Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: evaluate LUL collapse after positive pressure Left apical loculated pleural effusion with associated compressive atelectasis similar to prior when accounting for differences in technique.Mass in the lingula also similar to prior.Bilateral pulmonary nodules.Surgical clips and sternotomy hardware is unchanged.Mild gaseous distention of the stomach is noted.

Output: Persistent left apical loculated pleural effusion and associated compressive atelectasis without significant interval change.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: 40 year-old female with disseminated leiomyomatosis in peritoneal cavity. Abdominal/pelvic pain, nausea/vomiting with menses Respiratory motion throughout the examination limits fine detail.CHEST:LUNGS AND PLEURA: Calcified granulomata bilaterallyMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Innumerable round enhancing soft tissue deposits are seen throughout the omentum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus contains multiple lesions, compatible with leiomyomas. Two nodules in the cul-de-sac are likely peritoneal in origin rather than rising exophytically from the lower uterine segment.Loculated fluid (approximately 8 x 7 cm) is seen is seen the right adnexa and cannot be separated from the right ovaryBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enhancing omental nodules.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Fine detail limited due to respiratory motion.Numerous omental/peritoneal nodules with uterine lesions, compatible with known disseminated leiomyomatosis peritonei.Loculated right adnexal fluid collection measuring approximately 8 x 7 cm cannot be separated from the right ovary. Pelvic ultrasound may be beneficial for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: c/f PNA History: 4/4 SIRS, productive sputum Low lung volumes with basilar atelectasis no specific evidence of infection or edema

Output: Little interval change in appearance with basilar atelectasis but no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Unchanged pulmonary opacities consistent with atypical infection or aspiration.Dobbhoff tube removed.Left subclavian pacemaker, leads unchanged in position.

Output: No pneumothorax following pacemaker placement. Unchanged pulmonary opacities consistent with atypical infection or aspiration. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: 44 yo with new central line, check placement History: new line placement Left IJ venous catheter identified with its tip curled within the left innominate.No evidence of pneumothorax.Stable cardiomediastinal silhouette with perihilar and basilar opacities compatible with edema/atelectasis.No new pulmonary opacities identified.

Output: IJ venous catheter with its tip curled within the left innominate.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for infiltrate, ACS; hx of SCD History: SOB, fever Moderate cardiomegaly.New small bilateral pleural effusions with underlying opacity, greater at the right base which may represent edema, infection or vascular occlusive disease.Skeletal findings consistent with sickle cell disease.

Output: Cardiomegaly with small pleural effusions and underlying nonspecific pulmonary opacity compatible with edema, infection or vascular occlusive disease.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and CHF Massive nonspecific cardiomegaly with a globular appearance suggesting a possible large pericardial effusion. Lungs are otherwise essentially clear other than minimal basilar atelectasis

Output: Cardiomegaly with questionable possible pericardial effusion


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with squamous cell cancer of unknown primary. LUNGS AND PLEURA: Centrilobular emphysema. No pleural effusions or suspicious pulmonary nodules.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No significant mediastinal or hilar adenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: eval progression/resolution of pneumothorax History: pneumothorax Stable position of apically directed left chest tube that rests adjacent to the mediastinum. Lucency at the left costophrenic angle may represent a small residual pneumothorax. No change in the chronic interstitial opacities with low lung volumes. Heart size unchanged.

Output: Lucency left costophrenic angle may represent small pneumothorax in the setting of a chest tube.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: pleural effusions/pulmonary edema History: SOB Interval placement of enteric tube with proximal side port in the stomach. Unchanged position of right chest wall port.Unchanged cardiomediastinal silhouette.Stable right perihilar and left lower lobe predominant interstitial and airspace opacities, including right hilar masslike opacity.Stable small pleural effusions.

Output: Unchanged pulmonary edema and pulmonary opacities which may infection or aspiration in the setting of known metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: desat History: desat Small lung volumes with opacities suggestive of edema, left-sided predominant, also consistent with aspiration.Mild to moderate cardiomegaly is present.Right PICC common tip in axillary region.Bullet fragment projects over the left lung apex.Status post left shoulder replacement.

Output: Small lung volumes with left-sided predominant opacities suggestive of edema although aspiration is also in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Desaturations.VIEW: Chest and abdomen AP (2 views) 9/30/2016 at 0842 hours. Right upper extremity PICC terminates at the confluence of both innominate veins. UVC has been removed. Misplaced NG tube unchanged. ET tube tip is at the thoracic inlet.Cardiac silhouette size is normal. Persistent diffuse, coarse lung haziness with pattern of PIE.Development of paucity of abdominal gas.

Output: Misplaced NG tube, retraction of right upper extremity central line and removal of UVC.Bilateral diffuse, coarse lung haziness with pattern of PIE.Development of paucity of abdominal gas.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: 84 yo male with lung adenocarcinoma presenting with recurrent L-sided pleural effusion History: SOB, weakness New marked left hemithorax volume loss with a left pleural effusion.Right lung volume small, but unremarkable.Heart size probably upper normal.

Output: New marked left hemithorax volume loss with a small left pleural effusion. This could be due to bronchial obstruction either from tumor or aspirated secretions/mucous plugging. This obscures the known left lung mass. A CT might be helpful.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Chest pain History: CP, SOB Heart size normal. No specific evidence of infection or edema. No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old. Right IJ venous catheter placed with its tip in the RA.Stable cardiac enlargement.Right-sided predominant airspace and interstitial opacities are similar to the prior exam.No large pleural effusions.No pneumothorax.Healed fracture of the right clavicle again noted.

Output: New right IJ venous catheter with its tip in the RA. Right sided predominant airspace and interstitial opacities slightly more confluent and consolidated than the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Reason: assess ng and triple lumen placement, also w/ leukocytosis History: as above Moderate cardiomegaly.Pleural effusions left larger than right, with basilar consolidation left worse than right.An NG tube terminates in the stomach.No triple lumen identified despite the clinical history provided.

Output: Pleural effusions and basilar consolidation left greater than right. No triple lumen identified despite the clinical history.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: intubated History: see above No change in pleural effusions and retrocardiac opacity.Moderate cardiomegaly.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip at cavoatrial junction.NG tube high, the side port above the GE junction.

Output: CHF. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for etiology of SOB, volume overload vs. other new process History: shortness of breath Cardiomegaly with retrocardiac left lower lobe atelectasis and probable small pleural effusions.Questionable interstitial edema.Catheter tip in the SVC.No specific evidence of pneumonia.

Output: Cardiomegaly with basilar atelectasis and small effusions, similar to previous, consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: s/p left lower lobectomy for CPAMVIEW: Chest AP Cardiothymic silhouette normal. Cardiac apex and stomach are left-sided. Multiple surgical clips at the left perihilar region. Left chest tube in place. There is a small left-sided pneumothorax. Left lateral subcutaneous emphysema noted. The right lung is clear.

Output: Postoperative changes with a small left-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: r/o infection History: shortness of breath Right Port-A-Cath with its tip in the SVC.Mild/moderate cardiac enlargement.Left basilar consolidation/atelectasis similar to that noted on outside CT.No new pulmonary opacities noted.No large pleural effusions.

Output: Left basilar consolidation/atelectasis similar to that noted in prior outside CT dated 11/22/2015 and may be a source of infection. No new pulmonary opacities noted.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: eval ETT, lung fields History: s/p AVR, MVR, CABG Swan-Ganz catheter appears to loop on itself over the left superior mediastinum. This may be in the left pulmonary artery. There is been subsequently pulled back slightly. Endotracheal tube terminates approximately 4.5 cm from the carina. Left-sided chest tubes and mediastinal drains noted. Mild pulmonary edema. Left greater than right bibasilar pleural-parenchymal opacities. No large pneumothorax.

