Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: s/p L thoracentesis, eval for pneumothorax History: SOB, pleural effusion Status post left thoracentesis, the left effusion smaller with no pneumothorax.Left lower lung zone consolidation likely compression atelectasis.A Dobbhoff tube extends below the lower margin of the image.

Output: No pneumothorax following left thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Shortness of breath. COPD. Mild cardiomegaly, similar to prior.Mild bronchial wall thickening. No focal opacities suggestive of infection. No evidence of overt left-sided heart failure.No large pleural effusions.No pneumothorax.

Output: Mild bronchial wall thickening, without specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: assess for signs of new PNA History: SOB, cough, worsening leukocytosis Right IJ port catheter remains unchanged. Multiple surgical clips again overlying the mediastinum and left upper quadrant.Cardiac silhouette is normal in size. Calcified aortic knob.Interval increase in left pleural effusion with significant component along the left major fissure. Small right pleural effusion also seen. Redemonstration of diffuse coarse interstitial coarse and nodular opacities, stable to slightly improved since prior examination. No pneumothorax.

Output: Interval increase in left-sided pleural effusion with localized component along left major fissure. No other significant interval changes.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Chest pain. Lungs are clear. Cardiomegaly slightly progressed. No pneumothorax. Surgical clips again noted in the upper abdomen.

Output: Mild cardiomegaly, progressed from previous. Clear lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: r/o infiltrate History: sob/cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: cardiopulmonary process History: CP Linear density is seen in the left lower lobe. The cardiac silhouette is normal. There is no evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: Left lower lung linear atelectasis or scar.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Moderate nonspecific cardiomegaly with patchy opacities again suggesting edema with moderate effusions and left lower lobe consolidation. Appearance unchanged.LVAD, tracheostomy tube and ICD are all otherwise unchanged

Output: Unchanged pulmonary nonspecific opacities


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: blood streaked sputum, eval for any focal infiltrate c/f hemorrhage History: see above Left sided Port-A-Cath unchanged. Decreased lung volumes with stable cardiomediastinal silhouette.Mild basilar atelectasis.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: upright film - ro perf viscus History: abdominal pain There is no evidence of pneumoperitoneum on this semierect labeled portable radiograph. If there is high clinical suspicion for pneumoperitoneum, recommend upright abdominal radiograph when the patient can tolerate.The lungs and pleural spaces are clear. Heart size is upper limits normal. Multilevel degenerative changes of the thoracic spine are present. No pneumothorax.

Output: No evidence of pneumoperitoneum on this semierect portable radiograph. If there is high clinical suspicion for free abdominal air, recommend upright abdominal radiograph when the patient can tolerate.


Instruction: Generate impression based on medical findings.

Input: Reason: Is there pathology? History: L arm numbness Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 35 years old Female. Reason: lung eval History: lung eval. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema with improved. Small amount of bilateral pleural effusions are noted. The tubes and lines are stable in position.

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


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer status post 6 cycles of chemotherapy. Evaluate response to treatment compare with previous. Metastatic HER-2+ breast cancer. CHEST:LUNGS AND PLEURA: Right pulmonary micronodules are unchanged.MEDIASTINUM AND HILA: Index right paratracheal lymph node is unchanged measuring 1.4 x 1.2 cm (image 33; series 3), unchanged. Index right hilar lymph node is unchanged and measures 10 mm in diameter (image 46; series 3).CHEST WALL: Postoperative changes in the left axilla, unchanged. Right chest port.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in segment two of the liver is unchanged. No enhancing lesions or intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. Bilateral extrarenal pelves.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Ovarian varices. Consider pelvic venous congestion syndrome.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesion in the right femoral neck is unchanged.OTHER: No free fluid.

Output: Stable thoracic reference lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: s/p SLT History: s/p lung transplant Gradually increasing atelectasis in the base of the transplanted left lung.Stable appearing fibrotic native right lung.

Output: Increasing left basilar opacity suggestive of atelectasis from mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Reason: 58yoM hx of seizure, recent seizure, now w/ O2 requirement History: O2 requirement Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Bullet fragments and old fracture deformity of the proximal left humerus.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: chest tube in place History: asymptomatic Right chest tube with no pneumothorax and a small persistent pleural effusion.Unchanged right sided opacities.Right SVC jugular stent unchanged.

Output: No significant pneumothorax. Right chest tube in place.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: serial eval given sepsis s/p fluid History: fever, tachycardia, mental status changes Right Port-A-Cath unchanged with its tip in the RA.Stable cardiomediastinal silhouette.Again noted are multiple pulmonary nodules.No new pulmonary opacities identified.Large left supraclavicular soft tissue mass with destruction of the left clavicle redemonstrated.No pleural effusions.

Output: Pulmonary nodules with large left supraclavicular soft tissue mass in left clavicular destruction unchanged. No new pulmonary opacities to indicate acute infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: O2 requirement Catheters and chest tubes unchanged.Cardiomegaly with bilateral nonspecific opacity compatible with edema, atelectasis and small effusions. No pneumothorax or other acute change.

Output: Nonspecific airspace and interstitial opacities with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: s/p bilateral chest tube placement History: chest tube Bilateral chest tubes with no significant pneumothorax.An NG tube traverses a gastric pull-up.Stable basilar postop atelectasis.

Output: No significant pneumothorax. Status post gastric pull-up with basilar postop atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: post MVC History: post MVC, shoulder pain No significant cardiopulmonary abnormality.No evidence of traumatic injury.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: MaleReason for Study: Reason: pain crisis History: pain Table cardiac enlargement.Mild chronic interstitial opacities without focal areas of consolidation.No pleural effusions.Osseous changes of sickle cell disease.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female history of HD. Status post Allo SCT 2.5 years. Restaging. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Some small nodes along the right and left common iliac chains and external iliac chains, not pathologic by size and unchanged.BOWEL, MESENTERY: Clusters of small nodes in the right lower quadrant mesentery series 2 image 136, unchanged from prior exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Enlarged uterine cavity containing fluid correlate clinically.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of fluid in the cul-de-sac likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small nodes unchanged. Enlarged fluid filled uterine cavity correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube in place, PNA History: ET tube ET tube tip approximately 3 cm above the carina.NG tube tip in the stomach.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with a left neck mass LUNGS AND PLEURA: Mild emphysematous changes are identified predominantly in the upper lung zones. There are scattered micronodules. No pleural effusion can be identified.MEDIASTINUM AND HILA: There are calcified mediastinal lymph nodes. No lymphadenopathy can be identified. Calcification within the aorta and coronary arteries is demonstrated.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: There is no evidence of metastatic disease within the chest.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: MaleReason for Study: Reason: Evaluate postion of ET tube History: Respiratory failure with ET tube advanced ET tube with its 5 cm above the carina.Left PICC line with its tip in the SVC.NG tube with the tip in the margin of the image.Stable cardiomediastinal silhouette with bilateral airspace/interstitial opacities similar to the prior exam.No new pulmonary opacities noted.

