Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Malignant neoplasm of thyroid gland. Moderate left pneumothorax. Pneumomediastinum and subcutaneous emphysema. Trace pneumothorax on the right. Right chest tube, surgical drain and ETT unchanged in position.Basal atelectasis bilaterally. Bronchial wall thickening on the right suggesting aspirated secretions. Right upper lobe has improved expansion compared to prior but remains partially atelectatic.

Output: Moderate left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Intensive care unit postop. Aortic valve disorder. Unchanged cardiomegaly and left apical pleural or extrapleural mass, suspicious for hematoma. Tubes and lines unchanged in position; the left jugular catheter can be followed to the level of the left brachiocephalic vein.Low normal lung volumes, unchanged. Moderate pleural effusions with basal atelectasis. Moderate edema and dependent atelectasis, slightly worse.Loop of dilated, featureless bowel the region of the splenic flexure

Output: Worsening hypervolemia/CHF. Dilated splenic flexure may indicate ileus or obstruction, correlate with abdominal radiograph.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumomediastinum History: chest pain s/p vomiting Normal mediastinum with no evidence of mediastinal air.Small lung volumes with mild basilar subsegmental atelectasis.

Output: No acute abnormalities.


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 No pleural effusion or pneumothorax. No focal pulmonary opacities. The cardiac mediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: line placement, eval for ptx History: line placement Scarring or subsegmental atelectasis left lower lobe, and either artifact or opacity over the right apex, most likely the former.Heart size normal.No significant pneumothorax.Right jugular catheter tip at cavoatrial junction level.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: HIV, check for tuberculosis No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: routine CXR for CT ICU post-op patient History: routine CXR for CT ICU post-op patient Right IJ Swan-Ganz catheter remains in stable position. A complete mitral annuloplasty ring is in place.Slight interval decreased lung volumes with mid to lower zone subsegmental atelectasis and mild edema. Cardiomegaly is stable. No pneumothorax.

Output: Persistent mid to lower zone edema with subsegmental atelectasis and stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male 23 months old Reason: assess pleural effusion, lung volume History: intubated, chest tube in placeVIEW: Chest AP (one view) 4/9/2016 at 0317 hours. Feeding tube terminates at the second portion of the duodenum. Central line tip is at the right atrium. Left-sided chest tube unchanged. ET tube tip is below thoracic inlet.Cardiac silhouette size is normal. Interval development of left-sided medial pneumothorax. Persistent left lower lobe opacity and possible pleural effusion.

Output: Interval development of left-sided medial pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Swan positioning History: as above Stable cardiomegaly.Lungs remain clear with out evidence of pneumothorax or pleural effusion.Support devices stable in position with tip of Swan-Ganz catheter in main pulmonary.

Output: Stable support devices with no evidence of infection or edema. Tip of Swan-Ganz catheter in main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 80-year-old man with history of endocarditis status post aortic valve replacement and subsequent revision due to aortic root abscess, now admitted after being found down after presumed stroke. Status post median sternotomy. A right subclavian pacemaker is seen with 2 transvenous leads, one projected over the right atrial appendage and the other directed toward the apex. Enteric tube tip is in the distal gastric body with sidehole projecting over the proximal gastric body. Persistent cardiomegaly with stable bibasilar atelectasis, consolidations and pleural effusions. Radiolucency at the right lung base raises the question of a right pneumothorax.A few mildly prominent loops of bowel are seen in the upper abdomen.

Output: Stable bibasilar atelectasis, consolidations and pleural effusions. Radiolucency at the right lung base raises the question of a right pneumothorax.Findings were discussed with the ordering physician, Dr. Mansour, and left lateral decubitus chest radiograph is to follow.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: chest pain/sob History: chest pain/sob Small lung volumes mild basilar interstitial opacities, not as intense as on the prior study.No reliable evidence of infection.Heart size at least upper normal.Left subclavian ICD, leads unchanged in position.

Output: Mild basilar interstitial opacities suggestive of edema but no sign of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: assess IABP position History: dampened balloon pump waveform. Left subclavian AICD leads unchanged; atrial lead remains inferiorly directed, possibly free in the right atrium. IABP marker projects 2.5 cm below the top of the aortic arch.No focal air space opacity. No pleural effusion or pneumothorax.Mild cardiomegaly.

Output: IABP marker projects 2.5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: r/o infection History: seizure Nodular opacity at the posterior right 9/10 interspace may represent a nodule. No focal pneumonia or evidence of edema. The heart size is upper limits normal. Recommend a PA and lateral radiograph.

Output: No evidence of pneumonia. PA and lateral radiograph recommended for nodular opacity at the right base.


Instruction: Generate impression based on medical findings.

Input: Female 52 years old Reason: evaluate for acute cardiopulmonary process History: severe asthma exacerbation Ventricular peritoneal shunt catheter tubing again identified, unchanged in position. No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: s/p RIJ TLC placement. Confirm location History: see above Right jugular catheter tip in the cranial aspect of SVC with no evidence of pneumothorax. Increased perihilar airspace opacity.

Output: Right jugular catheter tip in the cranial aspect of SVC with no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: FemaleReason for Study: Reason: pneumonia? History: cough 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, 66 years old.Left chest pain. Rule out infection. Bibasilar atelectasis/scarring, unchanged. Unchanged calcified left hilar lymph nodes and left lower lobe granuloma. No focal pulmonary opacities to suggest infection. No pleural effusions or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: please evaluate lung fields History: respiratory failure The marker of the balloon pump is not well seen. Other support hardware is stable.No evidence of significant pneumothorax. No new opacity.

Output: No evidence of significant pneumothorax. No new opacity.


Instruction: Generate impression based on medical findings.

Input: Review for retained lead from AICD. One of the two previously seen AICD leads has been removed. The remaining orphaned left subclavian AICD lead fragment is present extending to the level of the confluence of the brachiocephalic veins (proximal coil). No pneumothorax. Sternal drains and Swan-Ganz catheter have been removed. A pericardial drain is in place. Sternotomy hardware similar in alignment.New small to moderate left pleural effusion with associated atelectasis. Right lung with minimal pleural fluid and atelectasis, but no pneumothorax post chest tube removal

Output: One of the two retained AICD leads remains as described in the body of the report. No pneumothorax. Moderate pleural fluid with associated atelectasis at the left base is new, but there is no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for widened mediastinum, cause of cp History: cp, positional, hypertensive pt Cardiomediastinal silhouette is unremarkable. No focal airspace opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with head and neck cancer status post G-tube placement and recurrent aspiration pneumonia, now with leukocytosis; evaluate for aspiration pneumonia and abscess the G-tube site CHEST:LUNGS AND PLEURA: Interval improvement in previously seen groundglass and interstitial opacities; pleural effusions have resolved.Right upper lobe pulmonary nodule has increased in size, measuring 2.3 x 1.7 cm (series 4, image 36), previously measuring 1.8 x 1.5 cm. Multiple other pulmonary nodules are again seen, most notably in the left upper lobe (series 4, image 40), which have also appear to have increased in size since prior study.MEDIASTINUM AND HILA: Stable mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple, bilobar hypodense lesions within the liver likely represent metastatic disease, largest of which measures 1.8 x 1.7 cm (series 3, image 73).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. Specifically, a G-tube is seen in its expected location without evidence of adjacent abscess formation or contrast leak.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small ascitesPELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic free fluid

Output: Interval progression of metastatic disease in the lungs and liver.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old. New right chest tube with its tip directed medially at the level of T9. This has been withdrawn on a subsequent radiograph.Extensive underlying loculated pleural effusion and atelectasis.

Output: New right chest tube with its tip extending to the midline of the level of T9.


Instruction: Generate impression based on medical findings.

Input: Age: 89 yearsGender: MaleReason for Study: Reason: eval lung fields History: s/p AVR, CABG ET tube and Swan-Ganz catheter have been removed.Right IJ introducer in place.Chest/mediastinal tubes and left sided pacemaker unchanged.Decreased lung lines with stable cardiac enlargement.Bilateral pleural effusions and basilar atelectasis similar to the prior exam.No significant pneumothorax.

