Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: assess chest tube position History: chest tube New left chest tube doubled back upon itself, with improved but persistent left pneumothorax.Right chest tube tip in apex with no pneumothorax.Cardiomegaly status post median sternotomy presumably for CABG.Stable basilar consolidation following surgery.An NG tube traverses a gastric pull-up, the tip several centimeters above the hemidiaphragm level.ET tube tip approximately 5 cm above the carina.

Output: New left chest tube doubled back upon itself near the hilum, with improvement but not yet resolution of a left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: MaleReason for Study: Reason: eval for ICD lead placement History: possible seizure Left-sided ICD unchanged.Stable cardiomediastinal silhouette.Decreased lung volumes with minimal basilar atelectasis.No focal areas of consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. Left-sided single-lead ICD unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: evaluate for pneumonia History: dyspnea, chills The cardiomediastinal silhouette is within normal limits. New streaky right basilar opacities. No significant pleural effusion or pneumothorax.

Output: New streaky right basilar opacities, which could represent atelectasis, though early aspiration or pneumonia could also have this appearance. Consider repeat imaging in 8 weeks.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Evaluate pleural effusion. Dyspnea. Large right pleural fluid collection similar in volume. A pleural drain is unchanged in position with tip projecting at the level of the right mid thorax. The adjacent lung is atelectatic. No acute abnormality on the left.

Output: Large right pleural fluid collection with compressive atelectasis of the right middle lobe and majority of the right lower lobe, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: ARDS PNA History: above Interval extubation. Stable degree of bilateral airspace opacities and retrocardiac consolidation. No pneumothorax. No change in small effusions.

Output: No significant interval right change.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: eval pneumonia. History: worsening tachypnea, WOB. Again seen are multifocal opacities suspicious for pneumonia with opacities in the left lung that appear more confluent compared with the recent examinations. Questionable interval increase in the right-sided pleural effusion. Probable new left pleural effusion. Cardiomediastinal silhouette is unchanged.

Output: Multifocal airspace opacities, suspicious for pneumonia. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: dizziness History: dizziness, hypotension No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval for pna History: fever Improvement in bibasilar opacities. Unchanged heart size. No large pleural effusion or pneumothorax. Right-sided abdominal drain noted.

Output: Improvement in bibasilar atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: 34 years old Male. Reason: swan placement History: swan placement. Swan-Ganz catheter terminates balloon within the left pulmonary artery. Intra-aortic balloon pump terminates approximately 3 cm from the top the aortic arch. The right jugular catheter and ICD electrode are stable in position. Pulmonary opacities unchanged. Unchanged cardiomegaly.

Output: Diffuse pulmonary opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Check balloon pump IABP marker remains 1 cm from the aortic arch. ICD similar position. Mildly improving overall lung aeration with underlying diffuse chronic appearing interstitial changes, specifically no superimposed new air space process observed.Mild cardiomegaly unchanged

Output: IABP unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.SOB evaluate for pneumonia Normal cardiomediastinal silhouette. No focal airspace opacity, pleural fluid or pneumothorax. Considerable artifact from overlying chest wall soft tissue.

Output: Normal chest. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: evaluate lung fields History: s/p right thoracotomy Tubes and lines unchanged.Right hydropneumothorax slightly smaller, now with pneumothorax component about 3 mm in size laterally. Pleural fluid component slightly increased. Dependent atelectasis. Hazy opacity in the left lower lobe lingula suspicious for aspirated secretions.Displaced right lateral rib fractures likely postsurgical.

Output: Right hydropneumothorax with improving pneumothorax component and slight increase in pleural fluid component.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: S/P LVAD. Eval for placement for left PICC line History: PICC line insertion Moderate cardiomegaly status post sternotomy and mitral valve repair.Pleural effusions and basilar opacities slightly worse especially in the left lower lobe.LVAD unchanged.Right PICC, tip at cavoatrial junction.Left PICC, tip in the SVC.Swan-Ganz catheter removed.

Output: Left PICC, tip in the SVC. Swan-Ganz removed. Increased basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: new R IJ please confirm placement History: above Left jugular catheter tip in SVC. Interval extubation. Increased left pleural effusion. No evidence of pneumothorax.

Output: Left jugular catheter tip in SVC. Increased left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Tachycardia, abnormal EKG, active IBD. PE? PULMONARY ARTERIES: Study is technically adequate. No evidence of pulmonary embolus.LUNGS AND PLEURA: Bronchial wall thickening in both lower lobes. Small nodular opacities in lingula (image 158, series 9) and in the left lower lobe (image 149, series 9), as well as tree in bud-like appearance in the left lower lobe (image 171, series 9). These findings are likely related to bronchiolitis.Mild centrilobular emphysema predominantly in the upper lobes.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No evidence of PE. 2. Bilateral bronchial wall thickening and left lower lobe/lingular small nodular opacities/ tree in bud, compatible with bronchiolitis.3. Mild centrilobular emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Known history of NSCLC prior to stent placement. Dyspnea. History of lung cancer. Decreased volume of pleural fluid on the left. Retrocardiac opacity unchanged. Patchy atelectasis bilaterally, slightly improved on the left.

Output: Improved aeration of the left lung. No new findings.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with sinonasal cancer status post chemotherapy. LUNGS AND PLEURA: Previously identified right upper lobe subpleural opacity adjacent to the vertebral column (image 37, series 5) is unchanged since 3/2005 and unlikely to represent a metastasis. Stable appearing nodule in the superior segment of the right lower lobe, 6 mm x 6 mm (image 59, series 5) likely represents an intrapulmonary lymph node.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Multiple well-defined hypodense lesions scattered throughout the liver compatible with simple cysts, unchanged.

Output: No new findings. No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: swan out of place History: swan out of place Swan-Ganz catheter has been retracted and the tip is near the tricuspid valve. IABP unchanged. Other findings stable. Enteric tube has been removed.

Output: Swan-Ganz catheter has been retracted and the tip is near the tricuspid valve.


Instruction: Generate impression based on medical findings.

Input: Evaluate for colon or gastric distention after dilated advancement in patient with recent postoperative ileus after partial colectomy Multiple midline skin staples. Diffuse mild to moderate dilatation of small and large bowel, most consistent with postoperative ileus. Decreased osseous mineralization and multilevel spinal degenerative disease.

Output: Findings suggesting diffuse postoperative ileus as above.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Confirm ET tube placement History: hypoxia Endotracheal tube terminates within 1 cm superior to carina. Repositioning is recommended. Nasogastric tube side hole is immediately inferior to the GE junction. The remaining support devices are unchanged in position.Low lung volumes. No significant change in the right greater than left pulmonary opacities and retrocardiac consolidation. No interval pneumothorax.

Output: Endotracheal tube terminates within 1 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Desaturation. ETT tip 2.5 cm above the level of the carina. Right jugular catheter projects over the right atrium. Enteric tube tip off the caudal margin of the film.Right lower lobe opacification, extending to the level of the major fissure, with subsegmental atelectasis in the right middle lobe and left retrocardiac region. Unable to exclude superimposed pleural fluid.

Output: Multifocal atelectasis most likely the result of aspiration. Right lower lobe atelectasis may be from aspiration or mucus plugging of the airway.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: altered mental status History: altered mental status Heart size is upper limits normal. There is evidence of atherosclerotic disease in the proximal descending thoracic aorta. Reticular opacities at the costophrenic angles scarring. There is a skinfold at the right apex; no pneumothorax is present.

Output: No evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Right lower lung abnormal sounds. Desaturation Give an mild differences in patient positioning and technique. Again no acute cardiopulmonary abnormalities observed. Scattered granuloma minimal scarring and/or basilar atelectasis. No definite effusionsThe cardiac and mediastinal contours are grossly within limits

Output: Minimal scarring and atelectasis with scattered granuloma. No superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: assess swan position History: assess swan position Cardiomegaly with edema and pleural effusions right larger than left, not significantly changed.Right jugular Swan-Ganz catheter tip still peripherally in the right lower lung zone which can lead to infarction.Left subclavian dual chamber ICD unchanged.

