Instruction: Generate impression based on medical findings.

Input: Female 57 days old Reason: is the chest tube in correct placement History: new chest tube insertionVIEW: Chest AP (one view) 1/15/15 2248 hrs. ET tube terminates below thoracic inlet. NG tube is present. Left upper extremity central line is at the left innominate vein. Left-sided chest tube is noted. Persistence of tissue edema.Cardiac silhouette size is normal. Streaky opacities of the right upper, left upper, left lingular lobes in both lung bases are noted on a background of chronic lung disease. Small right-sided pleural effusion. Improving in left sided pleural effusion with developing of small left-sided medial pneumothorax.

Output: Interval slight improvement in left-sided pleural effusion and development of right-sided pleural effusion on left-sided medial pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: h/o burn, unstable and bleeding requiring transfusion in OR, if increased vent requirements History: see above Small lung volumes with unchanged edema like opacities but increased retrocardiac consolidation.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Dobbhoff tube tip in distal duodenum.Left jugular catheter, tip in SVC.Left subclavian catheter in region of confluence of left jugular left subclavian veins.

Output: Slight increase in retrocardiac consolidation, with an overall edema pattern unchanged. Tubes and devices are stable in position.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: New infection History: new fever, hypotension Interval progression of basilar opacities. Increase in left lower lobe consolidation.Heart size within normal limits.No pneumothorax.

Output: Interval progression of basilar opacities and left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: bladder cancer and bilateral renal masses History: bladder cancer and bilateral renal masses Moderate cardiomegaly, unchanged. Tortuous aorta. There is a bulky subcarinal mass, likely lymphadenopathy, consistent with metastatic disease. No suspicious pulmonary nodules or masses. No pleural effusions or pneumothorax.

Output: Subcarinal mass, likely mediastinal and hilar lymphadenopathy. CT is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: Reason: eval subclavian line placement History: s/p central line Right subclavian line extending across the midline with its tip in the area of the left subclavian vein.Small lung volumes with streaky basilar opacities compatible with atelectasis and consolidation possibly related to aspiration.

Output: Abnormal location of right subclavian catheter.


Instruction: Generate impression based on medical findings.

Input: Reason: esophageal perf History: sob ET tube, a left jugular catheter and left chest tube unchanged. Small lung volumes with bilateral effusions and underlying basilar atelectasis.Stent traversing the distal esophagus.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: 53 years old Male. Reason: r/o VAD driveline fracture History: driveline fault alarm. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. The cardiac pacemaker/defibrillator electrode and cardiac assist device are again noted.

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


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: eval lung fields History: s/p CABG Right IJ Swan-Ganz and chest/mediastinal tubes unchanged.Decreased lung volumes with stable cardiac enlargement.Mild basilar atelectasis and small effusions similar to the prior exam.No new pulmonary opacities.No pneumothorax.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: pna History: cough The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No specific evidence of infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Patient w/ multifocal necrotizing PNA, please eval for interval change and pleural effusions History: As above Right lung cavitary lesions, the superior one slightly more lucent than before.Left lung grossly unremarkable.An NG tube extends below the lower margin of the image.

Output: Right-sided cavitary pneumonia, the right upper lung zone slightly more lucent than before, otherwise unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: EMPROVE clinical trial IRB# 13-0530 6 month f/u post valve placement History: COPD Hyperinflation of lungs again noted consistent with COPD. Left lower lobe endobronchial valves again noted. Interval increase in left lower lobe volume loss/atelectasis. Extensive basilar preponderant emphysema again noted. Scarlike opacities again noted at the right lung base. No new focal pleural parenchymal opacity. Unchanged heart size. No significant pneumothorax.

Output: Increased left lower lobe volume loss/atelectasis due to endobronchial valves.Basilar preponderant emphysema consistent with alpha-1 antitrypsin deficiency.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female history of NLPHL. status post ABVD done 1/07. Also history of bleo- lung injury. Reevaluate compare. CHEST:LUNGS AND PLEURA: Dense area of consolidation in the left upper lobe is essentially resolved with only a small amount of residual fibrosis in this area. I see no evidence of active airspace disease. Scarring both lung bases. No nodules. No effusions.MEDIASTINUM AND HILA: The bilateral axillary nodes pathologic by clustering in size approximately unchanged. Index noted high in the right axilla as seen on series 3 image 19 and measures 1.5 x 0.9 cm.No evidence of hilar or mediastinal adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No pathologic sized retroperitoneal nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality. Previous exam left adnexal cyst is resolved.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral obturator nodes proximally unchanged. Index node in the left obturator region measured on series 2 image 104 is 2.9 x 1.6 cm. No new sites of disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable adenopathy. Resolved left upper lobe infiltrate. Resolved left adnexal cyst.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above The cardiomediastinal silhouette is normal.There is subsegmental basilar atelectasis and scarring but no suspicious mass or nodule.

Output: No evidence of metastatic disease to the chest.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: shortness of breath History: desaturation, crackles Heart size upper limits normal. There is some degree of vascular redistribution and bilateral pulmonary opacities greater in the perihilar and lower lobe region. This likely represents pulmonary edema. Follow-up will be necessary.Minimal blunting of costophrenic angles. No pneumothorax.

Output: Some degree of vascular redistribution and bilateral pulmonary opacities likely represent early pulmonary edema. Follow-up will be necessary.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: MaleReason for Study: Reason: eval infection, edema, effusion History: cough, dka The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with productive cough and history of sarcoidosis. Evaluate for infiltrate. Cardiomediastinal silhouette is within normal limits.Bilateral patchy and streaky pulmonary opacities with architectural distortion. Particularly dense focal opacity in the left lower lobe is more suggestive of a chronic process such as sarcoidosis.Left lung base scarring.

Output: Patchy and streaky pulmonary opacities with evidence of scarring and architectural distortion; findings are nonspecific but compatible with clinical history of sarcoidosis. Particularly dense focal opacity in the left lower lobe is more suggestive of a chronic process such as scarring and atelectasis due to sarcoidosis rather than pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval ETT History: ETT advanced Status post median sternotomy with chest tubes but no pneumothorax.Unchanged basilar edema, pleural effusions and left lower lobe consolidation.ET tube tip approximately 6 cm above the carina.

Output: ET tube tip 6 cm above the carina. No other change.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.RFO Surgical Case Information | Procedure(s): Procedure(s): | ORGAN PROCUREMENT | Operating Room: CDOR 16 CENTRAL | Surgeon(s) and Role: | * ORGAN, HARVESTER - Primary | Endotracheal tube in place. Enteric tube tip projects over the region of the gastric body. Two radiopaque densities are present, one in each hemithorax, compatible with surgical sponges. Extensive postoperative air collections in both hemithoraces and abdomen following organ donation, including a large amount of air.

Output: Retained surgical sponges within the left and right pleural spaces.No contact number was provided to communicate these findings.


Instruction: Generate impression based on medical findings.

Input: Line change Interval exchange of the right jugular sheath for a multilumen catheter extending into the IVC. ETT removed.Underlying cardiopulmonary. Otherwise unchanged including dense focal opacities largely left lower lobe with mild cardiomegaly. Small effusions

Output: ETT removed and right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: Is there pneumonia History: Cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with GIST status post resection. Evaluate and compare to prior. CHEST:LUNGS AND PLEURA: Stable emphysematous changes in the right lower lobe. No suspicious nodule or mass. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Previously referenced left axillary lymph node measures 0.8 x 1.3 cm on axial image 30/208 and is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesions in segments 4a and 7 demonstrate discontinuous peripheral enhancement most compatible with benign hemangiomas and are unchanged. Scattered additional subcentimeter hypoattenuating lesions are too small to characterize. 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: Exophytic cystic lesion off the lower pole of the left kidney is unchanged.RETROPERITONEUM, LYMPH NODES: A referenced porta hepatis lymph node measures 1.4 x 2.1 cm on axial image 88/208 and is unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the thoracic and lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted

Output: Stable examination. No evidence of residual or recurrent mass.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: wheezing, look for pul edema History: look for pul edema, wheezing Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Status post right lung transplant with emphysema of the native left lung. Left perihilar bronchial valves are seen in place. No pneumothorax is identified.Scarring is seen in the right costophrenic angle, however no large pleural effusion is identified. No focal airspace opacity identified. The cardiac mediastinal silhouette is normal.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Aortic dissection. Postoperative lung evaluation. Cardiomegaly with mild diffuse interstitial opacities and small pleural effusions suggesting edema. Right jugular Swan-Ganz catheter tip overlying the right ventricular outflow tract. No pneumothorax. Multiple chest tubes and mediastinal drains are noted.

