Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.SOB evaluate for pneumonia. Left subclavian single lead pacemaker and a TAVR device are unchanged in position.Multichamber cardiomegaly with enlargement of the central pulmonary vasculature and tortuosity of the thoracic aorta unchanged.Low lung volumes with chronic blunting of the costophrenic angles posteriorly. Minimal septal thickening on the right appears chronic. No specific signs of acute edema.

Output: Cardiomegaly and signs of pulmonary hypertension unchanged. Chronic septal thickening, but no acute appearing abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Cough and altered mental status evaluate for infection or aspiration. Multichamber cardiomegaly and tortuous, calcified thoracic aorta and coronary vasculature again noted. Main pulmonary artery appears enlarged, suggesting pulmonary hypertension. Near complete resolution of previously seen pulmonary opacities. Moderate volume of pleural fluid on the right.

Output: Mild CHF. Cardiomegaly with tortuous thoracic aorta which may be ectatic. No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: 10 days postpartum with acute onset SOB, LE edema History: SOB postpartum Diffuse pulmonary opacities with small pleural effusions. Heart is at the upper limit of normal. No pneumothorax. Large patient body habitus.

Output: Pulmonary edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: interval change s/p chest tube removed History: interval change Interval removal of right-sided chest tube without evidence of significant pneumothorax.Stable position of right Port-A-Cath. Stable cardiomediastinal silhouette. Decreased lung volume with basilar opacities are unchanged.

Output: No significant pneumothorax following removal of right-sided chest tube. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: neutropenic fever History: neutropenic fever Normal heart size with a moderate scoliosis.Catheter tip in the SVC.No sign of pneumonia or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: PNA? History: transfer from OSH with dx of PNA There is mild cardiac enlargement.Widening of the mediastinum compatible with lymphadenopathy.Decreased lung volumes with increased interstitial opacities and bronchial wall thickening.No focal areas of consolidation.No large pleural effusions.

Output: Increased interstitial opacities and bronchial wall thickening without specific evidence of pneumonia. Mediastinal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female with recurrent granulosa cell tumor of ovary 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: Cholelithiasis without CT evidence of cholecystitis. Nonspecific punctate hypodensity in the right lobe of the liver on image number 95, series number 3 is too small to accurate characterize was most likely benign.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: Status post hysterectomy and oophorectomy. Vaginal cuff is prominent protrusion on the left side. MRI of the pelvis may be helpful if further characterization of the vaginal cuff is clinically indicated.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.

Output: Prominent vaginal cuff, with asymmetric enlargement on the left side. Correlation with pelvic exam and or pelvic MR may be helpful.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Pneumothorax check Interval placement of new bronchial valves now observed in the right hilar region in addition to the previously described left sided valves. Diffuse underlying severe bilateral lower lobe predominant bullous emphysema similar to prior. No definite new superimposed focal change however a possible focal opacity in the right lung base cannot entirely be excluded. Serial imaging is needed to confirm clearance

Output: Right hilar bronchial valves placed. Please see above and possible right lower lung focal nonspecific opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: cough, fever, eval for PNA History: cough, fever, eval for PNA Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: any sign of volume overload History: short of breath Complete opacification of the left upper lobe and moderate left pleural effusion, not significantly changed allowing for patient position.Hypovascular right upper lobe consistent with emphysema as shown on the recent CT scan.No sign of pulmonary edema.

Output: Left upper lobe opacification and pleural effusion without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: r/o infection History: sob Mild cardiomegaly.No pleural or parenchymal abnormalities.Mild bronchial wall thickening, may indicate bronchitis or asthma.

Output: No evidence of pneumonia; mild bronchial wall thickening may indicate bronchitis or asthma.


Instruction: Generate impression based on medical findings.

Input: Cardiac arrest and suspected pulmonary edema ETT terminates under 2 cm above the carina. Diffuse changes suggesting moderate 4 quadrant pulmonary edema with marked cardiomegaly and suspected small to moderate right layered effusion. See subsequent report

Output: Suspected pulmonary edema and ETT placed


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: Pt with metastatic head and neck cancer with fever. Evaluate for infection. History: as above The cardiac and mediastinal contours are within normal limits.Left subclavian port catheter terminates in the superior cavoatrial junction, stable from prior.Persistent asymmetric right apical pleural thickening, unchanged from prior study.No findings suggest pneumonia, as clinically questioned.Left posterior pleural thickening and trace residual pleural effusion is unchanged.Tracheostomy cannula and thoracolumbar spinal hardware again noted.

Output: No new radiographic findings to suggest pneumonia.Persistent left pleural effusion..


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of lung cancer CHEST:LUNGS AND PLEURA: Multiple pleural-based nodules in the left lung associated with left pleural effusion and volume loss and mediastinal shift to the left is again noted. Nodularity is minimally decreased.Pleural thickening along the medial surface at the level of the azygos arch measures 14 mm on image number 32, series number 5.MEDIASTINUM AND HILA: Index left cardiophrenic lymph node measures 1.5 by 1.1-cm image number 71, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Small hypodense lesions in the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered nonenlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with persistent cough. History of breast cancer. Left internal jugular central venous catheter with tip in the right atrium.Cardiomediastinal silhouette is unremarkable.Right apical scarring compatible with radiation fibrosis as seen on recent CT study.Mild loss of left heart border may be due to left lingular scarring/atelectasis noted on 7/30/2015 CT. No new opacity.Left sided rib deformities.

Output: Mild loss of left heart border may be due to left lingular scarring/atelectasis noted on 7/30/2015 CT. No new opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: Cough. ? Etiology History: As above Mild elevation of the right hemidiaphragm again noted. Mild bibasilar subsegmental atelectasis or scarring in noted. No new focal lung consolidation. No pleural effusion or pneumothorax. New mild to moderate wedging of the midthoracic spine noted, age indeterminate.

Output: New mild to moderate wedging of the midthoracic spine noted, age indeterminate.No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: HypoxemiaVIEW: Chest AP Left chest port with tip at the SVC. Cardiothymic silhouette at the upper limits of normal. Bilateral lung opacities at the right lower lobe and left lower lobe not significantly changed. No pleural effusion or pneumothorax.

Output: Bilateral lung opacities not significantly change.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female, mechanically ventilated. Endotracheal tube tip is approximately 3 cm above the carina.Stable cardiomediastinal silhouette.Low lung volumes with persistent patchy, basilar predominant opacities.Probable small bilateral pleural effusions with thickening of the minor fissures.

Output: Persistent patchy basilar predominant opacities, may be secondary to aspiration and/or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ICD, r/o ptx History: SOB ICD leads projected in the area of the right atrial appendage, right ventricular apex and a left ventricular vein.No pneumothorax or other complications.

Output: ICD leads in expected location with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Status post cardiac surgery. Interval removal of endotracheal tube. Remainder of lines/tubes/hardware are grossly unchanged in positioning. Right base chest tube tip is more laterally oriented compared with the previous exam. Balloon catheter marker is more visible and is within the proximal descending thoracic aorta. Improved aeration at left base and right infrahilar region. Small left pleural effusion.

Output: Interval removal of endotracheal tube. Slight improved aeration at the lower lung fields.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Nasal intubation. Evaluate ET tube. ETT tip 3 cm above the carina.Cardiothoracic ratio at least upper normal. Moderate right and small left pleural effusions about the same, though basal atelectasis has increased.Prominence of the pulmonary hila unchanged.Right chest, about the same with destruction of the lateral right fourth rib.

Output: ETT tip 3 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: lung infiltrate History: chest pain Lungs and pleural spaces are clear. The heart size is within limits of normal. No pneumothorax.

Output: No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: sob and chest pain History: increasing exertional cp and doe No significant cardiopulmonary abnormality.Heart size normal.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Essentially unchanged bilateral pleural effusions moderate on the right and large on the left. Underlying compression atelectasis with COPD changes. No gross cardiac or mediastinal contour change within this limited evaluation.