Output: Expected postoperative appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, cough, hx of History: as above Unremarkable cardiac and mediastinal silhouette. Scarring at the right costophrenic angle.Small calcified granuloma in the right midlung consistent with previous infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: eval for resolution pneumothorax History: currently asymptomatic Stable mediastinal silhouette.Small pleural effusions similar prior exam.Interval improvement in the airspace and interstitial basilar opacities.No evidence of a pneumothorax.Interbody spacers are noted within the lumbar spine.

Output: Persistent small pleural effusions with interval improvement in basilar edema/atelectasis. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: MaleReason for Study: Reason: aortic dissection History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: eval for internal change History: worsening hypoxia Unchanged pulmonary opacities and pleural effusions.Left jugular catheter tip at cavoatrial junction.

Output: Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: pt with hypernatremia placed NG tube for flush History: AMS Feeding tube terminates within the distal esophagus.This has been advanced on more recent studies. Diffuse pulmonary opacities again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Pain to terminates within the distal esophagus.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: IABP, Swan History: above Adequate position of ET tube, enteric tube and Swan-Ganz catheter, the latter overlying the proximal right pulmonary artery.Pulsation artifact obscures the tip of the IABP, although the radiopaque marker is localized approximately 5.5 cm below the top of the aortic arch.Persistent small right pleural effusion and right basilar discoid atelectasis. No signs of pulmonary edema.

Output: Interval retraction of the Swan-Ganz catheter with tip overlying the proximal right pulmonary artery. Stable adequate position of additional support apparatus. Persistent small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.SOB evaluate pneumonia. Interval development of mild basal atelectasis and a small right pleural fluid collection.Normal heart size. No convincing evidence of pulmonary edema or pneumonia.Cholecystectomy clips and IVC filter noted.

Output: Right small right pleural effusion. Right costophrenic angle opacity suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pleural effusion History: prior effusion, s/p lots of diuresis Cardiomegaly with large bilateral pleural effusions, greater on the right, slightly decreased compared to previous.Underlying pulmonary opacity compatible with compressive atelectasis.

Output: Slightly decreased pleural effusions with large residual effusions bilaterally.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: Evaluate for cardiopulmonary disease. History: R-sided chest pain There are multiple new nodular opacities, the largest of which in the right lower lobe measures approximately 2.5 cm. Bibasilar atelectasis/scarring. Small left greater than right pleural effusions. New right hilar fullness indicates probable lymphadenopathy. No pneumothorax. The heart size is normal. Degenerative disc disease affects the thoracic spine.

Output: Multiple new nodular opacities may represent metastatic disease, please refer to CT from same date for further findings.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: s/p pacemaker; r/o pneumothorax Cardiac leads, unchanged. No pneumothorax. Mild basilar opacities, likely atelectasis. Moderate cardiomegaly again noted. Stigmata of previous granulomatous disease, as before.

Output: Cardiac leads, unchanged. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: evaluate lung fields post op History: s/p cardiac surgery ET tube with its tip 4 cm above the carina.Right IJ Swan-Ganz with its tip in the pulmonary artery.Chest/mediastinal tubes in place without evidence of pneumothorax.The cardiomediastinal silhouette is unremarkable.Decreased lung volumes with basilar atelectasis and possible small effusion.

Output: Postoperative chest without complications.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.AMS. Evaluate for pneumonia. Low lung volumes.No focal pulmonary opacities, pleural effusions, or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No focal cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: 78 years, Female. Reason: colonic distention; eval for perforation; eval for change in size of distention History: see above Persistent marked dilatation of colon which may be due to ileus or distal obstruction. No definite evidence of free air. The degree of colonic distention puts the patient at risk for ischemia. Descending colon measures up to 8.0 cm.

Output: Persistent marked dilatation of colon suggestive of diffuse colonic ileus without definite evidence of free air.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for interval change History: ARDS ET tube and catheters unchanged.Feeding tube tip in the stomach.Bilateral mainly interstitial pulmonary opacity compatible with ARDS, slightly improved compared to previous.

Output: Resolving ARDS.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Pt is a 54 yo male; potential stem cell donor History: evaluate Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Bronchiectasis with exacerbation. Hyperinflated lungs. Bronchial wall thickening and possible bronchial impaction with atelectasis in the lingula and right middle lobe, similar to the prior. No focal consolidation. No pleural effusion or pneumothorax.

Output: Stable bronchiectasis with some atelectasis in the lingula and right middle lobe.


Instruction: Generate impression based on medical findings.

Input: 27 years old Female. Reason: evidence of infection or acute chest? History: has SCD, complaining of some SOB. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. The tip of the right subclavian catheter project over the right atrium.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: eval for infection History: AMS No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: s/p cabg History: above Cardiomegaly, status post sternotomy and ventricular repair device placement.Moderate pulmonary opacity is unchanged.Tubes and devices are unchanged in position.

Output: No change in pulmonary opacities, tubes or devices.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: preop cleareance for hip + copd History: preop Unremarkable cardiac and mediastinal silhouettes. Large lung volumes with flattening of the hemidiaphragms suggestive of COPD. No focal consolidation, pleural effusion, or pneumothorax.

Output: COPD with no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: FemaleReason for Study: Reason: lung transplant, History: as noted above Status post bilateral lung transplants.Port-A-Cath with its tip in the SVC.Left PICC line with its tip in the axilla.Stable cardiomediastinal silhouette.Interval improvement in the pleural effusions and basilar opacities.No new pulmonary opacities identified.

Output: Interval improvement in the pleural effusions and basilar opacities compatible with atelectasis/edema


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: f/u Pleurx catheter placement History: pleural effusion Left-sided Pleurx catheter with tip overlying the left upper paraspinal region.Cardiac silhouette is again mildly enlarged. Calcified aortic arch.Near complete resolution of left-sided pleural effusion with a small amount of residual pleural fluid. Question posterior pleural implant versus loculated fluid in the lateral view. Left upper lobe masslike lesion again seen. No pneumothorax.

Output: Stable appearance of left-sided Pleurx catheter with near complete resolution of previously identified pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: s/p PA catheter History: sob Patient is intubated, endotracheal tube terminates approximately 2.5 cm from the carina. Swan-Ganz catheter terminates in the RPA. Other lines and tubes, unchanged. Mild pulmonary edema and patchy basilar opacities again noted. Tiny left apical pneumothorax noted.

Output: Lines and tubes, as above. Tiny left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: SICU patient intubated History: SICU patient intubated Enlarging pleural effusions and worsening basilar atelectasis.Mild cardiomegaly.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Enlarging pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male 29 years old with history shortness breath, evaluate for pneumonia Normal cardiomediastinal silhouette without evidence of focal airspace opacities or pleural effusions. No evidence of free intraperitoneal air. Scoliosis of the thoracic spine noted.

Output: 1. No acute cardiopulmonary abnormalities. No specific evidence of infection.2. Scoliosis of the thoracic spine noted.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: R/o infection History: DKA Large lung volumes.No specific evidence of infection or edema.External artifact projected over left side of the chest.

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


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: fracture History: mid chest pain after a fall Small lung volumes with interstitial opacities consistent with edema.No large pleural effusions.Heart size upper normal.Left subclavian pacemaker, leads unchanged in position.

Output: CHF with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Status post intubation. The endotracheal tube tip is approximately 2 to 3 cm above the carina. The enteric tube appears coiled over the gastric body/fundus.Stable cardiomediastinal silhouette with cardiomegaly and an ectatic aorta.Interval expansion of the right upper lobe with persistent right lower lobe atelectasis and rightward mediastinal shift. Stable left basilar atelectasis.