Output: Mild pulmonary edema pattern. No measurable pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Acute respiratory failure with hypoxia evaluate for pneumonia. Suboptimal exam quality due to motion. Cardiomegaly and mediastinal widening unchanged.Apparent pulmonary vascular redistribution and unsharpness of the vasculature moderately suspicious for pulmonary edemaPatchy airspace opacity in the bases, nonspecific.

Output: Suboptimal exam with signs of CHF. Basal opacities may reflect edema however superimposed infection is not excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Infectious source History: fever Moderate to severe interstitial and airspace opacities have not significantly changed.Moderate cardiomegaly.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Unchanged interstitial and airspace opacities consistent with edema, infection or evolving ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: r/o acute process History: chest pain RxRight jugular stent, unchanged. Right pleurex catheter, unchanged. Right volume loss and scarring, unchanged. Known upper lobe mass better evaluated on CT. Loculated right pleural effusion, unchanged. No new pulmonary findings.

Output: Unchanged loculated right pleural effusion. No new pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: congestion History: congestion Moderate to severe cardiomegaly status post sternotomy and aortic valve replacement.Minimal basilar edema may be present.No specific evidence of infection.A Dobbhoff tube extends below the lower margin of the image.

Output: Moderate to severe cardiomegaly, equivocal edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: eval lung fields History: s/p CABG Right IJ venous catheter and left-sided chest tube have been removed.No evidence of a pneumothorax.Stable cardiomediastinal silhouette.Pleural effusions and left basilar atelectasis slightly increased from the prior exam.

Output: Interval removal left-sided chest tube without evidence of a significant pneumothorax. Increasing pleural effusions and basilar atelectasis compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: infiltrate History: asthma exacerbation No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old. Reason: r/o mets History: none The heart size is normal with a calcified aorta.Basilar atelectasis/scarring.No focal opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality or evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Rule out foreign body. No radiopaque foreign bodies noted. Endotracheal tube terminates 3 cm from the carina. Esophageal probe noted. ECMO catheters are noted. Bilateral chest tubes and mediastinal drains are present. Swan-Ganz catheter is in the RPA. Marked reduction in size of pleural effusions. Diffuse pulmonary opacities are present. Moderate cardiomegaly. No significant pneumothorax.

Output: No radiopaque foreign body. Lines and tubes, as above. Marked reduction in size of pleural effusions. Diffuse pulmonary opacities again noted, most consistent with pulmonary edema and/or diffuse alveolar damage.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: weight loss History: weight loss Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: ET tube placement History: see above Mild enlargement of the cardiac silhouette again noted.Signs of interstitial edema, bilateral discoid atelectasis and trace bilateral pleural effusions, unchanged.Appropriate position of ET tube overlying the mid trachea.

Output: Appropriate position of ET tube overlying the mid trachea.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: is there an infiltrate History: uri complaints, no hemoptysis, history renal transplant, history dvt on coumadin Low lung volumes. No focal lung consolidation or evidence of overt left-sided heart failure. Mild cardiomegaly again noted. No large pleural effusion or pneumothorax. Bony lesions within right ribs have increased in size since previous study and likely represent slight growth of Brown tumors given renal history.

Output: No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Fever. Evaluate for infiltrates. Left lower lobe associated opacity, concerning for pneumonia. Minimal right basilar opacities, improved from the previous studies. No significant pleural effusion or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: Left lower lobe consolidative opacity concerning for pneumonia.. Multilobar heterogeneous opacities possibly represent multifocal infection. Attention on forthcoming chest CT.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: pt with lung cancer, recent pneumonitis, increased shortness of breath, decreased breath sounds on the right. Is there pleural effusion? History: shortness of breath Diffuse fine miliary nodules likely unchanged, more discretely visualized given resolution some of the left lung opacities. Airspace opacities persist in the right lung.No significant pleural effusion.Volume loss from right upper lobectomy with elevation of the right hemidiaphragm.Stable cardiomediastinal silhouette.

Output: Miliary nodules may reflect disseminated fungal infection, TB, or miliary hematogenous metastases.Findings relayed via telephone to Dr. Malec at 4:32 PM on 7/27/2016.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with head and neck cancer, compare to previous LUNGS AND PLEURA: Scattered, calcified and noncalcified micronodules are stable. No suspicious pulmonary nodular masses can be identified.MEDIASTINUM AND HILA: Stable minimally enlarged right hilar lymph nodes. No mediastinal adenopathy identified.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Stable calcified and noncalcified micronodules. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: anemia, SOB History: as above Unremarkable cardiac and mediastinal silhouette. Small bilateral pleural effusions.No sign of pulmonary edema or infection.Small amounts of air in the right abdominal wall, likely iatrogenic.

Output: Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: S/P OHT; routine History: as above Postop change from orthotopic heart transplant with no evidence of significant pulmonary edema or pleural effusion. Right PICC tip in right axillary vein. Degenerative change involving spine.

Output: Postop change from orthotopic heart transplant with no evidence of significant pulmonary edema or pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with chronic lower abdominal pain with worsening anorexia, evaluate for etiology including ovarian mass. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Adnexa appear unremarkable. Minimal uterocervical fullness can be further evaluated with OBGYN consult. Bilateral ovaries appear unremarkable. BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER:No significant abnormality noted.

Output: No findings to account for the patient's abdominal pain and anorexia. There is no evidence of pelvic or adnexal masses or pelvic adenopathy.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with metastatic colorectal cancer on chemotherapy CHEST:LUNGS AND PLEURA: Numerous pulmonary nodules are again identified bilaterally. A few of them have mildly decreased in size, however the majority are unchanged. Additionally, several now exhibit areas of cavitation. The reference left lower lobe nodule measures 18 x 18 mm (series 5; image 70), not significantly changed. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right-sided port terminates in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Hemangioma in the lateral segment of the left lobe remains. Homogeneously enhancing lesion in the right lobe of the liver with a central hypodense focus is grossly unchanged.5-mm hypodensity is now identified in segment 7 of the liver (series 3; image 71).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Numerous para-aortic lymph nodes are again identified, not significantly changed. The previously measured nodes represented a cluster of distinct nodes. A more discrete node in the paraaortic region measures 10 x 9 mm (series 3; image 125), previously 11 x 10 mm on the prior two examinations. BOWEL, MESENTERY: Concentric thickening of the hepatic flexure remains, presumably the site of cancer. Thickening of the ascending colon and cecum is identified, not significantly changed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Incompletely distendedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lumbosacral degenerative changesOTHER: No significant abnormality noted

Output: Mild decrease in size of a few pulmonary nodules, though the vast majority are unchanged in size.New subcentimeter hypodensity in the liver; cannot exclude early metastatic focus. Follow-up is suggested.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Right jugular Swan-Ganz has been placed with tip projected into the right pulmonary outflow tract. Unchanged right jugular PICC line and moderate nonspecific cardiomegaly. Lungs remain clear. See subsequent report

Output: Swan-Ganz catheter placed as described


Instruction: Generate impression based on medical findings.

