Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: asthma exacerbation History: wheezing Small lung volumes with perihilar bronchial wall thickening.Heart size normal.No evidence of infection or atelectasis.

Output: Perihilar bronchial wall thickening consistent with asthma, without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.S.O.B., pneumonia follow up. Perforation of esophagus history. Tubes and lines unchanged in position.Moderate left pleural fluid collection with a small subpulmonic pneumothorax, minimally improved. Interstitial opacities in the left lung appear to be improving. Patchy consolidation however is unchanged.Opacification on the right presumably due to fluid loculated in the major fissure and adjacent compressive atelectasis, unchanged. No pneumothorax on the right.

Output: Small left pneumothorax with air space opacities and consolidation on the left unchanged but interstitial opacities are improving.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Shortness of breath. No focal airspace opacity, pleural effusion, or pneumothorax. Calcified left lower lobe granuloma.The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary process. 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, 63 years old.Reason: s/p lung transplant History: lung txp Clamshell sternotomy for bilateral lung transplant.Unchanged basilar interstitial opacities and pleural effusions right larger than left.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with history of osteosarcoma (2003), rectal carcinoma (2010), chronic renal insufficiency. Left lung nodules. Preoperative CT. CHEST:LUNGS AND PLEURA: Lingular mass with dense central calcification (series 5, image 37) measures 22 x 18 mm (stable). Left lower lobe partially calcified mass (series 5, image 56) measures 14 x 12 mm (stable).Ill-defined ground glass nodular opacities in the lung apices as present on 2005 examination are again possibly smoking-related and are unchanged. Largest lesion in the left apex (series 5, image 21) measures 8 mm. Centrilobular emphysema.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes, unchanged. Heart size normal without pericardial effusion.CHEST WALL: Presumed exostosis of the left sixth rib, unchanged since June 2003. UPPER ABDOMEN: Benign-appearing renal cysts.

Output: Two calcified left lung masses again consistent with metastatic osteosarcoma without significant change since prior exam from June 2011. Multiple ground glass nodules in the lung apices likely related to smoking, the largest of which measures 8 mm and may represent atypical adenomatous hyperplasia.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumonia? History: febrile Small right upper lobe cavitary lesion and surrounding interstitial opacity, better shown on the CT scan of the previous day.PICC tip in the left axilla.No other significant findings.

Output: Right upper lobe cavity and interstitial opacity with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval PNA History: cough, SOB, CP Heart size upper normal.Possible small effusions on the lateral view, but no sign of edema or pneumonia.

Output: Heart size upper normal, but no sign of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: see below History: sickle cell, sob -- concern for acute chest -- assess progression of RLL opacity post-abx and blood transfusion Slight increase in right basilar opacity which may be due to superimposed edema, effusion or atelectasis.

Output: Slight increase in right basilar opacity which may be due to superimposed edema or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: assess for cardiac volume status History: complete heart block The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: r/o acute process History: fever Lateral radiograph is limited by motion artifact. Superior most sternotomy wire is fractured, new from previous study. Mild left basilar subsegmental atelectasis or scarring. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: Superior most sternotomy wire is fractured, new from previous study. Clinical correlation suggested to assess for any localized pain in this area.


Instruction: Generate impression based on medical findings.

Input: LVAD placement LVAD and ICD appear unchanged. Underlying or new pulmonary appearance is also similar with an elevated left hemidiaphragm and mild asymmetric lung volumes. No discrete superimposed new air space process observed

Output: No acute new disease. Hardware unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: reassess swan position History: as above Moderate cardiomegaly status post sternotomy.Questionable lower lung zone edema with subsegmental atelectasis.IABP catheter tip at the level of the arch.IVC Swan-Ganz catheter tip in right interlobar pulmonary artery.Right jugular catheter tip at cavoatrial junction.

Output: Unchanged support devices. Cardiomegaly with the suggestion of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval for fluid overload, pna History: as above No change in the degree of mild cardiomegaly with bilateral pulmonary opacities likely representing pulmonary edema.

Output: No change in the degree of mild cardiomegaly with bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: eval for effusion History: chest pain Cardiac leads, unchanged. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: pna History: chest pain, pleuritic, reproducible Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Patient status post cholecystectomy. Patient status post sternotomy and CABG.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: 75F s/p VHR with separation of components and mesh, + vaginectomy by Gyn on 11/24 now with n/v, ? ileus v obstruction History: nausea vomiting Cardiomediastinal silhouette is within normal limits. No pleural effusion or pneumothorax. No pulmonary consolidation.There are prominent air-filled loops of small bowel measuring up to 5.3 cm in diameter. Air and stool are seen within the colon. These findings may represent developing or partial small bowel obstruction. Midline abdominal/pelvic staples are again seen. Degenerative disease affects the spine.

Output: There are prominent air-filled loops of small bowel measuring up to 5.3 cm in diameter. Air and stool are seen within the colon. Findings suspicious for developing or partial small bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with non-small cell lung cancer status post chemo/XRT presenting with acute dyspnea and hypoxemia. PULMONARY ARTERIES: Slightly limited examination secondary to motion artifact, but no evidence of pulmonary embolus to the segmental level. Enlargement of bilateral main pulmonary arteries is unchanged. Abrupt attenuation of the left main pulmonary artery likely reflects tumor thrombus and is grossly unchanged.LUNGS AND PLEURA: Paramediastinal fibrosis is unchanged reflecting prior radiation therapy.Interval progression of right lung interstitial opacities with scattered foci of airspace opacity likely reflects some component of pulmonary edema. However, additional etiologies such as lymphangitic spread of tumor and infection should also be considered.New right upper lobe nodular opacity measures 8 mm in longest dimension on axial image 54/143.Interval resolution of right pleural effusion.Significant volume loss on the left with near complete opacification of the left lower lobe is reidentified. Previously noted enhancing masses in the left lower lobe are again identified. Differences in technique prevent accurate measurement. However, tumor bulk on the left appears grossly unchanged. MEDIASTINUM AND HILA: Small mediastinal lymph nodes show no significant change. Cardiac size is enlarged with a moderate pericardial effusion which has improved from the prior exam.CHEST WALL: Tumor invasion of the left lateral ribs (axial image 152/286) has progressed. The thoracic spine is scoliotic.UPPER ABDOMEN: The left adrenal gland appears thickened, although evaluation of the abdomen is limited secondary to the PE protocol technique.

Output: 1.No PE to the segmental level.2.Stable left pulmonary artery tumor thrombus.3.Interval development of right lung interstitial and air space opacity which may reflect edema as well as lymphangitic tumor spread or infection.4.New right upper lobe nodular opacity.5.Grossly stable left lower lobe tumor bulk with progression of adjacent rib invasion.6.Question of left adrenal thickening as above.A preliminary interpretation of this examination was provided to the clinical service by the radiology resident on call. No significant discrepancy between preliminary and final interpretation.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of urothelial carcinoma CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter nodule image number 17, series number 7 in the left upper lobe.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: 11-mm hypodense lesion in the anterior aspect of the left lobe of the liver like representing a cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral scarring involving both kidneys. Bilateral punctate stones. Left-sided double J stent extending from the left renal collecting system to the bladder.3.2 by 1.7-cm cystic lesion with thin septations in the upper pole of the left kidney. Smaller benign-appearing cysts are also present in the left kidney.Multiple benign-appearing cysts involving the right kidney.There are focally dilated calices and calyceal diverticula associated with parenchymal scarring in the upper and lower poles of the right kidney and upper and midportion of the left kidney. In addition there are multiple punctate foci of contrast within the papilla of the right kidney as seen on coronal delayed images number 37, suspicious for multifocal papillary necrosis.There is an enhancing mass involving the lower pole calyx of the left kidney measuring approximately, 2.6 x 2 cm consistent with transitional cell carcinoma.There are also bilateral subcentimeter hyperdense foci which cannot be optimally characterized and may represent small complex cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral nephrolithiasis.Enhancing mass in the left lower pole collecting system consistent with transitional cell carcinoma.Bilateral irregularly dilated calices associated with calyceal diverticula and parenchymal scarring. Possible multifocal papular necrosis involving the right kidney. These changes can all be secondary to chronic infection.Bilateral renal scarring.


