Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Evaluate PICC line placement. Evaluate for pleural effusions, pulmonary edema and cardiac silhouette. Right upper extremity PICC tip in the right atrium. The cardiomediastinal silhouette is within normal limits. Interval decreasing pleural effusions, now small and left greater than right. Resolved right basilar opacity and improved left basilar opacity.Multiple dilated loops of bowel noted in the upper abdomen. IVC filter in place.

Output: 1.PICC tip in the right atrium. Cardiomediastinal silhouette is within normal limits with improved bilateral pleural effusions and basilar opacities.2.Multiple dilated loops of bowel in the upper abdomen. Consider further evaluation with dedicated abdominal imaging.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: pulmonary edema History: pulmonary edema Endotracheal tube tip approximately 5 cm from the carina.Sternotomy fixation intact.Cardiomegaly. Very mild basilar edema, left effusion, and left basilar atelectasis mildly improved.

Output: Minimal basilar edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: ro pneumonia History: reported altered mental status per family, bibasilar crackles on exam Decreased lung volumes with increased basilar markings suggestive of aspirated secretions or edema.Moderate cardiomegaly.

Output: Basilar opacities suggestive of aspiration or edema, with moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 56 year-old female with metastatic breast cancer involving bone. History of scleroderma. CHEST:LUNGS AND PLEURA: Scattered peripheral fibrosis with significant bi-basilar honeycombing and fibrotic changes compatible with the patient's history of scleroderma are unchanged. No focal consolidation, edema or pleural fluid. No suspicious nodules or masses.MEDIASTINUM AND HILA: A previously referenced right hilar lymph node measures 1.1 x 1.3 cm on axial image 47/228 and is unchanged. Additional small mediastinal nodes are unchanged.CHEST WALL: Status post left mastectomy with stable postoperative changes in the left axilla. Extensive metastatic disease involves all the visualized bones of the chest wall. No significant interval change is evident. No pathologic fractures.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse bony metastatic disease in all visualized bones is grossly unchanged. No pathologic fractures.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified uterine fibroids have not significantly changed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse metastatic disease involves all bones of the pelvis without evidence of significant interval change. No pathologic fractures.OTHER: No significant abnormality noted.

Output: Stable examination with diffuse metastatic disease involving all the visualized bony structures. Multiple additional stable findings as described above.


Instruction: Generate impression based on medical findings.

Input: 75 year-old female with history bladder cancer with lung metastasis. Follow-up for disease progression. Fatigue. CHEST:LUNGS AND PLEURA: Index left upper lobe nodule has increased, series 5 image 36/90, measuring 12.9 x 11.6 mm. Previously 4.5 mm.Index right lower lobe nodule has increased, series 5 image 61/90, 20 by 15.5 mm. Previously 17.3 x 14.2 mm.No new nodules. Other nodules stable to slightly increased as well. No effusions.MEDIASTINUM AND HILA: Small mediastinal nodes stable. Not pathologic by size criteria.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: A few small nonspecific hyperattenuating foci.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously seen left-sided hydronephrosis is resolved. Some cortical thinning left kidney.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, ADNEXAE: Atrophic or surgically absent.BLADDER: Status post cystectomy and neobladder. 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: Increased size lung lesions. Resolution of left-sided hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: CHF History: shortness of breath Marked cardiomegaly with evidence of previous coronary bypass surgery.Mild nonspecific interstitial opacity compatible with edema or chronic interstitial disease, unchanged from previous.No sign of pneumonia.

Output: Cardiomegaly with probable mild CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old with low LVAD flow. Evaluate LVAD placement and for infection, edema, or effusion. The cardiomediastinal silhouette with cardiomegaly is unchanged. No new pulmonary opacity, pleural effusion or pneumothorax.Status post median sternotomy. Left subclavian ICD leads are unchanged although the right ventricular lead is obscured by the LVAD device. Unchanged appearance of LVAD.

Output: 1.Unchanged appearance of the LVAD.2.No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: 63yoM intubated on vent History: see above Patient is status post sternotomy. Left-sided ICD lead and generator in place. Tricuspid valve prosthesis. ET tube tip is approximately 3 cm from carina. Enteric tube tip extends below the diaphragm outside the field of view. Right IJ central venous catheter tip in the right atrium. LVAD components partially visualized.Stable cardiomegaly. Mild bibasilar patchy interstitial opacities unchanged. Unchanged small pleural effusions.

Output: Stable support devices. Mild pulmonary edema unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Moderate cardiomegaly.No significant edema, except for some thickening of the fissures on the lateral view.Left subclavian single chamber ICD, lead tip in the expected location of the RV apex.No significant pneumothorax.

Output: No pneumothorax following ICD placement.


Instruction: Generate impression based on medical findings.

Input: -year-old male with history of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Two right upper lobe micronodules are stable.MEDIASTINUM AND HILA: Right thyroid nodule is not included in the study today.CHEST WALL: Left chest wall mass measures 2.8 x 2.4 cm on image number 28, series number 3, not significantly changed.ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic cysts and pneumobilia.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Subcentimeter lesion in the upper pole of the right kidney is grossly unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant presumed omental necrosis area is unchanged. Fluid density lesion anterior to the right external iliac vessels is also unchanged measuring 3.2 x 2.8 cm on image number 175, series number 3.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Enhancing soft tissue nodule in the left gluteal region subcutaneous tissue measures 23 x 18 mm image number 144, series number 3, unchanged.Right ischiorectal fossa lesion is stable measuring 14 x 13 mm image number 198, series number 3.OTHER: No significant abnormality noted

Output: Overall stable examination.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with metastatic urothelial cancer status post two cycles of chemotherapy. Evaluate for response. CHEST:LUNGS AND PLEURA: Calcific granulomata and punctate micronodules are unchanged. Previously seen basilar atelectasis and fluid are resolved.MEDIASTINUM AND HILA: Scattered left axillary adenopathy is all markedly decreased the index node seen on series 2 image 27/223 to measure 15.7 x 6.1 mm. It previously measured 20.2 x 12.5 mm.No new nodes. Calcific granulomata right hilum.CHEST WALL: Port-A-Cath right chest wall. Previously seen soft tissue mass in the subcutaneous tissues of the left back measures 18.3 x 13 mm cyst image 37. It previously measured 17.9 x 10.1 mm. No new lesions are seen.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. In that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Granulomata.PANCREAS: Mild atrophy.ADRENAL GLANDS: Previously seen left adrenal mass is decreased and could no longer be measured.Right adrenal mass this previously measured in the coronal plane. It too is also markedly decreased in size and difficult to separate from the inferior vena cava. It might correspond to coronal image 44/89, 24 x 16.4 mm.KIDNEYS, URETERS: Markedly atrophic left kidney, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lipoma subcutaneous tissues left upper back, unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Surgically absent.BLADDER: Surgically absent.LYMPH NODES: Decrease in size of bilateral inguinal nodes. Previously measured left inguinal index node, series 2 image 188 17.6 x 6.5 mm. No new nodes. None of the pelvic nodes are pathologic in size.BOWEL, MESENTERY: Postsurgical changes with ostomy in the right lower quadrant.BONES, SOFT TISSUES: Stable sclerotic punctate foci; two in the right iliac bone and one in the left sacrum.OTHER: No significant abnormality noted

Output: Decrease in size of all measurable lesions. No new sites of disease. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: r/o pna History: wheezing and nonproductive cough x 1wk with intermittent chest pain Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: evaluate for new infiltrate/pulm edema History: hypoxia Continued worsening of interstitial airspace opacity suggestive of edema with possible superimposed aspirate or infection.

