Instruction: Generate impression based on medical findings.

Input: 31-year-old male with history of Crohn's disease involving the small bowel. Patient has anal symptoms and fevers. Evaluate extent of small bowel Crohn's in etiology and fevers with attention to the anal area. CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Low density hepatic lesions (series 3, images 46 and 57) are incompletely evaluated on this examination, however are likely benign given patient's age.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: Diffuse mild dilatation of the small bowel with mild inflammatory change and luminal narrowing seen at the terminal ileum consistent with patient's history. Prominent lymph nodes are seen throughout the mesentery as well.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple, multiloculated perianal fluid collections (series 3, image 152; series 80260, coronal image 27), consistent with perianal abscesses. For reference, a collection measures 5.7 x 2.7 cm in the axial plane; it measures approximately 4.9 x 3.4 cm in the coronal plane.

Output: 1. Multiple, multiloculated perianal fluid collections consistent with abscesses as above; given their extent and loculation, they are not amenable to percutaneous drainage.2. Inflammatory changes and mild luminal narrowing of the terminal ileum with mild upstream small bowel dilatation.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Lung transplant, repositioned ET tube. The endotracheal tube remains high, with its tip near the thoracic inlet, 8 cm above the level of the carina.Other tubes and lines unchanged in position. Small left hydropneumothorax, pneumothorax component is improving. Subcutaneous emphysema left chest wall. Atelectasis and consolidation bilaterally, left greater than right, about the same.

Output: Endotracheal tube remains high, with tip 8 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: NICM s/p HVAD eval for opacities or effusions History: post cardiac surgery No change in pulmonary opacities including left lower lobe consolidation and right basilar atelectasis.Small pleural effusions are present.Tracheostomy tube tip approximately 6 above the carina.Two right jugular catheters terminate in the SVC.A Dobbhoff tube extends below the lower margin of the image.Two LVADs unchanged in position.

Output: No change in pulmonary opacities and pleural effusions, or in support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Evaluate for infection History: Fever to 38.5, WBC to 15.0 Low lung volumes. Persistent left pleural effusion with adjacent atelectasis, as well as right basilar subsegmental atelectasis.

Output: No specific evidence of pneumonia. Left pleural fluid collection is nonspecific; potential sources for unilateral left pleural fluid collection include pulmonary embolus, myocardial infarction, left upper quadrant pathology or infection or neoplasm within the pleural space.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: evaluate PTX History: s/p lobectomy Left apical hydropneumothorax possibly loculated.Decreased left lung volume with improved left basilar consolidation.Scattered pulmonary nodules unchanged.

Output: Left apical hydropneumothorax. Improved left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ET tube History: advanced ET tube 2 cm ET tube tip approximately 3 cm above the carina.Bilateral lower lobe airspace opacity compatible with aspirated secretions and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: line placement History: s/p MVR post op Study limited by rightward patient rotation and low lung volumes. Patient has been extubated. Other lines and tubes, not substantially different. No substantial change in bibasilar pleural-parenchymal opacities. No significant pneumothorax. Unchanged cardiomegaly.

Output: Study limited by rightward patient rotation and low lung volumes. Patient has been extubated. Other lines and tubes, not substantially different. No substantial change in bibasilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Systemic sclerosis. ETT placement. ETT tip 6.5 cm above the level of the carina. Left jugular catheter and NGT unchanged in position.Low lung volumes with severe interstitial lung disease. Basal and retrocardiac atelectasis is improving, with moderate remaining retrocardiac atelectasis on the left. There may be a trace amount of pleural fluid also on the left.

Output: ETT tip 6.5 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: Sepsis History: sepsis Increased basilar atelectasis particularly in the left lower lobe. Left pleural effusion.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.New upper abdominal drains been placed.

Output: Increased basilar atelectasis likely from mucous plugging/aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: pancreatic cancer with pleural effusion with decreased 02 sat History: see above Moderate right pleural effusion and small left, compressing the right lung base. Basilar interstitial opacities could represent edema.Heart size normal.Right jugular catheter, tip in SVC.

Output: Moderate right pleural effusion and small left, compressing the right lung base. Nonspecific interstitial opacities noted.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: ETT check History: removed by 1 cm The endotracheal tube terminates 1 cm from the carina. Enteric tube tip in the gastric body. Central venous catheter tip in the right atrium, unchanged. Diffuse right-sided pulmonary opacities and moderate right pleural effusion, unchanged. Slight interval worsening of left-sided pulmonary opacities. Unchanged cardiomediastinal silhouette with cardiomegaly. No evidence of pneumothorax.

Output: Endotracheal tube in a low position. Unchanged appearance of bilateral pulmonary opacities compatible with congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Chest pain question cardiopulmonary abnormality. Normal heart size. Tortuous thoracic aorta, unchanged in appearance.The lungs are clear. No pneumothorax. Rim calcified densities in the right upper quadrant present previously, most likely reflecting gallstones.

Output: No acute cardiopulmonary abnormality. Tortuous thoracic aorta without acute change by conventional chest radiographs.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Empyema, evaluate for persistent pneumothorax. Right chest tube and central line unchanged in position. Right hydropneumothorax similar to previous, with maximal pleural separation from the chest wall laterally of 2.5-cm, previously 3.5-cm at the same level. Masslike opacity near the right costophrenic angle may reflect rounded atelectasis but is nonspecific. Patchy air space opacities at the lung bases bilaterally, correlate for signs of infection. Porcelain gallbladder.

Output: Improving moderate right hydropneumothorax. Patchy basal opacities suspicious for aspirated secretions bilaterally. Possible rounded atelectasis at the right lung base.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: assess swan placement, any pulmonary opacities History: s/p swan catheter, ADHF Median sternotomy for valve replacement.Small lung volumes with small pleural effusions, and the suggestion of mild edema.No specific evidence of infection.Left jugular Swan-Ganz catheter tip in right interlobar pulmonary artery, slightly pulled back.2. Right jugular catheters terminate in the SVC.

Output: Unchanged pulmonary opacities and small pleural effusions. Left jugular Swan-Ganz catheter slightly pulled back, the tip still in the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Shortness of breath Cardiomegaly with diffuse interstitial as well as airspace opacities most notably in the retrocardiac region not significantly changed from previous may reflect combination of edema, aspiration and/or infection. Left jugular central line tip unchanged over the right atrium. NG tube unchanged over the stomach. No pneumothorax.

Output: No significant change to bilateral pulmonary opacities or tubes.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: eval for worsening hypoxia History: eval for worsening hypoxia Moderate to severe pulmonary opacities unchanged consistent with edema or aspiration.Small pleural effusions are present.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: No change in pulmonary opacities or in support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: H/o lung transplant on left due to fibrosis, right sided lung native, has chest tightness History: chest tightness Unremarkable transplanted left lung, and stable fibrotic native right lung.Left bronchial stent unchanged in position. Heart size normal.No new findings.

Output: Unremarkable transplanted left lung, unchanged with no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: evolution of PNA? History: high oxygen requirement Support hardware unchanged in position, NG side port near GE junction.Persistent bilateral airspace and interstitial opacity.

Output: No change in bilateral airspace and interstitial opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Acute pulmonary edema History: tachycardia, tachypnea, desat Venous catheters unchanged in position. Increasing interstitial and airspace opacities, especially on the right, with probable increase in right pleural effusion. Left pleural effusion unchanged.

Output: Increasing interstitial and airspace opacities, especially on the right, with probable increase in right pleural effusion. Left pleural effusion unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: fever, SOB History: see above Cardiomegaly with a tortuous calcified aorta. Mild diffuse interstitial opacity compatible with edema with small pleural effusions and basilar atelectasis.Feeding tube tip in the stomach. No sign of pneumonia.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: eval for effusions, infiltrate History: sob Right hemidiaphragm elevation with overlying atelectasis, the lungs otherwise unremarkable.Heart size upper normal with a tortuous aorta.Status post extubation and NG tube removal as well as the right jugular catheter, with the findings.