Instruction: Generate impression based on medical findings.

Input: 2-day-old infant, previously 34 weeks gestation, with suspected infection.VIEW: Chest and abdomen AP (2 views) 9/4/2015 18:10 UVC tip is in the high right atrium.The cardiac silhouette size is at the upper limits of normal. Minimal bilateral hazy opacities are seen in addition to large lung volumes. The patient has been extubated.Gaseous distended loops of bowel are seen in a disorganized pattern.

Output: UVC tip in the high right atrium.


Instruction: Generate impression based on medical findings.

Input: Reason: f/u chest tube removal and neck incision History: same Nonspecific retroareolar cardiac left lower lobe consolidation with atelectasis and small pleural effusions, not significantly changed.NG tube tip in the gastric interposition.Port catheter with its tip in the area of the SVC/RA junction.

Output: Basilar opacities and pleural effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia Persistent large hilar pleural effusions greater on the right with underlying edema-like changes. Please see subsequent report

Output: Large bilateral pleural effusions, essentially unchanged


Instruction: Generate impression based on medical findings.

Input: 40-year-old female who had stress thallium in 6/08 with increased uptake in bilateral axilla. LUNGS AND PLEURA: No suspicious pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: Normal cardiac size. No pericardial effusion. No significant hilar lymphadenopathy.CHEST WALL: There is symmetric thickening of the skin overlying both axillae. No significant axillary lymphadenopathy. Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: No significant abnormality noted.

Output: Symmetric skin thickening overlying the axillae which may be related to cellulitis or hidradenitis.


Instruction: Generate impression based on medical findings.

Input: Reason: 59 y/o asthma with URI symptoms History: cough, congestion Unremarkable cardiac and mediastinal silhouette. Large lung volumes consistent with asthma.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: chest pain History: chedt pain Right Port-A-Cath with its tip in the SVC. Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.Again noted are multiple ribs with sclerosis compatible with osteoblastic metastases in this patient with known prostate carcinoma.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalites identified without interval change. Multiple ribs with osteoblastic metastases.


Instruction: Generate impression based on medical findings.

Input: 26 year old male with history of giant cell tumor of the distal right femur. Evaluate for metastatic disease. There is a nodular opacity which measures 12 mm in diameter projecting over the heart on the lateral view in addition to several questionable nodules noted on both the PA and lateral views.Heart size is normal.No pleural effusion or pneumothorax.

Output: Nodular opacities, which, in view of the patient's history, may represent metastatic disease. Recommend chest CT for further evaluation if one has not been obtained elsewhere in the recent past.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Infiltrate? Aspiration? ET tube placement? History: Hypoxemia No acute abnormality.ET tube tip approximately 5 cm above the carina.Left jugular catheter tip in left brachiocephalic vein near the midline.

Output: No acute abnormality. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA, effusion History: fatigue cough Unremarkable cardiac and mediastinal contours with a tortuous calcified aorta compatible with age.Large lung volumes with no sign of pneumonia or CHF.Mild scarring or atelectasis medially in the left lower lobe.Skin folds of the right lung but no pneumothorax.Large calcification projected over the left upper quadrant of the abdomen of uncertain significance.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Acute chest, S.O.B. and cough. Mild cardiomegaly. Scarring in the lower lung field, right greater than left. Hazy perihilar and basal groundglass opacity suggestive of acute edema. Right lower lobe air space opacity suspicious for acute chest.

Output: Right lower lobe air space opacity suspicious for sequela of acute chest. Groundglass opacities and cardiomegaly, most suggestive of acute pulmonary edema, though viral or other atypical infection may produce this appearance. Suggest short-term plain film follow-up.


Instruction: Generate impression based on medical findings.

Input: Age: 18 yearsGender: FemaleReason for Study: Reason: intubated History: as above ET tube, Dobbhoff tube, and left IJ venous catheter unchanged.Cardiomediastinal silhouette is unremarkable.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with chest pain and history of lung cancer. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study diagnostic the level of the subsegmental pulmonary arteries.LUNGS AND PLEURA: Significant upper lobe predominant centrilobular emphysema with scattered areas of chronic interstitial fibrosis and mild bronchiectasis. More focal areas of consolidation are seen in the left upper lobe (series 7, image 35) and right lower lobe (series 7, image 94); which may represent acute infection or scarring.Marked bronchial wall thickening.Scarlike opacity seen at the site of a previously described right lower lobe mass.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Chest wall soft tissue mass eroding the seventh left rib laterally (series 5, image 172) measures approximately 2.5 x 4.2 cm in the axial plane. It does not appear to be pulmonary in origin.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Left chest wall mass eroding the seventh rib laterally. Differential considerations include myeloma versus metastasis.2. Emphysema and chronic interstitial fibrosis with more focal areas of consolidation, which may represent acute infection versus scarring.3. No PE. Study diagnostic to the level of the subsegmental pulmonary arteries.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval for infil History: cough for 2 weeks, former smoker Mild bronchial wall thickening with lingular atelectasis may represent bronchitis or asthma. No evidence of pneumonia or pulmonary edema. Heart size is upper limits normal. The results were communicated to the nurse practitioner in the emergency room.

Output: Bronchial wall thickening which can be seen in the setting of bronchitis or asthma. No focal pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: 55 year old female with increased respiratory rate, eval for infiltrate History: increased respiratory rate Improving left basilar opacity, which may been infection or atelectasis from mucous plugging.Moderate cardiomegaly.Tracheostomy tube tip 6 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Improving left base opacity with no new findings.


Instruction: Generate impression based on medical findings.

Input: Reason: trach History: trach Tracheostomy tube and venous catheter unchanged.Diffuse nonspecific airspace opacity suggestive of edema.No new findings.

Output: Diffuse airspace opacities suggestive of edema without significant change.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Swan-Ganz again projects into the right pulmonary outflow tract. Left jugular catheter and tracheostomy tube are all otherwise similarIABP remains unchanged in position, measuring 4 cm from the aortic archMild cardiomegaly with otherwise unchanged persistent chronic interstitial changes and suspected mild edema with small to moderate effusions

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Gift of hope evaluation Tracheostomy tube tip approximately 3.5 cm from the carina. Right IJ tip in the right atrium. Bilateral moderate to large pleural effusions with diffuse scattered patchy pulmonary opacities. Cardiomediastinal silhouettes is within normal limits. Rightward curvature of the thoracic spine again noted.

Output: Bilateral moderate to large pleural effusions with diffuse scattered patchy pulmonary opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: fever History: fevers and labored breathing Unremarkable cardiac and mediastinal silhouette. Bilateral lower zone reticular interstitial opacities and bronchial thickening of uncertain chronicity, not typical of pulmonary edema.Probable small right pleural effusion.

Output: Bilateral lower zone interstitial opacity of uncertain etiology and chronicity. Differential diagnosis includes viral pneumonia and drug reaction. If findings do not resolve promptly a CT scan is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: chest pain, eval for fluid overload/PNA History: chest pain, eval for fluid overload/PNA No pleural effusion or pneumothorax. No focal pulmonary abnormality. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality. No specific findings of infection or edema as clinically queried.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: IABP in place History: As above Tip of IABP is approximately 4 cm below the top of the aortic arch.Stable position of ICD and sternotomy wires.Stable position of tracheostomy tube.And pulmonary opacities suggesting pulmonary.No evidence of pneumothorax.

Output: Stable line position. Stable pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.History: Dyspnea. Unremarkable cardiomediastinal silhouette.No focal pulmonary opacity.No pneumothorax or pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: SOB s/p thora on 11/18 with pleural effusion History: SOB Enteric tube place with the tip coursing below the image.Cardiac silhouette is mildly enlarged, unchanged.Low lung volumes with unchanged bibasilar atelectasis and moderate to large left pleural effusion.No pneumothorax.