Output: No change in pulmonary opacities and pleural effusions. The tip of the Swan-Ganz catheter is far peripherally into the right lower lung zone, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old Reason: evaluate lung fields History: intubated Support tubes, lines and medical devices unchanged.Retrocardiac opacity suggests atelectasis/consolidation, not substantially changed. Questionable small left pleural effusion.There is persistent mild/moderate enlargement of cardiac silhouette.The imaged upper abdomen and skeleton are unremarkable.

Output: Retrocardiac atelectasis/consolidation and questionable small left pleural effusion, unchanged. Persistent mild/moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Recent right subclavian single chamber pacemaker unchanged, with no pneumothorax.Stable right upper lobe scarlike opacity.No new findings.

Output: No pneumothorax following recent pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: MaleReason for Study: Reason: Evaluate for acute intrathoracic process History: Pt presents with syncopal episode The cardiac mediastinal silhouette is unremarkable.Nonspecific basilar opacities are compatible with atelectasis.No focal areas of consolidation.No pleural effusions.Degenerative changes in thoracic spine.

Output: Mild nonspecific right basilar subsegmental atelectasis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Sepsis. A presumed left jugular catheter extends into the left subclavian vein directed peripherally.Tip of the endotracheal tube is difficult to visualize, probably similar to prior.An enteric tube traverses the esophagus and is partially visualized extending to the upper abdomen.Lung volumes remain low with elevation of the right hemidiaphragm and associated atelectasis. No pneumothorax or focal airspace opacities.

Output: No signs of pneumonia. Left jugular catheter extends into the left subclavian vein directed peripherally, consider repositioning.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.SOB history of lung cancer. Small right pleural effusion with improved basilar lung aeration. Right inferior hilar mass. The right middle and lower lobes remain largely consolidated with known underlying tumor, unable to exclude a postobstructive pneumonia. Multiple nodules bilaterally. Right chest port unchanged in position.

Output: Pulmonary metastases with a large infiltrative right hilar mass with pleural and mediastinal invasion. Right lower lobe consolidation consistent with known tumor however a superimposed postobstructive pneumonia cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o infection, edema, effusion History: productive cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with ovarian cancer status post two cycles of therapy. Please compare to previous scans of 2/16/2008. CHEST:LUNGS AND PLEURA: Calcific granuloma the left lung. No noncalcified lung nodules or effusions.MEDIASTINUM AND HILA: Calcific granulomata left hilar area. No pathologic-sized noncalcified nodes.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Postsurgical changes. Left adnexal mass increased in size to 3.4 x 3.2 cm is seen on series 2 image 153/191 this is contiguous with general soft tissue fullness in the left adnexa and a second focal mass along the posterior aspect of the cul-de-sac is seen on image 161 common is also slightly increased in size. No new masses.BLADDER: The wall thickening along the left aspect contiguous with the aforementioned mass.LYMPH NODES: Small groin nodes left greater than right, unchangedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Increase in size of left adnexal masses. No new sites of disease. Granulomatous disease chest. Atrophic left kidney. Colonic diverticulosis. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Chest pain. Evaluate for pneumonia. No focal consolidation, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No evidence of infection or other abnormality.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with pneumothorax s/p SLT. S/p re-transplant to left native lung on 5/28/2016 due to BOS III in right transplanted lung (performed in 2011). Interval removal of left chest tube.Chronic volume loss in the right lung with associated loculated apical pleural fluid not significantly changed. Left sided interstitial opacities slightly worse. New small left pleural effusion. Probable atelectasis in the left base also slightly worse. No pneumothorax.Left lateral chest wall subcutaneous emphysema has nearly completely resolved.

Output: New small left pleural effusion, and worsening edema-like opacities in the left lung.


Instruction: Generate impression based on medical findings.

Input: Reason: lung infiltrate History: cough; fever Unremarkable cardiac and mediastinal silhouette. Moderate perihilar bronchial thickening, suggestive of asthma.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: evaluate for fluid overload History: SOB No significant cardiopulmonary abnormality.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: intra-aortic ballon pump stopped showing waveform, pls comment on position History: as above Swan-Ganz catheter tip in the main pulmonary artery.Balloon catheter marker visible in the descending aorta at the level of T10-T11.Moderate cardiomegaly and mild nonspecific residual right lower lobe airspace opacity, slightly improved.

Output: Balloon catheter marker in the lower thoracic aorta without significant change.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with tachycardia and tachypnea and alteration in gas exchange. Additional history upon discussion with ordering service: Non-small cell lung cancer status post removal of a left bronchial stent. CHEST:PULMONARY VASCULATURE: Filling defect in a right lower lobe subsegmental pulmonary artery is compatible with PE (series 5, image 182 - 191; and series 8048, coronal image 51).LUNGS AND PLEURA: Interval removal of left mainstem bronchial stent. The left mainstem bronchus and distal lower lobe branches are patent with slight interval improvement in aeration of left lower lobe. Stable small to moderate pleural effusions.Cavitary mass in the left upper lobe with large air-fluid level is reidentified and appears similar to prior study.Widespread centrilobular and tree in bud opacities in the right lung with improving consolidation in the right lung base.Severe bullous disease is again seen at the lung apices.MEDIASTINUM AND HILA: Tracheostomy tube in expected location. Interval removal of right PICC.Severe narrowing of the left pulmonary artery due to the mass is reidentified. Large left hilar mass is grossly stable in appearance. Coronary calcifications.Slightly increasing subcarinal lymphadenopathy with reference node measuring 19 x 18 mm (series 5, image 143); previously measuring 18 x 15 mm.Enteric tube with tip in stomach.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. PE in right lower lobe subsegmental pulmonary artery branch.2. Left hilar mass with cavitation appearing similar prior to study.3. Widespread centrilobular and tree in bud opacities in the right lung with improving consolidation at right lung base; findings are suggestive of improving infection.4. Interval removal of left mainstem bronchial stent with patent left mainstem bronchus and distal lower lobe branches. There is also slight interval improvement in aeration of left lower lobe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: s/p left thoracotomy \T\ LLL resection Left chest tube in place, position unchanged.Small persistent left apical pneumothorax.Streaky bibasilar opacities consistent with atelectasis.Left chest wall subcutaneous emphysema, similar to prior.

Output: Small persistent left apical pneumothorax, with left chest tube position unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: r/o pneumonia History: fever of unknown origin No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Left pneumothoraxVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. Feeding tube tip in the second portion of the duodenum. Lower extremity PICC with tip in the right atrium. Right central line with tip in the SVC. Cardiothymic silhouette normal. There is placement of a left chest tube with decrease in size of the left pneumothorax. The mediastinal shift has resolved from prior exam.

Output: Left pneumothorax decreased in size from prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: bilateral crackles in pregnant women History: SOB, crackles No evidence of overt left-sided heart failure. No focal lung consolidation. No pleural effusion or pneumothorax. Heart size, likely normal.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: eval for edema History: SOB, hx of CHF ICD lead and generator in place. Unchanged cardiomediastinal silhouette. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No specific findings of edema. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Check for cardiomegaly. End stage renal disease A small focal nodular subcentimeter densities observed in the lower right lung. This appearance likely represents the patient nipple. Lungs are otherwise clear. Cardiac and mediastinal contours are within limits, however the heart is borderline in overall size

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Pericardial drain in place History: N/A New pericardial drain placed without complication.Unchanged enlargement of the cardiac silhouette.Increased lower lung zone opacities suggestive of edema with foci of consolidation and bilateral pleural effusions.

Output: Pericardial drain placement. Worsening basilar opacities.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with new IJ. Evaluate line placement. Right internal jugular venous courses superiorly beyond the superior margin of the image and then descends with tip just superior to the thoracic inlet.Chronic appearing interstitial opacities unchanged. No significant pleural effusions. No pneumothorax. Unchanged cardiomediastinal silhouette.

Output: Right internal jugular venous courses superiorly beyond the superior margin of the image and then descends with tip just superior to the thoracic inlet.Findings were relayed by radiology on call resident Dr. David Kromrey via text page to pager 4219 (covered by 7228).


