Instruction: Generate impression based on medical findings.

Input: 72 years Female (DOB:1/2/1944)Reason: stroke evaluation History: dysarthriaPROVIDER/ATTENDING NAME: CHRISTINE A BABCOCK BETTY C SOLIVEN MRI of the brainNo diffusion weighted abnormalities are appreciated.There is an extra-axial mass present along the planum sphenoidale measuring 23 mm in width, 16 mm superior-inferior dimension and 21 mm AP dimension which previously measured similar dimensions.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a focus of encephalomalacia present in the inferior aspect of the left cerebellar hemisphere along the left posterior inferior cerebellar artery territory. The intracranial portion of the left vertebral artery flow-void is absent.Small foci of encephalomalacia are present along the right inferior parietal lobule.Normal vascular flow voids are present in the distal carotid and right vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is redemonstration of a small right calvarial osteoma.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 70% stenosis along the left M1 segment along the midportion of the M1 segment one centimeter proximal to the bifurcation. There is also stenosis at the origin of the superior division of the left middle cerebral artery.There is 50% stenosis present along the distal right M1 segment proximal to the bifurcation of the right middle cerebral artery.There is a high-grade stenosis present at the proximal portion of the left A1 segment.There is a 60% stenosis present in the right P2 PCA segmentThere is a stenosis present along the proximal portion of the superior division of the left middle cerebral arteryNo flow is identified in the distal left vertebral artery.The anterior communicating artery is small. The right posterior communicating artery is not readily identified. There is an infundibulum at the origin of the left posterior communicating artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. There is an approximately 67% stenosis at the left subclavian artery proximal to the origin of the left vertebral artery On the basis of NASCET criteria there is 80% stenosis at the origin of the right internal carotid artery. There is an approximately 67% stenosis at the origin of the right vertebral artery. There is a high grade stenosis of the origin of the left vertebral artery as well as in the midportion of the left vertebral artery.

Output: 1.There is 80% stenosis at the origin of the right internal carotid artery. 2.There is an approximately 67% stenosis at the origin of the right vertebral artery. 3.There is an approximately 67% stenosis at the left subclavian artery proximal to the origin of the left vertebral artery 4.There is a high grade stenosis of the origin of the left vertebral artery associated with tandem stenosis along the midportion of the cervical right vertebral artery and occlusion of the distal left vertebral artery.5.70% stenosis along the left M1 segment proximal to the MCA bifurcation.6.There is 50% stenosis present along the distal right M1 segment proximal to the bifurcation.7.There is a high-grade stenosis present at the proximal portion of the left A1 segment.8.High grade stenosis along the superior division of the left MCA.9.High-grade stenosis along the left A1 segment of the anterior cerebral artery associated with a hypoplastic right A1 segment.10.There is a 60% stenosis present in the right P2 PCA segment11.Stable meningioma along the planum sphenoidale.12.There are small chronic phase foci of infarction along the left cerebellar hemisphere and right parietal lobe13.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with history of ADPKD and stage II-III CKD. Please provide kidney measurements including length, width, and depth. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar subcentimeter T2 hyperintense foci are most compatible with cysts. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Multiple subcentimeter T2 hyperintense foci predominantly of the pancreatic body and tail are too small to fully characterize and favored to be cystic. No pancreatic ductal dilatation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral enlarged kidneys containing numerous cysts of varying size and signal intensity. The majority of these cysts are simple T2 hyperintense cysts. A few T1 hyperintense cysts are noted and could represent hemorrhage versus proteinaceous material. No solid components identified. No hydronephrosis.The right kidney measures at least 15 cm in length, 10 cm in AP and 9.8 cm in transverse diameter.The left kidney measures at least 12 cm in length, 9.5 cm in AP, and 9.5 cm in transverse diameter.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral enlarged kidneys containing numerous cysts of varying size and signal intensity. Measurements of the kidneys are listed above.


Instruction: Generate impression based on medical findings.

Input: There is an elongated non-enhancing T2 hyperintense lesion that measures up to 14 mm in length and 5 mm in width within the anterolateral left larynx, centered in the region of the laryngeal vestibule. There is associated surrounding mild edema and enhancement with mild narrowing of the airway. Otherwise, there is no evidence of soft tissue mass or significant cervical lymphadenopathy in the neck. There is nonspecific fluid in the bilateral mastoid air cells. The osseous structures are otherwise unremarkable. The airways are patent. There is mild prominence of the subarachnoid spaces anterior to the bilateral temporal lobes. The orbits are unremarkable.

Output: A cystic lesion in the left anterolateral larynx measures up to 14 mm and is associated with mild airway narrowing. The imaging characteristics are nonspecific and the evaluation is somewhat limited without an available preoperative comparison study. Nevertheless, differential considerations include residual congenital saccular laryngeal cyst and perhaps less likely a branchial apparatus anomaly or lymphatic malformation. Apparent mild surrounding inflammatory changes may be reactive or postoperative in nature, although superimposed infection cannot entirely excluded.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with pain. Evaluate for spinal stenosis. For the purposes of numbering, there are 5 lumbar-type vertebral bodies. There is grade 1 anterolisthesis of L3 on L4 as well as mild levocurvature of the lumbar spine with apex at the L3-L4 level. There is severe multilevel degenerative disc disease at L3-4, L4-5, and L5-S1 which results in severe central canal stenosis and compression of nerve roots at these levels. There is endplate related degenerative marrow signal abnormality without acute fracture. There is redundancy of the nerve roots due to central stenosis, but the distal spinal cord and conus medullaris appear unremarkable. Additional level specific findings are as follows:T12-L1: No significant degenerative disc disease, central canal, or neural foraminal stenosis.L1-L2: No significant degenerative disc disease, neural foraminal, or central canal stenosis.L2-3: Mild degenerative disc disease with disc bulge and mild facet degenerative changes result in mild central canal stenosis. There is no significant neural foraminal stenosis.L3-4: Moderate degenerative disc disease with superior disc extrusion along the posterior inferior L3 vertebral body. These findings along with severe facet hypertrophic degenerative changes result in severe central stenosis and compression of nerve roots at this level. There is severe right and mild left neural foraminal stenosis.L4-5: Moderate degenerative disc disease with disc bulge and severe hypertrophic facet degenerative changes results in severe central canal stenosis with compression of nerve roots at this level. There is severe left neural foraminal narrowing. There is no significant right neural foraminal narrowing.L5-S1: Degenerative disc disease and severe hypertrophic facet degenerative changes result in moderate central canal stenosis and severe bilateral neural foraminal stenosis.

Output: 1. Severe lumbar degenerative disc disease and hypertrophic facet degenerative changes results in severe central canal stenosis at L3-4 and L4-5. There is also mild to moderate canal stenosis at L2-3 and L5-S1.2. Severe neural foraminal stenosis on the right at L3-4, on the left at L4-5, and bilaterally at L5-S1.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 37 years old; Reason: Evaluate right patellofemoral joint for recurrent damage History: Right knee pain s/p patellar chondroplasty 6 months ago MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There are two foci of near full-thickness cartilage defects at the posterior aspect of the lateral femoral condyle, without underlying bone marrow reactive changes. There is near total absence of cartilage at the lateral facet of the patella, with underlying bone marrow reactive changes and cyst formation. The cartilage of the medial facet of the patella is unremarkable. Otherwise, the cartilage is unremarkable. Two subcentimeter subchondral cysts are noted at the posterior lateral aspect of the medial tibial plateau.LIGAMENTS: The cruciate and collateral ligaments are intact and unremarkable.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Cartilage defects at the lateral femoral condyle and lateral facet of the patella, as described above.


Instruction: Generate impression based on medical findings.