Output: No change in low lung volumes with basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male; 68 years old. Reason: assess for PNA or other cause of left sided CP History: left sided chest pain/pressure Cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: MaleReason for Study: Reason: IJ placement - patient agitatd in bed and pulled out line partially History: see above IJ venous catheter with its tip in the IJ.Stable cardiac enlargement with interval increase in perihilar interstitial air space opacities compatible with edema.Left retrocardiac consolidation/atelectasis and pleural effusions similar in appearance exam.

Output: Right IJV venous catheter retracted with its tip now in the internal jugular vein. Increasing pulmonary opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Fever. There is a new large left-sided pleural effusion with overlying consolidation/atelectasis. The left cardiac silhouette is obscured.

Output: New large left pleural effusion with overlying consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Swan repositioned. Swan-Ganz catheter from an IVC approach; the tip has not changed in position located peripherally in the right upper lobe. No pneumothorax. Cardiomegaly. Left subclavian stent.

Output: Unchanged position of peripheral Swan-Ganz catheter tip which projects into a distal branch of the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: Cardiomegaly, pulmonary edema History: 65YOM admitted to MICU for shock, cardiogenic vs. septic ET tube, NG tube, left IJ venous catheter unchanged.Stable cardiac enlargement with increasing pulmonary opacities and pleural effusions compatible with CHF.Basilar atelectasis.

Output: Increasing pulmonary opacities and pleural effusions compatible with worsening CHF.


Instruction: Generate impression based on medical findings.

Input: Tachycardic status, now post chest tube removal Multiple pulmonary nodules, similar to prior. Mild to moderate interstitial edema partially loculated appearing moderate right pleural fluid collection about the same. No significant sized pneumothorax. Tubing overlying the right chest wall presumably external to the patient.

Output: No significant sized pneumothorax. Moderate interstitial edema. Unchanged pleural fluid and poorly defined pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Reason: fever History: fever Elevated right hemidiaphragm with mild basilar opacity compatible with atelectasis and possibly pleural effusion.No new findings.

Output: Mild atelectasis and small effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: "ETT" check. Altered mental status Unchanged mixed and largely interstitial opacities suggesting probable edema with potential aspiration. Again no distinct superimposed focal findings to suggest infection however serial imaging is needed to ensure clearance.Cardiac images sound contours are grossly within limits given technique

Output: Unchanged nonspecific and largely interstitial opacities


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Fever and cough evaluate for pneumonia. Normal heart size. No evidence of pneumonia. No focal airspace opacities, pleural fluid or pneumothorax. Degenerative changes spine, most severe at T11/T12.

Output: No signs of pneumonia or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Metastatic gastric cancer. CHEST:LUNGS AND PLEURA: Centrilobular emphysema, unchanged. No new nodules to suggest metastatic disease. MEDIASTINUM AND HILA: 1 cm thyroid nodule in the isthmus. Small mediastinal nodes. stable pericardial thickening.CHEST WALL: Bilateral axillary adenopathy. Reference left axillary node measures 13 x 12 mm on image number 18/221, smaller compared to previous CT.ABDOMEN:LIVER, BILIARY TRACT: Possible, benign hypervascular lesion in the left lobe is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive retrocrural, retroperitoneal and mesenteric adenopathy surrounding the distal stomach and periportal region. Index perigastric node now measures 4.1 x 1.9 cm on image number 104/221.BOWEL, MESENTERY: Stable stent in the distal stomach with gastric wall thickening consistent with patient's known history of gastric cancer. Peritoneal soft tissue thickening in small nodules increase in size consistent with peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Slight increase in the size of the ascites. Small fat containing umbilical hernia.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic adenopathy, unchanged. Reference right inguinal lymph node measures 17 x 11 mm image number 183/221.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the axillary adenopathy and upper abdominal adenopathy. Stable gastric mass.Interval increase in the ascites and peritoneal carcinomatosis.


Instruction: Generate impression based on medical findings.

Input: 85-year-old male with non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Scattered micronodules in the right lower lobe are unchanged. Some of the calcified.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable hepatic cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate bilateral renal stones without evidence of hydronephrosis. Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable soft tissue mesenteric infiltration,, slightly increased in size compared to previous CT now it measures 7.2 x 2.4 cm image number 118, series number 6.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple sigmoid diverticuli associated with slight wall thickening and pericolonic fat stranding consistent with acute diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal increase in the size of the mesenteric soft tissue infiltration.Acute diverticulitis.Bilateral nephrolithiasis without evidence of hydronephrosis, unchanged.Patient`s nurse Kathy was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: PNA, effusions, mass History: SOB, hx of pulmonary fibrosis 2/2 asbestos with right pleural plaque Calcified pleural plaques.Mild hyperexpansion consistent with COPD.Heart size normal.Right infrahilar fullness probably vascular.

Output: Prior asbestos exposure with calcified pleural plaques. COPD. No other significant abnormality, although if there is a high index of suspicion of a mass a thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Evaluate for ET tube, nurse states it was pulled 2 cm while cleaning him History: pls see above Unchanged mild interstitial opacities suggestive of atypical edema or infection/aspiration, unchanged.ET tube has been partially withdrawn, now 8 cm above the carina with the cuff in the vocal cord region. A follow-up radiograph has been obtained.An NG tube extends below the lower margin of the image.

Output: Very high ET tube. Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: s/p thoracocentesis, R/o pneumothorax History: shortness of breath Status post thoracentesis with decrease in left pleural effusion. No pneumothorax. Small right pleural effusion, decreased. Support devices are unchanged.

Output: Status post thoracentesis with interval decrease in pleural effusions. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: ett History: ett Tracheostomy tube in place and enteric tube traversing the esophagus.Patchy bilateral airspace opacity suggestive of pneumonia with no acute change.Probable small pleural effusions.

Output: Patchy airspace opacities suggestive of pneumonia with no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval position of ETT History: ETT repositioned ET tube tip approximately 1 cm above the carina.Diffuse nonspecific airspace and interstitial opacity, without significant change.

Output: Interval adjustment of ET tube with the tip about 1 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: SOB History: above Small lung volumes with high diaphragms and basilar atelectasis.Nonspecific patchy opacities may be present.Heart size upper normal.

Output: Nonspecific pulmonary opacities with small lung volumes. A more recent CT has been performed.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: DEVICE History: DEVICE Moderate cardiomegaly.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.

Output: Left subclavian ICD, leads unchanged in position. No pneumothorax following recent placement.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: eval acute process History: left lower rib pain Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities. The left lower ribs are not completely included in the field of view.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Status post VATS for lung mass. Large mass inseparable from the left hilum anteriorly involving the lingula and left upper lobe proper as well as the adjacent fissure. Linear scarring or atelectasis on the left. Elevation of the left hemidiaphragm unchanged consistent with phrenic nerve paralysis. Right basal atelectasis has cleared since the prior study. Unchanged cardiomegaly.

Output: No pneumothorax. Left upper lobe mass extends from the hilum to the pleural surface and is compatible with known primary neoplasm. Small left pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: SS History: SS No pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity. Right chest port terminates in the SVC. Scattered calcified granulomata.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Lung nodule History: Lung nodule Status post left lower lobectomy with volume loss.No evidence of tumor recurrence.Heart size normal.Right jugular catheter, tip in SVC.

Output: Status post left lower lobectomy, unchanged and no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Shortness of breath. Stable cardiomediastinal silhouette with mild cardiomegaly and a tortuous aorta. Decreased lung volumes. Chronic appearing left costophrenic angle blunting. Vascular redistribution and mild basilar interstitial opacities suggesting mild edema.

Output: Early mild interstitial edema cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: pulmonary edema History: sob Stable cardiomegaly and pulmonary edema. Vascular stent in the right subclavian region is unchanged.

Output: Stable cardiomegaly and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 96 years old.Chest pain, shortness of breath, cough, previous pneumonia, evaluate for pneumonia The cardiac silhouette is unchanged.Low lung volumes with basilar scarring and atelectasis. No specific evidence of infection, edema, or effusions.Dilated loops of bowel in the upper abdomen are incompletely visualized but appear similar to prior.Severe erosive changes involving the glenohumeral joints.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Evaluate ET tube placement History: Endotracheally intubated The esophageal probe is no longer seen. Left basilar chest tube remains in place but has been slightly repositioned. Other lines and tubes are not substantially different. Large amount of subcutaneous gas again noted. Probable pneumomediastinum, as before. Possible small pneumothoraces though this may very well represent extension of extrapleural gas. Heart size difficult to assess. Unchanged diffuse pulmonary opacities.

