Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for pneumonia History: fever, sob, pulm HTN Large lung volumes.Moderate basilar reticular interstitial opacities are in part chronic, but reviewing prior CTs from 5/4/2015 raises the possibility of superimposed edema.No specific evidence of infection.Heart size normal.

Output: COPD with persistent basilar interstitial opacities at least in part chronic although mild superimposed edema is possible.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old. Right PICC line with its tip in the right axilla.Mildly decreased lung volumes.Borderline cardiac enlargement.No focal airspace opacities.No large pleural effusions.

Output: Right PICC line with its tip in the axilla. No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval for PNA, PTX History: known mesothelioma, worsened SOB since intercostal nerve block on L side Left-sided pleural disease and left hemithorax volume loss is unchanged compared to the prior exam. Retrocardiac atelectasis is improved compared to the prior exam. No specific evidence of superimposed infection or edema. No pneumothorax.

Output: Pleural disease and left hemithorax volume loss is unchanged. No specific evidence of superimposed infection or edema. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Chills and chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: is there an infiltrate History: cough, one episode ? Hemoptysis The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Female 20 years old Reason: Evaluate for PNA History: Cough, fever, chills, sore throat 6 days. History of lupus and interstitial lung disease. The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. Diffuse lower lobe predominant reticular opacities consistent with the diagnosis of interstitial lung disease appears similar to the prior chest radiograph. No evidence of superimposed infection.

Output: Interstitial lung disease with no evidence of superimposed infection.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: r/o acute process History: shortness of breath No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: ? pneumonia History: coughing, fevers, NSW Heart size about upper normal.Retrocardiac midline opacity compatible with a hiatal hernia, unchanged.Port catheter with its tip in the right brachiocephalic vein.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Green card physical evaluate for pulmonary TB. Normal cardiomediastinal silhouette. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality. No radiographic signs of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: serial eval pna and effusions History: worsening sob Increasing airspace opacity which may be due to worsening pulmonary edema. Heart size stable. Pleural effusions stable to increased.

Output: Increasing airspace opacity which may be due to worsening pulmonary edema. Pleural effusions stable to increased.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: s/p tracheogastric fistula repair, CT in place History: air leak and PTX Interval decrease in size of apical right pneumothorax, now measuring 1.3 cm from the chest wall. Right chest tube is not significantly changed from prior examination. Small right effusion with adjacent subsegmental atelectasis. New opacity overlying the left hemithorax is likely outside of the lung and may represent skin fold.

Output: Improving right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with MDS-lymphoma now with likely fungal pneumonia status post SCT. Please evaluate for progression and treatment efficacy. LUNGS AND PLEURA: Right-sided pneumothorax has resolved. Right pleural effusion is larger. Posteromedial right lower lobe mass noted on the prior exam cannot be identified secondary to the effusion. A left lower lobe mass measures 1.3 x 2.0 cm on axial image 63/104 and is smaller (measured 2.3 x 2.3 cm on 3/21/08).Postsurgical changes and a staple lines are reidentified in the right upper lobe.MEDIASTINUM AND HILA: Left-sided central venous line terminates in the left subclavian vein.Referenced AP window lymph node is grossly unchanged measuring 1.3 x 1.8 cm on axial image 37/104.Cardiac size is normal with no pericardial effusion.CHEST WALL: Multiple healed rib fractures noted on the right. Mild compression fracture of a lower thoracic vertebral body is unchanged as are degenerative changes of the spine.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Resolution of right pneumothorax with an interval increase in right pleural effusion.2.Decrease in the size of a left lower lobe mass.3.Stable AP window lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: Post intubation History: As above Slight improvement in pleural effusions and lower lung zone air space opacities.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 4 cm above the carina. Improved pulmonary opacities and pleural effusions versus improved inflation following intubation.


Instruction: Generate impression based on medical findings.

Input: Hiatal hernia being treated with ceftriaxone and azithro. Assess for worsening CHF versus aspiration. SOB and desaturation. Unchanged mediastinal silhouette with air-filled large hiatal hernia.Improving reticulonodular opacities suggesting resolving aspiration bronchiolitis. There is persistent paramediastinal atelectasis and bronchial wall thickening in the right lung, seen to a lesser extent on the left. Small pleural effusions.

Output: Extensive aspiration bilaterally is improving. No visible signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Altered mental status status post recent surgery evaluate for infection. Left subclavian single lead ICD with proximal coil in the projection of the left brachiocephalic vein/SVC and distal coil in the projection of the right ventricle. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.Normal heart size and mediastinal silhouette.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of pneumonia. If patient remains symptomatic, short-term follow-up may be obtained.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for flash pul edema History: new O2 requirement Moderate cardiomegaly with a tortuous calcified aorta.Interstitial opacity compatible with edema with small pleural effusions.Large lung volumes suggestive of COPD.Calcified right upper lobe granuloma and calcified lymph nodes compatible with previous infection.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute abnormalities History: sob Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: evaluate for ILD History: abnormal PFT's (parenchymal process) in the setting of SLE vs possible overlap connective tissue disease with myositis Minimal interstitial opacities are seen at the periphery of the right lung base, but there is no other evidence of interstitial lung disease.No specific evidence of infection or edema.Heart size normal.

Output: Minimal interstitial opacities right lung base periphery, otherwise unremarkable. Thoracic CT, ILD protocol, would be more sensitive for the detection of early interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: 79 years, Male. Reason: DHT placement History: DHT placement Blurring due to respiratory motion. Generalized ileus. Postsurgical changes chest. Lung bases clear. Changes lumbar spine and postsurgical changes lumbosacral area.Dobbhoff tube tip in distribution of proximal gastric body. Other findings unchanged from prior exam.

Output: Dobbhoff tube in distribution of proximal gastric body. Generalized ileus favored.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: evaluate gastric conduit distention. NG tube placement History: nausea Enteric tube tip is unchanged in position in the mid neoesophagus.The cardiomediastinal silhouette is stable and compatible with gastric pull-up.The left pleural effusion appears somewhat smaller and there are no new focal pulmonary opacities.There is small amount of subcutaneous emphysema.

Output: Slightly decreased left pleural effusion, otherwise stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: eval for source of infection, volume status History: CKD, s/p renal transplant, chest pain, cough, fevers Small lung volumes, with increased opacities which could be developing edema or subsegmental atelectasis.ICD leads unchanged.

Output: No no reliable evidence of infection although small lung volumes are present and there may be evolving edema or retrocardiac subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 86-year-old male with pulmonary fibrosis and iron deficiency anemia, abdominal pain and nausea. Suspect GI bleed CHEST:LUNGS AND PLEURA: Bilateral moderate sized pleural effusions, new from previous CT. bilateral dependent atelectasis.MEDIASTINUM AND HILA: Cardiomegaly. Elevated right hemidiaphragm is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Atrophy of the anterior segment of the right lobe and medial segment of the left lobe is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign appearing multiple left renal cysts. Atrophic right kidney with hydronephrosis. Multiple calcifications within the right kidney likely representing stones and vascular calcifications.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction.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: Redundant sigmoid colon. 1 cm polypoid lesion within the sigmoid colon may represent polyp, neoplasm versus retained stool. Colonoscopy is recommended for further evaluation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Colonoscopy is recommended for the possible polypoid lesion within the sigmoid colon. Bilateral pleural effusions and cardiomegaly.Atrophic right kidney with multiple stones and hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Chills and cough Unchanged mild non specific cardiac enlargement again exaggerated by suspect is scarring and cardiac rotation .Left essentially basilar pleural thickening with a questionable small fluid collection and left basilar atelectasis, unchanged. No new pulmonary opacities identified.

Output: Left basilar scarring without evidence of new superimposed disease


Instruction: Generate impression based on medical findings.

Input: Sickle cell trait and chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: assess for fracture History: s/p fall, weakness No evidence of fractures. Left internal jugular central venous catheter with tip in the cavoatrial junction. Abdominal clips from previous surgery is noted. Lungs clear. No pleural effusion or pneumothorax.

Output: No evidence of fractures. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: re-eval atelectasis/pnemuo History: as above Right pleural effusion and improved right basilar atelectasis.Left lung unremarkable.ET tube tip approximately 5 cm above the carina.Right PICC, tip in right atrium.An NG tube terminates in the stomach.