Output: Bilateral pleural effusions essentially unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: pleural effusion? History: sob Enlarging pleural effusions and increasing basilar consolidation with underlying edema.Mild cardiomegaly status post sternotomy.Status post aortic valve replacement.

Output: Worsening CHF with enlarging pleural effusions, basilar edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: Ass lung fields to r/o lung ca History: WEight loss in chronic smoker The cardiomediastinal silhouette is unremarkable.The lungs are clear.No suspicious pulmonary nodules or masses.Evidence of prior granulomatous disease.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: chest tubes History: chest tubes Small lung volumes with basilar subsegmental atelectasis, unchanged.Chest tubes remain in place with no significant pneumothorax.Right jugular venous access sheath stable.

Output: Stable mild basilar atelectasis. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval for acute heart failure exacerbation History: see above Mild cardiomegaly status post sternotomy.Patchy basilar opacities more suggestive of atelectasis from aspirated secretions and edema.No reliable evidence of infection noted.Right jugular catheter, tip at cavoatrial junction level.Left jugular Swan-Ganz catheter tip directed towards the right interlobar pulmonary artery.

Output: Patchy basilar opacities more suggestive of aspirated secretions and atelectasis than edema at this time.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: nstemi eval cardiopulmonary abnormality History: nstemi Cardiomediastinal silhouette is normal. Lungs clear of airspace and interstitial opacities. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: ecmo History: ecmo The right central catheter has been retracted, now terminating at the roof of the right atrium. The venous ECMO cannula remains in stable position.Septic emboli with: There are multiple cystic foci in the bilateral lower lobes with thin walls, better characterized on previous CT.

Output: Right central catheter terminates at the superior cavoatrial junction. Persistent mid to lower zone cystic bronchiectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: eval for infection History: URI symptoms No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with exudative lymphocyte predominant pleural effusion and abdominal pain. Concern for malignancy. CHEST:LUNGS AND PLEURA: Moderate left-sided pleural effusion. Subsegmental atelectasis involving the left lower lobe.MEDIASTINUM AND HILA: Nonenlarged mediastinal lymph nodes.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, ADNEXA: Leiomyomatous uterus.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: Moderate left-sided pleural effusion and dependent atelectasis at lung bases. No CT evidence of malignancy in the chest abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: lung field progression History: lung field progression Again noted are changes of prior median sternotomy. LVAD in place. ICD with tip overlying the right ventricular apex. A bullet projects over the mid abdomen.The heart is apparently magnified and most likely enlarged. No focal pulmonary opacity suggestive of pneumonia. A small left-sided pleural effusion with adjacent compressive atelectasis. No pneumothorax.

Output: Unchanged left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: SOB History: ? Volume Cardiomegaly with small bilateral pleural effusions, right greater than left. Mild interstitial opacities of edema. No pneumothorax.

Output: Cardiomegaly with small pleural effusions and minimal edema.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: Sepsis History: Sepsis No specific evidence of infection or edema.ET tube tip approximately 5 cm above the carina. An NG tube extends below the lower margin of the image.

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


Instruction: Generate impression based on medical findings.

Input: 71 years old Female. Reason: History of AL-amyloidosis with post obstructive PNA with large L effusion, eval for interval change History: Pneumonia. Near complete opacification of the left hemithorax with the bilateral pleural effusions, without significant interval change. Extensive mediastinal and supraclavicular calcified masses.

Output: Near complete opacification of the left hemithorax with bilateral pleural effusions. Calcified lymph nodes in the neck and mediastinum. Superimposed pneumonia in the left lung cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: FemaleReason for Study: Reason: r/p pulm edema History: crackles in RLung base Mild cardiac enlargement.Diffuse increased interstitial opacities with septal lines suggestive of edema.Blunting left costophrenic angle compatible with small effusion.Probable left retrocardiac atelectasis.

Output: Diffuse increased interstitial opacities compatible with edema, small left pleural effusion, and left basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Hypotension Persistent mildly decreased lung volumes with interval placement of a right jugular catheter terminating in the SVC just beyond the confluence with the left innominate. Incompletely visualized catheter projected over right upper quadrantLungs remain clear. Mild tortuosity of the aorta with a borderline cardiac silhouette

Output: Right jugular catheter placed without postprocedural complication


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Hypoxia, tachycardia, elevated WBC. Evaluate for infiltrate. No pulmonary or pleural abnormalities.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: SOB, CABG 7/2015 History: SOB Interval removal of central venous catheter. Iatrogenic devices are otherwise unchanged. Improvement in patchy bibasilar opacities. Moderate cardiomegaly again noted. No pneumothorax. No acute bony abnormalities.

Output: No unexpected findings status post thoracic surgery.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: Confirm swan catheter location History: see above Left-sided ICD unchanged.Right IJ Swan-Ganz has been placed with its tip in the right pulmonary artery.Stable cardiac enlargement and pleural effusions.Lucency under the right hemidiaphragm may represent interposed bowel, although a pneumoperitoneum cannot be excluded.No evidence of a pneumothorax.

Output: Swan-Ganz catheter tip in the right pulmonary artery. No evidence of a pneumothorax. Lucency underneath the right hemidiaphragm probably represents interposed bowel although a pneumoperitoneum can't be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p ECMO insertion eval lung fields Support devices are unchanged. Cardiomegaly and bilateral pulmonary opacities compatible with a combination of edema and atelectasis are unchanged. Right pleural effusion is similar in size. Left pleural effusion is tracking up along the lateral chest wall to the apex.

Output: Support devices unchanged. Bilateral pulmonary opacities and effusions are not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o atelectasis vs pe History: dyspnea Small lung volumes with basilar opacity compatible with atelectasis and effusions, not significantly changed.Catheter tip in the SVC.No other significant change.

Output: Basilar atelectasis and pleural effusions without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 39 yearsGender: MaleReason for Study: Reason: r/o infection History: seizure The cardiomediastinal silhouette is unremarkable.The diffuse airspace and interstitial opacities in both lungs are compatible with atypical infection.However, noncardiogenic edema and pulmonary hemorrhage cannot be excluded.No pleural effusions.

Output: Bilateral extensive airspace and interstitial opacities compatible with atypical infection, edema, or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: pneumothoraces History: - Unchanged moderate pneumothoraces, loculated on the right.Stable cystic lung disease.

Output: Unchanged moderate pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Pain over lobectomy site check for pneumothorax Persistent postsurgical changes without new acute cardiopulmonary abdomen. Specifically no pneumothorax. Cardiac and mediastinal contours are within limits

Output: No acute cardiopulmonary abnormality and postsurgical changes are similar


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: assess ET tube placement History: assess ET tube placement The endotracheal tube tip terminates approximately 5 cm above the carina. There is perihilar vascular engorgement suggesting pulmonary venous hypertension. There are mild basilar interstitial opacities and mild cardiomegaly. No pleural effusion or pneumothorax is evident. The bones and upper abdomen are unremarkable.

