Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: post op TECAB History: SOB The cardiomediastinal silhouette is within normal limits. No focal consolidation, or significant pneumothorax.Small left pleural effusion.Interval improvement of basilar atelectasis.

Output: Small left pleural effusion. Interval improvement of basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 4-month-old male intubated status post cardiac repair. Evaluate ET tube and central line placement.VIEW: Chest AP (one view) 2/18/2015 6:49 ET tube below the thoracic inlet and above the carina. Right-sided chest tube tip terminates at the right lung base. Right IJ central catheter tip in the SVC. NG tube tip in the stomach.Cardiothymic silhouette is normal. Persistent pulmonary vascular engorgement. No focal pulmonary opacities. Right pneumothorax resolved. No pleural effusion.

Output: ET tube below the thoracic inlet and above the carina. Right IJ central catheter tip in the SVC. Pulmonary vascular engorgement unchanged. Interval resolution of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with non-Hodgkin lymphoma. Reevaluate and compare to previous. CHEST:LUNGS AND PLEURA: Bilateral mild emphysema, unchanged. Scarring in the upper lobes, unchanged. New subcentimeter nodule measuring 6-mm in the upper lobe wall the left lung. Another new subcentimeter nodule in the lower lobe of the left lung adjacent to the pleura measuring 5-mm on image number 71.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Air froe wedge-shaped hypodense areas about the knee Kapseal of the left lobe in segments 3 and 4. The lesion in segment 3 measures 2.7 x 1.7 and the lesion in segment 4 measures 2.5 x 1.4 cm on image number 92/196. Subcentimeter hypodense lesion in the right lobe on image number 94 is unchanged and likely represents a cyst. Another hypodense lesion in the segment 6 of the right lobe, on image number 108/196 is unchanged compared to previous study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilobular cystic lesion in the lower pole of the right kidney is slightly increased in size and now measures 2.7 x 1.3 cm. Left upper pole cystic lesion is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New two subcentimeter nodules in the left lung. The upper lobe nodule is ill-defined. Close follow up with imaging is recommended.New hepatic lesions abutting the capsule of the left lobe. The etiology of these lesions is not clear. They may represent true lesions versus focal fatty infiltration. MRI of the liver is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Newborn 25 week gestational age patient with pneumothorax. Desaturations.VIEW: Chest AP (one view) 03/12/16, 2227 Endotracheal tube tip is below thoracic inlet. Two right chest tubes remain in place. Umbilical venous line tip is in right atrium. Umbilical arterial line has its tip at T5.Lung volumes are large with hemidiaphragms between ninth and 10th posterior ribs. Granular lung opacities are seen bilaterally. No pneumothorax is identified. Cardiothymic silhouette is normal.

Output: No pneumothorax. Large lung volumes. Changes from surfactant deficiency.


Instruction: Generate impression based on medical findings.

Input: Reason: Dobbhoff tube placement, evaluate. Enteric tube tip terminates in the gastric body. Bilateral chest tubes are visualized. Devices appears similar to the recent chest radiograph. Multiple surgical sponges are again noted overlying the left chest and abdomen. Please refer to the same day chest radiograph for additional findings.

Output: Enteric tube tip overlies the gastric body. Please refer to same-day chest radiograph additional findings.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with head and neck cancer in 2007 with NED for surveillance. CHEST:LUNGS AND PLEURA: Few scattered micronodules bilaterally, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Presumed cysts at the upper back (series 3, image 11) and right chest (series 3, image 35) are stable. Mild degenerative changes of the spine.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Occasional colonic diverticula.BONES, SOFT TISSUES: Mild degenerative changes of the spine.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: assess for ET tube placement History: s/p intubation Status post CABG with unchanged basilar opacities suggestive of edema and subsegmental atelectasis.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular temporary pacemaker, the tip projected over the pulmonary outflow tract.

Output: Unchanged tubes and devices, edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Chest pain. Low lung volumes with mild interstitial pattern suggesting edema. No consolidation or pneumothorax. Heart size within normal limits.

Output: Mild edema pattern. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Interval new moderate to pronounced perihilar and basilar patchy opacities with interstitial findings suggesting edema with mild cardiomegaly and layered moderate effusions

Output: Moderate CHF


Instruction: Generate impression based on medical findings.

Input: Male, 97 years old.SOB. Hypoxemia. Evaluate for edema or aspiration. Low lung volumes with elevation of the left hemidiaphragm. There is at least a small volume of pleural fluid bilaterally. Basal atelectasis, left greater than right.Coarse granular interstitial opacities predominantly in the right lung again noted, new from the examination of 1/23/2014.Scarlike abnormality in the right apex present previously, poorly assessed by this technique and can be followed on PA and lateral chest radiographs when feasible.

Output: Moderate hypervolemia/edema with superimposed fine interstitial process in the right lung which is atypical for edema and could reflect acute aspiration bronchiolitis, infection or other pathology, of unclear etiology. Follow-up to complete radiographic resolution recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: s/p thoracotomy History: s/p thoracotomy Left-sided chest tubes unchanged without evidence of a pneumothorax.Mild amount of subcutaneous emphysema along the left lateral chest wall.Stable cardiac enlargement.Nonspecific left-sided pulmonary opacities similar to the prior exam.The right lung is clear.

Output: Stable postoperative appearance of the left hemithorax.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with medullary thyroid cancer status post 15 cycles of chemotherapy. Please compare to 11/14/09. Provide measurements and evaluate disease status. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Postsurgical changes consistent with thyroidectomy.Stable punctate anterior mediastinal node measures 9 x 5 .7 mm, series 3 image 34.CHEST WALL: Gynecomastia unchanged.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Gallstones.SPLEEN: No significant abnormality notedPANCREAS: Fatty pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic lesion right iliac wing unchanged 90.7 x 0.5 .9 mm as measured on series 3 image 172. Sclerotic focus left femoral diametaphysis, unchanged. Lytic changes right sacrum and L2 vertebral body are stable.OTHER: No significant abnormality noted

Output: Osseous metastases unchanged. Cholelithiasis. Gynecomastia. Punctate anterior mediastinal lymph node unchanged. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: chest pain, SOB, eval for pneumonia, PTX History: as above Left pleural effusion/basilar scarring. Unchanged cardiomegaly with prominent central vasculature. Improved perihilar edema. No focal pulmonary opacities. No evidence of pneumothorax.

Output: Unchanged cardiomegaly with left pleural effusion. No focal pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: Metastatic prostate cancer CHEST:LUNGS AND PLEURA: Reference right posterior costophrenic angle nodule is enlarged measuring 17 x 14 mm on image number 76, series number 3. Other spiculated small nodules are unchanged. MEDIASTINUM AND HILA: Prevascular node is stable measuring 10 by 8mm image number 42, series number 3. Other small mediastinal lymph nodes are also stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is unchanged. Splenomegaly is unchanged. No focal lesions are seen in the liver within the limitations of a noncontrast study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Radiation pellets within the prostate.BLADDER: No significant abnormality notedLYMPH NODES: Previously mentioned right external iliac reference lymph nodes unchanged measuring 20 x 9 mm image number 170, series number 3. Multiple perirectal lymph nodes are again noted. Right perirectal lymph node measures 9 x 8 mm on image number 178, series number 3. It was measuring 8 by 8mm on on the seventh 5, series number 3 on the previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the right lower lobe nodule. Other smaller nodules are stable. Mediastinal adenopathy is stable. Pelvic adenopathy is stable.


Instruction: Generate impression based on medical findings.

Input: Check for cardiomegaly. Prekidney transplant Mildly decreased lung volumes with chronic appearing interstitial changes in both lung bases. No discrete superimposed focal airspace acute abnormality. Mild COPD. No definite cardiomegaly, however cardiac size is borderline overall dimension.Moderate atherosclerotic changes of aorta

Output: Chronic interstitial changes without definite cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: evaluate for fluid overload History: lightheaded , diaphoretic Right pleural effusion involving the fissures with mild basilar subsegmental atelectasis. Left lung unremarkable.Heart size appears normal.

Output: Right pleural effusion with mild basilar subsegmental atelectasis, consistent with CHF or hypervolemia, unless there is underlying infection.


Instruction: Generate impression based on medical findings.

