Instruction: Generate impression based on medical findings.

Input: Male, 79 years old. Sepsis, now s/p Dobbhoff placement eval for position. New Dobbhoff tube, located in the airway, with tip in a right lower lobe bronchial branch.The lower pelvis is excluded from the field-of-view. Mild gaseous dilation of small and large bowel, compatible with mild ileus pattern.

Output: Malpositioned Dobbhoff tube as described above.Findings were discussed via telephone with Dr. Gray at 3:45 PM on 12/15/2015.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: PNA? History: sob known HIV see prior CT Diffuse miliary pattern not significantly changed since the prior study.There are no pleural effusions.Cardiomediastinal contour is unremarkable.

Output: Unchanged miliary pattern suggestive of atypical infection including disseminated fungal infection or mycobacterial infection. Follow-up CT recommended to ascertain differences since 2/6/2015.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Borderline cardiomegaly without additional cardiopulmonary abnormality for semiupright portable technique. Please note poor visualization of the upper mediastinum likely due to rotation. Consider serial imaging if there is concern and need for further characterization

Output: Borderline cardiomegaly with limitations described


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: assess for acute process - chest pain History: assess for acute process - chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Shortness of breath Mild cardiomegaly.Interstitial and airspace opacities predominantly in the lung bases.No pleural effusion or pneumothorax.

Output: Mild cardiomegaly with basilar predominant interstitial interspace opacities may represent a mild component of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: Hx of intermitted cough x 3 months History: cough and sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: please re-evaluate for pneumonia History: persistent cough, Dementia, sundowning Right central catheter is unchanged in position. Increased interstitial opacities compatible with mild edema. Small pleural effusions. No consolidation to suggest pneumonia. Cardiomegaly is unchanged. No interval pneumothorax.

Output: Increased interstitial opacities compatible with mild edema. Small pleural effusions. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for acute process History: fever, cough Unremarkable cardiac and mediastinal silhouette.A small nodule questioned in the preliminary report probably represents an end on vascular structure in the left upper lobe.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o new opacity History: new o2 requirement ET tube tip approximately 4 cm above the carina.NG tube tip in the stomach.Mild cardiomegaly and basilar opacity compatible with small effusions and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Repositioned ET tube. Endotracheal tube 5.5-cm above the level of the carina. Other tubes and lines unchanged in position. Small left-sided pneumothorax about the same. Atelectasis and consolidation bilaterally, left greater than right, likely with mild superimposed dependent edema.

Output: Small left pneumothorax. ETT 5-cm above carina.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate pna History: wheezes, SOB, cough Massively enlarged cardiac silhouette, compatible with multichamber cardiomegaly and pericardial effusion.Mild blunting of the right costophrenic angle compatible with a small pleural effusion.Increased upper zone blood flow but no reliable evidence of pulmonary edema or infection.

Output: Massively enlarged cardiac silhouette and a small right pleural effusion, suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: NG tube History: NG tube No significant cardiopulmonary abnormality.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: An NG tube terminates in the stomach.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Patient with consistent productive cough, eval for new consolidation History: see above Stably enlarged heart silhouette.Low lung volumes with coarse interstitial opacities likely representing chronic lung fibrotic changes superimposed on bibasilar cysts.Right fifth pathologic rib fracture deformity is again evident with soft tissue component. The cardiac pacemaker/defibrillator electrodes are stable in position.

Output: Cardiomegaly and bilateral interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: daily am cxr History: daily am cxr Support devices unchanged.Stable cardiomediastinal silhouette.Bilateral pleural effusions and perihilar/basilar edema similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Shortness of breath Mild cardiomegaly is seen. Pulmonary vascularity appears normal. Mild atherosclerotic calcifications and mild tortuosity aorta seen. Lung parenchyma shows no evidence of focal airspace disease or mass lesions. No pleural effusions. Soft tissues and bony structures are pertinent only for degenerative changes throughout the thoracic spine.

Output: No acute cardiopulmonary disease in patient with mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: tube placement, History: tube placement The endotracheal tube terminates approximately 3.5 cm from the carina. Enteric tube terminates within the gastric fundus. Right IJ line terminates in the SVC. Slight increase in the left lower lobe opacity with probable small left pleural effusion. Unchanged mild right basilar atelectasis. Unchanged heart size. No pneumothorax.

Output: Endotracheal tube terminates approximately 3.5 cm from the carina. Slight increase in left lower lobe opacity and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: eval PNA History: productive cough, CP, SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 28 years old Male. Reason: r/o acute chest History: cough, chills, NS in setting of sickle cell pain crisis. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. A calcific density is seen in the right apex.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: r/o infiltrate History: productive cough Lungs and pleural spaces are clear. Cardiovascular mediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: ETT position History: as above Unchanged pulmonary opacities and pleural effusions.ET tube tip approximately 3 cm above the carina.

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


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: cardiac arrest at OSH this pm, transferred intubated History: pulm HTN, normotensive and oxygenating ok The patient is intubated with the endotracheal tube 3 cm above the carina. Left IJ cordis terminates at the inferior left clavicular head. Right IJ central catheter terminates at the superior right atrium.Severe cardiomegaly. Diffuse pulmonary opacities favoring edema with small pleural effusions. Calcified left mammoplasty again noted. No pneumothorax.

Output: Severe cardiomegaly with pulmonary opacities favoring edema. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 50 years old Reason: PNA History: cough/sob Cardiomegaly. Right lower lobe diffuse airspace opacities. Sternotomy wires are noted and intact. No pneumothorax or significant pleural effusion is identified.

Output: Right lower lobe pneumonia. Recommend follow up PA/lateral chest radiographs in 6 weeks.


Instruction: Generate impression based on medical findings.

Input: Dry cough. Melanoma No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Shortness of breath History: Pt reports hx of COPD, but has never been to our ER before. Saying he's had shortness of breath for the past week. There is a bullet in the posterior thoracic wall, left of midline.Low lung volumes with streaky basilar opacities of subsegmental atelectasis. Heart size is accentuated by under inflation. No pneumothorax, significant pleural effusion or evidence of edema. Mild osteophyte formation of the midthoracic spine.

Output: No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: s/p chest tube 11/30 History: hypoxia Right chest tube and second right pleural drain, with a persistent right effusion and consolidation throughout the right lower lung zone.Mild atelectasis left lower lung zone.No significant pneumothorax.

Output: No significant pneumothorax. Stable chest tubes and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: eval for source of chest pain History: chest pain Lungs and pleural spaces are clear. The cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: eval for acute chest in HbSS crisis History: see above .Mild cardiomegaly.Chronic appearing blunting right costophrenic angle.No evidence of acute infection or infarction.Mild sickle cell related skeletal deformities

Output: Mild cardiomegaly. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: LVAD routine chest xray on admission History: Routine xray Support devices and multiple mediastinal surgical staples are unchanged in position. The inflow cannula of the left ventricular assist device is directed cranially, stable over multiple exams.Cardiomegaly is unchanged. Mild pulmonary edema with retrocardiac consolidation. No interval pneumothorax.

Output: Inflow cannula of left ventricular assist device is directed cranially, stable compared to prior. Cardiomegaly is unchanged. Mild pulmonary edema is present.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: intubated History: intubated ET tube tip is 4 cm above the carina.Mild cardiomegaly is unchanged.No pleural effusion or pneumothorax. Basilar opacities may reflect aspirated secretions.

Output: ET tube is in appropriate position.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p right lung biopsy History: s/p right lung lesion biopsy Right apical pneumothorax enlarged from 10 mm to 40 mm.Scattered pulmonary nodules noted.Left subclavian catheter, tip in SVC.