Output: Interval extubation and removal of Swan-Ganz catheter. Stable cardiopulmonary appearance with pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: Leukocytosis History: As above. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. The small bowelsSeen in the upper abdomen appear dilated.

Output: Dilated small bowel loops, which can be due to intestinal obstruction. Suggest clinical correlation.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: effusion, pna? History: s/p ecmo Support devices unchanged.Stable marked cardiac enlargement.Bilateral pleural effusions and pulmonary opacities compatible with edema/atelectasis increased from the prior exam.Increasing left retrocardiac consolidation/atelectasis.No evidence of pneumothorax.

Output: Support devices unchanged. Increasing pleural effusions, basilar atelectasis, and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: assess for pneumonia, cause of tachypnea History: tachypnea The Arctic silhouette is magnified by technique.Persistent signs of emphysema with superimposed interstitial pulmonary edema, improved from prior. Left basilar discoid atelectasis.Trace left larger than right pleural effusions again noted. No pneumothorax.Stable position of tracheostomy cannula.

Output: Improving interstitial pulmonary edema. No new focal abnormal lung opacities to suggest superimposed pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: assess iabp position History: iabp There is a right-sided aortic arch with intra-aortic balloon pump terminating at the proximal descending thoracic aorta. The right IJ Swan-Ganz catheter terminates at the right hilum. There is evidence of prior coronary arterial revascularization with the sternal wires well aligned.Mild pulmonary edema superimposed on emphysema, decreased. Trace pleural effusions.

Output: Appropriate position of intra-aortic balloon pump within a right-sided descending thoracic aorta. Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Cardiac arrest, atrial fibrillation. Concern for inappropriate sensing question hardware movement. There is a single lead pacemaker from an IVC approach which terminates in the projection of the right ventricle directed inferiorly towards the apex, and similar in position compared to the scout image of a CTA chest of the same date. The visualized portion of the lead appears intact.Moderate to large partially loculated appearing pleural effusions with associated compressive atelectasis. Mild pulmonary edema. Linear suture line in the right upper lobe presumably from previous wedge resection. Right paramediastinal surgical clips.

Output: Pacemaker lead is unchanged in position. Moderate to large loculated appearing pleural fluid collections and atelectasis unchanged. Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with bladder cancer, status post cystectomy with neobladder and chemotherapy. Status post left percutaneous nephrostomy. Fever, hematuria. Rule out metastases or hydronephrosis. Lack of intravenous contrast limits evaluation of solid organs and lymphadenopathy.CHEST: LUNGS AND PLEURA: Stable bilateral micronodules. Azygos pseudo-lobe is identified. Atelectatic changes at the lung bases, but no acute infiltrates or effusions.MEDIASTINUM AND HILA: No significant abnormality noted CHEST WALL: No significant abnormality noted ABDOMEN: LIVER, BILIARY TRACT: This study is limited due to lack of IV contrast. Within the limitations, no evidence of focal lesions in the liver. The liver is enlarged with craniocaudal dimension of 22.2 cm.SPLEEN: No significant abnormality noted PANCREAS: No significant abnormality noted ADRENAL GLANDS: No significant abnormality noted KIDNEYS, URETERS: Stable nephrostomy tube and double-J catheter on the left side. No evidence of left hydronephrosis. Stable right lower pole nonobstructing calculus. Mild thickening of the right-sided uroepithelium surrounding the right pelvis is unchanged. Mild caliectasis on the right kidney is unchanged. Large cyst in the upper pole of the right kidney compresses the collecting system. Right ureter is unchanged in caliber. RETROPERITONEUM, LYMPH NODES: Stable borderline enlarged lymph nodes. BOWEL, MESENTERY: Stable left anterior bowel wall hernia with adjacent hernia repair. No evidence of mechanical obstruction or free fluid/air.BONES, SOFT TISSUES: No significant abnormality noted PELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality noted BLADDER: Neobladder is unremarkable. Stable postsurgical changes in the pelvis.LYMPH NODES: No significant abnormality noted BOWEL, MESENTERY: No significant abnormality noted BONES, SOFT TISSUES: No significant abnormality noted

Output: No significant change. No new suspicious lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: Please evaluate previously mentioned worsening left upper lobe opacity. Patient started on Prednisone 3 weeks ago. History: Please evaluate previously mentioned worsening left upper lobe opacity. Patient started on Prednisone 3 weeks ago. Cardiac silhouette is again normal in size. Right lung volume loss again present with elevated right hemidiaphragm and linear right basilar atelectasis/scarring. Significant interval improvement in left upper lung predominant airspace opacities.

Output: Significant interval improvement in left upper lung dominant airspace opacities.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with metastatic endometrial cancer on chemotherapy. CHEST:LUNGS AND PLEURA: Right upper and lower lobe anterior reticular opacities most likely due to radiation reaction, unchanged. Stable right middle lobe bronchiectasis and scarring. Right lower lobe atelectasis/scarring. No suspicious pulmonary or pleural nodules.MEDIASTINUM AND HILA: Small mediastinal lymph nodes. Multiple bilateral thyroid nodules are unchanged.CHEST WALL: Left Port-A-Cath with its tip at the junction of the SVC and right atrium. Bilateral mastectomies with surgical clips in the right axilla.Stable fluid collection extending from the right axilla to the level of the diaphragm is unchanged and likely represents a postoperative seroma.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.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: Enlarged, bulky retroperitoneal lymphadenopathy appears similar to the previous exam. The reference aortocaval lymph node measures 3.6 cm in transverse dimension (image 124, series 3) compared to 3.5 m previously. Additional periaortic and aortocaval lymph nodes appear stable in size. Multiple surgical clips in the retroperitoneum, likely represent prior lymph node dissection.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is absent.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged, bulky right iliac chain lymphadenopathy. A right external iliac lymph node measures 3.3 x 2.9 cm (image 157, series 3) compared to 3.4 x 3.2 cm, previously. Additional smaller left iliac lymph nodes appear similar to the previous exam. Left iliac surgical clips likely represent prior lymph node dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable retroperitoneal and pelvic lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: s/p clavicle lesion removal History: s/p clavicle lesion removal Right basilar atelectasis, but the lungs overall improved inflation compared to the prior study with no new findings.Stable pulmonary nodules suggestive of metastases.Soft tissue locule of air adjacent to the clavicular resection site.

Output: Known metastases, with multiple pulmonary nodules and air adjacent to the clavicular resection site.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: fever, PNA? History: as above Minimal right basilar scarring. Multiple healed right-sided rib fractures again noted. No new focal consolidation, pleural effusion or pneumothorax is evident. The cardiac and mediastinal contours are within normal limits for size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: is there an infiltrate, right sided chest pain. ho melanoma History: right pleuritic chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Chest pain and SOB rule out acute process Cardiothoracic ratio appears increased compared to prior however this could be due to magnification from portable technique.No focal airspace opacities or signs of pulmonary edema. Mild scarring or atelectasis near the right cardiophrenic angle unchanged.

Output: No acute pulmonary abnormality however cardiothoracic ratio may has increased in the interim. More accurate assessment may be made with erect PA and lateral chest radiographs when feasible.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of metastatic renal cell carcinoma. CHEST:LUNGS AND PLEURA: . Reference right lower lobe lesion seen on image number 68, series number 3 measures 6 x 7 mm. mm. Reference left lower lobe lesion best seen on image number 65, series number 5 measures19 x 14 mm. Both of these nodules is slightly decreased in size.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference left lobe lesion measures 3.3 by 3.3-cm on image number 95, slightly decreased in size. Reference right lobe lesion measures 13 x 11 mm on image number 91, again slightly decreased in size.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. No residual or recurrent tissue in the right nephrectomy bed.RETROPERITONEUM, LYMPH NODES: Stable left para-aortic adenopathy measuring 15 x 11 mm image number 113.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval decrease in the size of the hepatic and lung metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Pneumonia follow up History: Shortness of breath No change in bilateral pleural effusions and basilar atelectasis.Right jugular cannula removed, although other support devices are unchanged in position.Left jugular catheter tip at SVC/RA junction level.