Output: ET tube with its tip 5 cm above the carina. Diffuse pulmonary opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: pna? History: months of cough, course breath sounds, diminished right lower lung fields Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: 86-year-old female with breast cancer metastatic with pleural effusions and weight loss. CHEST:LUNGS AND PLEURA: Right apical scarring. Left lower lobe pleural-based nodules are evident, the largest of which measures 1.0 x 0.6 cm on axial image 64/97. Scattered additional micronodules. Small bilateral pleural effusions and/or pleural thickening, right side larger than left.MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. The cardiac size is normal. No pericardial effusion. Extensive coronary artery and mitral annulus calcifications. A small amount of air is evident within the right atrium.CHEST WALL: Surgical clips in the left axilla and postsurgical changes of the left chest wall. No pathologically enlarged axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: Punctate segment 8 hypodensity is too small to characterize but probably represents a benign cyst. Cholelithiasis without evidence of cholecystitis.SPLEEN: Scattered punctate hypodensities are too small to characterize but probably represent benign cysts.PANCREAS: 3.1 x 3.8 cm cystic lesion within the head of the pancreas on axial image 112/198, possibly in continuity with the main pancreatic duct, may represent an IPMN or pseudocyst. Two additional smaller cystic lesions are seen within the body of the pancreas. The pancreatic duct is not dilated.ADRENAL GLANDS: Left adrenal nodule measuring 0.9 x 0.7 cm on axial image 95/198 statistically most likely represents a benign adenoma.KIDNEYS, URETERS: Multiple bilateral low attenuation lesions probably represent benign cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease affects the aorta and its branches. No evidence of aneurysm. Small mesenteric and retroperitoneal lymph nodes are seen.BOWEL, MESENTERY: Diffuse colonic diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. A subtle pattern of permeative lucency is evident throughout the vertebral bodies which could represent metastatic disease. Please refer to the nuclear medicine examination performed today for a more thorough evaluation.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: A focus of fat is evident within the fundus of the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: See above.OTHER: No significant abnormality noted.

Output: 1.Bilateral pleural effusions and subpleural nodules compatible with metastatic disease.2.Pancreatic cystic lesions may represent IPMNs or pancreatic pseudocysts.3.Questionable bony metastatic involvement.4.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate/edema History: shortness of breath Postsurgical abnormalities in the left hemithorax and right perihilar radiation reaction, unchanged from previous.Bone island in the right posterior eighth rib, unchanged.No sign of edema or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: daily am cxr History: daily am cxr . Status post lung transplant. Large bilateral layered out pleural effusions, greater on the right, with underlying edema and atelectasis.Possible small loculated pneumothorax at the right apex.Feeding tube tip in the body of the stomach.

Output: Pulmonary edema and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: is there an infiltrate History: cough Stable cardiomediastinal silhouette.No specific evidence of infection or edema. No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval for infection History: seizure Heart size is within normal limits.Focal opacity in the upper lateral right lung.Mild basilar predominant patchy opacities, nonspecific.No pleural effusion.Partially imaged distended loops of bowel in the upper abdomen.Status post cholecystectomy.

Output: Question pneumonia or aspiration in upper aspect of the right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: Evaluate ETT History: intubation Iatrogenic devices are unchanged. Left lower lobe opacity, unchanged. Small left pleural effusion, as before. No pneumothorax. Unchanged heart size.

Output: No substantial difference compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant Mild cardiomegaly with no evidence of CHF or active pulmonary disease.Catheter tip in the SVC.

Output: Mild cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Median sternotomy and valve replacement with mild cardiomegaly.Unchanged asymmetric opacity suggestive of atelectasis with pleural effusions.Right subclavian ICD leads unchanged.A Dobbhoff tube terminates in the stomach.Right jugular venous access sheath unchanged.Right side inserted IABP, proximal marker projects over the aortic arch.

Output: Unchanged pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA History: hypoxia Bilateral diffuse predominantly lower zone opacity with septal lines at the periphery, compatible with edema.NG tube tip in the stomach.Partial clearing of left lower lobe consolidation and atelectasis over the past 2 days.

Output: Findings suggestive of pulmonary edema with no acute change.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with history of Hodgkin lymphoma with known bone and liver metastases. CHEST:LUNGS AND PLEURA: Bilateral moderate sized pleural effusions (left greater than right) with associated compressive atelectasis are present. Few streaky opacities in left upper lobe is also observed.MEDIASTINUM AND HILA: Previously noted mediastinal lymphadenopathy persists and is stable. Reference pretracheal lymph node on image 34/223 on series 3 measures 1.6 cm x 1.9 cm.Pericardial thickening versus effusion is also observed.CHEST WALL: Port-A-Cath in right chest wall with tip of the catheter in the caval atrial junction.ABDOMEN:LIVER, BILIARY TRACT: Multiple ill-defined hypodense lesions are observed the liver. Perihepatic ascites is also present. Unchanged from prior exam.SPLEEN: Numerous ill-defined hypodense lesions are seen in the spleen. No significant change from prior exam.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Significant retroperitoneal adenopathy is observed without interval change on comparison to previous exam. Reference conglomerate of nodes on image 118/223 of series 3 measures 2.7 cm x 4.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Ascites is noted in bilateral paracolic gutters, similar to previous exam.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable osseous lesions in T10 and T11.OTHER: No significant abnormality noted.

Output: 1.Bilateral pleural effusions with associated compressive atelectasis. Few streaky pulmonary opacities also seen in left upper lobe.2.Mediastinal, retroperitoneal, and pelvic adenopathy as described above. No interval change on comparison to previous exam.3.Numerous hypodense lesions in the liver and spleen. No significant change on comparison to previous exam4.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Evaluate lines, tubes and devices. PA catheter. Cardiomyopathy. Hardware and devices unchanged in position. No pneumothorax. Small to moderate pleural effusions and basal edema about the same. Slight worsening of patchy airspace opacities in the bases, most likely also edema but should be monitored to exclude pneumonia.