Output: Enlarging right apical pneumothorax, the service was text paged regarding this.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia, cardiomegaly, effusion History: productive cough and sore throat x 5 days Unremarkable cardiac and mediastinal silhouette. Mild basilar scarring but no sign of pneumonia or pleural effusions.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: PICC was pulled back Left-sided PICC has been pulled back slightly and now terminates over the medial aspect of the left clavicle possibly within the left subclavian vein. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. Small left pleural effusion. No pneumothorax. Aortic stent again noted.

Output: Left-sided PICC has been pulled back slightly and now terminates over the medial aspect of the left clavicle possibly within the left subclavian vein.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with aortic root dilatation on echocardiogram. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No evidence of enlarged lymph nodes in the mediastinum.Descending aorta measures 3.7-cm in its greatest dimension. Descending thoracic aorta measures 2.6-cm. The aortic arch measures 2.5-cm in its greatest AP dimension.There are calcifications involving the aortic valve cusps.Focal dilatation of the ascending aorta at the level of the origin of the left corner artery represents sinus of Valsalva aneurysm. Significant calcifications along the LAD is suspicious for more than 50% stenosis. Mild atherosclerotic calcifications are also seen in the right coronary artery. This study is not tailored for imaging of the coronary arteries.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: 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.

Output: Possible left-sided sinus of Valsalva aneurysm. Severe atherosclerotic changes involving the left anterior descending artery and right coronary arteries branches. Calcifications at the aortic valve.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: Fever No acute cardiopulmonary abnormalities are identified. No specific evidence of infection or edema. Mild chronic interstitial abnormality. Borderline cardiomegaly with adjacent suspected atelectasis.Vascular stent noted in the right axilla.Minimal retained contrast in the splenic flexure.

Output: No acute new disease with interval increasing aeration of the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Extreme prematurity with acidemia. Evaluate for pneumothorax.VIEW: Chest and abdomen AP (2 views) 5/2/2016 at 1242 hours. ET tube tip is below thoracic inlet. Umbilical lines and both left-sided chest tubes unchanged. Interval redevelopment of left sided tension pneumothorax with mediastinal shift. Lung haziness unchanged. Cardiac silhouette size is normal.The abdomen is gasless.

Output: Interval development of left-sided tension pneumothorax.Findings were communicated to and acknowledged by Dr. QADIR, ASAD on 5/2/2016 at 12:53 PM


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with CLL. The previously known lymphadenopathy. Please repeat CT to compared August 2008 study. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Extensive mediastinal adenopathy. Reference left paratracheal lymph node has increased in size and currently measures 2.2 x 1.5 cm (image 21; series 4).CHEST WALL: Bilateral axillary adenopathy. Reference right axillary node has increased in size minimally and measures 1.8 x 1.2 cm (image 24).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: Stable retroperitoneal lymph nodes. The reference portacaval lymph node measures 2.9 x 2.0 cm (image 99; series 4).BOWEL, MESENTERY: Stable extensive mesenteric adenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Extensive pelvic adenopathy. Right obturator lymph node measures 3.8 x 1.6 cm which is minimally increased compared to prior (image 154).BOWEL, MESENTERY: Wall thickening of the cecum described previously is less prominent on today's exam but difficult to evaluate due to lack of enteric contrast in this region.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Extensive lymphadenopathy. Slight interval enlargement of several of the reference lymph nodes.


Instruction: Generate impression based on medical findings.

Input: CHEST: Examination limited by field of view and range of coverage.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.Calcified mediastinal and hilar lymph nodes are noted consistent with prior granulomatous disease.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality noted in the extracardiovascular portions of the examination.


Instruction: Generate impression based on medical findings.

Input: Chest pain, vaginal pain, SOB. Evaluate for evidence of pneumonia or other causes for chest pain/SOB. Low lung volumes and chronic elevation of the right hemidiaphragm markedly limits assessment for pulmonary metastases. Scarring in the right lung base. Patchy opacity in the right upper lobe similar to earlier radiograph of 12/20/2015. Scarring and atelectasis in the left lung unchanged. Cardiomediastinal silhouette unchanged in appearance.

Output: No acute pulmonary abnormality. The findings appear chronic. Please note that pulmonary metastases cannot be reliably excluded by this examination in this patient with known neoplasm.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval for FL OL History: diminished basal breath sounds, SOB, Cardiomegaly with left lower lobe consolidation and left pleural effusion unchanged.Slight increasing opacity at the periphery of the right lung.

Output: Persistent left-sided opacities increasing right peripheral opacity suggestive of infection, although the latter could indicate infarction.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old. History: cough and dyspnea There is cardiomegaly and a left-sided pleural effusion.The left diaphragm is obscured by basilar consolidation/atelectasis.The right lung is clear.

Output: Cardiomegaly and left effusion with basilar atelectasis and consolidation.


Instruction: Generate impression based on medical findings.

Input: Male 43 years old Reason: cardiomegaly, effusion, pneumonia History: stroke workup, left sided weakness, facial droop, slurred speech No focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal contours are within normal limits for size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Pleural effusion, no symptoms Marked interval decrease in size in now moderate left effusion is observed, suggesting interval partial resolution and/or thoracentesis. No immediate postprocedural complications if a procedure was performed. Overlying atelectasisPersistent Cardiomegaly with otherwise clear lungs

Output: Decreasing size of but is now a moderate left pleural effusion


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Confirm accurate placement of L IJ central line History: New Left IJ placement Interval placement right IJ central catheter terminating at the superior caval atrial junction. Nasogastric and tracheostomy tubes unchanged in position.Overlying blanket generates some artifact; however, no interval consolidation is identified. The heart size remains normal. No pneumothorax.

Output: No pneumothorax following right IJ central line placement.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: ETT History: ETT Small lung volumes with increasing basilar consolidation.ETT tip 3 cm above the carina.An NG tube extends below the lower margin of the image.Right subclavian catheter tip in SVC.

Output: Worsening basilar consolidation possibly infection or aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: known sarcoidosis evaluation for pneumonia History: productive cough Heart size upper normal.Moderate size hiatal hernia.No significant pulmonary or pleural abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Tachypnea, retractions, peripheral edema and crackles on lung exam. Right jugular catheter tip projects over the right atrium. Moderate to large pleural effusions about the same. Patchy airspace opacities bilaterally increased from prior and may be the result of aspiration or infection.

Output: CHF with superimposed airspace opacity suspicious for aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old. Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Increase in diffuse pulmonary opacities. Mild cardiomegaly again noted. No large pleural effusion or pneumothorax.

Output: Increase in diffuse pulmonary opacities, most consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: 45F post total proctocolectomy with fever History: fever Free intraperitoneal air consistent with recent surgery.No sign of pneumonia or other significant cardiopulmonary findings.

Output: No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: HFOVVIEW: Chest AP ET tube tip is below the thoracic inlet. NG tube tip is in the stomach. The umbilical venous catheter tip is in the right atrium. Right chest tube tip is in the mid right lung. There is a small right pneumothorax unchanged. There are hazy pulmonary opacities. Cardiothymic silhouette normal. No pleural effusion.

Output: Small subpulmonic pneumothorax unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Sternal closure, open chest protocol. Surgical counts correct. Interval removal of surgical pads previously seen. No unexpected radiopaque foreign objects are identified.Endotracheal tube tip 3.5 seen above the level of the carina. Right jugular Swan-Ganz catheter terminates at the right main pulmonary artery. Mediastinal drains and bilateral basal chest tubes in place. Interval placement of sternal closure hardware. Right PICC and subclavian vein projection. Orphaned ICD coil in the left brachiocephalic/SVC projection.Small 6 mm right apical pneumothorax.Small pleural effusions and mild basal atelectasis.No specific evidence of edema.