Output: No change in pleural effusions with no pneumothorax. Right jugular cannula or catheter removed.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: worsening infiltrates or edema History: needed prior to bronch. Gradually worsening pulmonary opacities suggestive of edema, with small pleural effusions.Left PICC, tip in the SVC.

Output: Worsening pulmonary opacities suggestive of edema or atypical infection.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male history of NHL. Status post L. and CT day number 180. CHEST:LUNGS AND PLEURA: Solitary punctate nodule or intrapulmonary node series 5 and 62/128 unchanged. No new lesions. No effusions.MEDIASTINUM AND HILA: Clusters of mediastinal nodes and AP window nodes redemonstrated. Precarinal node series 2 image 34 measures 1.7 x 0.9 cm. No new sites of disease.Axillary nodes no longer reliably measurable. Index node been changed a smaller in the right axilla as measured on series 2 image 27 as 6 mm x 6 mm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes. Ostomy right lower quadrant. Small mesenteric nodes unchanged. No ascites. No bowel wall thickening. Questionable subtle mild intussusception jejunal loop in the left abdomen series 2 image 150.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable nodule or interpulmonary noted on the right. Mediastinal adenopathy. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval lung fields History: s/p CABG Endotracheal tube terminates 2 cm above the carina. The remaining support devices are unchanged in position.Left chest wall subcutaneous emphysema not significantly changed. Moderate layering pleural effusions with associated basilar edema and subsegmental atelectasis. Retrocardiac consolidation suspicious for aspiration. No significant pneumothorax.

Output: No significant change in subcutaneous emphysema, basilar edema and pleural effusions. Aspiration is suspected.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with ataxia, evaluate for shunt malfunction SHUNT DEVICE: Right frontal intraventricular shunt catheter with radiolucent connectors, extending down the right neck, chest wall, and abdomen, with its tip coiled in the pelvis. There is no kinking or discontinuity of the radiopaque portions of the shunt catheter appearedSKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: The lungs are clear.ABDOMEN: Nonobstructive bowel gas pattern..

Output: No discontinuity or kinking of the radiopaque portions of the shunt catheter.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: Preoperative clearance for bariatric surgery History: DOE The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Moderate degenerative changes within the thoracic spine.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: evaluate for acute changes, pneumothorax in post-thoracentesis pt History: s/p thoracentesis, 2L removed Cardiomediastinal silhouette is unchanged.Interval decrease in size of large right pleural effusion with partial aeration of the right upper lobe. No pneumothorax.Multiple nodules scattered throughout the lung parenchyma compatible with metastatic lesions seen on prior CT dated 3/2/15.

Output: Interval decrease in right pleural effusion status post thoracentesis without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Atherosclerosis of native arteries of extremities with rest pain, polysubstance abuse, hypertension The patient is intubated with the endotracheal tube terminating 3 cm above the carina. Surgical clips are noted in the left axilla. A staple projects over the right posterior 4/5 rib interspace. Surgical staples are noted in the mid abdomen.The lungs and pleural spaces are clear. The heart size is normal. No pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval for PNA History: eval for pna The cardiomediastinal silhouette is unremarkable. There are no focal pulmonary opacities. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: s/p cardiac surgery History: above Interval extubation.Swan-Ganz catheter tip in the right main pulmonary artery.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: Interval extubation. Otherwise no interval change.


Instruction: Generate impression based on medical findings.

Input: Metastatic pancreatic cancer. Bidimensional measurements. Status post 4 cycles and 8 weeks of C E. A. vaccine. Evaluate disease status. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest port.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. Pneumobilia. Presumed THAD in the subcapsular region of segment 6 (image 101; series 3).SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple surgery. Residual pancreas is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Encasement of the SMA with ill-defined soft tissue density proximally. Ill-defined soft tissue density between SMA and aorta extends more inferiorly. Reference mesenteric lymph node currently measures 16 x 7 mm (image 112; series 3) and probably stable given differences in technique.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gastroesophageal varices.PELVIS:UTERUS, ADNEXAE: Not visualized. Presumed THA/BSO.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: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: fever/cough History: fever/cough Left lower lobe opacity consistent with pneumonia.Heart size normal.No substantial pleural effusion.

Output: Left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: ams History: ams Mild cardiomegaly.Small lung volumes.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: 63 y.o. female w/ multiple myeloma; s/p clinical trial evaluation History: 63 y.o. female w/ multiple myeloma; s/p clinical trial evaluation Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: post op, eval lung fields History: s/p MVR, TVR The intra-aortic balloon pump is no longer visualized. The remaining support devices are unchanged in position.Streaky basilar opacities suggestive of aspirated secretions and atelectasis. Heart size remains stable. No interval pulmonary edema or pneumothorax.

Output: The intra-aortic balloon pump is no longer visualized. Otherwise, no significant change.


Instruction: Generate impression based on medical findings.

Input: Cough and wheezing Mild mild cardiomegaly borderline cardiomegaly without additional underlying acute cardiopulmonary abnormality. Specifically, lungs are clear. Unchanged apical scarring

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: cough, fall Unremarkable cardiac and mediastinal silhouette. Mild basilar interstitial opacity compatible with atelectasis and possibly mild edema.Mild wedge deformity of the L1 vertebra all uncertain chronicity. No visible rib fractures.

Output: Mild nonspecific basilar opacity compatible with atelectasis and possibly mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: swan placement History: swan placement Swan-Ganz catheter tip in the main pulmonary artery/proximal left pulmonary artery. Stable enlarged cardiac silhouette. Mild interstitial abnormality, better characterized on recent chest CT study, which appears to be resolving. No large pleural effusions or pneumothorax. No focal pulmonary consolidation.

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


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Dyspnea. Intact median sternotomy wires. The heart is normal in size. Stable position of the pacemaker with leads overlying the right atrium and apex of the right ventricle.Lung volumes are normal. No signs of pulmonary venous hypertension or pulmonary edema.The pleural spaces and visualized bones are within normal limits.

Output: Stable adequate position of dual-lead pacemaker. No signs of pulmonary venous hypertension or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Increasing oxygen requirement Motion degrades sensitivity.Persistent moderate largely basilar atelectasis with probable small effusions and decreased lung volumes. Mild cardiomegaly.

Output: Unchanged suspected mild CHF


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Status post new PICC placement History: As above Right PICC tip in SVC. Other findings stable in short interval.

Output: Right PICC tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Cough for 2 weeks with rales and dullness to percussion right side question pneumonia. Hazy opacities in the lung bases, right greater than left. Mild right lateral costophrenic angle blunting. Normal heart size. No pneumothorax.

Output: Mild bronchitis. Basilar opacities nonspecific but could reflect evolving viral pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: s/p thoracentesis History: see above Increasing left-sided airspace opacity consistent with infection or aspiration. No pneumothorax following thoracentesis.

Output: No significant pneumothorax. Increasing left-sided airspace opacities suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female presents for evaluation of her shunt. SHUNT DEVICE: The tip initiates at midline. There is a radiolucent connector. The shunt travels through the soft tissues the neck and anterior chest and enters the pelvis. It terminates in the pelvis. It is without evidence of breaks or kinks.SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: No significant abnormality noted.ABDOMEN: No significant abnormality noted.