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: r/o pneumo History: endoscopy with biopsy Sternotomy wires are in place. The cardiomediastinal silhouette is normal.No pneumothorax or pleural effusion.Multiple bilateral nodular pulmonary opacities are unchanged and based on CT findings remain suggestive of fungal pneumonia.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: ro spontaneous ptx vs worsening effusion History: shortness of breath No evidence of pneumothorax, as clinically queried. Worsening left pleural effusion, better demonstrated on same-day CT chest. Small right pleural effusion. Bilateral subsegmental atelectasis. Asymmetrical soft tissue density with axillary surgical staples and calcifications.

Output: Worsening left pleural effusion and interval development of right pleural effusion. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with COPD exacerbation, chest pain. Rule out ACS. No focal airspace opacities. No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: 51F with history of urethral cancer s/p exenteration with Indiana Pouch, surveillance imaging History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Chest pain rule out pneumonia. No pneumothorax, visible pleural fluid or signs of pneumonia. Persistent left basilar opacity, possibly reflecting scarring.

Output: No convincing evidence of pneumonia. Left basal opacity nonspecific and may reflect scarring. If patient's symptoms correlate to this area consider erect PA and lateral chest radiographs for further characterization.


Instruction: Generate impression based on medical findings.

Input: Reason: extubated, eval for pleural effusion, consolidation History: increasing oxygen requirement Interval extubation.Catheter tip in the SVC.NG tube doubled back in the stomach.Diffuse interstitial and airspace opacities suggestive of edema, slightly improved in the left upper lobe but otherwise unchanged.

Output: Interval extubation with diffuse pulmonary edema, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: ETT PLACEMENT History: dka, SEPSIS Endotracheal tube has been pulled back slightly now terminating 2 to 3 cm from the carina. Enteric tube terminates within the proximal aspect of the stomach. Esophageal temperature probe has been pulled back slightly. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Lines and tubes, as above. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: pneumonia? History: cough fever in old woman with flu symptoms Slightly large lung volumes consistent with COPD.Very small right pleural effusion, the lungs are unremarkable.No specific evidence of infection.Unremarkable mediastinal contours and cardiac silhouette.

Output: Very small right pleural effusion, otherwise unremarkable except for COPD.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: 78M with acute SOB History: as above Severe upper lobe predominant emphysema.Mild basilar interstitial opacities likely chronic.Heart size normal.No specific evidence of infection or edema.

Output: Severe emphysema, but no edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Homeless. Presents with fever and cough. Prominent interstitial opacities throughout. No focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Metallic fragments overlie the chest wall, probably bullet fragments.

Output: Fine interstitial pattern, probably represents interstitial lung disease. Cannot exclude superimposed edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: pneumonia History: cough Decreased lung volumes with basilar predominant fibrosis similar to the prior exam.Stable cardiomediastinal silhouette.No new pulmonary opacities identified.No pleural effusions.

Output: Basilar fibrosis without significant interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: 39yoM w/ hypoplastic right ventricle, tricuspid atresia, hypoxia History: hypoxia Severe cardiomegaly with persistent pulmonary edema. The left pleural effusion and consolidation have improved. Status post BT graft and Glenn shunt with no change in vascular calcification superior to aortic arch.

Output: Pulmonary edema. Left pleural effusion and consolidation have improved.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: Eval for Effusion and Atelectasis History: S/P Aortic Dissection Repair Sternotomy wires and sternal hardware are intact. Surgical clips project over the right upper lung.The cardiomediastinal silhouette is unchanged. Persistent right pleural effusion with resolution of left pleural effusion. No pneumothorax.

Output: Persistent right pleural effusion. Interval resolution of left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: r/o pneumonia History: chest pain sob, cough Very low lung volumes. Stable mild enlargement of the cardiac silhouette. Status post median sternotomy and mitral valve replacement. Intact sternotomy wires.Bilateral lower lobe, right middle lobe and lingular consolidative opacities in partial atelectasis.Moderate bilateral pleural effusions are new from prior. No pneumothorax.Vascular stents overlies the left axilla.

Output: Signs of alveolar pulmonary edema superimposed on bilateral lower lobe partial atelectasis associated with moderate bilateral pleural effusions.Status post mitral valve replacement.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: effusion, ptx History: effusion, ptx Tracheostomy tube remains in place. Diffuse pulmonary opacities with layering pleural effusions and basilar opacities again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Congestive heart failure, as before.


Instruction: Generate impression based on medical findings.

Input: Post device placement in EP lab question pneumothorax. Possible 10 mm pneumothorax on the left partially obscured by the overlying saline bag. Left subclavian ICD unchanged in position. No pleural fluid. Low normal lung volumes with nonspecific mild chronic appearing interstitial lung abnormality. Mild thickening of the fissures and vascular redistribution suggesting hypervolemia.

Output: There appears to be 10 mm left apical pneumothorax however please note that a pleural line may be mimicked by the margin of the overlying fluid-containing saline bag. Recommend removal of this overlying objects and a follow-up film.Cardiology fellow Andrew Beaser (3942) verbally notified at 10:25 AM on 12/29/2016.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of heart transplant. Evaluate for source of cough and wheezing LUNGS AND PLEURA: Interval clearing of the groundglass opacity identified in the right upper lobe on the prior exam.Subpleural reticulations are not significantly changed.Left lower lobe subpleural nodule (image 62, series 5) is stable or decreased in size.New right upper lobe subpleural nodule (image 23, series 5) measures 14 mm x 16 mm..No significant pleural effusion.MEDIASTINUM AND HILA: Status post cardiac transplant with demonstration of a median sternotomy.Infrasternal and retrosternal soft tissue/fluid has significantly decreased in size compared to the prior exam and most likely represented postsurgical changes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Clearing of the previously noted patchy ground glass opacities. New right upper lobe subpleural nodular opacity may represent atelectasis or be inflammatory in origin. Neoplasia cannot be excluded and a follow up exam in 3 months is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: 28M s/p LVAD placement History: s/p LVAD placement Support devices are unchanged in position, including a complete annuloplasty ring in the mitral position and left ventricular assist device.Retrocardiac subsegmental atelectasis is unchanged. No interval edema. The heart size remains enlarged. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: chf? History: sob Central venous catheter terminates in the SVC. Improvement in small pleural effusions. Mild basilar atelectasis or scar. Right hilar fullness, chronically unchanged. Unchanged cardiomegaly. Aortic atherosclerosis again noted. Patient again status post sternotomy.

Output: No focal lung consolidation or evidence of overt left-sided heart failure. Improvement in small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: History of pneumothorax.VIEW: Chest AP (one view) 2/5/15 at 606 hours. Left-sided chest tube unchanged. Cardiac silhouette size is top normal. Persistent bibasilar opacities and left-sided hydropneumothorax.

Output: No change in multifocal opacities in left-sided hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: s/p chest tube removal History: NA A left chest tube has been removed. Left internal jugular catheter has also been removed.The cardiac silhouette is enlarged but stable.There are bilateral pleural effusions, but no pneumothorax. Subsegmental atelectasis is noted in the right medial lung base and in the left lung base.

Output: Chest tube and left internal jugular venous catheter removed. No pneumothorax but small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: preop eval prior to AVR. r/o pulmonary disorders History: SOB Moderate cardiomegaly with tortuous aorta.No significant pulmonary or pleural abnormality.

Output: Moderate cardiomegaly. No evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: r/o infection History: cough Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Intubation. Verify endotracheal tube placement. The endotracheal tube tip is approximately 4 cm above the carina. The enteric tube tip overlies the gastric body. Persistent basilar and perihilar opacities compatible with edema, similar to the prior study. Left retrocardiac consolidation/atelectasis and trace effusions.Mild cardiomegaly.

Output: Stable cardiopulmonary appearance with edema, consolidation/atelectasis and effusions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male, assess ET tube position. Endotracheal tube tip is approximately 5 cm above the carina.Enteric tube tip extends below the lower margin of the submitted radiograph.Stable cardiomediastinal silhouette.Low lung volumes with interval improvement in aeration of the left lower lobe.Perihilar predominant opacities with probable small bilateral pleural effusions likely represent edema.

Output: Interval improvement in aeration of the left lower lobe. Perihilar predominant opacities with probable bilateral effusions likely represent edema.