Input: Reason: S/P BRONCHOSCOPY History: R/O PNEUMOTHORAX Unremarkable cardiac and mediastinal silhouette. Bilateral poorly defined focal pulmonary opacities, previously characterized by CT scan, with metallic fiducial markers.Nonspecific interstitial opacity is also present consistent with emphysema and possibly superimposed hemorrhage or large fluid.No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Peripheral right upper lobe lesion is not significantly enlarged and measures 3.7 x 2.5 cm in image number 27, series number 5. Second opacity in the right lower lobe with hazy borders has resolved. Other right upper lobe nodules are also slightly smaller.MEDIASTINUM AND HILA: Reason mentioned mediastinal lymph nodes are unchanged. Previously measured precarinal lymph node measures 15 x 10 mm image number 37, series number 5.CHEST WALL: No significant abnormality noted.ABDOMEN:The study is limited due to lack of IV contrast.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland is normal. Right adrenal gland is been removed.KIDNEYS, URETERS: Right nephrectomy site does not show any evidence of recurrence. Hyperdense lesion in the upper pole of the left kidney slightly enlarged measuring 15 x 14 mm on image number 93, series number 5. Lack of IV contrast limits optimal evaluation of this lesion. A neoplasm cannot be excluded.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the right upper lobe mass. Other nodules are slightly smaller.Interval increase in the size of the left upper pole renal lesion. A solid neoplasm cannot be excluded. Further evaluation with ultrasound is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: r/o infiltrate History: unresponsive Stable mild cardiac enlargement.Patchy new right basilar opacities suggestive of aspiration.No pleural effusions.

Output: Patchy right basilar opacities suggestive of aspiration or possible infection.


Instruction: Generate impression based on medical findings.

Input: Increased oxygen requirement. Dilated loops of bowel without visible wall markings in the midline upper abdomen and right upper quadrant may be further assessed with abdominal radiographs to exclude ileus, obstruction or pneumoperitoneum.Surgical staples.Low lung volumes with basal atelectasis and small pleural effusions. Left basal opacities suggest aspirated secretions.

Output: Probable aspirated secretions on the left. Suggest abdominal radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: lung eval History: lung eval Iatrogenic devices are unchanged. Mild pulmonary edema again noted. Unchanged patchy left basilar opacity. No pneumothorax. Unchanged cardiomegaly.

Output: Mild pulmonary edema not substantially different compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval of lung fields History: postop cardiac surg patient Cervical immobilization hardware is again visualized. Interval extubation. Left IJ Swan-Ganz catheter, basilar chest tubes and subxiphoid drains are unchanged in position..Increasing left-sided opacities favoring edema, aspiration during extubation is also a consideration. Increasing size of bilateral pleural effusions and basilar atelectasis. The mediastinum is widened, accentuated by semierect positioning and portable technique. Recommend upright radiograph if the patient can tolerate.

Output: Increasing pleural effusions and left-sided opacities suspicious for aspiration with atelectasis. Upright radiograph recommended when the patient can tolerate.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with fever, hypotension, signs of sepsis. Looking for source of fever and sepsis. Patient has history of Clostridium difficile colitis. CHEST:LUNGS AND PLEURA: Micronodules unchanged. New bilateral pleural effusions moderate in size with associated atelectasis or consolidation.MEDIASTINUM AND HILA: Small mediastinal nodes are unchanged. Nonpathologic in size.CHEST WALL: Loss of height of mid thoracic vertebral body, unchanged.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation, the following observations are made.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: Small nodes unchanged. Caval filter.BOWEL, MESENTERY: No significant abnormality noted. No signs of colitis.BONES, SOFT TISSUES: Minimal anasarca.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No free or loculated fluid. Scattered colonic diverticulosis.BONES, SOFT TISSUES: Osteopenia. Coarsened trabecular pattern, unchanged. This may be related to patient's history of myeloma.OTHER: Right femoral venous line.

Output: New large bilateral pleural effusions. Other findings essentially unchanged from prior exam. No obvious source of sepsis.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: evaluate position of Swan ganz catheter History: above Interval repositioning of right IJ Swan-Ganz catheter, no longer looped in the right atrium. The tip is positioned in the supravalvular left main pulmonary artery. External defibrillator pads remain in place.Stable cardiomegaly. Minimally increased perihilar opacities of edema mild edema. No pneumothorax.

Output: Repositioning of the Swan-Ganz catheter which terminates in the supravalvular main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Patient presents with cough, please evaluate. Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax. Calcified nodule overlying the left apex and left perihilar calcified nodules. No evidence of infection or edema.

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


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with chest pain. Evaluate for acute cardiopulmonary process. Multifocal nodular opacities, predominantly in the right lung, improved since 2012 with likely residual scarring and bronchiectasis in the right upper lobe. No new focal airspace opacities. No significant pleural effusions. No pneumothorax. Normal cardiomediastinal silhouette.

Output: Improved multifocal nodular opacities in the right lung with likely residual scarring and bronchiectasis in the right upper lobe. No superimposed acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 34 year old female with two days of pleuritic chest pain, negative cardiac enzymes. Rule out PE. PULMONARY ARTERIES: No filling defects within the pulmonary arteries.LUNGS AND PLEURA: Lungs are underinflated. Dependent bibasalar atelectasis.MEDIASTINUM AND HILA: The heart size is in the upper limits of normal, although this may be related to underinflated lungs.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No pulmonary embolus.


Instruction: Generate impression based on medical findings.

Input: New onset chest pain. Left upper lobectomy. Right jugular catheter tip at the confluence of the brachiocephalic veins with the SVC. Cardiomegaly, unchanged. Hazy opacity with bronchial wall thickening in the right lung. No visible pleural fluid. Pleural or extrapleural nodular opacity in the left lateral costophrenic angle region correlates to abnormality seen on CT of 6/20/2016 and appears larger.

Output: Asymmetric edema-like abnormality which may be due to mild aspiration bronchiolitis/pneumonitis versus interstitial edema in the right lung nonspecific at this time. As long as patient is stable, this can be followed by chest radiograph. Clinical service (Eric Swei , pager 1958) verbally notified at 8:23AM on 11/18/2016 via telephone and the possibility of hypoperfusion to the remaining left lung due to PE on the left was discussed as a possibility.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Eval for Pneumothorax or Effusion History: S/P R VATS Decortication S/P CT removal x 2 of 3 Two right chest tubes removed with the inferior most one still in place, barely entering the pleural space.Residual small subpulmonic pneumothorax unchanged.Right pleural effusion or pleural thickening with right lower lung zone consolidation stable.Right chest wall soft tissue emphysema slightly increased.Left subclavian catheter, tip in SVC.

Output: Two of three right chest tubes removed with a small stable right subpulmonic pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: 58yo M with leukocytosis. Eval for infection History: leukocytosis The heart is normal in size.Lung volumes in the upper limits of normal. Left basilar heterogeneous opacities are concerning for bronchopneumonia in the setting of leukocytosis.The right lung is within normal limits.No parapneumonic effusion.

Output: Findings suggestive of left basilar bronchopneumonia. Correlate with physical exam. No parapneumonic pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Nonspecific marked patchy interstitial and airspace opacities bilaterally but greater on the right in a perihilar distribution. Mild cardiomegaly. Suspected IABP pump projected in the aortic arch. Motion degrades sensitivity

Output: Suspected failure and CHF, however diffuse infection cannot be excluded in the appropriate clinical setting


Instruction: Generate impression based on medical findings.

Input: Urosepsis and fever Diffuse interstitial changes are observed with mildly decreased volumes. Likely chronic interstitial changes, however this is difficult to confirm without prior imaging for comparison. Minimal basilar atelectasis and/or scarring. No distinct effusions.Single right jugular port terminating in the proximal SVC

Output: Interstitial changes most likely chronic in nature it difficult to confirm without priors for comparison. Serial imaging may be indicated if suspicion remains high for an atypical acute concern


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: abnormality History: coughing up blood Lungs and pleural spaces are clear. The cardia sternal silhouette is unremarkable.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: sob, cough History: sob, cough Bilateral multifocal airspace opacities are suspicious for infection and may be accentuated by low lung volumes. Heart size is normal. No pneumothorax or pleural effusion.