Output: Normal shunt series.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma status post two cycles of chemotherapy. Assess response. CHEST:LUNGS AND PLEURA: Stable right upper lobe nodule measuring 1.3 cm in diameter (image 26; series 4). No new nodules.MEDIASTINUM AND HILA: Previous described nonenlarged multiple mediastinal nodes are unchanged. Previously mentioned borderline enlarged subcarinal lymph node measures 9 x 7 mm (image 39; series 3), unchanged.CHEST WALL: No significant axillary adenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Subtle hypoattenuating lesion in the spleen is unchanged. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes are unchanged. And not enlarged by CT size criteria. Slight soft tissue infiltration of the mesenteric stable.BOWEL, MESENTERY: Small bowel masses difficult to evaluate but is likely unchanged measuring 4.2 x 3.5 cm (image 120; series 3). Possible transient intussusception also noted adjacent to this region.BONES, SOFT TISSUES: Symmetric lytic lesions within the sacrum and pelvis are unchanged and likely due to osteopenia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Borderline internal obturator lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of duodenal carcinoid and multiple myeloma. Surveillance. CHEST:LUNGS AND PLEURA: Bibasilar scarring/atelectasis, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Multiple borderline enlarged mediastinal lymph nodes appear similar to prior study. Reference upper mediastinal lymph node (series 4, image 18) measures 1.1 x 1.1 cm (stable). Reference prevascular lymph node (series 4, image 39) measures 2.1 x 1.3 cm (stable).Heart size normal without pericardial effusion.CHEST WALL: Bilateral gynecomastia. Metallic shrapnel again seen in the infralateral right chest wall.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule, unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic lymph node (series 4, image 88) measures 8 mm (stable). Periportal lymph nodes also appear similar to prior study, the largest of which (series 4, image 55) measures 2.7 x 1.8 cm (stable).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Confluent soft tissue attenuation adjacent to the small bowel just superior to the bladder (series 4, image 123) is not present on prior study and is favored to represent unopacified small bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable reference measurements as above. Probable cluster of unopacified small bowel loops in the pelvis as described above; however, special attention may be given to this region on future scans.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Increased O2 requirement, aspiration pneumonia, NSCLC History: Altered mental status, dyspnea The right port is unchanged in appearance.Diffuse multiple pulmonary nodules partially obscured by associated edema, unchanged. Opacification of the left costophrenic angle and left base from confluent nodules and left pleural effusion. Small right pleural effusion. Right paratracheal and left AP window opacification compatible with lymphadenopathy. Deformity of the right chest wall again noted. No pneumothorax.

Output: Multiple pulmonary nodules with associated edema not significantly changed. Stable mediastinal lymphadenopathy with left greater than right pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Cough Focal opacity in the right upper lobe with associated minimal change in the left lung base. Decreased lung volumes. No cardiac or mediastinal contour abnormality

Output: Right upper lobe pneumonia and possible left basilar changes more suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: IgG Multiple Myeloma s/p 10 cycles of PdC; now progressing; screening for a clinical trial History: IgG Multiple Myeloma s/p 10 cycles of PdC; now progressing; screening for a clinical trial Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: aspiration History: as above The heart size is normal. Unremarkable cardiomediastinal silhouette. Interval improvement in left basilar atelectasis. No focal pulmonary opacities, pleural effusion, or pneumothorax. The bones and soft tissues appear unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.SOB and dyspnea. Sarcoidosis. New nodular opacities in the left upper lobe suspicious for mycetomas.Severe upper lobe architectural distortion and signs of fibrocavitary disease consistent with known diagnosis of sarcoidosis.No pneumothorax. No pleural fluid. Normal heart size.

Output: Left upper lobe solid nodules, most consistent with intracavitary mycetomas.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: Infiltrates History: Fever Bilateral airspace opacities compatible with developing multifocal infection.Heart size upper limits of normal.

Output: Bilateral airspace opacities compatible with developing multifocal infection.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: intubated pt History: intubated pt The endotracheal tube tip terminates approximately 6 cm above the carina. Multiple embolization coils project over the right lung apex, as well as suture material. The nasogastric tube tip is coiled in the stomach, with the tip terminating near the level of the GE junction. The right apical chest tube has been removed. Unchanged loculated right apical hydropneumothorax. Postsurgical volume loss and diffuse interstitial opacities in the right lung appear unchanged. Probable small left pleural effusion. Streaky retrocardiac opacity suggests atelectasis. Dense pancreatic parenchymal calcifications again noted.

Output: Endotracheal tube tip 6 cm above the carina. Removal of the right apical chest tube, with an unchanged loculated right apical hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Swan placement History: Swan Stable cardiomediastinal silhouette.Stable bilateral pleural effusions with patchy basilar airspace opacity/consolidation and interstitial opacities.No evidence of significant pneumothorax.Interval placement of Swan-Ganz catheter with tip overlying the distal right main pulmonary artery.

Output: Interval placement of Swan-Ganz catheter with tip overlying the distal right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Respiratory failure and intubation. History of pancreatitis.VIEW: Chest AP (one view) 02/02/15, 0435 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in stomach. Vagal nerve stimulator device is seen in left chest and lead extends into left neck.Cardiothymic silhouette is normal. Left pleural effusion persists. The subpulmonic component is slightly smaller. No focal lung opacity is identified.Musculoskeletal changes from neurological disease are again seen.

Output: Continued left pleural effusion. Right pleural effusion seen on CT (02/01/15) may be layering posteriorly.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: H/o PTX, eval for progression History: see above New right basilar airspace opacity consistent with infection or aspiration.Stable tubes 2.2 cm right apical pneumothorax.Right subclavian catheter, tip at the cavoatrial junction.

Output: Stable 2.2 cm right apical pneumothorax but new right basilar pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: intubated, check ET tube and lines History: see above Support devices unchanged. ET tube tip 5 cm above the carina.Stable cardiac mediastinal silhouette.Basilar opacities compatible with pleural effusions and atelectasis similar to the prior exam.No evidence of a pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with history of malt lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: An enlarged left lobe of the thyroid gland. Ultrasound may be helpful for further evaluation.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 10-mm benign appearing cysts in the right lobe on image number 112, and left lobe on image number 89, series number 3 although liver. Another subcentimeter cystic lesion on image number 102, series number 3.SPLEEN: No significant abnormality noted. Spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measuring 3.3 cm, image number 123, series number 3. Its greatest AP dimension.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal soft tissue, image number 165, series number 3 likely represents the right ovary. Correlation with surgical history is recommended. Uterus and left ovary are not visualized.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 evidence of enlarged lymph nodes in the chest, abdomen or pelvis. Right adnexal soft tissue likely represents the right ovary.Small infrarenal abdominal aortic aneurysm.Ultrasound is recommended for further evaluation of the left thyroid lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval for obstruction History: gyn CA and extensive peritoneal carcinomatosis now with n/v Abdomen: No free intra-abdominal air. Paucity of bowel gas without evidence of obstruction. There is a midline ovoid, heterogeneous opacity seen overlying the pelvis.Chest: Bilateral pleural effusions.

Output: Nonobstructive bowel gas pattern.Heterogeneous density seen overlying the midline pelvis is most consistent with calcified fibroid.


Instruction: Generate impression based on medical findings.

Input: Weakness Interval moderate bilateral pleural effusions with mild basilar edema and atelectasis. Suspected mild cardiomegaly partially obscuredTortuous aorta and atherosclerotic changes are grossly unchanged

Output: Moderate CHF with effusions


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: assess ETT Placement History: respiratory failure ETT 1.7 cm above the carina. The left internal jugular central venous catheter tip is in the SVC. Right shunt catheter tubing courses over the right hemithorax, beyond the field of view. The enteric tube has been removed.The cardiomediastinal silhouette is unremarkable. Very low lung volumes. Patchy multifocal airspace opacities and bilateral pleural effusions, unchanged. No pneumothorax. Mild gaseous distention of the stomach.

Output: ETT tip 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: infection History: infection No change in complete right hemithorax opacification.Nonspecific edema pattern left lung base nearly resolved.Heart size obscured by right hemithorax opacification.Retained pacemaker electrodes unchanged.