Output: Endotracheal tube tip approximately 5 cm above the carina. Findings consistent with mild interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with history of lung cancer. CHEST:LUNGS AND PLEURA: Interval increase in the size and number of bilateral nodular opacities, likely representing metastatic disease. A reference nodule measures 2 x 1.1 cm on image number 32, series number 6. Previously it was, measuring 7 x 5 mm image number 34, series number 5.Small left pleural effusion and dependent atelectasis. Enhancing pleural-based nodules, suspicious for metastatic disease.MEDIASTINUM AND HILA: Previously measured upper mediastinal lymph node is unchanged, measuring 8 by 8mm image number 16, series number 5. Paraesophageal lymph node is also stable.CHEST WALL: Axillary adenopathy is unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small bilateral renal cysts are unchanged. Left lower pole stone without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Hazy soft tissue density surrounding aorta, IVC and bilateral common iliac vesselsBOWEL, MESENTERY: Hazy density surrounding the mesenteric vessels may represent lymph nodes. Additional peripancreatic small lymph nodes are also present.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral enlarged inguinal adenopathy. A reference, left inguinal node measures 17 x 17 mm image number 202, series number 5.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size and number of lung nodules suspicious for metastatic disease. Small left-sided pleural effusion. Enhancing left pleural nodules suspicious for metastatic disease.Soft tissue density encasing the aorta and IVC and iliac vessels is unchanged. This may represent lymphoma or retroperitoneal fibrosis.Inguinal and axillary adenopathy and possible mesenteric lymph nodes. Biopsy of the inguinal or axillary adenopathy is recommended to differentiate between metastatic disease versus lymphoma.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.SOB. Moderate, right greater than left, interstitial and airspace opacities most consistent with acute pulmonary edema. Unchanged cardiomegaly. Small pleural effusions.

Output: Moderate acute pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: 70 y/o woman with acute cough an diffuse wheezing. Evaluate for pneumonia. History: Cough, wheezing. No specific evidence of infection or edema.Large central pulmonary arteries are consistent with pulmonary arterial hypertension.Heart size normal.

Output: Pulmonary arterial hypertension likely, otherwise no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: pre-surgery evaluation Heart size upper normal.Mild pulmonary vascular redistribution.No specific evidence of infection or edema.Mild renal osteodystrophy is noted.

Output: No specific evidence of infection or edema. Heart size upper normal.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: cause of neutropenic fever History: fever No new opacity to suggest pneumonia. Venous catheter tip in SVC.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Patient with cardiogenic shock status post IABP placement, evaluate. IABP is approximately at the level of the aortic arch, but the arch is poorly visualized. Enteric tube tip is outside the inferior margin of the image. Tracheostomy tip is approximately 7 cm above the level of the carina. Left jugular central venous catheter terminates in the right atrium. Multiple surgical clips overlie the sternum.Mild cardiomegaly is present. Diffuse bilateral interstitial opacities appear progressed as compared to the prior exam. Bilateral pleural effusion, left much larger than the right, appear unchanged.

Output: Interval increase in diffuse interstitial edema with persistent bilateral effusions.


Instruction: Generate impression based on medical findings.

Input: 22-24 week gestation male, one-day-old, pneumothoraxVIEW: Chest AP (one view) 5/19/2016, 6:05 The left chest tube is in similar position at the left lung base. The ETT tip is between thoracic inlet and carina. The enteric tube side-port is in the distal esophagus. UAC tip is at T6-7. UVC tip is in the right atrium.A small left pneumothorax persists. There is no mediastinal shift. The cardiothymic silhouette is obscured. New diffuse airspace opacification of both lungs on a background of PIE. The right basilar lucency persists. No pleural effusion.Less bowel gas is seen in the upper abdomen. Body wall edema.

Output: 1. Increased opacification of both lungs may represent pulmonary edema or hemorrhage. 2. Persistent small left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: FemaleReason for Study: Reason: 50F with AICD placement s/p possible firing History: chest pain Left-sided ICD unchanged.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No interval change in the ICD.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: follow up opacity noted on CXR 12/2/15 History: none Lungs and pleural spaces are clear. Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Intubated. ETT tip 2.5 cm above the carina.Left jugular catheter tip in the right atrium.Enteric tube has been advanced with tip now off the caudal margin of the film.Left subclavian ICD unchanged in position.Unchanged moderate cardiomegaly and enlargement of the central pulmonary vasculature.Unchanged right lower lobe airspace opacity.Mild retrocardiac atelectasis on the left.

Output: ETT tip 2.5 cm above carina. Enteric tube has been advanced.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: 71 yo male with history of MCL; pre-auto SCT evaluation History: evaluate Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history metastatic melanoma on chemotherapy. Evaluate response to treatment. CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules stable on comparison to previous exam. MEDIASTINUM AND HILA: Unchanged mediastinal lymphadenopathy with stable calcified right hilar nodes.CHEST WALL: Right-sided Port-A-Cath.Unchanged round soft tissue density is seen on series 4, and image 2/221.Unchanged soft tissue density replacing the posterior portion of the left fifth rib (series 4, image 35/221).ABDOMEN:LIVER, BILIARY TRACT: Previously seen liver lesions remain difficult to measure given the similarity of the peripheral enhancement to liver parenchyma.Given this limitation, the diffuse hypodense hepatic lesions appear unchanged. Reference lesion is seen on series 4, image 89/221 and measures 3.5 cm x 4.3 cm.SPLEEN: Heterogeneous splenic reference lesion measures 2.7 cm x 2.7 cm on series 4, image 95/221 (unchanged).PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable large retroperitoneal lymphadenopathy. Reference left para-aortic lymph node on series 4, image 119/221 measures 3 cm x 3.1 cm. Reference aortocaval node measures 4 cm x 3.2 cm on series 4, image 121/221. Both are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable lytic lesions in multiple vertebral bodies.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Unchanged pelvic and inguinal lymphadenopathy.Reference nodule measures 4.2 cm x 4.5 cm on series 4, image 189/221. (unchanged).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable lytic lesions in multiple vertebral bodies.OTHER: No other significant abnormality noted.

Output: Diffuse metastatic disease with bulky lymphadenopathy that remains stable on comparison to previous exam as detailed above.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: r/o edema History: orthopnea No change in mild cardiomegaly. No airspace or interstitial opacities. Vasculature normal. No pneumothorax. No pleural effusions.

Output: Stable mild cardiomegaly with no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: ICU/Lines History: ICU/Lines Aortic balloon pump marker in the descending thoracic aorta, unchanged. Chest tubes stable. Swan-Ganz catheter tip in proximal right pulmonary artery.Stable cardiomegaly. No evidence of pneumothorax. Minimal increase in atelectasis at the left base.

Output: Aortic balloon pump marker in the descending thoracic aorta, unchanged.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of metastatic esophageal adenocarcinoma. Compare previous. CHEST:LUNGS AND PLEURA: A left upper lobe index lesion measures 1.8 x 1.4 cm (image 55; series 4). Right lower lobe scar/atelectasis is unchanged. No new suspicious nodules or masses. Mild emphysematous changes are stable.MEDIASTINUM AND HILA: A reference left paratracheal/AP window lymph node equivocally enlarged measuring 2.0 x 1.5 cm (image 41; series 3). Multiple para-aortic nodes are redemonstrated. A left para-aortic reference lesion is equivocally enlarged measuring 2.6 x 1.9 cm (image 75).Postoperative changes are redemonstrated at the mid to distal esophagus.CHEST WALL: Right chest wall port catheter in place.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Confluent retrocrural, retroperitoneal and porta hepatic lymphadenopathy is redemonstrated. A previously referenced conglomeration of retroperitoneal nodes measures 11.1 x 6.0 cm (image 120; series 3). This conglomeration of tissue encases the right renal artery, displaces the left renal vein superiorly, and severely attenuates the adjacent IVC, findings which are grossly unchanged.Atherosclerotic disease affects the abdominal aorta and its branches.BOWEL, MESENTERY: A broad based ventral abdominal wall hernia is again seen.BONES, SOFT TISSUES: Bony bridging is again evident between two posterior right-sided ribs.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval change in reference measurements as above.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: Dyspnea History: dyspnea Heart size normal, the aorta tortuous but consistent with age.Calcified left hilar lymph nodes are from prior granulomatous infection.No specific evidence of infection or edema.Left subclavian dual-chamber pacemaker, leads in appropriate position.

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


Instruction: Generate impression based on medical findings.

Input: Reason: eval for opacities or effusions History: post-BIVAD The cardiomediastinal silhouette is obscured.Complete opacification of the left hemithorax is again seen. Streaky opacities at the right lung base are unchanged. No pneumothorax.Hardware and devices unchanged in position.