Output: Continued worsening of interstitial airspace opacity suggestive of edema with possible superimposed aspirate or infection.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with gist tumor CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Index lesion in the right lobe of the liver measures 10 by 9-mm image number 98, series number 7, not significantly changed from previous study. Postresection changes in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously seen hazy soft tissue density adjacent to the tip of the liver is also unchanged measuring 20 by 16mm image number 134, series number 7. Other surrounding similar density changes are also stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Pararectal soft tissue density nodule cannot be well seen on today's study but is likely unchanged measuring 14 by 9-mm image number 189, series number 7.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval for aspiration / pna History: fever after colonoscopy, pt w dlbcl Mild basilar subsegmental atelectasis may be the result aspirated secretions or mucous plugging.No other reliable evidence of pneumonia.Heart size normal.Left jugular catheter, tip in SVC.

Output: Nonspecific basilar opacities which may be the result of aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.History of weight loss, cough Cardiac silhouette unremarkable in size.No focal airspace opacities or pleural effusions. No pneumothorax.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old. ET tube has been removed.Dobbhoff tube with tip in the stomach.Left-sided ICD and LVAD unchanged.Stable cardiac enlargement.Mild left basilar atelectasis.No new pulmonary opacities identified.

Output: Interval extubation. Nipple placement of the Dobbhoff tube with its tip in the gastric fundus.. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Dyspnea on exertion evaluate for edema or enlarged lung volumes. Normal heart size. Probable emphysema with basilar scarring or fibrosis, chronic and not significantly changed. Mild pleural thickening. No specific evidence of pneumonia. Apical scarring and pleural retraction unchanged.

Output: No acute pulmonary abnormality; chronic findings are highly suspicious for pulmonary fibrosis and emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.COPD with acute exacerbation. Right upper lung zone surgical sutures or scarring.Minimal linear scarring left lower lobe.Relatively normal lung volumes.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: cough, fever, sore throat History: coughing, fever, sore throat, Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with metastatic disease. Prostate cancer. CHEST:LUNGS AND PLEURA: The lungs are emphysematous without focal nodule. A calcified granuloma is noted in the right middle lobe.MEDIASTINUM AND HILA: Coronary artery calcifications are identified.CHEST WALL: Scattered sclerotic lesions are seen throughout the ribs, scapulae (right greater than left), sternum and vertebral bodies. 3.6 x 3.0 cm soft tissue lesion at the right fifth sternoclavicular junction is identified (series 4; image 58).ABDOMEN:LIVER, BILIARY TRACT: A few subcentimeter hypodensities are scattered in the liver, too small to be definitively characterized.Cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.3 x 1.5 cm right adrenal nodule.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Prominent portacaval/peripancreatic and retroperitoneal lymph nodes are identified. A reference lymph node along the right common iliac chain measures 2.8 x 1.3 cm (series 4; image 132).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered sclerotic lesions throughout the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged and indents the base of the urinary bladderBLADDER: No significant abnormality notedLYMPH NODES: Enlarged right common iliac and obturator adenopathy is seen. A reference obturator lymph node on the right measures 2.9 x 1.7 cm.BOWEL, MESENTERY: A 2-cm region of moderate concentric narrowing in the sigmoid colon is identified (series 80264; image 63). This region does not distend on subsequent delayed images (series 80867; image 59).BONES, SOFT TISSUES: Scattered sclerotic lesions throughout the pelvis and spine.OTHER: No significant abnormality noted

Output: Metastatic disease in the form of diffuse osseous lesions and abdominal/pelvic adenopathy.Indeterminate right adrenal nodule, which cannot be further characterized on this single phase study. If clinically warranted, MRI may be been obtained.Subcentimeter hepatic hypodensities, too small to characterize.2-cm focus of concentric narrowing in the sigmoid colon, persistent over 2.5 minutes (delayed images). As this could be an annular lesion, correlation with colonoscopy (or recent colonoscopy results) is suggested.Emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: ETT placement History: ETT placement Extensive interstitial opacities with a cystic appearance probably reflecting underlying emphysema, unchanged.Stable pleural effusions.ET tube tip approximately 1 cm above the carina.Right jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.

Output: Pulmonary opacities suggestive of edema with underlying emphysema, unchanged.


Instruction: Generate impression based on medical findings.

Input: 55 year-old female with history of cough and shortness of breath and COPD participating in the Spiration research trial LUNGS AND PLEURA: Severe centrilobular emphysema is again identified. A focal somewhat nodular density noted in the right lower lobe that was not present on the previous examination. This may represent an area of mucous plugging or focal bronchiolitis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Redemonstration of severe changes of centrilobular emphysema2. New small right lower lobe nodular opacity (image 83 series 6) most likely representing mucous plugging


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: PNA History: SOB Endotracheal tube remains high with the cuff at or above the cords. Advancement is recommended. The remaining support devices are unchanged.Persistent multifocal patchy airspace opacities with small pleural effusions. The left costophrenic angle is excluded from the field-of-view. Cardiomegaly unchanged.

Output: Advancement of endotracheal tube recommended. Bilateral airspace opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Dry cough over the past 2-3 days History: Dry cough over the past 2-3 days Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Left axillary surgical clips and left mastectomy.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Evaluate ETT positioning. Tubes and lines unchanged in position with tip of endotracheal tube 5 cm above the level of the carina.Diffuse airspace opacities with increasingly confluent areas of consolidation in the lower lung zones.

Output: ETT 5 cm above the carina. Increasingly confluent consolidation in the lower lobes.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: intrapulmonary processes History: SVT, palpitations Bilateral loculated pleural effusions and marked elevation right hemidiaphragm similar in appearance to the prior exam.Surgical clips again identified in the right apex.No new pulmonary opacities identified.

Output: No interval change in the loculated right apical and loculated left basilar pleural effusions. No acute abnormality is identified.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with readjusted Swan position. Swan Ganz catheter tip has been retracted now located in the proximal right descending pulmonary artery. Left sided AICD with leads in stable position. No focal airspace opacities. No pleural effusion or pneumothorax. Stable cardiomediastinal silhouette.

Output: Swan Ganz catheter tip slightly retracted in the proximal right descending pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: s/p right lower lobectomy History: asx 2 right-sided chest tubes are identified with the tips at the apex.No significant pneumothorax.Mild volume loss in the right lung compatible with recent right lower lobectomy.Small right pleural effusion.Cardiomediastinal silhouette is unremarkable.

Output: Right-sided chest tubes unchanged. Volume loss in the right lung with small right pleural effusion compatible with recent right lower lobectomy.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with thyroid cancer, posttherapy imaging There is I-131 activity in the thyroid bed. Physiological activity is seen in the salivary glands, and mild activity in the liver.

Output: Functioning thyroid tissue in the neck, suggesting therapeutic I-131 sodium iodide is in the thyroid tissue.


Instruction: Generate impression based on medical findings.

Input: Reason: any sign of malignancy or lung infection History: cough, weight loss Normal cardiac and mediastinal contours.Marked elevation of the left hemidiaphragm, unchanged from previous, suggestive of phrenic nerve paralysis, with underlying air-filled stomach and/or bowel.No evidence of neoplasm or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: eval swan placement History: swan advanced Swan-Ganz catheter terminates in the main pulmonary artery. Other devices are unchanged. No new focal lung consolidation. No pleural effusion or pneumothorax. Moderate cardiomegaly, as before.

Output: Swan Gantz catheter has been pulled back and now terminates within the PA.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: s/p heart txp History: above Median sternotomy with chest tubes and drains are unchanged. Interval removal of Swan-Ganz catheter. Left IJ sheath in the subclavian vein. No pneumothorax.Basilar opacities are unchanged.Left upper extremity PICC tip is in the axillary region.

Output: Unchanged basilar opacities. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old. History of fever. Mild cardiomegaly. Basilar predominant opacities consistent with atelectasis and perhaps mild edema with faint septal lines on the right. No specific evidence of pneumonia.

Output: Mild cardiomegaly with basilar predominant opacities consistent with atelectasis and perhaps mild edema. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: eval for pulmonary edema History: shortness of breath Persistent right basilar consolidation and right pleural effusion. Probable atelectasis or scar at left lung base. Unchanged heart size. No pneumothorax.