Output: Right basilar subsegmental atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.S.O.B. status post LVAD, assess for pneumonia. LVAD. Disconnected ICD. No focal air space opacities. Unchanged mild cardiomegaly. Sternotomy hardware; the lower left sternotomy screw has backed out from the plate by 5-mm, this is a chronic finding. No signs of pulmonary edema. Left costophrenic angle blunting is chronic.

Output: No signs of pneumonia. Lower most sternotomy screw retraction from its plate, present previously.


Instruction: Generate impression based on medical findings.

Input: Hypotension Previously observed mid left lung atelectasis and scarring has diminished. Residual mild reticular changes are otherwise observed without new superimposed acute abnormality. Moderate COPD with bulla are also again observedCardiac images on contour is within limitsRight PICC line again projects into the upper arm shortness of the axilla

Output: COPD changes and scarring with no new acute cardiopulmonary abdomen


Instruction: Generate impression based on medical findings.

Input: Age: 89 yearsGender: MaleReason for Study: Reason: tachypnea History: as above Tracheostomy tube unchanged.Stable cardiomediastinal silhouette.Extensive pulmonary opacities and small pleural effusions without significant interval change.

Output: Stable cardiopulmonary appearance with extensive pulmonary opacities and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: r/o acute cardiopulmonary process, visualize aorta (per TTE apparent LA compression via descending Aorta) History: r/o acute cardiopulmonary process, visualize aorta (per TTE apparent LA compression via descending Aorta) Slightly large lung volumes with mild left base scarring.Heart size upper normal. No specific evidence of infection or edema.

Output: No specific evidence of infection or edema. Regarding the question of LA compression by the aorta, CT would be necessary.


Instruction: Generate impression based on medical findings.

Input: Reason: Fever History: Fever Unremarkable cardiac and mediastinal silhouette. Opacity at the right base may be due to an elevated right hemidiaphragm but I cannot exclude that there is focal consolidation and atelectasis in the right middle lobe.Erect PA and lateral views would be very helpful to clarify this.

Output: Nonspecific opacity at the right base for which erect PA and lateral radiographs are recommended when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: f/u pulm edema and pleural effusions History: see above Partially visualized enteric tube remains unchanged.Stable cardiac silhouette.Bilateral pleural effusions with localized fluid along the right-sided fissures remain unchanged. Right lower lobe volume loss with infrahilar opacity likely representing round atelectasis, unchanged. No pneumothorax.

Output: No significant change in bilateral pleural effusions and right lower lobe likely round atelectatic changes.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: Evaluate line placement History: Line placement Right IJ central catheter has been retracted, now terminating in the central superior vena cava. A portion of a catheter is visualized in the left upper abdomen.Elevation of the right hemidiaphragm persists. Progressive multifocal regions of airspace opacity, now within the right upper and lower lobes. While this may represent edema, aspiration is also a consideration. No pneumothorax.

Output: Progressive right-sided pulmonary opacities suspicious for aspiration. Edema is also a consideration.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: sob History: sob ET tube, NG tube, and right-sided ICD unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Basilar opacities are compatible with pleural effusions, edema, and atelectasis.

Output: Support devices unchanged. Stable cardiopulmonary appearance with pleural effusions, edema, and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: s/p arrest History: s/p arrest External defibrillator pads are in place.Relatively low lung volumes with basilar opacities subsegmental atelectasis. No pneumothorax. Heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: eval change History: intubated Limited by rotation. Support hardware unchanged in position with the ET tube tip 3 cm above carina. Basilar edema and atelectasis with small effusions unchanged.

Output: Support hardware unchanged in position with the ET tube tip 3 cm above carina. Basilar edema and atelectasis with small effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: pna Large bilateral pleural effusions, greater on the right, with underlying airspace opacities compatible with edema and/or pneumonia.Port catheter with its tip at the SVC/RA junction. No new findings.

Output: Large effusions and airspace opacities with no significant change allowing for position.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: assess for PNA, pneumothorax History: chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: pneumonia History: chest pain Minimal streaky opacity at the bases likely due to atelectasis. No evidence of pneumonia.

Output: Minimal streaky opacity at the bases likely due to atelectasis. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Chest pain. Unchanged cardiomediastinal silhouette and low normal lung volumes. No focal airspace opacities, visible pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: r/o acute pathology History: chest pain Mild cardiomegaly.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Endocarditis, aortic stenosis, status post aortic valve replacement. CAD status post CABG (3/2015). FSGS status post kidney transplant (3/2015). Query effusion/atelectasis. Interval removal of left chest tube. Decreased moderate right pleural effusion. No significant left pleural effusion or pneumothoraxPersistent decreased lung volumes and minimal bibasilar atelectasis.

Output: No pneumothorax following left chest tube removal.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, 70 years old.Dysphagia, risk of aspiration, cough. Right chest port and a partially visualized IVC filter appear similar in position.Unchanged cardiomegaly and coarse interstitial abnormality. No new focal airspace opacities.

Output: No signs of pneumonia. Unchanged cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: NG tube placement History: NG tube NG tube tip in the stomach, with the sidehole about the area of the GE junction.Catheter tip in the SVC.Small lung volumes with no acute interval change.

Output: NG tube tip in stomach.


Instruction: Generate impression based on medical findings.

Input: Reason: obstruction History: persistent HA; s/p VP shunt SHUNT DEVICE: A left frontal approach ventriculostomy catheter terminates in the midline. Its drainage catheter courses over the convexity and connects to a right frontal approach catheter, which subsequently courses down the lateral neck and right anterior chest terminating within the left hemi-pelvis. Portions of the catheter overlying the skull are radiolucent and hence difficult to evaluate, however, there is no evidence of discontinuity of the shunt tubing within this limitation.SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: No significant abnormality noted.ABDOMEN: No significant abnormality noted.

Output: Bilateral transfrontal ventriculostomy catheters without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval for interval change in IABP placement History: IABP IABP radiopaque marker at the level of the aortic arch, slightly retracted compared to prior. Left ICD unchanged.Mild cardiomegaly with cephalization and interstitial edema, increased compared to prior.

Output: IABP radiopaque marker at the level of the aortic arch, slightly retracted compared to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: CHF History: SOB Moderate cardiomegaly status post sternotomy and aortic valve replacement.Unchanged mild to moderate interstitial edema with pleural effusions.Worsening retrocardiac consolidation.Presternal ICD unchanged.

Output: Persistent edema and pleural effusions with increasing left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lung transplant History: s/p lung transplant Bilateral chest tubes in place with no significant pneumothorax.Diffuse nonspecific airspace opacity compatible with edema, unchanged or slightly improved.NG tube doubled back in the stomach.No new findings.

Output: Diffuse opacity compatible with pulmonary edema, unchanged or slightly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: desaturation History: desaturation, previously reported history of melanoma Right central catheter remains in stable position. There is an inferior vena caval filter projecting over the upper abdomen, right of midline.Persistent elevation of the right hemidiaphragm. Multiple pulmonary nodules are again identified. Infrahilar subsegmental atelectasis. No pneumothorax. Heart size is normal.

Output: Persistent elevation right hemidiaphragm with basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: eval picc placement History: picc placed Right PICC line with its tip in the right axilla.Decreased lung volumes with stable cardiac enlargement.Elevation of the right hemidiaphragm and right basilar atelectasis redemonstrated.

Output: Right PICC line with its tip in the right axilla.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pt with balloon pump, check for change in placement History: none IABP marker position unchanged, with the proximal tip located within the right innominate artery and the distal marker at the level of T12-L1.Right upper extremity PICC tip terminates in the right axillary vein.Left subclavian AICD lead position unchanged.No focal airspace opacity, pleural effusion or pneumothorax.Mild cardiomegaly unchanged.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: intubation History: intubated Unchanged edema-like opacities with left lower lobe consolidation and pleural effusions.New ET tube, tip within 1 cm of the carina.Left PICC, tip in the SVC.

Output: Low ET tube. Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: SICU patient intubated History: SICU patient intubated Unchanged aortic aneurysm/dissection with a wide mediastinum.Stable small right pleural effusion.Two left chest tubes with no pneumothorax.Other support devices unchanged in position.