Output: Complete opacification of the left hemithorax and right basilar opacities without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: Please eval for worsening pulm infiltrates and development of ARDS History: Increasingly hypoxemic and difficulty to ventilate ET tube tip at thoracic inlet. NG tube tip is difficult to visualize though appears to be near the GE junction.Increase in right basilar opacity likely due to aspirate or pneumonia.

Output: Increase in right basilar opacity likely due to aspirate or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: evaluating for pneumothorax, evidence on cxr of PT History: left sided chest pain, worse with deep breath, cough. pt w/ asthma, recent flight to/from New Orleans. pain is just under left nipple. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No focal airspace opacity. No evidence of rib fracture, however please note that chest radiograph is insensitive in the evaluation of rib fracture.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube back to water suction History: as above, assess for pneumothorax Decreased left pneumothorax with a chest tube in place.Minimal air collection along the right superior pleural surface that may represent a very small pneumothorax or extrapleural dissection of air from pneumomediastinum.Nonspecific diffuse interstitial opacity the differential diagnosis for which includes pneumocystis infection.

Output: Decreased left pneumothorax and new minimal right apical air collection as described.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Pulmonary Edema History: Chest Pain Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild elevation of the right hemidiaphragm again noted. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged cardiomegaly. Cervical spinal fusion hardware, incompletely visualized. Probable right thyroid goiter/nodule. Large patient body habitus.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 3 cm above the carina.NG tube and left Pleurx catheter unchanged.Large bilateral pleural effusions with underlying nonspecific pulmonary opacity, greater on the right.Interval removal of the right jugular catheter.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with recent intra-aortic balloon pump removal complicated by hemorrhage now with transfusion-dependent anemia. Evaluate for intra-abdominal versus retroperitoneal bleed. Generalized pain. CHEST:LUNGS AND PLEURA: Consolidation left lower lobe rule out pneumonia. Some small areas of patchy ground glass in the superior segment right lower lobe. No nodules. No effusions.MEDIASTINUM AND HILA: ET tube. NG tube. No adenopathy. Pacer wire.CHEST WALL: No significant abnormality noted

Output: Left lower lobe consolidation. Small amount of generalized free intraperitoneal fluid. No evidence of retroperitoneal hemorrhage. Packing in large left lower in tear abdominal wound. Other findings as above. Discussed with clinical service.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrate History: coughing and SOB for 4-5 days Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: Cough, s/p OHT History: s/p OHT 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, 59 years old.Reason: Patient with low grade fever and bilateral rales History: fever /chills Cardiomegaly with the suggestion of basilar edema and atelectasis.No reliable evidence of pneumonia.Known skeletal metastases.

Output: Cardiomegaly and the suggestion of edema with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: evaluate hypoxemia History: see above Large lung volumes suggest COPD. Left basilar interstitial opacity appears slightly more conspicuous compared to the prior examination and may relate to technique and mild atelectasis. There is no pleural effusion or pneumothorax.The cardiac and mediastinal contours are within normal limits for size.

Output: 1.Increased conspicuity of a left basilar interstitial opacities may relate to technique and mild atelectasis, but correlate with concern for aspiration.2.Findings suggestive of COPD.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with splenic artery aneurysm. The examination is limited by lack of intravenous and oral contrast which limits the sensitivity examination to detect lesions of the solid organs and bowel. With those limitations, the findings are as follows:CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: There is a heterogeneous hypoattenuating left thyroid nodule (series 3, image 13).There are atherosclerotic calcifications of the aortic valve, coronary arteries, ascending aorta, aortic arch, and descending thoracic aorta. The thoracic aorta is tortuous. Some of the calcifications are not in the periphery of the aorta, which suggests ulcerated plaques or an intra-aortic hematoma.The heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is unchanged. No significant abnormality is noted.SPLEEN: The previously seen splenic artery aneurysm measures 1.3 cm (series 3, image 97), unchanged from previous examination.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are atherosclerotic calcifications of the abdominal aorta and its branches, including the celiac artery, left renal artery, and superior mesenteric artery. BOWEL, MESENTERY: Hiatal hernia is unchanged. 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: 1. Unchanged splenic artery calcifications and aneurysm.2. Left thyroid nodule. Follow up ultrasound for further evaluation should be considered.3. Diffuse and extensive atherosclerotic calcifications of the aorta and its branches.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: r/o infection, edema, effusion History: cough x 1 week, fever Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Chills and increased productive cough. COPD. Rule out pneumonia. Large lung volumes with bronchial wall thickening consistent with history of COPD/chronic bronchitis. Atelectasis in the retrocardiac region, mild. No specific evidence of pneumonia. Unchanged cardiothoracic ratio.

Output: No specific signs of pneumonia. If patient remains symptomatic, consider PA and lateral chest radiograph.


Instruction: Generate impression based on medical findings.

Input: 19 year-old female with left lower quadrant pain, rectal bleeding, and diarrhea. CHEST:LUNG BASES: 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: The tip of the appendix is minimally dilated and fluid-filled while the remainder appears normal proximally and is opacified by contrast. No adjacent fat stranding or fluid collections are identified.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Arcuate uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No specific findings to account for the patient's symptoms. The tip of the appendix is minimally dilated while the remainder is normal in caliber. This is a nonspecific finding and correlation with patient's physical exam is recommended.Findings communicated to and after knowledge to by Gail Deluca of the Student Care Center at the time of dictation.Upon discussion with the ordering service, clinical suspicion for appendiceal pathology is very low. Therefore, the aforementioned finding is likely of little clinical significance.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: paramediastinal opacity eval History: noted on port cxr Right paramediastinal opacity seen on the portal chest radiograph is redemonstrated. On the lateral radiograph this appears to be anterior in position and is probably extrapleural.Upper normal heart size. Tortuous thoracic aorta with atherosclerotic calcifications.Moderate degenerative changes of the thoracic spine.

Output: Unchanged right paramediastinal opacity projecting over the lung apex favored to be extrapleural and may represent vascular tortuosity. As this is unchanged from 8/20/2015 a benign process is favored and conservative imaging follow-up with PA and lateral chest radiographs in 4 months is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: ETT tube and swan ETT tube 6 cm above the carina.Left pulmonary artery catheter with tip projecting over the right main pulmonary artery.Enteric tube tip is not visualized in the field-of-view.Right internal jugular catheter tip projects within the right atrium.Stable cardiomegaly and layering bilateral pleural effusions.

Output: 1. ETT tube 6 cm above the carina.2. Left pulmonary artery catheter with tip projecting over the right main pulmonary artery.3. Otherwise stable exam consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Epigastric pain, enteric tube placement Enteric tube seen with side-port at level of gastric fundus, tip overlies gastric body. Nonobstructive bowel gas pattern. Above average stool burden. Partially imaged contrast-containing urinary bladder, residual contrast also noted in renal collecting systems. Please see same day CT exam and chest radiography for additional findings.

Output: Enteric tube as above. Please see same day CT and radiographic imaging for additional findings.


Instruction: Generate impression based on medical findings.

Input: Reason: monitor infiltrates History: SOB Cardiomegaly with bilateral airspace opacity, unchanged or slightly increased, compatible with edema or aspiration.Catheter tip in the SVC.No new findings.

Output: Nonspecific airspace opacity compatible with edema or aspiration, unchanged or slightly increased.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old. Right PICC line is in place with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusion.

Output: Placement of a right PICC line with its tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: eval for pneumonia History: altered mental status Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.Superior mediastinal clips again identified.

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


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: acute pathology History: h/o CAD/MI with radiation to back Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Unchanged appearance of the mediastinum. No new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: r/o opacity History: new hypoxia Low lung volumes with basilar subsegmental atelectasis. No specific findings to suggest infection or edema.Borderline cardiac enlargement.No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: cticu patient, line eval History: line eval, s/p lung transplant Bilateral chest tubes and left central venous catheter unchanged.Bilateral apical pneumothoraces unchanged.Interval increase in subcutaneous emphysema along the right lateral chest wall and right supraclavicular region.Stable cardiomediastinal silhouette.Right basilar opacity unchanged compatible with atelectasis and possibly secondary to aspiration.