Output: No unexpected radiopaque foreign body. Findings were relayed to Dr. Onsanger, the attending surgeon, by telephone at 5:18 p.m. on 9/26/2016 by the radiology resident on call.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: shock, cough, eval for infiltrate History: see above Cardiomegaly is unchanged. Left basilar consolidation is increased with increasing layering bilateral pleural effusions, large on the left and moderate on the right. Right IJ catheter tip at the junction of the IVC and right atrium.

Output: Increasing bilateral pleural effusions and left basilar consolidation/atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: S/P RIGHT THORACOTOMY History: NA Two right apically directed chest tubes unchanged in position.Interval decreased lung volumes with basilar opacities of atelectasis and possible trace pleural effusions. Stable osseous postsurgical changes. No significant pneumothorax. Decreased subcutaneous emphysema right infralateral chest wall.

Output: No pneumothorax in the setting of two chest tubes.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Swan placement. Right jugular Swan-Ganz catheter tip at the right main pulmonary artery. No pneumothorax.Left jugular catheter terminates at the superior cavoatrial junction, unchanged.Unchanged left subclavian ICD.Mild interstitial edema and a small right pleural effusion, about the same.

Output: Right jugular SGC tip at the right main pulmonary artery, no pneumothorax. Mild CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.SOB, history of pleural effusion, history of breast cancer. Elevation of the right hemidiaphragm. Loculated appearing right pleural fluid collection increased in volume, now moderate to large. Much of the right lower and middle lobes are collapsed. Left lung is well-inflated. Small left pleural fluid collection unchanged, no acute parenchymal abnormalities on the left.Right lower paratracheal contour abnormality may indicate lymphadenopathy, and there appears to be new elevation of the right hemidiaphragm, suspicious for right phrenic nerve paralysis.Right subclavian chest port tip at the SVC level.Scoliosis.

Output: Large loculated appearing right pleural fluid collection. If thoracentesis is attempted, suggest utilization of ultrasound assistance given apparent diaphragmatic elevation.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: Evaluate for PNA History: shortness of breath Unremarkable mediastinal silhouette. The heart size is normal. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Tachypnea, c/f aspiration; NGT placement History: above Interval placement of enteric tube with tip in the stomach and side-port at the GE junction. Recommend advancing nasogastric tube.Stable cardiomegaly with mild basilar opacities suggesting atelectasis.No definite effusion. No pneumothorax.Line position stable.

Output: Stable cardiomegaly with basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.History: cough and low grade fever with history of ABPA and underlying bronchiectasis and no response to 3 days of 40 mg prednisone. Evaluate for underlying pneumonia. The lungs are mildly hyperinflated however no focal airspace opacities are identified. The heart size is within normal limits. No pneumothorax. Small bilateral effusions.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: MaleReason for Study: Reason: 81 y/o male with fever/mucositis r/o pneumonia History: fever Left Port-A-Cath with its tip in the SVC.The cardiac mediastinal silhouette is unremarkable.Minimal basilar scarring/discoid atelectasis.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: new o2 requirement, decreased air movement RLL History: new o2 requirement, decreased air movement RLL Stable position right IJ central catheter that terminates in the right atrium.Loculated right inferior hydropneumothorax with slight increased volume of fluid. Innumerable pulmonary nodules throughout both lungs are compatible with metastases, unchanged. No pneumothorax. Lucency at the abdominal midline may represent residual pneumoperitoneum.

Output: Slight increased volume of fluid within the loculated right inferior hydropneumothorax. Lucency abdominal midline may represent minimal residual pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: r/o infiltrate, malignancy History: hx of breast cancer, pt with chest discomfort Right central venous catheter with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Surgical clips noted in the left axillary region and evidence of a left mastectomy.

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


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: eval widened mediastinum History: back pressure radiating to chest, syncope Mild cardiomegaly with pulmonary vasculature at upper limits normal.Hyperexpansion lung fields with flattening of diaphragm, findings indicating COPD.No evidence of airspace opacities.7-mm right upper lobe calcified granuloma.

Output: Mild cardiomegaly with findings of COPD. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.History: Seizure disorder Unremarkable cardiomediastinal silhouette.Streaky right lower lobe opacities, consistent with subsegmental atelectasis. No focal consolidation.No pleural effusions or pneumothorax.

Output: Right lower lobe subsegmental atelectasis. No pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval lung fields History: s/p IABP Stable life support devices, including non typical linear radiopaque marker of an IABP. Small metallic ringlike density is again present projecting just below the aortic knob. Status post median sternotomy with multiple surgical clips overlying the mediastinum. Stable enlarged cardiac silhouette.Mild perihilar congestion with minimal edema, grossly unchanged. Mild worsening left retrocardiac atelectasis. No pneumothorax.

Output: No significant interval changes as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: r/o infectious process History: fever, tachycardia The right port remains accessed with the catheter terminating at the right superior caval atrial junction.Interval decreased lung volumes with lower zone opacities favoring subsegmental atelectasis. Cardiac contour is accentuated by portable technique and rightward rotation. Recommend straight PA and lateral radiograph when the patient can tolerate for further evaluation of heart size..

Output: No specific evidence of infection. Heart size is enlarged compared to prior which may be attributed to rotation and magnification. Recommend PA and lateral radiograph for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Cough and history of asbestos exposure. Normal cardiomediastinal silhouette. Low normal lung volumes. No focal pulmonary opacities. Mild blunting of the posterior costophrenic angles, but no visible pleural thickening or fluid.

Output: Low normal lung volumes, but no acute pulmonary abnormality. No visible pleural thickening.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pna History: hyperglycemia Normal heart size with a moderately tortuous aorta.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: pna? History: infectious workup Stable cardiomediastinal silhouette. Prosthetic mitral valve. No focal air space opacities or pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: 74 y/o intubated History: intubated` Enlarging left pleural effusion and stable right.Unchanged left lower lobe consolidation and cardiomegaly.ET tube tip approximately 3 cm above the carina.

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


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: pna Unremarkable cardiac and mediastinal silhouette. Hypovascular upper lungs suggestive of emphysema with chronic interstitial disease in the lower lungs.No specific evidence of pneumonia.

Output: Findings consistent with combined pulmonary fibrosis and emphysema as previously confirmed by CT scan. No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: aspiration pneumonitis History: shortness of breath. Chronic appearing right hemidiaphragm elevation or eventration.Small left pleural effusion.Heart size within normal limits.

Output: No specific evidence of infection or interval change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Improved technique decreases sensitivity, however mild motion again degrades sensitivityNasogastric tube is new, side port is seen 3 cm above the GE junction.Cardiopulmonary appearance is otherwise again significant for decreased volumes, moderate nonspecific cardiomegaly and streaky densities in both bases suggesting atelectasis. Vascular redistribution more likely due to semiupright positioning

Output: NG tube placed


Instruction: Generate impression based on medical findings.

Input: Hypoxia Dobbhoff remains under advanced, tip projects just at or beyond the GE junction. Left catheter extends into the dominantCardiopulmonary appearance otherwise similar with right basilar changes suggesting a small effusion and possibly edema versus aspiration. Mild left to right mediastinal shift and asymmetry in lung volumes similar to prior. See subsequent report

Output: Dobbhoff unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: LVAD History: LVAD Left ICD lead positions and LVAD are stable. Median sternotomy hardware.Cardiomegaly is stable. Blunting of the left costophrenic angle likely represents a small effusion. No focal lung opacity or pneumothorax.