Output: Endotracheal tube tip approximately 2 to 3 cm above the carina with interval right upper lobe reexpansion. Persist ent right lower lobe atelectasis with apparent obstruction of the bronchus intermedius. Stable left basilar opacity. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female 46 years old Reason: Evaluate for infection History: cough, fever The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. No pulmonary opacities to suggest infection.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: swelling, neck mass, work up for lymphoma CHEST: LUNGS AND PLEURA: NormalMEDIASTINUM AND HILA: Left superior mediastinal soft tissue mass measuring 6.5 x 2.5 x 6.5 cm (l x w x h) with internal hypoattenuation. Large subcarinal mass, measuring 8.1 x 2.2 x 4.9 cm extends into left hilum. CHEST WALL: No axillary lymphadenopathy. NECK: large soft tissue mass in left anterior neck is incompletely visualized (cephalic most portion out of viewing field), measures 3.0 x 2.1 cm at the level of the thyroid, slightly displaces trachea to the right, but no significant airway compression apparent. The mass compresses the internal jugular vein. A dilated external jugular vein is seen anteromedially to this mass. ABDOMEN:LIVER, BILIARY TRACT: NormalSPLEEN:NormalPANCREAS:NormalADRENAL GLANDS: NormalKIDNEYS, URETERS:NormalRETROPERITONEUM, LYMPH NODES:NormalBOWEL, MESENTERY:Normal.BONES, SOFT TISSUES:NormalOTHER:NonePELVIS:PROSTATE, SEMINAL VESICLES: NormalBLADDER:NormalLYMPH NODES:NormalBOWEL, MESENTERY:NormalBONES, SOFT TISSUES:NormalOTHER:None

Output: Left anterior neck soft tissue mass, superior mediastinal mass, subcarinal/left hilar lymphadenopathy -- all compatible with lymphoma.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: FemaleReason for Study: Reason: 28F with shortness of breath, fever, cough r/o PNA History: dry cough, fever, SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Status post esophagectomy, please evaluate chest tube position. Mild cardiomegaly. Low lung volumes. Chest tube terminates in the left lung apex. NG tube tip terminates adjacent to the left hemidiaphragm. Surgical clips project over the left lower lobe. Skin staples are noted in the left neck and left upper quadrant. Right chest port catheter tip in the SVC. Streaky left basilar opacities likely represent atelectasis. No significant pneumothorax.

Output: 1.Chest tube terminates in the left lung apex. 2.Postsurgical changes without significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 72-year-old man with metastatic prostate cancer. Please compare to prior scans. CHEST:LUNGS AND PLEURA: Reference pleural-based plaque-like lesion has decreased slightly in size and currently measures 1.0 x 0.4 cm (image 72; series 5). Left upper lobe linear atelectasis is unchanged.MEDIASTINUM AND HILA: Coronary artery calcifications. No adenopathy.CHEST WALL: Previously described sclerotic lesion in an upper thoracic vertebral body (image 16; series 4) is unchanged. Correlate with bone scan.ABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver, unchanged. Status post cholecystectomy. Mild intra-and extrahepatic biliary prominence is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enlarging vertebral body bony metastasis at the level of the SMA (image 100; series 4). Correlate with today's bone scan.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Status post left hip replacement. Left iliac metastasis is difficult to visualize secondary to streak artifact from the arthrodesis. Previously described fluid collection lateral to the musculature of the left hip has decreased in size. Increasing sclerotic metastases in the pelvis. Correlate with bone scan.OTHER: No significant abnormality noted

Output: 1. Progression of bony metastatic lesions. Correlate with today's bone scan. 2. Left pleural-based spiculated lesion has decreased slightly in size.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: sob, chest pain History: above The cardiopulmonary silhouette is normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: swan catheter placement History: none Swan-Ganz catheter tip terminates in the right main pulmonary artery. Left chest wall AICD lead position unchanged.Probable small right pleural effusion. No focal consolidation or pneumothorax is evident. Mild cardiomegaly unchanged.

Output: Cardiomegaly and possible small right pleural effusion similar to prior.


Instruction: Generate impression based on medical findings.

Input: Reason: compare to prior to assess for progression of ACS/PNA History: ACS in pt with SCD, PNA on CT PE Small lung volumes with bilateral nonspecific lower zone airspace opacity and a left pleural effusion.Aeration and inflation of slightly improved since the previous day.Moderate cardiomegaly.PICC line tip in the left axilla.

Output: Slightly improved lower zone aeration, at least partially attributable to upright position.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Cough producing sputum No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: fluid overload? PNA? History: febrile, elevated WBC Cardiopulmonary monitoring and support devices, unchanged.Diffuse interstitial and airspace opacity with pleural effusions, larger on the right, not significantly changed.No new findings.

Output: Diffuse pulmonary opacity, more suggestive of edema than infection, with moderately large pleural effusions. The findings are compatible with fluid overload, though superimposed infection is also possible.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: position of ET tube, eval for pneumothorax now s/p thoracentesis History: None Lower lung zone interstitial opacities and pleural effusions have improved.ET tube tip 4 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Improvement in pulmonary opacities and pleural effusions. Unchanged devices. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Rule out infection History: Neutropenic fever Interval placement of a right central catheter that the superior caval atrial junction.Lungs and pleural spaces are clear. There is no pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: where is PICC History: adjusted PICC length Left-sided PICC has been pulled back slightly now terminating at the cavoatrial junction. Otherwise, no substantial change.

Output: Left-sided PICC has been pulled back slightly now terminating at the cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old. History: near-neutropenic patient (ANC approximately 1600) with fever Central venous catheter terminates near the cavoatrial junction. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: AMS History: AMS Nonspecific mild basilar opacities likely subsegmental atelectasis. No specific evidence of pneumonia.

Output: Nonspecific mild basilar opacities likely subsegmental atelectasis. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: dyspnea with lying down History: dyspnea with lying down Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: eval for PNA History: left chest pain, SOB, prod cough Stable left midlung scarring or subsegmental atelectasis.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

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


Instruction: Generate impression based on medical findings.

Input: Reason: dyspnea on exertion History: dyspnea on exertion Nonspecific basilar opacity compatible with effusion and atelectasis and nonspecific airspace opacity, not significantly changed.Heart size upper normal with a tortuous aorta.

Output: Nonspecific basilar opacity, slightly increased compared to previous which may be related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: ams r/o pna History: ams Cardiomegaly status post sternotomy, with the suggestion of edema and small pleural effusions.No specific evidence of infection.Coronary stents and coronary calcifications are unchanged.Surgical repair right humeral head.Healed right rib fractures.

Output: Possible edema with pleural effusions, but no sign of pneumonia. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Swan adjusted, want to confirm ok position History: CHF The tip of the IABP is localized approximately 51 mm below the top of the aortic arch.The Swan-Ganz catheter has been retracted and the tip overlies the proximal right interlobar pulmonary artery.Improving pulmonary edema.Stable adequate position of additional support apparatus. IVC filter is partially visualized.Persistent small left larger than right pleural effusions. No pneumothorax.

Output: The tip of the IABP is localized approximately 51 mm below the top of the aortic arch. Adequate position of additional support apparatus.Improving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval for infection History: SOB, mild hypotension, concern for infection, cough, n/v x2 weeks Central venous catheter terminates in the RA. Study limited by leftward patient rotation. No focal lung consolidation or evidence of overt left-sided heart failure. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 86 yearsGender: FemaleReason for Study: Reason: intubated History: see above ET tube with its tip 5 cm above the carina.Right IJ venous catheter with its tip in the SVC.Stable cardiac enlargement with perihilar /basilar opacities compatible with edema.Bilateral pleural effusions with retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, pulmonary edema, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Abdominal aortic aneurysm, ruptured. Intubated status post TEVAR. Endotracheal tube tip 8 cm above the level of the carina. Right jugular catheter and enteric tube unchanged in position. Aortic stent graft in place. Mediastinal widening with contour abnormality compatible with history of aneurysm.Moderate volume of pleural fluid on the left with associated atelectasis, but no specific signs of pulmonary edema.The paramediastinal lungs cannot be assessed due to mediastinal widening and obscuration of the lung parenchyma.