Output: Unchanged support devices. ET tube tip 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Hit by car yesterday. Right arm and shoulder pain. No pneumothorax or pleural fluid. No focal pulmonary opacities on the right suggest parenchymal lung contusion. Mild basal atelectasis on the left.Although no displaced rib fractures are appreciated, please note that chest technique has a limited sensitivity for detection of osseous pathology including fracture or dislocation and dedicated films of the area of interest would be recommended.

Output: No pneumothorax or signs of right-sided parenchymal lung contusion. Mild basal atelectasis on the left.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: rule out infiltrate History: leukocytosis, stroke code activation No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pna History: HIV with fever, CD4 1000 Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: hx of bladder cancer s/p cystectomy, evaluate for metastatic disease History: see above No focal consolidation, effusion, or pneumothorax.Mildly tortuous aorta. Otherwise unremarkable cardiomediastinal silhouette.

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


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval for balloon pump placement History: balloon pump Cardiac size appears mildly enlarged.IABP marker is noted in the aortic arch.IVC Swan-Ganz catheter is noted with tip in the right pulmonary artery.Bilateral upper lobe perihilar opacities and possible septal lines which could represent edemaNo definite evidence of effusion.No pneumothorax.

Output: IABP marker in the aortic arch. Pulmonary opacities possibly representing edema


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: FemaleReason for Study: Reason: R/o pulmonary infiltrate History: VOC in sickle cell patient Right Port-A-Cath with its tip in the RA.Stable cardiomediastinal silhouette.No focal airspace opacities.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: intubated History: intubated Support devices unchanged with ET tube tip 3 cm above the carina.Decreased lung volumes with stable cardiac enlargement.Basilar opacities are compatible with pleural effusions, atelectasis, and edema.

Output: Support devices unchanged. Stable cardiopulmonary appearance with pleural effusions, edema, and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: cough, c/f aspiration History: cough No significant cardiopulmonary abnormality.Right jugular port catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: s/p cardiac surgery History: requiring HFNC Cardiomegaly with basilar opacities suggestive of edema.No change multiple support devices.

Output: No change in cardiomegaly and pulmonary edema, or in multiple support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: evaluate pulm edema History: see above Left-sided ICD unchanged.Stable to slightly improved diffuse pulmonary edema and left pleural effusion.

Output: Stable to slightly improved diffuse pulmonary edema and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Evaluate disease status for clinical trial. Provide 3-D measurements are all reference lesions and compare prior CT. Lung cancer status post 22 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Right upper lobe mass measures 2.3 x 1.8 cm (image 30; series 4), not significantly changed from previous study.MEDIASTINUM AND HILA: Small pericardial effusion. Stable calcified right hilar and subcarinal lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse, predominantly sclerotic bone metastases are unchanged. Again noted is narrowing of the spinal canal at the level of the L3 vertebral body.OTHER: 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: Diffuse sclerotic metastases are stable.OTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: s/p implant of a single chamber ICD --> r/o pneumothorax and evaluate lead position History: as above The cardiomediastinal silhouette is unchanged. There has been interval placement of an ICD with single lead intact in the distribution of the right ventricle. No pneumothorax.No focal opacities or dense consolidation. Hazy bibasilar opacities likely reflect edema and small bilateral effusions.

Output: Interval placement of an ICD with single lead intact in the distribution of the right ventricle. No pneumothorax. Hazy bibasilar opacities likely reflect edema and small bilateral effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: vented pt, ensure correct ETT placement, lung opacities interval change History: vented pt w/ prior lung opacities Mild cardiomegaly.No specific evidence of infection or edema.ET tube tip approximately 2 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.POD 1 status post AVR, MVR, TV repair. ETT tip about 4.5 cm above carina. Right jugular Swan-Ganz catheter terminates at the level of the right main pulmonary artery. Mediastinal drains in place. Valve prostheses faintly visible. Postoperative pneumomediastinum. No pneumothorax. No signs of pulmonary edema. Minimal pleural fluid. Resolution of atelectasis on the right and improvement on the left.

Output: Resolution of edema with improving pleural fluid and atelectasis. ETT 4.5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 45 year old male with history of severe mental retardation presenting with weakness. Rule out intraabdominal infection. ABDOMEN:LUNG BASES: Atelectasis noted on the left.LIVER, BILIARY TRACT: Low attenuation lesion in the anterior liver with a vessel coursing through it. This could represent focal fatty sparing or an atypical hemangioma. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The appendiceal wall is thickened with a total appendicular thickness of 1.0 cm. Early appendicitis cannot be ruled out.BONES, SOFT TISSUES: Compression fracture of L4 of indeterminate age.OTHER: No significant abnormality noted

Output: 1. Possible early appendicitis.2. Compression fracture of L4. If clinically concerned for cord/cauda equina involvement, recommend MR for further evaluation.3. Findings discussed with team at 08:35.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: evaluate crackles History: see above Support hardware unchanged in position. Unchanged extensive patchy interstitial and airspace opacity with pleural effusions

Output: Unchanged extensive patchy interstitial and airspace opacity with pleural effusions


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old. ETT has been repositioned with its tip now 1 cm above the carina.NG tube with its tip in the stomach.Right central venous catheter with its tip in the SVC.Left sided pacemaker unchanged.Stable cardiomediastinal silhouette with bilateral pleural effusions and basilar atelectasis similar to the prior exam.

Output: Interval repositioning of ET tube with its tip now 1 cm above the carina. Persistent pleural effusions and basilar atelectasis/edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: is there an infiltrate History: right upper-mid back pain Cardiomediastinal silhouette is within normal limits. No pulmonary opacity, pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: pna? History: wkness, old stroke No significant cardiopulmonary abnormality.Small lung volumes.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: tachypnea, mucus plug? History: tachypnea Tracheostomy tube and right jugular catheter, not significantly changed. Dobbhoff tube tip in the stomach. Low lung volumes. Left diffuse opacity compatible with atelectasis/consolidation and layering pleural effusion, slightly increased compared to prior. Right basilar atelectasis, not significantly changed.

Output: Increasing left atelectasis/consolidation with layering pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: bx History: bc r Right hilar mass with right upper lobe atelectasis and right pleural thickening or tumor, unchanged.No pneumothorax following biopsy.Right jugular catheter, tip in SVC.

Output: No significant pneumothorax, following recent biopsy.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient s/p R. IJ central line placement, please eval for appropriate placement/ penumothorax History: As above New right jugular catheter extending to the area of the upper right atrium.No pneumothorax or other complications.Cardiomegaly and basilar opacities compatible with atelectasis, scarring and possibly effusions.No new findings.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.SOB and hypotension question infiltrate versus worsened pulmonary edema from CT. Unchanged cardiomegaly. Mild to moderate bronchial wall thickening. Moderate layering pleural effusions, right greater than left, with associated atelectasis. Consolidation in the right costophrenic angle.

Output: Moderate bilateral pleural effusions with associated atelectasis. Consolidation on the right is slightly disproportionate to the volume of pleural fluid and a superimposed infectious process cannot be entirely excluded.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: s/p extubation Interval removal of ET tube. Enteric tube tip below the inferior margin image. Interval removal of bilateral chest tubes. Right central venous catheter tip in the SVC. Enteric tube tip below the inferior margin of the image. Second jugular catheter tip at the cavoatrial junction.No pneumothorax. Left basilar atelectasis/consolidation, similar to prior exam. Bibasilar edema, unchanged. Cardiomediastinal silhouette is unchanged.

Output: Interval extubation. No pneumothorax. Left basilar atelectasis/consolidation, unchanged. Bibasilar edema, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Febrile neutropenia , previous Hx of fungal pneumonia History: fever, neutropenic No new focal lung consolidation. Mild reticular abnormality again noted within the lung parenchyma. No large pleural effusion or pneumothorax. Unchanged normal heart size. Port catheter again terminates at the cavoatrial junction.

Output: No acute cardiopulmonary process on radiography. If symptoms continue, further evaluation with CT is suggested given history of neutropenia.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval lung fields History: s/p MVR Median sternotomy with chest tubes but no pneumothorax.Worsening basilar atelectasis and small pleural effusions.

Output: Increasing postop atelectasis. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pna History: fever Underinflated lungs with no visible cardiopulmonary abnormalities.