Output: Multifocal airspace opacities, most likely pneumonia given patient's age, right greater than left. Follow-up plain films are suggested to assess for resolution or development of cavitation from atypical infection given multifocal nature. Additionally, clinical correlation for noninfectious causes of these abnormalities is also recommended. Suggest follow-up PA and lateral chest radiographs until complete 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, 81 years old.Reason: eval pacemaker , ro ptx History: SOB Assessment of the cardio mediastinum is very limited by rotation. Severe global enlargement of the mediastinal silhouette again noted.Very limited assessment of the lungs. Possible residual pulmonary edema.Suggestion of small right pleural effusion. Right basilar chest tubes in place. Limited assessment for pneumothorax.ET tube and right IJ central venous catheter unchanged in position.There is a new dual lead pacemaker in place overlying the right cardiac contours on follow-up. Localization of the leads is very limited.

Output: New dual lead pacemaker overlies the right atrium and right ventricle, although adequate localization of the leads is very limited in this rotated single AP projection.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: assess swan History: as above Cardiomegaly with left basilar interstitial opacities suggestive of edema or aspiration.Right jugular Swan-Ganz catheter pulled back to the tricuspid level.Right subclavian single lead ICD unchanged.

Output: Right jugular Swan-Ganz catheter pulled back to the tricuspid level.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for widened mediastinum History: chest pain x6 hours this morning Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Abdominal aneurysm, check pulmonary status Left chest port tip at the SVC/RA junction. Normal heart size. Low lung volumes with basal atelectasis and a small left pleural effusion. No pneumothorax.

Output: Low lung volumes. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.History: Atrial fibrillation, CAD, hypertrophic cardiomyopathy, CHF. Symptoms: Rapid ventricular response, hypoxemia. ET tube with tip 3 cm above the carina.Two right central catheters with tips at the confluence of the right internal jugular vein and right brachiocephalic vein.Midline mediastinal drain.No pneumothorax.Layering right pleural fluid collection and mild pulmonary edema.Cardiomegaly and decreased lung volumes redemonstrated.Mild postoperative pneumomediastinum.

Output: Cardiomegaly, decreased lung volumes redemonstrated. Moderate right pleural fluid collection and mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: evaluate for cause of cough History: chronic, semi-productive cough Sternotomy wires remain well aligned.Chronic interstitial opacities without superimposed consolidation. Reticular scarring at the left cardiophrenic angle is unchanged. Heart size is within limits of normal.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with history of metastatic renal cell carcinoma status post 16 cycles of chemotherapy. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Scattered lung nodules previously identified bilaterally unchanged in appearance. The 5 x 7 mm nodule in the left lung base on series 5, image 65/95 remains stable in size.MEDIASTINUM AND HILA: Previously visualized superior mediastinal mass to the right of the trachea anteriorly measures 2.1 cm x 1.9 cm on series 80220, image 14/24 remains stable in appearance. Also on comparison to prior study, smaller, hypoattenuating mass superiorly just below the left thyroid lobe is seen on series 80220, image 3/184 and remains stable in size and appearance.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic ductal prominence unchanged from previous exam.SPLEEN: No significant abnormality noted.PANCREAS: There is redemonstration of diffuse pancreatic atrophy. Stable mass in the body the pancreas on series 80220, image 85/184 measures 1.5 cm x 1.2 cm. Complex cystic mass in head of the pancreas measuring 5.5 cm x 2.7 cm on series 80220, image 101/184 remains unchanged.ADRENAL GLANDS: Left adrenal nodule remain stable in size. Surgical clips are present in the region the right adrenal gland.KIDNEYS, URETERS: Surgically absent right kidney. Multiple small cysts are again visualized in the left kidney.RETROPERITONEUM, LYMPH NODES: Rim enhancing retrocaval mass on series 80220, image 105/184 is stable in size and appearance on comparison to prior study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the lumbar spine are observed.OTHER: No significant abnormality noted.

Output: All lesions are stable on comparison to prior study. No new lesions are identified.


Instruction: Generate impression based on medical findings.

Input: Patient with likely achondroplasia with decreased movement of the right diaphragm on fluoroscopy and hazy right lower lobe. Requires oxygen support and failed for weaning. Limited examination secondary to patient motion artifact. Within that limitation, the following observations are madeLUNGS AND PLEURA: Scattered areas of linear atelectasis. No definite focal consolidation. No pleural fluid or edema. MEDIASTINUM AND HILA: A feeding tube is in place terminating at the GE junction. Otherwise, grossly unremarkable within limits of this noncontrast examination.CHEST WALL: Flaring deformity of the distal ribs compatible with presumed diagnosis of achondroplasia.UPPER ABDOMEN: Limited evaluation due to the lack of IV contrast. Elevation of the right hemidiaphragm noted. Cannot exclude a mass lesion in the liver. Further evaluation with abdominal ultrasound is recommended.

Output: 1.Scattered atelectasis without evidence of other acute pulmonary abnormalities. 2.Elevation of the right hemidiaphragm, cannot exclude mass lesion in the liver. Consider further evaluation with an abdominal ultrasound exam.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of CLL. On chemotherapy. CHEST:LUNGS AND PLEURA: One of the previously described patchy peripheral opacities has nearly resolved. The remainder are unchanged.MEDIASTINUM AND HILA: Adenopathy is decreased. The reference subcarinal node measures 12 x 8 mm (series 3; image 45), previously 18 x 13 mm. The conglomerate right hilar node can now be visualized as two discrete nodes, together measuring approximately 13 x 13 mm, previously 22 x 17 mm (series 3; image 49).Coronary artery calcifications.CHEST WALL: Axillary adenopathy is decreased bilaterally . A reference right axilla lymph node measures 10 x 7 mm, previously 15 x 11 mm (series 3; image 33).ABDOMEN:LIVER, BILIARY TRACT: A cyst is seen in the left lobe of the liver. The previously described hypodensity in segment 8 is less well visualized.SPLEEN: The spleen is mildly enlarged, improved. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodensity in the upper pole of the left kidney is unchanged.RETROPERITONEUM, LYMPH NODES: Reference and interaortocaval lymph node measures 9 x 6 mm (series 3; image 129, previously 13 x 8 mm. The other interaortocaval lymph nodes are also smaller in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Diffuse atherosclerotic disease.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlargedBLADDER: No significant abnormality notedLYMPH NODES: Right external iliac lymph node has decreased in size, measuring 18 x 7 mm (series 3; image 184), previously 27 x 14 mm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Regression of disease involving the lymph nodes and spleen.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Chest tubes. Aortic valve disorders. Interval removal of pericardial drain and a right chest tube. Other tubes and lines unchanged in position.Cardiothoracic ratio moderately enlarged. Pleural fluid collections are at least moderate size, with associated atelectasis. Dependent atelectasis and edema is mild.

Output: Moderate to large pleural effusions with significant atelectasis and mild superimposed pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Increased oxygen requirements evaluate lung fields for pleural effusion, consolidation, atelectasis. Malignant neoplasm of esophagus. Tubes and lines unchanged.No significant pneumothorax.Dependent opacities consistent with pleural fluid, atelectasis and mild edema slightly worsened over the last 2 days.Focal opacity in the left upper lobe could be the result of aspirated secretions but should be monitored.

Output: Slight increase in pleural fluid atelectasis and mild. Possible aspiration of secretions in the left upper lobe.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: FemaleReason for Study: Reason: r/o pna History: as above The cardiomediastinal silhouette is unremarkable.The lungs are clear.Blunting the right costophrenic angle compatible small right pleural effusion.No focal areas of consolidation.

Output: Persistent small right pleural effusion without acute abnormalities. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: obstruction, ileus History: abdominal distension Please see same day chest radiograph for thoracic findings. Coffee bean shaped loop of dilated bowel in the pelvis with gaseous distention of other loops of small and large bowel. Left hip arthroplasty.

Output: Findings suspicious for cecal volvulus. Findings discussed with Dr. Crain in the ED at 8:35 AM on 5/14/2016


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Chest pain and subcutaneous emphysema. Persistent marked subcutaneous emphysema and pneumomediastinum. Subcutaneous emphysema limits evaluation of the lungs. Moderate size right pneumothorax measures 3.2 cm from the apex, appearing similar to the prior study. Right chest tube in place, unchanged. The cardiac size is within normal limits.