Instruction: Generate impression based on medical findings.

Input: End-stage renal disease Interval removal of dialysis catheter. No underlying cardiopulmonary abnormalities

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Decompensation and heart failure with intubation Motion degrades sensitivity.Moderate enlarged perihilar edema-like changes with effusions and cardiomegaly suggest CHFETT terminates 4 cm above the carina. Swan-Ganz extends into the right lower lobe pulmonary artery. ICD unchangedNG tube is observed, side port seen 5 cm above the GE junction

Output: ETT and NG placed with increasing diffuse moderate CHF


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: eval placement of Swan-Ganz History: see above Left-sided ICD and right central venous catheter unchanged.Left IJ catheter and IVC Swan-Ganz removed.Stable cardiac enlargement.Perihilar opacities and left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Interval removal of IVC Swan-Ganz and left IJ venous catheters.Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.ESRD needs to start hemodialysis. Left subclavian dual-chamber pacemaker, leads are unchanged in position since 2009; the ventricular lead is directed superiorly in the projection of the anterior right ventricle. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed. No signs of pneumonia or pulmonary edema. No pleural fluid. Mild degenerative changes of the spine.Normal heart size. Atherosclerotic calcifications of the thoracic aorta progressed, but similar in distribution to prior.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Increased work of breathing and feverVIEWS: Chest AP/lateral (two views) 3/12/2016, 0130 Cardiothymic silhouette is normal. Mild peribronchial thickening and slightly increased lung volumes. No focal airspace opacity to suggest pneumonia. No pleural effusion or pneumothorax.

Output: Bronchiolitis/reactive airway disease pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: RIJ Cordis placement History: above Right jugular catheter tip in the area of the right brachiocephalic vein with no pneumothorax or other complications. ET tube tip about 6 cm above the carina. NG tube tip above the GE junction, in the distal esophagus.Perihilar bronchial thickening and mild subsegmental atelectasis in the left lower lobe, not significantly changed.

Output: New right jugular catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 1 year old female with tympanic abdomen, rule out foreign body and FOS. VIEW: Abdomen AP and chest AP/lateral (three views) 1/20/15 at 0822. There is gaseous distension and dilation of loops of bowel with multiple air-fluid levels on the upright chest radiograph. No radiopaque foreign body is present. The aortic arch, cardiac apex, and stomach are left sided. The cardiomediastinal silhouette is normal in size. There are no pulmonary airspace opacities or pleural effusions.

Output: 1. Gaseous distension and dilation of multiple bowel loops with air-fluid levels, most consistent with a gastroenteritis pattern. 2. No radiopaque foreign body is present.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with acute onset left-sided chest pain, nausea, diaphoresis. Cardiomediastinal silhouette is within normal limits.No focal pulmonary consolidation or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o pulmonary edema History: PND and increased orthopnea. Unchanged position of aortic valve prosthesis with stent material, surgical clips and spinal hardware.Stable cardiomediastinal silhouette.Low lung volumes. Scarring versus atelectasis in the left lower lobe.No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: eval for ptx, edema History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No evidence of a pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Concern for acute chest syndrome. Evaluate for possible progression of new opacity. Cardiomegaly with prominent central pulmonary vasculature, unchanged.Right greater than left pleural and parenchymal scarring, but no acute appearing opacities.Blunting of the posterior costophrenic angles is new and may indicate small pleural fluid collections.Right jugular chest port tip at the SVC level.Scoliosis.

Output: Trace pleural effusions in the posterior costophrenic angles but no other radiographic findings to indicate acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: cough Unremarkable cardiac and mediastinal silhouette.Port catheter with its tip in the SVC.Surgical clips in the right chest wall.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Reason: pacemaker History: PM battery at EOL Cardiomegaly is present. Pacemaker appears unchanged. Mild bilateral basilar atelectasis is present.No pleural effusions present. Large hiatal hernia is redemonstrated.

Output: Stable cardiopulmonary exam with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: s/p Swan placement History: as above Worsening pulmonary opacities suggestive of atypical edema or aspiration.Right upper lobe infection is also a consideration.ET tube tip approximately 1 cm above the carina.An NG tube terminates in the stomach.IVC Swan-Ganz catheter, tip in right pulmonary artery.

Output: Low ET tube. Worsening pulmonary opacities especially in the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: assess line placement/SOB History: SOB, arrythmia The patient has been intubated with the endotracheal tube within the peripheral right main stem bronchus, 3 cm distal to the carina. This has been repositioned the subsequent radiograph. Interval exchange of a right IJ central catheter for IJ Swan-Ganz catheter which terminates in the central right pulmonary artery.There is interval atelectasis of the left lung with bilateral reduction in lung volumes, left greater than right. Right infrahilar opacities suggestive of aspirated secretions. No pneumothorax.

Output: Interval intubation of the right mainstem bronchus with associated collapse of the left lung. Successful repositioning of the endotracheal tube is documented on a subsequent radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: bladder cancer History: bladder cancer Normal heart size with mildly tortuous aorta.No focal pulmonary opacities, pneumothorax, or pleural effusions. No suspicious pulmonary nodules or masses.Multiple subcentimeter lucencies with sclerotic margins within the left humeral head compatible with degenerative subchondral cysts.

Output: No specific evidence of pulmonary metastases or acute cardiopulmonary abnormality. Osteoarthritic changes of the left shoulder.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: s/p OHT History: s/p OHT Lines and tubes are unchanged. Diffuse pulmonary opacities, unchanged. Stable bilateral pleural effusions. Stable basilar opacities. Unchanged heart size. No pneumothorax.

Output: Stable cardiopulmonary findings


Instruction: Generate impression based on medical findings.

Input: 58M s/p open incisional hernia repair with SOC with tachycardiac and hypoxia Apparent widening of the mediastinum is likely secondary to positioning and low lung volumes.Small bilateral pleural effusions, right greater than left, and basilar atelectasis.

Output: Low lung volumes, bilateral pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: assess VP shunt History: cerebral edema on CT Examination is significantly limited due to patient body habitus.SHUNT DEVICE: Intracranial shunt catheter exits the skull via a right frontal burr hole and courses down the right frontal scalp, neck, anterior chest wall, and anterior abdominal wall. The catheter enters the right hemiabdomen medially where it terminates in the right mid hemiabdomen. Portions of the shunt catheter overlying the skull are radiolucent and hence difficult to evaluate, although we see no evidence of complication. The notch on the pressure valve is unchanged in position when compared with the prior exam, again pointing inferiorly along the course of the shunt.A second shunt device is seen within the lumbar spinal canal with its tip at the level of L5. The catheter courses cephalad, extending the spinal canal at the level of L2-3. It then courses to the right flank and enters the right hemiabdomen with its tip in the right mid hemiabdomen. Portions of the shunt catheter overlying the right hemiabdomen are radiolucent and hence difficult to evaluate, although we see no evidence of complication. The notch on the pressure valve is unchanged in position when compared with the prior exam, again pointing superiorly along the course of the shunt.SKULL: Intracranial shunt catheter as described above. No acute abnormality.CERVICAL SPINE: No acute abnormality.CHEST: Tracheostomy catheter with tip projecting over the level of T2-T3. The previously described enteric tube is not visualized, presumably due to removal. There is persistent atelectasis of the right middle lobe. The cardiomediastinal silhouette is unchanged. There are diffuse interstitial and airspace opacities, likely reflecting edema.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Intracranial and intraspinal lumbar shunt devices as above without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: pna History: pna No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.SOB evaluate for infiltrate/edema. No focal pulmonary opacities, visible pleural fluid or pneumothorax. Second sternal wire is incomplete, unchanged. Right upper quadrant surgical clips.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: picc line placement History: as above Right arm PICC, tip in the upper SVC.The cardiomediastinal silhouette is unchanged.No new focal air space abnormality. No large pleural effusions.No significant pneumothorax.

Output: Right arm PICC, tip in the upper SVC. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: surveillance post bronchoscopy History: dyspnea Right perihilar opacity unchanged.No new findings.No pneumothorax following bronchoscopy.Left subclavian catheter, tip in SVC.Left bronchus intermedius stent.