Output: Bilateral apical pneumothoraces without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old. Reason: eval for new infiltrate History: dysphagia, h/o PNA Cardiomediastinal silhouette is unremarkable.Right basilar atelectasis without new focal opacity, pleural effusion, or pneumothorax. Tracheostomy tube tip 5 cm above the carina. Incompletely imaged cervical fixation hardware.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: trauma History: trauma ET tube tip approximately 3 cm above the carina.Focal streaky opacity in the right lower lobe area compatible with subsegmental atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Patient with history of stem cell transplant with influenza now with worsening cough and new fevers History: fever No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: eval for infection History: sepsis Left-sided ICD unchanged.Stable cardiac enlargement.Decreased lung volumes with mild basilar atelectasis.No new pulmonary opacities identified.No large pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: TachypneaVIEW: Chest AP Left chest port in place. Cardiothymic silhouette normal. Bilateral lung opacities at the right lower lobe and left lower lobe not significantly changed. No pleural effusion or pneumothorax.

Output: Bilateral lung opacities predominantly left lower lobe not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: Lung mass History: left upper lobe mass s/p biopsy No evidence of significant pneumothorax.

Output: No evidence of significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Dyspnea, evaluate left pleural effusion. Left jugular catheter crosses the midline to enter the opposite (right) subclavian vein, unchanged. Dobbhoff tube tip off the caudal margin of the. Surgical drain, staples and clips in the upper abdomen partially visualized. Staples overlie the left upper chest wall.Large layering left pleural fluid collection with associated atelectasis and atelectasis of the left lower lobe about the same. The right lower lobe remains collapsed and there is a small volume of remaining pleural fluid on the right.

Output: 1. The left jugular catheter has been displaced from its former position in the SVC, now entering the right subclavian vein.2. No significant change in large left and small right pleural effusions with complete lower lobe atelectasis bilaterally.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: s/p CABG; Evaluate for Pulm Edema vs. PNA History: SOB Status post CABG and aortic valve replacement.Interval improvement in the pleural effusions with persistent basilar atelectasis and elevation of the left hemidiaphragm.No new pulmonary opacities identified.

Output: Interval improvement of pleural effusions with persistent basilar atelectasis. No acute abnormalities identified. No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: 40 pack a day smoker for the last 10years. Now with dyspnea on exertion and cough rule out mass v/s other History: Heart size upper normal.No specific evidence of infection or edema.

Output: Heart size upper normal, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/p right thoracentesis r/o PTX History: hypotension, MS changes Interval intubation with the endotracheal tube high with the cuff likely at the cords. Interval placement nasogastric tube with the sidehole in the distal esophagus. Interval placement of external defibrillator pads. An electronic device projects over the thoracic midline. Interval placement right central dialysis catheter terminating in the superior vena cava. Right IJ central catheter has been removed. Tips noted along with several pigtail catheters and a drain at the left upper abdominal quadrant.Interval increased opacification of the right hemithorax, suspicious for hemothorax with atelectasis of the right lung. No significant leftward mediastinal shift. Small left pleural effusion/hemothorax tracking over the apex, slightly increased in size.

Output: Increasing opacification right hemithorax suspicious for progressive hemothorax with provided clinical history. The possibility of small pneumothorax cannot be excluded. Advancement of endotracheal and nasogastric tubes recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Evaluate ETT and lung fields status post CABG. Postoperative appearance of the thorax.ETT tip 3 cm above the level of the carina.Right jugular Swan-Ganz catheter overlies the right main pulmonary artery.Mediastinal drain and bilateral chest tubes in place. Peripheral catheter from the left terminates in the mid clavicular line of the left subclavian vein projection.Small left pleural effusion. A rounded retrocardiac opacity in the left lung base is new from the preoperative study. Mild basal atelectasis bilaterally. No significant sized pneumothorax.

Output: New 3 cm rounded opacity projecting over the left base is nonspecific and could reflect segmental atelectasis seen on-end due to bronchial mucus plugging. An infarct is possible but considered less likely.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: et placement History: intubated Persistent small right pleural effusion associated with right pleural thickening, stable from priors. No pneumothorax.Severe upper lobe predominant emphysema again noted. No abnormal lung parenchymal opacities.The heart is normal in size.Interval extubation and removal of the enteric tube.

Output: Interval removal of support apparatus.Persistent right pleural thickening and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male metastatic thyroid cancer, evaluate for growth LUNGS AND PLEURA: Multiple pulmonary nodules demonstrate interval growth. No new nodules can be identified. Reference nodule (image 48, series 4) now measures 21 mm x 21 mm, previously, measuring 18 mm x 19 mm. Other enlarging nodules in both lungs (image 51, series 4) measures 15 mm x 12 mm previously measured 13 mm x 12 mm and (image 51, series 4) now measures 12 mm x 11 mm, previously, measuring 10 mm x 9 mm.MEDIASTINUM AND HILA: Prior CABG with extensive calcification of the coronary arteries.No hilar or mediastinal lymphadenopathy. Cardiac size is normal without evidence of a pericardial effusionCHEST WALL: Tracheostomy.UPPER ABDOMEN: Lithiasis.

Output: Interval increase in size of numerous pulmonary metastases. No new sites of disease identified.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: leukocytosis, high risk for aspiration, assess for infiltrate History: leukocytosis Moderate cardiomegaly.Edema like opacities and increased left lower lobe consolidation progressed.There is either partial atelectasis of the left upper lobe or artifact from tortuous brachiocephalic vessels from leftward rotation of the patient. Two large right jugular catheters terminate at the cavoatrial junction.IVC filter and gastrostomy tube identified.

Output: Worsening pulmonary opacities. Findings consistent with a combination of edema and infection.


Instruction: Generate impression based on medical findings.

Input: Please provide bidimensional measurements of index lesions CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral obturator, para iliac, inguinal adenopathy. An index lesion in the right obturator location measures 2.3 x 1.8 cm on image number 175, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Pelvic adenopathy as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Reason: ETT advanced, recheck positioning History: s/p ETT Moderate cardiomegaly with mild retrocardiac subsegmental atelectasis.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Esophageal probe.

Output: ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of prostate cancer and pulmonary nodules, follow-up LUNGS AND PLEURA: Previous identified reference subpleural nodule in the superior right lower lobe (image 48, series 5) is stable, measuring 5 mm in size. Additional right lower lobe subpleural nodule (image 39, series 5) is also stable.Mild paraseptal emphysema in the apices.No new pulmonary nodules identified.MEDIASTINUM AND HILA: Severe aortic and coronary calcifications.Cardiac size is normal without evidence of a pericardial effusion.No hilar or mediastinal lymphadenopathy identified.CHEST WALL: Degenerative changes in the thoracic spine.UPPER ABDOMEN: No significant abnormality noted.

Output: Stable small peripheral nodules in the right lower lobe. No new nodules identified.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: ETT eval History: intubated in MICU Increasing basilar atelectasis possibly from aspirated secretions or mucous plugging.ET tube tip approximately 5 cm above the carina.Right jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.

Output: Increasing basilar atelectasis. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: PNA History: AMS Moderately decreased lung volumes with stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: interval change in opacities, indwelling lines History: s/p cardiac surgery Median sternotomy with chest tubes but no pneumothorax.Interstitial opacities at least in part chronic with pleural effusions or pleural thickening, stable.Status post extubation.Right jugular Swan-Ganz catheter tip in main pulmonary artery.

Output: No change in pulmonary opacities following extubation, and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: ?pneumonia, ?effusion History: sob, New patchy opacity within the right midlung and left peripheral lower lobe on a background of chronic appearing interstitial lung changes. No large pleural effusion or pneumothorax. Heart size is normal.