Output: 1. Persistent moderate-sized right pneumothorax.2. No interval change in extensive subcutaneous emphysema and pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with squamous cell carcinoma of the esophagus. Status post esophagectomy in 2000. CHEST:LUNGS AND PLEURA: Multiple calcified nodules scattered in both lungs are grossly unchanged. Other, ill-defined, small noncalcified nodules are also unchanged. Scarring in the left apex has minimally progressed within the interval. Hazy band of right upper lobe atelectasis or scarring is unchanged. Emphysematous changes throughout both lungs.MEDIASTINUM AND HILA: Postsurgical changes of esophagectomy with gastric pull-up. Bilateral hilar lymph nodes are unchanged. Calcified mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver cysts in the left lobe is unchanged. No new focal liver lesions.SPLEEN: Small ill-defined splenic lesion is unchanged.PANCREAS: Atrophic pancreas is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral small cysts and punctate left renal stone are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change other than minimal progression of the left upper lobe scarring.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p redo MVR; evaluate PTX History: SOB Cardiomediastinal silhouette is unchanged.Large lung volumes with flattened diaphragms compatible with COPD. Left apical hydropneumothorax appears similar to prior. Right apical bulla. Lower lung zone atelectasis unchanged. No conclusive pneumothorax on the right. Small pneumomediastinum.Mediastinal drain and left chest tube unchanged in position. Median sternotomy wires and hardware in place.

Output: Stable left hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: 55yo F w/ NSCLC, effusion, now s/p pleurX History: SOB Small right apical pneumothorax following pleural drain placement.Persistent right basilar consolidation and right pleural effusion.Mild left base subsegmental atelectasis.Right jugular catheter removed.

Output: Small right pneumothorax with unchanged right pleural effusion and basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Fever. Has PICC line in place. Evaluate for pneumonia. Unchanged left basilar retrocardiac streaky opacity, likely atelectasis. Right basilar compressive atelectasis, related to diaphragmatic elevation. No pleural effusions or pneumothorax.Unchanged cardiomegaly. Status post median sternotomyRight chest wall ICD, 3 leads unchanged. Right IJ central catheter with tip in the SVC. No PICC visualized.

Output: Bibasilar atelectasis. No evidence of pneumonia.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, 73 years old.Reason: post op, eval ETT, lung fields History: s/p ablation Mild cardiomegaly with lower lung zone edema and mild consolidation in the right infrahilar region.Right jugular catheter, tip in SVC.Chest tube with no pneumothorax.

Output: Pulmonary edema and focal consolidation, suggestive of CHF/fluid overload. No ET tube identified.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: chest pain Normal heart size and mediastinal contours.Status post median sternotomy with intact sternal fixation devices.Port catheter with its tip in the SVC.Large lung volumes compatible with emphysema.Focal scarring in the right mid lung with a fiducial marker, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: S/p placement of R IJ central line, check position History: s/p central line placement A faintly opaque central line is visible in the area of the right internal jugular vein extending to the SVC, though its tip is not clearly visible. No pneumothorax or other significant cardiopulmonary abnormality.

Output: Catheter tip in the area of the SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: COPD, Breast CA History: SOB New focal opacity in the mid aspect of the left hemithorax. With slight increased left basilar opacity. Small pleural effusions or pleural thickening again noted slightly worse on the left. Right upper pleural parenchymal scarring again noted. Unchanged heart size. No definite pneumothorax.

Output: Increased opacity in the mid aspect of the left hemithorax which may represent focus of pneumonia or aspiration or treatment-related changes within the lung parenchyma. Given slight worsening of left pleural effusion/pleural thickening, this may represent increase pleural thickening along the left major fissure though this is not definitively confirmed on the lateral radiograph. Chest radiograph or follow-up in 8 weeks after treatment is suggested.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with history of cervical cancer. Possible stent displacement versus urinary retention. Wound with bladder metastases. Severe abdominal pain and urinary retention. This examination is limited by absence of IV contrast. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Mass located anterior to left hepatic lobe is stable in size on image number 81, series number 3.SPLEEN: Peritoneal mass invading the splenic hilum is stable and measures 6.7 x 4.4-cm image number 35, series number 3.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left-sided hydronephrosis and dilated left ureter were resolved by interval placement of a nephroureterostomy.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Right pericolonic mass measures 6.6 x 7.5 cm image number 57, series number 3, not significantly changed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right ovarian cystic lesion is stable . Left adnexal mass is stable . Cervix is ill-defined and heterogeneous.BLADDER: Left wall of the bladder is asymmetrically thickened likely secondary to invasion by patient's known cervical cancer. Bladder is minimally distended. LYMPH NODES: Left inguinal lymph node is borderline enlarged and not significant changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The left-sided hydronephrosis is resolved with a nephroureterostomy. No other significant change from previous study. Cervical mass invading the left bladder wall and left ureter, peritoneal implants are unchanged.


Instruction: Generate impression based on medical findings.

Input: Right lower lobe nodule biopsy Mild volume loss on the right with an elevated hemidiaphragm and/or possible small effusion. No superimposed acute intrapulmonary or postprocedural abnormality, specifically no pneumothorax.

Output: No acute postprocedural abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Cough for 2 weeks with night sweats question pneumonia. Acute pharyngitis. Metallic foreign bodies consistent with piercings project over the anterior chest wall bilaterally.Normal heart size.No pneumothorax or pleural fluid.Subtle left lower lobe paramediastinal opacity suspicious for infection.

Output: Left lower lobe medial basal opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: 47 y/o F w/ Hx of MI x2, PNA, r/o PNA History: Chest pain r/o PNA Minimal linear atelectasis left lower lung zone, the lungs otherwise unremarkable.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Swan placement History: As above Swan-Ganz catheter tip in the right descending pulmonary artery.Markedly underinflated lungs with mild basilar atelectasis and no acute change.

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


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: infiltrate History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of neuroendocrine tumor. Evaluate for abscess or cause of purulent drainage from catheter site ABDOMEN:LUNGS BASE: Right lower lobe scarring and atelectasis is unchanged.LIVER, BILIARY TRACT: Unchanged multiple metastatic lesions in the liver. Reference hypodense lesion near the dome of the liver on image number 24, series number 3 is stable measuring 17 x 17 mm previously 18 x 17 mm. Multiple other hypodense lesions through the liver representing a combination of metastatic disease and debris and air in dilated ducts/abscesses, predominantly in the right lobe of the liver have not significantly changed. Largest air containing cystic lesion measures 4.2 x 2.7 cm previously 4.4 x 2.8 cm in the right lobe of the liver.An internal/external biliary drainage catheter extends into the duodenum through the metallic stent is unchanged in position.SPLEEN: Chronic splenic vein thrombosis with collaterals between the stomach and spleen.PANCREAS: Patient's ill-defined hypodense mass in the and of the pancreas measures 4.9 x 3.3 previously 4.8 x 3.3 cm, not significantly changed from previous study.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nodular soft tissue density between the left kidney and spleen is unchanged and measures 13 x 10 previously 13 x 11 mm image number 50, series number 3.RETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm is unchanged. Reference aortocaval lymph node is unchanged measuring 15 x 8 mm previously 14 by 8mm image number 61, series number 3.BOWEL, MESENTERY: Unchanged mild ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study. No new fluid collection. Multiple hypodense lesions, ill-defined pancreatic head mass, mediastinal lymph nodes are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Fever question infiltrates Basal atelectasis and scarring, right greater than left. No specific signs of pneumonia. Mild probable mild cardiomegaly. Heavily calcified thoracic aorta.Left upper quadrant air lucency appears to be above the level of the gastric air bubble and free intraperitoneal air cannot be excluded, though no similar finding is identified on the right, which would be more typical of free air distribution.

Output: Left upper quadrant air lucency could reflect air in the stomach or bowel however free intraperitoneal air cannot be excluded. Correlation with left side down lateral decubitus views of the abdomen or upright chest radiograph recommended if patient is symptomatic. No signs of pneumonia.Findings and recommendation discussed with the patient's nurse Shannon at 8:33 AM on 3/9/2016.


Instruction: Generate impression based on medical findings.

Input: Male; 33 years old. Reason: CHF History: as above Moderate cardiac enlargement. Mild streaky left basilar opacities, most likely due to subsegmental atelectasis and/or scarring. No specific evidence of edema or pneumonia. Right jugular central venous catheter tip in the right atrium.