Output: Stable right hemithorax complete opacification, unchanged. It is unclear from the history the patient has had a pneumonectomy.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Evaluate ET tube placement and evolution of aspiration. ET tube tip 5 cm above the carina.Right subclavian central line, tip at the SVC/RA junction. NG tube and Dobbhoff tube tip project off the inferior margin of the image.The cardiomediastinal silhouette is unchanged.Lung volumes are low. Bilateral pleural effusions and atelectasis left greater than right are not significantly changed. No large pneumothorax.

Output: ET tube tip 5 cm above the carina. No significant change in bilateral pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: ETT History: ETT Cardiac mediastinal silhouette is unchanged.ETT tube tip is in the right mainstem bronchus. NG tube tip projects inferiorly beyond the field-of-view.Low lung volumes. Patchy basilar opacities likely reflect atelectasis or aspiration.

Output: ETT tube tip is in the right mainstem bronchus. Patchy basilar opacities likely reflect atelectasis or aspiration.These findings were communicated to Dr. Guyton at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: sickle cell with chest pain History: chest pain Unremarkable cardiac and mediastinal silhouette. Skeletal findings compatible with sickle cell disease.Slightly decreased pulmonary inflation since the previous radiograph but no airspace opacity or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax History: pneumothorax ET tube tip close to the vocal cords, approximately 10 cm above the carina. This has been advanced on a subsequent radiograph.Right pneumothorax and nonspecific pulmonary opacity, unchanged.Multiple cannulae, chest tubes also unchanged.New feeding tube with its tip in the stomach.

Output: High position of ET tube. Moderate right pneumothorax, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: 73y/o woman s/p CVA with shortness of breath History: shortness of breath Cardiomegaly unchanged.Perihilar/basilar opacities compatible with edema.New left basilar peripheral opacity suggestive of infection or infarction.Left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Suggestion of a new focal peripheral opacity in the left upper lobe concerning for infection or infarction. Increasing mixed airspace interstitial opacities compatible with edema. Recommend PA and lateral views if possible. CT the chest with IV contrast may be of value.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Evaluate for cardiopulmonary disease History: chest pain/palpitations Heart size normal with a very tortuous aorta, unchanged.Minimal left basilar scar like opacity, the lungs otherwise unremarkable. No specific evidence of infection or edema.Cervicothoracic spine stabilization hardware.

Output: Very tortuous aorta, otherwise unremarkable and unchanged.


Instruction: Generate impression based on medical findings.

Input: Central line placementVIEW: Chest AP Right chest port with tip at the SVC. Cardiothymic silhouette normal. No focal lung opacity. No evidence of pneumothorax.

Output: Chest port placement without complication.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.History of wedge resection with chest tube. Left-sided apically directed chest tube unchanged. There is a residual, unchanged left apical pneumothorax with a small amount of pleural fluid at the left costophrenic angle. There are findings of wedge resection in the left upper lobe. Large lung volumes compatible with COPD. There is stable subsegmental atelectasis in the left lung base.

Output: Unchanged left chest tube with small residual hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: ETT position and evaluate bilateral pleural effusions History: cefepime (11/18-), flagyl (11/18-), Colistin (11/16-), and Vancomycin (11/15-) Endotracheal tube, partially visualized feeding tube and right apical chest tube remain unchanged.Cardiac silhouette is enlarged, unchanged. Calcified aortic arch.Unchanged pulmonary opacities, including a right lower lung zone nodular opacity. No pneumothorax.

Output: Stable line position. No change in lung opacities. No visualized pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.GERD-like chest pain. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Mild cardiomegaly with ICD leads projected in the area of the right atrial appendage and right ventricular apex.Focal streaky basilar opacities compatible with subsegmental atelectasis and scarring.No pneumothorax or other complications.

Output: ICD leads in appropriate position with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: r/o infiltrate History: DOE Cardiomediastinal silhouette is within normal limits.No focal air space abnormality. No pleural effusions.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: rule out pulmonary infection History: cough for three months in a patient with HIV Left basilar scarring with unchanged volume loss in left rib deformity from prior lobectomy. No superimposed focal pulmonary abnormality. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: 48M hx left partial nephrectomy for RCC. Evaluate for metastatic disease. History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: evaluate SOB History: see above Right central venous catheter with tip in the mid SVC. Small lung volumes. Bilateral pleural effusions, left greater than right, unchanged. Multifocal pulmonary airspace and nodular opacities, compatible with edema and infection, not significantly changed.

Output: Multifocal pulmonary opacities and bilateral pleural effusions, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain. Decreasing O2 saturation No cardiopulmonary abnormality. Interval removal of the left jugular catheter

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Status post right VATS lung biopsy. Right-sided chest tube tip projects over the apex. No measurable pneumothorax or large pleural effusion. There are multiple scattered areas of linear atelectasis bilaterally. Stable cardiac mediastinal silhouette.

Output: Right-sided chest tube without measurable pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: eval ETT position History: intubated No change in pulmonary opacities and pleural effusions.ET tube tip approximately 6 cm above the carina.IVC pacemaker tip in RV apex region.

Output: ET tube tip approximately 6 cm above the carina. Temporary pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: MaleReason for Study: Reason: s/p AVR History: s/p AVR Stable cardiomediastinal silhouette.Small bilateral pleural effusions.The lungs are clear.Median sternotomy is intact with demonstration of aortic valve placement.

Output: Persistent small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: intubated History: as above Pleural effusions and left basilar consolidation unchanged.ET tube tip approximately 3 cm above the carina.Right PICC, tip in the SVC.Left subclavian catheter, tip in SVC. An NG tube extends below the lower margin of the image.

Output: ET tube tip approximately 3 cm above the carina. Unchanged pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: evaluate for infiltrate, pulm edema History: at risk for pulm edema possible pre-eclampsia No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Shortness of breath. Please assess for edema or pneumonia. Left PICC with tip in the left axillary vein. The cardiomediastinal silhouette appears unchanged. Patchy airspace and interstitial opacities most prominent at the lung bases are similar to prior exam. Persistent small bilateral pleural effusions and numerous rib deformities.

Output: Stable, diffuse airspace and interstitial opacities suggestive of edema or infection. Left upper extremity PICC remains in the left axillary vein.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval for ET tube placement History: see above ETT tip 4 cm above the level of the carina. Enteric tube projects over the stomach. Retrievable IVC filter noted. Small to moderate pleural effusions with basal and retrocardiac atelectasis.Rib fracture deformities appear chronic.

Output: No change in left basilar opacity or line position.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Possible aspiration event this morning, history of Alzheimer's. Bone and soft tissues from the patient's upper extremities obscure the anterior lung fields and mediastinum on the lateral radiograph.Eventration of the right hemidiaphragm. Appearance of a bowel loop overlying the superior margin of the diaphragm similar to a radiograph seen on 5/7/2015. If of clinical concern, further evaluation may be made with a left side down lateral decubitus view of the abdomen.Paucity of vascular markings consistent with emphysema.Focal opacity at the intersection of the anterior right fourth rib with the posterior right sixth rib and tip of the scapula may represent summation artifact, correlate with physical exam. The lungs are otherwise clear.Normal heart size. No pneumothorax. Severe osteopenia with multilevel loss of height in the spine and a lower thoracic spine compression fracture of at least 50%. No prior lateral radiograph to establish chronicity of this fracture.

Output: No conclusive acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: PICC Line History: PICC line No acute abnormality.Left PICC, tip in the SVC.

Output: PICC placement.


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with history of appendiceal carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver, unchanged. Previously described low attenuation area within the resection site is smaller and now measuring 3 x 1 cm on image number 69, series number 5. No other focal lesions in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postsurgical changes in the liver, slightly smaller. Fat infiltration of the liver is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Eval for infiltrate or edema History: ICM s/p LVAD with hypotension and SOB, ICD generator exchange on 3/9/2016 Left subclavian ICD leads and generator has been replaced. Abandoned right ICD leads. LVAD in place.Cardiomegaly is stable.No large pleural effusions or pneumothorax. Bilateral basilar mild interstitial opacities compatible with edema. No focal pulmonary consolidation.