Input: History of metastatic renal cancer, status post retroperitoneal resection, evaluate for recurrence ABDOMEN: Examination limited by lack of intravenous contrast.LIVER, BILIARY TRACT: Stable bilobar T2 hyperintense hepatic lesions may represent cavernous hemangiomas. No intra or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy. The right adrenal gland is normal.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence within the left nephrectomy bed. Status post partial right nephrectomy. There is a complex septated lesion in the inferior pole of the right kidney measuring up to 1.5 x 1.0 cm (series 4, image 28), previously 1.4 x 0.9 cm. Additionally, there is a complex cystic lesion in the midpole of the right kidney, unchanged for 2 years, measuring 1.4 x 1.0 cm (series 4, image 42).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes affect the lumbar spine.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.

Output: 1.No evidence of recurrent or metastatic disease on this limited exam. 2.Complex cystic mass in the right midpole, unchanged for 2 years. RCC can not be excluded.3.Stable reference complex cystic right inferior pole lesion, likely represents postsurgical changes.


Instruction: Generate impression based on medical findings.

Input: Mild degenerative changes of the cervical spine are incidentally noted on the scouting sequence, with disc osteophyte complex formation.Thoracic Spine: The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Lumbar Spine: Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is no significant disc disease, spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits, with mild dependent edema.

Output: No spinal stenosis. No evidence of postprocedural complication status post lumbar puncture.


Instruction: Generate impression based on medical findings.

Input: Worsening LLE weakness, history of breast cancer- determine etiology of weakness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. T1 hyperintense lesions primarily involving the L1 and L3 levels with additional smaller ones such as at the L2 and S1 levels consistent with hemangiomas. The conus medullaris is normal in position. No suspicious enhancement in the lumbar spine.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy with small subchondral cyst on the right.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.L5-S1: There is disc desiccation with mild bulge. There is also mild bilateral facet arthropathy. There is no significant spinal canal stenosis. There is minimal right and mild to moderate left neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. No evidence of metastatic disease in the lumbar spine.2. Mild degenerative changes in the lumbar spine, relatively worse at the L5-S1 level where there is mild-to-moderate left sided neural foraminal stenosis and possible impingement of the exiting L5 nerve root related to combination of mild disc bulge and facet arthropathy.


Instruction: Generate impression based on medical findings.

Input: a 53 years old female with history of coronary artery disease with a CABG in 2006 (LIMA to CX, RIMA to LAD) and 2008 (SVG to DG, RI and OM1) with multiple PCI presenting with increasing dyspnea, referred to cardiac MR for evaluation of ischemia.MEDICATIONS: Aspirin, prasugrel, Atorvastatin, Metoprolol, Amlodipine, Pletal First Pass PerfusionDuring hyperemia, there is a perfusion defect (ischemia) throughout most of the basal to mid inferior/inferolateral and inferoseptal walls. There is also a perfusion defect noted in the apical septum and possibly lateral wall. The perfusion defect score is 12/32, representing 37% of the myocardium. The perfusion defect is decreased compared to prior stress MRI on 1/13/15.Viability/ Myocardial ScarThere is an area of subendocardial late gadolinium enhancement noted in the basal inferolateral wall. It is non-transmural throughout most of its length, occupies about 50% of the myocardial thickness and is suggestive of a prior myocardial infarction. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is viable. This area is unchanged from prior stress MRI in 1/13/15.Left VentricleThe left ventricle is upper normal in size with normal systolic function. There is akinesis of the inferolateral wall. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 184 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 82 ml (normal range 31+/-10), the LV mass index is 54 g/m2, and the LV mass is 110 g. There is akinesis of the basal to mid inferolateral wall (with associated myocardial thinning). There is basal to mid inferior/inferoseptal hypokinesis. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 166 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, there is a perfusion defect (ischemia) throughout most of the basal to mid inferior/inferolateral and inferoseptal walls. There is also a perfusion defect noted in the apical septum and possibly lateral wall. The perfusion defect score is 12/32, representing 37% of the myocardium. The perfusion defect is decreased compared to prior stress MRI on 1/13/15.2. There is an area of subendocardial late gadolinium enhancement noted in the basal inferolateral wall. It is non-transmural throughout most of its length, occupies about 50% of the myocardial thickness and is suggestive of a prior myocardial infarction. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is viable. This area is unchanged from prior stress MRI in 1/13/15.3. The left ventricle is upper normal in size with normal systolic function. There is akinesis of the inferolateral wall. The overall LV ejection fraction is 55%. There is akinesis of the basal inferoseptum and the mid lateral wall (with associated myocardial thinning)4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%5. Mild to moderate mitral and mild tricuspid regurgitation.6. Extra-cardiac findings as above. 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: Enlargement of his lateral and third ventricles in the setting of aqueduct stenosis, caused by a small glioma: yearly follow up. There is a non-enhancing, slightly T2 hyperintense lesion in the left periaqueductal region of the midbrain that measures up to approximately 5 mm. There is associated narrowing of the superior cerebral aqueduct and dilation of the third and lateral ventricles, which is unchanged. Indeed, there is no discernible cerebrospinal fluid flow across the aqueduct of Sylvius. There is unchanged mild periventricular T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Unchanged subcentimeter lesion in the left periaqueductal region of the midbrain with associated narrowing of the superior cerebral aqueduct and obstructive hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: Reason: Flexion/Extension History: Cephalagia There is loss of the normal cervical lordosis. There is preservation of the vertebral body heights and intervertebral disc spaces. No evidence of instability between flexion, neutral and extension. The neural foramina appear patent.

Output: No findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: cognitive declineComments: 3T DCAM, Dr Javed MS protocol version 1.1, No DTI | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of periventricular and subcortical white matter T2 and FLAIR signal hyperintense lesions in both hemispheres of the brain. When compared to the 9/20/2013 exam there does not appear to be convincing evidence for progression of these lesions. Additional lesions are present in the internal capsules, pons, medulla, cerebral peduncles and middle cerebellar peduncles which were also present on the prior exam as well and are unchanged. These lesions are also associated with T1 hypointensity.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right transverse and sigmoid sinuses are larger than the left upper parts.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular, internal capsule and subcortical white matter lesions and posterior fossa white matter lesions are present which are compatible with patient's diagnosis of demyelinating disorder. These are unchanged since the 2013 exam.


Instruction: Generate impression based on medical findings.

Input: Female 47 years old Reason: pain History: pain. Four views of the left knee show a poorly defined curvilinear lucency overlying the lateral tibial plateau indicating a nondisplaced fracture best seen on recent MRI. The previously seen joint effusion has decreased in size. Mild osteoarthritis affects the knee.Mild to moderate osteoarthritis affects the right knee as seen on frontal views.

Output: Nondisplaced lateral tibial plateau fracture and osteoarthritis.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old. History of AML s/p matched sibling stem cell transplant with knee pain. History of steroid treatment. Evaluate for AVN. MENISCI: Medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: The cartilaginous surface is intact. No evidence of avascular necrosis or focal marrow occupying lesion. No bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. No evidence of avascular necrosis or focal marrow occupying lesion.2. No meniscal, cartilaginous, or ligamental injury.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with a history of lesions in T3, T6, T7 and T12 suspicious for myeloma. Bone marrow biopsy shows less than 10% plasma cells. Evaluation of the left hip and surrounding bone and soft tissue is limited by metallic susceptibility artifact related to the patient's left total hip arthroplasty device. There is mild generalized heterogeneity of the bone marrow of the pelvis which is nonspecific and may simply represent residual red marrow elements. There is a subcentimeter round lesion within the proximal right ischium which has intermediate signal intensity on T1 weighted images and high signal intensity on T2-weighted images and shows enhancement on postcontrast sequences which may represent a small myelomatous deposit. There is a focus of low signal intensity of about 1 cm within the posterior aspect of the right ilium that shows no enhancement and may represent a bone island. There is a 2 cm focus of high signal intensity on fat-saturated T2-weighted images within the L4 vertebral body that appears to enhance following contrast, however, it is intermediate to high signal intensity on T1-weighted images and may represent a hemangioma rather than a myelomatous deposit. There is also a tiny 4 mm round hyperintense lesion within the L5 vertebral body seen on image 16 of series 701 which may represent a myelomatous deposit. Moderate to severe degenerative disc disease affects the lower lumbar spine. There is a small juxtavaginal cyst to the left of midline which may represent a Bartholin's gland cyst. There is atrophy of the gluteus medius and minimus muscles, particularly on the left.