Output: Unchanged consolidation at the right lung base with probable right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: cva History: ha left facial droop Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Swan placement Lines and tubes are unchanged. No focal lung consolidation or evidence of overt left-sided heart failure. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Lines and tubes are unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: 63M in CCU with IABP, ?placement History: 63M in CCU with IABP, ?placement Left-sided ICD unchanged.IABP marker in the aortic arch.Left PICC line with its tip in the left axilla.Decreased lung volumes with stable cardiomediastinal silhouette.The lungs are clear.No large pleural effusions.

Output: Support devices unchanged with an IABP marker in the distal aortic arch. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: lung eval History: lung eval Status post median sternotomy for total artificial heart placement. Unchanged pulmonary edema like opacities and pleural effusions right larger than left.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary edema and right pleural effusion. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: congestion History: desat Tracheostomy tube in place. Right internal jugular catheter tip in the SVC. Left upper extremity PICC tip has been repositioned and is now in the SVC. Enteric tube in the stomach, extending beyond the field-of-view.Normal cardiomediastinal silhouette. Moderate-sized bilateral layering pleural effusions with underlying bibasilar consolidation/and interstitial edema, not significantly changed given differences in technique.No pneumothorax.

Output: No appreciable change in bilateral pleural effusions and interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: re-assess pneumothorax History: see above Unchanged small left apical pneumothorax with the left apical subpleural bulla.Mild basilar interstitial opacities stable.Dense left upper lobe consolidation stable.Left subclavian catheter, tip in SVC.Right pleural drain.

Output: Very small right apical pneumothorax, with a right apical bulla.


Instruction: Generate impression based on medical findings.

Input: Reason: cough History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for cause of dyspnea History: dyspnea Normal heart size and mediastinal contours.Surgical clips in the anterior mediastinum.Small lung volumes with lower zone interstitial opacity and bilateral chronic pleural thickening, not significantly changed.

Output: Chronic interstitial disease of uncertain etiology with bilateral pleural thickening. These findings are likely related to the patient's symptoms and if clinically indicated a CT scan with interstitial disease protocol would be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: asp pna History: cough The chest is distorted by a severe scoliosis with internal fixation.Right costophrenic angle blunting most likely is chronic rather than an effusion, as there are healed rib fractures in this region.No reliable evidence of infection or edema.

Output: No reliable evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Status post arrest, evaluate for pneumo. No pneumothorax. Cardiopulmonary monitoring and support devices unchanged in position. Pulmonary edema slightly improved. Opacities in the left lung about the same. Pleural effusions unchanged. There may be a nondisplaced right lateral rib fracture.

Output: Probable nondisplaced right lateral rib fracture. No pneumothorax. No significant change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male 30 days old Reason: Evaluate lung fields History: Infant intubated with 3 chest tubes in placeVIEW: Chest AP (one view) 1/5/2016 at 0548 hours. NG tube terminates at the stomach. ET tube tip is at the thoracic inlet. Left upper extremity venous access terminates at the left innominate vein. 3 Right-sided chest tubes are unchanged.Cardiac silhouette size is normal. Slight improvement in right-sided subpulmonic pneumothorax with persistent diffuse lung haziness, left lower lobe opacity and pattern of PIE.

Output: Interval improvement in right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: PICC line placement New right PICC line placed with tip projected in the proximal subclavian at the confluence of the SVC.Moderate nonspecific cardiomegaly with otherwise unchanged cardiopulmonary appearance. ICD unchanged

Output: Right PICC line placed


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: assess for infection History: neutropenic fever. Has RSV, stable respiratory status, however want to make sure no pulm infection Small lung volumes.No significant abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: SOB rule out fluid. Moderate cardiomegaly, about the same.Minimal pleural fluid in the posterior costophrenic angles.Diffuse parenchymal opacity with bronchial wall thickening in the lower zones suggestive of acute on chronic edema.

Output: Mild acute on chronic CHF.


Instruction: Generate impression based on medical findings.

Input: 19 year-old pregnant female with shortness of breath. Tachycardia, hypertension, and elevated d-dimer. PULMONARY ARTERIES: Diagnostic examination demonstrating no pulmonary embolism.LUNGS AND PLEURA: No pulmonary edema, pleural effusions, or pneumonia. Small pleural-based opacities in the dependent regions of the lung may represent small foci of scarring.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No pulmonary embolism and no findings to explain the patient's shortness of breath.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of renal cell carcinoma status post nephrectomy CHEST:LUNGS AND PLEURA: Nonspecific, punctate nodule on image number 55, series number 6 is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There is a large collection around the liver measuring 8.9 x 6.6 cm on image number 102, series number 4. This likely represents a hematoma, however, secondary infection cannot be excluded.SPLEEN: No significant abnormality notedPANCREAS: Postsurgical changes involving the tail of the pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. There is as 7.6 x 5 cm collection the left nephrectomy bed on image number 113, series number 4. Right kidney and adrenal gland are unremarkable.RETROPERITONEUM, LYMPH NODES: Postsurgical changes secondary to thrombectomy from IVC. Multiple retroperitoneal lymph nodes. An index left para-aortic node measures 1.4 x 1.4 cm on image number 124, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postsurgical changes secondary to left nephrectomy. Two large fluid collections around the liver and in the left nephrectomy bed. These likely represent hematoma/seroma is, however, an abscess cannot be excluded based on CT findings.Borderline enlarged retroperitoneal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: COPD history with previous pneumonia. History of asbestos exposure and positive PPD. LUNGS AND PLEURA: Small bilateral pleural effusions greater on the left with associated pleural thickening. Associated pleural plaques and irregularity is noted particularly along the left posterior wall. Although partially representing mild compressed underlying lung, no definite additional abnormalities confirm a malignant process over old chronic pleural thickening from residual persistent effusions. Comparison with prior exams would be helpful.Reference Lesions:Level of the pulmonary veins (image 51 series 4), at 4 o'clock is 5 mm Level of pulmonary bifurcation (image 38 series 4), at 6 o'clock 6 mm.A 6-mm nodular densities noted in the right upper lobe (image 38 series 6). Again stability needs to be proven with outside exams and or follow up studies.Mild emphysematous changes and mild dominantly dependent edema. No evidence of significant airtrapping noted on expiration sequence.MEDIASTINUM AND HILA: Cardiac silhouette is top normal in size, with parallel cardia and is within limits. Enlarged pulmonary tear no root measuring 3.7 cm in diameter raises concern for pulmonary hypertension. No lymphadenopathy.CHEST WALL: No significant abnormality noted. Mild degenerative disk at it developed the visualized spine.UPPER ABDOMEN: No significant abnormality noted number however evaluation severely limited and incomplete with extension only to half the liver and top of the spleen.

Output: 1. Bilateral pleural effusions with abnormal pleural thickening and calcific plaques. Highly suspicious for mesothelioma or less likely old chronic changes, please provide comparison images if available or consider follow up.2. Right upper lobe nodule, see above.3. Enlarged pulmonary central arteries raising concern for hypertension.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: post op, eval ETT, lung fields History: s/p AVR, root repair Interval intubation with ET tube tip 2 cm above the carina. Interval placement of Swan-Ganz catheter with tip in the right main pulmonary artery. Median sternal wires and fixation plates. Two chest tubes are noted. Bioprosthetic aortic valve placement.New mediastinal and right paratracheal soft tissue density and represent fluid or hematoma from recent surgery.Engorged pulmonary vasculature. Left pleural effusion with adjacent atelectasis. No pneumothorax.