Output: No significant pneumothorax. Improving right basilar atelectasis and right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: new lactic acidosis, concern for sepsis History: above Mild cardiomegaly.Small pleural effusions and basilar atelectasis may be the result of aspirated secretions or mucous plugging.No reliable evidence of pneumonia.Left jugular catheter, tip in SVC.

Output: Basilar atelectasis possibly from aspirated secretions or mucous plugging. No reliable evidence of infection as of yet.


Instruction: Generate impression based on medical findings.

Input: Atrial fibrillation Moderate four-quadrant emphysematous changes with mild asymmetry and hyperexpansion observed on the left. No discrete superimposed focal airspace process.Mild tortuosity of the aorta exaggerated by scoliosis. Cardiac silhouette within limitsOld healed right sixth rib fracture and mild wedge deformity of what appears to be T7 and possibly T8.

Output: Marked emphysema without definite superimposed focal airspace abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: ett History: ett Lines and tubes, unchanged. Diffuse pulmonary opacities again noted, somewhat improved. Pleural effusions, as before. Unchanged cardiomegaly. No pneumothorax.

Output: Stable lines. Cardiomegaly with some improvement in pulmonary opacities. Stable pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient intubated, eval ETT placement History: see above ET tube tip approximately 2 cm above the carina.Small lung volumes with diffuse interstitial opacity compatible with edema superimposed upon emphysema.Left lower lobe opacity compatible with atelectasis and aspirated secretions.ECMO catheter, temporary pacemaker lead and TAVRs, one of which has apparently migrated into the descending aorta.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: Evaluate for infiltrates, edema, effusion History: Chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: ett placement History: ett placed 9/28 am Minimal retrocardiac subsegmental atelectasis, otherwise unremarkable appearing lungs.ET tube tip 7 cm above the carina.An NG tube terminates in the stomach, the side port above the GE junction.Right jugular catheter, tip in SVC.

Output: ET tube tip 7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Evaluate for necrotizing fasciitis in the abdomen. ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:LUNG BASES: Right pleural effusion with overlying compressive-type atelectasis roughly stable compared to prior. Left lung base is unremarkableLIVER, BILIARY TRACT: Postsurgical changes consistent with liver transplant. Since the prior examination, there's been interval insertion of a Z-stent in the intrahepatic IVC perihepatic fluid is again noted. Status post cholecystectomy..SPLEEN: Massive splenomegaly unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of retroperitoneal hematoma. Fat stranding consistent with a generalized anasarca. Small nodes. Largest node aortocaval distally Series IV image 120 measuring 1.1 x 0.8 cm, unchanged.BOWEL, MESENTERY: Moderate amount of generalized ascites increased compared to prior scans. As described above some of the fluid around the liver is loculated and causing mass effect on the liver. As noted previously, this suggests that some of the fluid may be sub-capsular rather than purely free intraperitoneal.Incisional midline ventral hernia containing large bowel small bowel and omentum but nonobstructive, unchanged.BONES, SOFT TISSUES: Extensive subcutaneous edema particularly in the anterior abdominal wall and laterally.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The previously seen left adnexal cyst cannot be discerned possibly due to the ascites.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of generalized ascites.BONES, SOFT TISSUES: Mild anasarca.OTHER: Small kidneys consistent with chronic medical renal disease, unchanged. Normal size renal allograft seen in the right iliac fossa, unchanged.

Output: Stable large right pleural effusion and resolution of left pleural effusion. New Z-stent in the intrahepatic IVC. Increased ascites. Unchanged massive splenomegaly and nonobstructive ventral hernia. Chronic medical renal kidneys. Anasarca but no definite evidence of necrotizing fasciitis.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: Rule out R lung effusion History: sob Complete opacification of the right hemithorax with left mediastinal shift indicates large pleural effusion with underlying atelectasis . No left pleural effusion. No pneumothorax.

Output: Complete opacification of the right hemithorax with leftward mediastinal shift, consistent with large right effusion and underlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: IJ placed History: RIJ Cardiomegaly, with pleural effusions, lower lung zone edema and left basilar consolidation, gradually worsening.Right jugular catheter tip in or at level.

Output: Worsening CHF. Low right jugular catheter, subsequently repositioned.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Empyema, shortness of breath chest tube placement. Right chest tube projects over the minor fissure. Right pleural fluid volume decreased, with small iatrogenic pneumothorax component. Left pleural fluid collection unchanged. Basal atelectasis and edema about the same.

Output: Right chest tube placement with small iatrogenic pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval lung fields History: cough Curvilinear opacity at the left medial hemidiaphragm compatible with Bochdalek hernia, more prominent than prior. No interval appearance of pneumonia, edema or pneumothorax. Mildly narrowed and rightward tracheal deviation; the thyroid gland is enlarged from a CT head and neck 11/13.

Output: No interval appearance of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: FemaleReason for Study: Reason: Pleural effusion History: pleural effusion s/p thoracentesis Right pleural effusion slightly reduced in size postthoracentesis.No pneumothorax.Stable cardiomediastinal silhouette with small left pleural effusion.Perihilar interstitial opacities compatible with edema.Pigtail catheter noted in left upper abdomen.

Output: No evidence of pneumothorax postthoracentesis.


Instruction: Generate impression based on medical findings.

Input: 23-year-old female with newly diagnosed adenocarcinoma of the esophagus. Evaluate disease status. CHEST:LUNGS AND PLEURA: Previously described right apical micro-nodule is not visualized on current exam and likely represents post treatment improvement or was postinflammatory in etiology. No other suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Substantial improvement in multiple hypoattenuating lesions in both lobes, both in size and number. A segment 6 reference lesion has significantly decreased in size now measuring 11 x 9 mm on image 101 series 3 (this is in comparison to 1.9 x 2.6 cm on axial image 102/209 on prior study).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: Multiple enlarged gastrohepatic and porta hepatic lymph nodes have decreased in the interval. A reference gastrohepatic ligament node has decreased in size measuring 1.5 x 1 cm on image 83 series 3 (this is in comparison to 1.5 x 1.6 cm on axial image 81/209 on prior study).BOWEL, MESENTERY: Large mass lesion involving the gastric cardia and fundus with extension above the GE junction corresponding to the patient's stated history of adenocarcinoma has substantially decreased in the interval.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right ovarian cystic mass measuring up to 4 cm which may be evaluated by pelvic ultrasound if clinically warranted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Substantial improvement in disease with decrease in the size of the gastric mass, decrease in size and number of multiple hepatic metastatic lesions, decrease in porta hepatic/gastrohepatic lymphadenopathy, and resolution of previously noted right apical micro-nodule.Right ovarian cystic mass measuring up to 4 cm which may be further evaluated by pelvic ultrasound if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: pneumonia History: left sided chest pain Left upper lobe opacity may have slightly decreased in size from the prior study. No pleural effusion or pneumothorax is present.The cardiomediastinal silhouette normal limits. Multiple air distended loops of colon are present in the left upper abdomen.

Output: Left upper lobe opacity has slightly decreased in size, however given its persistence, further evaluation with chest CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: s/p inhalational injury History: see above Near-complete opacification of the left hemithorax similar to the prior exam.Mild increase in right basilar nonspecific opacity is compatible with edema/atelectasis.Cardiac size cannot be evaluated.

Output: Near complete opacification of the left hemithorax similar to the prior exam and compatible with known large central obstructing lesion, significant atelectasis, and associated pleural effusion. Minimal interval increase in right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Patient status post aortic valve replacement. Patient has been extubated. Swan-Ganz catheter, mediastinal drains, and sternotomy fixation hardware unchanged. The cardiomediastinal silhouette is stable.Lung volumes are low and there are small bilateral pleural effusions with adjacent streaky atelectasis.

Output: Patient has been extubated, otherwise stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reevaluate pneumothorax after chest tube removed at 11:20 hours. Interval removal of right apical pigtail catheter. No significant sized pneumothorax. Subcutaneous emphysema right chest wall.Left chest port tip at the superior cavoatrial junction.Right middle and lower lobe volume loss and bilateral well-circumscribed nodules unchanged.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old with history of known metastatic cancer, right PICC placement Left PICC with tip projecting over the SVC. Median sternotomy wires and tracheostomy stable in position.Stable cardiomegaly. Bilateral patchy and nodular airspace opacities, right greater than left, not significantly changed from prior exam. Bilateral pleural effusions.

Output: Left PICC with tip overlying the SVC. Bilateral pulmonary nodules consistent with known metastatic disease with superimposed pulmonary edema.Please note exam from previous date was incorrectly labeled, and the clinical service was notified.