Output: Small subcentimeter round lesions within the right ischium and L5 vertebral body are nonspecific but may represent myelomatous deposits. A larger lesion within the L4 vertebral body is not optimally imaged on this study, but may represent a hemangioma. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA, edema History: LE edema, cough Unremarkable cardiac and mediastinal silhouette. Small lung volumes with mild basilar opacity compatible with atelectasis and possibly mild edema.No acute change.

Output: Mild basilar atelectasis and possibly interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Eval for pneumonia History: Fever, prior aspiration pneumonia Unchanged left pleural effusion and left basilar atelectasis or pneumonia.Right jugular catheter, tip in SVC.Left subclavian catheter, tip in SVC.

Output: Unchanged left pleural effusion and left basilar opacity. Right jugular catheter placed. NG tube removed.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: vad History: vad Cardiomegaly status post LVAD and TAVR.Equivocal edema.Left subclavian ICD, leads unchanged in position.

Output: Unchanged devices.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with right nephrectomy and left partial nephrectomy. CHEST:LUNGS AND PLEURA: Calcified right upper lobe granuloma. Mild biapical scarring, unchangedMEDIASTINUM AND HILA: Enlarged heterogeneous thyroid gland remains.CHEST WALL: Partial right 10th rib resection.ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic cysts, some large, are again identified. The small hepatic hypodensities are too small to definitively characterize but are unchanged and likely represent cysts. Mild biliary ductal dilatation affects the left lobe, not significantly changedSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The right adrenal fossa is obscured by artifact from metallic clips.KIDNEYS, URETERS: Status post right nephrectomy. No focal masses are identified in the postsurgical bed, however streak artifact from numerous surgical clips limits evaluation.Three wedge resections have been performed in the left kidney. Ill-defined soft tissue is seen at the surgical sites (series 5; images 100, 109, and 114). Small amount of perinephric soft tissue in these regions is also noted.The left renal vein is patent. Extrarenal pelvis on the left.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild-moderate atherosclerotic diseasePELVIS: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: L2 vertebral body hemangioma.OTHER: No significant abnormality noted.

Output: Multiple interval wedge resections of the left kidney, with remaining soft tissue density in the postsurgical bed. It cannot be determined whether this is granulation tissue and/or residual tumor. Follow-up for stability in size is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: Evidence of pulmonary edema? History: HF There is moderate/marked cardiac enlargement with evidence of a MVR.The lungs are clear without evidence of edema.No pleural effusions.Median sternotomy is intact.

Output: Cardiomegaly without evidence of pulmonary edema or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Emphysema question post procedure pneumo. Partial reexpansion of the left lower lobe. There is some lucency medial to the remaining collapsed segments without visible lung markings that could potentially reflect a pneumothorax if procedure was performed in this region. This could also reflect hyperlucent lung secondary to air trapping from a more proximal incomplete obstruction. No apical or lateral pneumothorax component however. Unchanged costophrenic angle blunting bilaterally as well as areas of atelectasis. Endobronchial valves on the left.

Output: Interval partial reexpansion of the left lower lobe. Left paramediastinal lucency near the diaphragm could reflect hyperlucent reexpanded lung due to air trapping versus a localized pneumothorax. Serial short-term plain film follow-up recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: Reason: OG, intubated History: OG, intubated Cardiopulmonary monitoring and support devices, unchanged.Bilateral opacity compatible with edema atelectasis and pleural effusions.No new findings.

Output: Pleural effusions with atelectasis and possibly edema, unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: FemaleReason for Study: Reason: evaluate for pneumonia vs. efusion History: worsening pulmonary exam The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: PTX History: as above Unchanged left apical pneumothorax measuring 12 mm. Diffuse pulmonary opacity, unchanged. Increased left lower lobe basilar opacity. Unchanged heart size. Feeding tube extends inferiorly off the field of view. Central venous catheter is unchanged. Mild diffuse osteopenia, as before.

Output: Unchanged left apical pneumothorax. Increased left basilar atelectasis or consolidation. Small pleural effusion may be present in this area as well. This can be reevaluated on follow-up.


Instruction: Generate impression based on medical findings.

Input: 63 years old Male. Reason: 63Y M with swan catheter, ? Placement History: 63Y M with swan catheter, ?placement. Swan-Ganz catheter terminates within the right pulmonary artery. Basilar pleuroparenchymal opacities, not substantially changed. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No pneumothorax.

Output: Swan-Ganz catheter as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for ETT History: intubated patient Severe pulmonary opacities with pleural effusions are unchanged.ET tube tip approximately 5 cm above the carina.Right subclavian and right jugular catheters terminate at the cavoatrial junction level.

Output: Persistent pulmonary opacities and pleural effusions consistent with edema or ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.History of cerebral infarction, patient intubated. The patient has been intubated with endotracheal tube tip approximately 1.5 cm above the carina. An enteric tube tip is beyond the field-of-view.The cardiomediastinal silhouette is normal. There is a calcified left hilar lymph node. There are aortic arch calcifications.Dense retrocardiac opacity likely representing atelectasis or aspiration.

Output: 1.Endotracheal tube tip approximately 1.5 cm above the carina.2.Subsegmental left basilar atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: 72 yo with new IABP and swan, assess location History: new IABP and swan, assess location Interval placement of an intra-aortic balloon pump with the tip at the proximal descending thoracic aorta. Femoral Swan-Ganz catheter terminates in the mid right descending pulmonary artery. Multiple right sided surgical clips are again identified.Right perihilar opacities may represent retained secretions. No interval pulmonary edema or pneumothorax.

Output: Femoral Swan Gantz catheter terminates in the mid right descending pulmonary artery. Intra-aortic balloon pump tip located in proximal descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: ETT History: ETT Small lung volumes.Mild left hemidiaphragm elevation with overlying consolidation slightly worse.Heart size normal.ET tube tip in right main bronchus, subsequently repositioned.An NG tube terminates in the stomach.

Output: ET tube tip in right main bronchus up slightly repositioned, with retrocardiac atelectasis developing.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Hypotension, rule out pulmonary disease. Normal heart size. No focal airspace opacities or visible pleural fluid. Large lung volumes suggestive of COPD/emphysema. No focal airspace opacities.

Output: COPD, but no signs of acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Chest pain, dyspnea, CHF question edema. No signs of pulmonary edema. No pleural fluid or pneumothorax. No focal airspace opacities. Region of the main pulmonary artery appears slightly prominent, please refer to CT.

Output: No acute cardiopulmonary abnormality. A subsequent CT has been performed and will be reported separately


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: intubated History: as above ET tube with tip 1 cm above the carina.Enteric tubes with tips beyond the inferior field of view.Persistently decreased lung volumes with stable mediastinal silhouette. Basilar opacities likely representing atelectasis/scarring.No new focal lung opacities. No pneumothorax.Scoliosis of the thoracolumbar spine.

Output: ET tube with tip 1 cm above the carina, low. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: 76 male with MDS, neutropenic fever. r/o infiltrate History: Neutropenic fever There are decreased lung volumes with stable cardiomediastinal silhouette.Minimal basilar scarring/subsegmental atelectasis.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: 61 y/o F with multiple comorbidities, concern for volume overload History: SOB, BLE edema No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Evaluate pneumonia. Decreased by mouth/energy. Normal heart size. Patient is rotated. Low lung volumes. Patchy basal opacities on the frontal radiograph most suggestive of atelectasis, possibly the result of aspiration. Opacity in the posterior lungs on the lateral radiograph indeterminate and may reflect atelectasis or infection. Abdominal surgical clips overlie the right upper quadrant.