Output: Left pleural effusion with adjacent retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: History of alpha one antitrypsin deficiency and left lower lobe wedge resection for cancer. LUNGS AND PLEURA: Paraseptal emphysema is seen, most prominent in upper lobes, with large bullae in the right apex. Panlobular emphysema, more prominently seen in lower lung zones.Suture in the left lower lobe, likely from the prior wedge resection, without findings suggestive of recurrence.Irregular opacity in the right upper lobe measuring 24 x 12 mm (image 29, series 7) with an adjacent nodule measuring 7 mm (image 24, series 7) is noted. A few smaller irregular opacities in the right lung base. PET CT is recommended for these lesions.Scarring in the right lung base and left lingula.MEDIASTINUM AND HILA: No significant abnormality noted. No mediastinal or hilar lymphadenopathy. Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted in the visualized portion of liver, gallbladder, kidneys, adrenal glands, spleen, or pancreas..

Output: 1. Paraseptal emphysema predominantly in upper lobes and panlobular emphysema predominantly in lower lobes. 2. Irregular opacity in the right upper lobe and a few smaller irregular opacities in the right lung base. PET CT is recommended for these lesions.3. Postsurgical changes in left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: New dyspena \T\ SOB, s/p stem cell transplant, concern for infection or acute pulmonary process History: DOE \T\ SOB Interval placement of right central venous catheter with tip in the superior vena cava.Cardiomediastinal silhouette is unremarkable.Large calcific opacity in the left breast and multiple surgical clips in the left chest are again noted.No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormalities noted. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: chest tube placement History: as above Chest tube placed alleviating the left pneumothorax.Mild left basilar atelectasis is present post reexpansion.Small left pleural effusion.Right lung unremarkable.ET tube tip high, at least 10 cm above the carina.Dobbhoff tube removed.Left subclavian catheter, tip in SVC.

Output: New left chest tube alleviating the left pneumothorax. Very high ET tube placement, well above the thoracic inlet level.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.ET tube placement ET tube extends approximately 6 cm above the carina. No acute cardiopulmonary abnormality. The cardiac mediastinal silhouette is within normal limits. Basilar atelectasis. No focal consolidation, significant pleural effusion or pneumothorax.

Output: ET tube approximately 6 cm above the carina. No evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: lung reexpansion History: s/p RUL lobectomy for cancer Two right chest tubes with a persistent small right pneumothorax, questionably improved.Right hemithorax postsurgical volume loss and overall small lung volumes unchanged.Diminished right chest wall soft tissue emphysema.

Output: Two right chest tubes, with a small right apical pneumothorax questionably improved.


Instruction: Generate impression based on medical findings.

Input: Bullet wound Small right pneumothorax with underlying right upper lobe focal opacity, possibly edema and/or hemorrhage given history. Overlying marked chest wall and neck emphysema. See subsequent reportBullet projects over the left chest without additional cardiopulmonary abnormality

Output: Small right pneumothorax and bullet


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: shortness of breath History: shortness of breath There is been interval removal of a right internal jugular central venous catheter.The cardiomediastinal silhouette is mildly enlarged. Dense diffuse atherosclerotic calcifications of the aorta and trachea are noted. Diffuse haziness to the lungs bilaterally due to expiration or poor inspiratory effort. No focal pulmonary opacity suggestive of pneumonia. No pleural effusion or pneumothorax.

Output: Cardiomegaly without superimposed acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 15 years old status post right-sided bronchoscopy, evaluate for pneumothorax. 4/21/2016, 1922 hours. No pleural effusion or pneumothorax is identified. Multiple pulmonary nodules and masses are again noted, as seen on the prior CT from 4/13/2016. Patchy right lower lobe airspace opacity appears new as compared to scout radiograph from PET CT study on 4/20/2016 and may be postprocedural versus aspiration given history. Mediastinal and hilar lymphadenopathy is identified. Cardiothymic silhouette normal.

Output: 1.No pneumothorax.2.Multiple pulmonary nodules and masses and hilar and mediastinal lymphadenopathy, better identified on prior CT from 4/13/2016.3.Patchy right lower lobe airspace opacity, new as compared to scout radiograph of PET/CT from 4/20/2016, which may be postprocedural or represent aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: tachypnea History: tachypnea Endotracheal tube and partially visualized enteric tube remain unchanged.Stable cardiomediastinal silhouette and calcification aortic arch.Large right lung mass is redemonstrated and appears unchanged. Mild interstitial edema. No pneumothorax.

Output: Slight increase in interstitial prominence likely related to edema and correlate with fluid status.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with breast cancer CHEST:LUNGS AND PLEURA: Left apical scarring.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Status post right mastectomy. Postsurgical changes with a drain in the mastectomy bed.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific punctate hypodense lesions in both lobes of the liver are too small to accurate characterize. There are seen on image number 79, 80, 69.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes secondary to mastectomy. No evidence of metastatic disease in the chest, abdomen, and pelvis.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: monitor ETT History: intubated Lines and tubes are unchanged. Diffuse pulmonary opacities, unchanged. Small pleural effusions, as before. Unchanged heart size. No pneumothorax.

Output: Diffuse pulmonary opacities again noted consistent with diffuse alveolar damage. Small pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: Stage III ovarian cancer CHEST:LUNGS AND PLEURA: 4-mm nodule in the left upper lobe on image number 21, series number 3 is unchanged. Nonspecific 5-mm hypodensity, right middle lobe on image number 57, series number 3 is unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst is unchanged. Perihepatic implants measures 16 x 12 mm image number 106, series number 3, unchanged.SPLEEN: Lobulated splenic mass is unchanged, measuring 2.5 x 1 .5 cm, image number 92, series number 3. Other splenic masses are also unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left-sided moderate hydronephrosis with a double-J stent is unchanged.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: Heterogeneous, complex pelvic mass is unchanged in size in appearance and measures 5.6 x 4 .4 cm, image number 169, series number 3.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Complex pelvic mass and other peritoneal implants, likely invades the sigmoid colon wall.BONES, SOFT TISSUES: Left rectus muscle. Mass is unchanged, measuring 1.7 x 1.4 cm.OTHER: No significant abnormality noted.

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: ro ptx, bony abn History: chest pain after fall, worse with coughing No significant change in cardiomegaly and mild edema.Central venous catheters.No pneumothorax.Well poorly visualized, there does appear to be fracture of the right ninth rib. There is no pneumothorax.

Output: 1. Poorly visualized but apparent fracture of the right ninth rib. No pneumothorax.2. Stable cardiomegaly with pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: swan position History: above Moderate to severe cardiomegaly.Small pleural effusions, the lungs otherwise unremarkable.Right jugular Swan-Ganz catheter tip obscured by overlying support devices, the tip still likely in the right interlobar pulmonary artery.Second right jugular catheter, tip in SVC.

Output: Cardiomegaly with small pleural effusions. Unchanged Swan-Ganz catheter, tip still in the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt with pain around her right rib area. Hx of CLL. Please eval for fracture or PNA History: Pain with deep breaths Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.No visible rib fractures, though a chest radiograph is not sensitive in this respect.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with end-stage renal disease. Evaluate central line placement. Comments: Surgical Case Information | Procedure(s): Procedure(s) with comments: | KIDNEY-PANCREAS TRANSPLANT - Kidney-pancreas transplant Interval intubation with endotracheal tube tip 4 cm from the carina. An esophageal probe is also present. Interval right internal jugular line placement with its tip overlying the cavoatrial junction. Interval placement of enteric tube with its tip in the gastric antrum.Right basilar atelectasis. No abnormal focal airspace opacity. No pneumothorax or pleural effusion.Staple lines from prior wedge resections or biopsies in the right lung.

Output: Central line tip overlying the cavoatrial junction. No unexpected radiopaque foreign objects. Discussed with Dr. Bodzin by telephone.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: 55 male with lymphoma. Now with bradycardia, assess PICC line position History: Bradycardia No change in known mediastinal lymphadenopathy, with a small left pleural effusion but improving right.Nonspecific retrocardiac atelectasis is unchanged.Right PICC tip at SVC/RA junction level, the left PICC removed.

Output: Improvement in right pleural effusion, otherwise unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: consolidation vs hemorrhage History: dyspnea There is moderate cardiac enlargement.Diffuse airspace and interstitial opacities in both lungs are similar to the prior exam.Increasing left retrocardiac consolidation/atelectasis and small left pleural effusion.