Instruction: Generate impression based on medical findings.

Input: Reason: Post op AAA TEVAR History: Post op AAA TEVAR Unremarkable cardiac and mediastinal silhouette. Status post median sternotomy.Focal nodular scarlike opacity in the right upper lobe, better characterized on a recent CT scan.No acute pulmonary abnormalities.Shunt catheter projected over the right hemithorax and coils in the left upper quadrant of the abdomen.Stent device in the upper abdominal aorta.

Output: Multiple findings as described with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Status post percutaneous tracheostomy. Tracheostomy and enteric tube again noted. Unchanged left lower lobe airspace opacities and small left pleural effusion. No pneumothorax.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evaluate for pneumothorax post procedure History: shortness of breath Surgical clips project over the right axilla and right lung as well as over the mediastinum. There is been an interval extubation. Left chest port with tip overlying the cavoatrial junction.The cardiomediastinal silhouette is unchanged given differences in technique. Stable bilateral airspace opacities. Bilateral pleural effusions. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Central line insertion, cardiac arrest. Left jugular tip at the confluence of the brachiocephalic veins with the SVC. An Impella device and other tubes and lines are unchanged in position. Moderate dependent opacities suggestive of atelectasis and edema, about the same.

Output: Left jugular catheter tip at the confluence of the brachiocephalic veins at the SVC, no visible pneumothorax. No acute change.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with metastatic sarcoma of pelvis. Evaluate for disease status. CHEST:LUNGS AND PLEURA: Status post right lung excision and thoracoplasty with mediastinal shift to right. Subcentimeter nodules on series number 3 are not significantly changed. No new nodules. MEDIASTINUM AND HILA: Postsurgical changes with small mediastinal nodes is unchanged. Cluster of several nodes which were previously measured as a reference unchanged measuring 11 x 8 mm on image number 30/222, series number 3.CHEST WALL: Previously mentioned metastatic lesion in the sternum now appears sclerotic but size wise has not significantly changed. Thoracoplasty on right with mesh repair and extensive rib resection is healed. ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesion in the left lobe of the liver is unchanged measuring 15 x 10 mm on image number 89/222, series number 3, likely representing cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Herniation of bowel into the left flank herniaBONES, SOFT TISSUES: Again noted are left pelvic sclerotic bone metastases with a pathologic fracture as well as bilateral acetabular, sacral and lower lumber vertebra metastases. Multiple other sclerotic foci throughout the thoracic lumber vertebral bodies are also suspicious for metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Marked distension of urinary bladder is increased since the prior exam. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive bone metastases as described above. Pathologic fracture of left iliac wing on axial image 172/222 of series #3. OTHER: Left lateral pelvic wall hernia contains non-obstructed bowel at the surgical defect, image 141/222 of series #3.

Output: Stable findings. Extensive metastatic bone disease. Most bone metastases are sclerotic. Pathologic fracture involving the left iliac wing.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: mass? CHF? 1 mo weakness, wt gain History: weakness Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. Bilateral basilar streaky opacity suggestive of atelectasis/scarring. No focal pulmonary consolidation.

Output: No specific evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 40-year-old male status post single chamber ICD implant. Evaluate for pneumothorax and leads. Interval placement of ICD with a lead projecting over expected location of the right ventricular apex, although evaluation is limited due to patient motion.Heart size is moderately enlarged.Low lung volumes. No focal pulmonary opacity or pleural effusion.No evidence of pneumothorax.

Output: Interval placement of ICD without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with history of tongue cancer. Rule out recurrence or lung mets. LUNGS AND PLEURA: Nonspecific pulmonary micronodules in the right lower lobe (image 74/112) unchanged since 8/11/06 and likely benign. No new pulmonary nodules. No pleural effusions. Unchanged nodularity along the right minor fissure.MEDIASTINUM AND HILA: Normal cardiac size. Stable small mediastinal nodes. No significant hilar lymphadenopathy.CHEST WALL: No significant axillary lymphadenopathy. Mild degenerative changes in the midthoracic spine.UPPER ABDOMEN: Unchanged left kidney hypodense lesions, likely cysts.

Output: No evidence of pulmonary metastatic diseaseI 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, 74 years old.Reason: IABP placement History: IABP placement ET tube tip is above the carina. Left internal jugular central venous catheter with tip in the SVC. Three chest tubes are noted. Swan-Ganz catheter with tip in the right pulmonary artery. IABP marker is a 1.5 cm below the aortic arch.Moderate cardiomegaly.Left pleural effusion. No pneumothorax.Interval improvement in in bilateral airspace opacities. Retrocardiac atelectasis.

Output: Mild improvement in pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Reason: R/o acute chest History: As above Small lung volumes with mild basilar opacity compatible with atelectasis. Skeletal findings compatible with sickle cell disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Status post pneumothorax with vent placement Persistent thoracovent projecting over left upper chest, unchanged. No appreciable underlying pneumothorax. No appreciable associated pneumothorax.Persistent moderate left effusion with underlying compression atelectasis.Unchanged T11 and T12 spinal fixation

Output: Persistent left moderate effusion with associated vent placed.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o aspiration History: leukocytosis, ams Slightly increased right infrahilar opacity, which is not specific but compatible with aspiration in the appropriate clinical setting.No other significant findings.

Output: New right infrahilar airspace opacity, compatible with aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old. PICC line tip in the SVC, partially withdrawn since the previous radiograph.Nonspecific basilar opacities compatible with atelectasis and consolidation, greater on the left.

Output: Catheter tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: Preop MVR History: Preop MVR Marked cardiomegaly with vascular redistribution.Moderate right pleural effusion with underlying atelectasis.No specific evidence of infection.

Output: Findings compatible with CHF, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: assess ETT position History: ETT advanced 2-3cm Unchanged pulmonary opacities and pleural effusions.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.IVC pacemaker, lead tip in artery apex region.

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


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: ETT placement verification History: ETT placement Improvement in basilar opacities and pleural effusions.New ET tube, tip 3 cm above the carina.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 3 cm above the carina. Improving basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: intubated, assess NGT positioning History: intubated Endotracheal tube terminates approximately 4 cm from the carina. Right IJ sheath is in place. Central venous catheters terminates near the cavoatrial junction. Enteric tube extends inferiorly off the field-of-view. Drain overlies the left axilla. Right-sided chest tube remains in place. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged heart size. No significant pneumothorax.

Output: Lines and tubes, as above. No substantial change in bibasilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: pna History: sob Central venous catheter terminates in the SVC. New oblong opacity in the lower aspect the left lung, likely atelectasis. Cardiomegaly, unchanged. No pleural effusion or pneumothorax.

Output: New oblong opacity in the left lower lobe, likely atelectasis. Early aspiration or pneumonia could also have this appearance. Consider close imaging follow-up as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: upright r/o free air History: abdominal and neck pain No convincing evidence of pneumoperitoneum on the semiupright radiograph. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. New catheter overlies the upper abdomen.

Output: No convincing evidence of pneumoperitoneum on semiupright radiograph. However, a PA and lateral chest radiograph would be the most sensitive radiographic study in this regard.


Instruction: Generate impression based on medical findings.

Input: Age: 89 yearsGender: MaleReason for Study: Reason: on bipap with pulm edema and/or aspiration, eval infiltrates History: SOB ] IJ venous catheter with its tip in the SVC.Stable cardiac mediastinal silhouette.Perihilar/basilar interstitial opacities compatible with edema.Bilateral pleural effusions and left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Stable cardiopulmonary appearance with pulmonary edema, pleural effusions, and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval line placement History: s/p triple lumen cath exchange over wire Right internal jugular central venous catheter tip is at the SVC. Interval removal of NG tube.Cardiomediastinal silhouette is unchanged.Small left pleural effusion. No pneumothorax.Retrocardiac opacity and increased right lower lung air space opacity.

Output: 1.Right internal jugular CVC tip is at the SVC. 2.Worsening bibasilar atelectasis and/or consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.History of hypotension. Median sternotomy fixation hardware and valvular annulus noted. Epicardial pacing leads noted.The cardiomediastinal silhouette is normal.No focal pulmonary opacities or large pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Chest tube placed Unchanged 2 left chest tubes with persistent small-to-moderate left pneumothorax which the more moderate component of subpulmonic. Please see subsequent report

Output: Left chest tubes in left pneumothorax grossly unchanged


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: eval lung fields History: cough, chills No focal opacity, pleural effusion or pneumothorax. Basilar atelectasis and scarring also seen on the prior CT may be related to chronic aspiration. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP position History: IABP position Balloon catheter and venous catheter unchanged.No significant cardiopulmonary abnormalities.