Output: Superimposed patchy opacities on a background of interstitial lung disease may represent aspiration and pneumonia or acute exacerbation of pulmonary fibrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pulmonary edema History: low saturation Normal heart size with superior mediastinal widening, consistent with mediastinal lipomatosis as shown on a recent CT scan.Elevation of the right hemidiaphragm with overlying subsegmental atelectasis.No sign of pulmonary edema.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 19 yearsGender: MaleReason for Study: Reason: Evaluate for infiltrate, pneumonia History: Productive cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Left VATS procedure Mild volume loss in the left without additional cardiopulmonary abnormality. Specifically no superimposed acute pulmonary disease.

Output: Postsurgical volume loss without acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: r/o infection History: SOB Mild interstitial pulmonary edema with small pleural effusion. Mild cardiomegaly. Aortic atherosclerosis. No acute bony abnormality. Mild degeneration and osteopenia.

Output: Mild pulmonary edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Motion degrades sensitivity.Right chest tube again projects into the apex with a residual small insignificant pneumothorax. Overlying chest wall emphysemaPersistent decreased lung volumes with mixed interstitial patchy airspace opacities again suggesting edema and/or aspiration. Borderline cardiomegaly exaggerated by technique.

Output: Right chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: eval lung fields History: s/p AVR, MVR, TVR, CABG Lines and tubes are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Apparent increase in diffuse pulmonary opacities with superimposed basilar opacities. Unchanged cardiomegaly. Probable small pleural effusions. No significant pneumothorax.

Output: Apparent worsening in diffuse and basilar pulmonary opacities which likely represent edema if a true change. This can be reevaluated on close imaging follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lung fields History: CHF s/p LVAD Cardiopulmonary monitoring and support devices, unchanged except for apparent removal of an aortic balloon pump.Small lung volumes with mild opacity compatible with edema and atelectasis, increased in the left lower lobe.Small pleural effusions.Slightly improved aeration in the left lower lobe.

Output: Improved left lower lobe aeration and removal of aortic balloon catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Endotracheal tube placement. Endotracheal tube is unchanged in position. Left greater than right pleural effusions with adjacent atelectasis/consolidation. Diffusely scattered pulmonary nodules compatible with known metastatic disease. Metastatic involvement of the left scapula. No pneumothorax.

Output: Left greater than right pleural effusions with adjacent atelectasis/consolidation. No interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: FemaleReason for Study: Reason: status post pleural drainage History: post pleural drainage Placement of a left upper quadrant pigtail catheter. NG tube with its tip in the stomach.ET tube has been removed.Stable cardiomediastinal silhouette.Left retrocardiac consolidation/atelectasis and left pleural effusion redemonstrated.No new pulmonary opacities identified.No evidence of a pneumothorax.

Output: Left pleural effusion and left retrocardiac consolidation/atelectasis similar to the prior exam. Interval placement of a left upper quadrant drain.


Instruction: Generate impression based on medical findings.

Input: Patient with history of acute leukemia and invasive fungal infection of the lungs. LUNGS AND PLEURA: Continued improvement in predominantly upper lobe groundglass opacities. Interval development of dense focal consolidation in the inferior lingula on axial image 68/100 and in the right lower lobe on axial image 77/100 with subtle surrounding ground glass opacity. These findings are concerning for invasive fungal infection. Additional scattered foci of centrilobular and tree in bud opacities are unlikely to represent fungal infection, although infection of another etiology cannot be excluded.Resolution of pleural effusions. Multiple cystic structures unchanged.MEDIASTINUM AND HILA: Right-sided central venous line terminates in the SVC. No pathologically enlarged mediastinal or hilar lymph nodes. Cardiac size is normal. Small residual pericardial effusion is improved.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Punctate segment 7 liver hypodensity unchanged. Splenic calcifications are also unchanged.

Output: 1.New dense foci of consolidation as above concerning for invasive fungal infection.2.Interval resolution of groundglass opacities and pleural effusions. 3.Scattered centrilobular and 3 and by the opacities may also represent infection.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval for infection, fluid. Would like to do v/q if clear History: chf, fluid overload Small to moderate right pleural effusion unchanged overlying atelectasis.Left lung unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Unchanged small to moderate right pleural effusion with overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: pneumonia History: shortness of breath Low lung volumes with bibasilar atelectasis. No large pleural effusion or pneumothorax. Heart size again mildly enlarged.

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


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old with a history of sickle cell disease and seizure. Moderate cardiomegaly is again noted. Low lung volumes with minimal bibasilar subsegmental atelectasis. No large pleural effusion, pneumothorax or specific evidence of infection.

Output: Cardiomegaly. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: chest pain 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: Female, 64 years old.Reason: worsening SOB in setting of PE and possible PNA History: worsening SOB Enteric tube side holes within the gastric lumen.Increased large right pleural effusion with underlying atelectasis/consolidation. The left lung is unremarkable.

Output: Increased large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: sp MV replacement, check swam placement History: - Cardiomegaly status post sternotomy with chest tubes but no pneumothorax.Unchanged pulmonary opacities suggestive of edema and atelectasis with small pleural effusions.ET tube tip approximately 2 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular Swan-Ganz catheter tip in main pulmonary artery.Left subclavian pacemaker, leads unchanged in position.

Output: Unchanged pulmonary opacities. No significant pneumothorax. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: routine xray s/p AV replacement History: s/p AV replacement Small pleural effusions with probable basilar atelectasis. No pneumothorax. Unchanged cardiomegaly.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male with history of testicular cancer. CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter nodule in the left lower lobe measuring 4 mm image number 72, series number 6 is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable lytic lesion with prominent trabecula in the right pubic bone.OTHER: No significant abnormality noted

Output: Stable exam with nonspecific stable nodule in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Line placed Minimal repositioning of both basilar chest tubes, however mediastinal chest tubes are otherwise unchanged. Small persistent apical right pneumothorax roughly similar given differences in technique and positioning.Underlying cardiopulmonary appearance is otherwise unchanged. This includes an ETT, Dobbhoff, Swan-Ganz and bilateral jugular cathetersSee subsequent report

Output: ETT unchanged and bilateral chest tubes mildly repositioned


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: eval CHF History: b/l LE edema Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: cardiopulmonary process History: fever Low lung volumes with basilar opacities, right greater than left likely representing atelectasis.Heart size normal.No pleural effusion. No pneumothorax.Enteric tube coiled within the gastric body.

Output: Low lung volumes with basilar opacities likely representing atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 38 yearsGender: MaleReason for Study: Reason: ETT placement History: Cough ET tube has been retracted with its tip now near the thoracic inlet.Remaining support devices unchanged.Stable cardiac mediastinal silhouette.Diffuse pulmonary opacities similar in appearance the prior exam.

Output: ET tube tip now in a high position. Subsequent imaging demonstrates appropriate repositioning. Stable cardiopulmonary appearance with diffuse pulmonary opacities compatible with ARDS.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: cough, shortness of breath. pna? History: as above No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: S/p ICD lead extraction/reimplantation. History: None Cardiomegaly, with patchy opacities suggestive of edema and/or aspiration.Left subclavian pacemaker, leads unchanged in position.

Output: Cardiomegaly and nonspecific opacities suggestive of edema and/or aspiration. No pneumothorax following ICD revision.


Instruction: Generate impression based on medical findings.