Output: High endotracheal tube with tip 8 cm above the level of the carina. Left pleural fluid collection without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: evaluation for chest pain, PTX etc History: chest pain with palpitations Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: r/o new infiltrate History: increasing leukocytosis Pleural effusions and basilar opacities have slightly improved.Moderate cardiomegaly. NG tube withdrawn.Right jugular catheter, tip in SVC.

Output: Improving basilar opacities and pleural effusions, with no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.HIV with shortness of breath question pneumonia Unchanged moderate cardiomegaly. No pleural fluid or pneumothorax. No focal airspace opacities or signs of interstitial edema.

Output: Cardiomegaly, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: hypoxic History: hypoxic Interval extubation. Interval removal of nasogastric tube. Findings of COPD. No other interval change.

Output: Lines removed as described above without other interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: pneumonia History: fevers to 103 Interval decreased lung volumes with new right upper lobe opacity compatible with pneumonia. The left lung and pleural spaces are clear. No associated pleural effusion.

Output: Right upper lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: F/u L empyema History: Persistent cough, SOB, recent interruption PO antibiotics Left basilar chest tube unchanged.Left lower lobe opacities similar to the prior exam.Minimal decrease in left pleural effusion.Persistent left loculated pneumothorax .Chronic interstitial opacities noted at the right lung base.No new pulmonary opacities.

Output: Interval reduction in left pleural effusion with persistent left lower lobe atelectasis/consolidation. Loculated left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old with history of adrenalectomy rule out pneumothorax Endotracheal tube with tip 3 to 4 cm above the carina.Moderate right pneumothorax and pneumoperitoneum noted. Mild cardiomegaly with coronary artery stents noted. Mild right basilar streaky opacities without focal consolidation.

Output: Moderate right pneumothorax and pneumoperitoneum.Findings discussed with Dr. Muricer on 3/3/2016 at 1100.


Instruction: Generate impression based on medical findings.

Input: Age: 39 yearsGender: FemaleReason for Study: Reason: r/o acute process History: chest pain Interval decrease in cardiac size and pulmonary vascular redistribution.Significant interval improvement in pulmonary edema and right pleural effusion.Right middle lobe scarring/atelectasis.No new focal areas of consolidation.

Output: Improvement in CHF. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old. Right PICC line has been placed with its tip in the SVC.Decreased lung volumes of stable cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Interval placement of a right PICC line. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: in PACU, s/p left nephrectomy eval size of PTX History: =-- No visible pneumothorax.Streaky opacities in the right upper lobe and both lower lobes suggestive of subsegmental atelectasis.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Weakness, evaluate for pulmonary edema The cardiomediastinal silhouette is normal.No evidence of infection, edema, or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: fever/productive cough Normal heart size with ICD leads unchanged.Small lung volumes with diffuse chronic predominantly perihilar interstitial opacity and probable small pleural effusions, not significantly changed from previous.No specific evidence of pneumonia, though superimposed infection would be difficult to detect given the extent of abnormalities.

Output: Extensive chronic interstitial disease without appreciable interval change.


Instruction: Generate impression based on medical findings.

Input: Resection of cardiac mass. Left pleural effusion follow-up.VIEW: Chest AP (one view) 03/13/15, 1715 Plate and screws devices are present in the lower cervical spine. Sternal sutures and mediastinal surgical clips are noted. Right atrial lines are seen. A right chest tube is identified.Small to moderate left pleural effusion persists. Focal opacity is seen in left lower lobe. Right lung is normal in appearance. Cardiac silhouette size is normal.

Output: Persistent left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: evalaute causes of fever History: Leukocytosis There are 2 parallel TIPS stents present. Cardiomediastinal silhouette is normal. Overall low lung volumes. No large pleural effusion or pneumothorax. No specific evidence of infection or edema.

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


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: Prekidney transplant evaluation, rule out cardiomegaly. Cardiomediastinal silhouette is normal.No focal opacity, pleural effusion or pneumothorax.

Output: 1.No signs of cardiomegaly, as clinically questioned.2.No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: ICD placement Moderate nonspecific cardiomegaly, however appearance suggests mildly left-sided predominant. A 4-lead left subclavian ICD is observed with lead tips in the expected locations. No immediate associated postprocedural complicationMild decreased lung volumes with largely interstitial changes in both lung bases. No definite effusions. Appearance likely suggest residual scarring over atelectasis however prior or serial imaging would be helpful to confirm.

Output: Suspected bilateral pulmonary scarring, potentially requiring serial or comparison with prior imaging. No postprocedural complications


Instruction: Generate impression based on medical findings.

Input: 83 old female with history of gallbladder adenocarcinoma. Restage. CHEST:LUNGS AND PLEURA: Previously noted scattered punctate pulmonary nodules are again visualized throughout the lung parenchyma bilaterally and remain stable in comparison to prior exam. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.Calcified right hilar lymph node as well as small peripherally calcified right thyroid nodule remain stable in comparison to prior exam. Coronary calcifications are again noted.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted. Two small splenules are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Subtle nodular changes in the mesentery remain stable. No measurable disease noted .BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic calcifications of the abdominal aorta.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic focus is noted adjacent to the left sacroiliac joint. Multiple calcified injection granulomas are again noted in the posterior pelvic soft tissues.OTHER: No other significant abnormality noted.

Output: No evidence of disease progression. Previously noted pulmonary and mesenteric findings remain stable on comparison to previous exam.


Instruction: Generate impression based on medical findings.

Input: Wheezing Interval nasogastric tube placement without additional cardiopulmonary change. Mildly decreased lung volumes with moderate cardiomegaly. No discrete new superimposed focal airspace process. Exam limited with mild motion

Output: Nasogastric tube placement


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Shortness of breath.VQ scan. Secondary pulmonary hypertension. Normal cardiomediastinal silhouette. The lungs are well-inflated and clear. No focal pulmonary opacities, pleural fluid or pneumothorax.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: Swan-Ganz catheter. Iatrogenic devices are unchanged. No new focal pleural parenchymal opacity. Small pleural effusions. Unchanged cardiomegaly. No pneumothorax.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Hypoxemia. Question ET tube placement. Extensive significant interstitial and air space opacities which may reflect pulmonary edema superimposed on interstitial fibrosis has not significantly changed. ET tube is 4 cm above the carina. No pneumothorax visualized. The stomach appears distended.

Output: Severe interstitial and airspace opacities which may reflect edema superimposed on fibrosis, stable.


Instruction: Generate impression based on medical findings.

Input: 77 year old female with epigastric pain, rule out abdominal free air No focal airspace opacities. Right upper lobe poorly defined streaky opacities likely related to prior pulmonary embolism in this region and suggestive of scarring. Left lower lobe streaky opacities at site of previous nodule likely scarring related to treated metastatic disease. No pleural effusion or pneumothorax. Stable cardiomediastinal silhouette. No visible free air.

Output: 1. No visible free air. Note that small amounts of free air may not be seen on a semierect radiograph. 2. Right upper lobe and left lower lobe streaky opacities likely scarring as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval for interval change History: hypoxia Interval placement of nasogastric tube which extends beyond the field of view of study. Other support hardware stable.Persistent bibasilar edema and atelectasis with small bilateral pleural effusions.

Output: Persistent bibasilar edema and atelectasis with small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female; 64 years old. Reason: infiltrates History: tachypnea Right central venous catheter tip in SVC. Unchanged cardiac silhouette. No specific evidence of acute infection or edema. Chronic left lung scarring and right rib fractures again noted.

Output: No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: aspiration History: sob The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: resp failure History: as above Unchanged pulmonary opacities and pleural effusions.Tracheostomy tube tip 7 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: No change in pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: Rule out free air History: chest pain x 2d with "40 episodes of emesis" The heart size is at the upper limit of normal allowing for AP projection. The lungs are clear. There is no focal pulmonary opacity, pleural effusion, or pneumothorax. No evidence of free intraperitoneal air.