Output: Proximal balloon catheter marker at the level of the aortic arch with the balloon in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. Intubated. ET tube tip 2 cm above the carina. Enteric tube curled in the stomach.Cardiomediastinal silhouette is unchanged. Left basilar pleural-parenchymal opacities are again noted. No pneumothorax.

Output: Persistent left basilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.ET tube placement. ET tube tip is 6 cm above the carina. Enteric feeding tube tip extends beyond the inferior margin of the image and sidehole projects of the gastric body. Right chest tubes unchanged in position. No pneumothorax. There is increased right pleural effusion with overlying atelectasis/consolidation. Extensive metastatic disease is again noted with patchy interstitial opacities in the right upper lobe.

Output: Increasing, now large right pleural effusion with overlying atelectasis/consolidation. Extensive metastatic disease again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old. Reason: r/o pna History: sob Cardiomediastinal silhouette is unremarkable.Low lung volumes without focal pulmonary opacity, pleural effusion, or pneumothorax.Degenerative changes affect the thoracic spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: positive PPD History: no cough, fever Small lung volumes with nonspecific basilar opacities likely chronic.No evidence of active TB.Left subclavian pacemaker unchanged.

Output: Mild chronic basilar opacities but no active TB or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: new CP History: as above No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of 2-cm left lower lobe lung nodule and left adrenal nodule CHEST:LUNGS AND PLEURA: The pleural-based nodule in the left lower lobe measures 21 x 17 mm, previously 20 x 15 mm.MEDIASTINUM AND HILA: Right hilar lymph node measures 15 x 10 millimeters (previously 18 x 14 mm) and the left hilar lymph node measures 10 x 7 mm, previously 13 x 9 mmCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 20 x 12 mm, previously 20 x 10 mm. Noncontrast, portal venous and delayed Hounsfield units are 0.4, 68.2, and 12.8, consistent with an adenoma.KIDNEYS, URETERS: Punctate nonobstructive right nephrolithiasis. Right renal cysts are unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left lower lobe pleural based nodule, most likely a solitary fibrous tumor of the pleura, minimally increased in size. Decrease in size of hilar lymph nodes.Left adrenal adenoma.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pain, left-sided No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Check position of "bovina" Cardiopulmonary appearance significant for increased patchy interstitial and airspace opacities in all 4 quadrants concerning for increasing edema and/or mixed acute airspace process such as multifocal infection. Borderline cardiomegaly.Unchanged right jugular single portSpecifically the described device is not clearly identified and and may not be radiopaque

Output: Increasing new patchy nonspecific opacities, concerning for infection given history


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60 y/o M with IABP History: chf Cardiomegaly with mild basilar interstitial edema and small pleural effusions.Stable retrocardiac atelectasis.Despite the clinical history, I am unable to identify an intra-aortic balloon pump catheter. Left subclavian ICD, leads unchanged in position.

Output: CHF with mild edema. No balloon pump catheter identified.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p 3/10 VATS RUL resection and mediastinal lymph node History: follow up Right hemithorax postsurgical volume loss.No evidence of tumor recurrence.Heart size normal.Right jugular catheter, tip in SVC.

Output: Right hemithorax postsurgical volume loss, without evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Eval for swan ganz placement History: above Swan-Ganz catheter tip in the main pulmonary artery.AICD, LVAD, sternotomy again noted.No focal pulmonary opacity, large pleural effusion, or pneumothorax.Moderate cardiomegaly.

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


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Right IJ line placement ET tube tip approximately 4 cm above the carina. Right PICC tip at the superior cavoatrial junction. Interval placement of a right jugular venous catheter tip at the superior cavoatrial junction. No pneumothorax.Gastric pull-up with esophageal stent noted. Drainage catheter projects over the right mid lung.Right greater than left bibasilar atelectasis, similar to prior.

Output: Postprocedural changes and atelectasis, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Rule out active pulmonary tuberculosis. Positive quantitative serum old indicating LTBl. No signs of active intrathoracic tuberculosis. No focal airspace opacities, pleural fluid or pneumothorax. Heart size is normal. Clustered calcifications on the lateral radiograph may be gallstones within the gallbladder.

Output: No signs of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Diabetes with ketoacidosis. Possible infection. Cardiomegaly has progressed from previous. However, lungs are clear without consolidation, effusion, or edema. No pneumothorax.

Output: Cardiomegaly but clear lungs.


Instruction: Generate impression based on medical findings.

Input: Fall and mental status change SHUNT DEVICE: An intracranial shunt device exits via a left frontal burr hole, courses down the left neck and anterior chest before entering the abdomen and terminating in the right lower quadrant. The tip situated in a position different than seen previously indicating that the tip is not fixed in nature. The notch on the pressure valve points superiorly towards the scalp while previously it pointed inferiorly. Portions of the shunt overlying the calvarium are radiolucent which limit its evaluation but the shunt otherwise demonstrates no evidence of kinking or discontinuity throughout its remaining course.SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: The lungs are clear. There is a fracture of the surgical neck of the right humerus. There is mild chronic appearing loss of height of the midthoracic vertebral bodiesABDOMEN: Mild degenerative disc disease affects the lower lumbar spine. The bowel gas pattern is nonobstructive.

Output: 1. Left-sided VP shunt without evidence of complication.2. Surgical neck fracture of the right humerus. According to ER triage notes, this is a known diagnosis that occurred one week ago following a fall.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with pulmonary fibrosis presents with shortness of breath, hypoxia. Multifocal patchy airspace disease superimposed on a background of interstitial fibrosis, most concerning for pneumonia however pulmonary edema is a less likely consideration on the differential. Mildly decreased lung volumes. No pleural effusion or pneumothorax. Cardiomediastinal silhouette appears stable.

Output: Findings concerning for multifocal pneumonia or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: shortness of breath Perihilar bronchial thickening.No pleural effusion and pneumothorax.The cardiomediastinal silhouette is normal.

Output: Perihilar bronchial wall thickening, but no reliable evidence of pneumonia or edema. A PA and lateral chest radiograph can be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male presents with subjective fevers and dyspnea. Evaluate for pneumonia. Cardiomediastinal silhouette is normal. Prominent bronchial wall thickening is noted. Prior radiographs for comparison would be helpful. No pleural effusion or pneumothorax.

Output: Diffuse bronchial wall thickening is indeterminate; differential diagnosis includes viral or bacterial bronchopneumonia. Correlate with history.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Pleural effusion post tap. Large left pleural fluid collection slightly decreased in volume with partial reexpansion of the left upper lobe. There may be a tiny pneumothorax component at the apex.Mild atelectasis right lung. Skeletal metastases.

Output: Slight decrease in left pleural fluid volume, possibly with a tiny apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval for NGT placement History: s/p NGT placement Cardiomegaly with a slurred opacities in pulmonary edema slightly improved.Stable pleural effusions.An NG tube terminates in the stomach, but the side port is above the hemidiaphragm level.Tracheostomy tube tip approximately 6 above the carina.

Output: Slight improvement in pulmonary opacities and removal of right jugular catheter. New NG tube, the side port above the GE junction.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Shortness of breath. Dual-lumen left jugular catheter terminates at the superior cavoatrial junction.Single lumen left jugular catheter terminates in the right atrium.No pneumothorax. Hypovascularity in the native left lung consistent with emphysema.Right lower lobe bronchus intermittently visualized probably related to marked enlargement of the left atrium with atelectasis but is nonspecificSmall right pleural fluid collection.Basal opacities consistent with mild edema and atelectasis bilaterally.Right lateral rib deformities suggesting prior thoracotomy.Trace pleural fluid on the left.Upper normal heart size.

Output: 1. The left atrium appears to be markedly enlarged which is new from earlier studies, suggest correlation with echocardiogram to exclude mitral valve disorder. 2. Mild CHF; unable to exclude findings of chronic rejection in the right lung, follow-up PA and lateral chest radiographs recommended after management of volume status.3. Low position of the single lumen left jugular catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: COPD exacerbation vs CHF exacerbation History: SOB with desat to 70, productive cough Study is limited by lordotic positioning. Tracheostomy tube remains in place. Diffuse reticulation again noted. No new focal lung consolidation. Cardiomegaly, grossly unchanged. Enlarged central pulmonary arteries, as before.