Output: Unchanged pulmonary opacities. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: ET tube History: Et Tube Right basilar airspace opacities suggestive of infection, although this region is better expanded than on the prior study where there was more atelectasis.Heart size normal.ET tube tip 8 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: Improving right basilar atelectasis but persistent right basilar airspace opacity suggestive of infection.


Instruction: Generate impression based on medical findings.

Input: Patient with left arm tingling, evaluate for VP shunt malfunction. SHUNT DEVICE: Intracranial shunt exits the skull via a right frontal parietal burr hole and courses through the right scalp, neck, and anterior chest wall, entering and terminating in the abdomen. Portions of the shunt overlying the skull are radiolucent and hence difficult to evaluate, but we see no radiographic findings of shunt complication.SKULL: No acute findings noted. Incidental note is made of dental cavities.CERVICAL SPINE: There is loss of normal cervical lordosis but there are no acute findings.CHEST: The lungs are clear.ABDOMEN: There is nonobstructive bowel gas pattern.

Output: Shunt device appearing similar to the prior study without findings to account for patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Presternal defibrillator lead noted. Aortic atherosclerosis. Vascular stent overlies the upper left hemithorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Status post assault with left and lateral rib pain. Evaluate for fracture. No focal pulmonary opacities, pleural effusions, pneumothorax.Cardiac mediastinal silhouette is within normal limits.No evidence of rib fracture, although chest radiograph is insensitive for nondisplaced acute fractures.

Output: No cardiopulmonary abnormalities. No evidence of rib fracture.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: r/o pna History: cough Low lung volumes with persistent elevation of the right hemidiaphragm. Basilar opacities favoring atelectasis are unchanged. There is rightward mid thoracic curvature which is stable. No specific evidence of edema or infection.

Output: Low lung volumes with basilar opacities favoring atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA History: rhonchi, fever of unknown origin, trach in place Tracheostomy tube and right jugular catheter are unchanged.Underinflated lungs with nonspecific perihilar streaky opacities suggestive of aspirated secretions with areas of focal subsegmental atelectasis.No specific evidence of pneumonia.

Output: Perihilar opacities compatible with atelectasis and aspirated secretions with no acute change.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with previous smoking history and no lung mass. Now with right lower quadrant pain for one month CHEST:LUNGS AND PLEURA: Multiple ill-defined, spiculated nodules in the right upper lobe. The reference nodule measures 6- millimeter on image number 25, series number 3. Multiple linear atelectatic areas extending to the pleura in both upper lobes.MEDIASTINUM AND HILA: Subcentimeter calcified lymph nodesCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal stone without evidence of hydronephrosis or focal lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple collateral vessels in the subcutaneous tissue of the pelvis, likely representing venous collaterals. Their etiology is unknown.OTHER: No significant abnormality noted.

Output: Right upper lobe. Subcentimeter spiculated nodules. Their etiology is unknown. Possibility of metastatic disease cannot be excluded.Right nephrolithiasis without hydronephrosis.Multiple venous collaterals in the anterior pelvic wall


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Line placement Right upper extremity PICC tip is deep in the right atrium.Mild cardiomegaly is unchanged. Chronic elevation of the left hemidiaphragm.New left pleural effusion with basilar atelectasis/consolidation. No pneumothorax.Small right pleural effusion. No focal airspace opacity or pneumothorax on the right

Output: Chronic elevation of the left hemidiaphragm with new left pleural effusion and basilar atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.PICC placement Left PICC tip in the SVC.Unremarkable cardiomediastinal silhouette.Low lung volumes. Small to moderate bilateral pleural effusions with underlying atelectasis.

Output: Left PICC identified. Bilateral pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of bladder cancer s/p cystectomy and nephrectomy, evaluate for metastatic disease History: see above Unremarkable cardiac and mediastinal silhouette. Apical opacities compatible with scarring, unchanged from previous.No sign of pulmonary metastases.

Output: No sign of metastatic disease in the chest.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: evaluate for source of infection History: elevated inflammatory markers Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Healed right-sided rib fractures. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: chest pain History: VOC Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of infection or infarction.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval for pulm edema History: inc o2 requirements, fluid boluses Increasing patchy left lower lung zone opacities are suggestive of infection rather than localized edema, although there is mild edema on the right.Two right jugular catheters terminate at the RA level.

Output: Worsening left lower lobe opacity suggestive of pneumonia with underlying pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: new shaking/seizure Unremarkable cardiac and mediastinal silhouette. Small lung volumes with mild basilar atelectasis.No sign of pneumonia.

Output: Mild atelectasis with no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: new central line, check placement History: new line Moderate cardiomegaly.No specific evidence of infection or edema.Right jugular catheter, tip in SVC, replacing a prior Swan-Ganz.

Output: Catheter exchange. Moderate cardiomegaly without acute edema.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: pna? History: abd pain Mild basilar subsegmental atelectasis, otherwise unremarkable.No specific evidence of infection or edema.Heart size normal.

Output: Nonspecific basilar subsegmental atelectasis, but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for aspiration History: worsening respiratory status Tracheostomy tube and venous catheters unchanged.Small lung volumes with dense basilar opacity compatible with atelectasis and possibly effusions, unchanged from previous, possibly due to aspiration.No new findings.

Output: Basilar atelectasis and consolidation with no acute change.


Instruction: Generate impression based on medical findings.

Input: Fall, sepsis alert, AMS. Low normal lung volumes. Scarring in the left upper and lower lobes. Diffuse bronchial thickening. Reticulonodular opacities at the right base may be the result of aspirated secretions. No specific signs of pneumonia. Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended.

Output: Nonspecific finding suggestive of mild chronic recurrent aspiration, but no visible pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated, pna History: intubated, pna ET tube tip approximately 6 cm above the carina.Catheter, pacemaker, left pleural drain and feeding tube unchanged.Left lung opacity compatible with left effusion with underlying atelectasis and consolidation.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: infection History: cough No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 85-year-old male with right leg asymmetry. Evaluate for pulmonary embolus. PULMONARY ARTERIES: Exam is diagnostic. No evidence of pulmonary embolus.LUNGS AND PLEURA: Groundglass air space opacity in the right upper lobe measures 4.0 x 2.8 cm, image 38/151. This may represent pneumonia, however bronchoalveolar carcinoma cannot be excluded. No pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Mild hydronephrosis bilaterally which is secondary to an ileal conduit.LOWER EXTREMITIES: Poor opacification of a low extremity venous system limits evaluation for deep vein thrombosis.

Output: 1. No evidence of pulmonary embolus.2. Ground glass air space opacity suspicious for bronchoalveolar carcinoma. If patient has clinical symptoms of infection, this could be due to pneumonia. Six week follow-up with chest CT is recommended.These findings were discussed with Dr. Andrew Davis on 1/23/2008 at 4 p.m.


Instruction: Generate impression based on medical findings.

Input: Intubation. MRSA pneumonia.VIEW: Chest AP (one view) 02/03/16, 1448 Endotracheal tube tip is in right mainstem bronchus. Right internal jugular line has its tip in right atrium. Ventriculoperitoneal shunt tubing is present. There is a right chest tube. A gastrostomy tube is in place.Soft tissue edema continues. Hazy opacities persist bilaterally. Prominent air bronchograms are noted in right lower lobe. Cardiothymic silhouette is upper limits of normal in size.

Output: Right mainstem bronchus intubation.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of malignant melanoma. Metastatic lesion to left supraclavicular lymph node. CHEST:LUNGS AND PLEURA: Biapical scarring. If you, scattered subcentimeter nodules. The reference nodule measures 5-mm image number 83, series number 3 in the left lower lobe.MEDIASTINUM AND HILA: Left supraclavicular adenopathy measuring 19 x 17 mm image number two, series number 3.Calcified AP window adenopathy. Right hilar lymph node measuring 13 x 9 mm image number 46, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: 1 cm cystic lesion in the left lobe of the liver, most likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign-appearing bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm measuring 2.4 x 2.2 cm.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: Left supraclavicular adenopathy.Nonspecific mediastinal and right hilar lymph node and small micronodules.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Evaluate NGT placement. NGT tip at the level of the gastric body. A right-sided peripheral catheter terminates at the SVC level.Lung volumes remain low with extensive dependent and basal atelectasis. Consolidation inferior to the left hilum appears to be improving.