Output: No gross abnormalities


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: hx advanced lung cancer sp stent with high fever eval for PNA or other change History: fever The cardiomediastinal silhouette is unchanged. Unchanged right upper lobe mass and right paratracheal lymphadenopathy with adjacent passive atelectasis. Interval increase in diffuse interstitial opacities may represent mild pulmonary edema or may be more conspicuous due to variations in technique. No focal pulmonary opacity suggestive of pneumonia. No pneumothorax.No radiopaque stent is confidently identified.

Output: Interval increase in diffuse interstitial opacities may represent mild pulmonary edema or may be more conspicuous due to variations in technique. No other significant interval changes.


Instruction: Generate impression based on medical findings.

Input: 92 year old male with history of pulmonary marginal zone lymphoma, please restage. CHEST:LUNGS AND PLEURA: Multiple new bilateral pulmonary micronodules are identified. A new larger nodule in the right lower lobe measures 1 cm x 0.9 cm (image 73, series 6). MEDIASTINUM AND HILA: Heterogeneously enhancing right thyroid lobe with calcifications is unchanged. Reference node within the superior pericardial recess stable in size, measuring 1.5 cm x 1.0 cm (image 39, series 4). It previously measured 1.7 cm x 1.2 cm. The other smaller mediastinal lymph nodes are stable in size.CHEST WALL: No significant abnormality noted. ABDOMEN:The evaluation of solid abdominal organs is limited by the lack of IV contrast. Within this limitation, the following findings are noted.LIVER, BILIARY TRACT: Stable bilobar hypoattenuating foci. Cholelithiasis without evidence of cholecystitis.SPLEEN: Stable hypodensity within the splenic parenchyma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm is stable and measures 3.0 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Multiple new pulmonary nodules are consistent with progression of metastatic disease.2. Other findings as described above are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: hemoptysis History: hemoptysis Mild basilar scarring or subsegmental atelectasis, without edema or pneumonia.Embolization coils are projected over the right upper lung zone.Left subclavian ICD, leads unchanged in position.

Output: New embolization coils projected over the right upper lung zone. No source of new hemoptysis identified.


Instruction: Generate impression based on medical findings.

Input: Angina. TECAB Interval removal of the left chest tube without evidence of postprocedural new complications. Persistent decreased lung volumes with basilar suspected edema and atelectasis. Mild cardiomegaly

Output: Left chest tube removed


Instruction: Generate impression based on medical findings.

Input: LVAD check Motion degrades sensitivityLVAD and ICD are unchanged. Right jugular catheter terminates in the mid SVCMarked nonspecific cardiomegaly is again associated with decreased lung volumes and diffuse changes suggesting mild to moderate CHF

Output: Mild to moderate CHF


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: re-evaluate pneumothorax RUL History: pneumo s/p lung bx Overall unchanged right pneumothorax with right pleural drain in place.No new findings.

Output: Unchanged right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: r/o cardiopulm process History: chest pain Cardiomediastinal silhouette and vasculature are within normal limits.No airspace or interstitial opacity. No pneumothorax. No pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval line placement - RIJ History: as above Right jugular catheter with its tip projected in the area of the SVC.No pneumothorax or other complications.Pacemaker leads unchanged.Marked elevation of the right hemidiaphragm with overlying atelectasis.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.History: Cirrhosis and ascites, recurrent pleural effusions. Status post VATS and pleurodesis (624/2015) at outside hospital. Right-sided chest tube has been repositioned with its tip more towards the apex.Right PICC line unchanged in position.Right pleural effusion/thickening increased from the prior exam.Underlying right basilar opacity may possibly represent infection or aspiration.Right hydropneumothorax, unchanged from 7/7/2015 chest x-ray.Left lung unremarkable.

Output: Increasing right pleural effusion/thickening with underlying nonspecific basilar opacity..


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: eval lung fields History: intubated, inhalational injury ET tube with its tip 4 to 5 cm above the carina.Enteric tube with its tip beyond the margin of the image.Bilateral pulmonary opacities similar to the prior exam.No new pulmonary opacities identified.

Output: Enteric tube has been repositioned with its tip now beyond the margin of the image. Stable cardiopulmonary appearance with multifocal bilateral pulmonary opacities.


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: 62 year old female with history of pancreatitis with new onset transaminitis. Evaluate for pseudocyst. ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: The gallbladder is surgically absent; there are cholecystectomy clips in place.SPLEEN: No significant abnormality notedPANCREAS: Enlarged pancreas with adjacent fat stranding and inflammatory changes. There are no peri-pancreatic fluid collections, and there is no evidence of hemorrhage or necrosis. No calcifications evident. The previously seen cyst-gastrostomy catheter has been removed. No evidence of venous thrombosis or pseudoaneurysm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 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: Acute pancreatitis without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Reason: assess lung fields History: ICH Prominent left ventricular contour with a moderately tortuous aorta.No significant pulmonary abnormalities.

Output: Mild cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: concern for pna vs fluid overload History: concern for pna vs fluid overload Normal heart size with pacemaker leads in place, unchanged from previous. No sign of pneumonia, fluid overload or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old. Cardiomegaly. Vasculature within normal limits. No obvious effusion or pneumothorax.

Output: Cardiomegaly with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of since lymphoma. Question interval progression of adenopathy, infection. Cough, shortness of breath. CHEST:LUNGS AND PLEURA: Interval development of mild to moderate right pleural effusion with overlying consolidation in the right lower lobe. Infection cannot be exclude. Emphysema. Several scattered micronodules are unchanged. MEDIASTINUM AND HILA: Thyroid nodules unchanged. Extensive mediastinal lymphadenopathy. Reference conglomerate lymphoid tissue in the right superior mediastinum is unchanged, measuring 5.4 x 5.3 cm image number 30, series number 3 at the level of the aortic arch. Bilateral hilar adenopathy. Right lymphoid tissue extends to the subcarinal space and into the retrocrural spaces.Bilateral supraclavicular adenopathy. Enlarged cardiophrenic lymph nodes. Borderline enlarged axillary lymph nodes.CHEST WALL: Scoliosis.ABDOMEN:LIVER, BILIARY TRACT: Several small hypodense lesions in the liver unchanged. Hepatomegaly.SPLEEN: Splenomegaly, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive retrocrural, mesenteric and retroperitoneal adenopathy which extends into the pelvis. Reference adenopathy at the level of the left renal vein is unchanged, and measures 6.5 x 4.5 cm on image number 133, series number 3.BOWEL, MESENTERY: Stable mild ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Conglomerate of adjacent adenopathy surrounding the proximal common iliac arteries and proximal external and internal iliac arteries. Bilateral borderline enlarged inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable small amount of free fluid in the pelvis.

Output: 1. Interval development of right pleural effusion and right lower lobe consolidation. Infection cannot be excluded.2. Stable size of the infiltrative conglomerate adenopathy in the chest and abdomen.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: eval for acute cardiopulm abnormality History: sob The cardiomediastinal silhouette is within normal limits. No focal consolidation, pneumothorax, or effusion.Basilar scarring/atelectasis.Large lung volumes.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: check left pleural effusion History: increasing O2 requirements Increase in moderate-sized layering left pleural effusion. Improvement in right basilar pleural-parenchymal opacities. Unchanged cardiomegaly. No pneumothorax.

Output: Increase in moderate-sized left layering pleural effusion. Improvement in right basilar pleural-parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval pna History: new leukocytosis Interval placement of tracheostomy tube with tip approximately 3 cm above carina.No evidence of infection. No pneumothorax. No pleural effusion. Chronic elevation of left hemidiaphragm.

Output: Interval placement of tracheostomy tube. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: assess position of swan History: swan Right IJ Swan-Ganz catheter and left PICC are unchanged in position.Heart size remains stable. No interval edema or evidence of aspiration.

Output: Swan-Ganz catheter remains in stable position.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: eval ETt, lung fields History: s/p aortic dissection repair ET tube tip is approximately 3-4 cm above the carina. Mediastinal drains are in place. Median sternotomy wires are intact.The cardiomediastinal silhouette is enlarged, consistent with known aortic dissection.Bilateral interstitial opacities and small pleural effusions. No pneumothorax.