Output: Worsening basal pulmonary opacities which may reflect atypical edema however serial radiographs are suggested to rule out possibility of infection. Support devices unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: s/p robotic MAZE. Left atrial appendage clip unchanged in position. Stable cardiomediastinal silhouette.No acute focal airspace opacity.No pneumothorax or large pleural effusion.

Output: No residual pneumothorax or large pleural effusion. No interval acute cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval ETT, lung fields History: s/p LVAD Cardiomegaly, and LVAD partially imaged.Stable mild basilar opacities suggestive of edema and subsegmental atelectasis.Right jugular introducer, tip in right brachiocephalic vein. ET tube tip approximately 4 cm above the carina. A Dobbhoff tube terminates in the stomach.

Output: Unchanged basilar opacities and cardiomegaly. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: sepsis History: fever, tachycardia, hypotension Right IJ line has been pulled back slightly now terminating in the superior aspect of the SVC. Elevation of the right hemidiaphragm again noted. Increased bibasilar opacities. Unchanged heart size. No pneumothorax. No acute bony abnormality.

Output: Right IJ line has been pulled back slightly. Increased subsegmental atelectasis at the left lung base. Increased right base atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with metastatic colorectal cancer. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules are again identified, all increased in size. The reference left upper lobe nodule measures 18 x 17 mm (series 4; image 42), previously 16 x 14 mm. Mild bronchial wall thickening is identified.MEDIASTINUM AND HILA: Calcified mediastinal and left hilar lymph nodes. A 16 x 10 mm anterior diaphragmatic lymph node has increased in size (series 3; image 73) (previously 10 x 9 mm).Coronary artery calcificationsCHEST WALL: The right-sided port terminates in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes affect the the liver with a residual 4.3 x 1.2-cm fluid collection, decreasing in size.6-mm hypodensity in segment two of the liver (series 3; image 95) is not significantly changed.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral nephrolithiasis without evidence of obstruction, not significantly changedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ileocolic anastomosis in the right upper quadrant.The small bowel loops are clustered in the right abdomen, likely due to postsurgical herniation, unchanged.Very small ventral, fat-containing herniasA small right-sided Spigelian hernia containing nonobstructed loops of small bowel is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Subcentimeter lymph node in the right obturator region, mildly increased in size.BOWEL, MESENTERY: Small fat-containing inguinal hernias.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderately severe infrarenal atherosclerotic disease.A graft originates from the right common femoral artery and is occluded proximally. The remainder of its extent is not visualized. Adjacent fat stranding may be postprocedural.

Output: Increase in size of the numerous pulmonary nodules. Enlarged anterior diaphragmatic lymph node.Indeterminate 6-mm hypodensity in the liver, not significantly changed.Subcentimeter right obturator lymph node, mildly increased in size.Partially visualized, occluded graft extending from the right common femoral artery.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Pneumothorax post chest tube placement. Interval enlargement of right pneumothorax now with maximal pleural separation from the chest wall of 5.4 cm. Partial collapse of the right lung. There is a small caliber tube projecting over the soft tissues of the right chest wall, but no intrapleural catheter is identified.Diffuse interstitial opacities with scattered airspace opacities appear fairly similar allowing for differences in lung volumes.

Output: Enlarging right pneumothorax. There is a small caliber tube projecting over the soft tissues of the right chest wall, but no intrapleural catheter is identified.


Instruction: Generate impression based on medical findings.

Input: IABP marker check IABP marker projects of the aortic arch unchanged. Interval Swan-Ganz placement from a right jugular approach, tip extends into the right pulmonary outflow tract at the level of the upper lobe takeoff.Mild nonspecific cardiomegaly. ICD and lungs are otherwise well-positioned and clear, respectively.

Output: Swan-Ganz placement


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: assess placement of swan ganz History: as above Right IJ Swan-Ganz with its tip in the right descending pulmonary artery.Right central venous catheter with its tip in the SVC.Left-sided ICD unchanged.Stable cardiac enlargement.Right pleural effusion and right basilar opacities slightly increased from the prior exam.

Output: Swan-Ganz catheter has been advanced with its tip now in the descending right pulmonary artery. Subsequent imaging demonstrates repositioning. Mild increase in right pleural effusion and basilar atelectasis/edema.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Assess History: shortness of breath Mild cardiomegaly.No significant pulmonary or pleural abnormality.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: r/o infection History: cough x 5 days Accounting for overlying soft tissue artifact, the lungs are unremarkable.Mild cardiomegaly.No specific evidence of infection.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Acute cardiopulmonary process, flash pulmonary edema History: Hx CHF here with SOB and increased WOB Mild basilar interstitial opacities suggestive of pulmonary edema. Heart size normal.No large pleural effusions.

Output: Mild interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: line placement History: none Right IJ line terminates near the cavoatrial junction. Endotracheal tube cannot be assessed due to overlying spinal fusion hardware. No pneumothorax. Diffuse right-sided pleural parenchymal opacities again noted. Basilar pleuroparenchymal opacities in the left hemithorax, not substantially changed. Unchanged cardiomegaly. No pneumothorax.

Output: Right IJ line terminates near the cavoatrial junction. Endotracheal tube cannot be assessed due to overlying spinal fusion hardware. No pneumothorax. Diffuse right-sided pleural parenchymal opacities again noted. Basilar pleuroparenchymal opacities in the left hemithorax, not substantially changed.


Instruction: Generate impression based on medical findings.

Input: Chest tube check Underlying cardiopulmonary appearance not significantly changed including the 2 inferior chest tubes however one right and one left chest tube has been removed in the interval without apparent complicationLeft jugular catheter unchanged, tip extends to the innominate junction

Output: 2 chest tubes removed


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Blood-tinged sputum. Stable cardiomegaly. The loop recorder device projects over the left chest wall. Median sternotomy wires are unchanged. Diffuse chronic interstitial opacities and basilar scarring are not significantly changed from prior.

Output: Cardiomegaly and and interstitial lung disease are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.CT in place. Right jugular Swan-Ganz catheter tip at the right main pulmonary artery level. Mediastinal drains and a left chest tube are in place.Mediastinal widening about the same.Low lung volumes with basal atelectasis and small pleural effusions.Groundglass opacity at the right base slightly worse.Tiny 2 to 3 mm left pneumothorax.

Output: Trace left pneumothorax. Groundglass opacity in the right lung base nonspecific and may reflect edema or less likely hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: is there an infiltrate History: fever Mild left basilar subsegmental atelectasis or scarring. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size in upper limit of normal. Aortic atherosclerosis.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Hypoxia with continued oxygen requirement status post cystoprostatectomy. Right IJ chest port catheter terminates in the SVC, unchanged.Minimal streaky basilar opacities are not significantly changed. No pneumothorax. Small left pleural effusion. The heart size is normal.