Output: Stable mild basilar pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old. Status post bilateral lung transplants. New left IJ venous catheter placed with its tip in the SVC.Remaining support devices including tracheostomy tube, chest tubes, NG tube, and left central venous catheter unchanged.Bilateral pulmonary opacities, left greater than right, similar in appearance the prior exam.Bilateral pneumothoraces stable.Clamshell sternotomy and multiple surgical staples across the lower thorax redemonstrated.

Output: Left IJ venous catheter placed with its tip in the SVC.Stable cardiopulmonary appearance with bilateral pulmonary opacities, left greater than right, and bilateral pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Pulmonary congestion ICD and numerous leads are all unchanged. Swan-Ganz again projects into the right middle lobe outflow.Mild nonspecific cardiomegaly with questionable minimal edema persist, however it is difficult to determine what is more acute superimposed upon chronic change

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Simple chronic bronchitis. SOB. Right jugular catheter tip at the SVC. Cardiomegaly with enlargement of the central pulmonary vasculature unchanged. Bronchial wall thickening with minimal associated atelectasis. No focal airspace opacities. Retrocardiac atelectasis.

Output: Bronchial wall thickening with atelectasis may reflect acute exacerbation of bronchitis. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: IABP positioning History: IABP Left PICC and sternotomy wires remain in stable position. Intraaortic balloon pump terminates at the distal transverse arch.No interval edema, pneumothorax or pleural effusion. Cardiomegaly stable.

Output: Stable position of support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: pain over left lateral chest around T4-T5 area in mid axillary region, evaluate for mass History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No obvious skeletal abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: fever Moderate cardiomegaly with a tortuous ectatic aorta, unchanged.Small lung volumes with mild basilar atelectasis. No sign of pneumonia

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Metastatic cervical carcinoma with abdominal distention and pain No acute intrathoracic process. No significant change in dilated small bowel loops. No free air. Bilateral nephrostomy tubes again noted.

Output: No acute intrathoracic process. No significant change in dilated small bowel loops; a mild obstructive component is suspected. No free air.


Instruction: Generate impression based on medical findings.

Input: Chest tube placementVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Umbilical lines are unchanged. There are two chest tubes on the right with placement of chest tube. There is a small pneumothorax at the right lung base. Cardiothymic silhouette normal.

Output: Placement of a new right chest tube with pneumothorax at the right lung base not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: ards History: ards Right IJ venous catheter and enteric tube unchanged.Stable cardiac mediastinal silhouette.Airspace and interstitial opacities, left greater than right, similar in appearance prior exam.No new pulmonary opacities identified.No large pleural effusions.

Output: Stable cardiopulmonary appearance with predominant left-sided pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: 66 y/o F neutropenic fever, r/o PNA History: neutropenic fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right lung granulomata unchanged.No specific evidence of infection.Left PICC, tip in the SVC.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with gist tumor status post surgical resection CHEST:LUNGS AND PLEURA: Right basilar subpleural nodule is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subtle echodensity in the left lobe is unchanged. No new lesions. Cholelithiasis, stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small right external iliac lymph node is also stable, measuring 10 x 6 mm on image number 179, series number 3.. BOWEL, MESENTERY: Left lower quadrant soft tissue tissue measures 2.9 by 2.3-cm, stable from previous study on image number 176, series number 3..BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with lung cancer status post chemotherapy. Please compare to prior study evaluate treatment response. CHEST:LUNGS AND PLEURA: Reference right middle lobe mass measures 2.1 x 3.1 cm (series 5, image 59); which is stable since prior study accounting for differences in technique. Adjacent micronodules in the right middle lobe again may represent metastases and are stable since prior study.Left upper lobe scarring along the major fissure as seen previously.MEDIASTINUM AND HILA: Right infrahilar mass is minimally smaller since prior study, measuring 2 x 4.2 cm (series 3, image 55); previously measuring 2.4 x 4.5 cm. Heart size normal without pericardial effusion.CHEST WALL: T10 vertebral compression fracture, unchanged. ABDOMEN: LIVER, BILIARY TRACT: Hypoattenuating lesion in the hepatic dome is too small to characterize but appears similar to prior study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Prominent mural nodularity along lesser curvature of the stomach as previously described. Few sigmoid diverticula without acute inflammation.BONES, SOFT TISSUES: Superior endplate depression and sclerosis of the L3 vertebral body similar to prior study.

Output: 1. Stable right middle lobe mass with adjacent micronodules appearing similar to prior study.2. Minimal decrease in size of right infrahilar mass as above.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female presents with syncope. There is a clinical concern for acute coronary syndrome or pneumonia. Surgical clips project over the right axilla.The cardiopulmonary silhouette is normal. Large lung volumes and flattening of the diaphragm suggest underlying COPD. Scattered bilateral upper lobe lucencies correlate to small bulla seen on prior CT. Mild bibasilar atelectasis or scarring. Left pleural thickening.. No pleural effusion or pneumothorax.

Output: Constellation of findings suggestive of underlying COPD without superimposed acute cardiopulmonary disease. Left pleural thickening.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval lung fields History: s/p AVR Patient has been extubated. Lines and tubes are unchanged otherwise. Lower lung volumes. Probable atelectasis at the lung bases again noted. Unchanged cardiomegaly. No pneumothorax. Small pleural effusions. Moderate distention of the stomach, unchanged.

Output: Probable atelectasis at the lung bases again noted.  Moderate distention of the stomach, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: rule out PNA vs effusion History: worsening cough, h/o COPD Left hilar mass again noted. Port catheter terminates within the brachiocephalic vein on the right. No large pleural effusion or pneumothorax. Likely normal heart size. Mild basilar reticulation again noted.

Output: No new focal lung opacity. Large left hilar mass again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: copd exacerbation, worsening hypoxia History: see above The right costophrenic angle is excluded from the field-of-viewEnteric tube has been removed.Interval extubation.Improved inflation with decreased basilar opacities.Possible small effusions. No pneumothorax.Stable cardiomediastinal silhouette.

Output: Interval improvement in basilar opacities following extubation.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Shortness of breath, pneumonia question fluid overload. Moderate septal and fissural thickening. Small pleural effusions. Right jugular catheter unchanged in position. Lung volumes remain low normal.

Output: Moderate CHF. No specific evidence of a superimposed pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old. Tip of endotracheal tube at 4 cm above carina.No change in left basilar opacity.Remaining lungs clear. No pneumothorax. No pleural effusion.

Output: No change in left basilar opacity. Line position stable.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Endotracheal tube terms approximately 4.5 centimeters from the carina. Swan-Ganz catheter is in the RPA. Enteric tube extends inferiorly off the field-of-view. Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable layering left pleural effusion. Left lower lobe atelectasis. Unchanged heart size. No pneumothorax.

Output: Lines and tubes, as above. Probable layering left pleural effusion. Left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: Check PICC Placement History: Check PICC Placement Left chest tube tip at the apex. Left PICC tip has rotated but remains doubled back upon itself in the projection of the left brachiocephalic vein. Right chest port unchanged in position. Subsegmental atelectasis left lower lobe. Posterior layering pleural fluid on the left unchanged. Tiny subpulmonic pneumothorax component on the left has nearly resolved.

Output: Left PICC has been rotated but the distal end remains doubled back upon itself in the left brachiocephalic vein with tip directed peripherally.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: rib fracture? History: left rib pain Clear lungs. No pleural effusion or pneumothorax. Normal heart size. No displaced rib fractures.