Output: 1. ET tube tip is approximately 3-4 cm above the carina. 2. Bilateral interstitial opacities and small pleural effusions consistent with mild pulmonary edema. 3. Widened mediastinum consistent with known aortic dissection.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of metastatic breast cancer CHEST:LUNGS AND PLEURA: Large left-sided pleural effusion. Dependent atelectasis in the left lung base. Multiple ill-defined airspace opacities in bilateral lungs. A reference nodule measures 13 x 9 mm. These are suspicious for metastatic disease although infectious etiology cannot be completely excluded.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral axillary adenopathy. A reference left axillary lymph node measures 15 x 12 mm number 31, series number 4.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: Extensive sclerotic bone lesions throughout the thoracic spine and lumbar spine suspicious for metastatic disease.Sternum has a mottled appearance which may be secondary to metastatic disease or radiation.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Lobulated contours of the uterus posteriorly, which may be secondary to fibroid or an ovarian mass. Pelvic ultrasound may be helpful for further evaluation.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive bone metastases in the sacrum, pelvic bones, and lower lumbar vertebral bodies.OTHER: No significant abnormality noted.

Output: Extensive bone metastases throughout the chest, abdomen, and pelvis.Pelvic ultrasound is recommended for further evaluation of the uterus.Large left-sided pleural effusion and bilateral axillary adenopathy.Bilateral ill-defined lung nodules suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: Swan in place, evaluate position History: Swan in place, evaluate position Mild cardiomegaly.Small right pleural effusion likely.Right jugular Swan-Ganz catheter tip in the main pulmonary artery, pulled back from the right pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter slightly pulled back, and no other change.


Instruction: Generate impression based on medical findings.

Input: 1-day-old male (former 23 week gestation) with desaturation. Evaluate for pneumothorax.VIEW: Chest crosstable lateral (one view) 12/16/2016 3:49 Enteric tube tip at the thoracic inlet. Endotracheal tube tip between the thoracic inlet and carina. UVC tip in the right atrium.Mild diffuse hazy pulmonary opacities persist. No pleural effusions or pneumothorax.Normal cardiothymic silhouette size.

Output: 1. No pneumothorax.2. Enteric tube tip at the thoracic inlet. UVC tip in the right atrium.


Instruction: Generate impression based on medical findings.

Input: 91 year old female with history of kidney mass and worsening headache. CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening or pericholecystic inflammatory changes are seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule with 52% relative washout and 67% absolute washout is characteristic of an adrenal adenoma.KIDNEYS, URETERS: There is a large round heterogeneously enhancing exophytic mass arising from the lower pole of the left kidney. It measures 5.2cm x 5.6cm (image 49, series 6). The left renal vein and IVC are patent. A tiny nonobstructing renal calculus in the lower pole of the right kidney is also visualized.RETROPERITONEUM, LYMPH NODES: A single 0.6 cm x 0.7 cm left para-aortic lymph node is also noted (image 42, series 6).BOWEL, MESENTERY: Diverticulosis of the colon without evidence of diverticulitis is noted.BONES, SOFT TISSUES: Degenerative changes of the spine are noted.OTHER: Atherosclerosis of the aorta and the renal arteries is noted.PELVIS:UTERUS, ADNEXAE: The uterus is atrophic or has been surgically removed.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes are noted.OTHER: No other significant abnormality noted.

Output: 1. Enhancing left renal mass as described above. This finding is consistent with renal cell carcinoma. 2. Borderline enlarged left para-aortic lymph node. 3. Left adrenal mass, likely an adrenal adenoma.


Instruction: Generate impression based on medical findings.

Input: Reason: trach History: coarse lung sounds Tracheostomy tube with its tip about 4 cm above the carina. Small lung volumes with streaky perihilar opacities, greater on the left, consistent with subsegmental atelectasis and aspirated secretions. No new findings.

Output: Lateral subsegmental atelectasis and likely aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p NuPulse Device History: anemia. NuPulse device Interval removal of right IJ sheath. NuPulse device and markers remain unchanged.Cardiac silhouette is again mildly enlarged.No focal pulmonary abnormalities or pleural effusions.

Output: Interval removal of right IJ sheath. Otherwise, stable appearance of the chest.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: suspect pulmonary edema. Post partum. Severe preEclampsia, h/o tobacco use History: sob, crackles, wheezing, o2 sat 80s Patchy interstitial and airspace opacities are present in a perihilar distribution. Minimal pleural effusions.Heart size upper normal.

Output: Perihilar interstitial and airspace opacities consistent with acute pulmonary edema or pulmonary hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumothorax History: r/o pneumothorax Persistent small right apical pneumothorax with chest tubes in place.Mild atelectasis at the right base with a probable small pleural effusion.Skin folds on the left but no left pneumothorax.

Output: Persistent small right pneumothorax without significant change.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with history of stage IIIc primary peritoneal carcinoma. Metastases to the brain, status post right parieto-occipital excision of tumor and gamma knife radiosurgery for a left parietal lesion. Status post TAH/BSO/omentectomy 3/2/06. Cholecystectomy in 1997. Type II DM, hypertension, status post MI with stent placement in 2002. Angina. Evaluate for metastases. CHEST: Lungs and Pleura: There are groundglass patchy areas throughout the lungs suggestive of some edematous areas. No lung nodules or effusions. Mediastinum and Hila: Multifocal thyroid nodules. The one on the left shows some calcification. These are nonspecific. Small mediastinal nodes not pathologic by size criteria. Some coronary artery calcification and mild cardiomegaly is noted. Chest Wall: No significant abnormality noted. ABDOMEN: Liver, Biliary Tract: Cholecystectomy clips. No focal liver lesions. Spleen: No significant abnormality noted. Kidneys, Ureters: No significant abnormality noted. Some mild cortical atrophy, right greater than left. Left renal cysts are stable. Adrenal Glands: No significant abnormality noted. Pancreas: No significant abnormality noted. Retroperitoneum, Lymph Nodes: No significant abnormality noted. Bowel, Mesentery: No significant abnormality noted. Specifically no evidence of peritoneal carcinomatosis. Nodular areas in the right upper quadrant omentum are no longer seen on the current study. There is no measurable peritoneal disease. Bones, Soft Tissues: No significant abnormality noted. Other: No significant abnormality noted. PELVIS: Uterus, Adnexae: Status post hysterectomy.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: There are midline incisional hernias both the right and left of midline containing small bowel but this is nonobstructive.

Output: Stable incisional hernias in the anterior pelvic wall. These contain small bowel but are nonobstructive. There is no evidence of metastatic disease. Other findings as above are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: SOB, evaluate for acute cardiopulmonary abnormalities History: SOB Nodular scarlike opacity abutting the right minor fissure, new as compared with prior study. Borderline cardiomegaly. No evidence of infiltrate, pleural effusion or pneumothorax. The left jugular catheter tip project over the atriocaval junction.

Output: New nodular scarlike opacity abutting right minor fissure. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: Chest pain in the setting of smoking crack cocaine. History: see above. The cardiomediastinal silhouette is unremarkable.Decreased lung volumes with basilar scarring/discoid atelectasis.No focal areas of consolidation.No pleural effusions.

Output: Mild basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval volume status History: respiratory failure Endotracheal tube, grossly unchanged. Enteric tube is difficult to visualize. Diffuse pulmonary opacities, increased from previous study. Query small pleural effusions. Unchanged cardiomegaly. No pneumothorax. Large patient body habitus.

Output: Worsening diffuse pulmonary opacities, consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with lung mass seen on chest x-ray. Evaluate for abdominal metastases. CHEST:LUNGS AND PLEURA: No pulmonary nodules or pleural effusions. There is a posterior right lower lobe groundglass opacity which is nonspecific and may represent atelectasis or infection.MEDIASTINUM AND HILA: There is a 12.0 x 8.8 cm mass (series 3, image 102) in the right infrahilar mass with mass effect on the bronchus intermedius and is adjacent to the right pulmonary artery. There is post obstructive atelectasis .CHEST WALL: There is no evidence of chest wall invasion.ABDOMEN:LIVER, BILIARY TRACT: There are no focal liver lesions. Gallstones.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: There is a 2.8 x 2.1 cm left adrenal nodule (series 3, image 97), which may represent adrenal gland thickening. The right adrenal gland appears uniformly hyperplastic.KIDNEYS, URETERS: There is a left subcentimeter midpole hypodense lesion which is complex (series 3, image 112). There is an left inferior pole subcentimeter hypodense lesion which is likely a renal cyst. Left renal non obstructing stone.There is a right subcentimeter midpole hypodense lesion which is complex (series 3, image 131).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostateBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Large right infrahilar mass , which may represent peripheral pulmonary carcinoid tumor.2. Bilateral adrenal thickening. This may be a result of ACTH secretion from the pulmonary mass.3. Bilateral renal complex cysts. Dedicated renal protocol CT should be considered for better characterization.