Output: Indeterminate basilar opacities at least mildly suspicious for infection. Suggest follow-up PA and lateral chest radiograph in 6 weeks to assess for clearance.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with productive cough with fever.Pneumonia. No focal airspace opacity, pleural effusions or pneumothorax. Persistent tracheal deviation to the right most likely related to goiter. Normal heart size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated History: Intubated ET tube tip approximately 2 cm above the carina.Catheter tip in the SVC.Mild pulmonary opacity compatible with aspirated secretions and small pleural effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: intubated/sedated History: above ET tube approximately 3 cm above the carina, unchanged.Enteric tubes terminate out of field of view.Partially imaged right upper quadrant pigtail catheters, unchanged.Left jugular catheter tip in the right atrium.Volume loss in the right hemithorax.Small bilateral pleural effusions, which appear slightly improved when compared to prior study. Persistent right basilar atelectasis.

Output: Improved, but persistent, bilateral pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Rule out TB, positive PPD. No radiographic findings suggest active intrathoracic tuberculosis. Upper normal heart size with tortuosity of the thoracic aorta. No pleural fluid or pneumothorax. Degenerative changes of the spine.

Output: No radiographic signs of active intrathoracic tuberculosis or other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: 68 yo M with COPD, increased wheezing, eval for new infiltrate History: eval for new infiltrate Marked apical fibrosis unchanged from the prior exam.The cardiac mediastinal silhouette is unremarkable.No new pulmonary opacities identified.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 30 year-old male with history of thyroid cancer with liver metastases. Evaluate for disease and compare to previous. CHEST:LUNGS AND PLEURA: Innumerable pulmonary metastases with areas of confluent metastatic disease appearing similar to prior study. Reference right conglomerate mass measures 4 x 1.7 cm (series 80256, coronal image 32). It previously measured 2.5 x 2.1 cm. This difference in measurement is artifactual due to motion artifact during scanning. However, based on the appearance of the other lesions, there has not been a significant change since prior study.Stable emphysema.MEDIASTINUM AND HILA: Heterogeneous right thyroid gland as before. No new areas of lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Diffusely scattered, small sclerotic foci likely representing osseous metastases are unchanged. ABDOMEN:LIVER, BILIARY TRACT: Heterogeneously enhancing lesion in the posterior segment right hepatic lobe is again seen (series 3, image 84), measuring 1.5 x 1.4 cm. It is difficult to compare to prior studies due to difference in phase of contrast during imaging.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 in the visualized portions of the bowel.BONES, SOFT TISSUES: Diffuse osseous metastases.

Output: Stable disease.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: baseline History: none Very mild chronic basilar interstitial opacities may be present left greater than right.No specific evidence of infection or edema.Heart size normal, with what appears to be a coronary stent in the LAD.

Output: Possible chronic basilar interstitial opacities, which could be confirmed by CT, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: position of PICC line History: bacteremia PICC tip in the right axilla.ICD leads unchanged.Elevation of the left hemidiaphragm with overlying atelectasis, also unchanged.

Output: Catheter tip in the right axilla.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Shortness of breath question pleural effusion, pneumonia or edema. Upper normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. No specific signs of pulmonary edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: chest pain, shortness of breath History: chest pain, shortness of breath Focal scarlike opacity noted within the mid aspect the left lung. No focal lung consolidation or evidence of overt left-sided heart failure. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Tortuous thoracic aorta. Aortic atherosclerosis.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: Evaluate cardiopulmonary abnormal finding. History: near syncope. There is interval near-complete resolution of bilateral interstitial and airspace opacities as compared with prior study. Minimal remaining interstitial changes are seen in the lung bases. There is no evidence of cardiomegaly, pleural effusion or pneumothorax.

Output: Interval near complete near complete resolution of the bilateral interstitial and air space opacities as compared with the prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: evolution of ards History: ards Significant interval progression of bilateral airspace opacities which would be compatible with the clinical suspicion for ARDS. No other interval changes.

Output: Progression of diffuse air space opacities, likely representing ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: sob, cp, hx sarcoidosis The cardiomediastinal silhouette is within normal limits. Equivocal fine nodular interstitial abnormality in the upper lobes.Slight prominence of the hila may represent mild symmetric lymphadenopathy.

Output: Mild intrathoracic lymphadenopathy consistent with sarcoidosis. Equivocal fine nodular interstitial abnormality in the upper lobes which can be seen in sarcoidosis but would be better evaluated with CT.


Instruction: Generate impression based on medical findings.

Input: Male 35 years old with respiratory failure, evaluate intubated status Stable support devices. Extensive bilateral pulmonary opacities unchanged from prior exam. No significant pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: assess for change in PTX History: L PTX s/p chest tube placement Lines and tubes are unchanged. Diffuse pulmonary opacities, unchanged. Small to moderate size left-sided pneumothorax, as before. Unchanged cardiomegaly.

Output: Unchanged diffuse pulmonary opacities. Small to moderate sized left pneumothorax, as before.


Instruction: Generate impression based on medical findings.

Input: Mitral valve replacement Right chest tube again projects to the level of the hilar region in the mid hemithorax. No appreciable associated pneumothorax however moderate effusions persists.Moderate nonspecific cardiomegaly. Patchy underlying changes consistent with edema and/or possibly atelectasis with superimposed questionable retrocardiac partial consolidation of left lower lobe. Midline sternotomy

Output: Right chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Down syndrome status post cardiac surgery.VIEW: Chest AP (one view) 8/17/2016 at 0507 hours. ET tube tip is below thoracic inlet. Mediastinal clips, epicardial pacer leads, atrial lines, bilateral chest tubes, pacemaker device, left mammary artery catheter and left upper lobe gausses are again noted.Cardiac silhouette size is top normal. Resolution of left subpulmonic pneumothorax. Persistent minimal diffuse lung haziness.

Output: Resolution of left subpulmonic pneumothorax with persistent minimal diffuse lung haziness.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Cough in smoker. Right subclavian dual-chamber pacemaker with leads in the right atrial appendage and right ventricle. Normal heart size. Atherosclerotic calcification of the thoracic aorta. Highly tortuous descending thoracic aorta. Asymmetric lung volumes, right greater than left with hypovascularity in the right lower lobe consistent with emphysema. Upper lobe predominant mild reticular interstitial abnormality may be the result of smoking related lung disease, including but not limited to pulmonary Langerhans' cell histiocytosis, though not a plain film diagnosis. No specific signs of pulmonary edema or pneumonia.

Output: Emphysema with upper lobe predominant interstitial lung disease, possibly PLCH. Suggest correlation with ILD protocol thoracic CT for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.BI-VADS, off diuretics. There is interval removal of the right jugular Swan-Ganz catheter. Left subclavian central venous catheter tip is in the superior vena cava. Enteric feeding tube tip projects over the gastric body. ECMO cannulae are unchanged in position. There is a 8 mm right apical pneumothorax and a possible small left apical pneumothorax. Cardiomediastinal silhouette is stable. There is minimal increase in right basilar atelectasis and edema.

Output: 1.Removal of right jugular Swan-Ganz catheter with other support devices unchanged.2.Small right apical pneumothorax and possible small left apical pneumothorax.3.Minimal interval increase in right basilar atelectasis and edema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: diffuse crackles History: bronchitis 1 week, L>R crackles New basilar opacities suggestive of atypical infection or edema, or aspiration given a very large hiatal hernia.Heart size normal.Cholecystectomy clips.

Output: Basilar opacities most consistent with chronic aspiration related to a large hiatal hernia, although atypical edema or infection are in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Status post biopsy Bilateral pulmonary nodules without new postprocedural complications. See prior reports

Output: Pulmonary nodules without interval change or postprocedural complications


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: pneumonia History: chets pain and cough Stable cardiomediastinal silhouette. Stable basilar interstitial opacities representing atelectasis/scarring. No new focal opacities. Stable appearance of single lumen central venous line.

Output: No evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Evaluate line. Right jugular catheter tip at the SVC. No pneumothorax.Moderate to large right pleural effusion increased from previous.Moderate pulmonary edema. Cardiomegaly.

Output: Worsening CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infection, edema, effusion History: productive cough w/ yellow phlegm x 2wks Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: s/p quinton insertion for exchange transfusion, confirm placement History: s/p central line placement Interval placement of right IJ central venous line tip in the SVC. Cardiac size is upper limits of normal. Increased left retrocardiac atelectasis. Left pleural effusion. No pneumothorax. Dextroscoliosis again seen.