Output: Stable cardiopulmonary appearance with minimal basilar atelectasis and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: intubated History: shortness of breath Dextrocardia with situs inversus.New retrocardiac right lower lobe consolidation.Slight improvement in mild pulmonary edema, with stable pleural effusions.Left PICC, tip in the SVC.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.

Output: New retrocardiac lower lobe consolidation. Improvement in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with nephrolithiasis, elevated vitamin D, history of lymphadenopathy. Evaluate for granulomatous disease. LUNGS AND PLEURA: Multiple scattered calcified and noncalcified pulmonary micronodules, compatible with granulomas. Nonspecific small nodule in right upper lobe (series 7 image 42) measures 6mm.Multiple small foci of groundglass opacities in the dependent lung zones bilaterally, likely postinflammatory. MEDIASTINUM AND HILA: Multiple prominent mediastinal and hilar lymph nodes. Right paratracheal lymph node (series 5 image 35) measures 17 mm in short axis. Right subcarinal lymph node (series 5 image 50) measures 36 x 29 mm. Punctate calcification in a left hilar lymph node is suggestive of prior granulomatous disease. Additional mediastinal and hilar lymph nodes are noncalcified and nonspecific, may be reactive vs malignant.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Cholelithiasis. Diffuse steatosis of the liver limits detection of focal lesions. Well-rounded hypodense lesion in the spleen posteriorly (series 5 image 104) measuring 3 cm is nonspecific, likely benign cyst. Indeterminate left renal cystic lesion with relative high density is incompletely evaluated on current exam.

Output: 1) Mediastinal and hilar lymphadenopathy of uncertain etiology. 2) 6mm right pulmonary nodule. Recommend follow-up imaging if high clinical risk of malignancy. 3) Indeterminate left renal cystic lesion. Recommend contrast enhanced abdominal CT with dedicated renal protocol for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Prekidney transplant. Prekidney evaluation, end-stage renal disease rule out cardiomegaly rule out infiltrates. Normal heart size. No focal airspace opacities or pleural fluid.Low normal lung volumes.

Output: Low normal lung volumes, but no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Evaluate for pneumonia. History: weakness Left-sided chest port has tip at the cavoatrial junction. Surgical clips project over the neck bilaterally.The cardiac mediastinal silhouette is normal. No pleural effusion or focal opacity. No pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Check for pleural effusions. Nausea and vomiting Motion degrades sensitivityPersistent decreased lung volumes with diffuse mild reticular changes suggesting chronic disease without new superimposed focal abnormality. Small left questionable effusion versus scarring unchanged. No definite distinct new interval acute abnormalitiesCABG clips, bilateral chest wall surgical staples and in an altered right subclavian 2-lead ICDMild retained barium partially visualized in the transverse colon

Output: Underlying chronic changes without evidence of new superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: acute desaturation History: SOB Diffuse chronic interstitial disease. Moderate to large left pleural effusion with left lower lobe consolidation, unchanged. Small right pleural effusion unchanged. Right port tip in SVC.

Output: Diffuse chronic interstitial disease. Moderate to large left pleural effusion with left lower lobe consolidation, unchanged. Small right pleural effusion unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval volume status, consolidation History: eval COPD , CAP Low lung volumes. Slight increase in basilar atelectasis. No overt left-sided heart failure. Mild cardiomegaly again noted. Prominent central pulmonary arterial structures again noted. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Status post CABG evaluate lung fields and ETT. Postoperative appearance of the thorax. Endotracheal tube tip about 5 cm above the level of the carina. Right jugular Swan-Ganz catheter tip at the main pulmonary artery level. Mediastinal drains and a left basal chest tube are in place. ECMO cannulae project over the right atrium and the aortic arch. IABP marker projects about 2.5 cm below the top of the aortic arch.No visible pneumothorax or pleural fluid. No evidence of pulmonary edema. Mild retrocardiac atelectasis on the left.

Output: Minimal retrocardiac atelectasis. ETT tip 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Liver cell carcinoma evaluate for lesions. Status post OLT 3/14 for HCC. Mild scarring at the right lung base. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Blunting of the right costophrenic angle unchanged.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Diaphragmatic hernia repair on ECMOVIEW: Chest AP and abdomen AP ECMO cannulas, left-sided chest tube, umbilical line, urinary catheter, left lower extremity PICC, left neck PICC and left upper extremity PICC again noted. There is complete opacification of both hemithoraces unchanged. There is paucity of bowel gas within the abdomen. Marked body wall edema.

Output: Complete opacification of both hemithoraces is unchanged. There is paucity of bowel gas within the abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval lung fields History: s/p pericardial window Left subclavian line remains in place. Mediastinal/pericardial drains again noted. Pleural effusion bibasilar opacities with mild pulmonary edema, as before. No pneumothorax. Unchanged cardiomegaly.

Output: Unchanged mild pulmonary edema, bibasilar opacities, and pleural effusions. Unchanged cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: post heart transplant w/ fluid overload \T\ infection sxs. concern for effusion, pna History: fever, sob Stable cardiomediastinal silhouette.Minimal scarring/discoid atelectasis at left lung base.No new pulmonary opacities identified.No pleural effusions.Redemonstration of fracture of the most superior median sternotomy wire.

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


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old, with known breast cancer, on chemotherapy. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules are unchanged. A reference right upper lobe micronodule measures 5 mm on axial image 35/102. A reference right lower lobe nodule measures 4 mm on axial image 50/102. No new suspicious nodules or masses.Pleural thickening and fibrosis anteriorly in the upper lobes as well as along the right major fissure, unchanged.MEDIASTINUM AND HILA: Reference right superior mediastinal lymph node measures 10 x 11 mm on axial image 20/158, unchanged.Calcified left hilar lymphoid tissue is redemonstrated. No new pathologically enlarged hilar or mediastinal lymph nodes.The cardiac size is normal. No pericardial fluid.CHEST WALL: Left chest wall port catheter, tip in the SVC.Status post mastectomy on the right. Skin of the left breast remains thickened.Lucent lesion with sclerotic margins in the sternum is grossly unchanged.ABDOMEN:LIVER, BILIARY TRACT: Probable hemangioma in the dome of the liver, unchanged. Scattered small hypoattenuating lesions probably represent cysts and are also unchanged.SPLEEN: Subcentimeter nodules adjacent to the spleen on axial image 90/150 are unchanged. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A few subcentimeter nodules in the anterior subcutaneous soft tissues are unchanged.OTHER: No significant abnormality noted

Output: Stable pulmonary nodules and other stable findings as above.