Output: No evidence of displaced rib fractures. Radiography may miss over half of rib fractures.\\


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with persistent globus sensation, eval for a motility disorder. Evaluate esophagus. Scout radiograph of the chest showed a tortuous thoracic aorta. No abnormal pulmonary opacities or pleural effusions noted. Double contrast evaluation of the esophagus and gastric cardia/fundus demonstrate mild thickening of the rugal folds in the stomach. There is a small hiatal hernia with reflux noted from the hernia to at least the mid thoracic esophagus (video series 28). Fluoroscopic evaluation of esophageal peristalsis demonstrated proximal escape compatible with mild esophageal dysmotility. Barium pill passed spontaneously without hold up.TOTAL FLUOROSCOPY TIME: 7:25AIR KERMA: 204.2 mGy

Output: 1.Small hiatal hernia with reflux to at least the level of the mid thoracic esophagus. 2.Mild esophageal dysmotility.3.Thickening of the rugal folds, correlate for gastritis and possible H. pylori.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Left hilar mass suspicious for primary lung cancer.Elsewhere the lungs are unremarkable.Apart from left hilar enlargement, there is no evidence of mediastinal adenopathy.No specific evidence of infection or edema.

Output: Left hilar mass consistent with lung cancer. This was discussed with the practitioner at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: ? volume History: ? volume history shortness of breath Left subclavian catheter tip in SVC.Cardiomegaly with mild pulmonary edema.

Output: Cardiomegaly with mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: sickle cell, eval for worsening opacities History: see above Cardiomegaly with stable bilateral pulmonary opacities. Patchy consolidation in the left lower zone persists, previously characterized on recent CT. No interval pneumothorax.

Output: Stable pulmonary opacities with retrocardiac consolidation, cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: rule out PNA History: tachypnea Small focal opacity in the left costophrenic angle may be artifactual although early infection is possible.Elsewhere, the lungs are unremarkable.Heart size normal.

Output: Possible opacity left costophrenic angle, artifactual or early infection.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval for pneumonia History: fever Patchy left basilar consolidation may be due to aspiration, atelectasis or pneumonia.

Output: Patchy left basilar consolidation may be due to aspiration, atelectasis or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Preop transplant Fine reticulonodular appearance of the lung parenchyma may reflect atypical edema. Normal heart size. Skeletal sclerosis suggestive of hyperparathyroidism/renal disease.

Output: Reticulonodular appearance of the lung parenchyma may reflect atypical edema. Follow-up PA and lateral chest radiographs recommended after management of fluid status.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: eval for acute chest History: cough Mild cardiomegaly.Basilar scarring or subsegmental atelectasis.No specific evidence of infection or failure.Prior splenectomy.

Output: Cardiomegaly and chronic basilar interstitial opacities, but no evidence of acute infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: pna History: copd, wheezing Diffuse interstitial opacities suggestive of edema versus fibrosis.Small left pleural effusion.Heart size normal.Probable underlying emphysema.

Output: Diffuse interstitial opacities suggestive of edema with underlying fibrosis and emphysema. If this persists following diuresis a thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: bladder ca surveillance History: same Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Moderately tortuous thoracic aorta. Mild aortic atherosclerosis.

Output: No acute cardiopulmonary process on radiography. Specifically, no evidence of metastatic disease in the thorax on radiography.


Instruction: Generate impression based on medical findings.

Input: 81 years old Male. Reason: febrile History: as above. Markedly limited examination secondary to patient's head obscuring the entire right upper lung /superior mediastinum. Within these limitations no significant change in bilateral patchy interstitial opacities. Gastric distention is again noted. Unchanged right jugular catheter with the tip in the SVC. Stable cardiomediastinal silhouette.

Output: Stable bilateral patchy interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: 78M with neutropenic fever. History: neutropenic fever Stable cardiomegaly. Basilar subsegmental atelectasis. Mid and upper lung zones are clear.No pneumothorax. No pleural effusion.

Output: Stable cardiomegaly with basilar atelectasis. No acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: chest tube History: see above Unchanged pulmonary opacities and slight improvement in right pleural fluid or blood.Unchanged left lower lobe consolidation.Right chest tube stable in position with no pneumothorax.Other tubes and catheters are unchanged.

Output: No pneumothorax, right chest tube stable. Improvement in right pleural effusion, otherwise unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: ET placement? changes in bilateral opacities? History: intubated, previous CXR with bilateral infiltrates ET tube tip approximately 4 cm above the carina.Swan-Ganz catheter tip in the area of the right descending pulmonary artery.NG tube tip in the gastric fundus.Bilateral opacities compatible with layering effusions, atelectasis and consolidation, slightly increased.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: r/o PNA History: asthma, cough, weakness Basilar opacities are suggestive of atelectasis, and given the history likely are the result of mucous plugging.Infection or embolus are in the differential however.Heart size normal.

Output: Basilar atelectasis, given the history of asthma most likely from mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Left IJ central line placed this A.M. Congestive heart failure. Left jugular catheter tip at the level of the SVC. No pneumothorax. Right jugular catheter tip at the level of the right brachiocephalic vein. Cardiomegaly, unchanged. Vascular unsharpness suggestive of edema and atelectasis, about the same.

Output: Left jugular catheter tip at the level of the SVC, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: infiltration/consolidation History: productive cough, sob, history of lung cancer Right chest wall PowerPort with tip at the cavoatrial junction is unchanged.Redemonstrated of the right lower lung and mid lung opacities with associated volume loss consistent with the patient's known lung cancer and metastatic pleural disease, slightly more prominent compared to the prior radiograph. No significant change from the chest CT from 1/6/2016

Output: No significant change in pulmonary findings when compared to the CT study of 1/6/2016


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: mets lung cancer, right pleural effusion, had thoracentesis on 10/14/16, 1700 cc removed, pls c/w previous study to evaluate status. History: right pleural effusion Right mid to lower lung zone opacities unchanged and the right pleural effusion improved, consistent with the patient's known lung cancer.No pneumothorax following thoracentesis.

Output: No significant pneumothorax. Unchanged right-sided opacities and persistent right pleural effusion, slightly smaller.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with metastatic colon cancer. CHEST:LUNGS AND PLEURA: Again noted innumerable pulmonary nodules suspicious for metastatic disease. Reference right upper lobe nodule measures 13 x 12 minutes on image number 35, series number 7. Other nodules are also increased in size and number. Dependent bilateral atelectasis.MEDIASTINUM AND HILA: Reference left paratracheal node now measures 18 x 13 mm image number 27, series number 5, not significantly changed from previous study.CHEST WALL: Bony metastases are again noted and there more prominent on the current study.ABDOMEN:LIVER, BILIARY TRACT: I. lobe aquatic metastases. Reference lesion in the right lobe measures 3.2 x 2 .7 cm, image number 55, series number 5. Today's CT is postcontrast, therefore, numerous hepatic metastases are better seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference left aortocaval lymph node measures 19 x 14 mm image number 121, series number 5, not significantly changed. Multiple other enlarged retroperitoneal nodes are also not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bone metastases involving the pelvic bones, and the lumber spine are slightly more prominent.OTHER: Increase amount of ascites. Peritoneal carcinomatosis is unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left obturator lymph node is unchanged in size, now measuring 2 x 0.6 centimeters.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Metastatic bone lesions.OTHER: Ascites.

Output: Interval increase in the size and number of the lung metastases. Hepatic metastases, Pergonal carcinomatosis and retroperitoneal adenopathy stable. Bone metastases and ascites are increased in size.


Instruction: Generate impression based on medical findings.

Input: Status post left thoracentesis evaluate for pleural effusion. Moderate left pleural fluid collection decreased in volume with improved aeration of the left lung.Moderate left apical pneumothorax with maximal pleural separation from the chest wall of 17 mm.Diffuse interstitial and airspace opacities bilaterally about the same.Right jugular catheter unchanged in position.

Output: 17 mm left apical pneumothorax. Improved left pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Et tube advanced Endotracheal tube terminates approximately 7 to 8 cm from the carina. Enteric tube terminates inferiorly off the field-of-view. Improvement in lung volumes. No substantial change in diffuse pulmonary opacities given differences in inspiration. Improvement in basilar atelectasis. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Endotracheal tube terminates approximately 7 to 8 cm from the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: dysphagia History: same Atherosclerotic calcification involving the aortic arch. Large lung volumes likely due to COPD. No new opacity. Chronic basilar scarring and blunting of the costophrenic angles.