Output: NGT terminates at the level of the gastric body.


Instruction: Generate impression based on medical findings.

Input: Female 32 years old Reason: SOB History: Dyspnea. Cardiomediastinal silhouette is normal in size.No focal airspace opacity, pneumothorax, or significant pleural effusion is identified.Minimal subsegmental atelectasis bilaterally.Anterior margin of the T7 vertebral body is not conclusively visualized.

Output: 1. No acute cardiopulmonary abnormality.2. Anterior margin of T7 vertebral body is not conclusively visualized. If patient has pain referable to this area dedicated thoracic spine radiographs are suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Fever and wheezing. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary vasculature are also within normal limits. Subsegmental atelectasis in lateral aspect of right mid lung field. No cystoplasty. No pleural effusion or pneumothorax. Surgical clips noted in the epigastrium. Mild degenerative changes of the thoracic spine.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Post-bronchoscopy and TBBx History: Cough No pneumothorax. No significant change in right lung pulmonary opacities and a right pleural effusion. No focal lung opacity on the left. The cardiac mediastinal contours are stable.

Output: No pneumothorax with unchanged right pulmonary opacities and right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: assess for new signs of PNA History: fevers, productive cough, SOB Decreased lung volumes.Stable cardiomediastinal silhouette with mediastinal widening dissipation of the previous esophagectomy and gastric interposition.Patchy nodular interstitial opacities slightly improved in the right lung and increased in the left and may be related to chronic aspiration..No focal areas of consolidation.No pleural effusions.

Output: Persistent patchy and nodular initial opacities may be related to chronic/recurrent aspiration pneumonia. CT of the chest is recommended for better evaluation.


Instruction: Generate impression based on medical findings.

Input: 29 years, Female. Reason: obstruction r/o History: n/v, RLQ pain typical to prior There multiple markedly dilated loops of both small and large bowel with multiple air-fluid levels. Stool is noted in the descending colon. Multiple surgical clips are present in the abdomen and pelvis. These findings appear chronic in comparison with prior radiographs and CT examinations. No intraperitoneal free air.

Output: Markedly dilated loops of small and large bowel which appear chronic in etiology. No acute interval change to specifically suggest definite acute obstruction, though a chronic or partial obstruction may have this appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: FemaleReason for Study: Reason: 30 y/o liver ca with worsening sob, PNA vs PE History: shortness of breath ET tube and NG tube have been removed.Left IJ venous catheter unchanged.There are decreased lung volumes with stable cardiomediastinal silhouettePerihilar and basilar opacities are similar to the prior exam and compatible atelectasis possibly secondary to aspiration.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with perihilar/basilar opacities consistent with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: ETT position History: ETT Line position stable. No change in bilateral pleural effusions.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: s/p CABG and MVR History: -- Mediastinal and pleural drains unchanged with no pneumothorax.Pleural effusions and basilar opacities are unchanged.Stable support devices.

Output: No pneumothorax. Stable pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Pectus carinatum versus excavatum. LUNGS AND PLEURA: There is no significant abnormality noted in the partial view of the lung is and pleuraMEDIASTINUM AND HILA: There is no significant abnormality noted in the partial view of the mediastinum and hila.CHEST WALL: There are two regions above and below a prominent sternum that they are dependent. Throughway the visualized inspection of patient the configuration of the chest wall appears to be likely pectus carinatum. The Haller index in the lower most dependent part of the chest is 2.7 which is normal. The other index in the upper most dependent part of the chest is 3 which is also normal.

Output: Findings consistent with pectus carinatum as described.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Postop cardiac surgery ET tube tip is 3.4 cm above the carina. Interval removal of left drain. Right and left internal jugular central venous catheters are unchanged in position. Enteric tube courses below the knee. IABP catheter marker is 2.4 cm from the top of the aortic arch.Moderate cardiomegaly is unchanged.Small pleural effusions and basilar atelectasis not significantly changed. Small component of edema is likely present.

Output: Mild pulmonary edema with bilateral pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: evaluate for SOB History: sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: ILD protocol, history of cough and shortness of breath. LUNGS AND PLEURA: Scattered calcified micronodules, lungs otherwise clear. Specifically no effusions, nodules or masses. Minimal scarring in the left base and apically.No air trapping or other abnormality seen on inspiration and expiration viewsMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Faint ill-defined hypodensity in the last image, presumably volume averaging with the gallbladder. No additional abnormalities in this limited upper abdominal view

Output: Mild granulomatous disease exposure without additional abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: 82yoF w urothelial cell ca, crackles History: crackles, cough Emphysema. No specific evidence of edema or pneumonia. Known lung nodules were much better appreciated on prior CT.

Output: Emphysema. No specific evidence of edema or pneumonia. Known lung nodules were much better appreciated on prior CT.


Instruction: Generate impression based on medical findings.

Input: 62 year old with stage III endometrial cancer. Chemotherapy last on 8/29/2008. Osteoarthritis. Micronodules in the lungs. Back pain. Single Port-A-Cath placed in April. Evaluate disease process compared to 8/19/08 scan. CHEST:LUNGS AND PLEURA: A few scattered calcified and noncalcified micronodules are unchanged. No new suspicious nodules consolidation or effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There is new intra-and extrahepatic biliary ductal dilatation of unclear etiology. Correlate with bilirubin and/or M.R.C.P./ERCP. Segment 6 low attenuation lesion is unchanged measuring 11 x 9 mm (image 89; series 4).SPLEEN: No significant abnormality noted.PANCREAS: Fatty replacement of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple punctate nonobstructing stones in the right kidney unchanged.RETROPERITONEUM, LYMPH NODES: Left periaortic ill-defined soft tissue appears enlarged compared to prior and currently measures 2.1 x 1.6 cm (image 112; series 4) compared to 1.3 x 1.6 cm on the prior examination (image 120; series 4; 9/26/2008 study). Reference left upper quadrant peritoneal deposit described previously is no longer able to visualize secondary closely apposed bowel. BOWEL, MESENTERY: New implant along the right colon (image 109; series 4).BONES, SOFT TISSUES: New metastatic implants in the rectus muscles (image 134; series 4 on the left and image 131 on the right). Small fat containing ventral abdominal hernia is unchanged. Left lower quadrant bowel-containing hernia is also unchanged. Recurrent disease in between hernias (image 162; series 4) is also noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarging bilateral inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Marked worsening of disease with new and enlarging implants as well as new biliary ductal dilatation of uncertain etiology.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with 1-2 PPD x 30 years, follow-up for right lower lobe nodule. Now complaining of weight loss and questionable early satiety. CHEST:LUNGS AND PLEURA: Mild upper lobe emphysema. Right apical and left apical micronodules are unchanged (image 15/100). Stable scarring in the right middle lobe. Right lower lobe nodule measuring 1.0 x 0.9 cm on axial image 42/100 is unchanged. Stable left upper lobe calcified granuloma. Stable left lower lobe scarring. No pleural fluid.MEDIASTINUM AND HILA: Aortic and coronary artery calcifications. Cardiac size is normal. No pericardial fluid.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal calculi.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Significant atherosclerotic calcification of the distal aorta and the common iliac arteries.BOWEL, MESENTERY: Small left Bochdalek hernia. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval lung fields History: s/p CABG Cardiomegaly and a wide mediastinum are unchanged.Stable left basilar consolidation and left pleural effusion.Mediastinal and pleural drains are unchanged in position.Status post extubation.IABP catheter distal tip 5 cm below the top of the aortic arch.Right jugular Swan-Ganz catheter tip in proximal right pulmonary artery.

Output: Unchanged pulmonary opacities and left pleural effusion following extubation. Wide mediastinum stable. Other support devices unchanged.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: evaluate for active TB History: Hx of positive PPD or positive quantiferon No focal lung opacity, pleural effusion, or pneumothorax. No pleural thickening, cavitary lesions or calcified granulomas.Heart size is normal.