Instruction: Generate impression based on medical findings.

Input: Lung cancer and shortness of breath A focal 4 to 5-cm mass and opacity is projected over the mid right lung extending from the hilar region. A second focal opacity is observed in the right upper lung along the midline. Moderate COPD changes and small right effusion and/or scarring. Left lung otherwise clear.Subcarinal density and suspected lymphadenopathy. Moderate tortuous aorta.A single lead right jugular port terminates in the mid SVC

Output: Right middle lobe and right upper lobe focal masses and suspected lymphadenopathy. Consider CT evaluation and/or serial comparison imaging if available given patient history.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: Dx Breast cancer History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No sign of metastases.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: Monitoring IABP History: none AICD and right IJ central venous catheter in unchanged position. IABP marker in the proximal descending thoracic aorta, unchanged.Stable cardiomegaly.No new focal air space abnormality. Mild basilar opacities, compatible with edema and small effusions, not significantly changed from the prior exam.

Output: IABP in unchanged position. Otherwise stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: check swan placement History: swan placement Swan-Ganz catheter tip in the right descending pulmonary artery, unchanged.ICD leads also unchanged.No evidence of pulmonary edema or infection.

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


Instruction: Generate impression based on medical findings.

Input: 28-year-old male with melanoma involving the right thigh. Please evaluate for distant metastases. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Multiple new hypoattenuating lesions scattered throughout the liver are compatible with metastases. The largest lesion in segment 7 (series 3, image 99) measures 1.2 x 1.1 cm.The portal and hepatic vasculature are patent.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.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Right external iliac lymphadenopathy with reference node measuring 3.2 x 2.2 cm; which is relatively stable accounting for differences in technique.Right inguinal lymph node (series 3, image 190) is slightly more prominent on current study, measuring 2.5 x 1.9 cm; previously measuring 2.4 x 1.5 cm.Ill-defined increased density in the right inguinal region (series 3, image two only) is unchanged from prior study. This again may represent postsurgical changes versus tumoral involvement.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter sclerotic focus in the anterior acetabulum on the right (series 3, image 197) likely represents a bone island.LOWER EXTREMITIES: Elongated, nodular soft tissue mass in the subcutaneous fat along the medial aspect of the right upper thigh (series 5, image 45; series 80476, coronal image 72) may patient's index lesion. For reference, in the axial plane it measures approximately 2.6 x 1.2 cmMore tubular masses seen in the subcutaneous fat along the medial aspect of the distal right thigh (series 80476, coronal image 50) likely represent venous structures.

Output: 1. Elongated, nodular soft tissue mass in the subcutaneous fat along the medial aspect of the right thigh may represent patient's index lesion. Increased soft tissue density in the right inguinal region is also noted, considerations for which would include postsurgical changes in the proper clinical context versus tumoral involvement. Right inguinal and pelvic lymphadenopathy as detailed above.2. Multiple new lesions in the liver compatible with metastases.


Instruction: Generate impression based on medical findings.

Input: 75 year old female with generalized weakness, decreased body weight, history of bladder cancer. Evaluate for metastatic disease. Upon review of medical records, patient has history of metastatic bladder adenocarcinoma status post partial bladder resection. CHEST:LUNGS AND PLEURA: Left lower lobe scarring, unchanged. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Scattered low-attenuating lesions are again seen throughout the liver and appear unchanged from prior exam. Reference lesion in the medial segment of the left hepatic lobe (series 3, image 86) measures 11 x 11 mm (stable). Hypodense lesion in hepatic segment 4 measures 7 x 7 mm (series 3, image 88), and is unchanged from prior study. No biliary duct dilatation is evident. The gallbladder is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland thickening, unchanged. Normal right adrenal gland.KIDNEYS, URETERS: Circumaortic left renal vein. Stable scattered hypodense subcentimeter lesions in both kidneys. No abnormally enhancing lesions are seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine and hips.PELVIS:UTERUS, ADNEXAE: Atrophic or absent.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Diverticulosis without evidence of acute inflammation.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: ETT placement, air in mediastinum? History: ETT, UGI bleed, esophageal tear No evidence of pneumomediastinum. ET tube tip 4 cm above carina. Nonspecific basilar edema and atelectasis. Endoscopy clip and multiple embolization: Are seen.

Output: No evidence of pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Unchanged large left effusion with underlying compression atelectasis and suspected marked cardiomegaly incompletely visualized. Right lung otherwise clearMulti lead left subclavian ICD appears similar without interval change or new complication

Output: Unchanged large left pleural effusion with atelectasis


Instruction: Generate impression based on medical findings.

Input: Age: 93 yearsGender: FemaleReason for Study: Reason: eval for pneumonia History: cough, multiple falls Stable moderate cardiac enlargement.Chronic appearing interstitial opacities similar to the prior exam.No new focal airspace consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p R-sided thoracentesis, eval for PTX History: cough, pressure Unchanged basilar opacities but slight improvement in the right pleural effusion, the left unchanged. No pneumothorax following thoracentesis.Left subclavian ICD, leads unchanged in position.

Output: No pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: s/p PICC placement History: NA Left basilar opacity and left pleural effusion, slightly improved.Right PICC, tip low in the right atrium.

Output: Low right PICC. Improved left basilar opacity likely pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with new onset A. fib. Heart size is normal. No pleural effusion, pneumothorax, or focal consolidation.

Output: No acute cardiopulmonary abnormality or interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Assess LUL for opacification vs breast tissues seen on portable CXR History: Cough, SOB Improving left midlung airspace opacity which may represent aspiration or infection.Elsewhere, the lungs are unremarkable.Mild cardiomegaly and a tortuous aorta are noted.

Output: Improving left midlung opacity which may represented aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old status post device placement in EP lab. Evaluate for pneumothorax. Left subclavian pacemaker leads unchanged in position.Stable mild cardiomegaly. Low lung volumes but no new pulmonary opacities or pleural effusions. No pneumothorax.

Output: No pneumothorax status post pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: ARDSVIEW: Chest AP 1/14/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the pylorus of the stomach. Left chest port in place. Cardiothymic silhouette normal. Diffuse pulmonary opacities bilaterally minimally improved in the left lower lobe. Bilateral small pleural effusions with no pneumothorax.

Output: Diffuse pulmonary opacities minimally improved in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Check ETT. Status post bronchoscopy ETT remains 4 cm above the carina. NG is also similar in position with the side port seen just at or beyond the GE junction, consider advancing 5 to 6 cm.Underlying cardiopulmonary appearance remains overall similar with diffuse patchy and mildly shifting mixed interstitial airspace opacities. Associated moderate layered effusions and although probably edema, hemorrhage cannot be excluded given the recent procedure.

Output: Unchanged ETT


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Evaluate IABP position and interval change History: Evaluate IABP position Yesterday's right pleural effusion diminished. Small left pleural effusion stable.Scattered septal lines and lung bases are still suggestive of edema, and there is subsegmental atelectasis in the lung bases, unchanged.Right jugular catheter tip at SVC/RA junction level.IABP catheter proximal marker 3 cm below the top of the aorta.Right Pleurx catheter unchanged. No significant pneumothorax.

Output: Stable tubes and devices. Little overall change in small effusions and basilar edema with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: MaleReason for Study: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Left-sided pacemaker is unchanged.Stable cardiomediastinal silhouette.Persistent elevation the right hemidiaphragm.The lungs are clear.