Output: Lines and tubes, as above. Diffuse pulmonary opacities, unchanged. Large amount of ectopic gas, as before.


Instruction: Generate impression based on medical findings.

Input: Female 19 years old Reason: Eval for PNA vs acute chest History: Sickle cell, CP, SOB There is no focal consolidation, pleural effusion or pneumothorax.The cardiomediastinal contours are within normal limits for size.The imaged skeleton and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Weakness, patient fell at home this morning Minimally wedged mid thoracic vertebra, suspected T8 without prior exams to confirm chronicity. No discernible rib fracturesLungs otherwise are clear, cardiac and mediastinal contours significant for mild to moderate tortuosity of the aorta.

Output: No acute pulmonary abnormality, however questionable mild minimal wedge deformity of a mid to lower thoracic vertebrae. See above and correlate with patient's symptoms


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old. Catheter tip in the SVC.Moderate elevation of the right hemidiaphragm, unchanged and no acute abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Chest pain. Coarse mid and lower lung zone interstitial and air space opacities have increased significantly since the prior examination, with focal consolidation in the periphery of the left mid lung. Normal heart size. No pneumothorax.

Output: Significant worsening of coarse interstitial opacities in the lung periphery suggestive of exacerbation of interstitial lung disease, a subsequent CT has been performed.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.ARDS survivor. Devices have been removed in the interim.Lung volumes remain low normal.Bilateral subpleural opacities suggestive of scarring or fibrosis, most pronounced in the left upper lobe. No pleural fluid or pneumothorax. Heart size is normal.

Output: Subpleural opacities suspicious for fibrosis. This can be confirmed by CT if required.


Instruction: Generate impression based on medical findings.

Input: Reason: infection, effusion History: cough Unremarkable cardiac and mediastinal silhouette. Chronically elevated left hemidiaphragm with mild basilar scarring, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Status post fall and left rib pain. Mild cardiomegaly is again noted. Low lung volumes with basilar subsegmental atelectasis. There is mild vascular redistribution. No focal airspace opacity, pleural effusion, displaced rib fracture, or pneumothorax.

Output: Mild cardiomegaly without acute cardiopulmonary abnormality or displaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Cough Bibasilar airspace opacities are similar to previous and may reflect infection or aspiration. Heart size within normal limits. Patient is status post right jugular line with tip over the SVC. No pneumothorax. Left PICC line tip also overlies the SVC. Tracheostomy tube again noted. A nodular opacity over the left lung base, new from recent previous likely reflects a nipple shadow.

Output: No pneumothorax status post right jugular central line with tip over the SVC. Stable bibasilar opacities may reflect aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: cardiopulmonary pathology History: chest pain Heart size is upper normal, with mild pulmonary vascular redistribution.Large lung volumes are consistent with COPD.No specific evidence of infection or edema.

Output: Heart size at least upper normal with COPD. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: is there pneumonia? History: fever Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable bibasilar subsegmental atelectasis or scarring. Question of hazy opacity in the upper aspect of the right lung which certainly could represent developing pneumonia or aspiration. Heart size difficult to assess due to low lung volumes but likely normal. No large pleural effusion or pneumothorax.

Output: Probable bibasilar subsegmental atelectasis or scarring essentially to by low lung volumes.Question of developing pneumonia or focal aspiration upper aspect the right lung which can be reevaluated on close radiographic follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old. Cough, congestion, rhonchorous wheezing on lung auscultation. Evaluate for pneumonia. Bronchial wall thickening suggestive of bronchitis or asthma. No definite evidence of pneumonia or edema.

Output: Bronchitis or asthma. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: pna History: bradycardia Flat diaphragms consistent with COPD.Mild cardiomegaly with pulmonary vascular redistribution.No specific evidence of infection or edema.Small pulmonary nodules seen on prior CT are barely visible.

Output: COPD and mild cardiomegaly with pulmonary vascular redistribution. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: question of pneumonia History: tachypnea Moderate cardiomegaly persists.There is no new focal consolidation, pleural effusion, or pneumothorax.Stable dense calcifications of the trachea and mainstem bronchi.Stable basilar bronchiectasis.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: fever History: none There has been placement of a left pericardial drain, with development of pneumopericardium. The right internal jugular central venous catheter tip terminates at the cavoatrial junction.The large pericardial effusion persists. Increased left basilar opacity suggesting a combination of atelectasis and possible pleural effusion. There is a possible small right pleural effusion.

Output: 1.Interval placement of a left pericardial drain with development of presumed postprocedural pneumopericardium, and persistent pericardial effusion.2.Increased left basilar opacity suggesting a combination of atelectasis and pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: CTICU interval History: artificial heart Cardiopulmonary monitoring and support devices, including a total artificial heart, unchanged. Slightly improved pulmonary aeration with resolution of right upper lobe atelectasis.ET tube tip approximately 3 cm above the carina.Venous catheters unchanged.No pneumothorax or other acute change.

Output: Improved pulmonary aeration with decreased atelectasis.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male status post lung transplant. Tracheostomy tube, left PICC, and jugular catheter are unchanged. Bilateral chest wall drains again seen with interval improvement in right subcutaneous emphysema. Right apical lucency is not significantly changed and may represent loculated hydropneumothorax. Additional nonspecific focal air collection inferior to the left hilum is also stable. Extensive airspace opacities and small pleural effusions are not significantly changed, likely postsurgical in etiology.

Output: No significant interval change in extensive pleural and parenchymal abnormalities as described above.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: shortness of breath History: shortness of breath Marked cardiac enlargement with prominence of the central pulmonary vasculature.Interstitial opacities with septal lines compatible pulmonary edema.Small right pleural effusion.No focal airspace consolidation.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of endotracheal tube placement. Endotracheal tube tip 5 cm above carina. Right IJ central venous catheter tip in the SVC.Cardiomediastinal silhouette is unremarkable. Low lung volumes. No focal air space opacities, pleural effusions, or pneumothorax.

Output: Endotracheal tube tip 5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: cough prod of blood tinged yellow sputum History: as above Basilar opacities suggestive of aspiration or infection.Heart size normal.Small pleural effusions seen on the lateral view.

Output: Basilar opacities suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: 54 years old Male. Reason: Pneumonia History: pneumonia. Diffuse lung airspace and interstitial opacities in both lungs, right greater than left, are again noted. Small bilateral pleural effusions. There is no evidence of pneumothorax. The tip of the endotracheal tube is about 2.5 cm above the carina.

Output: Diffuse lung airspace and interstitial opacities as well as small bilateral pleural effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female 72 years old Reason: sob with transfusion History: sob with transfusion Left chest wall ICD, tracheostomy, and LVAD are unchanged in position. Moderate cardiomegaly, unchanged. Patchy bilateral opacities likely representing edema, as well as effusions and left basilar consolidation, are not significantly changed.

Output: Edema, effusions and left basilar consolidation, not significant change from prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.IABP placement. IABP marker projects over the descending thoracic aorta approximately 4 cm below the top of the expected level of the aortic arch.Left subclavian ICD in place. Coronary stent noted.Lung volumes remain low. Vascular unsharpness on the left, but no conclusive signs of edema.

Output: IABP marker 4 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: 20 year-old female with shortness of breath and positive d-dimer. PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolus.LUNGS AND PLEURA: Scattered pulmonary nodules, most prominent in the right upper lobe (axial image 40/120), are nonspecific, but most likely represent an infectious etiology given the patient's age. TB should be considered as well as systemic granulomatous disease such as sarcoid. Short-term CT follow up in 4 to 6 weeks should be considered to document resolution. No pleural effusions.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Relatively hypodense round lesion in the left breast may represent a cyst. Correlation with physical exam is recommended. Further evaluation with mammography may be considered if clinically indicated.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.No PE.2.Nonspecific pulmonary nodules most likely represent an infectious etiology as discussed above. Short-term CT follow up in 4 to 6 weeks is recommended to document resolution.3.Cystic left breast lesion as described above.4.The ED senior resident was notified of the above recommendations by phone at 1145 hrs on 3/18/09.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: s/p TECAB History: s/p TECAB Chest tubes been removed with no pneumothorax.Mild basilar subsegmental atelectasis slightly increased on the left with small pleural effusions.