Output: Interval placement of right IJ central venous line tip in the SVC. No pneumothorax. Increased left retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: 38 year old female with metastatic breast cancer, evaluate for metastatic disease extent LUNGS AND PLEURA: Innumerable subcentimeter nodules scattered throughout bilateral lungs are again noted. Reference right upper lobe spiculated mass measuring 2 x 1 cm (series 5 image 42), previously measured 1.9 x 1 centimeters.MEDIASTINUM AND HILA: Scattered mediastinal, right hilar, and paratracheal lymph node are again noted. Reference subcarinal lymph node measuring 22 x 5 mm (series 3 image 54), previously measured 23 x 5 mm. CHEST WALL: Bilateral breast implants again noted. Right sided chest port noted with its tip terminating in the SVC right atrium junction. No other significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval decrease in size of numerous hypodense liver lesions. Numerous hypodense lesions are noted throughout the liver parenchyma. Reference hypodense lesion in segment 8 has decreased in size measuring 5 x 4mm (series 3 image 100), previously measured 6.5 x 6.5 mm. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Midpole non obstructing left renal stone is again noted. No other significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes again noted. Reference portal hepatis lymph node has decreased in size measuring 8 x 8 mm (series 3 image 99), previously measured 12 x 10 mm.  BOWEL, MESENTERY No significant abnormality noted.BONES, SOFT TISSUES No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA Intrauterine device again noted. No other significant abnormality noted.BLADDER No significant abnormality noted.LYMPH NODES No significant abnormality noted.BOWEL, MESENTERY No significant abnormality noted.BONES, SOFT TISSUES: Subtle sclerotic and lytic lesions involving bilateral iliac bones, sacral bone, and low lumbar spine. These are unchanged compared to prior study. OTHER No significant abnormality noted.

Output: 1.No significant change in pulmonary micro-nodules and right upper lobe spiculated mass.2.Interval decrease in size of liver lesions and porta hepatis lymphadenopathy.3.Stable bony lesions.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: intubation, cardiac arrest History: cardiac arrest ET tube with its tip 4 cm above the carina.NG tube with its tip in the margin of the image.Decreased lung findings of cardiac enlargement.Scattered areas of atelectasis.No large pleural effusions..

Output: ET tube in satisfactory position. Cardiac enlargement with scattered areas of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Patient hypotensive with wide pulse pressure, want to rule out PNA and look for edema as well as cardiomegaly History: Hypotensive Right jugular catheter tip in the right atrium.Postsurgical findings in the right hemithorax with small pleural effusions, greater on the right.Interval removal of nasogastric tube.

Output: Small effusion remains. Interval removal of nasogastric tube.


Instruction: Generate impression based on medical findings.

Input: Fever Decreased lung volumes without correlating discrete focal airspace abnormalities. Specifically lungs appear clear. Specifically the focal left mid and upper lung opacities have resolvedThe cardiac and mediastinal contours are within limits

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Respiratory failure Moderate CHF changes are again similar to prior study with decreased lung volumes. Retrocardiac opacity, nonspecific. ETT, Dobbhoff, ICD are otherwise unchanged

Output: Similar CHF appearance with partial collapse and/or consolidation a left lower lobe


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Swan placement (patient moved line). Mild edema-like opacity in the right lower lobe. Minimal pleural fluid on the right.A right jugular Swan catheter tip projects over the proximal right main pulmonary artery. The portion of the catheter in the low right atrium again projects near the suprahepatic IVC and may prolapse into the IVC.Left subclavian ICD unchanged.No pneumothorax.

Output: No significant change in position of the right jugular Swan-Ganz catheter. This appears to be slightly redundant in the position of the suprahepatic IVC, suggest slight repositioning.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: s/p thoracotomy History: same Bilateral chest tubes unchanged.No significant pneumothorax. Right pleural effusion and right basilar atelectasis increased from the prior exam.Decreased lung volumes with stable cardiac enlargement.

Output: Interval increase in right basilar consolidation/atelectasis and pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: MV regurgitation. History: MV regurgitatioin Heart size about upper normal with no evidence of CHF.Mild dextroscoliosis.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: Intubation, IAH, hardware History: above Endotracheal tube approximately 2 cm above the carina. Right jugular catheter with tip in SVC. NG tube with tip in the stomach.Mild cardiac enlargement which likely is accentuated by portable technique.Elevation of the right hemidiaphragm. Left retrocardiac consolidation/atelectasis, unchanged. Left layering pleural effusion, unchanged.

Output: Persistent left retrocardiac consolidation/atelectasis and layering left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for infection/effusion History: chest pain, dyspnea Normal heart size with a tortuous aorta.Small lung volumes with no acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: 29 y/o F no sig PMH new onset chest pain x2days concern for PE vs acute pulmonary process History: SOB, chest pain (pressure) Heart size borderline enlarged.Mild basilar subsegmental atelectasis/scarring. No pleural effusions.

Output: Mild basilar subsegmental atelectasis/scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: s/p heart transplant, swan catheter, assess placement lines History: above Iatrogenic devices are unchanged. Clear worsening in diffuse pulmonary opacities with perihilar prominence. Increase in left-sided pleural effusion. Heart size likely unchanged. No pneumothorax.

Output: Worsening congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Reason: Respiratory failure History: As above ET tube tip approximately 3 cm above the carina.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.Diffuse subcutaneous emphysema, slightly decreased.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Dobbhoff tube placement Dobbhoff tube seen extending towards ligament of Treitz, tip located at the distal third/fourth portion of duodenum. Partially imaged dilated small and large bowel again noted. Vertically oriented ovoid structure in left upper quadrant most likely due to splenic shadow with adjacent fluid. Please note that evaluation for free air suboptimal as only supine imaging submitted. Right upper quadrant drainage catheter. Additional left-sided approach drainage catheter seen with tip in mid upper abdomen. Sutures/coil material seen in upper abdomen. Skin staples. Please refer to same day chest radiography for additional findings.

Output: Enteric tube and additional findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: worsening pna History: pna Right IJ vascular sheath projects over the brachiocephalic vein.The cardiomediastinal silhouette is apparently magnified and most likely enlarged. Diffuse mixed airspace and interstitial opacities with a basal predominance in the right lung has increased since prior examination. Air bronchograms are present. Small-to-moderate sized right pleural effusion. Small left pleural effusion. Altogether, favored to represent asymmetric pulmonary edema with or without a component of sequela of aspiration. No pneumothorax.

Output: Apparent cardiomegaly and apparent increase in right-sided mixed airspace and interstitial opacities with basilar predominance; favor asymmetric pulmonary edema with or without a component of sequela of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: assess NG placement History: none Right basilar atelectasis possibly from aspirated secretions or mucous plugging.Elsewhere, the lungs are unremarkable.NG tube, side port above the GE junction.

Output: High NG tube. Mild right basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p MVR Tracheostomy tube, left subclavian catheter and Swan-Ganz catheter are unchanged.New feeding tube with its tip in the gastric fundus.Cardiomegaly with bilateral airspace opacities compatible with edema with focal atelectasis in the left lower lobe. Pleural effusions, greater on the left.

Output: Airspace opacities and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Tachycardia Essentially unchanged mediastinal chest tubes with basilar bilateral atelectasis. No new superimposed focal airspace process, however the left chest tube has been removed.Cardiomediastinal contours remain unchanged. CABG clips

Output: Left chest tube removed


Instruction: Generate impression based on medical findings.

Input: 54-year-old male prekidney transplant, end-stage renal disease. Evaluate for cardiomegaly, infiltrates. No focal airspace opacity, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality. Specifically heart size is normal with no evidence of pulmonary infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: post thoracentesis on R History: post thora There is a right hydropneumothorax as described on the CT study of 10/14/2016.Left subclavian single lumen chest port which terminates in the SVC.Left lung clear.Right basilar opacity as well as midlung opacity.