Output: Study limited by lordotic positioning. No new gross disease.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male presents with obstipation. Nonobstructive bowel gas pattern. Average stool burden. Right upper quadrant surgical clips are noted. No evidence of pneumoperitoneum.Stable cardiomegaly. No focal pulmonary opacity. Stable appearing healed rib fractures.

Output: No evidence of bowel obstruction. Average stool burden.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: evaluate lung fields History: s/p AVR, MVR Stable chest tubes removed with no pneumothorax.Status post sternotomy and valve replacement.Small lung volumes with basilar edema and atelectasis and pleural effusions, not significantly changed.Right jugular introducer unchanged.

Output: Chest tubes removed with no pneumothorax or other complication. Stable pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: sob History: sob Cardiac silhouette is significantly obscured on the left but is likely within normal limits in size.There is diffuse haziness of the left hemithorax with effacement of the left hemidiaphragm likely related to diffuse pleural thickening and/or loculated effusion in the setting of prior surgical changes. Slightly more focal left retrocardiac opacity may relate to atelectasis/consolidation.An element of perihilar congestion is evident within the right lung. A skin fold projects over the right mid and lower hemithorax.An apparent Pleurx catheter projects over the right lower hemithorax/right upper quadrant.Surgical clips project over the left axilla and left infrahilar region. Left chest wall soft tissue lobulation may relate to postsurgical changes with or without recurrent disease.

Output: 1.Left hemithorax diffuse pleural thickening and/or loculated effusion in the setting of prior surgical changes. Correlate with surgical history and consider CT chest for further evaluation as clinically warranted.2.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with shortness of breath. LUNGS AND PLEURA: Scattered calcified micronodules likely reflect prior to granulomatous disease. No focal consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: Cardiac size is normal with no pericardial effusion. Coronary artery calcifications noted. No significant hilar or mediastinal lymphadenopathy.CHEST WALL: Mild compression fracture of an upper thoracic vertebral body.UPPER ABDOMEN: Multiple subcentimeter hypoattenuating lesions in the liver are presumably cysts. The hypoattenuating lesion off the superior pole of the right kidney is also presumably a cyst.

Output: Incidental findings as above with no evidence of pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: SOB Normal heart size with a mildly tortuous aorta.Interval clearing of right perihilar opacity which may have been due to infection or aspiration.No sign of pulmonary edema or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: cough, r/o pneumonia History: cough No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Borderline heart size.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: Fever in immunocompromised patient, r/o pneumonia History: Fever And is noted that the lateral aspect left hemithorax is not included on the image.Right central venous catheter with this tip in the SVC.No focal areas of consolidation.Stable cardiomediastinal silhouette.No pleural effusions.Changes of degenerative joint disease involving the right glenohumeral joint with possible intracapsular loose bodies.

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


Instruction: Generate impression based on medical findings.

Input: Altered mental status, evaluate shunt. SHUNT DEVICE: There is an intracranial shunt with its tip in the midline, extending through a right parietal burr hole and coursing along the soft tissues of the right neck, anterior chest, and entering the abdomen, coiled with its distal tip in the left abdomen. Portions of the shunt near the valve are radiolucent. No kinking or discontinuity is noted.SKULL: Previously seen scalp skin staples have been removed. Multiple dental fillings and implants. Punctate metallic density again projects in the region of the right cavernous sinus, unchanged.CERVICAL SPINE: Moderate to severe degenerative disc disease throughout the cervical spine. Mild facet osteoarthritis.CHEST: Left greater than right basilar airspace opacities appear somewhat similar to the prior chest radiograph.ABDOMEN: Bowel gas pattern is nonobstructive. A percutaneous feeding tube overlies the stomach.

Output: Intracranial shunt without evidence of complication. Additional findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male 76 years old Reason: eval lung fields History: Bilateral infiltrate, SOB, s/p cardiac surgery, CHF Right IJ sheath unchanged in position.Cardiomegaly and moderate bilateral pleural effusions with loculation or pleural thickening on the left are unchanged. Low lung volumes with persistent mid and lower lungs opacities and consolidation.

Output: No change in basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: lightheaded, nausea, cough History: same Mild cardiomegaly. No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: 43 y/o with uveitis, eval LAD or sarcoid changes History: 43 y/o with uveitis, eval LAD or sarcoid changes Probable nipple shadows in the lower thorax both demonstrating incomplete borders sign consistent with extrapulmonary opacities. Lungs are clear. No large pleural effusion or pneumothorax. Heart size at the upper limit of normal. No convincing evidence of lymphadenopathy on radiography.

Output: No convincing evidence of sarcoidosis on radiography. Probable nipple shadows within the lower thorax.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: s/p intubation History: s/p intubation Interval placement of endotracheal tube with tip approximately 5 cm superior to the carina.Cardiac silhouette at the upper limit of normal, unchanged. Minimal improvement of bilateral, right greater than left, interstitial and airspace opacities; favored to represent asymmetric pulmonary edema. Possible right pleural effusion less conspicuous on the current study. The left costophrenic angle is sharp. No pneumothorax.

Output: Interval ET tube placement. Minimal improvement of asymmetric pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Known metastatic lung ca, s/p thoracentesis, sleepy, r/o infection History: sleepy, SOB Low lung volumes. Left suprahilar opacity has increased in density since last study. Increase in left pleural effusion and diffuse left lung opacity. Likely unchanged heart size. Right lung remains clear. Port catheter, unchanged. No pneumothorax.

Output: Increased density of the left suprahilar opacity with increase in left pleural effusion and diffuse left lung opacity, likely related to patient's underlying metastatic lung cancer.


Instruction: Generate impression based on medical findings.

Input: Reason: cp History: cp Heart size but upper normal or mildly enlarged.Mild basilar scarring but no sign of CHF or active pulmonary disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: Eval for pneumothorax History: S/P Chest tube removal Cardiomegaly, status post sternotomy.No pneumothorax following chest tube removal.Mild basilar edema and small pleural effusions are unchanged.Right subclavian catheter, tip at SVC/RA junction level.

Output: Cardiomegaly with pulmonary edema, unchanged. Stable right subclavian catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: TRALI? History: hemothorax Interval intubation with tip 4 cm above the carina. Enteric tube courses below the field of view. AICD with leads are unchanged. Right lower lung chest tube now points superiorly. Otherwise, chest tubes are similar in location. LVAD device is unchanged. Swan-Ganz catheter tip is in the right main pulmonary artery. Radiopaque marker of a surgical sponge is seen adjacent to the LVAD, not seen prior radiographs.Moderate cardiomegaly. Interval improvement of bilateral pleural effusions now with small amount of residual fluid capping the left apex. No pneumothorax is evident. Bilateral patchy airspace opacities retrocardiac atelectasis suggestive of edema.

Output: 1.Interval improvement of bilateral pleural effusions with residual fluid capping the left apex. Improving edema pattern.2.Radiopaque marker of a surgical sponge is seen adjacent to the LVAD, not seen prior radiographs.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: productive cough w/cp History: chest pain Reticular opacities at the lung bases with small pleural effusions versus thickening. Normal heart size. Prominent central pulmonary artery. Probable COPD. No acute bony abnormality. No pneumothorax.

Output: Probable COPD.Basilar reticulation which is somewhat atypical for pulmonary edema though there are likely small pleural effusions versus thickening. Alternatively, this may represent atypical infection or pulmonary fibrosis (which would be consistent with combined pulmonary fibrosis and emphysema).Probable pulmonary hypertension.Recommendation: Consider correlation with high resolution chest CT if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.History of renal neoplasm, evaluate for metastatic disease. Stable mild cardiomegaly. Calcified hilar lymph nodes are present. Mild rightward tracheal deviation is unchanged. No focal airspace opacity, pleural effusion, or pneumothorax. No discrete lung nodules are identified.

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


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: evidence of infection History: AMS, leukocytosis Right chest port tip at the cavoatrial junction. Basilar streaky opacities consistent with subsegmental atelectasis. No specific evidence of infection. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unchanged.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: Evidence of pulmonary or skeletal pathology? History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Chronic fracture deformity of the right clavicle consistent with previous trauma.