Input: Cardiomyopathy ETT has been placed terminating 4 cm above the carina. A new Swan-Ganz projects is also observed extending in right pulmonary outflow tract. Postsurgical bilateral chest tubes and mediastinal chest tubes unchanged project towards both bases and midline respectively. IABP marker projects in the aortic archLungs demonstrate patchy perihilar and basilar streaky densities, likely atelectasis versus mild edema. Cardiomediastinal contours are grossly within limits

Output: ETT placed


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: pe History: dyspnea Subcutaneous iatrogenic device overlies the left chest wall.Minimal right effusion. No pneumothorax. Left basilar opacities, better described on prior CT. Encouragement of the pulmonary vasculature, indicative of pulmonary hypertension. The cardiomediastinal silhouette is within normal limits.

Output: Minimal right pleural effusion. Otherwise, no acute cardiopulmonary abnormality. Please see CT chest 10/14/2016 for further details.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: assess of interval change in pleural fluid collection History: s/p thora Right basilar consolidation with right pleural effusion, unchanged.No pneumothorax following thoracentesis.Improved atelectasis left lung base.Shunt tubing courses over the right side of the chest.

Output: Persistent right pleural effusion with no pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: ETT position History: Type II RF Severe emphysema.No specific evidence of infection or edema.ET tube tip approximately 6 cm above the carina.An NG tube terminates in the stomach.

Output: Severe emphysema. ET tube tip approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 72 years old Female. Reason: interval changes in hardware History: none. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. Small amount of bilateral pleural effusions are noted.The venous catheter through the IVC is seen with the tip in the right pulmonary artery. The cardiac pacemaker/defibrillator electrodes are stable in position. The intra-aortic balloon pump tip is stable in position.

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


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: r/o mets History: Renal cell carcinoma status post resection Cardiac mediastinal silhouette is within normal limits. No pleural effusions or pneumothorax. No focal pulmonary consolidation. No suspicious nodular opacity.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 36 yearsGender: MaleReason for Study: Reason: ? acute chest History: cp The cardia mediastinal silhouette is unremarkable.Bilateral nonspecific basilar opacities compatible with atelectasis and/or edema.No focal areas of consolidation.No pleural effusions.

Output: Nonspecific basilar opacities compatible with atelectasis which may be related to an acute chest syndrome. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: ett History: ett Bilateral pleural effusions and basilar opacities are stable.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Unchanged pulmonary opacities and pleural effusions. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: ETT placement History: as above Coarse interstitial and airspace opacities left mid to lower lung zone predominant suggestive of edema and superimposed aspiration or infection, unchanged.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Unchanged interstitial and airspace opacities suggestive of edema with superimposed infection or aspiration. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 10-year-old male with severe abdominal pain. Evaluate for intra-abdominal process.VIEWS: Abdomen AP/lateral (two views) 11/25/2016 at 22:42 Hepatosplenomegaly. Relative paucity of bowel gas with focally prominent loops of small bowel in the right lower quadrant. No portal venous gas, pneumoperitoneum or pneumatosis intestinalis is identified.Partially imaged bilateral multifocal lung opacities, better evaluated on same-day chest radiograph.

Output: Hepatosplenomegaly. Relative paucity of bowel gas with focally prominent right lower quadrant bowel loops, which may represent ileus.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.History of respiratory failure, evaluate endotracheal tube placement. Endotracheal tube with tip approximately 7 cm above the carina and with cuff probably above the vocal cords. Distal nasogastric tube poorly visualized, but tip in distribution of stomach on subsequent abdominal radiograph with timestamp 1/25/2016 14:10.Persistent lower lung zone predominant opacities not significantly changed.

Output: High endotracheal tube with tip approximately 7 cm above carina.Findings text paged to CHANDIRAMANI, ANISHA at 2:36 PM on 1/25/2016


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval ETT, lung fields History: s/p lung transplant Endotracheal tube terminates approximately 7.5 cm from the carina. ECMO catheter overlies the superior mediastinum. A second ECMO catheter loops at the level of the RA and terminates below the level of the right hemidiaphragm which is unexpected. Swan-Ganz catheter is difficult to visualize but likely terminates in the main pulmonary artery. Bilateral chest tubes are noted. Multiple lap pads overlie the thorax, left greater than right (patient is still open due to large amount of bleeding). Bilateral soft tissue drains overlie the lower thorax. Diffuse left greater than right pleural-parenchymal opacities are noted. No definite pneumothorax though there is question of right-sided basilar pneumothorax given conspicuity of the right hemidiaphragm. Mild subcutaneous emphysema, left greater than right.

Output: An ECMO catheter loops at the level of the RA and terminates below the level of the right hemidiaphragm which is unexpected. Diffuse left greater than right pleural-parenchymal opacities.Question of small right-sided basilar pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: chest pain History: chest pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 62 year old female with high-grade endometrial cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mild intra-and extrahepatic biliary dilatation. Common bile duct is dilated throughout its course measuring up to 12-mm. Etiology is unknown. M.R.C.P. may be helpful for further evaluation, if clinically indicated.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Slightly enlarged left adrenal gland, nonspecific.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes. An index left para-aortic lymph node measures 10 by 8mm image number 115, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: Intra-and extrahepatic biliary dilatation. M.R.C.P. or ERCP may be helpful for further evaluation, if clinically indicated. The prior shotty retroperitoneal lymph nodes.Small mediastinal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, elevated blood sugars, eval for PNA History: SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: Patient with chest tube connected to Atrium system. Patient called office today stating that there is a clot at the bottom of Atrium and she is unable to drain the output History: unable to drain chest tube Right chest port tip in the right atrium. Left-sided chest tube is unchanged in position. Five left-sided endobronchial pulmonary valves are unchanged in position.Small left effusion tracks over the apex. Small focus of intrapleural air is noted in the left upper lung.No significant change in chronic diffuse interstitial lung disease.

Output: Small hydropneumothorax as described above.


Instruction: Generate impression based on medical findings.

Input: Elevated white count Persistent mildly decreased volumes with razor scarring greater on the left. No discrete new superimposed focal airspace process given patient history.

Output: Basilar scarring without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: central line placement History: post op Right jugular catheter extending to the SVC.Pacemaker leads unchanged.Status post aortic valve repair.Marked cardiomegaly with partial clearing of pulmonary edema.Small residual pleural effusions.

Output: New right jugular catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Altered mental status Mild motion and rotation limit sensitivity. Within this circumstance, no definite distinct interstitial or acute airspace abnormalities observed, however a small right effusion and possible atelectasis should be considered. Serial imaging would be helpfulPersistent mild nonspecific cardiomegaly. Projected mediastinal widening and tortuosity aorta appears exaggerated due to rotation, again however there is any concern for mediastinal abnormality or great vessel complication, serial imaging is suggested

Output: Suspected right basilar atelectasis and/or aspiration


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Similar unchanged mild nonspecific cardiomegaly with minimal interstitial changes greater both bases with mild vascular redistribution. Overall appearance appears chronic and without definite superimposed edema, however early changes may be obscured. Serial imaging may be helpful. No superimposed focal airspace process.Unchanged moderate degenerative changes

Output: Questionable early mild CHF versus underlying chronic baseline exam


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.History: Chest pain, dyspnea query pneumothorax Unremarkable cardiomediastinal silhouette.No pulmonary or pleural abnormalities.

Output: No acute cardiopulmonary process. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Postop atelectasis, consolidation, line placement. Interval extubation. Other hardware and devices unchanged. Right hemidiaphragm now appears elevated.Cardiomegaly with enlargement of the central pulmonary vasculature unchanged. Right basal consolidation is new. Left lower lobe bronchiolitis pattern with developing consolidation, suspicious for active infection.

Output: Worsening basal consolidation bilaterally suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.CABG evaluate lung fields. Cardiopulmonary hardware and support devices similar in position.Pleural effusions and atelectasis appear to be improving. No specific signs of pulmonary edema.

Output: Improving pleural fluid and atelectasis. No reliable signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Chest pain and possible assault. Chronic changes in the left lung with residual scarring at the right lung base. Stable cardiomediastinal silhouette with prominence of the central pulmonary arteries compatible with pulmonary hypertension. No new pulmonary opacities. No obvious acute rib fracture. No pneumothorax.No pleural effusions.