Output: Increasing left retrocardiac consolidation/atelectasis and small left pleural effusion. Diffuse air space and interstitial opacities in both lungs compatible with edema, hemorrhage, or atypical infection.


Instruction: Generate impression based on medical findings.

Input: Cough Improved overall aeration with the mild unchanged interstitial abnormality greater in both bases, presumably chronic. No superimposed acute air space abnormality. Mild scoliosis without additional cardiac or mediastinal contour abnormality or change

Output: Old chronic interstitial abnormality without additional new superimposed disease


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Battery. Chest pain. No pneumothorax or visible pleural fluid. No focal airspace opacities.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Within this limitation, no grossly displaced fractures of the visualized osseous structures are appreciated.

Output: No pneumothorax or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: fevers, assess for new opacity History: as above Small right pleural effusion, otherwise unremarkable.Heart size normal.No specific evidence of infection.

Output: Small right pleural effusion, but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: PNA, pulmonary edema History: hypoxia Moderate cardiomegaly.No specific evidence of edema or pneumonia, although respiratory motion degrades the image.Status post extubation.An NG tube terminates in the stomach.Right jugular catheter tip in right brachiocephalic vein region.

Output: No reliable evidence of edema or pneumonia although the image is degraded by respiratory motion.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Eval interval change in lung fields History: Volume overload Stable position of multiple support devices.Scattered interstitial and airspace opacities are without significant change.Stable small effusions and basilar atelectasis.No pneumothorax.

Output: Stable appearance of effusions and basilar atelectasis. Lines stable.


Instruction: Generate impression based on medical findings.

Input: Status post VSD repair.VIEW: Chest AP (one view) 5/28/2016 at 0514 hours. Interval removal of ET tube and NG tube. Lower extremity central line, the cardiac pacer leads, right atrial line and bilateral chest tubes are again noted.Cardiac silhouette size is is top normal but stable. Persistent lung vascular engorgement with no focal opacities, effusions or pneumothorax.

Output: Persistent lung vascular engorgement after ET tube and NG tube removal.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for intubation, line placement History: post-op ET tube tip approximately 2 cm above the carina.Right jugular catheter tip in the area of the right brachiocephalic vein.ICD leads unchanged.Mild cardiomegaly and mild basilar atelectasis with a probable small right effusion.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: congestion, cough. chills; r/o pna History: low grade temp, body aches, chills. Small lung volumes.Prior granulomatous disease.Bronchial wall thickening suggestive of asthma or bronchitis.No other evidence of infection.Surgical clips GE junction region.

Output: Bronchial wall thickening consistent with asthma or bronchitis. No other specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: hx of bladder ca sp cystectomy and neobladder History: same Cardiac silhouette is normal in size. Calcified aortic knob.Lungs are clear. No focal consolidation, sizable effusion or pneumothorax.

Output: No evidence of acute pulmonary process or gross evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Shortness of breath Cardiac silhouette is moderately enlarged.ICD with single right ventricular lead is noted.Small bilateral pleural effusions. No pneumothorax.Minimal interstitial septal lines. Peripheral airspace opacities in the lung bases.

Output: 1.Mild cardiomegaly with minimal interstitial septal lines and small pleural effusions may represent a component of CHF. 2.Multiple opacities in the lung bases most likely reflect atelectasis and possible infection. Infarcts may have a similar appearance and PE may be considered in the appropriate clinical setting. Follow-up chest radiographs recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval for volume overload History: SOB Stable cardiomegaly.Right-sided central venous catheter tip in the SVC.Left ICD with leads in position.Vascular congestion without frank edema or evidence of infection.No pneumothorax

Output: 1. Stable cardiomegaly2. Newly placed right-sided central venous catheter.3. Vascular congestion without edema or evidence of infection


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: Evaluate for metastasis History: osteosarcoma of arm Stable cardiomediastinal silhouette.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.Partially visualized right humeral prosthesis.

Output: No evidence of acute cardiopulmonary process or gross metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 82 year old female with non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Left lower lobe subsegmental atelectasis unchanged. Emphysema, unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable vena cava filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic L1 vertebral body lesion.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: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Hypoxemia. Severe cardiomegaly with moderate diffuse interstitial, airspace, and pleural fluid suggesting CHF is not significantly changed. Right PICC tip over the SVC. No pneumothorax.

Output: Moderate CHF pattern, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: eval for pulmonary edema History: dyspnea, CHF Severe cardiomegaly with redistribution of the pulmonary blood flow.Equivocal edema.No specific evidence of infection.

Output: CHF with equivocal edema but severe cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: F/u ICU CXR History: F/u ICU CXR Pleural effusions with marked right hemithorax volume loss and apical cyst formation unchanged. Stable left lower lobe consolidation.Tubes and catheters are unchanged.

Output: Stable tubes and devices, with no new pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: 82 years old Female. Reason: AM CXR s/p thoracotomy History: AM CXR s/p thoracotomy. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. The bilateral pleural effusions are stable. The chest tube position unchanged.The left chest tube is stable in position. There is no apparent pneumothorax identified.

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


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube in place History: chest tube in place Moderate right apical pneumothorax, Unchanged in the previous exam with chest tubes in place.Underlying opacity compatible with atelectasis, edema and pleural effusion. Partial reexpansion of the left lower lobe.

Output: Persistent right pneumothorax without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval for pulmonary edema History: sob Stable cardiomediastinal silhouette.Moderate bilateral pleural effusions and basilar atelectasis, not significantly changed from the prior exam. Mild interstitial edema, unchanged. No focal air space abnormality.

Output: CHF, without significant interval change or new acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 61 years old Female. Reason: assess for PNA History: elevated WBC count. New right middle and lower lung groundglass opacities. Right pleural effusion. The cardiac silhouette is normal. Tracheostomy tube is stable in position.

Output: New right middle and lower lung groundglass opacities due to edema or pneumonia. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with history of metastatic pancreatic cancer CHEST:LUNGS AND PLEURA: Again noted multiple calcified subcentimeter nodules. There are a few punctate nodules which are new. Index new noncalcified subcentimeter nodule measures 4-mm image number 68, series number 9 in the right lower lobe.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Mild atrophy of the right posterior hepatic lobe with mild intrahepatic biliary ductal dilatation is unchanged. No focal lesions in the liver suspicious for metastatic disease.SPLEEN: No significant abnormality notedPANCREAS: Dilated pancreatic duct is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: The peripancreatic, portacaval adenopathy is increased in size and now measures 2.3 x 2.3 cm image number 94, series number 7. Previously, it was measuring 17 x 12 mm on image number 88, series number 21. The main portal vein demonstrates contour irregularity adjacent to this peripancreatic lymph node. Mild fat stranding around the pancreas is unchanged. Scattered mildly enlarged mesenteric lymph nodes are grossly unchanged. Index mesentery no measures 14 by 8 mm on image number 107, series number 7.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Changes secondary to Paget's disease on the left side, unchanged.OTHER: No significant abnormality noted

Output: Interval developed on the a few, punctate micronodules of unknown clinical significance.Interval increase in size of the portacaval lymph node.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Hypotension, central line placement Right internal jugular catheter tip projects over the right atrium.Stable cardiomegaly.Diffuse chronic interstitial opacities.

Output: Right internal jugular catheter tip projects over the right atrium. Stable appearing chronic interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: ptx post biopsy? large pleural masses History: post biopsy Severe nodular right-sided pleural thickening again noted. No right-sided pneumothorax status post biopsy. Left lung remains clear.

Output: Severe nodular right-sided pleural thickening again noted. No right-sided pneumothorax status post biopsy.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: eval s/p ecmo decannulation History: as above A right chest tube is been removed leaving others in place with no pneumothorax.Stable pulmonary opacities.Cardiac assist cannula removed.Right jugular catheter tip at right atrial level.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.Left PICC, tip in left subclavian. Left jugular introducer stable.