Output: No acute cardiopulmonary abnormality. The heart appears at the upper limit of normal in size but this may be related to AP portable technique. No evidence of free intraperitoneal air.


Instruction: Generate impression based on medical findings.

Input: Headache, evaluate for ventriculoperitoneal shunt malfunction. SHUNT DEVICE: Right-sided intracranial shunt catheter with tip in the midline and coursing throughout the soft tissues of the right scalp, neck and anterior chest entering the abdomen with its tip in the pelvis. There is no kinking or discontinuity throughout the radiopaque portions of the shunt catheter. Again seen is an orphaned shunt catheter in the anterior soft tissues of the right chest wall and abdomen with tip terminating in the pelvis. SKULL: 2 views of the skull reveal the aforementioned shunt device without significant abnormality noted.CERVICAL SPINE: 2 views of the cervical spine reveal the aforementioned shunt device. Straightening of the cervical spine is likely positional. No evidence of fracture. The soft tissues of the neck and cervical spine are unremarkable.CHEST: 2 views of the chest reveal the aforementioned shunt device and orphaned shunt tubing without significant abnormality noted.ABDOMEN: 2 views of the abdomen reveal the aforementioned shunt device and orphaned shunt tubing. The bowel gas pattern is nonobstructive.

Output: No evidence of VP shunt malfunction or other findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with margin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Small pericardial effusion, unchangedCHEST WALL: Reference left axillary node measures 13 x 9 mm on image number 14, series number 5. Bilateral left axillar adenopathies unchanged.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly, unchanged. Cholelithiasis without evidence of cholecystitis.SPLEEN: Spleen measures 14.7 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral double-J stents. Stable bilateral hydronephrosis and hydroureter.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal adenopathy. Reference left para-aortic lymph node measures 25 x 13 mm on image number 101, series number 5.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 interval change in confluent retroperitoneal and pelvic adenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable study with axillary para-aortic and pelvic adenopathy as described above.


Instruction: Generate impression based on medical findings.

Input: 21 year-old male with history of intubation. Support devices unchanged. NG tube sidehole within the distal esophagus. Bibasilar atelectasis and small bilateral pleural effusions. The cardiomediastinal silhouette is unremarkable.

Output: Bibasilar atelectasis and small bilateral pleural effusions without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: s/p MVR History: s/p MVR Borderline cardiomegaly with nonspecific interstitial and airspace opacities suggestive of edema and/or aspiration.Left subclavian ICD, leads unchanged in position.

Output: Unchanged very opacities suggestive of edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Fever evaluate for pneumonia Right jugular catheter tip at the upper SVC level. Right jugular chest port projects over the superior vena cava.No focal pulmonary opacities, pleural fluid or pneumothorax. Low lung volumes.

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


Instruction: Generate impression based on medical findings.

Input: 68 year-old female with ovarian cancer. Increased right lower quadrant pain. Evaluate disease status. CHEST:LUNGS AND PLEURA: Stable scattered pulmonary micronodules in the right upper lobe. MEDIASTINUM AND HILA: Heterogeneously enhancement of the thyroid gland involving the isthmus, unchanged. Reference right peri-hilar lymphoid tissue measures 8 x 7 mm, previous remeasured 9 x 7 mm (image 36, series 3), somewhat unchanged.CHEST WALL: A right-sided chest port has its catheter tip in the SVC/right atrial junction.ABDOMEN:LIVER, BILIARY TRACT: Significant interval decrease in amount of perihepatic implants representing metastatic disease. The reference implants can no longer be measured and reproduced..No focal liver masses or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A peripherally enhancing left paraaortic lymph node/ omental implant adjacent to the left psoas muscle, best seen on image 131 series 3 have reduced in size.BOWEL, MESENTERY: Interval decrease in peritoneal soft tissue masses and omental nodularity compatible with peritoneal carcinomatosis. A representative omental nodule measures are 1.9 x 1.1 cm, previously measured 2.5 x 4 cm (image 106 series 3), reduced in comparison with prior study.Previously measured right paracolic gutter nodule (image 124, series 3) measures 13 x 9 mm, previously measured 11 x 17 mm, reduced in comparison with prior study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Perirectal soft tissue nodule (image 159, series 3) measures 12 x 16 mm, previously measured 22 x 28 mm, reduced in comparison with prior study. Interval decrease in ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Overall interval decrease in perihepatic serosal implants, omental implants, ascites.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: aspiration History: aspiration 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: 40 year-old female with fever, hemoptysis, abnormal chest x-ray. Evaluate for pulmonary hemorrhage. PULMONARY ARTERIES: Technically adequate exam. No evidence of pulmonary embolus.LUNGS AND PLEURA: Upper lobe predominant ground glass opacities with apical septal thickening and small bilateral pleural effusions most compatible with pulmonary edema. Pulmonary hemorrhage may also be considered as well as atypical (pneumocystis) or viral infection, although these possibilities are considered less likely.Scattered calcified nodules and micronodules likely represent prior granulomatous disease. No suspicious nodules or masses.MEDIASTINUM AND HILA: Multiple prominent and partially calcified mediastinal and hilar lymph nodes likely represent prior granulomatous disease.The cardiac size is mildly enlarged. No significant pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.No PE.2.Predominantly upper lung groundglass opacities and septal thickening with pleural effusions most compatible with pulmonary edema or hemorrhage. Other findings as discussed above are considered less likely.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Evaluate right IJ tract also slightly placement. Right jugular catheter can be followed to the right atrium. Endotracheal tube tip around 2.5 cm above the level of the carina. IABP marker projects about 5-6 cm below the expected level of the top of the aortic arch. And enteric tube is incompletely visualized. A single lead pacer from below projects over the level of the right ventricle. There is a poorly visualized ECMO cannula overlying the region of the IVC.Lung volumes remain low. Superior mediastinal widening with obscuration of the aortic arch suspicious for mediastinal hematoma due to vascular pathology such as dissection. Biapical opacity may reflect dissection of hematoma into the extrapleural space, though not specific. Mild pulmonary edema. Layering pleural fluid on the right.

Output: Mediastinal widening with contour abnormalities highly suspicious for mediastinal hematoma and dissection. Abdallah Bukari (3100/1049) notified at 8:15 AM on 10/30/2015 (PNR) via . This was discussed with CCU fellow Akhil Narang (2812/3228) at 8:19 a.m. on 10/30/2015 who stated that the patient was stable.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: congestion History: comgestion No change in degree of cardiomegaly and pulmonary edema.Tip of nasogastric tube beyond the lower border of the film.No pneumothorax.

Output: No interval change in findings of pulmonary edema and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Evaluate enteric tube placement Enteric tube seen with side-port at level of gastric fundus/proximal body. Right upper quadrant surgical clips seen. Pelvis excluded. Subjectively speaking improvement in degree of small bowel dilatation noted with air seen distally in transverse colon. Overall appearance favors that of an ileus. Mild bibasilar airspace opacities (more pronounced on left side), please refer to recent chest radiography for additional findings.

Output: Enteric tube and additional findings as above.


Instruction: Generate impression based on medical findings.

Input: Male; 64 years old. Reason: intubated History: intubated Tracheostomy tube tip at the thoracic inlet, unchanged.The cardiomediastinal silhouette is unchanged.Lung volumes are low with linear opacities at the lung bases suggestive of subsegmental atelectasis, unchanged.No pneumothorax.

Output: Stable position of tracheostomy tube. Bilateral subsegmental atelectasis not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: positive quantiferon gold, no respiratory sx History: none Cardiomediastinal silhouette is unchanged. No specific evidence of infection or edema. No pleural effusion or pneumothorax. No specific evidence of TB.

Output: No acute cardiopulmonary abnormality. No specific evidence of TB.