Output: Cardiomegaly with a small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: pre-op evaluation per OSH ortho request for TKR History: see above The heart size is normal. The lungs are clear. No pleural effusion or pneumothorax. No focal pulmonary consolidation. Degenerative disc disease in the thoracic spine.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Giant cell tumor of left proximal tibia, s/p curettage, evaluate for metastasis History: above No evidence of metastatic disease.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: hypoxemia History: hypoxemia Right central venous catheter has been placed with its tip in the SVC.Stable cardiac mediastinal silhouette.Perihilar opacities, pleural effusions, basilar atelectasis similar to the prior exam.

Output: Right central venous catheter placed without complication. No significant change in the pleural effusions and edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pacer leads History: AICD discharge Marked cardiomegaly with ICD leads in place, unchanged. Leads terminate in the area of the right atrial appendage, right ventricular apex and a left ventricular vein.Pulmonary vascular redistribution and mild basilar interstitial opacity with septal lines consistent with edema.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: LVAD History: LVAD Iatrogenic devices are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Increased left basilar atelectasis. No substantial change in right basilar pleural parenchymal opacity. Unchanged cardiomegaly. No pneumothorax.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Increased left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female 21 years old Reason: r/o pna, edema, effusion History: wheezing, asthma No focal airspace opacities to suggest acute infection.Perihilar bronchial wall thickening consistent with asthma.The cardiomediastinal silhouette is normal.

Output: Perihilar bronchial wall thickening consistent with asthma, but without specific evidence of superimposed infection or edema.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: Right neck mass positive for non-small cell cancer with unknown primary. History of malignant melanoma. LUNGS AND PLEURA: Mild paraspinous scarring in the right lower lobe. No significant pulmonary nodules or effusions.MEDIASTINUM AND HILA: No significant lymphadenopathy.Moderate coronary artery calcifications.CHEST WALL: Degenerative abnormalities in the spine. No skeletal metastases.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: r/o acute process History: left sided chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Status post cholecystectomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Shortness of breath, pre-operative evaluation for polycystic kidney. Very low lung volumes, decreased from the previous study. Elevation of the right hemidiaphragm has worsened since the examination of 2011. Linear scarring or atelectasis on the left with mild pleural thickening or fluid new from previous plain film of 2011. Discontinuous calcifications in the right upper quadrant which may correlate to patient's polycystic kidney disease.

Output: Mild residual pleural thickening or loculated fluid on the left, new from 2011 but probably decreased from the amount seen on abdominal CT dated 1/13/2014. Query history of previous pleural/chest wall hematoma.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: eval lung fields History: s/p MVR Chest/mediastinal tubes and right IJ venous catheter unchanged.No evidence of pneumothorax.Stable cardiac enlargement.Small left pleural effusion mild pulmonary edema similar to the prior exam.

Output: Stable cardiopulmonary appearance with cardiomegaly, small effusions, and mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: worsening hypoxemia History: see above Tracheostomy tube in place. Right arm PICC, tip in the SVC.Cardiomediastinal silhouette is unchanged.Status post right pneumonectomy and right chest wall resection with radiopaque packing material in the right hemithorax. Diffuse patchy interstitial and airspace opacities throughout the left lung, not significantly changed allowing for differences in positioning.Significant gaseous distention of the stomach.

Output: Patchy opacities throughout the left lung suggestive of pneumonia. Postsurgical changes of right pneumonectomy, right chest wall resection, with radiopaque packing material in the right hemithorax.


Instruction: Generate impression based on medical findings.

Input: Reason: fever History: fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Bilateral catheters extending to the SVC.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female who presents with cough. Limited exam due to patient rotation.Stable mild cardiomegaly, accounting for differences in patient positioning.Elevation of the right hemidiaphragm with streaky opacification at the right lung base, likely representing atelectasis. No large pleural effusion or pneumothorax.Median sternotomy fixation hardware in place. Status post mitral valve repair.

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


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with pancytopenia. Evaluate for lymphoproliferative disease. Additional history: Liver transplantation; colonoscopy complicated by perforation requiring colostomy Absence of IV contrast limits evaluation of the visceral organs.CHEST:LUNGS AND PLEURA: Minimal calcified pleural plaque is identified. Scattered tree in bud opacities are seen throughout both lungs with minimal patchy ground glass opacities. Mild scattered bronchiectasis is also identified. A patchy opacity is noted in the right lung base. Trace left pleural effusion.MEDIASTINUM AND HILA: Small mediastinal nodes are visualized. Calcified mediastinal and right hilar lymph nodes are identified. Small pericardial effusion. Mild coronary calcifications are seen. Visualization of the cardiac walls suggest anemia.CHEST WALL: Subcentimeter hypodensity is noted in the left lobe of the thyroid gland.ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant. The gallbladder is absent. Sutures are noted around the IVC at its confluence with the hepatic veins. SPLEEN: Numerous splenic granulomas are seen.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: Mild thickening and distortion effects the terminal ileum without evidence of obstruction.BONES, SOFT TISSUES: Focal bulge is seen in the ventral abdominal wall without a definite defect.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is absent. Trace free fluid is identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sutures are noted at the rectosigmoid junction. A few diverticula are seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Vascular calcifications are seen.

Output: Limited examination due to the lack of IV contrast. Tree-in-bud pulmonary opacities can be infectious versus inflammatory in natureStatus post liver transplant.No evidence of adenopathy.Distortion and thickening of the terminal ileum could be due to adhesions, though there is no evidence of obstruction.


Instruction: Generate impression based on medical findings.

Input: Esophageal tear and emesis. Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 18 year-old female with history of PNET of the liver. On therapy evaluation. CHEST:LUNGS AND PLEURA: Small nodular density is seen posteromedially in the right lower lobe (series 4, image 75), which may represent residual disease/atelectasis as seen on prior CT from 3/13/2009. No other lesions or suspicious nodules are identified. No pleural effusion is noted.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: Left parasternal chest wall Port-A-Cath has its tip in SVC. ABDOMEN:LIVER, BILIARY TRACT: The previously seen, heterogeneously enhancing lesion with internal areas of necrosis as well as calcifications is reidentified in the right hepatic lobe, which abuts but does not appear to invade the IVC. It is significantly smaller in size on comparison to prior study from 3/24/2009. The portal vasculature is patent, and no biliary ductal dilatation is seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Inferior displacement of right kidney has improved with the decrease in the size of the hepatic lesion. Renal vasculature appears to be patent without evidence of thrombus. Normal left kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Interval decrease in size of the right hepatic tumor. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: hypoxia History: hypoxia Interval development of bilateral interstitial opacities and bilateral pleural effusions. Cardiac silhouette however remains within normal size.No pneumothorax

Output: Interval development of bilateral, prominent interstitial opacities with bilateral pleural effusions likely representing pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: poss pna History: cough Unremarkable cardiac and mediastinal silhouettes. No specific evidence of infection or failure.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 40 year-old male. Reason: chronic nausea, h/o achalasia diagnosed earlier this year History: chronic nausea, h/o achalasia diagnosed earlier this year Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. No evidence of achalasia. During the exam, provoked gastroesophageal reflux was observed to the level of the thoracic outlet which cleared only with upright positioning. Fluoroscopic evaluation of esophageal peristalsis demonstrated moderate esophageal dysmotility with breakup of the primary wave and mild dilatation and tortuosity of the esophagus. An apparent obliquely oriented indentation in the upper thoracic esophagus is likely a result of the reflux-related changes as described above. A vascular ring is less likely due to lack of specific symptoms, but could have similar appearance.A swallowed barium pill was transiently delayed at a physiologic location and readily passed into the stomach with small sips of water.TOTAL FLUOROSCOPY TIME: 7:42 minutes

Output: 1. No evidence of achalasia.2. Provoked gastroesophageal reflux was observed to the level of the thoracic outlet which cleared only with upright positioning. 3. Moderate esophageal dysmotility with breakup of the primary wave and mild dilatation and tortuosity of the esophagus, likely a result of the reflux-related changes as described above.Findings were discussed via telephone with Dr Singh at 4:15 PM.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: infectious workup History: cough, altered mental status Cardiomediastinal silhouette is normal. Lungs clear airspace and interstitial opacities. No pleural effusions. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: pt with chest tube History: chest tube, hypoxia Large right pleural effusion, slightly increased. Right-sided chest tube remains in place. Left basilar scarring no pneumothorax. Left basilar scarring or atelectasis with small left pleural effusion again noted.