Output: No pneumothorax following removal of a right chest tube and cardiac assist cannulae removal.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: CTICU History: Daily CXR Unchanged pulmonary opacities and loculated right pneumothorax despite right chest tubes.Tracheostomy tube tip approximately 6 above the carina.A Dobbhoff tube extends below the lower margin of the image.Two right jugular catheters terminate in the SVC region.

Output: Unchanged pulmonary opacities and loculated right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ards History: 1040 Significant improvement in pulmonary opacities.Pleural effusions stable.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.Left jugular catheter, tip in SVC.

Output: Improvement in pulmonary opacities still consistent with ARDS.


Instruction: Generate impression based on medical findings.

Input: Reason: 29 y/o man w/ an indeterminate quantiferon gold History: 29 y/o man w/ an indeterminate quantiferon gold Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old, with right breast mass, hematoma versus abscess. LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Within the right breast, a large collection measures 7.1 x 6.0 cm (axial image 60/100) demonstrating a thin enhancing capsule with heterogeneous low attenuation internally. Although this finding may reflect an abscess or hematoma, the possibility of a necrotic malignancy must be considered. An additional, similar collection is evident more superiorly, adjacent to several calcifications (axial image 34/). The surrounding subcutaneous fat is infiltrated. A mildly prominent, enhancing lymph node within the right axilla is not pathologically enlarged by CT criteria. UPPER ABDOMEN: Gastric band in place.

Output: Findings within the right breast suspicious for malignancy, although a benign etiology such as abscess or hematoma may also be considered in the appropriate clinical context.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with history of sickle cell anemia who presents with dyspnea and chest pain. Evaluate for consolidation. Right sided chest port with catheter tip in the right atrium. Normal cardiac silhouette. Prominent right hilum as correlated with CT nonenhanced chest 3/14/2015 which may be related to aneurysmal pulmonary vasculature. Persistent right costophrenic angle scarring. No pleural effusions or pneumothorax.

Output: 1.No acute cardiopulmonary abnormality.2.Prominent right hilum as correlated with CT nonenhanced chest 3/14/2015 which may be related to aneurysmal pulmonary vasculature.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: work-up for cause of seizures; aspiration pneumonia? Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar atelectasis or scarring. No focal lung consolidation or evidence of overt left-sided heart failure. Heart size likely unchanged. Tortuous thoracic aorta again noted. No large pleural effusion or pneumothorax.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: ptx History: ptx Two right chest tubes unchanged in position. Continued improvement in right pneumothorax. Other findings stable.

Output: Two right chest tubes unchanged in position. Continued improvement in right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia, please assess for volume overload History: as above Small lung volumes with lower zone interstitial opacity compatible with edema, atelectasis and small effusions.Right jugular catheter extending to the right atrium and NG tube tip in the stomach.

Output: Basilar interstitial opacity compatible with edema, atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: sob respiratory failure History: sob, hypoxemia Cardiomediastinal silhouette is now completely obscured on the left. Extensive atherosclerotic changes of the thoracic aorta.Near complete opacification of the left lung with worsening in volume loss in the right upper lung air bronchograms likely related to interval collapse and mucous plugging. Patchy right lung airspace disease again seen. Small pleural effusions suspected. No pneumothorax.

Output: Interval worsening of left lung opacification likely related to superimposed postobstructive atelectasis and mucous plugging in the setting of multifocal bilateral airspace disease and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o aspiration pna History: found down, ams Normal heart size with a dual chamber pacemaker in place.Small lung volumes with no gross pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: rule out pneumonia History: coarse breath sounds Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pneummonia History: body aches and chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old. Reason: chest pain History: as above Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion or pneumothorax.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: History of uterine cancer and breast cancer. Rule out metastases disease. CHEST:LUNGS AND PLEURA: Bilateral emphysematous changes, more prominent in the apices. Bilateral calcified nodules likely representing granulomas.MEDIASTINUM AND HILA: AP window adenopathy measuring 12 by 8mm image number 35, series number 3.CHEST WALL: Partially imaged 4.7 by 2.4-cm mass in the left breast. Left axillary adenopathy measuring 14 x 10 mm on image number 27, series number 3. additional enlarged left axillary and subpectoral lymph nodes are also present.ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly. Cholelithiasis. No focal liver lesions to suggest metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Endometrial stripe is irregular and dilated measuring 2.3-cm consistent with patient's known history of cancer. Large calcified fibroid in the uterus.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: Emphysema. AP window adenopathy. Left breast mass and left axillary adenopathy.Dilated endometrial cavity consistent with patient known history of endometrial cancer. Large calcified fibroid.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Status post chest tube removal Surgical clips project over the left midlung. Interval removal of left chest tube. No pneumothorax.Persistent left hemithorax opacity compatible with pleural thickening, effusion and atelectasis/consolidation. No new focal airspace opacity in the right lung.Displaced right posterior eighth rib fracture.

Output: No significant pneumothorax status post chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: picc placement centrally History: picc line for tpn Nonspecific left basilar opacity suggestive of atelectasis and a left pleural effusion, unchanged.Otherwise, the lungs are unremarkable and the heart size normal.Left PICC, tip in SVC.

Output: Left PICC, tip in SVC. Unchanged left basilar opacity and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.History of leukocytosis. Basilar subsegmental atelectasis/scarring without superimposed focal airspace opacity, pleural effusion, or pneumothorax.Cardiac silhouette unchanged in size.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: ETT check Mildly improving lung aeration with persistently decreased volumes bilaterally with basilar patchy densities suggesting atelectasisNo gross cardiac or mediastinal contour change.ETT remains 4 cm above the carina. NG and right jugular catheters well-positioned

Output: Improving aeration with an unchanged ETT


Instruction: Generate impression based on medical findings.

Input: Fatigue. Headache and weakness. Check for pneumonia No acute cardiopulmonary abnormality. Mildly elevated right hemidiaphragm unchanged

Output: Minimal scarring without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. Reason: lung infiltrate History: chest pain Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: 47F s/p PICC placement History: PICC No significant cardiopulmonary abnormality.Left PICC removed.Right PICC, tip at cavoatrial junction level.

Output: Right PICC placement.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: resolving ptx? History: air leak No change in right basilar chest tube or right-sided pneumothorax. Other findings also stable.

Output: No change in right basilar chest tube or right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.With hypoglycemia. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable. Large lung volumes without focal pulmonary opacity. There has been interval improvement of the previously seen right upper lobe opacity with air-fluid level in a cavitary lesion. Small round opacity overlies the left aspect of the heart, presumably over the patient.

Output: Interval improvement of cavitary right upper lobe opacity.New small round opacity overlies the left aspect of the heart, presumably over the patient.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: Aspiration PNA? History: SOB, witnessed aspiration Interval removal of ET tube and NG tube.No sign of aspiration or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: 25 yo F with relapsed AML, NICM, increased O2 requirement; please eval for interval change in pulm edema, other acute pulm abnormality (eg infection) History: see above Slight improvement in lower lung zone edema with pleural effusions.Mild cardiomegaly.Left PICC, tip at cavoatrial junction.

Output: Slight improvement in pulmonary edema with pleural effusions. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: intubated, IABP History: intubated, IABP Median sternotomy, small lung volumes and nonspecific basilar atelectasis are unchanged.IABP catheter distal tip at the level of the aortic arch.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter, tip directed towards the right interlobar pulmonary artery.Left jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.

Output: Unchanged basilar atelectasis and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: assess central line placement History: central line reposition Left-sided airspace opacity unchanged.Mild cardiomegaly.Right jugular catheter tip at right atrial level.

Output: Unchanged pulmonary opacities. Right jugular catheter tip at right atrial level.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain; going for V/Q scan History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: fevers History: fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: infiltrate History: VOC sickle cell Mild basilar interstitial opacity may be due to edema though there is no focal opacity to suggest pneumonia. Borderline heart size stable.