Instruction: Generate impression based on medical findings.

Input: 22 years old Male. Reason: pneumothorax History: right sided chest pain, shortness of breath. There is a right-sided pneumothorax in the apex that measures up to 2 cm in thickness. There is no mediastinal shift. Cardiomediastinal silhouette is within normal limits.

Output: Right pneumothorax. The clinical service was notified by phone at 6:50 PM on 12/19/2015.


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube placement History: PNA with ET tube placement ET tube tip approximately 5 cm above the carina.Bilateral extensive airspace opacity, suggestive of infection and aspiration, with probable pleural effusions.Extensive sclerotic skeletal metastases.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: AMS and coarse bs History: ams Nonspecific left basilar opacities could represent aspiration.Elsewhere, the lungs are unremarkable.Heart size normal.

Output: Possible left basilar aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: evaluate for pulmonary edema History: cirrhosis, volume overload Small lung volumes.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: Pulmonary edema History: SOB, h/o CHF Unchanged cardiac lead. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No substantial change in bibasilar pleural-parenchymal opacities, possibly edema versus atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: NG placement History: NG NG tube tip in the body of the stomach.Mild cardiomegaly with an aortic valve prosthesis and aortic aneurysm as recently characterized by CT scan.Mild opacity at the left base compatible with atelectasis.

Output: NG tube tip in the stomach.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p pleurodesis History: chest tube Right chest tube in place with no significant pneumothorax.Bilateral patchy opacities compatible with atelectasis and small effusions.Subcutaneous emphysema on the right.

Output: Chest tube in place with no pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: r/o pna, acute cardiopulmonary process History: weakness, arrhythmias Mild basilar atelectasis or scarring. 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: Age: 42 yearsGender: FemaleReason for Study: Reason: evaluate for pneumonia History: recent surgery/intubation, productive cough, dyspnea Decreased lung volumes with unremarkable cardiomediastinal silhouette.Interstitial and patchy airspace opacities in both lower lobes are compatible with aspiration/infection.No pleural effusions.

Output: Patchy lower lobe opacities compatible with aspiration and/or infection.


Instruction: Generate impression based on medical findings.

Input: 76 years old Male. Reason: edema History: elevated bnp, peripheral edema. Interval development of the bilateral interstitial opacities, predominantly in the lower lung fields. There is a new small bilateral pleural effusions. The cardiac silhouette is normal. There is no evidence of pneumothorax.

Output: Bilateral small pleural effusions and bilateral diffuse interstitial changes, new as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with pain around scar of left upper chest. Reason: Evaluate soft tissue of left upper chest wall. Small nodule confined to the skin measuring 1 x 0.4 x 1.1 cm may represent a granuloma or hematoma. There is no associated drainable fluid collection. Inferolateral to the small nodule is an encapsulated lesion in the hypodermis that is isoechoic to fat and measures 1.4 x 0.7 x 1 cm, compatible with a lipoma.

Output: Small nodule compatible with location of patient's scar may represent a granuloma or hematoma. There is no associated drainable fluid collection.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Presenting with G and tachypnea. Stable mixed interstitial and airspace opacities with improving aeration. Unchanged cardiomegaly and support hardware. Moderate left pleural effusion.

Output: Stable pulmonary opacities as above with improving aeration.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiopulmonary abnormalities History: chest pain, left UE pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrate and evaluate mediastinum History: atypical cp Normal heart size with a mildly tortuous aorta, but no other abnormal mediastinal widening.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: concern for mass, interstitial disease History: chronic cough Cardiomediastinal silhouette is unremarkable. No focal lung opacity or pleural effusion. Kyphosis and mild degenerative changes of the thoracic spine.

Output: No specific evidence of lung mass.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Volume History: hypotension, volume resusitation No change in cardiac configuration. No evidence of pulmonary edema or infection.Line position stable.No pleural effusion. No pneumothorax.

Output: No reliable evidence of pulmonary edema or infection.


Instruction: Generate impression based on medical findings.

Input: Endotracheal tube. Tubes and lines unchanged. Moderate interstitial opacities and minimal pleural fluid on the right, about the same. Unchanged cardiomediastinal silhouette. NGT side port projects over the stomach.

Output: No acute change in diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval IABP History: see above Moderate cardiomegaly.Left lower lung zone atelectasis unchanged.IABP catheter proximal marker projects just above the top of the aortic arch.Right jugular Swan-Ganz catheter tip in right pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Unchanged support devices and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: recurring pleural effusions History: Pleural effusion There is no significant interval change in the bilateral pleural effusions and basilar opacities.Heart size remains normal following aortic valve replacement.No pneumothorax.

Output: There is been no significant interval change in the bilateral pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: PA catheter. Right jugular catheter tip at the level of the main pulmonary artery. Unchanged cardiomegaly and diffuse pulmonary opacities. No pneumothorax. Central pulmonary vasculature appears prominent.

Output: Right jugular catheter tip at the level of the main pulmonary artery. No pneumothorax. No acute change in diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: eval swan and IABP placement History: swan and IABP in place Swan-Ganz catheter tip projects of the right main pulmonary artery. Aortic balloon pump radiopaque marker projects 4.5 cm from the top of the aortic arch. Basilar opacities and right layering pleural effusion are not significantly changed. Stable ICD. Cardiomediastinal silhouette is unchanged.

Output: Swan-Ganz catheter tip in the right main pulmonary artery.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: Age: 47 yearsGender: FemaleReason for Study: Reason: r/o pneumonia History: fever, cough Stable cardiomediastinal silhouette.Lungs are clear without focal areas of consolidation.No pleural effusions.Calcified hilar and mediastinal lymph nodes compatible with prior granulomatous disease.

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


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: eval for acute cardiopulmonary process History: chest pain Moderate to severe cardiomegaly with pulmonary vascular redistribution.No specific evidence of infection or edema.

Output: Cardiomegaly, without acute edema or pneumonia. A follow-up CT has been reported.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: s/p IR thoracentesis with pleural catheter placed for R-side PTX History: SOB Right basilar pigtail catheter placed partially alleviating a large right pneumothorax which may have had a tension component. The right base has partially reexpanded.Extensive right side predominant paraseptal emphysema noted.

Output: Partial resolution of right pneumothorax following pleural drain placement.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Status post thoracentesis with air return. Semierect film limits sensitivity for pneumothorax. No visualized pneumothorax.Slight interval decrease in left pleural effusion. Adjacent atelectasis. Persistent marked cardiomegaly.