Output: Old fracture deformity of the right clavicle and no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: assess swan History: as above Moderate cardiomegaly without acute edema or pleural effusions.Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery, pulled back from the prior position.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Chest pain evaluate lung fields. Normal heart size. The lung apices cannot be accurately assessed on the lateral radiograph due to summation artifact from overlying soft tissues. The remainder of the lungs are clear. No pleural fluid or pneumothorax.

Output: Frontal radiograph is unremarkable. The lateral radiograph is limited due to overlying soft tissue summation and the lung apices cannot be assessed.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: PRE Lung or Heart-Lung Transplant Evaluation History: PRE Lung or Heart-Lung Transplant Extensive emphysematous changes again noted within the lungs. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Extensive emphysema again noted. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for pneumonia History: hemoptysis after severe coughing episode. Also chest pain with cough, left mid-axillary Stable cardiomediastinal silhouette.No focal consolidation, sizable effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 88 year old female with mesothelioma, pancreatic mass CHEST:LUNGS AND PLEURA: Pleural thickening and nodularity in right hemithorax are again noted, with minimal increase inferiorly-posteriorly Reference measurements as below:At the level of the main pulmonary artery (series 5, image 39): 0 mm at 12 o'clock position (stable); 0 mm at 6 o'clock position (stable).At the level of the right inferior pulmonary vein (series 5, image 52): 12 mm at the 3 o'clock position (previously 13 mm); 5 mm at the 4 o'clock position (previously 4 mm).At the level of the coronary sinus (series 4, image 63): 8 mm at the 6 o'clock position (previously 6 mm). A similar mild increase in thickness is seen along the posterior aspect of the hemithorax at this level.Small amount of loculated fluid along the inferior-lateral aspect of the right hemithorax is now seen, with associated atelectasis. Resection line along the left lower lobe is also unchanged. The previously described subpleural nodule in the left lower lobe is no longer visualized as well, with residual pleural thickening in the place.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Soft tissue mass in inferior right chest wall measures approximately 30 mm, previously 32 mm (series 5, image 83). Fluid collection about left shoulder joint remains. ABDOMEN:LIVER, BILIARY TRACT: Stable hypoattenuating lesion in hepatic dome is unchangedSPLEEN: No significant abnormality noted.PANCREAS: Severe pancreatic ductal dilatation in the tail is again identified with associated atrophy, consistent with a stricture in the region of the body/tail. Multiple cystic lesions are reidentified within the pancreas. For example, cystic focus in the region of the uncinate process measures 2.4 x 1.9 cm (series 5; image 110), previously 2.2 x 1.9 cm. Smaller cystic focus in the pancreatic neck has decreased in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral benign renal cysts.The contents of the renal collecting systems demonstrate increased density bilaterally without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: Diffuse atherosclerotic disease.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Mild increase of disease in the right hemithorax (measurements provided).Stricture at the junction of the pancreatic body/tail, suspicious for malignancy. M.R.C.P. without and with contrast is suggested for further evaluation.Cystic lesions in the pancreas, one of which has increased and the other of which has decreased. The larger in the uncinate process definitively communicates with the pancreatic duct, suggestive of branch-type IPMNIncreased density of the renal collecting systems can be due to hemorrhage, possible debris. Correlation with urinalysis is suggested.


Instruction: Generate impression based on medical findings.

Input: Pulmonary edema and heart failure Persistent marked nonspecific cardiomegaly and small lung volumes. Mild motion artifact again limits sensitivity. Within these limitations, suspected patchy basilar changes representing edema are again observed, mildly improved but still concerning for questionable failure.

Output: Mild interval improvement in bilateral basilar pleural-parenchymal opacities previously observed again suggesting partially resolved pulmonary edema with small residual effusions


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: tachycardia History: sob No significant cardiopulmonary abnormality.Right subclavian catheter tip in SVC.Cholecystectomy clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old. Reason: icu History: shortness of breath Lines and tubes are unchanged. Resolution of right-sided pneumothorax. Otherwise no substantial change.

Output: Resolution of right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: pneumonia History: fever, cough, dyspnea Branching opacity in the left upper lobe which certainly could represent pneumonia. No large pleural effusion or pneumothorax. Normal heart size. No acute bony abnormality.

Output: Branch opacity in the left upper lobe suggestive of mucous plugging within dilated airways. Allergic bronchopulmonary aspergillosis is a distinct possibility. Given history of acute presentation, community-acquired pneumonia could also have this appearance. A central obstructing lesion such as carcinoid tumor with postobstructive bronchiectasis and mucous plugging is another possibility.Chest radiographic follow-up after treatment in 8 weeks is suggested to reassess this area. If this lesion does not resolve or markedly improved, further evaluation with contrast-enhanced chest CT is suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old. Reason: check pulmonary status History: check pulmonary status Status post median sternotomy.Cardiomediastinal silhouette is unchanged.Right greater than left layering pleural effusions are unchanged, with associated basilar atelectasis. No pneumothorax.

Output: Unchanged pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: Check Pulmonary Status History: Check Pulmonary Status ET tube tip approximately 1 cm above the carina with the neck in a flexed position..Right jugular catheter tip in the right atrium.Bilateral pleural effusions and basilar opacity compatible with edema and atelectasis.Interval resolution of subsegmental atelectasis in the right upper lobe.

Output: Pleural effusions and atelectasis with slightly increased right pleural effusion and clearing of right upper lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Cough with sputum evaluate lung fields. Patient rotation from scoliosis. Normal heart size. Hazy opacity in the periphery of the right upper lobe could be artifact of overlying soft tissue, inconclusive. No pneumothorax. No visible pleural fluid.

Output: Hazy opacity in the projection of the right upper lobe is suspicious for overlying soft tissue artifact rather than an intraparenchymal process. Suggest further evaluation with erect PA and lateral chest radiographs.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: infiltrate, edema History: PMH CHF, MI, CVA, DM p/w pleuritic chest pain Cardiac size is enlarged, similar to prior exam. Bilateral pleural effusions, right greater than left with adjacent opacities suggestive of underlying atelectasis and edema. Right effusion appears slightly decreased as compared to the prior exam. No pneumothorax.

Output: Bilateral pleural effusions, right greater than left and cardiomegaly, suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: ARDS. Intubation Motion degrades sensitivity. Streaky densities again suggesting atelectasis are observed greater both bases with mild cardiomegaly and questionable retrocardiac partial consolidation. Serial imaging is needed to confirm clearance.NG tube, suspected ETT and right jugular catheter have been placed, ETT terminating proximally 5 cm above the carina.

Output: ETT placed, otherwise limited exam. Serial imaging is needed to confirm a possible retrocardiac left lower lobe consolidation


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: s/p right lung biopsy History: s/p right lung biopsy Stable cardiac mediastinal silhouette.Extensive interstitial fibrosis and right pleural effusion similar in appearance to the prior exam.No new pulmonary opacities identified.No evidence of a pneumothorax post biopsy.

Output: No evidence of a pneumothorax post biopsy. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Status post TECAB evaluate for effusion and atelectasis. Low lung volumes with basal atelectasis and small right pleural effusion. Hiatal hernia. Subcutaneous emphysema left chest wall and neck. Interval removal of left-sided chest tubes with air along the chest tube tracts, but no significant pneumothorax. Thoracic kyphosis with multilevel vertebral body compression fractures in the lower thoracic spine.

Output: Mild to moderate basal atelectasis and small pleural fluid collections.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with lymphoma CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules, some of which are calcified are unchanged.MEDIASTINUM AND HILA: Stable fluid attenuation area in the prevascular space may represent fluid in the pericardial recess is unchanged and measures 21 x 25 mm image number 38, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable, small hypodense lesions in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: cardiomegaly, pneumonia, effusion History: hx of afib, had syncopal episode tonight. Improvement in left pleural effusion since 8/2015. There is persistent small left pleural effusion with probable left basilar atelectasis. No new focal lung consolidation. Unchanged cardiomegaly. No pneumothorax.

Output: Improvement in left pleural effusion since 8/2015. There is persistent small left pleural effusion with probable left basilar atelectasis. No new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Left anterolateral rib pain. Decreased lung volumes may be due to poor inspiration. Minimal basilar atelectasis.No focal airspace opacity pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.No displaced rib fracture is evident.

Output: Low lung volumes without acute cardiopulmonary abnormality or displaced rib fracture.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: ETT check ETT minimally retracted, tip projects 4 cm above the carina. ICD, NG and right jugular catheters are otherwise unchangedMild basilar atelectasis with persistent mildly decreased lung volumes.