Output: Significant right hydropneumothorax is described on the CT study of 10/14/2016. In addition right mid and lower lung opacities are demonstrated as well.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: r/o infection. Admission for stem cell transplant History: prev exam with LLL infiltrate Right central venous catheter with its tip in the SVC.The cardiomediastinal silhouette is unremarkable. Mild basilar scarring/discoid atelectasis.No focal Erskine salivation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#1 Two chest tubes on each side with no pneumothorax following lung transplant.The lung bases are clear on the prior study, but there is residual atelectasis in the left retrocardiac region.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery or loops back in the pulmonary outflow tract.

Output: No significant pneumothorax.Improving pulmonary opacities.Unchanged tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Chest pain check for pneumothorax. Unchanged cardiomediastinal silhouette with a tortuous thoracic aorta. Unchanged course basal chronic peribronchial opacities.No pneumothorax.

Output: No pneumothorax. Chronic basilar opacities nonspecific but could be the result of chronic aspiration or possibly interstitial lung disease. Tortuosity of the thoracic aorta is unchanged; CTA may be obtained if there is clinical concern for vascular pathology.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male he male newly diagnosed diffuse large B-cell non-Hodgkin's lymphoma. Staging. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Confluent anterior and superior mediastinal masses are seen. For baseline purposes the anterior mediastinal mass is measured on image 38/2018 as 8.6 x 7.1 cm. This is confluent lymph nodes in the AP window. Small hilar nodes are seen. There is also heavy calcific granulomata in the right paratracheal and right hilar region.No evidence of axillary, retrocrural nodes. There are pericardiac nodes near the xiphoid process in the right left cardiophrenic region. For baseline purposes a right cardiophrenic node is measured on image 62/218 is 2.7 x 1.6 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate nonspecific hypodensity lateral segment left lobe of the liver. Liver otherwise normal.SPLEEN: Normal size with no focal lesions.PANCREAS: No significant abnormality notedADRENAL GLANDS: Sub-centimeter left adrenal nodule measuring about 7 x 7 mm on image 103.KIDNEYS, URETERS: Few punctate hypodensities too small to characterize likely cysts.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal nodes none pathologically size criteria.BOWEL, MESENTERY: No bowel wall thickening or dilatation. No adenopathy or ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Adenopathy in the chest as detailed above. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Weight loss and cough. Smoker. AP dimension of the thorax appears increased on the lateral view, suggestive of COPD. No visible lymphadenopathy or mass lesion. Spinal osteophytes.

Output: Probable COPD, but no specific signs of primary pulmonary malignancy. If there continues to be a high level of clinical suspicion, CT may be of use.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath, status post thoracentesis Interval decrease in what is now a moderate to large left pleural effusion without postprocedural complicationCardiopulmonary appearance is also a similar with scattered nodular opacities edema changes in both bases.Left PICC line terminates in the axilla. G-tube projects over left upper quadrant

Output: Interval decreased size of what is now a moderate to large left pleural effusion consistent with recent a non complicated thoracentesis


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: For HD clearance History: as above Small pleural effusions.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.Right jugular catheter, tip in SVC.Retained sleeve in the right anterior chest wall trauma prior catheter, unchanged.

Output: Right jugular catheter, tip in SVC. Small pleural effusions noted.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Oxygen desaturation History: Oxygen desaturation Narrowing of the superior aspect of the trachea again noted. No new focal lung consolidation. No large pleural effusion or pneumothorax. Unchanged heart size. Pacer leads again noted.

Output: Stable narrowing of the superior aspect of the trachea. No new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: eval lung fields History: chest pain, sob, cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: eval for PNA History: fever The cardiomediastinal silhouette is within normal limits.Peribronchial thickening again noted, bilaterally.No pneumothorax. No pleural effusion. No airspace opacities.Left brachiocephalic vein stent unchanged in appearance.

Output: No specific evidence of infection or interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Ulcerative colitis. ETT placement. History of recent pulmonary emboli. Right jugular catheter tip at the SVC. Moderate pulmonary edema. Moderate volume of pleural fluid bilaterally with associated atelectasis and/or infarcts.Cardiomegaly with tortuosity of the thoracic aorta.

Output: Moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: CTICU History: Pleural mesothelioma. Right chest tube in place with no significant pneumothorax. Venous catheter and NG tube unchanged with the tip of the NG tube in the stomach and the sidehole in the esophagus. Nonspecific pulmonary opacities compatible with consolidation and atelectasis. Pneumoperitoneum, not significantly changed.

Output: Nonspecific pulmonary opacities without significant change. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Right jugular catheter placed Interval new placement of a right jugular catheter terminating in the upper SVC without postprocedural immediate consultation. Interval removal of the ETT and NG however the Dobbhoff is otherwise unchanged.Lungs remain decreased in overall volume with minimal basilar atelectasis and small right effusion

Output: Right jugular catheter placed without complication


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: pna? History: cough Chronic appearing elevation left hemidiaphragm.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.Gas distended colon noted.

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


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: r/o infection. Hx: stem cell transplant History: fever Mild left base scar like opacities or subsegmental atelectasis.No specific evidence of infection or edema.Heart size normal.Right jugular catheter tip in SVC.

Output: No sign of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval chest pain History: L-sided chest pain Cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity, pneumothorax, or pleural effusion, however mild COPD changes are observed. No osseous abnormalities are evident.

Output: No acute cardiopulmonary abnormality.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: 69 year old male with history of orthotopic heart transplant with lung nodules and masses presumed metastatic; please evaluate. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: 74-year-old man with RCC with METs to lung. Evaluate for progression. The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation, the following observations are made.CHEST:LUNGS AND PLEURA: Multiple scattered lung nodules of varying sizes seen in both lungs have increased in size. Reference peripheral lung nodule in the right lower lobe previously measured 1.2 cm (image 87) now measures 1.2 x 1 cm on series 4 image 58.MEDIASTINUM AND HILA: Stable small nodes. Coronary calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule unchanged.KIDNEYS, URETERS: No interval change. Right nephrectomy. Left kidney normal contour.RETROPERITONEUM, LYMPH NODES: Stable nodes gastrohepatic ligament, portacaval, porta hepatis peripancreatic. Aorta unchanged with two areas of mild aneurysmal dilatation.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Trabeculation of bladder diverticulum redemonstrated.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Increase in size of some of the lung lesions. Other findings as above, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: increasing oxygen requirements History: tachypnea Diffuse bilateral airspace opacities suggestive of edema with a linear down right pleural effusion.Venous catheters unchanged.Feeding tube tip in the stomach.

Output: Findings suggestive of pulmonary edema with a layered out right pleural effusion and no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia, worsening effusion History: Shortness of breath Bilateral pleural effusions with underlying atelectasis, slightly increased on the left.Small amount of air in the left lower lobe cavity, previously confirmed by CT scan.No other appreciable change.

Output: Slightly increased left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 80-year-old female presents for evaluation of lines and tubes. Endotracheal tube has its tip approximately 5 cm above the carina. An esophageal temperature probe superimposes the distal esophagus. Right central venous catheter has its tip at the cavoatrial junction. An enteric tube tip terminates over the gastric fundus.Obscuration of the left heart border is mildly increased. Small increase in left-sided pleural effusion. Stable central and right basilar airspace and interstitial opacities. Small right apical pneumothorax was present on prior CT chest 11/24/16 and is stable.

Output: 1.Stable central and right basilar airspace and interstitial opacities.2.Small right apical pneumothorax, unchanged.3.Slight increase in left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with shortness of breath. Follow for pneumonia, edema. Streaky right basilar opacities most likely atelectasis. No focal consolidation. No significant pleural effusions. No pneumothorax. Mildly enlarged cardiomediastinal silhouette.Large hiatal hernia similar to prior.

Output: Right basilar atelectasis, otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: intubated History: intubated ET tube repositioned, the tip now 5 cm above the carina.No acute abnormality.