Output: No pneumothorax. Slight interval decrease in large left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with new 9 mm left upper lobe nodule found on 4/28/2010. Small nodule also in left upper lobe (3 mm). Please compare to CT of 4/28/10 and PET of 5/2010. CHEST:LUNGS AND PLEURA: Previously noted left upper lobe nodule has decreased in size, measuring approximately 4 mm in greatest axial dimension (series 4, high-resolution image 96). The second smaller nodule more superiorly in the left upper lobe has also decreased in size and is no longer accurately measurable (series 4, high-resolution image 79). Pulmonary micronodules are seen bilaterally.No suspicious nodules, masses, or pleural effusion.Postsurgical changes reidentified in the right upper lobe as is the pleural and parenchymal scarring/atelectasis in the left lower lobe.Upper lobe predominant centrilobular emphysema with patchy areas of fibrosis, some adjacent to previous surgical resection site.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Moderate to severe coronary artery calcifications. Calcifications of the aorta as well as the aortic valve/annulus are also noted.Lipomatous hypertrophy of the interatrial septum as seen previously.CHEST WALL: Left thyroid cyst reidentified.UPPER ABDOMEN: Right hepatic cyst is reidentified. Left renal cyst partially visualized.

Output: Interval decrease in size of previously referenced left upper lobe nodules.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with a history of lymphoma, now with dyspnea. Evaluate for progression of disease. CHEST:LUNGS AND PLEURA: There is a new large right pleural effusion with an opacity in the RUL/RML, which may represent atelectasis; however, consolidation and an infectious process cannot be excluded.Hyperinflation and emphysematous changes of the lungs bilaterally are again noted.MEDIASTINUM AND HILA: There has been interval progression of multiple mediastinal lymph nodes. The reference right paratracheal lymph node now measures 1.2 cm x 1.1 cm (image 114/759, series 2), compared to 0.8 cm x 0.6 cm on the previous exam. Heart size normal without pericardial effusion.CHEST WALL: Bulky bilateral axillary adenopathy has increased in size with the reference right axillary lymph node now measuring 3.2 cm x 2.4 cm (image 94/759 from series 2), compared to 1.6 cm x 2.0 cm seen on the last exam.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: Again seen are several retroperitoneal lymph nodes with the reference left periaortic lymph node measuring 3.4 cm x 2.0 cm (image 49/759 from series 2), compared to 1.9 cm x 1.1 cm on the previous exam.The reference right peri-psoas nodule has also increased in size and measures 1.5 cm x 1.7 cm (image 43/759, series 2), compared to 0.5 cm x 0.6 cm on the previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: There is been interval progression of the pelvic adenopathy. The reference right external iliac lymph node measures 2.7 cm x 4.8 cm (image 611/759, series 2), compared to 0.8 cm x 2.2 cm on the previous exam. The reference left external iliac lymph node now measures 2.3 cm x 5.6 cm (image 621/759, series 2), compared to 1.1 cm x 2.5 cm on previous exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The left inguinal lymph node is also enlarged, but stable in size, and measures 2.5 cm x 2.2 cm (image 660/759, series 2), compared to 2.5 cm x 2.0 cm on the previous exam.OTHER: No other significant abnormality noted.

Output: 1.New right pleural effusion with an opacity in the RUL/RML which could represent atelectasis; however, consolidation and infection cannot be excluded2.Interval progression of adenopathy


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: why hypoxic History: above Heart size normal. Lungs clear. No pneumothorax. No pleural effusion. PICC line in projection of superior vena cava.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: please eval lung fields and lines History: hypoxic resp failure Median sternotomy with chest tubes but no pneumothorax.Unchanged left lower lobe consolidation.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.LVAD partially visualized.IABP no longer seen, but possibly due to motion rather than removal.Right jugular Swan-Ganz catheter looped in the main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Probable IABP removal. All other devices unchanged, the ET tube tip 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: s/p esophageal bypass History: hypoxia Two right chest tubes postop with no pneumothorax but right chest wall and bilateral supraclavicular soft tissue emphysema.Right-sided predominant edema.An NG tube traverses gastric pull-up.

Output: An NG tube traverses a gastric pull up.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Acute abdominal pain; r/o free air Low lung volumes with bibasilar opacities, which may represent atelectasis or aspiration. Peritoneal dialysis catheter in place. Moderate stool burden without evidence of bowel obstruction. No evidence of intraperitoneal free air. Heavy vascular calcifications.

Output: Low lung volumes with bibasilar opacities, which may represent atelectasis or aspiration. Moderate stool burden without evidence of bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Swan-Ganz again projects into the right pulmonary flow tract just at or beyond the right upper lobe takeoffICD and underlying cardiopulmonary appearance are also entirely similar without new superimposed focal airspace abnormality

Output: ICD and Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: assess LUE opacity (edema vs consolidation) History: LUL opacity, hypoxia IABP marker again projects at the level of T5. Status post posterior cervical fusion with metallic hardware and drain in place.Mildly enlarged cardiac silhouette.No significant change in bilateral interstitial and airspace opacities. Small left pleural effusion again seen. No pneumothorax.

Output: No change in the left upper and lower lobe pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval bilateral opacities History: hypoxemia, ETT, hardware Lines and tubes are unchanged. Diffuse pulmonary opacities again noted. Small right pleural effusion. Unchanged cardiomegaly. No pneumothorax.

Output: Diffuse pulmonary opacities, unchanged. Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: 72F intubated in CCU, ?ETT placement History: 72F intubated in CCU, ?ETT placement Endotracheal tube tip approximately 4 cm from the carina. Enteric tube terminates beyond the field-of-view.Low lung volumes.Perihilar and basilar edema, pleural effusions, and basilar atelectasis unchanged.

Output: Endotracheal tube tip approximately 4 cm from the carina.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: 70 year-old female with metastatic colorectal cancer status post resection CHEST:LUNGS AND PLEURA: Right apical scarring. Multiple subcentimeter calcified nodules in both lungs. Bilateral emphysema. Moderate right-sided pleural effusion.MEDIASTINUM AND HILA: Paratracheal adenopathy measuring 1.5 by 0.9-cm image number 35, series number 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple new liver metastases. Existing small lesions have also enlarged. Previously measured lesion on image number 23 now measures 2.9 x 2.7 cm on image number 88, series number 4.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral benign cysts.RETROPERITONEUM, LYMPH NODES: Peripancreatic and para-aortic metastatic adenopathy. The reference peripancreatic adenopathy measures 1.2 x 1 .2 cm, image number 106, series number 4.BOWEL, MESENTERY: Small amount of ascites. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Emphysema. Right apical scarring. Moderate right-sided pleural effusion.Interval increase in the size and number of the hepatic metastases and retroperitoneal adenopathy.I. Interval increase in the size of the patient's known hepatic abscess.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Worsening cough with history of aspiration pneumonia. Right jugular chest port tip at the SVC. Dobbhoff tube extends to the upper abdomen to the tip is below the caudal margin of the film. Partially visualized retention balloon left upper quadrant, presumably for a gastrostomy tube.Normal heart size.No specific evidence of pulmonary edema or pleural fluid.Near complete clearance of previously seen pulmonary opacities with very faint residual opacity in the right midlung.

