-Ganz catheter terminate within the intralobar pulmonary artery, as before. Other iatrogenic devices, unchanged. Increasing diffuse pulmonary opacities. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Increase in diffuse pulmonary opacities, likely edema.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Wheezing and right flank/back pain. Evaluate for infection or pneumothorax. The cardiomediastinal silhouette, with moderate tortuosity and atherosclerotic calcification of the aorta, is unchanged.There is no pleural effusion, pneumothorax, or abnormal pulmonary opacity.Degenerative changes affect the spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of right renal cell carcinoma This study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Right lower lobe nodule measures 16 x 60 mm image number 54, series number 3, not significantly changed.MEDIASTINUM AND HILA: Subcarinal adenopathy measures 7 x 3.6 cm image number 45, series number 3, not significantly changed. Thyroid nodules and calcifications are 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: Status post right nephrectomy. No evidence of recurrence in the right renal bed. Left renal mass is very difficult to see and measure. It measures 4.9 x 4.7 cm in image number 111, series number 3, slightly larger. Additional hypodense lesions in the left kidney cannot be optimally characterized due to lack of IV contrast.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Small hernia containing nonobstructive colon loops, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Subcarinal adenopathy and right lower lobe nodule are stable. Left renal mass is slightly increased in size.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: SOB History: as above Primarily status post sternotomy.Worsening coarse interstitial opacities with pleural effusions suggestive of edema with patchy atelectasis.

Output: Worsening CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: cause of sob History: sob Small lung volumes with minimal basilar subsegmental atelectasis.Mild cardiomegaly.A large goiter deviates the trachea to the right at the thoracic inlet level.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Characterize retrocardiac opacity History: abnl CXR Diffuse interstitial opacities and septal lines compatible with interstitial edema. Bilateral pleural effusions. No pneumonia. No pneumothorax.Left chest port with tip in the right atrium.

Output: Interstitial edema with bilateral pleural effusions. No pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: are there any abnormalities History: episode upper back pain, no trauma. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: Chest pain, fatigue History: Chest pain Moderate cardiomegaly with tortuous brachiocephalic vessels and aorta.Healed granulomatous disease.No specific evidence of infection or edema.

Output: Tortuous brachiocephalic vessels and aorta, and moderate cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with newly diagnosed right maxillary sinus lymphoma. Staging CT. CHEST:LUNGS AND PLEURA: Moderate emphysematous changes, most pronounced in the lower lobes. Biapical scarring. Scattered micronodules are nonspecific, the largest of which measures approximately 6 x 7 mm on axial image 56/117. MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. The cardiac size is normal. Small pericardial effusion versus pericardial thickening. A moderate hiatal hernia is also evident.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Homogeneous, well-demarcated hypoattenuating lesion within the caudate lobe most likely represents a benign cyst. Scattered additional small hypoattenuating lesions are too small to characterize but probably also represent benign cysts. No intrahepatic biliary ductal dilatation. The portal and hepatic vasculature is patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild ectasia of the infrarenal abdominal aorta with a maximal dimension of 3.0 cm on axial image 145/234.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: 1.Moderate emphysema.2.Scattered nonspecific pulmonary micronodules.3.Hiatal hernia.4.Likely benign hepatic cysts.5.Mild abdominal aortic ectasia.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: Infiltrate, History: cough, chest tightness, R lung rales Mild cardiomegaly is accompanied by pleural effusions and basilar atelectasis.Median sternotomy.Surgical clips GE junction region.

Output: Cardiomegaly with pleural effusions and basilar atelectasis likely the result of CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: pulm edema History: volume overload Right IJ venous catheter with its tip in the SVC.Decreased lung volumes with stable cardiac enlargement.Perihilar/basilar opacities are similar to the prior exam and compatible with edema/atelectasis.No new pulmonary opacities identified.No large pleural effusions.

Output: No interval change with cardiomegaly and mild hilar and basilar atelectasis/edema.


Instruction: Generate impression based on medical findings.

Input: 83-year-old male with history of IPF with solid and semisolid pulmonary nodular opacities. Evaluate lungs for changes, evaluate nodular opacities. Please provide schedule for continued follow-up. CHEST:LUNGS AND PLEURA: The previously seen solid and semisolid nodules in the left lower lobe are now generally more confluent dense consolidation in a peribronchovascular distribution.Diffuse interstitial abnormalities with fine peripheral reticulation (basilar predominant) and mild bibasilar bronchiectasis are not significant changed. Few scattered areas of mild air trapping noted on expiration views.MEDIASTINUM AND HILA: Enlarged mediastinal and hilar lymph nodes, some of which contain calcifications, without significant change (series 8020, coronal image 49 for example). Heart size mildly enlarged without pericardial effusion. Moderate coronary calcifications.CHEST WALL: Left chest pacer. Degenerative changes of the spine.UPPER ABDOMEN: Cholecystectomy clips. Punctate granulomata in the liver and spleen from prior granulomatous disease.

Output: 1. Previously seen nodular opacities in the left lower lobe are now more confluent dense consolidation. Taking into account the evolution of this lesion over multiple prior studies, differential considerations include organizing pneumonia as well as an indolent malignancy such as minimally differentiated adenocarcinoma (formerly bronchioloalveolar carcinoma).2. Chronic interstitial findings compatible with patient's history of IPF, not significant changed.