Input: 63-year-old woman adrenal cortical cancer status post surgery and XRT. Evaluate growth. CHEST:LUNGS AND PLEURA: Right base series 5 image 53 nodule measuring 4.8 x 4.5 mm. minimally more prominent on the prior scan series 5 image 56. No other lung nodules.MEDIASTINUM AND HILA: No pathologic size nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The hypodensity subcapsular along the gallbladder fossa approximately unchanged measurements is 4 image 91 is 1.3 x 1 cm. No other liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: In the right adrenal bed persistent low attenuation material process on series 4 image 85 measuring 3.1 x 1.5 cm. Is decreased in size suggesting that this may represent postsurgical change.The left adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality.RETROPERITONEUM, LYMPH NODES: Caval filter in calcification high density material caudal to the filter, unchanged in appearance.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Hypoattenuating bulge along the posterior aspect uterus, unchanged represent a fibroid. No calcification.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: Lung nodule slightly more prominent. Intermediate density material in the surgical bed decreased in size. Other lesions stable.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: check lines and lung eval; increased oxygen requirement History: increased oxygen requirement Two right-sided venous catheters in high right atrium, as on prior. Enteric tube extends beyond the field-of-view of study.Persistent edema with bilateral pleural effusions.

Output: Persistent edema with bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: hypoxia, likely fluid overload History: hypoxia Stable cardiomediastinal silhouette.Mild increased basilar interstitial opacities similar to the prior exam.These may be chronic in origin or may represent mild edema.No focal areas of consolidation.No large pleural effusions.

Output: Mild specific nonspecific basilar predominant interstitial opacities similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old Reason: Trauma History: above. Cardiomediastinal silhouette is within normal limits.No focal air space opacity, pleural effusion, or pneumothorax.No displaced rib fracture is identified.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.G J-tube coming out of the mouth. The GJ tube has extended in a retrograde fashion cranially through the esophagus and mouth with tip external to the patient.Cardiomegaly, mediastinal and hilar lymphadenopathy and probable enlargement of the central pulmonary vasculature unchanged. Basilar bronchiectasis and scarring bilaterally. Minimal pleural fluid. No pneumothorax or visible pneumomediastinum.

Output: GJ tube extends through the mouth. No evidence of aspiration or visible pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with widened mediastinum CHEST:LUNGS AND PLEURA: Bilateral moderate size pleural effusions. Dependent atelectasis.MEDIASTINUM AND HILA: Bilateral thyroid nodules. Atherosclerotic changes involving the thoracic aorta, most prominent in the descending and proximal abdominal aorta.Nearly 50% stenosis of distal thoracic aorta.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Gallbladder is distended. No definite wall thickening. No evidence of biliary dilatation. Scattered punctate hypodensities in the liver, too small to characterize but likely benign.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: The distal abdominal aorta is occluded. Severe atherosclerotic changes involving the proximal abdominal aorta. Significant stenosis the right enlarger.BOWEL, MESENTERY: A long segment (approximately 50 cm) of distal ileal loops including the terminal ileum demonstrates significant wall thickening, mild dilatation (as measuring up to 3.3 cm) and associated fat stranding. Proximal small bowel loops are slightly distended measuring up to 3-cm in diameter. Small fat containing hernia. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.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: Small amount of ascites. Severe atherosclerotic changes involving bilateral iliac vessels.

Output: Bilateral pleural effusions. No evidence of mediastinal mass. Significant wall thickening of the distal ileal loops with mild dilatation. The etiology is unknown and may be infection, inflammation or ischemia. Severe atherosclerotic changes involving the aorta and its branches including nearly 50% stenosis of distal abdominal aorta and complete occlusion of the distal abdominal aorta. Significant stenosis of the right renal arteries.Small amount of ascites. Mild small bowel dilatation is secondary to ileus.Dr. Miller waNotified and acknowledged at the time of dictation.s


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: post thoracentesis History: as above Improvement in left pleural effusion following thoracentesis with no pneumothorax.Improved left lower lung zone consolidation.Right lung unremarkable.Status post median sternotomy.

Output: Improvement in left pleural effusion following thoracentesis with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: Edema vs. Infection? History: hypoxia Patchy airspace opacity in the left lung with decreased volume compared to previous, compatible with infection and atelectasis.Mild subsegmental atelectasis at the right base and probable small pleural effusions.Catheter tip in the SVC.

Output: Focal predominately left-sided air space opacity, more compatible with infection/aspiration than edema.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: lung CA History: none Electrodes are unchanged in position.Resolution of previous subcutaneous inferolateral chest wall emphysema. Scarring at the right base is now evident. Surgical staples in the right paratracheal location following excision of previous medial right upper lobe nodule. No pneumothorax or pleural effusion. Heart size within limits of normal.

Output: Postoperative changes in the right medial upper lobe. Resolution of previous right infralateral subcutaneous chest wall emphysema. Scarring at the right base without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.CHF and cough. Swan in place assess placement and any interval change. Left subclavian ICD and right jugular Swan-Ganz catheter unchanged in position.No pneumothorax or specific signs of pulmonary edema.Mild interstitial opacities appear chronic.

Output: No specific signs of CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval lung fields History: sinus tachycardia, hypotension Minimal right apical pneumothorax, right chest tube unchanged in position, with persistent right chest wall soft tissue emphysema.Stable basilar subsegmental atelectasis.An NG tube traverses a gastric pull-up.Right jugular catheter, tip in SVC.

Output: Very small pneumothorax, and basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrate History: febrile and left sided cp Heart size about upper normal.Perihilar bronchial thickening, compatible with bronchitis, unchanged. No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: Preop TECAB History: Preop TECAB The cardiomediastinal silhouette is unremarkable.Minimal basilar scarring/discoid atelectasis .No focal areas of consolidation.No suspicious nodules or masses.No pleural effusions.Moderate degenerative changes within the thoracic spine.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: advancement of PA catheter History: advancement of PA catheter Interval repositioning of Right IJ Swan-Ganz catheter tip to the right pulmonary artery.No change in position of Dobbhoff tube and IABP marker.No interval change in cardiac enlargement, perihilar/basilar interstitial edema, and pleural effusions.

Output: Interval repositioning of right IJ Swan-Ganz tip to right pulmonary artery. No interval change in other cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Pneumothorax chest tube placementVIEW: Chest AP ET tube tip below thoracic inlet and above carina. NG tube tip in the stomach. The umbilical lines are unchanged. Left upper extremity PICC tip at the confluence of the brachiocephalic veins. Cardiothymic silhouette normal. Mediastinal shift from left to right unchanged. There are bilateral pulmonary interstitial emphysema left greater than right unchanged. The moderate size left pneumothorax is unchanged. There are two chest tubes on the left.

Output: Moderate size left pneumothorax not significantly change.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: evaluate for pneumonia History: febrile neutropenia Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient with fevers, hypotension after surgery, complete sepsis workup History: complete sepsis workup, assess for acute abnormality Normal heart size.Small lung volumes with streaky basilar opacities consistent with subsegmental atelectasis.No specific evidence of pneumonia.

Output: Basilar atelectasis, but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p four hour clamp trial of her chest tube History: see above Right chest tube unchanged in position with no evidence of pneumothorax. Subcutaneous emphysema unchanged. Other findings stable in short interval.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Chest pain, sickle cell disease with crisis Left subclavian vascular catheter terminates in the projection of the left brachiocephalic vein to the right of midline. Cardiomediastinal silhouette unchanged in appearance over multiple prior studies. No specific signs of pulmonary edema or pneumonia. No pneumothorax. Subsegmental atelectasis at the lung bases and dependent aspects of the lungs posteriorly. Right basal opacity, most likely atelectasis, is new.