Output: No acute cardiopulmonary abnormality or specific evidence of TB.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate Lines/Drains/Devices History: Evaluate Lines/Drains/Devices Cardiopulmonary monitoring and support devices, unchanged.Perihilar and left lower lobe airspace opacity compatible with atelectasis and consolidation, unchanged.No pneumothorax.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: 31M hx of SCC of the tongue w/ mets, s/p BAL for lung abscess, desaturating to 84% History: SOB Medium layering right pleural effusion, stable cardiomegaly with diffuse bilateral interstitial opacities also unchanged. Status post extubation. Left Port-A-Cath tip over the SVC. No pneumothorax.

Output: Status post extubation. Right effusion with diffuse interstitial abnormalities, stable.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: evaluate for volume overload History: sob, le edema Port left-sided ICD leads unchanged.Stable cardiomediastinal silhouette.Decreased lung volumes.No new pulmonary opacities identified.No pleural effusions.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval cardiopulm History: stroke r/o No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: ? Pna History: tachy, cp Unremarkable mediastinal contours and cardiac silhouette.Minimal left midlung zone subsegmental atelectasis.

Output: Minimal subsegmental atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: interval change; d/ced L chest tube History: interval change Interval removal of a left chest tube with no pneumothorax or other acute change.Swan-Ganz catheter tip in the right main pulmonary artery.Other devices unchanged.

Output: Interval chest tube removal with no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: ET tube position History: ET tube in place Lines and tubes are unchanged. Unchanged left basilar opacity. Slight increase in right basilar opacity. Unchanged mild cardiomegaly and pulmonary arterial enlargement. No pneumothorax. Question of a small left pleural effusion.

Output: Slight increase in right basilar opacity which most likely represents atelectasis or aspiration and can be reevaluated on imaging follow-up.


Instruction: Generate impression based on medical findings.

Input: Central line placement Persistent marked nonspecific cardiomegaly with decreased lung volumes and nonspecific basilar opacities. No definite effusions are however mild edema superimposed upon chronic changes cannot be excluded.

Output: Cardiomegaly without definite superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: FemaleReason for Study: Reason: r/o worsening of pleural effusion as cause of cough History: above There is now complete opacification of the right hemithorax compatible with a large pleural effusion.The left lung is clear.Cardiac size cannot be assessed.

Output: Complete opacification of the right hemithorax compatible with a large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Tripoding, diaphoretic on BiPAP. SOB. Large lung volumes. Vascular unsharpness suggestive of edema. Significant atelectasis in the lower lung zones bilaterally, possibly the result of aspiration and layering pleural fluid.

Output: Acute edema and pleural fluid with atelectasis, possibly reflecting superimposed aspiration or infection. Plain film follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: IABP placement History: IABP placement Cardiomegaly without edema. IABP catheter proximal marker projected just below the aortic arch.Left subclavian ICD, leads unchanged in position.Right jugular catheter, tip in SVC.

Output: IABP catheter proximal marker projects just below the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Reason: 50M with IABP in CCU, ?placement History: 50M with IABP in CCU, ?placement ICD leads and aortic balloon catheter is unchanged.Decreased interstitial opacity in the right lung compatible with resolving edema.Small amount of residual subcutaneous emphysema on the left.No new findings.

Output: Balloon catheter in the descending aorta, unchanged.


Instruction: Generate impression based on medical findings.

Input: Check for infection. Pseudopapillaedema Persistent decreased lung volumes with mildly elevated right hemidiaphragm. No additional superimposed discrete cardiopulmonary abnormality observed. Interval removal of the right chest wall superimposed shunt.Moderate scoliosis. G-tube projects over left upper quadrant

Output: Interval chest wall shunt removed


Instruction: Generate impression based on medical findings.

Input: 63 years, Female. Reason: bowel obstruction History: multiple previous surgeries, total colectomy, TAH, abd pain x2d Focal dilated loop of small bowel measuring up to 4.2 cm in the left hemiabdomen. There is air present within the rectum. No evidence of pneumoperitoneum. Components of left total hip arthroplasty are partially visualized. Degenerative changes of the right hip are noted.Hyperinflated lungs without evidence of focal pulmonary opacity, pleural effusion or pneumothorax.

Output: Focal dilated loop of small bowel in the left hemiabdomen. Given history of multiple abdominal surgeries, findings are concerning for focal obstruction.


Instruction: Generate impression based on medical findings.

Input: Reason: Respiratory Failure History: Respiratory failure ET tube, esophageal stent and drainage catheters unchanged. Diffuse nonspecific airspace and interstitial opacity. No new findings.

Output: Extensive bilateral nonspecific pulmonary airspace opacity, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: sob, cp History: above Large lung volumes suggest COPD. Probable small right pleural effusion versus pleural thickening. No focal consolidation or pneumothorax is evident. The cardiac and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: Large lung volumes suggest COPD. Probable small right pleural effusion/pleural thickening.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Fluid overload r/o pleural effusion History: Fluid overload Pleural effusions and basilar opacities suggestive of edema and atelectasis.The heart may be slightly large but is obscured by the left pleural effusion.Right axillary surgical clips.

Output: Pleural effusions and basilar opacities suggestive of CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Reason: Episode of emesis overnight, now SOB, tachy, febrile. History: As above New patchy airspace opacities in the left perihilar region which are compatible with aspiration.Other findings are not significantly changed.

Output: New left lung opacity compatible with aspiration pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: evaluation of lung fields and heart border History: hx of aortic dissection ET tube has been removed. Other support hardware is stable.No change in perihilar and basilar opacities suggestive of edema, atelectasis and small effusions.

Output: No change in perihilar and basilar opacities suggestive of edema, atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: Eval R pleural effusion History: as above Interval extubation. Significant decrease in right pleural effusion.

Output: Significant decrease in right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: assess for metastatic urothelial carcinoma History: cough, muscle invasive bladder cancer Median sternotomy presumably for CABG, the heart size normal.No significant pulmonary or pleural abnormality.No sign of metastases.Left subclavian ICD, leads unchanged in position.

Output: No evidence of metastases, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: eval lung fields History: s/p AVR, MVR Left IJ Swan-Ganz with its tip in the pulmonary artery.Chest/mediastinal tubes and left-sided ICD unchanged.Decreased lung volumes with stable cardiac enlargement.Small pleural effusions and basilar atelectasis similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and cough Persistent mild cardiomegaly without additional cardiopulmonary abnormality

Output: Cardiomegaly without additional pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval for fluid overload History: orthopnea and nighttime cough, mild LE edema Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pna - cough History: assess for pna - cough Tracheal deviation to the right thoracic inlet most likely due to a goiter.Normal heart size.Small bleb at the right apex suggestive of emphysema.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: CT ICU Daily Cxray History: Systolic heart failure. Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with bilateral opacity compatible with atelectasis, greater on the left.No pneumothorax or other acute change.

Output: Severe cardiomegaly and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Chest pain and shortness breath. There is significant shaped curvature of the thoracic and upper lumbar spine. Basilar predominant bronchial wall thickening/bronchiectasis and subsegmental atelectasis may represent aspiration. Otherwise, no focal airspace opacity, pleural effusion, or pneumothorax. Cardiac size within normal limits with atherosclerosis of the intrathoracic aorta.

Output: Basilar predominant bronchial wall thickening/bronchiectasis and subsegmental atelectasis is suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Swan/IABP in place Lines and tubes are unchanged. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Intubation. Endotracheal tube terminates 3 cm above the expected level of the carina.Nasogastric tube sidehole is above the GE junction, the tube may be advanced.Focal consolidation in the right cardiophrenic angle involving the medial segment of the right middle lobe.There appears to be a hazy airspace opacity in the right midlung, but this is partially obscured by an overlying pad.Coarse basilar interstitial opacities with linear subsegmental atelectasis or scarring at the right lung base.Low lung volumes.No pneumothorax.

Output: ETT 3 cm above carina. Small area of right middle lobe consolidation, correlate for signs of infection. Interstitial and airspace opacities nonspecific and may be the result of aspirated secretions. NGT may be advanced.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: et tube History: et tube ET tube tip 4 to 5 cm above carina. NG tube tip in stomach. Venous catheter tip in SVC. Previously noted presumed esophageal probe in the right mainstem bronchus has been removed.Basilar interstitial opacities are unchanged. Left lower lobe airspace opacity also stable.