Output: Cardiomegaly without specific evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: chest pain History: chest pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: cough, desaturation on room air History: cough, desaturation on room air Borderline cardiac enlargement.Right perihilar opacity likely representing infection.Distended loops of bowel seen as well as pneumoperitoneum. This most likely is secondary to C-section performed same day. Case was discussed with the primary service.

Output: Right perihilar opacity likely representing infection.Postoperative pneumoperitoneum. Discussed with primary service.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female status post herniorrhaphy presents for evaluation of a leukocytosis. The cardiomediastinal silhouette is normal in size. Low lung volumes. Bibasilar atelectasis noted. No focal pulmonary opacity suggestive of pneumonia. No large pleural effusion. No pneumothorax.

Output: Low lung volumes and associated atelectasis. No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant SVC stent again noted, unchanged. Left IJ line has been removed. No pleural effusion or pneumothorax. No focal lung consolidation. Normal heart size. Aortic and coronary atherosclerosis. Minimal disc degeneration. Large patient body habitus. Focal calcifications in the breast tissue.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Interval new opacity overlying the right hemithorax suggesting a layered moderate effusion. Vascular redistribution is also observed, more likely secondary to semiupright positioning. Of particular note is increased opacity along the minor fissure suggesting a right upper lobe nonspecific airspace process, partial consolidation or aspiration cannot be excludedInterval removal of the right PICC line

Output: Suspected layered moderate right pleural effusion and questionable new nonspecific focal opacities in the right upper lobe


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: infiltrate History: Sickle cell crisis, chest pain Right chest wall port terminates in the cavoatrial junction.Cardiac size is normal. Right mediastinal shift is unchanged. Patchy areas of subsegmental atelectasis or scarring are unchanged. No focal airspace consolidation, pleural effusion, or pneumothorax.

Output: Patchy areas of subsegmental atelectasis with no airspace consolidation or pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p IABP removal History: IABP removal Swan-Ganz catheter tip in the right main pulmonary artery.Cardiomegaly with interstitial opacity compatible with edema and pleural effusions, greater on the right with partial loculation.

Output: Increased right pleural effusion and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: IABP History: IABP IABP marker at the top of the aortic arch.Swan-Ganz catheter tip in the right main pulmonary artery.Nonspecific bilateral basilar opacities suggestive of edema and effusions, similar to the prior exam.Moderate cardiomegaly.

Output: IABP marker at the level of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: cp History: cp Chronic basilar interstitial lung disease and a mass projected over the left hilum are unchanged.No evidence of superimposed edema or pneumonia.Status post median sternotomy for CABG, with mild cardiomegaly.

Output: Chronic interstitial lung disease a known left lung mass, but no acute findings.


Instruction: Generate impression based on medical findings.

Input: Lung cancer. Evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Right upper lobe cavitating lesion is grossly unchanged in size with more fluid content. Previously mentioned ground glass opacities in the upper lobes have almost completely resolved. Right upper lobe tree in bud opacities are again noted. Right lower lobe atelectasis. Right lower lobe tree in bud opacities have improved.MEDIASTINUM AND HILA: Right superior mediastinal lymph node is unchanged measuring 11 x 11 mm on image number 9/218. A pretracheal lymph node measures 2.5 x 1.6-cm image number 39/218, unchanged.Right hilar mass measuring 2.1 x 1.5 cm which may represent an enlarged lymph node.CHEST WALL: Again noted the bony destruction of second third and fourth right posterior ribs.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: Punctate stone in the right kidney without hydronephrosis. Subcentimeter hypodense lesions in both kidneys, most likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right upper lobe cavitary malignant lesion with metastases to the right upper ribs. Mediastinal and right hilar adenopathy.Previously described ground glass opacities have resolved and centrilobular opacities improved.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with altered mental status. New moderate right pleural effusion with adjacent compressive atelectasis. Right upper lobe nodular opacity previously characterized on CT. No pneumothorax. Normal cardiomediastinal silhouette.

Output: New moderate right pleural effusion with adjacent compressive atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval for pulmonary edema History: dyspnea Heart size upper normal.No significant pulmonary or pleural abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Operative Evaluation History: SOB Single pacemaker lead with its tip in the area of the anterolateral wall of the right ventricle.Heart size upper normal or mildly enlarged with a tortuous aorta.Calcification in the area of the aortic valve consistent with a history of aortic stenosis.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: s/p dual chamber pacemaker implant --> r/o pneumothorax and evaluate lead positions History: as above Mild cardiomegaly.Small lung volumes without specific evidence of edema or pneumonia.Mild subsegmental atelectasis bilaterally.Left subclavian dual-chamber pacemaker placed, without complication.

Output: Pacemaker placement without complication such as pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: cll History: fever and h/o pleural effusion Large bilateral pleural effusions, increased compared to previous.Underlying opacity consistent with atelectasis.Focal nodular pleural thickening superolaterally in the right hemithorax, unchanged.

Output: Large pleural effusions with underlying atelectasis but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 47 year-old female with metastatic gastric cancer CHEST:LUNGS AND PLEURA: Unremarkable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal lesions except for a subcentimeter cyst in segment 8. Previously described heterogeneous appearance of the liver has resolved. Liver is slightly enlarged. Liver has nodular contours and hypertrophied left lobe suggestive of chronic liver disease. Splenorenal shunts suggestive of portal hypertension.SPLEEN: Small, subtle hypodensities in the lower pole of the spleen are unchanged.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: Concentric wall thickening of the stomach consistent with patient's known history of gastric cancer is unchanged. Previously described ascites has resolved.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffuse gastric wall thickening consistent with patient's known history of gastric cancer. Possible chronic liver disease and portal hypertension. Interval resolution of ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: c/f swan not working History: see above Swan-Ganz catheter tip in the area of the left main pulmonary artery. Aortic balloon catheter tip in the proximal descending aorta.Nonspecific basilar opacities suggestive of atelectasis and consolidation, greater on the left.

Output: Interval extubation and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: mass? History: 5 d of constant left cp Stable cardiomediastinal silhouette. No focal pulmonary opacity. No specific evidence of infection or edema. No pleural effusion or pneumothorax. Cholecystectomy clips. No mass as clinically questioned. Mild bronchial wall thickening and very mild scarring at the left base.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 18 yearsGender: MaleReason for Study: Reason: evaluate for pneumonia History: cough x 6 weeks, wheezing 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: Male, 40 years old.History of sickle cell pain crisis Cardiac silhouette stable in appearance.Basilar predominant interstitial opacities/scarring without acute interval change. No superimposed focal airspace opacity or pleural effusion. No pneumothorax.

Output: No significant interval change. No evidence of pneumonia.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, 69 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Cardiomegaly status post sternotomy with chest tubes but no pneumothorax.Pneumoperitoneum likely related to recent LVAD placement.Left basilar atelectasis unchanged.ET tube tip approximately 5 cm above the carina.Right jugular Swan-Ganz catheter, tip in right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Unchanged basilar opacities. No pneumothorax. Postoperative pneumoperitoneum or subpulmonic pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: hypoxemia History: na Worsening pulmonary opacities and pleural effusions with basilar consolidation.

Output: Worsening pulmonary opacities suggestive of edema, with basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: eval endotracheal tube placement History: respiratory failure ET tube tip at the level of the carina directed towards the right main bronchus with the neck in a flexed position.Left lower lobe opacity compatible with atelectasis and consolidation.A more recent radiograph has been interpreted.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: hemothorax and chest tube in place, LVAD, ICD, swan catheter History: hemothorax and chest tube in place, LVAD, ICD, swan catheter Unchanged right chest tube with a right pleural effusion, but a small right apical pneumothorax.Stable basilar atelectasis right greater than left.LVAD and ICD unchanged.Right jugular Swan-Ganz catheter, tip in right pulmonary artery.Right subclavian catheter, tip in SVC.