Instruction: Generate impression based on medical findings.

Input: History of myasthenia gravis Left chest tube removed without postprocedural additional new complication. Persistent decreased lung volumes without definite superimposed new focal abnormality. A nonspecific retrocardiac opacity and probable atelectasis versus partial consolidation again observed

Output: Left chest tube removed


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.SOB question acute pathology. Hazy basal opacity suspicious for mild aspiration of secretions. No specific signs of pulmonary edema or pneumonia. Upper normal heart size.

Output: Probable mild aspiration of secretions at the lung bases. Upper normal heart size.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: re-eval pneumothorax post chest tube placement History: cp, pneumothorax s/p biopsy Right pleural drain unchanged, the right pneumothorax even smaller, with 12 mm separation between apical pleural surfaces but extending below the right lung base.Small right pleural effusion.Multiple nodules.Right jugular catheter, tip in SVC.

Output: Improving right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Intubation Interval ETT placement, tip projects 4 cm above the carina. Mildly decreased overall lung volumes without additional new cardiopulmonary findings.Punctate calcification overlies right upper abdominal quadrant, possible gallstoneSee subsequent report

Output: ETT placed


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Altered mental status, evaluate for effusions. Left subclavian ICD with proximal coil in the projection of the left brachiocephalic vein/SVC and distal coil in the projection of the right ventricle with tip directed towards its cranial aspect.No pneumothorax.Multichamber cardiomegaly and/or pericardial fluid, about the same.Pulmonary vascular redistribution consistent with hypervolemia, though no signs of pulmonary edema are present. No visible pleural fluid.

Output: Signs of hypervolemia, but no pulmonary edema or pleural fluid.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with metastatic large cell neuroendocrine carcinoma. CHEST:LUNGS AND PLEURA: Other than emphysema. Right upper lobe mass measures 19 by 16mm, not significantly changed from previous study. Other small satellite nodules in the right upper lobe are also unchanged.MEDIASTINUM AND HILA: Reference and benign-appearing precarinal lymph node measures 11 x 12 mm image number 45, series number 3CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The study is limited due to lack of IV contrast. Patient's known mass now measures 19 x 12 cm image number 105, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Ill-defined intermediate attenuation lesion in the right kidney is unchanged. Bilateral punctate stones are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.OTHER: Small amount of ascites is unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate glandBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse also demineralization is unchanged.OTHER: Fat-containing left inguinal hernia.

Output: Limited study due to lack of IV contrast. No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with large B-cell lymphoma. CHEST:LUNGS AND PLEURA: Large left-sided pleural effusion, unchanged from previous study.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Mild hepatic megaly is unchanged.SPLEEN: Invasion of the spleen by the mass is slightly unchanged.PANCREAS: Irregularly marginated low density lesion indicating the tail of the pancreas, splenic vessels and spleen it appears more hypodense on the current study. On the coronal image number 44/79 measures 6.5 by 4.1-cm, slightly decreased in size. Splenic vein is invaded by this mass.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy. Reference left para-aortic adenopathy measures 20 x 14 mm image number 119, series number 3.BOWEL, MESENTERY: Diffuse wall thickening of the colon is unchanged and still suggestive of colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate ascites.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: Diffuse wall thickening of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse wall thickening of the colon segments.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate ascites.

Output: Left-sided pleural effusion is unchanged. Patient's known infiltrative mass invading the retroperitoneum and pancreas is slightly smaller and less dense. Retroperitoneal lymph node is slightly smaller.Diffuse wall thickening of colon is unchanged. Moderate ascites.Wall thickening of the bladder.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female status post PICC placement. Interval placement of left upper extremity PICC with tip at the cavoatrial junction. An IVC filter and sternal fixation hardware are present.Stable cardiomegaly. Unchanged left retrocardiac dense opacities likely representing atelectasis/consolidation with moderate sized pleural effusion. Patchy airspace opacities are present bilaterally. Left upper lobe mass is not well seen on radiography.

Output: Interval placement of left upper extremity PICC with tip at the cavoatrial junction. Otherwise, stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: fever and productive cough Extensive scarring and pleural thickening in the left hemithorax, unchanged from previous.Normal heart size with a moderate scoliosis.No sign of pneumonia or other acute findings.

Output: . No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: R/o infection History: cough The tip of Port-A-Cath is stable in position. There is no evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: eval lungs History: eval lungs ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery.Balloon catheter in the proximal descending aorta.Cardiomegaly with basilar opacity compatible with atelectasis and small effusions, unchanged.

Output: No acute interval change


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old. Low-grade fever. History of CLL. Evaluate for infiltrate. Unremarkable cardiac and mediastinal silhouette.No evidence of infection or edema. Left basilar linear atelectasis and/or scarring, new from prior.

Output: Left basilar linear atelectasis and/or scarring, new from prior. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath, history of right lower lobectomy and effusion. Persistent moderately sized loculated air collection at the right apex, not significantly changed from prior study. Large volume of pleural fluid on the right about the same. Unable to exclude bronchopleural fistula. Left lung remains clear. Unchanged cardiomediastinal silhouette.Surgical clips in area of right hilum unchanged.

Output: Persistent moderate right loculated right apical air collection and pleural fluid not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: enlarged cardiac History: chest pain Mild cardiomegaly with an ICD lead in place, not significantly changed.No sign of pulmonary edema or infection.Perihilar bronchial thickening compatible with hepatitis or asthma, unchanged.

Output: Mild cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: PNA? recurrent empyema? History: fever Stable cardiomediastinal silhouette.Right PICC projects over the right axilla.Stable right midlung scarring and underlying loculated pleural fluid/pleural thickening and atelectasis.

Output: Stable loculated right pleural effusion. If there is clinical concern for empyema, the right pleural fluid collection could be better evaluated by contrast-enhanced CT scan.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: SOB, eval for fluid overload History: SOB, eval for fluid overload Small lung volumes with scattered septal lines in the lung base peripheries consistent with edema.Heart size normal.Minimal pleural effusions may be present.

Output: Mild edema suggestive of CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Low-grade temperature. Hypoxia No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Acute hypoxia in vented patient History: Hypoxia Dense interstitial and airspace opacities not significantly changed.Heart mildly enlarged.Tracheostomy tube tip approximately 6 above the carina.Left jugular catheter, tip in SVC.A Dobbhoff tube extends below the lower margin of the image.

Output: Extensive interstitial and airspace opacities, unchanged since the most recent study, consistent with edema or developing ARDS.


Instruction: Generate impression based on medical findings.

Input: 7-week-old former 27 week gestational age patient with chylothorax. Respiratory distress.VIEW: Chest AP (one view) 01/11/15, 1546 Endotracheal tube tip is at thoracic inlet. Feeding tube tip is in stomach. Left upper extremity PICC tip is in left brachiocephalic vein. Left chest tube continues in position.Soft tissue edema persists.Almost complete opacification of the hemithoraces persists. The cardiac borders are rarely visible.

Output: Continued bilateral pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Headache, with history of VP shunt. SHUNT DEVICE: The intracranial shunt catheter tip terminates to the left of midline. The shunt catheter extends along the anterior thorax soft tissues. The shunt catheter extends into the abdomen and is coiled within the pelvisSKULL: No significant abnormality identified.CERVICAL SPINE: The cervical spine is unremarkable.CHEST: No significant abnormality identified.ABDOMEN: Abdominal bowel gas pattern is unremarkable. Thoracolumbar levoscoliosis is present.

Output: No evidence of malfunction of the radiopaque portions of the shunt catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Dyspnea on exertion in CHF patient History: Dyspnea on exertion Cardiomegaly status post sternotomy and mitral valve replacement.No specific evidence of infection or edema.

Output: Status post mitral valve replacement, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: infiltrate History: chest pain, SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: infiltrate, IABP placement History: CHF The left Swan-Ganz catheter has been removed. There is no pneumothorax.Left subclavian ICD leads are unchanged in position.Stable cardiomegaly. Lungs otherwise clear.