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: 87-year-old male with history of leukocytosis. Evaluate for aspiration pneumonia. Interval replacement of enteric tube with tip terminating in the distal stomach. Interval placement of gastrostomy tube.Again seen is abrupt cut off of the left mainstem bronchus with associated complete opacification of the left hemithorax compatible with mucous plugging. Streaky opacities in the right lung likely represents scarring and atelectasis. There are calcifications of the thoracic aorta. The cardiomediastinal silhouette cannot be evaluated secondary to left hemithorax opacification.Pneumoperitoneum likely related to recent gastrostomy tube insertion.

Output: Interval placement of percutaneous G tube and enteric tube with tip terminating in the distal stomach. Persistent complete opacification of the left hemithorax secondary to left mainstem mucous plug.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: eval lung fields History: s/p CABG Interval removal of catheter sheath and chest tubes.Stable cardiomediastinal silhouette.Unchanged small left effusion.Slightly increased basilar atelectasis.

Output: Slightly increased basilar atelectasis. No pneumothorax or other significant pulmonary abnormality after removal of chest tubes and right IJ sheath.


Instruction: Generate impression based on medical findings.

Input: 51 year-old female with atypical chest pain. ACS workup, rule out acute pathology No focal airspace opacities.No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: OHT, SOB, evaluate for pneumonia. Sternotomy wire unchanged in position. Surgical clips project left chest wall. Cardiothoracic ratio similar to prior. No evidence of pulmonary edema. No visible airspace opacities to suggest pneumonia. No pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Intubated. Has left chest tube. Respiratory failure.VIEW: Chest AP (one view) 02/14/16, 0509 Endotracheal tube tip is between thoracic inlet and carina. Feeding tube tip is in second portion of duodenum. Right internal jugular line has its tip in superior vena cava. The lower extremity PICC tip is in the right atrium.Left chest tube remains in place. Left subpulmonic pneumothorax is unchanged. Apical, lateral, and anteromedial components are slightly decreased.Focal opacities are seen in right upper, right lower, and left lower lobes. Cardiothymic silhouette is normal in size.

Output: Decrease in left pneumothorax. Increase in opacities which are most likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: enlarged cardiac History: chest pain, SOB Coronary stent. Heart size normal. No acute cardiopulmonary abnormality. IVC filter partially visualized.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: aspiration pna? History: hypoxemia, recent eating Extensive opacification and volume loss in the right hemithorax consistent with known mesothelioma and possibly superimposed infection.Patchy and nodular airspace opacities in the left lower lung compatible with suspected aspiration pneumonia, mainly in the superior segment of the left lower lobe.No new findings.

Output: Extensive bilateral abnormalities compatible with known mesothelioma and aspiration pneumonia, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.History of fever and fatigue evaluate for infectious process. Left subclavian ICD and an LVAD appears similar in position. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed..Patchy nonspecific small opacities in the right lower lobe could be consistent with aspiration but should be followed to exclude infection or nonbenign pathology.

Output: Small patchy opacities are nonspecific in appearance and could be related to aspiration however follow-up PA and lateral chest radiographs are suggested to exclude development of infection or nonbenign pathology. Given presence of intracardiac devices, correlation with blood cultures to exclude possibility of septic emboli may be obtained if required.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with esophageal cancer with progression recently to the bones. CHEST:LUNGS AND PLEURA: New right upper lobe micronodule (axial image 20/101). Left lower lobe nodule likely representing an intrapulmonary lymph node is unchanged (axial image 46/101). No focal consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: Referenced right paratracheal lymph node is slightly smaller measuring 1.3 x 1.1 cm on axial image 33/138 (compared to 1.3 x 1.2 cm on the prior exam). A left paratracheal lymph node is also slightly smaller measuring 1.2 x 1.1 cm on axial image 30/138 (previously measured 1.5 x 1.0 cm). A subcarinal lymph node is smaller measuring 2.0 x 1.8 cm on axial image 47/138 (previously measured 2.5 x 1.4 cm).Left-sided Port-A-Cath in place with its distal tip in the SVC.Cardiac size is normal with no pericardial effusion.CHEST WALL: Multiple foci of bony metastases are re-identified. A right lateral rib metastatic lesion has increased in size and measures 5.0 x 3.2 cm on axial image 59/138 (compared to 2.4 x 4.8 cm on the prior exam). New pathologic fracture within an upper thoracic vertebral body (coronal image 49/125). Multiple lytic lesions within the vertebral bodies appear slightly larger.ABDOMEN:LIVER, BILIARY TRACT: Small hypoattenuating liver lesions are unchanged. Gallbladder sludge noted.SPLEEN: No significant abnormality notedADRENAL GLANDS: Slight thickening of the left adrenal gland is not significantly different when compared to the prior exam considering differences in slice selection and technique.KIDNEYS, URETERS: Multiple hypoattenuating lesions in both kidneys are unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Gastrohepatic lymph node is unchanged measuring 1.2 x 1.3 cm on axial image 89/138.Mural thrombus and atherosclerotic calcifications within the abdominal aorta are unchanged (axial image 125/138).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Progression of bony metastatic disease as above.OTHER: No significant abnormality noted

Output: 1.Referenced lymph nodes have decreased in size slightly.2.Slight progression of bony metastatic disease.3.Stable liver and renal lesions.


Instruction: Generate impression based on medical findings.

Input: Reason: balloon pump placement History: HF with mech circulatory support Aortic balloon catheter marker at the level of the aortic arch. ICD leads unchanged.Heart size about upper normal with no sign of CHF.

Output: Balloon pump catheter in the descending aorta, unchanged.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with history of thyroid cancer. Compare to previous measurements please. CHEST:LUNGS AND PLEURA: Growing left pleural effusion with new large right pleural effusion.Continued interval increase in number and size of metastatic lesions, particularly in the left lung. Pleural-based metastases are also more prominent than before.Right perihilar mass (series 5, image 51) measures 33 x 31 mm; previously measuring 31 x 27 mm.Previously referenced left lower lobe nodule is not discretely visualized and is probably now confluent with new extensive left pleural-based lesion (series 5, image 71); it is not discretely measurable.New consolidation of the right middle lobe along the major fissure is also noted (series 5, image 73).MEDIASTINUM AND HILA: Several prominent mediastinal lymph nodes are again noted with reference right hilar lymph node (series 3, image 55) measuring 20 x 25 mm; previously measuring 16 x 24 mm.Moderate coronary artery calcifications are again noted. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Multiple hypoattenuating liver lesions are reidentified.

Output: Interval progression of metastatic disease with new large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: iABP History: as above No significant pulmonary or pleural abnormality.IABP catheter marker 6 cm below the top of the aortic arch.New right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery.Left PICC, tip in the SVC.

Output: New Swan-Ganz catheter, tip in interlobar pulmonary artery.IABP catheter tip 6 cm below the top of the arch.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: check pulmonary status History: check pulmonary status Right basilar consolidation with a right pleural effusion, and the suggestion of mild left basilar edema, not significantly changed.Mild cardiomegaly.Right jugular catheter tip at right atrial level.

Output: Unchanged pulmonary opacities and pleural effusions with mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Bladder neoplasm follow-up after cystectomy and left nephrectomy for urothelial carcinoma. Normal heart size. No visible lymphadenopathy. No specific signs of pulmonary edema. No focal airspace opacities to suggest pneumonia.

Output: No visible signs of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: S/p AVR, MVR with Atrial pacing History: 4L NC O2 requirement Swan-Ganz catheter is been removed, jugular introducer sheath in right jugular vein. Other support hardware stable.No change in perihilar and basilar opacities

Output: No change in perihilar and basilar opacities


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Any progression of aneurysm/stenosis since previous MRA studies History: Takayasu's. Severe anemia. Fatigue Please note that only the proximal cervical vessels are visualized.Conventional anatomy of the aortic arch. The origins of the great vessels are patent. The visualized carotid arteries are grossly patent without evidence of stenosis or aneurysm. The vertebral arteries are not well visualized, likely technical. Multilevel areas of narrowing and dilatation of the subclavian arteries appear similar to the prior exam, however please see separate MRA chest report for further details.