Output: Small right apical pneumothorax with a right pleural effusion despite a right chest tube. Unchanged pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with metastatic colon cancer This study is limited due to lack of IV contrastCHEST:LUNGS AND PLEURA: Micronodules on image number 82, series number 6 in the left lower lobe is unchanged. No new nodules.MEDIASTINUM AND HILA: Stable small mediastinal lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Asymmetric renal atrophy on the left side is unchanged. Stable cortical desiccation the left kidney which may represent stones. Right renal cyst is unchanged. Small hypodensities in the left kidney cannot optimally characterize its lack of IV contrast, however, grossly unchanged from previous study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Midline incisional hernia containing nonobstructed bowel loops. Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Left inguinal bowel cannot is increased in size and now measures 4.2 x 3.6 cm on image number 214, series number 4.BOWEL, MESENTERY: Postsurgical changes and presacral soft tissue density is again noted. Presacral soft tissue density is slightly more prominent compared to previous study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the left inguinal adenopathy. Presacral soft tissue density is more prominent compared to previous study. Recurrence cannot be excluded. No other significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Malignant mesothelioma Persistent right pleural effusion with fluid tracing into the apex and minor fissure. No significant interval change and probable partial loculation given the absence of layering.Suspected resolution of right chest wall emphysema, however portions of the chest wall are cut off, limiting evaluationLeft subclavian ICD and right jugular port unchanged. Cardiac and mediastinal contours are within limits

Output: Persistent unchanged right pleural thickening and suspected loculated minimal fluid


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: ?right PTX History: poor oxygenation Right chest tube with no pneumothorax but a large right pleural effusion compressing the right lung medially.Moderate to severe interstitial and air space opacities are consistent with edema as well as left lower lobe consolidation and a left pleural effusion.NG and Dobbhoff tubes extend below the lower margin of the image.Right jugular and right subclavian catheters terminating in the SVC and RA respectively.

Output: No pneumothorax. Large right pleural effusion as well as edema.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: QUESTION OF HYDROTHORAX. History: SHORTNESS OF BREATH Right midlung atelectasis. Remaining lungs clear.Heart size normal. No pneumothorax. No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: s/p AV and MV repair History: fever Status post mitral and aortic repair.Unchanged basilar opacities and pleural effusions, including areas of consolidation.Right jugular catheter tip at cavoatrial junction.

Output: Unchanged basilar opacities and pleural effusions. In addition to mild CHF that there may be superimposed aspiration or less likely infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for patholgoy History: lethargy Moderately underinflated lungs with mild basilar atelectasis.Venous catheter with its tip projected in the area of the right jugular vein.

Output: Mild basilar atelectasis but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: chest tubes in place s/p cabg History: same Line position stable. No change in cardiomegaly with interstitial edema and basilar atelectasis

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: 51-year-old female presents after desaturating. Evaluate for pulmonary edema. The cardiomediastinal has loss of the silhouette at the left inferior border, a new finding since the prior radiograph. Increasing predominantly interstitial opacities bilaterally. Small bilateral pleural effusions. Increasing cephalization of the vasculature as well as vascular indistinctness of the hila. No pneumothorax.

Output: Worsening pulmonary edema and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.History of end-stage renal disease, prekidney transplant evaluation. Unremarkable cardiomediastinal silhouette.No focal pulmonary opacities, pneumothorax, or pleural effusions.

Output: No significant radiographic abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: s/p trach, assess for pneumo/subq emphysema History: as above Tracheostomy is in place. Central venous catheter terminates in the superior aspect of the RA. Low lung volumes. Diffuse pulmonary opacities again noted. Unchanged heart size. Very small pleural effusions. No pneumothorax. Gastrostomy tube, incompletely visualized.

Output: Tracheostomy is in place. Pulmonary edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of recurrent oropharyngeal cancer. Status post left neck dissection evaluate for pulmonary metastases LUNGS AND PLEURA: Scattered small calcified granulomas are noted. No pulmonary or pleural masses can be identified. No pleural effusions are present.MEDIASTINUM AND HILA: There is demonstration of a minimally prominent right hilar lymph node, unchanged in comparison with the examination.there is no evidence of a pericardial effusion. There is redemonstration of atherosclerotic changes of the coronary arteries and aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: There is a gastrostomy feeding tube. A small cyst is noted in the upper pole left kidney.

Output: There is no evidence of metastatic disease. There has been no interval change in comparison to the exam dated 6/29/09


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: FemaleReason for Study: Reason: evaluate for cardiomegaly, pulmonary edema History: 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 edema


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Concern for pneumothorax. The right pneumothorax has decreased in size after recent placement of right pigtail pleural catheter. The volume of the pneumothorax is now small.Mild cardiomegaly.Diffuse bilateral fine reticular opacities are unchanged from priors, consistent with history of LCH.

Output: Interval decrease in size of the right pneumothorax, now small, with new pigtail pleural catheter in place.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old. PICC tip in the SVC.Right chest tubes in place with a small residual apical pneumothorax and moderate pleural effusion.Skin folds of the left lung but no left pneumothorax.Right perihilar opacity compatible with postoperative contusion, hematoma and atelectasis.

Output: New catheter with its tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: On-going respiratory infection with wheezing noted on exam History: Stage IV melanoma Interval resolution of a right upper lobe mass with mild residual streaky opacity in this area consistent with scarring.Focal right retrohilar opacity suggestive of scarring and better depicted on a previous CT scan.No new findings.

Output: Focal scar like opacities and no specific evidence of metastatic disease or infection.


Instruction: Generate impression based on medical findings.

Input: 44 year-old female with abdominal pain and air on chest x-ray. CHEST:LUNGS AND PLEURA: A right-sided hydropneumothorax with extensive right chest wall subcutaneous emphysema is identified over the site of the thoracotomy. The lung parenchyma demonstrates a mosaic attenuation pattern with some nodular ground-glass opacities, which is suggestive of edema. Bibasilar atelectasis and consolidation are also seen.MEDIASTINUM AND HILA: Left sided central line tip is in the SVC. Cardiomegaly and enlarged main pulmonary artery. Post operative changes from valve replacement. Small paratracheal CHEST WALL: Status post right thoracotomy with right-sided chest wall subcutaneous emphysema. ABDOMEN:LIVER, BILIARY TRACT: Multiple bilobar peripheral hypodensities without significant mass effect, which are suggestive of infarcts. The portal vein and its branches are patent. SPLEEN: Multiple peripheral wedge-shaped hypodensities likely represent infarcts.PANCREAS: The pancreas is enlarged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is free intraperitoneal air with a hyperattenuating fluid collection in the pelvis. Additionally, a loculated fluid collection in the right paracolic gutter and iliac fossa is present. There is no focal free air in the right lower quadrant or evidence of pneumatosis intestinalis. Nasogastric tube terminates in the distal antrum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is heterogeneous in appearance with an enlarged fluid filled endometrial cavity.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Pelvic ascites.

Output: 1.Hyperdense fluid collection in the pelvis is concerning for a large pelvic hematoma.2.Pneumoperitoneum in the upper abdomen most likely represents tracking of pleural air into the peritoneum as there is no other specific evidence to suggest bowel perforation. 3.Multiple peripheral hypodensities in the liver and spleen are suggestive of age indeterminate infarcts.4.Right-sided hydropneumothorax with chest wall emphysema.5.Bibasilar atelectasis/consolidations and pulmonary edema.6.Atrophic kidneys.7.Heterogeneous appearance of the uterus and fluid filled endometrial cavity. Followup examination is recommended for evaluation of a mass when the patient is stable.These findings were discussed with the clinical service at approximately 8:30 a.m. on 11/10/2010


Instruction: Generate impression based on medical findings.

Input: 71-year-old female presents with acute decompensated heart failure. Left-sided port has tip overlying the superior vena cava.The cardiomediastinal silhouette is borderline enlarged. Mild septal thickening consistent with pulmonary edema. Left retrocardiac atelectasis. Left upper lung nodule. Small bilateral pleural effusions.

Output: 1.Mild CHF pattern with small bilateral pleural effusions.2.Left retrocardiac atelectasis with or without pneumonic consolidation.3.Left upper lobe nodule. Comparison with prior imaging if available would be useful to assess for stability. Alternatively, consider low-dose unenhanced CT chest imaging for further assessment.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with history of fever and cough. Evaluate for pneumonia. Postoperative changes from prior sternotomy.Mild cardiomegaly. No focal opacities to suggest infection. No pleural effusions.

Output: Mild cardiomegaly with no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: infection? History: fever Tracheostomy tube and venous catheter unchanged.Small bilateral pleural effusions.No specific evidence of pneumonia.