Output: No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: assess swan History: as above Swan-Ganz catheter terminates within the right pulmonary artery. Unchanged cardiac lead. Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Evaluate for enteric tube placement Enteric tube seen with side-port above gastroesophageal junction. Further advancing recommended. No specific evidence for bowel obstruction. Mildly distended colon (lumen measures less than 6 cm). Above average stool burden.

Output: Further advancing of enteric tube recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: PNA History: cough, leukocytosis with Left Shift Left base slightly better aerated. No new opacity to suggest pneumonia. Mild cardiomegaly stable.

Output: Left base slightly better aerated. No new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: 64 y/o with hypoxemia eval change History: sob Increase in diffuse pulmonary opacities. Left basilar pleuroparenchymal opacity, not substantially changed. No pneumothorax. Unchanged heart size. Unchanged left PICC terminating over the upper left hemithorax.

Output: Increase in diffuse pulmonary opacities, likely edema. Left basilar pleuroparenchymal opacity, not substantially changed.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with newly diagnosed lung cancer. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Right hilar mass (series 3, image 58) measures 5.5 x 3.5 cm. Scattered pulmonary nodules, many of which are calcified. A noncalcified, subpleural nodule is identified on series 4, image 56; it is nonspecific but may represent a metastatic lesion.Predominantly upper lobe centrilobular emphysema. Patchy ground glass opacities are noted as well.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy is identified. Reference precarinal lymph node (series 3, image 49) measures 1.8 x 1.1 cm.. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No mass lesions identified. Portal vasculature is patent. No intra-or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal lesions, consistent with metastatic disease. For reference, the right adrenal lesion measures 5.3 x 4.4 cm (series 3, image 106).The left adrenal lesion invades the left renal vein at its confluence with the left gonadal vein (series 3, image 121).KIDNEYS, URETERS: No significant abnormality noted in the kidneys. Invasion of the left renal vein left adrenal mass as above.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta.BOWEL, MESENTERY: A metastatic deposit within the mesentery of the left hemiabdomen (series 3, image 112) measures 3.2 x 3 cm.BONES, SOFT TISSUES: Nonspecific, scattered subcentimeter subcutaneous nodules. Degenerative disease of the spine.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific, scattered subcentimeter subcutaneous nodules. Degenerative disease of the spine.

Output: 1. Right hilar mass in the lungs with mediastinal and hilar lymphadenopathy as described above.2. Multiple lesions within the abdomen consistent with metastatic disease are described above as well. The left adrenal lesion invades the left renal vein at its confluence with the left gonadal vein.


Instruction: Generate impression based on medical findings.

Input: Reason: persistent cough; prior smoker History: persistent cough; prior smoker Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old. Interval removal of multiple surgical packs.No unexpected radiopaque foreign object.Scope in the esophagus and Swan-Ganz catheter extending to the area of the main pulmonary artery.Bilateral chest tubes in place with pulmonary opacity, greater on the left, compatible with edema and effusion.

Output: No unexpected radiopaque foreign object. The findings were discussed with the attending surgeon, Dr. Wigfield, at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: post left decortication History: decortication ET tube has been removed.Right Port-A-Cath with tip in the RA.2 left-sided chest tubes unchanged.Large left hydropneumothorax similar to the prior exam.Moderate sized right pleural effusion and right basilar consolidation/atelectasis redemonstrated.

Output: Interval extubation. Persistent large left hydropneumothorax and right pleural effusion with underlying consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: 62 years old Male. Reason: cardiopulmonary abnormality? History: pain. Unchanged bibasilar opacities. Stable triangular opacity in the right middle lobe along the right minor fissure. Subtle irregularity along the anterolateral aspect of the left ninth rib may reflect a rib fracture. The left costophrenic sulcus is somewhat deep, however, it appears similar to the examination from 5/11/2016. A small pneumothorax cannot entirely be excluded. Stable cardiomediastinal silhouette and unchanged surgical/orthopedic hardware.

Output: Stable triangular opacity in the right middle lobe. Questionable small right pneumothorax. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: PPD screening test History: PPD screening test Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: sp nupulse History: - Interval removal of Swan-Ganz catheter. Left subclavian catheter tip in SVC. IABP 3 cm below the arch. Cardiac support device in electrodes are unchanged in position.Slight interval improvement in bilateral pleural effusions with mild basilar edema and atelectasis.

Output: Slight interval improvement bilateral pleural effusions with mild basilar edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: cp History: cp Stable mild cardiac enlargement.Mild basilar interstitial opacities compatible with atelectasis/edema.No focal areas of consolidation.Blunting the right costophrenic angle may represent small effusion.Median sternotomy intact with evidence of prior CABG.Left-sided ICD unchanged.

Output: Mild increased pulmonary edema and possible small right pleural effusion. Attending physician was notified by phone on 10/7/2015 at 9:30 AM


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: left subclavian History: left subclavian Right subclavian catheter tip in SVC. New presumed esophageal probe in the right mainstem bronchus which has been removed on subsequent images. NG tube tip in stomach. ET tube tip 5 cm above carina.Basilar interstitial opacities with left lower lobe consolidation stable.

Output: Right subclavian catheter tip in SVC


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: ET tube repositioning Endotracheal tube tip approximately 2 cm above the carina. Right central catheter with tip in the right atrium. Enteric tube tip in the gastric fundus.Cardiomediastinal silhouette is unchanged. No pneumothorax. Persistent left basilar retrocardiac opacity which may be secondary to aspiration and small bilateral pleural effusions. Surgical clips are present in the right upper quadrant.

Output: 1.Persistent left basilar opacity which may be secondary to aspiration. Small bilateral pleural effusions.2.Endotracheal tube in adequate position.


Instruction: Generate impression based on medical findings.

Input: 71 years, Female. Reason: r/o obstruction History: "gas" + constipation Nonobstructive bowel gas pattern. Above average stool burden. No free air. Suture material projects over the pelvis.Tortuous aorta. No focal pulmonary opacity, pleural effusion or pneumothorax.Degenerative changes affect the lumbar spine, SI joints, shoulders and hips.

Output: Nonobstructive bowel gas pattern. Above average stool burden.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: confirm line placement Right IJ line terminates to the cavoatrial junction. No pneumothorax. Unchanged cardiac lead. Study limited by leftward patient rotation. Diffuse interstitial opacities again noted. Unchanged cardiomegaly. Markedly enlarged central pulmonary artery again noted.

Output: Right IJ line terminates to the cavoatrial junction. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: Evaluate for etiology of hypoxemia and r/o free air under diaphragm - 22 yo w ESRD 2/2 Alport, poorly compliant p/w hypoxemia, epigastric abdominal pain, reported hemoptysis History: epigastric abdominal pain, firm abdomen, hypoxemia, reported hemoptysis Extensive bilateral pulmonary opacities, increased from prior study. This is associated with severe but stable cardiomegaly. The differential diagnosis includes pulmonary edema or possibly hemorrhage. Mild diffuse sclerosis of the vertebral bodies suggestive of renal osteodystrophy. No pneumothorax or significant pleural effusion.

Output: Extensive bilateral pulmonary opacities, increased from prior. Severe cardiomegaly. Findings suggestive of pulmonary edema or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: assess ng tube placement History: as above The ET tube is localized approximately 5 cm above the carina. New enteric tube in place coursing below the diaphragm.Right IJ venous catheter overlies the distal SVC.No abnormal focal lung parenchymal opacities.No pleural effusion or pneumothorax.

Output: Adequate position of new ET tube and enteric tubes.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Fever and leukocytosis. Rule out infiltrate. No pulmonary or pleural abnormalities.Cardiomediastinal silhouette is within normal limits.Interval removal of right upper extremity PICC.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: PA catheter placement History: PA catheter placement Swan-Ganz catheter tip in the main pulmonary artery.Cardiomegaly with diffuse interstitial opacity compatible with edema.Focal dense consolidation and atelectasis in the anterior segment of the right upper lobe, suggestive of pneumonia.