Output: New basilar opacities on the right nonspecific and could reflect atelectasis or developing infection. Short-term follow-up suggested.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with shortness of breath, pleural effusions, and atrial fibrillation LUNGS AND PLEURA: Large bilateral pleural effusions are identified more prominent on the left. Our compressive changes at both lung basesMEDIASTINUM AND HILA: There is marked cardiac enlargement with evidence of a pericardial effusionCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Large bilateral pleural effusions with accompanying marked cardiac enlargement and a pericardial effusion .2. Compressive atelectasis of both lung bases.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: eval for pneumonia, bony abn, fluid on l lung History: L sided chest pain, shortness of breath Stable cardiac mediastinal silhouette with prominence of the pulmonary arteries.Increased lung volumes compatible COPD.Basilar interstitial opacities, more pronounced on the left, similar to the prior exam compatible chronic fibrotic changes.No new pulmonary opacities identified.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Right-sided weakness Decreased lung volumes without additional cardiopulmonary acute abnormality. Diffuse intrahepatic skeletal hyperostosis

Output: Decreased lung volumes without focal disease


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: R/o Pneumonic process History: Course breath sounds Mild cardiomegaly status post sternotomy and valve replacements/repair.No specific evidence of infection or edema.Very small right pleural effusion.

Output: Mild cardiomegaly status post valve replacements/repair, with a small right pleural effusion but no pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Chest pain. Right jugular catheter tip in the projection of the right atrium. Large right pleural fluid collection about the same. The right lower lobe cavitary mass now contains air. Moderate pulmonary edema. New consolidation of the left lower lobe may reflect aspiration or infection. No pneumothorax.

Output: Pulmonary edema with left lower lobe consolidation. Right lower lobe mass now contains air.


Instruction: Generate impression based on medical findings.

Input: Hypoxia, shortness of breath and fever with concern for pneumonia. History of thyroid cancer. Aspirated dense contrast material in the left lower lobe, present previously since the patient's initial exam of 4/30/2016.Chronic volume loss in the right upper lobe with development of irregular endobronchial/peribronchial nodule opacity. Faint nodular opacities in the left upper lobe appears similar in distribution and may been present previously though difficult to confirm by plain film technique. Right apical scarring, query history of radiation therapy to the neck. Scarring at the right lung base. Unchanged cardiomediastinal silhouette

Output: New clustered endobronchial/peribronchial nodular opacities in the right upper lobe which are indeterminate but favored to represent pulmonary sarcoidosis. Aspiration into this lobe is also possible. As the patient has a history of thyroid cancer which can produce endobronchial metastases, this should be evaluated by CT after resolution of acute symptomatology.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: hypoxia History: hypoxia Interval progression of basilar opacities and pleural effusions likely secondary to pulmonary edema. Mild cardiomegaly.No pneumothorax.

Output: Interval development of basilar opacities and pleural effusions likely related to pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Wheezing assess for pneumonia. Bronchial wall thickening but no signs of pneumonia. Normal heart size. Mild prominence of the ascending aortic segment suggesting tortuosity or ectasia.

Output: Bronchial wall thickening but no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: ETT positioning, eval for infiltrate, s/p cardiac arrest History: as above Endotracheal tube terminates approximately 4.5 cm from the carina. Low lung volumes makes detailed cardiopulmonary assessment difficult. Slight increase in basilar opacities, likely atelectasis. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: hx of left partial nephrectomy, please evaluate for disease History: see above Lungs and pleural spaces are clear. Heart size remains normal.

Output: No visible pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.SOB and dyspnea. Lung transplant evaluation, ILD. There appears to be a suture line in the lateral aspect of the right upper lung from prior wedge biopsy or resection.Basal chronic appearing volume loss with mild bronchial dilatation, probable groundglass opacity and consolidation. Mild subpleural thickening in the upper lobes, nonspecific. Normal heart size. Right upper quadrant surgical clips.

Output: Chronic appearing interstitial lung abnormality, described on a recent CT as myositis related ILD overall not appreciably changed. No signs of a superimposed acute process.


Instruction: Generate impression based on medical findings.

Input: 69 years, Female. Reason: 69F with ER+ metastatic breast cancer to bone and liver s/p g tube placement for gastric outlet obstruction from liver mets admitted with concern for acute bowel obstruction; please evaluate History: Nausea, emesis, constipation, obstipation Right chest port tip overlying SVC. No focal lung opacity, pleural effusion or pneumothorax.Gastrostomy tube, abdominal surgical clips, IVC filter and left hip hardware. Paucity of bowel gas, but no definite evidence of obstruction. No pneumoperitoneum or pneumatosis. Average stool burden.

Output: Paucity of bowel gas, but no definite evidence of obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval for metastatic disease History: bladder cancer There is evidence of prior granulomatous disease. The lungs and pleural spaces are clear. The heart size is normal.

Output: No visible pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: SOB, Cough History: Cough SOB The Carty mediastinal silhouette is unremarkable.Focal area of consolidation right middle lobe compatible with aspiration/infection.The left lung is clear.No pleural effusions.

Output: Right middle lobe opacity compatible with aspiration/infection. Neoplasia cannot be excluded. Follow-up examination until resolution is recommended.


Instruction: Generate impression based on medical findings.

Input: 59 years old Male. Reason: infiltrate? History: candidemia. Slightly improved pulmonary basilar opacities compatible with small effusions and atelectasis. Bilateral pleural drains in place. No new findings.

Output: Mild improvement of small effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Repeated vomiting, assess for bowel obstruction Suboptimal study secondary to patient motion artifact. Enteric tube seen with side-port in proximal stomach. Persistent small bowel obstruction with dilated small bowel loops seen with paucity of colonic gas. Pelvic catheter, may be a peritoneal dialysis catheter. Additional tubing overlying patient. Extensive vascular calcifications. Status post sternotomy, partially imaged right-sided cardiac device and leads in right atrium and right ventricle. Spinal degenerative disease.

Output: Persistent SBO.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval for rib fracture and/or pneumothorax History: fall, landed on right lower posterior ribs. Pain with movement and breathing Hyperinflation of lungs again noted. Saber-sheath trachea, as before. Scarlike opacities again noted at the lung bases. Query small right pleural effusion. Mildly displaced right lateral 10th rib fracture.

Output: Mildly displaced right lateral 10th rib fracture. Small right pleural effusion. COPD.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz placement Swan-Ganz remains projected in the right pulmonary outflow tract without interval movement. Underlying cardiopulmonary appearance is also similar with opacity in the left lung base, likely atelectasis given marked nonspecific cardiac megalyLeft subclavian 3-lead ICD unchanged

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrate History: fatigue and cough x 2 weeks. Hx on NICMP Cardiomegaly with small pleural effusions and mild interstitial opacity compatible with edema.Tortuous and heavily calcified aortic arch.Pacemaker leads unchanged from previous. No specific evidence of pneumonia.

Output: Findings consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.History of ASD status post closure March presenting with chest pain left of sternum reproducible. Moderate cardiomegaly with right cardiac chamber enlargement and enlargement of the central pulmonary vasculature suggesting pulmonary hypertension. Small aortic knob.Mild basal scarring and bronchial dilatation nonspecific but could indicate early fibrosis. No specific signs of pulmonary edema. No pneumothorax or focal airspace opacity.

Output: Cardiac configuration consistent with provided history of atrial septal defect. Enlargement of the central pulmonary vasculature is highly suspicious for pulmonary hypertension. Basal opacity could be the result of atelectasis/scarring, though is not specific and may be reevaluated by follow-up PA and lateral chest radiographs at full inspiratory effort when feasible. This should also be correlated with patient's prior medication history as some cardiovascular medications can produce pulmonary toxicity resulting in fibrosis.No acute findings to account for the patient's symptom of chest pain.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: evidence of infection History: fever There are decreased lung volumes with borderline cardiac enlargement.Basilar subsegmental atelectasis without focal areas of consolidation.No large pleural effusions.Extensive degenerative changes of the thoracolumbar spine with mild scoliosis.Cervical stabilization hardware identified.

Output: Low lung volumes with no change in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Fever Interval new patchy mixed interstitial and airspace opacity in both bases greater on the right. Small effusions. Concern for aspiration versus bilateral infection and less likely atelectasis. No gross cardiac or mediastinal contour abnormality

Output: Bilateral nonspecific patchy opacities concerning for infection given patient history as well as possible aspiration