Output: Chest tube removal with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Reason: 93F h/o HTN, p/w SOB History: SOB Moderate cardiomegaly with tortuous aorta, unchanged.Small lung volumes.No specific evidence of infection or edema.

Output: Cardiomegaly, but no reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Shortness of breath. Evaluate for pulmonary edema. History CHF. Right jugular catheter tip at the SVC. Left subclavian ICD unchanged.Moderate to severe cardiomegaly with enlargement of the central pulmonary vasculature about the same.Small pleural effusions, unchanged.Vascular redistribution, thickening of the fissures and bronchovascular bundles consistent with mild hypervolemia/edema.A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: Mild hypervolemia/edema.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Crackles at the bases and hypoxia. Moderate right pleural effusion with adjacent consolidation/atelectasis. Trace left pleural effusion.Cardiomegaly and prominent main pulmonary artery suggesting pulmonary hypertension.

Output: Moderate right pleural effusion with adjacent consolidation/atelectasis.Cardiomegaly and prominent main pulmonary artery suggesting pulmonary hypertension. See the subsequent CT report.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: ETT History: ETT Right pleural effusion and volume loss.Ventriculopleural shunt unchanged with no pneumothorax.Atelectasis is present medially in the right lung base.ET tube tip approximately 4 cm above the carina.

Output: ET tube tip approximately 4 cm above the carina. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.SOB. Status post AVR/MVR. Sternal hardware and valvular prostheses similar in position.Bilateral pleural fluid collection similar in volume with probable fluid loculated in the right minor fissure.Mild basilar atelectasis and edema.

Output: Mild CHF without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: URI symptoms for 5 days not responding to antibiotic treatment History: cough, pleuritic chest pain Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female; 63 years old. Reason: metastatic ovarian ca, on therapy, eval for progression, compare to previous with measurements CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Multiple borderline enlarged superior mediastinal lymph nodes are overall similar to prior. Left supraclavicular node (series 3 image 6) measures 1 x 1.7 cm (previously 1.2 x 1.7 cm)CHEST WALL: Right Port-A-Cath tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Two hypoattenuating liver lesions, unchanged, likely represent hepatic cysts.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: Retroperitoneal lymphadenopathy, overall similar to prior. Conglomerate referenced aortocaval lymph nodes (series 3 image 112) measures 1.2 x 2 cm (previously 1.2 x 1.8 cm) Left para-aortic lymph node (series 3, image 13) measures 1.1 x 1.4 cm ( previously 1 x 1.5 cm).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: AbsentBLADDER: No significant abnormality noted.LYMPH NODES: Post-surgical appearance of the right pelvic lymph node dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The bones are demineralized.OTHER: No significant abnormality noted.

Output: Stable retroperitoneal and superior mediastinal/supraclavicular lymphadenopathy as described above. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: 54 yo with SOB History: SOB Relatively low lung volumes with basilar opacities favoring subsegmental atelectasis. No pulmonary edema or pneumothorax. The heart size is normal.

Output: Relatively low lung volumes with basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female newly diagnosed high grade leiomyosarcoma of the vulva. status post surgical [illegible]. Outside CT 10/07 pulmonary nodules right lung. Evaluate pulmonary nodules or evidence metastatic disease CHEST:LUNGS AND PLEURA: Few nodules seen throughout the right lung there is largest nodule is probably in the right middle lobe seen on image 30 34/90 and measures 8.7 x 8.7 mm. Examples of other nodules seen in the right lobe include two other nodules seen on image 34, two nodules seen on image 43, a nodule on image 45 in the right base. Punctate nodule left CP angle image 65. Many of these were annotated with circles for identification.There are no pleural effusions.MEDIASTINUM AND HILA: Scattered small mediastinal nodes none are pathologic by size criteria. There is also a small right cardiophrenic node.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There are two clusters of lesions in the liver. There are a few scattered punctate nonspecific hypodensities. There are also other lesions that are hypoattenuating with peripheral nodular hyper attenuating areas suggestive of hemangioma. The largest is in the medial segment of the left lobe image 84 measuring 2.3 x 1.8 cm. A second probable hemangiomas seen in segment 7 image 69 measuring 1.3 x 0.9 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.KIDNEYS, URETERS: Parapelvic cysts on the left. Kidneys otherwise normal.ADRENAL GLANDS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small shotty nodes none significant by size criteria. Some distortion to a rotatory dextroscoliosis of the lumbar spine. Surgical clips left retroperitoneum infrarenal.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. Specifically, no lytic or blastic disease.OTHER: Full extent of the vulvar lesion seen on MR is not included in the CT. Note that the issue rectal fossa fat perirectal fat are normal. No evidence of ascites.

Output: Two clusters of lesions in the liver several hemangiomas and other small nonspecific hypodensity that can be followed. Multifocal lung lesion suspicious for metastatic disease. Small mediastinal nodes can be followed on a pathologic size criteria. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: ETT History: acute resp failure Endotracheal tube terminates 3 cm above the carina. Nasogastric tube is unchanged in position.The lungs and pleural spaces remain clear. The cardia mediastinal silhouette is unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Coughing up blood. Rule out pneumonia, has trach in place. Over the low neck, there are multiple surgical clips and a thin looped wire or radiopaque suture which is unchanged from the time of the 6/20/2015 CT. The C7 vertebral spinous process appears dense, this may be correlated with CT at the time of the patient's next regularly scheduled exam.Healed rib fractures on the right. No pleural fluid or pneumothorax. No focal airspace opacities or other acute abnormalities to account for the patient's source of hemoptysis.

Output: No pulmonary source of hemoptysis is appreciated. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#2 Bilateral chest tubes following lung transplant with small left apical pneumothorax.Patchy air space opacities slightly worse than on the prior study.Right jugular Swan-Ganz catheter removed leaving the introducer sheath.

Output: Slight worsening of pulmonary opacities and there is a small left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: coughing History: cough, persistent Pneumoperitoneum likely related to recent abdominal surgery. Pigtail type catheter overlies the left upper quadrant the abdomen. Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar atelectasis. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged heart size. Tortuous thoracic aorta.

Output: Pneumoperitoneum likely related to recent abdominal surgery. Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar atelectasis. No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: 53 yo female with history of CML; pre-allo SCT evaluation The heart size is normal.The lungs are clear. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 84 yearsGender: MaleReason for Study: Reason: eval cause of hypoxemia, size of R hemothorax History: R hemothorax, R atelectasis, pulmonary edema, hypoxemia Chest/mediastinal tubes unchanged.Probable loculated right basilar pneumothorax. .Stable cardiac enlargement with widening of the mediastinum.Right pleural effusion and basilar edema/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with right pleural effusion/thickening, pulmonary edema, basilar atelectasis, and basilar loculated pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male status post resection of massive retroperitoneal sarcoma 10/22/08 with en bloc resection of left kidney and left colon. Final path revealed dedifferentiated high-grade liposarcoma with local involvement resection margins CHEST:LUNGS AND PLEURA: Calcified right upper and middle lobe granuloma.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The left adrenal gland is not seen, possibly due to resectionKIDNEYS, URETERS: Left nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ill-defined soft tissue/fat stranding in the postsurgical bed to the left of the SMA is more conspicuous (series 3; image 111). Partial left colectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged.BLADDER: 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: Ill-defined soft tissue/fat stranding in the postsurgical bed adjacent to the SMA is more conspicuous. While this could represent evolving postsurgical changes, early recurrence could have a similar appearance. Special attention to this focus should be made on subsequent examinations.


Instruction: Generate impression based on medical findings.