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


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval for infiltrate History: sob, cough Basilar atelectasis or scarring with a chronically elevated left hemidiaphragm.Heart size normal.No specific evidence of infection or edema.

Output: Basilar scarring and chronic left mibefradil ovation. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: History of lung cancer on Tarceva for two months. CHEST:LUNGS AND PLEURA: Previously noted left upper lobe opacity appears fuller and measures slightly larger at 5.3 x 6.2 cm on axial image 22/112. Erosion of the adjacent ribs has progressed. Referenced right upper lobe nodule is smaller measuring 9.3 x 8.6 mm on axial image 25/112. Additional scattered micronodules are unchanged. No pleural effusion.MEDIASTINUM AND HILA: Cardiac size is normal with no pericardial effusion. AP window lymph nodes have changed in configuration but measure approximately 29 x 23 mm with no definite change in size noted (axial image 33/154). Precarinal lymph node is stable measuring 13 x 15 mm (axial image 41/154). Left hilar lymph node is also unchanged measuring 25 x 23 mm (axial image 46/154).CHEST WALL: Rib erosion as above.ABDOMEN:LIVER, BILIARY TRACT: Small hypoattenuating lesion within the posterior lobe of the liver probably represents a cyst. No suspicious liver lesions. Punctate calcific density within the gallbladder likely represents a gallstone.SPLEEN: Splenic calcification reflects prior granulomatous disease.ADRENAL GLANDS: Bilateral adrenal masses are unchanged.KIDNEYS, URETERS: Hypoattenuating renal lesions are unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the spine. A sclerotic focus within the right iliac wing as well as additional smaller sclerotic foci throughout the vertebral bodies likely represent bone islands. Injection granulomas noted in the posterior soft tissues.OTHER: No significant abnormality noted

Output: 1.Increase in size of the left upper lobe mass with progression of adjacent bony erosion.2.Other pulmonary nodules are stable to smaller.3.Stable mediastinal and hilar lymphadenopathy.4.Small gallstone. 5.Stable bilateral adrenal masses.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: please re-evaluate after diuresis, no longer on oxygen. Please compare to previous CXR. History: no SOB, not hypoxic Multiple skin staples projecting over the chest wall.Stable cardiomediastinal silhouette.Near resolution of airspace and interstitial opacities as well as improved pleural effusions.Mild bibasilar atelectasis.

Output: Significant interval improvement of pulmonary edema.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, 60 years old.Reason: CHF History: SOB. Cardiomegaly is stable. Kerley B line's and subpleural edema noted. No pleural effusion or pneumothorax. Right midlung opacity favored to be artifactual. Attention on follow-up radiographs.

Output: Mild pulmonary edema; findings are in keeping with a diagnosis of CHF. Right midlung opacity favored to be artifactual; attention on follow-up radiographs.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Abdominal pain and guarding question free air under diaphragm. Semierect portable chest radiograph. No visible free intraperitoneal air, but please note that small amounts of free air may not be visible as the patient is not fully erect. The lungs are clear.

Output: Limited assessment for free air due to semierect patient positioning, but no free air is identified.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Swan-Ganz placement. Swan-Ganz catheter tip projects over the main pulmonary artery. ICD leads and median sternotomy wires are unchanged. Stable small bilateral pleural effusions. Nodular density projecting over the right lower lung compatible with a nipple shadow. No new focal airspace opacity or pneumothorax.

Output: Swan-Ganz catheter tip projects over the main pulmonary artery. Stable small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: esophageal cancer/ tracheoesophageal fistula History: esophageal cancer/ tracheoesophageal fistula Left apical opacity unchanged consistent with pleural fluid and adjacent consolidation.The right base atelectasis has continued to improved.Left lung unremarkable.

Output: Unchanged right apical pleural fluid and consolidation. Improving right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: ett History: ett ET tube with its tip approximately 4 cm above the carina.Left IJ venous catheter with its tip in the left innominate.New IABP marker with its tip in region of the aortic arch.Dobbhoff tube with its tip beyond the margin of the image.Stable cardiomediastinal silhouette.Native left lung fibrosis unchanged.Mild interstitial opacities and possible small right pleural effusion within the transplanted right lung.

Output: ET tube in satisfactory position.IABP marker in the region of the aortic arch.Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: assess pericardial drain positioning History: as above Interval placement of a pericardial drain which terminates at the lateral wall of the right atrium.Interval decreased size of the cardiac silhouette. Bulky right mediastinal adenopathy unchanged. Diffuse opacities of increasing pulmonary edema with small pleural effusions and basilar atelectasis. No pneumothorax.

Output: Interval decreased size of pericardial effusion following drain placement. Increasing pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with stage II colorectal cancer. Status post 12 cycles of adjuvant chemotherapy. Please evaluate and compare. CHEST:LUNGS AND PLEURA: Small right middle lobe nodule appears stable and measures 4.3 mm (image 30/107, series 5), compared to 4.6 mm on the previous exam. There is compressive atelectasis of the lingula.MEDIASTINUM AND HILA: Cardiomegaly with calcifications of the coronary arteries, aortic root and mitral annulus.A catheter is noted in the left and right brachiocephalic veins.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips are noted. Multiple hyperdense lesions in the liver, likely represent granulomata however, without IV contrast, these lesions cannot be further characterized. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Two hyperdense lesions are seen within the lower pole of the right kidney and the lower pole of the left kidney, which appear stable but cannot be optimally evaluated due to lack of IV contrast the likely complex cyst. There are also multiple bilateral hypodense lesions, which also cannot be adequately characterized without IV contrast.RETROPERITONEUM, LYMPH NODES: Multiple subcentimeter retroperitoneal lymph nodes. A reference left aortic lymph node is mildly decreased in size and measures are 0.9 cm x 1.3 cm (image 121/216, series 4), compared to 1.5 cm x 1.2 cm on the prior study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Improvement of anasarca.OTHER: Resolution of perihepatic ascites is noted.Atherosclerosis of the aorta and its branches.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted..BLADDER: No significant abnormality noted..LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitisBONES, SOFT TISSUES: Interval resolution of the ubcutaneous abdominal fluid collection..OTHER: No significant abnormality noted..

Output: Limited evaluation of the solid organs due to lack of IV contrast.1.Slight decrease in size of subcentimeter retroperitoneal lymph nodes2.Interval resolution of the previously seen subcutaneous abdominal fluid collection.3.Resolution of perihepatic ascites and decreased anasarca4.Hyperdense lesions in the lower pole of the right kidney and lower pole of the left kidney appear stable and likely represent complex cysts; however, without IV contrast these lesions cannot be further characterized. Multiple bilateral hypodense lesions are again seen and appear stable.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: post op, eval ETT lung fields History: s/p MVR, CABG Chest tubes following redo sternotomy with no pneumothorax.Basilar edema and atelectasis are present postop with a left pleural effusion.ET tube tip approximately 4 cm above the carina.Right subclavian Swan-Ganz catheter, tip in main pulmonary artery.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: Pulmonary Sequestration History: Pulmonary Sequestration Small right pleural effusion/pleural thickening with chronic elevation of the right hemidiaphragm. No pneumothorax. Interval improvement in bibasilar interstitial opacities consistent with edema.

Output: Interval improvement of pulmonary edema without significant change in right pleural effusion and elevation of the right hemidiaphragm.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval for acute cardiopulmonary abnormality History: sob, edema Persistent cardiomegaly, but improving edema like opacities compared to the prior study.Right jugular catheter tip at SVC/RA junction level.

Output: Improving CHF with diminished pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Metastatic small cell lung cancer and right malignant pleural effusion. Shortness of breath postthoracentesis. There is interval decrease in size of the right pleural effusion, now small. No pneumothorax. Stable right basilar atelectasis. Right-sided chest port tip in the superior vena cava. Streaky left basilar atelectasis and small left pleural effusion.

Output: Interval decrease in size of right pleural effusion without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: aspiration History: sob, desaturation Small lung volumes with new basilar atelectasis and a smallLeft pleural effusion. Heart size normal.An NG tube terminates in the stomach.