Output: 1.Limited MRA of the lower neck without stenosis or aneurysm of the proximal carotid arteries.2.Multifocal dilatation and stenosis of the subclavian arteries bilaterally appears similar to the prior exam, however for further details of findings in the chest and abdomen, please see separate reports.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old. ET tube is in place with its tip 1 cm above the carina.Left IJ venous catheter with its tip at the SVC/innominate junction.There are decreased lung volumes with stable cardiomediastinal silhouette.Perihilar/basilar opacities are compatible with atelectasis.No new pulmonary opacities identified.

Output: Interval reintubation with the ET tube tip 1 cm above the carina. Stable cardiopulmonary appearance with perihilar/basilar opacities compatible with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for evidence of infection - 58 yo M w reported h/o EtOH abuse and cirrhosis transferred for management of AMS and reported UGIB History: altered mental status, diffuse anasarca Small lung volumes with opacity at the left base suggestive of pleural effusion and underlying atelectasis.No specific evidence of pneumonia.

Output: Left pleural effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: r/o pneumonia History: hypoxia Heart size upper normal, status post median sternotomy.Mild interstitial edema with small pleural effusions unchanged.

Output: Mild interstitial edema with small pleural effusions consistent with CHF/hypervolemia. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: concern for volume overload, evaluate for etiology of chest pain that patient confused with shock History: as above Moderate cardiomegaly.Mild interstitial opacities suggestive of edema.No specific evidence of infection.Left subclavian ICD, leads unchanged in position.

Output: CHF with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: Patient with bilateral pleural effusions R>L on prior XR. s/p diuresis with 4L removed. Please re-eval effusions and if R. Effusion still present History: effusions Pleural effusions and basilar consolidation have improved. Mild to moderate cardiomegaly is present.Upper abdominal drainage catheters remain although the NG tube is been removed.

Output: Interval improvement in pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: Chest pain in LVAD patient with elevated troponin at OSH History: As above Median sternotomy, heart size upper normal.Minimal pleural effusions and basilar opacities, improved.LVAD and ICD are unchanged.Prior left jugular catheter no longer present.

Output: Unchanged support devices. Very small pleural effusions noted.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Swan-Ganz line evaluation Right IJ Swan-Ganz catheter tip in the right main pulmonary artery. Patient is status post sternotomy. Surgical clips overlie the mediastinum. Stable cardiomegaly. Stable low lung volumes. Bilateral basilar patchy opacities and pleural effusions, left greater than right. No pneumothorax.

Output: Unchanged patchy bilateral basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: ? worsening fluid overload History: as above Left-sided ICD and LVAD unchanged.Stable cardiac enlargement.Mild interval improvement in the perihilar edema.No new pulmonary opacities noted.Median sternotomy is intact.

Output: Stable cardiomegaly with minimal improvement in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Rule out rib fracture. Fall. Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended.Mild cardiomegaly. Valve prosthesis. Sternal wires, the fourth sternal wire is discontinuous.Bronchial wall thickening and peribronchial opacity nonspecific but may be the result of aspiration. No pneumothorax or pleural fluid.Abnormal bone density value.Mild loss of vertebral body height.

Output: Mild cardiomegaly, prominence of the central pulmonary vasculature and nonspecific bronchial wall thickening. If there is clinical suspicion for rib fracture, dedicated series would be suggested.


Instruction: Generate impression based on medical findings.

Input: 1 year old male patient with hemophilia. Assess PAC line placement.VIEWS: Chest AP/lateral (two views) 4/15/2015 Right chest port catheter tip is in the right atrium. The cardiac silhouette size is normal. No focal lung opacity, pleural effusion, or pneumothorax is identified. Peribronchial thickening is noted.

Output: Right chest port catheter tip in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluating for etiology of shortness of breath History: shortness of breath Small lung volumes with diffuse interstitial edema and moderate pleural effusions, not significantly changed.Cardiac silhouette is grossly within normal limits allowing for under inflation.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: pneumothorax; post-device placement in EP Lab History: s/p device placement in EP lab Left subclavian ICD lead and generator in place.Cardiac size is within normal limits. Apparent mediastinal widening may be artifact of rotation.Decrease in left layering pleural effusion. No evidence of pneumothorax. No focal pulmonary opacity.

Output: No evidence of pneumothorax. Decreased left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Dyspnea, history of COPD evaluate for pneumonia. Heart size is at least upper normal, unchanged. Tortuosity of the thoracic aorta, similar to previous. No specific evidence of CHF. No focal airspace opacities. Minimal atelectasis or scarring at the lung bases.

Output: Minimal basal atelectasis or scarring, but no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with pain and purulent drainage with right chest wall hematoma, site of port removal There is a heterogenous, loculated fluid collection of the right chest wall measuring 4.6 x 2.6 x 4.3 cm.

Output: Heterogenous, loculated fluid collection of the right chest wall, likely corresponding to right chest wall hematoma seen on prior CT study.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 2 cm above the carina.Catheter tip in the SVC.Cardiomegaly with bilateral opacity compatible with pulmonary edema, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: Bronchitis, COPD History: Chronic Normal chest.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: lung collapse History: chest pain Minimal bibasilar atelectasis. No evidence of focal consolidation to suggest infection. No evidence of pleural effusion or pneumothorax.Cardiomediastinal silhouette is within normal limits.Unchanged dextroscoliosis.

Output: Minimal bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: eval for pneumonia, whitish sputum, sob, tachypnea History: sob 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: Reason: PNA History: Tachy Right hilar and paramediastinal opacity, of uncertain etiology and chronicity, possibly related to previous radiation therapy for lymphoma if the history is compatible.Normal heart size.Small right and minimal left pleural effusion.No specific evidence of pneumonia.

Output: Right hilar and suprahilar opacity possibly related to previous radiation therapy. Erect PA and lateral radiographs and comparison with any available outside imaging studies would be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Confirm PICC placement History: NA Interval placement of right upper extremity PICC with tip in the superior vena cava. No pneumothorax. Moderate cardiomegaly, pulmonary edema, and small effusions appear similar compared to prior exam. Note that the left cardiophrenic angle is incompletely imaged.

Output: PICC tip in the superior vena cava without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 64 year old female with history of esophageal cancer, status post resection CHEST:LUNGS AND PLEURA: Previously described subcentimeter nodule along the left major fissure is not well seen on today's study. Subsegmental atelectasis in the left lower lobe adjacent to the gastric pull-through posteriorly. Small focal area of groundglass opacity in the left upper lobe and left apical scarring unchanged.MEDIASTINUM AND HILA: Postsurgical changes secondary to gastric pull through surgery. Index precarinal node is slightly smaller measuring 1.3 x 0.5 cm on image number 37, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific a hypodense lesion in the left lobe on image number 82, series number 3. Another punctate hypodense lesions on image number 101, series number 3 and image number 112, series number 3 are stable. Geographic hypodensity within the left lobe of the liver best seen on image number 103, series number 3 likely represents postsurgical changes. Subcentimeter hypodense lesion at the tip of the left lobe on image number 96 on series number 3 also likely represents postsurgical changes.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: Small retroperitoneal lymph nodes are grossly unchanged. Index left para-aortic node measures 1.3 by 1.2-cm image number 114, series number 3, unchanged.BOWEL, MESENTERY: Interval resection of the distal esophagus with gastric pull-through. Previously measured index lymph nodes are not visualized. No evidence of enlarged lymph nodes in the upper abdomen. Ill-defined soft tissue around the celiac axis is nonspecific and needs to followed up to exclude recurrent tumor.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Index left common iliac lymph node measures 9 by 8 mm in image number 135 of series number 3 smaller compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval resection of patient's esophageal cancer. Some of the index lymph nodes are not visualized and some of the more slightly smaller. Follow-up CT is recommended for retroperitoneal lymph nodes.Nonspecific hypodense lesions in the liver which are more likely to be benign.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: chest pain History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Cervical spine stabilization hardware.GE junction surgical clips probably from fundoplication.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 85M with esophageal stent for strictures s/p EGD revealing a TEF during bronchoscopy s/p stent placement History: R/o aspiration pneumonia Poorly defined air space and interstitial opacity in the left upper lobe, of uncertain chronicity but compatible with aspiration.Large lung volumes suggestive of emphysema.Stents in the upper and mid esophagus. Normal heart size with an extensively calcified aorta.

Output: Left upper lobe opacity of uncertain chronicity but compatible with aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: evaluate for volume overload, hx of CHF History: as above Slightly increased basilar opacities could be an artifact of under inflation or early edema.Heart size is at least upper normal.No specific evidence of infection.

Output: Possible edema or underinflation artifact. No specific evidence of infection.