Input: 84 year male with shortness of breath, rule out asthma LUNGS AND PLEURA: Mild bronchiolar wall thickening with minimal tree in bud opacities.Focal 1 cm ground glass opacity posteriorly in the right upper lobe (image 30 series 5).No evidence of interstitial fibrosis, or air trapping.No pleural abnormalities.MEDIASTINUM AND HILA: Mildly prominent paratracheal and subcarinal lymph nodes are. Moderate coronary artery calcification with a stent in the LAD..Mild/moderate pericardial effusion.CHEST WALL: Degenerative changes within the thoracic spine.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Mild bronchiolar wall thickening and scattered tree in bud opacities compatible with bronchiolitis.2. Focal right upper lobe ground glass opacity most likely is related to aspiration/inflammation.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: 61 year old male hx of copd/chf s/p aicd w/ 1 week of SOB History: 786.09 Cardiomegaly with a mild basilar interstitial edema pattern and small pleural effusions.Left subclavian dual chamber pacemaker, leads in appropriate positions.

Output: CHF with pulmonary edema, small pleural effusions and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: r/o PNA, assess for any lung disease History: heart transplant pt switching to everolimus with cough and low grade fever Large right-sided hemidiaphragmatic eventration again noted. Mild basilar opacities, likely represent atelectasis and/or scarring. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Patient again status post sternotomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: s/p MVR History: s/p MVR Status post mitral and tricuspid valve repairs.Heart size normal.No significant pulmonary or pleural abnormality.

Output: Status post valve repair, otherwise unremarkable with out edema or residual pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: lung transplant History: as noted above Status post bilateral lung transplants.Stable cardiac enlargement with prominence of the central pulmonary arteries.Perihilar/basilar edema and pleural effusions, right greater than left, similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with cardiomegaly, pleural effusions, edema, and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: assess for pna History: hypoxia, tachycardia, cough Right basilar opacity most likely in the middle lobe consistent with pneumonia.

Output: Right pneumonia, probably middle lobe.


Instruction: Generate impression based on medical findings.

Input: Male; 58 years old. Reason: interval change? History: chf, swan No change in position of left subclavian ICD and Swan-Ganz catheter.Stable cardiomegaly.No change in bilateral perihilar opacities suggestive of edema.No pneumothorax.

Output: Stable cardiomegaly and pulmonary opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of head and neck ca, unknown primary, s/p CRT, eval for dz, compare to previous History: as above LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant lymphadenopathy. A previously measured subcarinal node is 5 mm in short axis, unchanged and within normal limits.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: eval ETT, lung fields History: s/p LVAD ET tube with its tip 4 cm above the carina.Right IJ Swan-Ganz with its tip in the pulmonary artery.Chest/mediastinal tubes in place without evidence of a pneumothorax.Left-sided ICD and LVAD unchanged.Stable cardiomediastinal silhouette.Minimal basilar atelectasis.

Output: Postoperative chest without complications.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Cough and scant hemoptysis. Cardiac size within normal limits. There is interval placement of a left subclavian biventricular ICD. There is no focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.History of cough and shortness of breath. Evaluate for pneumonia. Subtle left upper lobe airspace opacity may represent early pneumonia.Normal cardiomediastinal silhouette. Tortuous thoracic aorta. No pneumothorax. Mild blunting of the costophrenic angles, best seen on the lateral view, may represent small effusions or scarring.

Output: Subtle left upper lobe airspace opacity may represent early pneumonia. Six-week follow-up radiographs recommended to document resolution.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, 82 years old.Rule out volume overload versus infection. History: shortness of breath, cough. Interval placement of right IJ central venous catheter with the distal tip in the right atrium.Cardiomegaly. Prominence of the bronchovascular markings, greatest at the bases bilaterally, is believed to represent chronic interstitial change. Superimposed acute airspace disease cannot be excluded.

Output: Chronic interstitial changes consistent with known UIP. Superimposed acute airspace disease at bases cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.History of hypoxia. Right chest tube and right port catheter unchanged.The cardiomediastinal silhouette is stable.Increasing loculated right pleural fluid. Left base opacity has increased, likely also due to pleural fluid and/or consolidation. Bilateral interstitial opacities appear stable.

Output: Increasing right pleural fluid with chest tube in place. Increasing left basilar opacity, likely also due to pleural fluid and/or consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Bilateral wheezing Normal cardiomediastinal silhouette.No evidence of infection or edema.

Output: No acute cardiopulmonary abnormality evident.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: evaluate for pulmonary edema History: dyspnea, bibasilar rales There are decreased lung volumes with mild basilar discoid atelectasis.No focal areas of consolidation.No pleural effusions.The cardiac mediastinal silhouette is unremarkable.

Output: Mild basilar atelectasis without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: high peak, possible pneumothorax History: high peak Endotracheal tube tip approximately 4.5 cm from the carina. Enteric tube terminates below the field of view.Extensive subcutaneous emphysema is new from the prior exam, limiting evaluation of lung fields.Upper lobe predominantly interstitial opacities suggestive of known sarcoidosis, though superimposed acute infection cannot be excluded.Stable cardiomediastinal silhouette.

Output: Extensive subcutaneous emphysema, new from prior exam.Pulmonary opacities suggestive of known sarcoidosis, though superimposed acute infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: chest pain 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: 63 years old Female. Reason: chest pain. History: chest pain. No focal airspace opacity is noted. Basilar atelectasis and interstitial changes are noted. The cardiac silhouette is normal. There is no evidence of pneumothorax or pleural effusion.

Output: Basilar atelectasis and interstitial changes.


Instruction: Generate impression based on medical findings.

Input: 28-year-old female with metastatic colorectal cancer status post 16 cycles of FOLFIRI and panitumumab. Compare to previous. CHEST:LUNGS AND PLEURA: Multiple scattered bilateral pulmonary nodules are not significantly changed. Reference nodule in the left lower lobe measures 1.1 cm by 1.3 centimeters (image 54, series 6), previously measuring 1.1 x 1.1 cm.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Right chest port tip is in the right atrium.CHEST WALL: Small nodular soft tissue density in the subcutaneous tissue of the right lower chest is unchanged and nonspecific. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference conglomeration of small para-aortic lymph nodes measures 1.2 cm x 2.1 cm (image 119, series 5). It previously measured 2.0 cm x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is heterogeneously enlarged and unchanged in appearance.PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Left pelvic sidewall mass extending to the proximal iliac bone measures 7.9 cm x 4.7 cm on image 166, series 5. It previously measured 6.5 cm x 3.7 cm.Reference left external iliac lymph node measures 1.5 cm by 0.6 cm (image 210, series 5), previously measuring 1.1 x 1.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Unchanged pelvic ascites. Collateral vessels in the low anterior/pelvic wall again noted.

Output: 1. Interval slight increase in size of reference pulmonary nodule. The rest of the nodules are not significant changed. 2. Interval increase in size of the left pelvic sidewall mass.3. Stable to slight decrease in size of retroperitoneal and inguinal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Swan-Ganz mildly repositioned, tip extends in the pulmonary outflow tract, retracted 3 cm. Left jugular catheter is otherwise unchanged, tip extends into the innominate.Underlying cardiopulmonary appearance is otherwise similar with right over left basilar patchy opacities, nonspecific with probable loculated moderate effusions.

Output: Swan-Ganz repositioned


Instruction: Generate impression based on medical findings.

Input: 13-year-old male status post right subclavian line placement, assess for pneumothorax.VIEW: Chest AP (one view) 5/31/2016, 16:51. Cardiac silhouette is within normal limits. The aortic arch, cardiac apex, and gastric bubble is on the left. No focal pulmonary opacity, pneumothorax, or pleural effusion.Right subclavian chest wall port with the catheter tip terminating in the right atrium. Partially visualized catheter tubing of a VP shunt.

Output: Normal examination. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Pulmonary edema Severe cardiac megaly with bilateral pleural effusions and diffuse interstitial and airspace opacities suggesting CHF are not significantly changed from previous. No pneumothorax. Right jugular catheter tip over the SVC. Dobbhoff tube in the proximal stomach.

Output: Moderate to severe CHF pattern, stable.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Weight loss, cough, history of smoking. Marked basilar reticulation and cystic changes suggestive of interstitial lung disease. Calcified right-sided pleural thickening. Normal heart size. No pleural effusion or pneumothorax. Small right anterior hemidiaphragmatic eventration. No acute bony abnormality. Mild disc degeneration.