Output: New basilar atelectasis and small pleural effusion suggestive of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: s/p IVC filter placement History: s/p IVC filter placement Small lung volumes with new basilar opacities consistent with atelectasis. This may be the result of aspiration or mucous plugging.Mild cardiomegaly.IVC filter not visualized likely below the lower margin of the image.

Output: New basilar opacities consistent with atelectasis from mucous plugging or aspiration, although pulmonary embolism is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: pulmonary infection etiology for acute mental status changes History: AMS The cardiomediastinal silhouette is unremarkable.Decreased lung volumes with nonspecific basilar opacities compatible with atelectasis.No focal areas of consolidation.No large pleural effusions.

Output: Decreased lung volumes with nonspecific basilar opacities compatible with atelectasis. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Emphysema new AML with worsening DOE. Large lung volumes consistent with COPD/emphysema. Unchanged heart size. Left PICC has been removed.Interval worsening of diffuse predominantly interstitial opacities in the mid to lower lungs. No pneumothorax. Small effusions.

Output: Worsening of diffuse pulmonary opacities suspicious for atypical infection and superimposed edema


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.History of CLL and recurrent effusions. Right pleural catheter is no longer draining. Please evaluate. Right chest tube tip is in the right posterior lung apex where there is not a significant volume of pleural fluid in the upright position.The cardiomediastinal silhouette is unchanged, with mediastinal and hilar lymphadenopathy.The right perihilar opacity appears similar to the prior exam and remains consistent with loculated fluid in the fissure and adjacent atelectasis. Fluid volume at the right lung base is unchanged. Moderate left pleural effusion has decreased in volume but there is persistent left lower lobe atelectasis. No pneumothorax.

Output: 1.Loculated right pleural fluid collection and atelectasis are unchanged.2.The left pleural effusion has decreased.3.Suggest repositioning chest tube tip to the right lung base. Ultrasound guidance may be of use given loculation .


Instruction: Generate impression based on medical findings.

Input: Male 54 years old Reason: sp zenkers repair wtih chest pain and concern for mediastinitis History: sp zenkers repair wtih chest pain and concern for mediastinitis . Subcutaneous emphysema noted in the upper thorax and lower neck. Mild pneumomediastinum,likely post-operative.Increased lung volumes.No mediastinal widening.No significant pleural effusion or pneumothorax.No focal airspace opacities.No cardiomegaly.

Output: Subcutaneous emphysema pneumomediastinum may be post-operative in nature. No specific evidence of infection. Please refer to esophagram findings.


Instruction: Generate impression based on medical findings.

Input: 79 year-old female CHF, atrial fibrillation, on heparin and Coumadin with history of retroperitoneal bleed with left thigh bruise and decreased hemoglobinglobin. Evaluate for bleed. Chest abdomen pelvis lower extremity to knee without contrast. CHEST:LUNGS AND PLEURA: Large bilateral pleural effusions. Extensive bibasilar atelectasis or consolidation. Probably unchanged. Cardiomegaly right central line and pacer wires redemonstrated. Upper lobe some edematous.MEDIASTINUM AND HILA: Cardiomegaly. Pacer wires. No pathologic size nodes.CHEST WALL: Pacer left chest wall.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs of bowel to to the lack of IV or oral contrast. Given that limitation, following observations are made.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left nephrectomy.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta and no evidence of retroperitoneal bleed. Previously demonstrated small hypodense focus in or abutting the right psoas is less well distinct due to lack of IV contrast but appears to have decreased in size as seen on axial image 115 of series number 3. It measures 1.6 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Left ovarian cyst unchanged.BLADDER: Foley catheter in a collapsed urinary bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Specifically, no evidence of intraperitoneal bleed or free intraperitoneal fluid.BONES, SOFT TISSUES: Large hematoma in the medial and anterior compartments of the left thigh as seen on series 3 image 194 the area of involvement measures 10.6 x 8.1 cm. Stranding in the fat subcutaneous tissues of the left thigh.OTHER: No significant abnormality noted.

Output: Large hematoma left thigh. Large bilateral pleural effusions and atelectasis or consolidation. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: ETT check Motion heavily degrades sensitivity.ETT remains 3 cm above the carina. Left jugular catheter and NG are otherwise similar.Diffuse patchy nonspecific air space opacities in all 4 quadrants with layered effusions demonstrate mild shifting and improvement, specifically the right lower lung. Suspected resolving and/or shifting atelectasis. Nonspecific multifocal opacities again remain and consistent with known reference lesions described on CT.Right chest port unchanged

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: 73 yo F with submassive PE, ?EKOS placement History: EKOS catheter placement Catheter from the IVC extending to the left main pulmonary artery.Mild blunting of the left costophrenic angle and no other significant cardiopulmonary abnormalities.

Output: Catheter tip in left main pulmonary artery


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: r/o pna History: cough Mild basilar subsegmental aspirate or atelectasis on the left. No specific findings of pneumonia.

Output: Mild basilar subsegmental aspirate or atelectasis on the left. No specific findings of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Increasing right basilar opacity with a right pleural effusion consistent with infection or aspiration.Small left pleural effusion.Left subclavian dual-chamber pacemaker, leads unchanged in position with no pneumothorax.

Output: No significant pneumothorax. Increasing right basilar opacities with a right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: s/p dobhoff History: as above Dobbhoff tube tip in stomach. Other findings stable in short interval.

Output: Dobbhoff tube tip in stomach.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p Heart Transplant, r/o effusions and evaluate lung fields History: O2 requirement Median sternotomy with mediastinal drains and no pneumothorax.Increased retrocardiac postop atelectasis, and mild basilar edema.Left jugular Swan-Ganz catheter tip in the right pulmonary artery.Remnants of a left subclavian ICD are present.

Output: Mild edema and left basilar atelectasis worse than on the prior study.


Instruction: Generate impression based on medical findings.

Input: Reason: 65 yo M with COPD and possible ILD, no prior images available. History: COPD, ? ILD Unremarkable cardiac and mediastinal silhouette. Mild blunting of the left costophrenic angle compatible with scarring and mild basilar interstitial opacity, probably chronic.

Output: Mild basilar interstitial opacity, probably chronic, which could be better evaluated by CT scan.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with esophageal cancer CHEST:LUNGS AND PLEURA: Subcentimeter subpleural pulmonary nodule left lower lobe (series 5; image 64), unchanged. Mild dependent atelectasis/scarring.MEDIASTINUM AND HILA: Paraesophageal lymph node measures 15 x 14 mm (series 3; image 48 was prior, previously 18 x 12 mm. Morphologically normal paratracheal lymph node measures 7 mm in short axis, not significantly changed.Hypodense right thyroid nodules. Coronary calcifications are seen.Stable trace chronic right lower lobe pulmonary embolism (series 3; image 45).An esophageal stent extends from the lower esophagus into the stomach, not significantly changed. Persistent esophageal wall thickening is identified.CHEST WALL: The right-sided port terminates in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: 6-mm hypodensity in the posterolateral right lobe, continues to decrease in size (series 3; image 101), previously measuring 8 mm. The other previously described metastatic foci cannot be resolved.SPLEEN: No significant abnormality noteddPANCREAS: No significant abnormality noteddADRENAL GLANDS: No significant abnormality noteddKIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: A small gastrohepatic lymph nodes remain.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: No significant abnormality noteddBONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd

Output: Continued decrease in the hepatic metastatic foci, with only one able to be discretely resolved on this exam. Otherwise, stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: evaluate for infiltrate History: CHEST PAIN Unchanged cardiac and mediastinal silhouette. No specific evidence of infection or edema. Poor inspiratory effort with basilar atelectasis. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male rule out hydronephrosis. History of prostate cancer and melanoma. Acute leukemia. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left upper lobe on image number 34, series number 5. Another subcentimeter nodule in the right middle lobe is on image number 46, series number 5. Subpleural nodules on the right on the left on image number 53, series number 5. Bilateral dependent atelectasis.MEDIASTINUM AND HILA: 1.7-cm nodule in the left thyroid lobe.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. Specifically, no evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post radical prostatectomy and lymph node dissection. No evidence of recurrence.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis with mild wall thickening and peri-clonic fat stranding around the sigmoid colon suggestive of mild acute diverticulitis. No evidence of peridiverticular abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Nonspecific subcentimeter lung nodules as described above.No evidence of hydronephrosis.Acute diverticulitis.Clinical team was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval lung fields History: s/p LVAD, MVR, TVR Moderate cardiomegaly, unchanged.Patchy bibasilar opacities likely reflect subsegmental atelectasis. The right apical pneumothorax described previously has resolved. No large pleural effusion.Right jugular Swan-Ganz catheter tip is at the level of the right main pulmonary artery. ET tube tip is approximately 3 cm above the carina. IABP markers roughly 5 cm below the top of the aortic arch. Median sternotomy wires are intact. ICD leads unchanged in position. Chest tubes and mediastinal drains are in place.