Output: Interval removal of left Swan-Ganz catheter. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: new hypoxia; s/p transfusions and maintenance fluids, eval for pulm edema History: concern for hypoxia Unremarkable cardiac and mediastinal silhouette. Focal streaky opacity at both bases suggestive of atelectasis and scarring, of uncertain chronicity.No sign of pulmonary edema or other acute findings.

Output: Basilar atelectasis or scarring with blunting of the posterior left costophrenic angle of uncertain chronicity. Although nonspecific, the differential diagnosis includes pulmonary embolism in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Testicular cancer No cardiopulmonary abnormalityUnchanged numerous surgical clips project in the central upper abdomen

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: r/o acute process History: ams Cardiomediastinal silhouette is normal.Low lung volumes.No pleural effusion or pneumothorax.Diffuse patchy bibasilar opacities.

Output: Diffuse bibasilar opacities most likely representing aspiration in the setting of the patient with history of altered mental status. Infection may also be considered in the differential diagnosis in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval for effusions History: intubated pt Endotracheal tube terminates 4 cm above the carina. The cuff is mildly overinflated. Nasogastric tube side hole terminates in the distal esophagus, slightly advanced on the subsequent radiograph.Streaky basilar opacities favor subsegmental atelectasis. No focal pneumonia or edema. The heart size is normal.

Output: Repositioning of the endotracheal tube is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: above, h/o HTN, family hx of MI at 53. p/w chest pain exertional, doe Unremarkable cardiac and mediastinal silhouette.Very mild scoliosis.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.SOB question pneumonia. Normal heart size. Bilateral hilar lymphadenopathy in addition to enlargement of the central pulmonary vasculature.Low normal lung volumes unchanged. No focal airspace opacities, pleural fluid or pneumothorax.Degenerative changes of the spine with multilevel vertebral body height loss and osteophyte formation.

Output: No signs of pneumonia. Pulmonary hypertension and lymphadenopathy consistent with sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: 76 year old male status post left upper lobe non-small cell lung cancer. LUNGS AND PLEURA: Left apical scar-like opacity (series 5 image 17), not significantly changed from priors. Groundglass and mixed density nodule in the superior aspect of left lower lobe (series 5 image 23) measures 8 x 6 mm (previously 9 x 8 mm). Linear scar like opacities adjacent to this nodule are also unchanged. Scattered bilateral subcentimeter nodules are unchanged- a few of these likely represent intrapulmonary lymph nodes. No new nodules.MEDIASTINUM AND HILA: Calcified right hilar and mediastinal nodes, similar to prior, suggestive of prior granulomatous disease.Low attenuating lesion in the right thyroid lobe, likely cyst.Extensive coronary artery calcification. No pericardial effusion.CHEST WALL: Sternotomy wires. Healed left sixth rib fracture. Moderate degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Calcified hepatic and splenic granulomata, similar to prior. Moderate to severe vascular calcifications of the thoracic and abdominal aorta and its branches. Left adrenal module (series 3 image 97) measuring 13 x 13 mm, is unchanged from 2005.

Output: Stable exam without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 64 years, Female. Reason: Og tube placement History: OG tube Please see same day chest radiograph report for thoracic findings. The enteric tube tip overlies the mid gastric body. Skin staples overlie the left chest and upper abdomen.

Output: The enteric tube tip overlies the mid gastric body.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with head and neck cancer. CHEST:LUNGS AND PLEURA: Scattered micronodules, stable. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Scoliosis and degenerative changes. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Jejunojejunal intussusception is seen in the left hemiabdomen (series 4, image 137; series 8034, coronal image 51) without evidence of proximal obstruction. No definite lead point is identified.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No definite evidence of metastatic disease.2. Nonobstructing jejunojejunal intussusception without evidence of complication. No definite lead point is identified. This finding is often transient in adults. However, if patient has abdominal symptoms, a fluoroscopic small bowel series may be considered.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female presents with carcinoid syndrome. Please evaluate for evidence of carcinoid tumor. CHEST:LUNGS AND PLEURA: No pulmonary masses or suspicious pulmonary nodules. No pleural abnormalities.MEDIASTINUM AND HILA: Calcified right hilar lymph nodes compatible with prior granulomatous disease. No enlarged mediastinal or hilar lymph nodes. Normal cardiac size without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology without biliary ductal dilatation. Two right hepatic lobe subcentimeter hypodense lesions are too small to characterize. Normal appearing gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Note is made of one right and two left accessory renal arteries.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcutaneous nodule in the soft tissues of the right buttocks which may be related to prior injections. Please correlate with clinical history.OTHER: No significant abnormality noted.

Output: No hypervascular lesions identified or other findings suggestive of carcinoid tumor. Additional findings described above.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated, follow up R pneumonitis History: sob Chest tube extending to the right apex with no significant pneumothorax. Residual focal right upper lobe opacity, decreased in extent over the past 2 days. ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.

Output: Chest tube in place with decreasing right upper lobe opacity and no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: assess for pulm edema and cause of SOB History: as above increase Decreased lung volumes a stable cardiac mediastinal silhouette.Basilar opacities compatible with atelectasis and possible small effusions.No new pulmonary opacities identified.Vertebral stabilization hardware and intraspinal stimulator redemonstrated.

Output: Markedly decreased lung volumes with basilar opacities compatible with atelectasis and possible small effusions similar to the prior exam..


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with abdominal pain and hyperbilirubinemia CHEST:LUNGS AND PLEURA: Right lung calcified granuloma is unchanged. Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. Mild gallbladder wall thickening. No evidence of intra-exudate biliary dilatation. Few subcentimeter hypodense lesions in the liver. These are not significantly changed from previous study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cholelithiasis with mild choler wall thickening without evidence of biliary dilatation, not significantly changed from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Evaluate lines, tubes, devices. Cerebral infarction. Tubes and lines similar in position. A presumed external tubing component projects over the midline at the thoracic inlet.Cardiomegaly, small pleural effusions and basal/dependent predominant pulmonary opacities about the same.

Output: No acute change in atelectasis and pulmonary opacities suggestive of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Pulmonary edema History: SOB Moderate to severe cardiomegaly is present.While there are a few scattered septal lines there is no other evidence of edema and there are no pleural effusions.Status post median sternotomy for CABG.Right subclavian biventricular dual chamber ICD, the RV lead directed towards the pulmonary outflow tract.

Output: Cardiomegaly with only equivocal evidence of edema. ICD in place.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Shortness of breath. Status post intubation. ETT with tip approximately 1.5 cm above the carina. Unchanged left chest wall port with tip in the right atrium.Mild interval improvement in left lower lobe consolidation, otherwise stable bilateral interstitial opacities. No new focal pulmonary opacities. No right pleural effusion, questionable small left pleural effusion. No pneumothorax.Cardiomediastinal silhouette is unchanged.

Output: ETT tip approximately 1.5 cm above the carina. Mild interval improvement in left lower lobe consolidation, otherwise stable bilateral interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: FemaleReason for Study: Reason: 83y/o woman with cough x >1 year, worsened over past 2-3 months History: cough x 2 months Right-sided pacemaker unchanged.Stable cardiomediastinal silhouette.Evidence of prior granulomatous disease.No focal areas of consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Cough Right infrahilar opacity, new from previous, could reflect aspiration or infection. Heart size within normal limits. Left lung is clear. No pneumothorax.

Output: New right infrahilar opacity could reflect aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Seizures, PICC placement. Right upper extremity PICC at the SVC/RA junction. Other tubes and lines unchanged in position. No pneumothorax or signs of aspiration.