Output: CT findings of significant pulmonary fibrosis. Calcified right-sided pleural thickening suggests that diffuse lung disease is asbestosis. Correlation with HRCT protocol is suggested as well as correlation with occupational exposure.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: assess vol status s/p thora and diuresis History: adhf with hypoxia, fluid overload and recurrent R pleural effusion No change in pleural effusions right larger than left, with overlying atelectasis.No pneumothorax following thoracentesis.

Output: No pneumothorax or change in size of pleural effusions following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: severe COPD w/ concern for multifocal PNA by CT History: severe COPD w/ concern for multifocal PNA by CT Severe bullous emphysema. Reticular opacities seen on CT are redemonstrated in the right upper lobe, right middle lobe, and lingula.Right CP angle scarring.Unremarkable cardiomediastinal silhouette.

Output: Opacities superimposed upon severe emphysema, suggestive of multifocal infection.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: pna? History: seizure Small lung volumes with the suggestion of basilar interstitial edema and subsegmental atelectasis.Mild cardiomegaly.No reliable evidence of infection.Left subclavian pacemaker, leads unchanged in position.

Output: Cardiomegaly, with the suggestion of mild interstitial edema. No reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: SOB History: as above Moderate to severe cardiomegaly.No specific evidence of infection or edema.

Output: Moderate to severe cardiomegaly, which could be the result of cardiomyopathy although a pericardial effusion is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: PICC line placement s/p RIJ pull History: PICC line placement s/p RIJ pull Right internal jugular catheter has been removed. The left PICC tip is in the SVC. Sternotomy sutures are noted.The cardiomediastinal silhouette is stable.Bibasilar scarring and atelectasis is stable. There is no pneumothorax.

Output: Right internal jugular catheter removed with left PICC tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: pleuritic chest pain History: pleuritic chest pain Low lung volumes makes detailed cardiopulmonary assessment difficult. Slight increase in basilar opacities, likely atelectasis. No large pleural effusion or pneumothorax. Unchanged cardiomegaly. Surgical spinal fusion hardware, incompletely visualized, as before.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Increased basilar opacities, likely atelectasis. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.History of RCC. Please evaluate for metastases. No new focal airspace opacity, pleural effusion, or pneumothorax. Previously seen right upper lobe nodule appears smaller with flattening of its margins, appearing more scarlike. Linear apical and bibasilar opacities most consistent with scarring/atelectasis.The cardiomediastinal silhouette is within normal limits. Surgical clips project over the mid abdomen.

Output: No new nodules. Right upper lobes nodule smaller and may represent scarring or perhaps a treated lesion.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: 45-year-old male, assess for progression of lung nodule and possible psoas hematoma This study is severely limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Bilateral pleural effusions and bibasal atelectatic and also the changes, unchanged. Right middle lobe consolidation suspicious for pneumonia. Bilateral patchy groundglass opacities in both lungs may represent edema, however, early pneumonia cannot the exclude.There is a spiculated right lower lobe nodule, measuring 1 cm in diameter image number 51, series number 5.MEDIASTINUM AND HILA: Enlarged mediastinal, and right hilar adenopathy, not significantly changed from previous study. Tumoral extension into the right middle lobe area cannot be excluded.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No evidence of retroperitoneal hematoma.BOWEL, MESENTERY: Small amount ascites.BONES, SOFT TISSUES: Generalized anasarca.OTHER: Generalized anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Limited study due to lack of IV contrast. Right middle lobe pneumonia. Postobstructive pneumonia secondary to mass in the right hilum. Cannot excluded. Large mediastinal adenopathy.Left lower lobe spiculated nodule suspicious for malignant neoplasm.Bilateral pleural effusions.Bilateral ground glass patchy opacities, nonspecific, however, pneumonia cannot be excluded.No evidence of retroperitoneal hematoma..


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Fluid overload evaluate for pulmonary edema. Moderate pleural fluid and pulmonary edema. Right jugular catheter with the SVC stent unchanged.

Output: Moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: r/o acute chest History: chest pain, cough Right chest port, tip in right atrium.Stable cardiomegaly.Mild indistinctness to the vascularity at the lung bases. No focal airspace opacity.

Output: Mild indistinctness to the vascularity at the lung bases is nonspecific. Mild acute chest syndrome cannot be excluded. No discrete focal airspace process to support infection.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube placement History: s/p radical pleurectomy decortication Chest tubes extending to the left apex with no significant pneumothorax.Volume loss and opacity in the left lung consistent with atelectasis, consolidation and pleural effusion.Small right pleural effusion.No new findings.

Output: Postoperative findings with atelectasis and small pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: hypoxia, atelectasis and small pleural effusion History: hypoxia Cardiomegaly and elevation of the right hemidiaphragm unchanged allowing for decrease in lung volumes. Pleural fluid and atelectasis on the right appears improved, though at least some of the differences are projectional. Retrocardiac scarring or atelectasis on the left. Right upper quadrant surgical staples. No pneumothorax.

Output: Right pleural effusion with basal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: chest pain, mesothelioma Right port catheter tip projects over the atriocaval junction. Right pleural effusion and pleural thickening appears similar to that seen on outside hospital CT dated 11/20/2015. Patchy airspace opacities in the right greater than left lung bases are consistent with known mesothelioma. No pneumothorax. The heart size is within normal limits.

Output: Right pleural effusion and patchy bilateral airspace opacities consistent with known mesothelioma.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT remains 3 cm above the carina. NG tube well positioned, side port advanced into the mid gastric lumenUnderlying mildly asymmetric cardiopulmonary appearance is also similar and grossly clear with basilar scarring and/or atelectasis, however of note are multiple air-filled bowel loops incompletely visualized. The overall appearance remains grossly similar, however if there is concern for an abnormality, dedicated abdomen imaging should be considered

Output: Suspected scarring and/or atelectasis without new superimposed acute airspace abnormality. ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Dyspnea, lung transplant. Interval removal of right chest tube. Persistent moderate to large pleural effusions, basal atelectasis and bronchial wall thickening. No significant sized pneumothorax.

Output: Pleural effusions and atelectasis. No significant sized pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval for PNA History: transplant cardiac now with fever, cough Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Status post sternotomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: s/p 6/5 BRONCHOSCOPY, MEDIASTINOSCOPY History: none Interstitial and airspace opacities throughout the right lung extending to the hilum are suggestive of diffuse infection or lung cancer.No pneumothorax following bronchoscopy.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: r/o pna, eval for cancer History: FTT There is a pacemaker with the pulse generator located at the right superior thorax. The atrial electrode obstructed cranially. The right ventricular electrode is at the expected mid chamber. Sternotomy wires are well aligned without evidence of prior coronary arterial revascularization.Linear scarring or subsegmental atelectasis at the right cardiophrenic angle. No pneumothorax, evidence of edema or infection. Ill-defined opacity projecting over the anterior right sixth rib suspicious for nipple shadow. This can be confirmed with a energy subtracted radiograph.

Output: Nodular opacity at the right base suspicious for nipple shadow, which can be confirmed with an energy subtracted radiograph. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: Eval for hypervolemia, status post right thoracentesis. Moderate right and small left pleural effusions are noted. No evidence of pneumothorax after recent right thoracentesis, as clinically questioned.Very low lung volumes and multilobar consolidative opacities superimposed on emphysema, considered indeterminate in nature.Very limited assessment of the cardiomediastinum.

Output: Moderate right and small left pleural effusions. No postprocedural pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 6-year-old female with abdominal pain after trauma evaluate for injury. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Two small, linear ill-defined areas of hypoattenuation in the anterior aspect of the left hepatic lobe may represent a liver laceration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Two linear areas of hypoattenuation in the anterior aspect of the left upper lobe may represent liver lacerations.


Instruction: Generate impression based on medical findings.