Output: Mild basilar interstitial opacity may be due to edema though there is no focal opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 39 year old male s/p cardiac surgery. Asymptomatic Right IJ Swan Ganz catheter tip unchanged. Enteric tube tip extends beyond the inferior margin of the image. ET tube 5 cm above the carina. Cardiomegaly with retrocardiac opacity unchanged.

Output: No interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: pna History: cough Stable cardiomegaly.Stable vascular congestionStable ICD leads.No significant pleural effusion. No pneumothorax.

Output: Stable cardiomegaly with no new findings.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with follicular non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Mild basilar pleural thickening on the left side. Left lower lobe left unchanged.MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, unchanged. No focal lesions in the liver.SPLEEN: Well-circumscribed hypodense lesion in the lower pole of the spleen is unchanged and measures 13-mm in diameter image number 102, series number 3.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: New fat stranding around the descending colon centered around the diverticula consistent with diverticulitis. No evidence of peridiverticular abscess.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: Bilateral fat containing inguinal hernias.

Output: Acute diverticulitis involving the sigmoid colon without evidence of peridiverticular abscess. No other significant change from pre-study.Dr. Cohen was notified and acknowledged about the acute diverticulitis at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 76 years old Female. Reason: pneumonia, effusion, cardiomegaly History: productive cough. There is a large left pleural effusion which compresses the left lung. Numerous nodules and masses are seen in the right lung and in the left upper lung. The tip of Port-A-Cath projects over the right atrium. Severe degenerative changes in both shoulders.

Output: Multiple masses in both lungs and left large pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: r/o infectious etiology/fluid History: L crackles Upright radiographs reveal distal esophageal stent in stable position, with the proximal component above the level of the diaphragm.No evidence of pneumoperitoneum on PA and lateral views. Basilar reticulation of scarring is again noted. Ill-defined opacity at the right 7/8 rib interspace that may represent a nodule. A CT thorax is recommended for further evaluation. Right anterolateral rib deformity suggestive of prior fracture.

Output: No evidence of pneumoperitoneum on these upright radiographs. If there is persistent pain, the mediastinum and upper abdomen can be further evaluated with a CT, if clinically appropriate.Right mid zone opacity suspicious for nodule. This can be further characterized with a CT thorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval heart failure exacerbation History: cough Mild cardiomegaly.Improvement in previous edema, although not completely resolved.Left subclavian ICD, leads unchanged in position.A Dobbhoff tube terminates in the stomach.

Output: Cardiomegaly, but improvement in previous edema. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: Evaluate lung fields History: s/p arrest Interval placement of external defibrillator pads with left-sided pad projecting over the left axilla. The right port remains accessed with a portion of the catheter extending into the central right internal jugular vein. Flexible tracheostomy tube terminates at the level of C1 with mild leftward patient rotation.Progressive opacities at the lung bases, greater on the right. This may represent interval aspiration. No visible displaced rib fractures in the setting of recent arrest. No pneumothorax. Heart size remains stable, within limits of normal.

Output: Increasing basilar opacities following arrest resuscitation, raising the question of aspiration. No displaced rib fracture or interval pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female history RCC status post left nephrectomy evaluate for recurrence. CHEST:LUNGS AND PLEURA: Extensive right upper lobe scarring pleural thickening and calcification the left so on the right side. Areas of bronchiectasis in the area of scarring in the left upper lobe. Minimal scarring at the bases. No effusions.MEDIASTINUM AND HILA: Dominant nodule right thyroid lobe 3.1 x 2.2 cm Series IV image 4/2011. Small axillary nodes.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left kidney is surgically absent. No evidence of recurrence in the left renal fossa. Within the limits of no IV contrast no obvious mass in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Surgical staples (LapRTye) in the left renal fossa.BOWEL, MESENTERY: Scattered colonic diverticulosis. No evidence of diverticulitis. No evidence of ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified uterine masses likely fibroids.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: Scarring and areas of calcification bronchiectasis in the lungs particularly the upper lobes. Is there any prior chest x-rays or CT scans suggest comparison. No definite evidence of metastatic disease. Right thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: concern for pulmonary congestion History: bibasilar crackles Increasing basilar opacities likely edema and atelectasis.

Output: Increasing basilar opacities likely edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old. ETT. Subarachnoid hemorrhage. Interval extubation and removal of NGT. There is placement of a new enteric tube, tip distal to caudal margin of film.Mild increase in left lower lobe opacity consistent with atelectasis and aspirated secretions. Mild blunting of the costophrenic angles consistent with small pleural effusions or scarring.

Output: Interval extubation. Mild increase in left lower lobe opacity consistent with atelectasis and aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: s/p rib fractures, PEA arrest History: chest pain Endotracheal tube terminates 3 cm from the carina. Unchanged port catheter. Low lung volumes makes detailed cardiopulmonary assessment difficult. Persistent bibasilar opacities. No pneumothorax. Normal heart size. No displaced rib fractures. Stomach is again distended.

Output: No displaced rib fractures though radiography has modest sensitivity for acute and/or mildly displaced rib fractures. No pneumothorax. Persistent bibasilar opacities. Stomach again distended. Consider decompression.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: Chills \T\ rigors, immunocompromised patient s/p stem cell transplant, afebrile. R/o infection History: Chills \T\ rigors Central venous catheters, unchanged. Small pleural effusions and bibasilar atelectasis. Heart size again at the upper limit of normal. No new focal lung consolidation. No pneumothorax.

Output: Small pleural effusions without focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.3 weeks wheezing and shortness of breath, orthopnea. No significant pulmonary edema. Faint right sided lung opacity which is nonspecific. Though it may represent scarring or atelectasis follow up with CT is recommended for further evaluation to exclude a pulmonary nodule.

Output: No significant pulmonary edema. Faint right sided lung opacity which is nonspecific. Though it may represent scarring or atelectasis follow up with CT is recommended for further evaluation to exclude a pulmonary nodule/neoplasm.Findings discussed with Dr. Fernandez Del Castillo at 16:40.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: evaluate passage of oral contrast History: - Low lung volumes with diffuse pulmonary opacities again noted. Unchanged cardiomegaly. No large pleural effusion or pneumothorax. Large patient body habitus.

Output: Low lung volumes with diffuse pulmonary opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: infection History: hypotensive Leftward patient rotation. No new focal lung opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.History of left rib pain. The cardiomediastinal silhouette is normal.Emphysematous changes, apical scarring, and mild basilar scarring are noted. A calcified left upper lung nodule is unchanged.The bones are diffusely demineralized and small lytic lesions are noted. Deformity of the clavicle is unchanged. Multiple rib deformities are noted bilaterally. Multiple thoracic wedge deformities also noted.

Output: Multiple osseous deformities including the left clavicle, bilateral ribs, and mid thoracic vertebral bodies of unknown chronicity, consistent with multiple myeloma.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with asthma, shortness of breath, cough. Evaluate bronchiectasis and gas trapping. CHEST:LUNGS AND PLEURA: Scattered micronodules bilaterally. No suspicious nodules, masses, or pleural effusion.Bilateral lower lobe lobe bronchial wall thickening and mild bronchiectasis with ill-defined ground glass opacities and centrilobular nodules at the lung bases.No evidence of significant air trapping; only regionally in the superior segments.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Severe coronary artery calcifications.CHEST WALL: Left chest wall ICD. UPPER ABDOMEN: Hypoattenuating lesions in the liver are incompletely characterized on this nonenhanced examination. Layering high density material in the gallbladder likely represents dependent cholelithiasis.Numerous renal cysts bilaterally of varying densities, some of which contain calcifications. There are incompletely evaluated and only partially visualized on this examination.