Output: Large right pleural effusion, slightly increased. Right-sided chest tube remains in place


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: iabp, picc History: iabp, picc Left upper extremity PICC with tip in the left brachiocephalic vein. IABP marker position unchanged. Right PleurX catheter stable in position. Curvilinear line projecting over the left apex has the appearance of an artifact rather than a pneumothorax and is unchanged when compared to the prior study.Stable cardiomegaly. No significant effusions at this time. Mild basilar opacities persist.

Output: Decrease in right effusion. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Cough and fever rule out lung infection. Unchanged lingular opacity, favored to represent atelectasis but nonspecific. New focal nodular basal opacities on the right. Normal heart size. No pleural fluid or pneumothorax.

Output: Basal opacities nonspecific but may be sequela of aspiration/ infection. Suggest follow-up chest radiograph in 6 weeks to assess for clearance.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: aortic balloon pump placement History: balloon pump Mild cardiomegaly status post sternotomy.Small right pleural effusion with overlying atelectasis.IABP catheter proximal marker projects over the aortic arch.Left PICC, tip in the SVC.

Output: Right pleural effusion and overlying atelectasis. IABP catheter unchanged.


Instruction: Generate impression based on medical findings.

Input: 83-year-old male with highly elevated PSA and an prostate cancer. Please stage. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Enlarged scattered mediastinal lymph nodes. Reference node measures 1.1 cm x 2.5 cm (image 18, series 3). Calcified right hilar lymph node. Bilateral enlarged superior intercostal veins is of unknown significance.CHEST WALL/RIBS: A small focus of calcific hyperattenuation in the lateral 11th right rib is of unknown clinical significance. Please correlate this finding with the bone scan.ABDOMEN:LIVER, BILIARY TRACT: A few small subcentimeter hypodense lesions in the right hepatic lobe are too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral round homogeneously hypodense lesions of varying sizes. These most likely represent simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic calcifications of the aorta and its branches.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: Bladder wall is thickened, likely secondary to chronic bladder outlet obstruction.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Enlarged mediastinal lymph nodes with reference node as measured above.2. Nonspecific focus of hyperattenuation in the 11th rib. Please correlate this finding with the bone scan.3. Bilateral renal cysts


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Pain on respiration, usually at night with sleep. History of bronchiectasis with new onset right-sided intermittent rib/lung pain. Mild bronchiectasis and moderate basilar bronchial wall thickening about the same. No focal airspace opacities, pleural fluid or pneumothorax. Chronic blunting of the costophrenic angles. Plate and screw sternal closure device.Moderate degenerative changes of the spine. Lucency immediately below the level of surgical clips compatible with an anterior intercostal/parasternal lung hernia.

Output: Tiny right anterior intercostal hernia may be the source of the patient's pain, this occurs just above the level of the sternal closure device (below the right anterior second rib).


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: 59F with h/o tobacco abuse, p/w STEMI s/p PCI, c/o acute SOB and abdominal pain History: 59F with h/o tobacco abuse, p/w STEMI s/p PCI, c/o acute SOB and abdominal pain Left lower lobe focal atelectasis possibly from aspirated secretions.Follow-up CT showed small pleural effusions.Heart size upper normal.

Output: Heart size upper normal, with focal atelectasis left lower lobe. No reliable evidence of edema although a follow-up CT showed small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Persistent cough 1 month. Faint patchy foci of bronchial wall thickening in the lower lung zones may be the result of aspiration or bronchitis.No pleural fluid or pneumothorax. Normal heart size.

Output: Faint nonspecific opacities, favor sequela of aspiration. Follow-up PA and lateral chest radiographs may be obtained in a few weeks if the patient remains symptomatic


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Reference ureters are lymph nodes are significantly smaller. Superior mediastinal lymph node now measures 18 x 11 mm image number 18, series number 3.CHEST WALL: Postsurgical changes in the right axilla again noted. Right axillary lymph nodes are significantly smaller. Reference lymph nodes now measures 6 by 8mm image number 31, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypodense area around the falciform ligament has developed within the interval. The shape angiographic appearance is very atypical for metastatic disease. This may represent focal fat infiltration. However, metastatic disease cannot be entirely excluded. For reference it measures 2.6 x 2.2 cm image number 92, series number 3. No other new hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node is smaller now measures 10 x 10 mm image number 117, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small fibroids in the uterus are unchanged.BLADDER: Small pelvic lymph nodes are unchanged.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The appearance of the right iliac bone lesion is unchanged. OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the mediastinal and axillary lymph nodes.Interval development of a large hypodense lesion in the liver. Its shape angiographic pattern is very atypical for metastatic disease. This may represent focal fatty infiltration versus metastatic disease. MRI is recommended for further evaluation.Right iliac lesion is unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: as above Tracheostomy tube and venous catheter unchanged.Extensive nonspecific pulmonary opacity with bilateral partly loculated pleural effusions.Interval removal of a right pigtail catheter.No pneumothorax or other acute change.

Output: Diffuse nonspecific pulmonary opacity and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old with fever, chills, cough and chest congestion and history of pneumonia. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: s/p central line placement History: s/p central line placement Interval placement of right IJ catheter with tip in the right brachiocephalic vein.Stable cardiomegaly.Stable calcified left mid lung granulomas.Interval improvement in interstitial opacities and pleural effusions.Bibasilar streaky opacities similar in appearance from prior exam.No evidence pneumothorax.

Output: Interval placement of right IJ catheter with tip in right brachiocephalic vein. No evidence of pneumothorax.Interval improvement in pulmonary edema with stable bibasilar atelectasis and/or scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: evaluate lung function History: NSTEMI Right PICC tip at RA/SVC junction.Increased pulmonary edema and bilateral pleural effusions.

Output: Increased pulmonary edema and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval for pneumo, post-op complication History: CRT placement today Right atrial cardiac lead again is pointed inferiorly which is not the typical appearance of this lead. Presumed right ventricular lead overlies expected location of the RV. Patient is status post MVR. No change in patchy right basilar opacity and small right pleural effusion. Unchanged marked cardiomegaly. No definite pneumothorax.

Output: Right atrial cardiac lead again is pointed inferiorly which is not the typical appearance of this lead. Otherwise, no substantial difference compared to last study.


Instruction: Generate impression based on medical findings.

Input: Female 52 years old Reason: sob Right internal jugular central venous catheter tip terminates at the cavoatrial junction.Left subclavian AICD/pacemaker device with position unchanged.Resolution of bibasilar interstitial opacities and pleural effusions, with subtle persistent septal lines consistent with improved pulmonary edema.Cardiomegaly unchanged.

Output: Resolving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: pt with increased O2 requirements, now hypothermic History: hypotension Worsening basilar opacities and pleural effusions following extubation.Heart size unremarkable.NG tube removed.

Output: Worsening basilar opacities and pleural effusions following extubation.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: pleural effusion Cardiopulmonary monitoring and support devices, unchanged.Left loculated effusion, unchanged or slightly decreased with underlying left lower lobe atelectasis.Moderate right effusion and atelectasis.