Output: Small pleural effusions but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: r/o pna History: SOB with cough Right central venous catheter with its tip in the SVC.Stable cardiomediastinal silhouette. Nonspecific basilar opacities similar to the prior exam.No new focal airspace opacities.Blunting of the left costophrenic angle redemonstrated.Bilateral shoulder arthroplasties noted.

Output: No acute cardiopulmonary abnormality identified without interval change. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: s/p DDRT History: s/p DDRT Right IJ venous catheter with its tip in the SVC.Decreased lung volumes with stable cardiomediastinal silhouette.Vascular stent in the left axilla.Basilar subsegmental atelectasis unchanged.No new pulmonary opacities identified.

Output: No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p thoracentesis, assess for pneumo History: as above No sign of pneumothorax or other acute change following thoracocentesis.Persistent large bilateral pleural effusions with underlying atelectasis.ET tube tip approximately 3 cm above the carina.

Output: Large pleural effusions and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: swan History: swan Patient is status post sternotomy. LVAD in place. Disconnected ICD leads in place. Distal portions of the Swan-Ganz catheter tip and left IJ tip are not well seen due to motion and overlying materials. Moderate cardiomegaly status post sternotomy and valve repair.Unchanged pulmonary opacities suggestive of edema with a small left pleural effusion.

Output: Cardiomegaly with pulmonary edema unchanged. Distal portions of the Swan-Ganz catheter tip and left IJ tip are not well seen due to motion and overlying materials.


Instruction: Generate impression based on medical findings.

Input: 41 year-old female with history of anal cancer status post resection of liver and lung metastasis 8/13/09.Additional history: Diaphragmatic infiltration noted at surgery CHEST:LUNGS AND PLEURA: The left apical lung nodule has been resected. A 7 mm nodular opacity in the postsurgical bed (series 4, image 17) is noted and should be followed.MEDIASTINUM AND HILA: A few subcentimeter lymph nodes are identified within the mediastinum, slightly increased in size, but not pathologically enlarged by CT criteria.A small right pleural effusion with associated passive atelectasis has developed.CHEST WALL: Bilateral breast implants.ABDOMEN:LIVER, BILIARY TRACT: The lesions involving the right lobe of the liver have been resected. A fluid collection measuring approximately 5.8 x 2.6 cm is seen in the postsurgical bed. A 5.0 x 2.9 cm soft tissue mass arising from the right hemidiaphragm (series 3, image 76) is compatible with residual tumor.Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate, nonobstructive calculus in the right upper pole.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: Haziness of the perirectal fat remains.BONES, SOFT TISSUES: Patchy sclerosis affects the iliac bones at the SI joints, unchanged.OTHER: Trace free fluid layers within the pelvis.

Output: Interval resection of the left apical lung nodule and lesions in the right lobe of the liver.5 x 3 cm metastatic lesion involving the right hemidiaphragm.Subcentimeter nodule in the left apical postsurgical bed: Postsurgical change versus residual tumor which should be followed.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Line placement History: Line placement Bilateral pleural effusions and basilar atelectasis have progressed since the prior study.New left jugular catheter place, terminating at the right atrial level.

Output: Worsening pleural effusions. New left jugular catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Evaluate lung mass. Lung mass/pneumonia. Slight increase in volume of right pleural fluid collection, moderate. Mild pulmonary edema. Small volume of pleural fluid on the left is not significantly changed. Multiple pulmonary nodules, presumably metastatic, though continued plain film follow-up recommended to exclude possibility of superimposed infectious lesions. Basal atelectasis/consolidation on the left, nonspecific.

Output: Worsening hypervolemia/CHF. Left basal consolidation unchanged.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of rheumatoid arthritis and anemia with dysphagia Scout radiograph of the chest showed enlarged cardiac silhouette with bibasilar patchy opacities superimposed on diffuse chronic interstitial changes appearing similar to the prior exam. Double contrast evaluation of the esophagus and gastric cardia/fundus revealed a patulous esophagus without morphologic abnormalities of the mucosal surfaces or mural contours. Fluoroscopic evaluation of the hypopharynx and upper esophagus demonstrate a prominent cricopharyngeal bar at the C5 level. No evidence of aspiration was noted. Fluoroscopic evaluation of esophageal peristalsis cessation of the primary peristaltic wave at the level of the aorta with secondary and intermittent tertiary waves.During the exam, one episode of provoked gastroesophageal reflux was observed to the level of the mid-thoracic esophagus with rapid clearing. A swallowed 13mm barium tablet was held briefly in a physiologic location and passed readily into the stomach with sips of waterTOTAL FLUOROSCOPY TIME: 6:05 minutesENTRANCE DOSE: 201.50 mGy

Output: 1.Mild to moderate motor abnormality of the esophagus. 2.Cricopharyngeal bar at the C5 level.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: 66F s/p hepaticoJ now with fever, tachycardia. History: fever, tachycardia Support devices in the right upper abdominal quadrant are again noted. Small, right greater than left, pleural effusions. Heart size remains normal. No pneumothorax.

Output: Small pleural effusions, right greater than left.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: SOB History: SOB Left Port-A-Cath with its tip in the SVC.Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.Evidence for prior granulomatous disease.Multiple surgical clips identified in the right axilla and interval right mastectomy.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: productive cough, dyspnea Dense focal opacity in the left lower lobe and anteriorly in the lingula, not significantly changed from previous.Blunting of the right costophrenic angle, also unchanged, compatible with scarring.

Output: Abnormal left lower lung opacity, better characterized on a subsequent CT scan which shows chronic bronchiectasis.


Instruction: Generate impression based on medical findings.

Input: Patient fell on left chest Persistent mild cardiomegaly with moderate tortuosity aorta and a large hiatal hernia similar to prior exam. Mediastinal contours are otherwise unremarkable given mild patient rotation and techniqueLungs continue to demonstrate mild basilar changes representing suspected scarring mixed with minimal atelectasis. Scattered calcified granulomataNo discrete osseous abnormalities however given demineralization, consider serial or dedicated imaging if suspicion remains high

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: DOE, eval for ADHF History: DOE, eval for ADHF Lung volumes are low. Perihilar and basilar patchy airspace opacities with small pleural effusions. Enlargement central pulmonary arteries suggestive of pulmonary arterial hypertension. No significant pneumothorax.

Output: Small pleural effusions with perihilar and lower zone opacities favoring edema.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: r/o pneumonia History: fever No significant cardiopulmonary abnormality.Chronic appearing right costophrenic angle blunting.No specific evidence of infection or edema.Right upper quadrant embolization coils and a right upper quadrant pigtail drain are present.

Output: Right pleural scarring, otherwise unremarkable, without evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: assess heart size, lung fields for fluid overload History: SOB Moderate to severe cardiomegaly with pulmonary vascular redistribution.Focal pulmonary edema is present with a very small right pleural effusion.

Output: Severe cardiomegaly, with mild CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: emypema s/p drainage History: emypema s/p drainage Right chest tube in place with a small subpulmonic pneumothorax and underlying pulmonary consolidation. Right pleural thickening or loculated effusion, unchanged. Moderate left effusion.Port catheter with its tip in the SVC.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with shortness of breath, chest pain. Possible PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic of level of the proximal segmental pulmonary arteries.LUNGS AND PLEURA: A micronodule in the right lower lobe, likely calcified. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size mildly enlarged without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: No PE. Study is diagnostic of level of the proximal segmental pulmonary arteries.


Instruction: Generate impression based on medical findings.

Input: History of myxoid liposarcoma. CHEST:LUNGS AND PLEURA: Tiny micronodules unchanged.Left lower lobe mass adjacent to the descending thoracic aorta measures 2.5 x 1.9 cm (image number 39, series number 4) is slightly larger compared to previous CT. It was measuring 1.8 x 1.6 cm on image number 40 on the previous study.MEDIASTINUM AND HILA: Nonocclusive thrombus in the SVC. Interval removal of the port catheter.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypodensities in segment 4 of the liver on image number 81. The etiology of these small hypodensities is unknown. Follow-up imaging is recommended for further evaluation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the left lower lobe lung mass suspicious for metastatic disease. A primary lung cancer is another possibility.New nonocclusive thrombus in the SVC.Dr. Undevia was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Pt with swan catheter, eval for placement History: see above Swan-Ganz catheter with tip favored to be in the left main pulmonary artery and unchanged in position compared to the radiograph one day prior. Left internal jugular venous catheter with tip in the left brachiocephalic vein.Apparent cardiomegaly appears unchanged. Right-sided pleural effusion increased in size. Bilateral diffuse interstitial opacities minimally increased from the prior examination. No pneumothorax.