Output: Bibasilar subsegmental atelectasis. Interval resolution of right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Post device placement in EP lab. Left subclavian AICD proximal coil projects over the SVC, the distal coil projects over the RV. The lead appears intact. The pulse generator is incompletely included on the image. No visible pneumothorax.Multichamber cardiomegaly with enlargement of the central pulmonary vasculature.Well-circumscribed right paratracheal opacity near the thoracic inlet may reflect loculated fluid in a bulla and can be monitored on subsequent exams.

Output: Well-circumscribed opacity near the right apex of unclear etiology etiology but most likely represents fluid loculated within a bulla seen at this site on earlier studies. This can be conservatively monitored as long as patient is asymptomatic with serial chest radiographs.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Pacemaker device with a single lead extending to the area of the anterolateral wall of the right ventricle.Status post TAVR.Basilar interstitial edema and small pleural effusions.Interval partial clearing of pulmonary edema.

Output: Interval improvement in pulmonary edema. No pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old. ET tube and chest tube unchanged.Right jugular catheter tip in the SVC with no pneumothorax or other complications.Aortic balloon catheter with its tip in the proximal descending aorta.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: swan placement History: swan placement Iatrogenic devices are unchanged. Question mild pulmonary edema, as before. Left basilar opacity, unchanged. No pneumothorax. Unchanged cardiomegaly.

Output: Question mild pulmonary edema, as before. Left basilar opacity, unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: aspiration History: emesis ] PICC line with its tip in the SVC.Enteric tube with its tip in the margin of the image.Stable cardiac mediastinal silhouette.Elevation right hemidiaphragm right basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with elevation of the right hemidiaphragm.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: lung transplant eval, IPf History: as above Known interstitial fibrosis, UIP pattern, unchanged.No evidence of superimposed infection or edema.Heart size upper normal.

Output: Severe pulmonary fibrosis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: fever, c/f aspiration, eval for pna History: see above There are decreased lung volumes and stable cardiomediastinal silhouette. Nonspecific basilar opacities are compatible with atelectasis and possible small right pleural effusion.No new areas of consolidation.

Output: Mild nonspecific basilar opacities unchanged. No acute abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Reason: resp failure, possible pneumonia History: same Moderate cardiomegaly with a mitral valve ring in place.Bilateral lower zone opacities consistent with consolidation, atelectasis and pleural effusions.The differential diagnosis includes aspiration, infection and CHF.

Output: Persistent patchy basilar consolidation and atelectasis with pleural effusions, not significantly changed allowing for decreased pulmonary inflation following extubation.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.dyspnea, h/o CPFE No significant interval change of severe chronic interstitial fibrosis. Large apical bullae, but no significant pneumothorax. Extensive subcutaneous emphysema, slightly improved.

Output: Grossly stable appearance of severe chronic interstitial lung disease and subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: 47 years old Female. Reason: chest pain History: chest pain. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. There is a nodular density in the right upper lung.

Output: Small nodular density in the right upper lobe, which can be due to granulomatous disease.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: pneumothorax; post-device placement in EP Lab History: s/p device placement in EP lab . Right-sided pacemaker has been placed with lead wires and right atrial appendage and high within the right ventricle.No evidence of pneumothorax.Stable cardiac enlargement.Small pleural effusions and adjacent subsegmental atelectasis.Median sternotomy is intact with evidence of an aortic valve replacement.

Output: Interval placement of a right-sided pacemaker with the right ventricular leads somewhat high in position. No evidence of a pneumothorax. There are new small effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: PTX History: PTX Stable small left apical pneumothorax.Stable patchy opacities in left lung.Heart size normal.

Output: Stable left apical pneumothorax. Stable pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: eval changes in L pneumothorax s/p clamping chest tube History: none Lines and tubes are unchanged. Pleural-parenchymal opacities within the lungs are unchanged. Unchanged heart size. No pneumothorax.

Output: No pneumothorax. Left greater than right pleural parenchymal opacities, unchanged. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: FemaleReason for Study: Reason: eval pna, ptx History: sob The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate for SOB - known pleural effusion History: as above Stable bilateral pleural effusions and (left greater than right) and diffuse airspace and interstitial opacities. Residual contrast media in the left upper abdomen at paraspinal region.

Output: Stable bilateral pleural effusions and bilateral airspace and interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: crackles in the Rt lower lobe R/o fluid overload History: cough Very mild lower zone interstitial opacities compatible with subsegmental atelectasis and possibly mild edema. Possible small left pleural effusion. No sign of infection.

Output: Small pleural effusion and possible mild basilar interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old. Reason: swan placement History: swan placement Left PICC unchanged in position, with tip in the SVC. IABP proximal marker unchanged in position, overlying the aortic arch. A Swan-Ganz catheter is not identified on this exam. Status post median sternotomy. Surgical clips overlying the left chest wall.Cardiac silhouette is enlarged, unchanged.Moderate right and small left pleural effusions are unchanged, with adjacent atelectasis.

Output: IABP marker unchanged. Unchanged moderate right and small left pleural effusions with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Chest pain. Mild dependent atelectasis in the posterior lung fields. Subsegmental atelectasis in the lingula. No pneumothorax or visible pleural fluid. No focal consolidation. Normal heart size.

Output: Nonspecific mild basal atelectasis. No signs of pulmonary edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: pleural effusion History: see above Left-sided ICD unchanged.Cardiac mediastinal silhouette is unremarkable.Left retrocardiac consolidation/atelectasis redemonstrated.Small pleural effusions.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with left retrocardiac consolidation/atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Female 3 months old Reason: code blue History: Congenital heart disease and esophageal atresia.VIEW: Chest AP and abdomen (2 views 7/17/2015 at 1123 hours. ET tube terminates below thoracic inlet. Left femoral venous access tip is at the left common iliac vein. Mediastinal clip unchanged. 3 identification of vertebral malformations.Cardiac silhouette size is enlarged but stable. No focal opacities, effusions or pneumothorax. Note is made that 2 hands are overlying the chest and upper abdominal region.A featureless dilated bowel loop is noted in the mid and lower abdomen. No evidence of free air.

Output: Interval ET tube and central line placement as described.No focal opacities or pneumothorax.Featureless distended bowel loops.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: 82F with recent TAVR and intubated. History: ETT position Status post TAVR, with moderate cardiomegaly.No change in lower lung zone edema and pleural effusions. ET tube tip approximately 2 cm above the carina.An NG tube terminates in the stomach.IVC pacemaker tip in RV apex region.Right jugular catheter, tip in SVC.

Output: Status post TAVR, without acute complication. No change in edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ett position History: ett position Endotracheal tube has been pulled back and now terminates approximately 2 cm from the carina. Probable focus of atelectasis in the mid lower aspect of the right lung. Left basilar pleural-parenchymal opacity, unchanged. Unchanged cardiomegaly. No pneumothorax.

Output: Interval retraction of the endotracheal tube now terminating 2 cm from the carina.


Instruction: Generate impression based on medical findings.