Output: Pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Tunica vaginalis mesothelioma status post orchiectomy. Evaluate extent of disease and compare to previous.. CHEST:LUNGS AND PLEURA: New 7 x 6 mm left lingular pulmonary nodule (image 50; series 5). Given history, this should be regarded as a metastasis until proven otherwise. A small primary lung carcinoma is a second consideration although the nodule has relatively smooth margins rather than being spiculated. Biapical pleural scarring, unchanged. Right pleural thickening (image 63; series 5) stable.MEDIASTINUM AND HILA: Complex right lobe thyroid nodule is unchanged measuring 2.5 x 1.8 cm (image 16; series 3). Subcentimeter mediastinal lymph nodes unchanged.CHEST WALL: Metallic screws in right humeral head. Bilateral gynecomastia. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral small cysts are stable. RETROPERITONEUM, LYMPH NODES: Nonspecific retroperitoneal lymph nodes are unchanged. No lymphadenopathy. No nodes larger than 1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged heterogeneous prostate gland. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Postsurgical changes in the right groin.

Output: New 7-mm left upper lobe pulmonary nodule concerning for metastatic lesion. No substantial change in right thyroid complex nodule.Findings discussed with Dr. Kindler at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 36 years old Male. Reason: Evaluate for acute infection History: fevers, chill. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: pneumonia History: cough, weakness, history of lung transplant Single prior median sternotomy wire noted. Surgical clips project over the hilum of the lungs bilaterally.The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: Changes of a bilateral lung transplant without evidence of superimposed cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: Stg I testicular cancer, evaluate for recurrence History: testicular cancer Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: evalaute for interval change in opacity History: opacity on OSH CT and prior XR Focal subpleural airspace opacity in the right upper lobe, new since the previous radiograph, suggestive of an infectious or embolic etiology.Unremarkable cardiac and mediastinal silhouette. Blunting of the right costophrenic angle posteriorly and pleural opacity superolaterally, consistent with a small effusion.

Output: Right upper lobe subpleural opacity with a small right pleural effusion, suggestive of pulmonary infection or infarct.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: cough and wheezing for 1 week History: cough and wheezing for 1 week Some scarring lower lung zone scarring or subsegmental atelectasis.Heart size normal.No specific evidence of infection or edema.

Output: Basilar scarring or subsegmental atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: pulmonary edema with known limb ischemia History: intubated on pressor ET tube and right IJ venous catheter unchanged.Interval retraction of the NG tube with the side port at the GE junction.Stable cardiac enlargement.Extensive pulmonary opacities and pleural effusions with slight interval progression.

Output: Increasing pulmonary edema with pleural effusions and basilar atelectasis. NG tube mildly retracted with its side port at the GE junction.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate R pleural effusion History: sob Marked cardiomegaly and bilateral pleural effusions considerably larger on the right with a chest tube projected over the right costophrenic angle.Underlying basilar atelectasis, not significantly changed allowing for differences in positioning and inflation.Intact sternal fixation devices.

Output: Bilateral pleural effusions, larger on the right, without significant change.


Instruction: Generate impression based on medical findings.

Input: Endometrial cancer.. Assess disease process. CHEST:LUNGS AND PLEURA: A few scattered calcified and noncalcified micronodules are unchanged. No new suspicious nodules consolidation or effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Segment 6 low attenuation lesion is unchanged measuring 11 x 9 mm on image number 107, series number 4.SPLEEN: No significant abnormality noted.PANCREAS: Fatty replacement of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple punctate nonobstructing stones in the right kidney unchanged.RETROPERITONEUM, LYMPH NODES: Reference left upper quadrant peritoneal deposit measures 4-mm image number 124, series number 4. Other scattered mesenteric deposits are also smaller.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing ventral abdominal hernia is unchanged. Left lower quadrant bowel-containing hernia is also unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged bilateral inguinal lymph nodes, more prominent on the left are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable study.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p CABG History: s/p CABG Moderate cardiomegaly with basilar atelectasis and bilateral pleural effusions, partly loculated on the left.Catheter tip in the SVC.No pneumothorax or other acute change.

Output: Cardiomegaly, atelectasis and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: intubation History: intubation ET tube tip approximately 5 cm above the carina.Venous catheter from the right now extending across the midline with its tip in the left brachiocephalic vein.Right chest tubes in place with a small loculated right subpulmonic pneumothorax.Diffuse right lung opacity compatible with edema, atelectasis and effusion.Focal consolidation and atelectasis in the left lower lobe, increased.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for CHF History: SOB Normal heart size with a single lead ICD device extending to the area of the apex of the right ventricle.Spinal stimulator device in place, unchanged. No evidence of CHF or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with abdominal pain and diarrhea. Evaluate pelvic mass. CHEST:LUNGS AND PLEURA: Scattered micronodules. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Well-defined hypoattenuating lesion in the left hepatic lobe; probable cyst. The portal and hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts incompletely evaluated on this study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Long segment bowel wall thickening of the sigmoid colon with adjacent stranding. Additionally, there are two, complex, gas-containing collections within the mesentery anteriorly, consistent with abscesses. One extends to the anterior abdominal wall while the other extends inferiorly towards the bladder. The bladder wall is also thickened, and while no foci of air seen within the bladder, a colovesicular fistula cannot be entirely excluded with this study.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Bladder wall thickening from adjacent abscess. Please see above.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Sigmoid colonic wall thickening with adjacent stranding and abscesses as above.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Long segment bowel wall thickening of the sigmoid colon with perforation and adjacent stranding and complex abscesses as detailed above. While findings may be secondary to colitis complicated by perforation, an underlying neoplasm is also a consideration. Therefore, correlation with endoscopy is recommended when acute symptoms have resolved.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: MaleReason for Study: Reason: history of treated TB History: none The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: rule out chest metastasis History: renal cell carcinoma, post partial nephrectomy Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Images are slightly limited by patient motion. The axial gradient echo images are essentially nondiagnostic. The cervical spine is in normal alignment, with a normal cervical lordosis. There is minimal disk narrowing C5-C6. There is mild diffuse disk desiccation. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is a mildly heterogeneous appearance of the bone marrow which is nonspecific. The spinal cord is of normal caliber and signal. There is mild diffuse developmental narrowing of the cervical spinal canal due to shortened pedicles.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is a minimal central disk protrusion which indents ventral thecal sac and minimally flattens the left ventral cord. There is no significant stenosis.At C4-C5, there is a mild diffuse posterior osteophyte disk complex with ligamentum flavum thickening. There is moderate spinal stenosis with indentation of the ventral cord.At C5-C6, there is a minimal posterior osteophyte disk complex with right paracentral prominence and a small superimposed right proximal foraminal disk extrusion which minimally migrates cranially and caudally. There is mild to moderate central spinal canal stenosis. There is right greater than left uncovertebral hypertrophy with overall moderate-severe right foraminal narrowing.At C6-C7, there is a left foraminal disk protrusion superimposed upon a minimal left paracentral/foraminal posterior osteophyte disk complex. There is left uncovertebral hypertrophy resulting in overall moderate to severe left foraminal narrowing.At C7-T1, there is a tiny central disk extrusion which migrates minimally cranially.Sagittal images suggest a minimal central disk extrusion at T1-T2 which migrates cranially and caudally.

Output: Developmental narrowing of the cervical spinal canal with superimposed mild spondylotic changes overall. Resultant moderate-severe left foraminal narrowing at C6-C7 and on the right at C5-C6. Up to moderate central spinal canal stenosis at C4-C5.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: s/p Esophagectomy History: s/p Esophagectomy Unchanged pleural effusions and basilar opacities.No significant pneumothorax.An NG tube traverses a gastric pull-up.