Output: Apparent increase in size of right-sided pleural effusion. Radiographic signs of arterial pulmonary hypertension and other abnormalities are unchanged.


Instruction: Generate impression based on medical findings.

Input: Rule female locally advanced pancreatic cancer status post 5-FU XRT. Status post therapy. Follow for disease status. CHEST:LUNGS AND PLEURA: There are stable moderate-sized bilateral pleural effusions. Single nodule left lower lobe image 69 measures 5.2 mm in diameter unchanged from the previous exam image 64.MEDIASTINUM AND HILA: Pretracheal paratracheal prevascular adenopathy proximally unchanged.Paratracheal index node measures 1.6 x 1 cm on image 35. Previously measured 1.5 x 1.3.Right hilar node is difficult to measure accurately and is estimated on image 43 is 2.2 x 1.4 cm. Previously it measured 3.2 x 1.5 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast. Given that limitation: there is a biliary stent and pneumobilia with no obvious liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: The lesion cannot be measured due to lack of IV contrast. Visually the shape and size of the pancreatic head region is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The there is new or progressive generalized anasarca and haziness of the mesenteric small amount of generalized ascites. The bowel is normal.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel normal. Small amount of generalized ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Comparison measurements difficult to the lack of IV contrast. Probably stable disease. Progressive anasarca and new ascites. Stable bilateral pleural effusions and left lung nodule.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: dyspnea - concern for worsening pulmonary effusions/volume overload History: dyspneic, tachycardic Stable cardiac enlargement.Bilateral pleural effusions similar to the prior exam.Mild interval improvement in the perihilar edema.Left retrocardiac consolidation/atelectasis redemonstrated.IVC filter is present.

Output: Interval improvement in pulmonary edema with pleural effusions and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: slurred speech History: same Mild to moderate cardiomegaly.Left lower lobe patchy opacity probably atelectasis from aspirated secretions or mucous plugging.No reliable evidence of pneumonia or edema.

Output: Cardiomegaly with nonspecific retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: 69 year old male with stroke, increased WOB. Bilateral perihilar opacities, left greater than right of undetermined chronicity. No pleural effusion or pneumothorax. Cardiomegaly. Prominence of the pulmonary arterial vasculature suggestive of pulmonary hypertension.

Output: Cardiomegaly with bilateral perihilar opacities, left greater than right of undetermined chronicity which could be due to aspiration, infection, or less likely edema. Recommend prior radiographs if available for comparison. If no prior studies are available, these can be further evaluated with CT.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval for acute abnormality History: acute SOB, rhonchorous breath sounds, desating No change in the right upper and lower lobe lung opacities. There is a question of right hilar adenopathy. Left lung remains clear.

Output: No significant change in right upper lobe opacities with question of right hilar adenopathy. Consider follow-up contrast enhanced CT of chest.


Instruction: Generate impression based on medical findings.

Input: Reason: iabp History: iabop Aortic balloon catheter marker at the level of the aortic arch with the balloon in the descending aorta.Swan-Ganz catheter tip in the branch of the right pulmonary artery.ICD leads in place.Bilateral pulmonary opacity compatible with edema and moderate pleural effusions.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: check pulmonary status History: check pulmonary status Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.Catheter tip in the SVC.No new findings.

Output: Atelectasis and effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Asthma and COPD No definite distinct superimposed acute cardiopulmonary abnormality, however mild prominence to the interstitial changes suggest a more chronic abnormality and/or related to patient's related history of asthma. Comparison with prior outside imaging if available would be very helpful to confirm. In addition a subcentimeter focal nodular opacities project over the mid right lung, not clearly observed on the lateral projection. This may represent superimposed artifact however again follow-up imaging is needed given patient's age.Cardiac and mesial contours are well within limitsDr. W Parker contacted.

Output: Questionable lung nodular opacity, uncertain significance


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: 63F with LVAD - eval lines History: - Stable cardiomediastinal silhouette.Worsening bilateral large pleural effusions with bibasilar airspace and interstitial opacities.No evidence of pneumothorax.Tracheostomy tube with tip located approximately 3.5 cm above the carina.Interval removal of left central venous sheath.Multiple additional hardware and support devices are unchanged.

Output: Worsening bilateral large pleural effusions with bibasilar airspace and interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with Ewing sarcoma of the mandible, status post resection/chemo, evaluate and compare LUNGS AND PLEURA: Small micronodules knee and two segment of the right upper lobe is stable. No other pulmonary nodules or masses can be identified. No pleural effusion is noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Schmorl's nodes with mild degenerative changes in the midthoracic spineUPPER ABDOMEN: No significant abnormality noted.

Output: Stable micronodule in the right upper lobe. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 19-day-old male with right pneumothorax. EvaluateVIEW: Chest AP (one view) 12/1/2015, 0018 Endotracheal tube tip is between thoracic inlet and carina. Enteric tube with tip in the proximal gastric body. Lower extremity PICC tip is in the inferior vena cava. Right sided chest tube with tip unchanged in position. Cardiothymic silhouette is normal. Persistent bilateral coarse pulmonary opacities on background of pulmonary interstitial emphysema. Mild interval decrease in size of right pneumothorax. Soft tissue chest wall edema persists.

Output: 1.Mild interval decrease in size of right pneumothorax.2. Persistent bilateral pulmonary opacities on the background of pulmonary interstitial emphysema.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Improved aeration, specifically reexpansion of the left lower lobe representing resolved atelectasis and decreased basilar edema. No new superimposed acute cardiopulmonary findings and persistent mildly decreased lung volumes. Mild cardiomegaly

Output: Resolving atelectasis without new disease


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Laparoscopic cholecystectomy with increased shortness of breath and confusion. Vascular stent the left paratracheal region.Lung volumes similar to prior with basal scarring or atelectasis about the same.Small pleural effusions.

Output: No significant change in pleural fluid or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for pulmonary edema and PICC placement History: Dyspnea Marked cardiomegaly with ICD leads extending to the area of the right ventricular apex and a left ventricular vein.Catheter from a right extending to the area of the right atrium though the tip is not clearly visible.Small lung volumes with possible mild interstitial edema and basilar opacity compatible with atelectasis and pleural effusions.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lungs and mediastinum History: sob Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: ETT removal ETT removed and the right jugular catheter remains unchanged terminating in the upper SVCUnderlying moderate cardiomegaly and CHF changes persist with questionable mild decreasing effusions. Minimal overall improvement as compared to 10/6/2016. No new superimposed focal airspace process

Output: Moderate CHF and ETT removed


Instruction: Generate impression based on medical findings.

Input: Reason: History of Asthma - Evaluate. History: History of Asthma - Evaluate. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Lung transplant, subcutaneous emphysema Persistent marked left chest wall emphysema with minimal gas extending into the left neck. Overall appearance essentially unchanged, however the underlying small pneumothorax is currently not well appreciated existing with continued resolution.Asymmetric lung volumes elevated left hemidiaphragm unchanged. Questionable perihilar patchy opacities, nonspecific. The native right lung remains clear other than emphysema

Output: Resolving left pneumothorax with overlying persistent marked chest wall emphysema


Instruction: Generate impression based on medical findings.

Input: Female 42 years old Reason: 42F with ARDS, eval for change History: SOB, hypoxia, Hx of PNA, s/p trach Tracheostomy tube and venous catheters unchanged.Small lung volumes with persistent diffuse nonspecific interstitial and air space opacities without significant interval change.

Output: ARDS without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval IABP History: IABP repositioned IABP catheter tip now 5 cm below the top of the aortic arch.No specific evidence of infection or edema.Moderate cardiomegaly.Spinal stimulation leads unchanged.

Output: IABP catheter tip marker 5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Reason: ho COPD History: - Interval extubation.Diffuse reticular interstitial opacities suggestive of chronic interstitial fibrosis, which could be better defined by CT scan.Diffuse interstitial opacities suggestive of fibrosis probably with underlying COPD.

Output: COPD and pulmonary fibrosis which could be better defined by CT scan.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.