Output: Right upper extremity PICC at the superior cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: FemaleReason for Study: Reason: 71 yo f with COPD with unresolving exacerbation History: as above Stable cardiomediastinal silhouette.Chronic right middle lobe atelectasis similar to the prior exam.Upper lobe emphysema.No new pulmonary opacities identified.No pleural effusions.Old right rib fracture deformities.

Output: No acute cardiopulmonary abnormalities. Persistent right middle lobe atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: evaluating for pna History: fever, cough-productive, Tm103.7, lungs cta on exam Retrocardiac opacity possibly atelectasis or early infection.Heart size normal.Mild thoracic scoliosis.

Output: Left basilar opacity possibly early pneumonia or atelectasis.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with history of colon cancer CHEST:LUNGS AND PLEURA: Scattered micronodules in both lungs, not significantly changed from previous CT.MEDIASTINUM AND HILA: Stable reference left retrocrural node measuring 8 x 11 mm in image number 90, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index superior mesenteric lymph node is stable measuring 1.6 by 1 cm on image number 149, series number 3. Other and large mesentery lymph nodes are also stable. Index mesenteric lymph node near the ileorectal anastomosis is stable measuring 1.5 by 1.3 cm in image number 169, series number 3. Postsurgical changes involving the rectum and presacral area is stable.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: post arrest History: post arrest Bilateral pleural effusions and basilar opacities suggestive of edema, slightly worse than before.A Dobbhoff tube extends below the lower margin of the image.ET tube tip approximately 4 cm above the carina.

Output: Worsening CHF with edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP placement History: As above Balloon catheter tip in the descending aorta, unchanged.ICD leads also unchanged.Moderate cardiomegaly with no evidence of CHF.

Output: Balloon catheter in the descending aorta but no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: wheezing, 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: Female, 57 years old.Reason: Is central line in central venous system? History: Post line placement Interval placement right IJ central catheter terminating at the central superior vena cava.Interval decreased lung volumes with mid to lower zone opacities of atelectasis. Heart size is accentuated by under inflation. No pneumothorax.

Output: No pneumothorax following right central catheter placement.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Reason: cough x 3 weeks, evaluate for pulmonary process History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Reason: R shoulder pain, ACS? History: 45481 Unremarkable cardiac and mediastinal silhouette. Streaky basilar opacities consistent with scarring and subsegmental atelectasis.No acute abnormalities.

Output: Basilar scarring with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: chest pain History: chest pain Prominent epicardial fat pad.No significant pulmonary or pleural abnormality.Heart size normal.

Output: Unchanged prominent epicardial fat pad, with no other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval for pneumothorax History: ?ptx on previous film No pneumothorax. Diffuse pulmonary fibrosis again noted. Focal opacity at the left lung base again noted. Unchanged heart size.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old; Reason: SOB, pleural effusion seen on CXR Right pleural effusion with visualized portions not appearing loculated. Left pleural effusion is not well visualized.

Output: Bilateral right greater than left pleural effusions without definitive evidence of loculation.


Instruction: Generate impression based on medical findings.

Input: Reason: line placement (PICC) History: line placement, adjusted PICC line from a left extending to the SVC. No significant cardiopulmonary abnormalities.

Output: Interval adjustment of PICC line with its tip now in the SVC.


Instruction: Generate impression based on medical findings.

Input: LUNGS AND PLEURA: Filling defect is seen mainly within the right lower lobe pulmonary artery, extending to lower lobe branches, consistent with pulmonary embolism. No definite pulmonary nodules or focal consolidation. Subpleural reticulation compatible with history of breast irradiation left upper lobe. No pleural fluid or pneumothorax.MEDIASTINUM: No lymphadenopathy. Stable stenosis of the proximal left subclavian artery. Ascending aorta is stably ectatic. Descending aorta is normal in size.CHEST WALL: Left chest port. Left mastectomy and breast reconstruction with axillary dissection. No axillary or internal mammary lymphadenopathy.UPPER ABDOMEN

Output: 1. Pulmonary embolism as described above. 2. No definite pulmonary metastases.3. Dr. Villaflor was notified via phone at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Brain lesion, suspect primary cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: ?tuberculosis or lung mass History: black streaked phlegm and excessive sweating The heart size is normal. No focal pulmonary opacities, pleural effusion, or pneumothorax. No active TB.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: concern for polymyositis, eval for ILD History: muscle weakness Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No evidence of interstitial lung disease although CT would be more sensitive if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: pulm edema History: sob Left subclavian AICD unchanged.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Increased moderate to severe cardiomegaly.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: r sided cp, hx of asthma and PTX History: R sided pain Right hemithorax postsurgical volume loss for what appear to be ABPA.Elsewhere, the lungs are unremarkable.Heart size normal.

Output: Status post right upper lobectomy and wedge resection. No acute abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Evaluate for reemergence of stroke symptoms History: pls see above No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: post bronch History: lesion No evidence of pneumothorax. Right hilar mass and right-sided pulmonary nodules were better seen on prior CT.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: ett distance History: ett ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Cardiomegaly with nonspecific basilar opacities compatible with atelectasis and aspirated secretions.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: r/o ptx History: s/p right thoracentesis Unchanged cardiomediastinal silhouette.Persistent bilateral pleural effusions, basilar atelectasis, slightly improved on the right.Stable perihilar interstitial opacities.No significant pneumothorax is identified.Other findings are unchanged.

Output: Slightly improved right pleural effusion without significant pneumothorax. Other findings are not significantly changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: endotracheal tube placement History: new intubation Moderate cardiomegaly with pulmonary opacities suggestive of edema.Increasing left lower lobe consolidation.ET tube tip at the carina level.An NG tube is barely visible in the upper chest region.

Output: Low ET tube. Increasing left lower lobe consolidation with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Wheezing asthma exacerbation. History: sob Large lung volumes and flat diaphragms are suggestive of obstructive airway disease or asthma.No specific evidence of infection or edema.Heart size normal.Moderate size hiatal hernia.

Output: Large lung volumes suggestive of obstructive airway disease. No acute abnormality. Hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval for cardiomegaly, pulm edema History: as above Very small left pleural effusion and minimal left base subsegmental atelectasis.Right lung unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Small left pleural effusion and minimal left basilar atelectasis, which could be the result of aspiration or early infection.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Patient status post right lung transplant 12/11/2015, now with wound closure. Endotracheal tube present with tip above the carina. Endoscopy probe noted within the distal esophagus. Central venous cannula seen with tip in the IVC. 3 chest tubes in the left hemithorax, 3 chest tubes in the right hemithorax, and 2 mediastinal drains again noted. Raytec sponge seen in the left upper quadrant.Dense left upper lobe consolidation again noted with persistent bilateral interstitial opacities and small, loculated pleural effusions. Small amount of subcutaneous gas noted.

Output: Raytec sponge in the left upper quadrant abdomen. The RROC discussed these findings with Dr. Wigfield, the attending surgeon, by phone at 10:41 on 12/13/2014.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with history of COPD and lung cancer status post right pneumonectomy presenting with increasing shortness of breath. Prior CT from 10/26/2010 showed enlarged mediastinal nodes. Evaluate for malignancy. CHEST:LUNGS AND PLEURA: Status post right pneumonectomy. Moderate centrilobular emphysema and calcified granuloma the left lung, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Calcified lymph nodes compatible prior granulomatous disease are unchanged. The previously referenced partially calcified right para-tracheal node (series 4, image 22) measures 22 x 18 mm; previously measuring 26 x 20 mm. No new, pathologically enlarged lymph nodes identified. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Degenerative changes of the spine. UPPER ABDOMEN: Atherosclerotic calcifications of the descending aorta and its major branches, including the origin of the left renal artery. Punctate, nonobstructing renal stones bilaterally. Subcentimeter renal hypodensities are too small to characterize. Cholelithiasis.Compression of the right heart by intrathoracic location of the liver as seen previously.

Output: No evidence of tumor recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: eval for infiltrate History: cough, fever Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.