Output: Unchanged pleural effusions and basilar opacities following esophagectomy.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: eval lung fields History: s/p MVR Right-sided chest tube remains in place. Increased left basilar opacity, likely atelectasis. Small left pleural effusion. Unchanged heart size. No pneumothorax.

Output: Right-sided chest tube remains in place. Increased left basilar opacity, likely atelectasis. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: lt Subclavian placement History: lt subclavian central line placement Enteric feeding tube extends below the lower margin of the image. Removal of right subclavian line and placement of left subclavian central line, with tip in the SVCStable cardiomediastinal silhouette.Nonspecific basilar opacity compatible with atelectasis, similar in appearance to the prior. Probable small effusions. No pneumothorax.

Output: New left subclavian central line, tip in the SVC. No pneumothorax. Basilar opacities compatible with atelectasis, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: post op- check dobhoff position History: none Tracheostomy tube redemonstrated with its tip 6 cm above the carina.Dobbhoff tube with its tip in the gastric fundus.Stable cardiomediastinal silhouette.Interval clearing of the bilateral pleural effusions.No new pulmonary opacities identified.

Output: Dobbhoff tube with its tip in the gastric fundus. No acute cardiopulmonary disease identified.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.History of shortness of breath and orthopnea. There is mild cardiomegaly, stable.Bilateral basal predominant interstitial opacities are seen. Very small bilateral pleural effusions noted.

Output: CHF pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Intubated History: None Slightly improved aeration of the left lung base. Other findings including support hardware unchanged.

Output: Slightly improved aeration of the left lung base.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female history of NHL. Reevaluate and compare to previous. CHEST:LUNGS AND PLEURA: Emphysematous changes and apical scarring redemonstrated. Groundglass opacities in the right middle lobe have resolved.Few micronodules. Index micro-nodule in the right lower lobe seen on series 4 image 66 measures 3.6 mm. no new nodules.MEDIASTINUM AND HILA: No pathologically enlarged nodes. Calcified granulomata. Coronary artery calcifications. Prominent aortic root unchanged. CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Non-fluid density hypoattenuating lesion in the dome of segment 7 seen on series 2 image 77 is unchanged measuring 1.3 x 1.2 cm.1SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Shotty lymph nodes unchanged. Atherosclerotic disease redemonstrated.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osteopenia loss of height of vertebral bodies unchanged. No definite lytic or blastic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No pathologically enlarged nodes. Reference left inguinal lymph node is unchanged as seen on series 3 image 180 measuring 7.5 x 5.5 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Resolution of groundglass opacities in the right middle lobe. Other findings are changed as above.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left-sided ICD unchanged.Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.No evidence of a pneumothorax.

Output: No interval change without acute abnormalities. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: htn, dm, dyspnea with exertion Cardiac size is upper limits of normal. Slightly decreased lung volumes. Small bilateral pleural effusions. No pneumothorax. No focal pulmonary consolidation.

Output: Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: sob History: cp Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: lung infiltrate History: Cough, SOB, chest pain Small lung volumes.No significant abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.intra OR, check for RFO No unexplained radiopaque foreign object present.Intra-aortic balloon pump is again noted at the aortic arch. 2 left-sided chest tubes are present. Right Swan-Ganz catheter with tip in right pulmonary artery. An enteric tube noted. Bibasilar opacities are dense left lower lobe opacification remain unchanged. Pulmonary edema and small pleural effusions are redemonstrated. Stable cardiomegaly is noted.

Output: No evidence of unexplained radiopaque foreign object. No significant interval change in the cardiopulmonary disease and lines and tubes. These findings were discussed by telephone with Dr. Onsager, the attending surgeon, on 08/28/2015 at 9:00 AM.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: line History: line ET tube tip abuts the carina. Interval placement of NG tube coiled in the stomach with tip in the gastric body. Interval placement of left central venous catheter with tip at the SVC.Cardiomediastinal silhouette is normal. Tortuous aorta. No pleural effusion or pneumothorax. No focal pulmonary opacities.

Output: ET tube tip abuts the carina, retraction is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: eval for effusions History: L arm pain/weakness, slurred speech The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Renal cell carcinoma CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules are mostly stable. However previously mentioned nodule in the right lower lobe is slightly increased in size now measuring 6 mm on image number 47, series number 5. Previously it was measuring 4 mm. stable emphysematous changes. No new nodules.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: Status post right nephrectomy. No evidence of mass in the right nephrectomy bed. Minimal left perinephric stranding is unchanged.RETROPERITONEUM, LYMPH NODES: Portacaval lymph node is stable measuring 2 x 1 cm image number 111, series number 3.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: Interval increase in the size of the one of the micronodules in the right lower lobe, raising the suspicion for primary or metastatic disease. No other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: hx ALL and stem cell transplant, worsening cough History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right PICC, tip in right axillary region.Healed or healing left rib fractures unchanged.

Output: No reliable evidence of infection, although early infection in a stem cell transplantation can be subtle and if symptoms persist a thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain, hx of lupus, factor v History: same Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lungs History: eval lungs Tracheostomy tube and venous catheter unchanged. Small lung volumes with mild basilar opacity compatible with atelectasis.No specific evidence of pneumonia or other acute change.

Output: Mild basilar atelectasis and no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Pneumothorax post chest tube placement. Left apical pneumothorax with maximal pleural separation from the chest wall of 3 cm, minimally smaller at the apex, though some of the air has now tracked into the costophrenic angle. The left chest tube may been retracted slightly, the tip projects just under the left fourth rib posteriorly. Left chest wall subcutaneous emphysema.Basal atelectasis and pleural fluid about the same. Emphysema. Lung volumes slightly decreased. Left lower rib fracture deformity poorly visualized.

Output: Overall no significant change in size of left pneumothorax, about 3 cm.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64 yo male with history of MF; pre-allo SCT evaluation History: evaluate Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old. Intubated post PEA arrest. Endotracheal tube tip 2 cm above the level of the carina. Nasogastric tube tip off caudal margin of the film. Unsharpness of the central pulmonary vasculature suggestive of hypovolemia/edema. No pneumothorax.

Output: Endotracheal tube tip approximately 2 cm above the level of the carina. Mild hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: pulmonary edema, cardiomegaly History: chest pain 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: Age: 70 yearsGender: MaleReason for Study: Reason: eval lead placement History: increase RA impedance Left-sided ICD unchanged. Stable cardiac enlargement.Perihilar/basilar interstitial opacities compatible with edema similar in appearance the prior exam.No large pleural effusions.No focal areas of consolidation.

Output: ICD leads unchanged. Stable appearance of cardiomegaly and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Evaluate for active TB History: Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: sob, chest pain. pneumonia? History: sob, chest pain Lower lung zone opacities suggestive of edema along with pleural effusions and left lower lobe consolidation.Mild cardiomegaly.Right jugular catheter, tip in SVC.

Output: Pulmonary edema unchanged with left lower lobe consolidation possibly infection or residual atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for IABP placement History: s/p IABP Aortic balloon catheter and ICD leads unchanged.No evidence of pulmonary edema or infection.