Output: ET tube tip 4 to 5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Altered mental status Persistent bilateral lower lung zone mixed interstitial and airspace opacities greater on the left with small lung volumes. Again concern for aspiration is high however appearance is nonspecific. Possible small effusions.

Output: Nonspecific bilateral basilar left over right opacities with volume loss. Concern for recurrent aspiration remains


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: is there pul edema History: hypertension, mild sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: Pna? History: pna? Double density projected over the heart likely is an enlarged left atrium but is slightly irregular, having an present on the prior study three years ago.Otherwise, the heart size is normal.Right upper lobe scarring where there had previously been no pneumonia, with a small amount of herniated lung peripheral to this.Right costophrenic angle blunting likely is scarring, but there may be a small right effusion as well.

Output: Scarring from right upper lobe pneumonia with pleural thickening. Double density projected over the heart could be an enlarged left atrium but CT confirmation is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: 80F with history of productive cough, rule out infection History: Cough Small left pleural effusion, with overlying subsegmental atelectasis. Heart size normal, coronary stent noted. Small pneumoperitoneum from recent laparoscopy.

Output: Postprocedure pneumoperitoneum. Small left pleural effusion and atelectasis. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: ro PNA History: spo2 89% RA, fever, intermittent prod cough Nonspecific opacity left mid to lower lung zone could represent aspiration or early infection.Elsewhere, the lungs are unremarkable without reliable evidence of edema.Heart size upper normal.Right subclavian dual-chamber pacemaker, leads projected over the right atrial appendage and the RV apex.

Output: Nonspecific left basilar opacity possibly infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: post op, eval lung fields History: s/p AVR, CABG Multiple chest tubes with no pneumothorax.Left side predominant interstitial opacities unchanged.Small pleural effusions are present.ET tube tip 4 cm above the carina.Right jugular Swan-Ganz catheter, tip in right interlobar pulmonary artery.

Output: No change in tubes and devices. but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: MaleReason for Study: Reason: eval lungs for hemorrhage, infiltrate History: c/f vasculitis The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 64 year-old female with Hodgkin's disease, relapsed, status post ABMT on 3/7/2008. CHEST:LUNGS AND PLEURA: Multiple new nodules identified in both lungs including the right upper lobe (axial image 27/102), leftupper lobe (axial image 30/102), and the right lower lobe (axial image 53/102). Although a somewhat atypical appearance for lymphoma, neoplastic disease as well as infection should be considered. Additional scattered nodules are unchanged.Multiple thin-walled cystic structures in both lungs are unchanged. Mild apical scarring. No pleural effusions.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged. Cardiac size is normal with no pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cystic lesions are unchanged.RETROPERITONEUM, LYMPH NODES: Small mesenteric lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified uterine masses likely represent uterine fibroids and are unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A vague lucent lesion in the L3 vertebral body is unchanged.OTHER: No significant abnormality noted.

Output: Increasing nodules within the lungs can represent infection versus neoplastic disease. Other findings as above are stable.


Instruction: Generate impression based on medical findings.

Input: 82 years old Female. Reason: eval pacemaker lead placement History: temp pacer wire in place. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. Small amount of bilateral pleural effusions are noted. The tip of the right IJ catheter project over the right atrium. The pacemaker noted from the IVC with its tip projecting over the area of the right ventricle is stable in position.

Output: The above findings are consistent with severe congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: CHF History: ascites, SOB Cardiomegaly with perihilar opacities suggestive of aspiration or infection, not significantly changed.Severe cardiomegaly and distended deep venous structures and PA enlargement, unchanged.

Output: No change in perihilar opacities suggestive of aspiration or infection, or atypical edema.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: s/p pleurectomy with 2 Chest Tubes on Right Side History: none Right-sided chest tubes unchanged in position. Small right apex pneumothorax is stable. No new opacity.

Output: Right-sided chest tubes unchanged in position. Small right apex pneumothorax is stable.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: post CT tube removal History: SOB . pOST vats One right chest tube has been removed. The other remains in the same position of the right lung base.Right upper extremity PICC tip at the superior cavoatrial junction. Right IJ catheter tip in the right atrium.No pneumothorax.Right lung opacities are stable to slightly increased from the previous exam, suggesting effusion, atelectasis and/or consolidation.Stable cardiomediastinal silhouette.

Output: No pneumothorax after chest tube removal. Pulmonary opacities unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: pneumonia, volume overload History: shortness of breath No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: interval changes History: as above ET tube tip approximately 2 cm above the carina.Catheter tip in the SVC or right atrium.Small lung volumes with basilar nonspecific opacity compatible with atelectasis, consolidation and effusions.

Output: Basilar opacities and pleural effusion without significant change.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male presenting with bladder cancer status post chemotherapy. CHEST:LUNGS AND PLEURA: Few calcified granulomas bilaterally appear stable.MEDIASTINUM AND HILA: Heterogenous enlarged thyroid gland with multiple nodules appears unchanged compared to the prior study. Previously noted subcarinal lymph node appears similar to the prior study and measures 1.0 x 0.8 centimeters (series 4, image 41)CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Stable splenic granulomas.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the visualized thoracic and lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic hypertrophy is noted.BLADDER: There is focal thickening of the right lateral wall of the bladder, which was previously noted. In addition, fat stranding adjacent to the wall thickening is more evident on today's study and is suspicious for transmural invasion.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Focal thickening of the right lateral wall of the bladder with adjacent fat stranding, suspicious for extravesical invasion of recurrent tumor.2.Mediastinal lymphadenopathy unchanged compared to prior study.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: Hx of ADHF and COPD History: sob The cardiomediastinal silhouette is unremarkable.Significant interval improvement in the interstitial and airspace opacities noted on the prior exam.Scattered areas of scarring/discoid atelectasis redemonstrated.No focal areas of consolidation.No pleural effusions.Right Port-A-Cath with its tip in the SVC.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Cough and fever evaluate for pneumonia. Abdomen was shielded.Unchanged appearance of the cardiomediastinal silhouette with mediastinal widening and SVC/left brachiocephalic stents. Mild basal scarring and atelectasis on the left. No specific signs of pneumonia. Small right pleural effusion is unchanged.

Output: No specific signs of pneumonia. Subsegmental atelectasis left base.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: PNA? History: cough, SOB, hypoxemia The cardiac silhouette is normal.Hila are prominent as evident on both PA and lateral views of the chest. This may represent symmetrical lymphadenopathy or pulmonary artery enlargement. Contrast-enhanced CT of the chest is recommended as follow-up.Lungs are clear of airspace or interstitial opacities.No pleural effusion. No pneumothorax.

Output: Enlarged hila. Recommend follow-up contrast enhanced CT of the chest. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female; 53 years old. Reason: am cxr History: amcxr Postsurgical changes from right upper lobectomy with two stable right chest tubes.Small right apical pneumothorax has slightly decreased since prior study. Stable opacity in the right upper lung compatible with postsurgical change and atelectasis.Normal cardiac silhouette.Mild right chest wall subcutaneous emphysema.

Output: Small right apical pneumothorax has slightly decreased.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Status post transbronchial biopsy. Stable cardiomediastinal silhouette. No pneumothorax. Right-sided central venous catheter tip in the superior vena cava. Again seen is a patchy airspace opacity in the left upper lobe, corresponding to consolidation on recent chest CT. Streaky retrocardiac opacities. No new focal airspace opacity or significant pleural effusion. Cervical spine hardware is again noted.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: 38F with IABP, assess position. History: IABP Aortic balloon catheter marker at the level of the aortic arch and ICD lead unchanged.PICC line tip in the left subclavian vein.Marked cardiomegaly with vascular redistribution but no sign of pulmonary edema.

Output: Balloon catheter in the descending aorta, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: line position History: throbbing / burning with infusion / pain right arm Right internal jugular central venous catheter tip in the SVC. No focal airspace opacity pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: Central venous catheter tip in the SVC. Otherwise no acute cardiopulmonary abnormality.