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


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval central line History: line changed over wire Evolving right upper lobe airspace opacity and persistent left lower lobe abnormality suggestive of infection, aspiration or an infarction.Mild cardiomegaly.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.Unchanged LVAD.

Output: Evolving right upper lobe opacity. Right jugular catheter exchange.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with metastatic renal cancer CHEST:LUNGS AND PLEURA: Reference right middle lobe nodule is smaller and appears linear and much thinner compared to previous study on image number 45, series number 4. It measures 6-mm in longer diameter with only 2-mm in short diameter. Other bilateral lung nodules are stable. New atelectasis in the right lower lobe. New areas of groundglass opacity in the right lower lobe, nonspecific. Consolidation the left lower lobe is stable. Small left pleural effusion is unchanged.MEDIASTINUM AND HILA: Prevascular lymph node measures 14 x 5 mm image number 33, series number 3, stable. Other scattered mediastinal lymph nodes are also stable.CHEST WALL: Left paraspinal soft tissue mass measures 8.6 x 3.9-cm on image number 48, series number 3, not significantly changed from previous study. This mass invades the adjacent thoracic vertebral body and destroys the adjacent rib and extends into the spinal canal.ABDOMEN:LIVER, BILIARY TRACT: Stable multiple bilobar hepatic cysts of various size. No ductal dilatation. Previously described hypodense mass suspicious for metastatic disease in the right lobe is stable measuring 2.4 x 2.1 cm image number 88, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post left adrenalectomy. Right adrenal gland is unremarkable. KIDNEYS, URETERS: Right kidney is unremarkable. Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left paraspinal soft tissue mass at the level of T12/L1 measures 6.9 x 4.8 cm image number 99, series number 3, not significantly changed. The mass compresses and invades the T12 vertebral body and extends into the spinal canal.OTHER: 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: Right sacral mass and left iliac mass are similar. Right sacral mass extending into the iliac bone measures 6.3 x 5.2 cm image number one there 64, series number 3.OTHER: No significant abnormality noted

Output: Lung nodules are overall stable, although some are minimally decreased in size.Bone metastases, hepatic metastases are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: Intubated, Sepsis, Check Pulmonary Status History: Intubated, Sepsis, Check Pulmonary Status Endotracheal tube tip projects 5 cm above the level of the carina. Right internal jugular sheath with tip in the distal SVC. Enteric tube projects inferiorly beyond the visualized field. Low lung volumes. Apparent cardiomegaly may be exaggerated by low lung volumes. Persistent perihilar and basilar opacities, and left lower lobe consolidation. Layering small left pleural effusion.

Output: Endotracheal tube tip projects 5 cm above the level of the carina. Perihilar and basilar opacities appear similar to previous, and may represent a combination of atelectasis, aspiration and/or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Swan placement. Swan-Ganz catheter from an IVC approach has been retracted with tip now in the right main pulmonary artery.Left subclavian stent and sternotomy fixation hardware similar in position.Cardiomegaly. No specific signs of pulmonary edema. No pneumothorax.

Output: Retraction of Swan-Ganz catheter with tip now in the projection of the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: Evaluate chest tube, evaluate for pleural effusion and PTX History: S/p diaphragm repair Posteriorly directed right chest tube unchanged in position. Small right hydropneumothorax with maximal pleural separation from the chest wall of 5 mm.Small to moderate pleural fluid collections, increasing in volume on the left. Interval development of retrocardiac opacity most consistent with atelectasis.Midline abdominal surgical staples.

Output: Decrease in pneumothorax with no other changes.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval position of swan after manipulation History: see above Swan-Ganz catheter looped in right atrium, the tip is in the proximal PA. Pulmonary edema and cardiomegaly unchanged.

Output: Swan-Ganz catheter looped in right atrium, the tip is in the proximal PA.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: ETT adjustment History: as above Endotractheal tube tip approximately 3 cm above the carina. NG tube extends beyond the inferior margin of the image, beyond the pylorus.Small lung volumes with bibasilar atelectasis. Trace pleural effusions, unchanged.

Output: Endotractheal tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: s/p thora History: MM with pleural Effusion Right pleural effusion decreased in size post-thoracentesis.No evidence of a pneumothorax.There are decreased lung volumes with stable cardiomediastinal silhouette.Extensive osseous changes related to underlying multiple myeloma redemonstrated.

Output: Normal decreased right pleural effusion postthoracentesis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: New fevers to 104, post platelet transfusion, also history of acute lymphoblastic leukemia History: chills, fever No significant cardiopulmonary abnormality.No specific evidence of infection.Right PICC, tip in the SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval for rib fx, dislocation History: R 9th-12th rib tenderness throughout anterior and posterior ribs, no trauma Heart size upper normal. No significant pulmonary or pleural abnormality.No specific evidence of infection.No evidence of displaced rib fracture or other traumatic abnormality.

Output: Heart size upper normal, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: s/p SC-ICD implant, evaluate for pneumothorax and evaluate lead position History: as above Left chest wall ICD lead projects over the right ventricle. The cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax.Calcified granuloma on the right.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: fevers History: shortness of breath Right apical chest tube remains in place. No significant pneumothorax. Mild right-sided subcutaneous emphysema again noted. Mild diffuse pulmonary opacities again noted. Unchanged cardiomegaly. No large pleural effusions.

Output: No significant pneumothorax. Mild diffuse pulmonary opacities again noted which may represent edema or atypical infection.


Instruction: Generate impression based on medical findings.

Input: Evaluate for enteric tube placement Enteric tube seen extending beyond level of ligament of Treitz, tip overlies left upper quadrant. Based on appearance of catheter, coiling of tubing in third portion of duodenum not excluded (versus traversing loops of proximal jejunum), kinking noted approximately 9 cm from catheter tip. Pulmonary edema and effusions partially imaged.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: S/p CABG History: CTICU Daily CXR Status post sternotomy with several chest tubes but no pneumothorax.Moderate right pleural effusion present postop.ET tube tip approximately 3 cm above the carina.IABP catheter distal tip projects over the aortic arch.Right subclavian Swan-Ganz catheter tip in main pulmonary artery. Left subclavian pacemaker, leads unchanged in position.Right jugular catheter tip at RA level.

Output: Postop, right pleural effusion but no pneumothorax. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: 63F with recent thoracentesis, assess for complication. History: thoracentesis Tracheostomy tube and right port catheter are unchanged in appearance.Decreased size of left pleural effusion with improved aeration of the left lower lobe. Reticular basilar opacities of subsegmental atelectasis and likely aspirated secretions. No pneumothorax.

Output: No pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices Interval removal of chest tubes. Right jugular catheter tip in the area of the junction of the jugular and brachiocephalic veins.Marked cardiomegaly with an aortic valve prosthesis. Bilateral pulmonary opacity compatible with atelectasis and overlying pleural effusions No new findings.

Output: Interval removal of chest tubes with no other significant change.


Instruction: Generate impression based on medical findings.

Input: Acute lymphoid leukemia No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for causes of odynophagia, ulcerations, abnormal motility, reflux Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. A moderate-sized sliding hiatal hernia was present, measuring approximately 2.3 x 2.6 cm (series #7). Immediately superior to the hernia, there was a focal fixed narrowing at which point the maximum luminal diameter of the esophagus measured 8 mm (series #18). The barium tablet failed to pass through the narrowed segment (series #37).During the exam, no spontaneous or provoked gastroesophageal reflux was observed.  Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. Mild motor abnormality was observed, with recurrent episodes of proximal escape.TOTAL FLUOROSCOPY TIME: 3:51 minutesEntrance dose: 116.40 mGy

Output: 1. Small to moderate-sized sliding hiatal hernia.2. Fixed focal narrowing of the distal third of the esophagus, suggesting an underlying stricture or ring.3. Mild esophageal motor abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Altered mental status. Breast cancer. Interval removal of an enteric tube, right central line and enteric tube. Increased moderate bilateral pleural effusions. Increased diffuse bilateral airspace opacities. Surgical clips overlie the left chest wall.