Output: Interval clearance of previously seen pulmonary opacities. There are only very minimal signs of bronchiolitis remaining in the right lung.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Right IJ line placement. Interval placement of right internal jugular central venous catheter with tip in the high right atrium. Moderate left and small right pleural effusions appear similar compared to prior with overlying left-sided atelectasis/consolidation. Patchy right basilar opacities are improved. Mild basilar predominant interstitial opacities.

Output: Right IJ central venous catheter tip in the high right atrium. Persistent pleural effusions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with diffuse abdominal pain and bandemia on labs. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Aortic arch atherosclerotic calcifications. No enlarged mediastinal or hilar lymphadenopathy. The heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is absent with cholecystectomy clips in place. No focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are extensive right lower quadrant inflammatory changes adjacent to a 5.6 x 4.8 cm fluid collection (series 3, image 162). The fluid collection abuts the right broad ligament and sigmoid colon. There are numerous colonic diverticula. The proximal bowel is normal in appearance.Free fluid is present in the pelvis.Fat containing umbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral radiopaque surgical clips compatible with tubal ligation.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are extensive right lower quadrant inflammatory changes adjacent to a 5.6 x 4.8 cm multiloculated fluid collection (series 3, image 162). The fluid collection abuts the right broad ligament and sigmoid colon. There are numerous colonic diverticula. The proximal bowel is normal in appearance.Free fluid is present in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiloculated fluid collection in the right lower quadrant adjacent to the sigmoid colon and right broad ligament. The differential for the fluid collection includes diverticulitis with adjacent abscess versus tubo-ovarian abscess.


Instruction: Generate impression based on medical findings.

Input: Asbestos exposure. Normal heart size. Mild unfolding of the thoracic aorta. No visible calcified pleural plaques. Very mild scarring or atelectasis at the right lower lobe. No pleural fluid.

Output: No acute pulmonary abnormality and specifically no visible signs of asbestos exposure by plain film technique. Please note that parenchymal findings of asbestosis may not be visible by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: s/p thoracentesis History: dyspnea Right sided pleural thickening with decreased size of the right hemithorax again noted, not substantially different. Small left pleural effusion has nearly completely resolved. No new focal left lung consolidation. Unchanged heart size. No pneumothorax.

Output: Improvement in left pleural effusion. No evidence of pneumothorax. Pleural thickening within the right hemithorax consistent with mesothelioma.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: Check ETT Placement History: Check ETT Placement Interval endotracheal tube placement with tip approximately 2 cm above the carina.Remaining support devices unchanged in position.Stable cardiomediastinal silhouette.Small lung volumes with persistent perihilar and lower lobe opacities.Pleural effusions not significantly changed prior exam.

Output: Interval intubation with endotracheal tube tip approximately 2 cm above carina. Persistent pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: routine pa/lat s/p tecab History: s/p TECAB Markedly underinflated lungs with perihilar and basilar nonspecific opacity compatible with atelectasis, consolidation and effusions. No significant change line for differences in inflation and projection.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Chest pain No focal airspace opacity, pleural effusion, or pneumothorax. Linear right basilar opacity most consistent with scarring/atelectasis.The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary process. 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: 55-year-old male with history of gist tumor, status post resection CHEST:LUNGS AND PLEURA: Subcentimeter nodule in image number 69, series number 5 is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes involving the bowel segments unchanged.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. No evidence of metastatic or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with history of pancreatic cancer CHEST:LUNGS AND PLEURA: Air space opacity in the right upper lobe is stable measuring 10 x 7 mm on image number 44, series number 5. Right lower lobe nodule is stable image number 57, series number 5. A new nodular density is noted in the right middle lobe image number 75, series number 5. This may represent a parenchymal nodule versus part of atelectatic changes in the right middle lobe. Follow-up imaging is recommended.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia and metallic stent in the common bile duct unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Amount of pancreatic ductal dilatation has decreased. Ill-defined hypodense dense focus in the of the pancreas likely representing patient's known pancreatic cancer slightly smaller measuring 1.6 x 1.2 cm in image number 109, series number 3. Soft tissue infiltration in the porta hepatis region is unchanged. Decrease in the caliber of the main portal vein at the level of the confluence is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening of duodenum is unchanged. Engorgement of mesenteric vessels and mesentery collection secondary to encasement of the main portal vein, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal interval decrease in the size of the pancreatic head mass as described above.New subcentimeter nodular density in the right middle lobe, nonspecific. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 22 yearsGender: MaleReason for Study: Reason: consolidation vs acute chest History: hypoxemia Right IJ venous catheter with its tip in the SVC. Stable cardiac mediastinal silhouette.Perihilar/basilar airspace and interstitial opacities compatible with edema similar in appearance the prior exam.No new pulmonary opacities identified.

Output: Bilateral pulmonary opacities similar in appearance to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: IABP History: as above Cardiomegaly without acute edema or pneumonia.IABP catheter proximal marker projects over the aortic arch.Left subclavian ICD unchanged.Right PICC, tip in axillary region.

Output: No change in support devices.


Instruction: Generate impression based on medical findings.

Input: End-stage renal disease. Line placement Interval new right jugular catheter placed, tip extends into the SVC just beyond the left innominate. No postprocedural complicationNo interval positional change of the cardiopulmonary appearance. Mild cardiomegaly with minimally decreased lung volumes.