Output: ET tube tip approximately 5 cm above the carina, repositioned.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: History of COPD. Preop evaluation, also with mild oxygen desaturation. Stable cardiomediastinal silhouette.Severe emphysematous changes again noted.Wedge shaped opacity in the left midlung concerning for infarction, however tumor cannot be excluded but considered unlikely given stability and lack of new development.Right lower lobe scarring stable. Blunting of left costophrenic angle corresponding with pleural thickening seen on CT.

Output: Wedge shaped opacity in the left midlung concerning for infarction, however tumor cannot be excluded but considered unlikely given stability and lack of new development. Infection may be considered in the appropriate clinical context.Findings relayed via text page to Connor King at the time of signing of report.


Instruction: Generate impression based on medical findings.

Input: Chest wall pain, non-smoker. Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: Evidence of aspiration? History: hypoxia Dense bilateral predominantly upper zone airspace opacity compatible with aspiration and infection, slightly improved. Catheter tip in the SVC.

Output: Diffuse predominantly upper zone opacity compatible with aspiration, slightly improved.


Instruction: Generate impression based on medical findings.

Input: 42 year old female with AMS, cough No focal airspace opacities.No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Re evaluate infiltrates, rule out pneumothorax History: hypoxia, shortness of breath Small lung volumes with diffuse nonspecific airspace opacity, pleural effusions, larger on the right.Catheter tip in the SVC.No new findings.

Output: Diffuse airspace opacity and pleural effusions without significant change. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: left sided pleural effusion History: fatigue, dyspnea, improved after the previous tap Biventricular ICD electrodes are unchanged in position. Sternotomy wires remain well aligned.Significant elevation of the left hemidiaphragm is increased from immediate prior. This raises the question of phrenic nerve paralysis or potential diaphragmatic injury. Small associated pleural effusion. No pneumothorax. Blunting right costophrenic angle from trace right pleural effusion.

Output: Elevation left hemidiaphragm increased from prior with small associated pleural effusion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Check central catheter, line placement Interval exchange of the right jugular Hickman catheter for a multilumen catheter terminating in the mid SVC. No postprocedural complication observed. Underlying cardiopulmonary appearance is otherwise unchanged and unremarkable

Output: Right jugular catheter placement


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Eval for pneumo History: S/P CT removal Pulmonary opacities suggestive of edema or infection, gradually worsening over the last 4 days.No significant pneumothorax.Right jugular catheter, tip in SVC.Mediastinal drain removed AP two chest tubes

Output: No significant pneumothorax. Gradually worsening pulmonary opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.New triple lumen placed. Right jugular catheter tip at the level of the SVC. The previously seen introducer has been removed. No significant pneumothorax on the right. Other tubes and lines unchanged in position. Possible small pneumothorax in the left costophrenic angle difficult to quantify.Basal atelectasis and pleural fluid unchanged. Improving edema and atelectasis left upper lobe.

Output: New right jugular catheter with tip at the SVC, and no significant pneumothorax. Improving edema.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Moderate nonspecific cardiomegaly with a globular shape raising the question of a mild pericardial effusion. Associated mild perihilar edema-like changes are otherwise observed, with a small questionable right effusion.

Output: Patchy changes suggestive of early CHF, however in the absence of prior imaging confirmation is difficult. Please consider serial imaging to confirm


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: new onset pedal edema History: new onset pedal edema 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: 17-year-old male. Pectus excavatum. Calculate Haller index for pectus workup. LUNGS AND PLEURA: Limited examination of the lungs do not demonstrate a focal opacity.CHEST WALL: Pectus excavatum deformity of the chest wall. The transverse diameter of the chest wall measures 26.5 cm. The AP diameter of the chest wall from the sternum to the anterior aspect of the underlying vertebral body measures 5.7 cm. The calculated Haller index is 4.6.

Output: Pectus excavatum deformity with a Haller index of 4.6.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: preop for MVR TVR History: SOB Large lung volumes suggestive of emphysema.No acute abnormality.Bilateral breast implants.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Malignant pleural mesothelioma. S.O.B. Left hemithorax nodular pleural thickening and loculated fluid consistent provided history of mesothelioma. There has been increase in pole of apical and mediastinal disease since the prior plain film of 10/21/2014, with rightward mediastinal shift. However, the appearance is similar to the scout radiograph obtained at time of CT dated 1/14/2015. Numerous pulmonary nodules are now visible.

Output: No conclusive change since time of the last CT, with extensive pleural and mediastinal tumor on the left, rightward mediastinal shift and globular cardiac configuration consistent with pericardial fluid/metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: pna History: sepsis No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: Rule out reccurent pleural effusions History: chest pain The cardiomediastinal silhouette is unremarkable. No focal areas of consolidation.Mild basilar scarring/discoid atelectasis.Small right pleural effusion.Right-sided chest tube unchanged without evidence of pneumothorax.

Output: No interval change without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: r/o pneumonia History: productive cough and fever By basilar lower lobe opacities representing infection.Heart size normal.No pneumothorax. No pleural effusion.

Output: Bilateral lower lobe pneumonia


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Neutropenia. Multiple myeloma status post stem cell transplant now with neutropenic fevers. Clear lungs. Unchanged lines. No pleural effusion or pneumothorax. No acute bony abnormality. Old right lateral rib fractures.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with respiratory distress. Assess bronchogenic cyst. Compare with previous. CHEST:LUNGS AND PLEURA: Extensive and progressive interstitial and airspace opacities bilaterally and small bilateral pleural effusions. More confluent consolidation is seen in the right middle and right lower lobes.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy is slightly more prominent on comparison to prior study with reference right paratracheal node measuring 2.3 cm; previously measuring 1.9 cm. Heart size normal without pericardial effusion. Moderate vascular calcifications are seen in the left circumflex, right coronary, and left anterior descending arteries.Right paravertebral bronchogenic cyst is now nearly completely air-filled, with a pigtail drainage catheter entering posteriorly.Tracheostomy tube in expected location.CHEST WALL: The bones are demineralized. Degenerative changes of the spine.Vascular collaterals are again seen in the anterior chest wall. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Worsening ARDS pattern on comparison to prior CT from 7/25/2010.2. Mostly air-filled right paravertebral bronchogenic cyst containing pigtail drainage catheter.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Minimal right basilar scarring without additional acute cardiopulmonary abnormality. Borderline cardiomegaly unchanged

Output: Minimal scarring and borderline cardiomegaly unchanged


Instruction: Generate impression based on medical findings.

Input: Follicular non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Previously measured pretracheal lymph node now measures 3-mm in size.CHEST WALL: Previously measured left axillary lymph node has completely resolved.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pectoral calcifications and mildly prominent pancreatic duct consistent with chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate right renal stone. Hydronephrosis has resolved.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Infrarenal abdominal aortic aneurysm measuring 2-cm in its greatest dimension.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of enlarged lymph nodes in the chest abdomen or pelvis. Right renal stone without evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: eval for acute process History: breast pain, CP x 2 months No pleural effusion or pneumothorax. No focal pulmonary abnormality. Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: any cardiopulmonary changes? History: VAD placement Moderate size right pleural effusion compressing the right lung medially unchanged.Median sternotomy with chest tubes and no pneumothorax.Multiple ECMO cannulae are stable in position.Right jugular catheter tip in SVC.Right PICC loops into the right jugular before also terminating in the SVC.

Output: Right pleural effusion compressing the right lung medially unchanged. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: assess for focal consolidation History: as above Median sternotomy with mild cardiomegaly.No specific evidence of infection or edema.

Output: Cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: chest pain and sob History: cp/sob The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with metastatic bladder cancer presenting with left hip pain. Question of lymph node, pulmonary metastases, known pelvic mass status post RT. Please evaluate for metastasis, response to RT. CHEST:LUNGS AND PLEURA: New nodules in the upper lobes. For reference, a left upper lung nodule measures 8 x 7 mm (5, image 29).MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Two hypoattenuating lesions in the left hepatic lobe (series 3, images 79 and 93). For reference, one lesion measures 12 x 12 mm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval placement of left nephrostomy tube. Right caliectasis may be secondary to distended neobladder.RETROPERITONEUM, LYMPH NODES: Reference node measures 15 x 7 mm (previously 17 x 15 mm) on series 3, image 127.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Continent neobladder.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large mass invading left ilium and left acetabulum is again noted. It measures 11 x 9.5 cm; previously measuring 10.9 x 9.7 cm. Intramuscular hypodense area is also again seen and appears similar to prior study.