Output: Increase moderate bilateral pleural effusions with adjacent atelectasis and diffuse patchy airspace opacities, probably aspiration/infection post extubation.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with esophageal cancer CHEST:LUNGS AND PLEURA: Atelectasis/scarring in the right lung bases unchanged.MEDIASTINUM AND HILA: Paraesophageal lymph node measures 19 x 19 mm image number 46, series number 3, slightly enlarged. Dilatation of the esophagus is unchanged. Wall thickening is slightly progressed especially distally. There is peripherally enhancing collection on the left side of the esophagus extending for approximately 5 cm at the greatest transverse dimension of 1.8 x 1.3 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter up study in the right lobe is unchanged on image number 99, series number 3. Measures 5 mm. Other punctate hypodensities in the liver also unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: 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: Paraesophageal lymph node is slightly enlarged. New collection along the left side of the esophagus. Dr. Villaflore was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Fever and neutropenia. Again seen is chronic eventration and elevation of the hemidiaphragms. Stable cardiomediastinal silhouette. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: evaluate for worsening of R apical pneumothorax s/p removal of chest tube History: s/p removal of chest tube Unchanged right apical pneumothorax following chest tube removal, and stable pneumoperitoneum.Increased left base subsegmental atelectasis.Status post median sternotomy for CABG.

Output: Unchanged right pneumothorax following chest tube removal. Stable pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Lower extremity edema, AKI. Evaluate volume status. No focal pulmonary opacities or signs of pulmonary edema. No pleural effusions or pneumothorax.Cardiomegaly with severely enlarged pulmonary arteries, unchanged.Interval removal of left IJ central catheter. Right upper extremity PICC terminating in the right brachiocephalic vein, unchanged.

Output: No evidence of pulmonary edema. Unchanged cardiomegaly with severely enlarged pulmonary arteries.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: intubation, ETT placement? History: intubation Interval endotracheal tube placement with tip approximately 2 cm above carina.Right IJ catheter unchanged in position.Median sternotomy hardware noted.Stable cardiomegaly.Interval development of right pleural effusion with underlying atelectasis.Interstitial opacities increased from prior exam.Streaky left basilar opacities.

Output: Interval intubation with tip approximately 2 cm above carina.New right pleural effusion with underlying atelectasis as well as stable left basilar atelectasis and/or scarring. Interstitial pulmonary edema increased from prior.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Mycoplasma pneumonia Right lower lobe interstitial airspace opacities are not significantly changed allowing for differences in technique may reflect infection. Elsewhere lungs are clear and may reflect resolving edema elsewhere. Cardiomegaly again noted.

Output: Stable right lower lobe opacities may reflect infection. Improvement elsewhere suggestive of resolving edema.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: Infiltrates History: fever Right upper lobe scarring and volume loss.No specific evidence of infection or edema.Heart size normal.Right jugular catheter, tip in SVC.

Output: Right upper lobe scarring and volume loss, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Pneumonia status post extubation now with tachypnea. Moderate right and small left pleural effusions. Severe multifocal airspace process slightly worse with superimposed severe pulmonary edema.

Output: Severe pulmonary edema. Worsening airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old, with questionable history of PE in the past presenting with chest pain and positive d-dimer. PULMONARY ARTERIES: No evidence of pulmonary embolus to the segmental level. Motion artifact limits the evaluation of more distal vessels.LUNGS AND PLEURA: Left apical scarring with a large, calcified nodule likely representing prior granulomatous disease. Additional scattered calcified micronodules also likely reflect prior granulomatous disease.Groundglass peripheral nodular opacities in the left lower lobe may represent aspiration or mild infection. Mosaic groundglass attenuation within the right upper and middle lobes is compatible with atelectasis or air trapping.Relative hyperlucency of the left lung with diffuse bronchial wall thickening and small caliber pulmonary vessels is suggestive of bronchiolitis obliterans. Bronchiectasis noted at the left base.MEDIASTINUM AND HILA: The cardiac size is mildly enlarged. No pericardial effusion. Mildly prominent hilar lymphoid tissue bilaterally.CHEST WALL: Dextroscoliosis.UPPER ABDOMEN: Cholelithiasis. 1 cm left adrenal nodule likely represents a benign adenoma.

Output: 1.No PE.2.Multiple findings as above suggestive of bronchiolitis obliterans.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval for focal abnormality History: weakness, R ant chest pain No focal consolidation, effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.Deformity of right third rib, consistent with prior remote trauma. Post surgical changes in the region of the right shoulder again noted.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.SOB status post AVR Unchanged appearance of the cardiomediastinal silhouette. Mild blunting of the costophrenic consistent with small pleural fluid collections, but no specific signs of pulmonary edema. The aortic valve prosthesis is only faintly visible.

Output: Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Thoracentesis. Shortness of breath. Visualized tubes and lines unchanged in position. Lung volumes remain low. Large layering left pleural fluid collection unchanged with associated compressive atelectasis. No pneumothorax.

Output: No pneumothorax post thoracentesis. Large left pleural fluid collection and significant compressive atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Evaluate for ARDS, intubation ET tube approximately 5 cm from the carina. Enteric tube tip extends below the diaphragm outside the field-of-view. Left IJ catheter tip in the SVC. Right IJ Swan-Ganz catheter tip in the right main pulmonary artery.Cardiomegaly and pulmonary opacities compatible with edema, not significant changed.

Output: ET tube in acceptable position. Unchanged support devices and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Post bronchus. Change in CAT scan. History of metastatic pancreatic cancer. Left subclavian chest port tip at the SVC. Normal heart size. No pneumothorax. Hazy airspace opacities in the left lower lobe are slightly more pronounced which could be due to interval worsening or sequelae of bronchial washing, correlate with history. Mild to moderate superimposed edema and bronchial wall thickening. Small pleural effusions.

Output: No postprocedural pneumothorax. Interval development of mild pulmonary edema. Worsening of left lower lobe opacities could be due to progression of pre-existing abnormality or superimposed bronchial washing.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: is there an infiltrate History: cough, asthma/copd history, +smoking Cardiomediastinal silhouette is normal. Subsegmental basilar atelectasis. Chronic appearing interstitial abnormalities. No pleural effusion or pneumothorax.

Output: No specific evidence of infection. Chronic appearing interstitial abnormalities. In the absence of prior examination, follow-up or comparison to prior outside imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Weakness, persistent nausea vomiting. History of small cell lung cancer. Architectural distortion and volume loss right hemithorax with pleural thickening and nodularity unchanged. Left lung volume remains low with patchy air space opacity in the lobe new from yesterday's exam consistent with atelectasis and aspiration. Bilateral pleural effusions about the same.

Output: New left lower lobe opacities suggest aspiration and possible pneumonitis.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: r/o pneumonia History: syncope Lung volumes are normal.Persistent left lower lobe bandlike opacities suggestive of subsegmental scarring, stable from priors.No new abnormal lung parenchymal opacities.The pleural spaces are within normal limits.Tortuosity and atherosclerotic calcification of the thoracic aorta. The heart is normal in size.

Output: No radiographic findings to suggest pneumonia, as clinically questioned.Left lower lobe bandlike opacities likely represent scarring, stable from priors.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate lung fields, IABP History: IABP Balloon catheter marker 2 cm below the top of the aortic arch.No sign of pulmonary edema or infection.

Output: Aortic balloon catheter in the descending aorta with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: NG tube placement, malignant neoplasm of brain unspecified Dobbhoff tube located in gastric body. Partially imaged residual enteric contrast seen in colon and mildly prominent air-containing small bowel seen in central abdomen. IVC filter present.Please see same day chest radiography for additional findings.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: pneumonia History: sob NG tube has been removed.Right PICC line with its tip in the right axilla.Stable cardiomediastinal silhouette.Diffuse increased opacity in left lower lobe may represent infection or edema.The right lung is clear.

Output: Mild diffuse increased opacity in the left lower lung zone compatible with edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Prekidney transplant rule out cardiomegaly or infiltrates. End-stage renal disease. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. No evidence of pulmonary edema. Left subclavian vascular stent.

Output: No acute pulmonary abnormality. Normal heart size.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated Small lung volumes with nonspecific opacity compatible with limited effusions, atelectasis and edema. ET tube tip approximately 1 cm above the carina.Venous catheters and NG tube unchanged.

Output: Low position of ET tube.