Output: 1. Lower lobe bronchial thickening and mild bronchiectasis with basilar scarring and ground glass opacities. Findings are compatible with changes of chronic aspiration.2. Innumerable renal cysts bilaterally of varying densities incompletely evaluated on this noncontrast examination.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated patient (status epilepticus) History: intubates for status epilepticus. otherwise uneventful ET tube tip approximately 4 cm above the carina.No significant pulmonary abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: r/o mets; h/o GCT History: none No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: assess pleural effusion and Pleurx placement History: as above Interval removal left IJ Swan-Ganz. Right-sided PICC, right apical Pleurx catheter and left subclavian dual-chamber ICD remain unchanged.Stably enlarged cardiac silhouette with coronary stents in place.Stable partially loculated right-sided pleural effusion and associated atelectatic changes. No pneumothorax.

Output: No significant change in partially loculated right-sided pleural effusion allowing for differences in position.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Eval lung fields- s/p b/l lung transplant, treating PNA History: as above No change in pulmonary opacities and pleural effusions, with a right pleural drain.Tracheostomy tube tip approximately 6 above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: No change in pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: PNA History: cough and sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval tamponade, lung fields History: s/p pericadial effusion drainage, hypoxia Marked cardiomegaly with mediastinal and pericardial drains in place.Right jugular catheter tip in the area of the SVC.Bilateral pulmonary nodules with pleural effusions and underlying atelectasis, not significantly changed.

Output: Extensive pulmonary and pleural abnormalities with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: patient with abdominal pain History: DOE, pain, distension Chest: Marked stable cardiomegaly. Visualized lung fields are without focal abnormality.Abdomen: No dilated loops of bowel are noted. Mild ileus pattern of the colon.

Output: Mild colonic ileus.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: r/o PNA History: SIRS with hx of cough Borderline cardiomegaly.Very low lung volumes limit cardiopulmonary assessment. Perihilar and bibasilar predominant interstitial and airspace opacities probably pulmonary edema. Likely small bilateral pleural effusions.Surgical clips project over both axillae and mediastinum.

Output: Limited examination with very low lung volumes and perihilar and bibasilar interstitial and airspace opacities probably pulmonary edema in the setting of chronic lung changes. Atypical infection and/or element of aspiration remain in the differential considerations.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.History: Congestive heart failure. Signs and symptoms: Dyspnea Persistent cardiomegaly although decreased from prior.Atherosclerotic calcifications of the aortic arch and thoracic aorta redemonstrated.Focal pulmonary opacity.No pneumothorax or pleural effusions.

Output: Interval decrease in cardiomegaly. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Altered mental status No cardiopulmonary abnormality. Dobbhoff remains unchanged extending beyond the inferior edge of the image. New right PICC line terminates in the right axilla

Output: Right PICC line placed


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: PTX s/p pleurectomy for mesothelioma. CT clamped at 6:30 AM History: Air leak Low lung volumes, decreased from prior. 12 mm left apical pneumothorax, slightly larger. Left apical chest tube in place. Postoperative appearance of the left hemithorax with atelectasis and edema. Opacities in the right lung suggestive of edema and atelectasis with a small volume of pleural fluid have improved.

Output: No change in left apical pneumothorax. No other significant change in cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: 46 year old female with severe chest pain and right-sided point tenderness. LUNGS AND PLEURA: Multiple micronodules, the largest of which in the lingula measures 4 mm in diameter (axial image 56/93), are most likely benign. No focal consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: Cardiac size is normal with no pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Old healed fracture of a posterior left rib.UPPER ABDOMEN: No significant abnormality noted.

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


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: assess for pulmonary edema, rule out pneumothorax History: h/o ILD with worsening hypoxia Severe chronic interstitial opacities unchanged, without reliable evidence of edema or infection.No significant pneumothorax.

Output: Chronic interstitial lung disease. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Postop cardiac surgery, evaluate for pulmonary edema Swan-Ganz catheter tip is in the right main pulmonary artery. Iatrogenic devices are otherwise unchanged.Moderate to severe cardiomegaly. Low lung volumes. Bibasilar opacities compatible with atelectasis/consolidation with small pleural effusions.No pneumothorax.

Output: Bibasilar opacities compatible with atelectasis/consolidation with small pleural effusions without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Respiratory failure, ARDS ETT has been minimally retracted, tip extends 5 to 6 cm above the carina. NG unchangedCardiopulmonary appearance otherwise remains significant for decreased lung volumes, mild nonspecific cardiomegaly and basilar opacities greater on the left with probable left lower lobe consolidation. Moderate effusions

Output: ETT minimally repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate for position of balloon pump History: above IABP superior margin is 1.5 cm from the top of the aortic arch. Otherwise, no substantial difference compared to previous study.

Output: IABP superior margin is 1.5 cm from the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: pleural effusions History: as above Pleural effusions and basilar opacities.Left subclavian ICD, leads unchanged in position.A Dobbhoff tube extends below the lower margin of the image.Right jugular and right subclavian catheters terminate at the right atrial level.

Output: Unchanged pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: sob, leg swelling History: eval for HF Moderate cardiomegaly and pulmonary vascular redistribution.Bilateral pleural effusions right greater than left, with pleural fluid tracking into the right horizontal fissure.Basilar predominant interstitial opacities suggestive of pulmonary edema.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia History: see above Small lung volumes with bilateral symmetrical mainly interstitial opacity compatible with ARDS.PICC line tip in left subclavian vein.No significant interval change.

Output: Pulmonary opacities compatible with ARDS without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: razor blade? foreign body? - UPRIGHT EXAM History: may have swallowed razor blade - UPRIGHT EXAM No significant cardiopulmonary abnormality.No radiodense foreign object in the chest and upper abdomen visualized.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with history of lung transplant. There are increased basilar prominent interstitial opacities with small bilateral pleural effusions compatible with moderate edema. There is small amount of loculated fluid along the left lateral pleural space. Postoperative changes of median sternotomy.

Output: Moderate pulmonary edema with small bilateral pleural effusions, partially loculated on the left without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for acute process incl pna - cough History: assess for acute process incl pna - cough Unremarkable cardiac and mediastinal silhouette. Slightly prominent interstitial markings, likely due to technique and perihilar bronchial thickening. No specific evidence of pneumonia or edema.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p ICD procedure History: s/p ICD procedure Presternal ICD device in place with the generator in the left lateral chest wall.Moderate scoliosis and no acute cardiopulmonary abnormalities.

Output: Presternal ICD device in place with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Motion degrades sensitivity. Persistent moderate nonspecific cardiomegaly with streaky densities in both bases, likely scarring and/or atelectasis. Consider serial imaging to ensure absence of a subtle change.Persistent focal hilar regions consistent with previous described adenopathy

Output: Suspected atelectasis and/or scarring without definite superimposed new abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: shortness of breath History: sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: r/o acute process History: chest pain No focal airspace opacity, pneumothorax or pleural effusion.The cardiomediastinal silhouette is normal.

Output: No specific evidence of edema or infection, or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: aspiration History: aspiration Retrocardiac subsegmental atelectasis and consolidation, consider aspiration or infection. No associated pulmonary edema or pneumothorax. The pleural spaces are clear. Heart size is upper limits normal.

Output: Retrocardiac opacity suspicious for aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Cough and wheeze, history of asthma and hamartoma. Left lower lobe pulmonary nodule again noted.Normal heart size. Tortuosity of the thoracic aorta about the same.Mild bronchial wall thickening and possible mild bronchiectasis at the lung bases nonspecific, but suggestive of chronic aspiration. No specific signs of pneumonia. Mild subsegmental atelectasis at the left base.

Output: Chronic bronchial wall thickening, subsegmental atelectasis and mild bronchiectasis at the lung bases which could be the result of chronic aspiration. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: evaluate for infection History: cough, hypotension No pneumothorax. Bibasilar scarring. Unchanged cardiomegaly. Scattered calcified granulomata. No focal airspace opacities to suggest infection.

Output: Unchanged cardiomegaly without specific evidence of infection.