Input: Reason: patient intubated evaluate ETT History: ETT placement ET tube tip approximately 3 cm above the carina. Moderate left pleural effusion and volume loss in the left lung, not significantly changed.Probable small right effusion.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female; 82 years old. Reason: Pancreatic Cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter early arterial enhancing foci are nonspecific, but not classic for adenocarcinoma metastases.SPLEEN: Peripherally calcified splenic artery aneurysm near the splenic hilum, measuring approximately 1 cm. The splenic vein is thrombosed with collaterals.PANCREAS: Poorly enhancing lesion in the body of the pancreas (series 9 image 104) measures approximately 2.6 x 2.1 cm. There is atrophy and ductal dilatation of the pancreatic tail. Soft tissue extends to encase the celiac axis and abut the SMA. Abnormal soft tissue also insinuates in the porta hepatis. The portal vein and is attenuated at the level of the mass where the splenic vein is thrombosed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive colonic diverticulosis.BONES, SOFT TISSUES: The bones are demineralized.OTHER: No significant abnormality noted.

Output: 1. Pancreatic head mass with abnormal soft tissue extending to involve the celiac, SMA, and hepatic hilum. Thrombosed splenic vein and attenuated portal vein.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with history of papillary thyroid cancer status post administration of I-131 75 mCi who presents for post therapy I-131 whole body scan. There is increased activity in the neck bilaterally, in the region of the thyroid gland, and faint activity bilaterally in the lungs; findings consistent with functioning thyroid tissue is seen.

Output: Functioning thyroid tissue in the neck, thyroid gland, and bilateral lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Shortness of breath with a history of heart failure. New, moderate-sized, loculated right pleural effusion with increased right basilar patchy opacities, likely compressive atelectasis. Interval resolution of left sided pleural effusion and improvement in left basilar opacities. No pneumothorax.Pulmonary venous hypertension. Unchanged cardiomegaly, status post median sternotomy and AVR, MVR.

Output: New loculated right pleural effusion, mostly lateral, with adjacent compressive atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.History of CHF presenting with lower extremity swelling. Decreased lung volumes may be due to under inflation. Patient's body habitus contribute to diffuse lung haziness.The patient is rotated resulting in exaggeration of the superior mediastinum.Basilar atelectasis. Right costophrenic angle blunting may reflect scarring.Right basilar opacity corresponds to large pericardial fat pads and mediastinal lipomatosis as seen on the subsequent CT.

Output: Decreased lung volumes with basilar atelectasis/scarring.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: cough; coarse breath sounds Small lung volumes with mild basilar opacity compatible with atelectasis.No specific evidence of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath No new focal lung consolidation. Low lung volumes, as before. No pneumothorax or pleural effusion. Right lung is again fibrotic. Healing left lateral rib fractures. Unchanged heart size given low lung volumes. Right diaphragmatic elevation, as before.

Output: No pneumothorax. Healing left-sided rib fractures.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: FemaleReason for Study: Reason: r/o pna, fluid overload History: generalized weakness There is moderate cardiac enlargement with atherosclerotic changes of the aorta and pulmonary vascular redistribution. Increased lung volumes compatible with COPD.Scattered areas of scarring/discoid atelectasis.No focal areas of consolidation. No large pleural effusions.Deviation of the trachea to the right at the thoracic inlet a slight related to enlargement thyroid gland.Extensive degenerative changes of the thoracic spine with anterior wedging of multiple midthoracic vertebrae.

Output: Cardiomegaly without specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with ETT Interval intubation with ET tube tip 3 cm above the carina. Shunt catheter projects over the right hemithorax.Enlarging right pleural effusion. Probable small left pleural effusion. Persistent small right apical pneumothorax. Stable cardiomediastinal silhouette.

Output: ET tube tip 3 cm above the carina. Enlarge right pleural effusion. Small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 90 yearsGender: MaleReason for Study: Reason: eval for edema vs pna History: shortness of breath Stable cardiac enlargement with tortuosity of the aorta. Redemonstration of elevation of the right hemidiaphragm with mild right basilar atelectasis.No focal areas of consolidation.No large pleural effusions.

Output: Persistent elevation of the right hemidiaphragm with mild right basilar atelectasis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old. No evidence of unexpected radiopaque foreign body.ET tube tip approximately 2 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Diffuse bilateral opacity compatible with pulmonary edema and pleural effusions.A more recent radiograph has been interpreted.

Output: No radiopaque foreign body. The findings were discussed with the attending surgeon, Dr. Jeevanandam, by the resident on call.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Chest pain. Status post median sternotomy. Intact sternotomy wires. The heart is normal in size.Lung volumes are normal. There is a well-defined pulmonary nodule in the anterior segment of the right upper lobe, which measures approximately 17 mm.Two additional bilateral well-defined nodular opacities only visualized in the AP view (see key image), most likely represent nipple shadows.No pleural effusion or pneumothorax.No osseous lesions are present.

Output: Well-defined 17 mm pulmonary nodule in the anterior segment of the right upper lobe, indeterminate in etiology. Further characterization with chest CT is recommended.No radiographic findings to suggest pneumonia.Notification: Nonemergent modification to the preliminary report was performed.Findings and new recommendations where placed on notification system by Dr. Bueno 8:00 AM on 9/9/2016.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Superior mediastinal adenopathy increased in size compared to previous CT. A reference lymph node measures 20 by 16mm on image number 19, series number 3. Previously K+ measuring 12 x 11 mm image number 20, series number 3. New paracardiac metastatic mass measuring 4.3 x 2.5 cm image number 66, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:The study is limited due to lack of IV contrast. LIVER, BILIARY TRACT: Again noted numerous masses in the liver. The reference mass is increased in size measuring 16 x 11 cm on image number 106, series number 3. Multiple other lesions in the liver also significantly in size with in the interval. New small perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral double-J ureteral stents with bilateral hydronephrosis, worse on the left compared to the right.RETROPERITONEUM, LYMPH NODES: Numerous enlarged retroperitoneal lymph nodes have increased in number. Reference left retroperitoneal lymph node measures 2.6 x 1.8 cm on image number 121. Other retroperitoneal metastatic masses have also increased in size. The mass measures 2.4 x 4 cm on image number 137, series number 3. Previously closed measuringBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval development of bone metastases in the lower thoracic and lower lumbovertebral bodies. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Large prostate mass has further increased in size and now measures 9.8 x 9 cm image number 168.BLADDER: No significant abnormality notedLYMPH NODES: Borderline enlarged pelvic lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval progression of disease with interval increase in the size of the mediastinal adenopathy, hepatic metastases, retroperitoneal adenopathy and prostate cancer. New paracardiac adenopathy and bone metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: ptx? History: crepitus on exam Cardiomegaly.Resolution of prior basilar opacities with no new findings.Tracheostomy tube tip approximately 3 cm above the carina.Left subclavian pacemaker, leads unchanged in position.A Dobbhoff tube terminates in the stomach.

Output: Resolution of prior basilar opacities, with no new findings. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with urethral carcinoma and lymph node metastases, evaluate for lung lesions LUNGS AND PLEURA: No pulmonary nodules can be identified. Minimal scarring is identified at both lung bases. No pleural effusion can be noted.MEDIASTINUM AND HILA: Coronary artery calcification with a stent in the LAD. There is no evidence of adenopathyCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: There is no evidence of metastatic disease within the chest or visualized upper abdomen


Instruction: Generate impression based on medical findings.

Input: Reason: intubated, 2 r chest tubes, eval for effusion, ptx History: 2 r chest tubes ET tube, venous catheter and right chest tubes unchanged.Small lung volumes with nonspecific basilar opacity compatible with edema and atelectasis.Extensive subcutaneous emphysema.No visible pneumothorax.

Output: No pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 22 yearsGender: MaleReason for Study: Reason: rule out pneumonia History: pleuritic chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: r/o PNA History: fatigue Small lung volumes.Heart size are upper normal.No specific evidence of infection or failure.Prior right jugular catheter removed.

Output: No specific evidence of infection or failure.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with cough and history of antiphospholipid antibody syndrome and immunosuppressed status. Cardiac silhouette is within normal limits.No focal airspace opacity.No pneumothorax.Small right-sided pleural effusion.

Output: Small right pleural effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.