Output: Stable pelvic mass with new lesions in the lungs and left hepatic lobe, which are suspicious for metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: F/U Pleural Effusions History: F/U Pleural Effusions Right central catheters and tracheostomy tube are unchanged in position.The patient is rotated to the right. Bilateral lower zone opacities of atelectasis and small pleural effusions with a component of basilar edema. No pneumothorax. The heart size remains normal.

Output: Mid to lower zone opacities of atelectasis with pleural effusions and basilar edema.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: sp MAZE History: - Chest tubes are present with no pneumothorax.Moderate cardiomegaly is seen with small pleural effusions and basilar atelectasis.Two right jugular venous access sheaths are present, both kinked near the skin insertion site.Status post extubation.

Output: No significant pneumothorax. Unchanged basilar opacities and pleural effusions following extubation.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated, interval change History: intubated Extremely small lung volumes, with volume loss and opacity at the left base compatible with atelectasis and likely aspirated secretions.Tracheostomy tube and venous catheters unchanged. The tip of a right jugular catheter is in the area of the right atrium or possibly right ventricle.

Output: Small lung volumes with left lower lobe atelectasis, and no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: Cardiac abnormality History: BP 240/140 Heart size is upper limits of normal. No focal consolidation, pleural effusion or pneumothorax.

Output: No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: evaluate for pneumothorax History: respiratory distress PICC catheter with its tip in the SVC.Small lung volumes with coarse diffuse interstitial opacity, previously characterized CT scan.No acute abnormalities. No interval change.

Output: Severe chronic interstitial lung disease with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p esophagectomy History: s/p esophagectomy Catheter tip in the SVC.Hazy opacity on the left compatible with layered pleural effusion and underlying atelectasis.Pleural calcification at the left apex, unchanged.Right paratracheal mediastinal widening, compatible with esophagectomy.

Output: Pleural effusion and underlying atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval for trialysis line in correct place History: s/p placement trialysis New left lower lobe consolidation suggestive of infection or aspiration, with small bilateral pleural effusions and increased atelectasis elsewhere.Right jugular catheter, tip in SVC.Increased mediastinal width following line placement most likely is distention of deep systemic veins and patient rotation although follow-up radiographs recommended.

Output: New left lower lobe consolidation. Mild right paratracheal widening following right jugular catheter placement, follow-up radiograph recommended over the next day.


Instruction: Generate impression based on medical findings.

Input: Evaluate aorta and axillofemoral graft. History of coarctation of the aorta. Right flank mass. 3-D images were not performed due to inadequate opacification of the axillary-femoral graft (due to occlusion). CHEST: Focal calcified pleural plaque in the left lower lung (series 3 comminuted E4). Minimal biapical emphysematous changes. Subcentimeter mediastinal nodes are identified. The right subclavian artery is prominent, stable.Atherosclerotic changes affect the proximal descending aorta, with mild mural plaque and wall calcification, stable.Left shoulder degenerative changes.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A 2.1 X 1.9 cm lesion is seen in the lower pole the left kidney (series 8, image 141), previously measuring 1.3 x 1.0 cm. It exhibits at least 20 HU enhancement and demonstrates a thin enhancement (image 141).Bilateral simple renal cysts are seen.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes are identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: A graft extends from right axillary artery to the right common femoral artery. No flow is identified within the graft, though the right common femoral artery is reconstituted-these findings are similar to those found on 12/21/02. Thick-walled fluid collection measuring 7.6 x 4.8 cm maximally extends along the midportion of the graft, increased in size from 2005. There is focal 2.1 x 1.9 cm dilatation of the right common femoral artery just distal to the graft, reported in 2005.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Mildly enhancing, complex left renal lesion: renal cell carcinoma until proven otherwise.Thrombosed right axillary-femoral graft, unchanged, with reconstituted right common femoral arterial flow. Thick-walled fluid collection along the midportion of the graft continues to increase in size.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: s/p trach yesterday History: s/p trach yesterday ET tube is been removed and tracheostomy is in place with its tip 6 cm above the carina.The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: Interval placement of a tracheostomy. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.History of stroke, persistent cough, fatigue, shortness of breath. Evaluate for pneumonia and pleural effusion. Unchanged right upper lung volume loss and streaky opacity consistent with radiation fibrosis. Unchanged blunting of the right costophrenic angle. No evidence of pneumothorax. Minimal left basilar atelectasis. No focal pulmonary opacities to suggest infection.Cardiomediastinal silhouette is unchanged.Interval removal of enteric tube.

Output: No focal pulmonary opacities to suggest pneumonia. Unchanged blunting of the right costophrenic angle.


Instruction: Generate impression based on medical findings.

Input: Assess right-sided pleural effusion of unclear etiology Stable cardiomediastinal silhouette. Moderate to large right pleural effusion with associated compressive atelectasis not significantly changed from prior exam. Left basilar opacities without new focal opacities identified.

Output: Stable moderate to large right pleural effusion. Recommend CT with IV contrast.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval ETT, lung fields History: s/p CABG Postoperative radiograph demonstrates endotracheal tube approximately 2 cm above the carina. Interval placement of a right IJ Swan-Ganz catheter that terminates in the main pulmonary artery. Bilateral basilar chest tubes and mediastinal drain have been placed. There is evidence of arterial revascularization with sternotomy hardware in good alignment.Basilar opacities representing small pleural effusions and subsegmental atelectasis. No pneumothorax.

Output: Postoperative radiograph demonstrating basilar subsegmental atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with recurrent breast cancer, restaging CHEST:LUNGS AND PLEURA: A bilateral scattered micronodules. A referenced nodule measures 3-mm image number 108, series number 4.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right axillary node resection. Postsurgical changes in the right axilla. Multiple soft tissue nodules on the right side in the region of the right axilla and right chest wall. There referenced nodule measures 10 x 10 mm on image number 47, series number 3. A larger nodule is partially imaged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 19 x 17 mm left adrenal nodule, nonspecific and indeterminant in etiology. Given the low density on postcontrast images more likely to represent adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right axillary and chest wall nodules adjacent to the areas demonstrating postsurgical changes. These are suspicious for metastatic lymph nodes.Left adrenal nodule.


Instruction: Generate impression based on medical findings.

Input: 70 year-old man with history of lung cancer stage IIIB in the right middle lobe. Status post chemo and radiation therapy. CHEST:LUNGS AND PLEURA: Nodule in the medial aspect of the right middle lobe measures 2.1 x 1 cm as seen on image 64/117. Multiple calcified granulomas scattered in the lungs. Small right pleural effusion. Mild centrilobular emphysema.MEDIASTINUM AND HILA: Right prevascular mass measuring 2.8 x 1.9 cm as seen on image 36/156 which most likely represent tumor but could be hematoma from catheter placement. Suggest PET scan for further characterization unless remote outside previous is available for comparison which demonstrates its presence prior to catheter placement. Bilateral calcified hilar lymph nodes. Nonspecific esophageal wall thickening.CHEST WALL: Small diaphragmatic lymph node.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Multiple calcified granulomas in the spleenADRENAL GLANDS: Nodular thickening of the right adrenal gland measuring 1.2 x 1.3 cm as seen on image 99/156 which may represent adenoma versus metastases. Follow-up with PET scan is recommended.KIDNEYS, URETERS: Simple cysts in the kidneys bilaterally.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Penetrating atherosclerotic ulcer seen in the descending thoracic aorta as seen on image 83/156.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Right middle lobe lesion as above, compatible with history of known malignancy.2. Mass in the prevascular region of the mediastinum, more likely to represent tumor than a hematoma, though the latter cannot be excluded as above.3. Right adrenal nodule, indeterminate. PET scan is suggested for further characterization.