Output: Large lung volumes likely due to COPD. Chronic basilar scarring and blunting of the costophrenic angles. No new opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: tachypnea History: decreased R side Complete white out of the right hemithorax most consistent with large right pleural effusion with right lung atelectasis. There is no substantial rightward mediastinal shift to suggest isolated right lung atelectasis. Left lung is unchanged. Unchanged heart size. Multiple osseous lesions noted consistent with multiple myeloma.

Output: Complete white out of the right hemithorax most consistent with large right pleural effusion with right lung atelectasis. Multiple osseous lesions noted consistent with multiple myeloma.


Instruction: Generate impression based on medical findings.

Input: 40 year-old male with leiomyosarcoma with chemotherapy CHEST:LUNGS AND PLEURA: Stable postoperative changes in the right lung from prior wedge resection.. Reference right middle lobe nodule measures 8 x 6 mm image number 39, series number 5. Filling defect of the right lower pulmonary arteryMEDIASTINUM AND HILA: Stable small mediastinal lymph nodesCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter high attenuation lesions in the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal hypodense lesion is slightly smaller now measuring 3.3 x 2.2 cm number 94, series number 3.RETROPERITONEUM, LYMPH NODES: Stable borderline enlarged retroperitoneal lymph nodes.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: Stable right external iliac lymph node measuring 11 x 7 mm image number 160, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval decrease in the size of the right renal lesion, otherwise no significant change from previous study. Borderline enlarged retroperitoneal and pelvic lymph nodes, right middle lobe nodule and pulmonary embolus in the right lower lower artery are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Large hiatal hernia, probably paraesophageal in type.No significant pulmonary or pleural abnormality.Heart size normal.

Output: Large hiatal hernia, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male; 73 years. Reason: met melanoma, s/p 4 cycles of Ipi, evaluate for response CHEST:LUNGS AND PLEURA: Scattered micronodules and lower lobe subsegmental atelectasis/scarring are stable.MEDIASTINUM AND HILA: Stable calcified mediastinal lymphadenopathy, likely post infectious. Severe coronary calcifications versus stents.CHEST WALL: No significant abnormality noted. No axillary adenopathy. Previously measured left axillary lymph node (series 3 image 34) measures 6 x 5 mm (previously 7 x 8 mm).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous bilateral renal cysts are overall similar in appearance. No definite solid enhancing components identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.priors. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Few metallic surgical clips.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted. No inguinal adenopathy.BOWEL, MESENTERY: Small fat-containing right inguinal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate vascular calcifications.

Output: 1. No evidence of metastatic disease.2. Severe coronary calcification versus stents.


Instruction: Generate impression based on medical findings.

Input: Pneumothorax and chest tube placement.VIEW: Chest AP (one view) 12/08/15, 1905 Right chest tube has been placed and its courses within the subcutaneous tissues of the right chest. Endotracheal tube tip is between thoracic inlet and carina. Umbilical venous line tip is in right atrium. Umbilical arterial line has its tip at T7.Left thoracic curve and abnormal thoracic shape from all ago hydramnios are again seen.Small right subpulmonic pneumothorax is noted. Mediastinum is no longer shifted to the left. Hazy opacity is seen on the left. Cardiothymic silhouette is normal in size.

Output: Right chest tube is outside of the pleural space.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: chest tube History: high output s/p bedside pleurodesis 10/9 Chest tube in stable position. No change in small bilateral effusions. No visible pneumothorax. No new findings.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: SOB History: Above No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusions? History: SOB Moderate cardiomegaly and basilar opacities compatible with atelectasis and probable small pleural effusions.Sharply defined and likely calcified left upper lobe nodule, unchanged.No new findings.

Output: Basilar atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: 40 yo male with history of T-ALL; pre-allo SCT evaluation History: evaluate No acute cardiopulmonary abnormality. Left PICC tip at RA/SVC junction.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Hx Pneumonia, Hemoptysis History: Cough Nodular opacity approximately 3 cm projected over the left supra aortic region of the left upper lobe, versus artifact. Extensive fibrotic lung disease with bronchiectasis, which could account for the patient's hemoptysis. No reliable evidence of superimposed pneumonia.Heart size upper normal, the aorta tortuous.Left subclavian pacemaker, leads unchanged in position.

Output: Extensive fibrotic lung disease with bronchiectasis, which could account for the patient's hemoptysis. Left upper lobe nodular opacity versus artifact, thoracic CT recommended.


Instruction: Generate impression based on medical findings.

Input: Chest pain Mildly improving lung volumes, however overall aeration remains decreased with an elevated left hemidiaphragm. Questionable left basilar scarring. Lungs otherwise clearCardiac and mediastinal contours remain within limits given mild rotation. Dobbhoff projects into the distal stomach, newly placed

Output: Dobbhoff placement


Instruction: Generate impression based on medical findings.

Input: Follow-up of patient with hepatocellular carcinoma CHEST:LUNGS AND PLEURA: No change in the pleural plaques some of which are calcified. Emphysematous changes unchanged. Prior noted micronodules are less prominent and difficult to visualize on today's examination. No parenchymal masses identified.MEDIASTINUM AND HILA: Atherosclerotic changes again noted. No significant abnormality notedCHEST WALL: No change in small right cardiophrenic angle lymph nodeABDOMEN:LIVER, BILIARY TRACT: Multiple vascular enhancing lesions are seen throughout the liver greatest accumulation a right lobe but throughout both lobes. The the reference right hepatic lobe lesion in segment 8 is unchanged in size measuring 4.5 x 3.6 cm (series 9, image 22) compared with previous 4.6 x 3.5 cm. However the other large reference lesion in anterior right hepatic lobe (series 9, image 54) has markedly increased in size measuring 8.6 x 6.2 cm compared with previous 6.3 x 4.3-cm. Other lesions in the liver have similarly increased in size (for example lesion posterior right lobe series 9, image 34) now measures 3.6 x 2.7 cm compared to previous 2.8 x 2.5 cm.). Several small new enhancing lesions are also identified. Most of these lesions all show washout on delayed phase consistent with hepatocellular carcinoma.The right and main portal vein remain patent and the tumor thrombus in the left portal vein remains unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Hepatoduodenal lymph nodes are again noted to be enlarged. The reference lymph node (series 12 image 111) measures 1.7 x 4 .2 cm, which is unchanged. The cluster of other nodes in this area also appear unchanged. As enlarged lymph nodes to this degree can be seen in patients with chronic liver disease comes significance is lymph nodes remains uncertain.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No change in the sclerotic eighth rib focus of uncertain significance. No other bony abnormalities are seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Increasing number and size of enhancing liver lesions meeting AASLD criteria for hepatocellular carcinoma. 2. No change in prominent hepatoduodenal lymph nodes of uncertain significance -- see above discussion. 3. No change in appearance of right eighth rib sclerotic focal abnormality of uncertain significance. 4. No change in left portal vein thrombus presumed tumor extension. A


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: eval pneumothorax History: right pneumothorax following lung biopsy Stable cardiomediastinal silhouette.Interval resolution of right apical pneumothorax.No acute focal airspace opacity. No pleural effusion.

Output: Interval resolution of right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: check placement of quinton catheter as it is not working anymore, may be mispositioned now History: needs PLEX Right IJ central catheter has been removed, and a left IJ central catheter has been with tip at or just beyond the left brachiocephalic/SVC junction. Decreased lung volumes and cardiomediastinal silhouette within normal limits, unchanged. Minimal bibasilar subsegmental atelectasis/scarring pulmonary opacity, pleural effusions or pneumothorax.

Output: Left central catheter with tip likely at the junction of the left brachiocephalic vein and the SVC.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with chest pressure. Chest tightness in patient with ulcerative colitis. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. Scattered punctate likely postinflammatory nodules. Mild central bronchial wall thickening compatible with bronchitis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: No PE. Mild central bronchial wall thickening, compatible with bronchitis.