Output: Balloon catheter in the proximal descending aorta, unchanged.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with metastatic neuroendocrine cancer CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules are unchanged.MEDIASTINUM AND HILA: Index subcarinal lymph node is unchanged measuring 15 by 9 mm on image number 47, series number 3. Other smaller mediastinal lymph nodes are also unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic metastases are again noted. Complemented lesion in the left lobe measures 11.6 by 7.3 cm on image number 95, series number 3, not significantly changed. Other large metastatic lesions are also grossly unchanged.SPLEEN: No significant abnormality notedPANCREAS: Postsurgical changes consistent with Whipple procedure.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index portacaval lymph node measures 4.8 by 3 .3 cm on image number 109, series number 3, not significantly changed. Other retroperitoneal lymph nodes are also grossly stable.BOWEL, MESENTERY: Hypervascular heterogeneous mesenteric root mass measures 4.7 x 3.6 cm in image number 137, series number 3. This mass is also stable. Attenuation of the superior mesenteric vein is stable. Multiple venous collaterals in the small bowel mesentery.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: 58-year-old female with cough. Inspiratory and expiratory views requested. LUNGS AND PLEURA: Poorly defined density in right upper lobe that is approximately 1.5 cm in diameter and appears to be nodular and partly solid with linear extension to the pleura. Multiple bilateral micronodules in the range of 2 to 3 mm. No significant air trapping.MEDIASTINUM AND HILA: No evidence of lymphadenopathy. Moderate coronary calcifications. The aortic root appears to be slightly ectatic relative to the descending aorta, measuring approximately 4 cm in AP dimension (series 3, image 48).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted in the visualized portions of the liver, spleen, and kidneys. Left adrenal nodule, most likely an adenoma. Normal right adrenal gland.

Output: 1.Poorly defined right upper lobe nodule for which the differential diagnosis is wide, including granulomatous infection versus primary lung carcinoma in the appropriate clinical context.2.Bilateral pulmonary micronodules, nonspecific but most likely post-infectious.3.No significant air trapping.


Instruction: Generate impression based on medical findings.

Input: Reason: S/p esophagectomy, now with DHT, NGT. S/p dilation History: asx New large air collection projected over the mediastinum, at least partially due to a dilated gastric conduit, though there may be additional air in the mediastinum in an extraluminal location.NG tube projected over the dilated conduit and feeding tube traversing the esophagus with its tip visible in the left upper quadrant of the abdomen.Right chest tube in place with a minimal apical pneumothorax.Nonspecific basilar opacities compatible with atelectasis and pleural effusions.

Output: Increased air collections consistent with dilated conduit and possibly extraluminal air in the mediastinum. If clinically indicated a CT scan could be performed for more accurate evaluation. A text page was sent to Dr. SYMALLA, TREVER at 1607, at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate swan positioning History: shortness of breath Swan-Ganz catheter from the IVC extending to the left main pulmonary artery.Prominent pulmonary arteries suggestive of pulmonary hypertension and moderate cardiomegaly.Mild basilar interstitial opacity compatible with edema and atelectasis, slightly improved.

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


Instruction: Generate impression based on medical findings.

Input: Reason: ards History: ards New left jugular catheter extending to the SVC and a right jugular catheter tip in the area of the brachiocephalic vein. Diffuse mainly interstitial opacity, greater on the left, not significantly changed.No new findings.

Output: Nonspecific mainly left sided interstitial opacity without significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT History: as above ET tube tip approximately 3 cm above the carina.Probable small pleural effusions and mild basilar atelectasis.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 58 years old Male. Reason: hypoxia History: as above. Support devices are not significantly changed. Interval decrease in size of the left pleural effusion. Patchy opacities of edema or segmental atelectasis appear decreased compared with prior study.

Output: Interval improvement of the left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 29-year-old male status post liver transplant complicated hospital course now with recurrent fevers CHEST:LUNGS AND PLEURA: Large right-sided pleural effusion has increased. Left-sided pleural effusion is decreased in size.Tracheostomy tube is in place. Compared to previous CT parenchymal calcifications on the right side at significantly increased, more prominent in the right upper and middle lobe. Parenchymal calcifications in the left lobe have also slightly increased.Patchy airspace consolidations in the left lobe have slightly improved. However, bilateral groundglass opacities affecting almost the entire right lung has progressed and patchy ground glass opacities affecting the left lung have also improved. Bilateral lower lobe atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The medial aspect of the transplanted liver is again hypodense compared to the rest of the liver, unchanged. An ill-defined hypodense area in the right lobe is new from previous CT. Lack of IV contrast severely limits further characterization of this focal area. Small amount of perihepatic ascites is present.SPLEEN: Spleen is again enlarged.PANCREAS: 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: Small amount of ascites and anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted

Output: Interval progression of bilateral parenchymal calcification which may be secondary to metastatic calcification and less likely two interval Hollowell or hemorrhage, oral contrast aspiration or alveolar microlithiasis.Interval increase in the size of the right pleural effusion and bilateral groundglass opacities. These are nonspecific in appearance and may be secondary to edema, microcalcification or less likely infection.Interval decrease in the left-sided patchy air space opacities.Medial aspect of the transplant liver is hypodense, unchanged from previous CT. New small focal hypodense area in the right lobe which cannot be optimally characterized due to lack of IV contrast.Splenomegaly unchanged.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with fever. Evaluate for infiltrates. Interval placement of right central venous catheter with tip in the cavoatrial junction. Left upper extremity vascular stent is again seen. No focal airspace opacities.No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: cough, body ache History: as above New basilar, left greater than right. Mild cardiomegaly again noted. Unchanged cardiac leads. No pneumothorax.

Output: New basilar, left greater than right, certainly consistent with aspiration or pneumonia. Chest radiographic follow-up in 8-12 weeks is suggested to ensure resolution.


Instruction: Generate impression based on medical findings.

Input: Mitral valve replacement and chest tube removed No immediate postprocedural complications again observed on the right, specifically no pneumothorax.Improved overall aeration with streaky densities in both bases again suggesting largely atelectasis with associated volume loss appears improvedMild nonspecific cardiomegaly. Mildly tortuous aorta and atherosclerotic disease unchanged. Prosthetic mitral valve

Output: Improving aeration and decreasing basilar edema


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Shortness of breath Essentially unchanged cardiopulmonary appearance with a well-positioned tracheostomy tube and NG. Persistent borderline mild cardiomegaly with underlying interstitial predominant changes, at least partially suspected chronic in nature. No definite new superimposed focal airspace process superimposed upon previously observed edema with small to moderate bilateral effusions.

Output: Unchanged suspected mild edema


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: r/o rib fracture History: fall pain to right side Lungs and pleural spaces are clear. No displaced rib fracture or pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: No displaced rib fracture or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable residual triangular anterior mediastinal mass measuring 3.8 x 1.3 cm (series 4; image 48). This residual mass has configuration of the thymus and most likely represents prior/residual thymic involvement with Hodgkin's lymphomaCHEST 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: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: eval lung fields History: s/p CABG Removal of lines and tubes. Improvement in basilar opacities, which likely represented atelectasis. No significant pneumothoraces. Unchanged cardiomegaly.

Output: Removal of lines and tubes. Improvement in basilar opacities, which likely represents atelectasis. No significant pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: fever and weakness and cough, assess for pneumonia History: fever cough The right port terminates in the central superior vena cava, unchanged in position.Slight decreased lung volumes. Increasing mid to lower zone airspace opacities suspicious for aspiration or infection. Elevation of the right hemidiaphragm with small pleural effusion. Pulmonary metastases partially obscured by parenchymal opacities. Heart size unchanged.

Output: Progressive mid to lower zone opacities suspicious for aspiration or infection superimposed on pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: R/O pleural effusions History: 66 yo WF with Ph+ ALL had pleural effusions on prior MTX chemotherapy. Starting next cycle tomorrow and would like to verify that the effusions are completely resolved. Left PICC is redemonstrated with tip in the SVC.Cardiomediastinal silhouette appears unremarkable.Lungs are clear.Interval resolution of small pleural effusions.

Output: Interval resolution of pleural effusions with no other acute cardiopulmonary findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.