Input: 47 year old female with shortness breath, tachycardia, elevated d-dimer. Evaluate for PE. CHEST:PULMONARY VASCULATURE: Large pulmonary emboli involving the left and right main pulmonary arteries with extension into at least the segmental branches in the upper and lower lobes bilaterally.LUNGS AND PLEURA: Mild bronchial wall thickening at the bases and tree in bud opacities. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Enlargement of the right ventricle, straightening of the interventricular septum and mild reflux of contrast into the hepatic veins suggest right ventricular strain.CHEST WALL: Mild degenerative changes of the spine. UPPER ABDOMEN: No significant abnormality noted.

Output: Large pulmonary emboli bilaterally with suggestion of right ventricular strain.Findings were communicated to the emergency department at 4:46 am by the radiology resident on call via stat consult.


Instruction: Generate impression based on medical findings.

Input: Leiomyosarcoma of the sphenoid sinus. Anterior mediastinal lymph nodes from previous PET CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Previously seen anterior mediastinal, small lymph nodes are unchanged. A reference nodule measures 10 x 7 millimeter. (On image number 43/270).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 1 cm nodular density in the left lower quadrant on image number 178/270,. This lesion is of indeterminate etiologyBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small anterior mediastinal lymph nodes are unchanged.Fat infiltration.Small soft tissue nodule in left lower quadrant of indeterminate etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Eval for aspiration pna, acute changes History: Increased WOB after emesis Stable cardiac silhouette.Unchanged chronic biapical pleuroparenchymal scarring and bullous changes. Slight worsening in bibasilar predominantly bandlike opacities likely atelectatic in nature. Persistent minimal blunting of the costophrenic angles likely related to pleural thickening.

Output: Slight worsening in bibasilar streaky opacities likely atelectatic in nature. No other significant changes.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old. Right PICC line with its tip in the SVC. Stable cardiomediastinal silhouette.Left basilar opacity compatible with consolidation/atelectasis and small effusion increased from prior exam.No new pulmonary opacities identified.

Output: Interval placement of a right PICC line. Increasing left basilar consolidation/atelectasis and associated pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Interval repositioning of the right subclavian catheter, tip currently projects at the level of the left innominate confluence. Dobbhoff projects into the distal stomach.Underlying cardiopulmonary appearance otherwise similar with persistent left basilar opacities suggesting atelectasis and mild cardiomegaly. Chronic appearing interstitial changes in both bases without superimposed acute edema and/or pneumonia

Output: Right subclavian catheter repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Respiratory failure. Marked increase in extra pulmonary opacities along right and left chest wall may represent loculated pleural effusions and/or extrapleural hematomas in the setting of probable anticoagulation. Interval placement of nasogastric tube. Remainder of lines and tubes, unchanged. Increase in diffuse pulmonary opacities. Unchanged cardiomegaly. No definite pneumothorax.

Output: Progression of opacities along the chest wall - now with right greater than left - which may represent loculated pleural effusions and/or extrapleural hematomas in the setting of probable anticoagulation. Increased diffuse pulmonary opacities, likely edema.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: chf? pna? effn? History: SOB Grossly unchanged large left pleural effusion compressing the majority of the left lung.Blunting of the right costophrenic angle likely represents small pleural effusion.Interval development of patchy interstitial and air space opacities bilaterally, may represent edema/infection.

Output: Large left and possibly small right pleural effusion, bilateral patchy opacities likely represent edema. However, superimposed infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female 52 years old Reason: COPD History: SOB Large lung volumes consistent with severe emphysema.Basilar pleural parenchymal scarring similar to prior.Questionable liver nonspecific 1.5 cm left upper lobe nodule not seen on prior radiographs or CT scan.No new focal airspace opacity seen to suggest infection.The cardiac mediastinal silhouette is normal.

Output: Emphysema without evidence of acute infection. Questionable new nonspecific left upper lobe nodule, CT is recommended for further evaluation.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: 28-year-old female with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Multiple, nonenlarged mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Plastic stent in the common bile duct. Intrahepatic mild biliary dilatation persists.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst is stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine device.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged compression fracture of L4 with greater than 90% loss of the body height.OTHER: No significant abnormality noted.

Output: Stable exam from 4/4/2010.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of mediastinal non-Hodgkin lymphoma. Compare to prior scan. CHEST:LUNGS AND PLEURA: Mild basilar scarring. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Substernal extension of the thyroid gland as seen previously. Calcified soft tissue in the anterior mediastinum (series 5, image 42), unchanged. Hiatal hernia.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric atrophy compatible with chronic kidney disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Stable bilateral inguinal and external iliac lymph nodes.BOWEL, MESENTERY: Minimal diverticulosis, unchanged.BONES, SOFT TISSUES: Degenerative changes of the lumbosacral spine with small scattered sclerotic foci again seen in the pelvis, unchanged.OTHER: Surgical clips in the inguinal regions as seen previously.

Output: Stable exam. No significant lymphadenopathy to suggest tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: congestion History: dyspnea Left basilar atelectasis similar to prior. Unchanged elevation of left hemidiaphragm.There is unchanged. Mild widening of the mediastinum. Low lung volumes. There is moderate gaseous distention of the stomach as well as several loops of bowel, possibly representing postoperative ileus. Surgical clips project over the upper abdomen.

Output: 1.Left basilar atelectasis similar to prior.2.Gaseous distention of the stomach and upper abdominal bowel, more fully evaluated on the abdominal radiographs from the same day.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: evaluate pleural effusion History: dyspnea Increasing size of left pleural effusion with a new component at the base appearing partially loculated. Increasing opacification of the aerated left mid zone. Large lung volumes on the right with increased reticular opacities and suggestion of right lower lobe bronchial wall thickening.

Output: Increasing left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated History: Intubated ET tube tip approximately 4 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Bilateral nonspecific opacity, with an underlying mass in the right upper lobe and pleural effusions, unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: s/p lung transplant, concern for rejection History: s/p lung transplant, concern for rejection Diffuse opacity in the right lung again noted. Small right-sided pleural effusion, as before. Interval removal right apical chest tube. Very small right apical pneumothorax. Newly apparent lucency along the inferior medial aspect of the left hemithorax. Right basilar chest tube remains in place. Slight increase in right-sided subcutaneous emphysema. Left lung remains clear.

Output: Interval removal of right apical chest tube with small right apical pneumothorax. Newly apparent lucency in the medial and inferior aspect left hemithorax. Close imaging follow-up imaging is suggested.


Instruction: Generate impression based on medical findings.

Input: Reason: trach History: trach Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with pulmonary edema, basilar atelectasis and moderate pleural effusions consistent with CHF, unchanged.No pneumothorax or other acute change.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: Post-cardiac surgery (valve) chest/lung evaluation History: Post-cardiac surgery (valve) chest/lung evaluation ET tube tip within 1 cm of the carina.Open sternotomy wound with drains and surgical sponges in place.Catheters and chest tubes unchanged.Small lung volumes with nonspecific airspace opacity, greater on the right, suggestive of edema with a moderate right pleural effusion.No pneumothorax or other acute change.

Output: Multiple postoperative findings. Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: r/o acute chest History: cp Low lung volumes. Heart size upper normal.Basilar subsegmental atelectasis.No findings to indicate edema or infection.No pleural effusion. No pneumothorax.

Output: No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Mesothelioma Right chest tube projects again towards the apex without significant underlying pneumothorax. Small crescentic lucency again projects after over the diaphragm and is unchanged, possibly postsurgical and related to diaphragmatic mesh.Essentially similar nonspecific patchy enlarged basilar opacities suggesting a mixture of atelectasis and minimal edema.NG coiled in proximal stomach. Right jugular catheter unchanged. The left PICC line demonstrates improved positioning with the tip now projected into the innominate and not the jugular

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: preop CABG History: chest pain Heart size at upper limits normal. No specific evidence of infection or edema. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Shortness of breath. Evaluate for pneumonia Cardiomediastinal silhouette is normal. No focal consolidation or pneumothorax.

Output: No evidence of pneumonia.