Output: Right jugular catheter placed without complication


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of chordoma CHEST:LUNGS AND PLEURA: Again noted bilateral multiple lung nodules. Previously measured index nodule in the left lower lobe is slightly smaller now measures 5 mm in diameter image number 75 series number 5. A more inferior, Index left lower lobe nodule, however, is unchanged measuring 9 x 8 mm on image number 84, series number 5. Medially located right lower lobe reference mass measures 3.2 by 3.2 cm on image number 75, series number 5, stable. Other nodules also grossly stable.MEDIASTINUM AND HILA: Index left hilar lymph nodes measures 1.3 by 1 cm on image number 52, series number 3, unchanged. Index right hilar lymph node measures 10 x 9 mm on image number 46, series number 3, not significantly changed. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Small hypodense lesions in the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Reidentification of large lytic lesion with sclerosis and destruction of the sacrum which appears similar to the previous study. Soft tissue component in the right inferior sacrum measures 2.9 by 1.6-cm image number 183, series number 3. This has not significantly changed from previous study. Additional soft component of the lesion the presacral space measures 6.3 by 1.5-cm image number 175, series number 3, stable.Previously noted left thigh mass has been resected within the interval. Postsurgical changes in the left thigh. There is an 5.5 x 5.5 cm fluid collection at the site of the resection in the left thigh, incompletely imaged.OTHER: No significant abnormality noted.

Output: No significant change in the lung nodules other than minimal decrease in the size of one of the index nodules.Sacral mass is also stable.Interval resection of left thigh mass. Postsurgical collection in the left thigh, incompletely imaged.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Eval for progression of pneumonia History: Increased O2 requirement Worsening upper lobe interstitial and airspace opacities consistent with multifocal pneumonia or aspiration.Mild improvement in basilar atelectasis.Small left pleural effusion is likely.Mild cardiomegaly.A Dobbhoff tube may be coiled in a hiatal hernia.

Output: Progressive upper lobe opacities consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: RRT called History: above Persistent perihilar opacities with increasing, layering pleural effusions favoring edema. A skinfold is noted on the right; no pneumothorax is present. Opacities at the thoracic inlet are suspected to be atherosclerotic plaque. Severe cardiomegaly with extensive atherosclerosis and mitral annular calcification is evident.

Output: Edema-like pattern with cardiomegaly not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: pre op History: ex smoker Mild cardiomegaly.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 42-year-old with history of cervical carcinoma status post pelvic radiation with worsening bilateral lower extremity edema. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Previously measured reference right pelvic lymph nodes significantly smaller measuring 7 x 5.4-mm image number 157, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrence or metastatic disease in the chest abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: s/p PICC line placement History: s/p PICC line placement New left PICC line is seen in place with its tip at the cavoatrial junction.Left lower lobe opacity has decreased from the prior study. Basilar predominant septal lines are present suggesting mild pulmonary edema. The cardiomediastinal silhouette is unchanged.

Output: Left PICC tip at the cavoatrial junction. Possible mild pulmonary edema. Decrease in left lower lobe opacity.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with shortness of breath and leukocytosis. The right heart border is obscured and there are patchy ill-defined opacities within the right mid to lower lung zone. Single nodular opacity in the right upper lung zone or overlying the patient is indeterminant, new from prior. Significantly increased right pleural effusion. The left lung is clear. No pneumothorax.Tracheostomy and right chest port unchanged.

Output: The right heart border is obscured and there are patchy ill-defined opacities within the right mid to lower lung zone which may represent aspiration or infection. Significantly increased right pleural effusion. Single nodular opacity in the right upper lung zone is indeterminant, but may represent an additional focus of aspiration or infection; this may also be overlying the patient.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of ovarian cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 15 x 10 mm on image number 40, series number 3. This is unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the posterior right hepatic lobe on image number 99, series number 3 is unchanged.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: Reference peripancreatic lymph node measures 18 by 12-mm image number 102, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Age: 37 yearsGender: MaleReason for Study: Reason: R side ant chest pain History: chest pain Stable cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Stable mild cardiac enlargement. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: 53 old female history DVT with shortness of breath and sputum. PULMONARY ARTERIES: No significant abnormality noted. No evidence of pulmonary embolus.LUNGS AND PLEURA: No significant abnormality noted. Lung volumes are normal. Scar in the right upper lobe. Scattered micronodules, largest in the left lower lobe. No evidence of mosaic perfusion or air trapping.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Subcentimeter left adrenal nodule has internal fat consistent with an adenoma

Output: 1. No specific findings to explain patient's symptoms.2. No evidence of pulmonary embolus.


Instruction: Generate impression based on medical findings.

Input: MDS now with neutropenic fever, history of stem cell transplant. Large lung volumes suggestive of COPD. No pleural fluid or pneumothorax. No focal airspace opacity.

Output: No visible signs of pneumonia. COPD.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval infiltrate History: SOB Stable deformity lateral right sixth rib. Diffuse bronchial wall thickening not significantly changed from prior. Heart size remains stable. No interval edema or significant pleural effusion.

Output: Findings reflective of bronchitis or asthma without interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: Chest tube placement History: None Right Port-A-Cath with is tip in the SVC.NG tube with its tip at the GE junction.Left-sided chest tube with its tip directed medially at the left lung base.Surgical clips noted in the left neck.Cardiac mediastinal silhouette is unremarkable.Left perihilar and left basilar opacities may represent atelectasis.No pneumothorax identified.No pleural effusions.

Output: No pneumothorax identified. Nonspecific left perihilar and left basilar opacities may be related to recent surgery.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o aspiration History: pulled dobhoff, coughing Interval extubation. Tip of enteric tube beyond the lower extent of the film.Increase in right pleural effusion. No change in basilar opacities.

Output: 1. Dobbhoff tube placement below diaphragm.2. Interval extubation3. Increased right effusion4. Stable basilar opacities


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Tumor lysis. Trialysis right IJ. low position of right jugular catheter with tip in right atrium. No pneumothorax. Low lung volumes with basilar atelectasis and elevation of the right hemidiaphragm. Mediastinal widening nonspecific and may be exaggerated by low lung volumes however the possibility of mediastinal hematoma cannot be excluded in the postprocedural setting.

Output: Low position of right jugular catheter with tip in the right atrium. No pneumothorax. Nonspecific mediastinal widening.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Hemoptysis evaluate lung fields. The right atrium is markedly dilated. Heart size is unchanged. Enlargement of the central pulmonary vasculature suggesting pulmonary hypertension is also unchanged. On the lateral radiograph, there is a small focus of subpleural consolidation anteriorly; this was characterized as a spiculated nodule on a recent CT scan.Coarse interstitial abnormality consistent with emphysema and fibrosis. No specific evidence of superimposed pulmonary edema or pneumonia.

Output: Spiculated anterior right upper lobe nodule, described on the recent CT scan has suspicious for primary pulmonary neoplasm. Right atrial dilatation and signs of pulmonary hypertension. No new superimposed acute parenchymal lung abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evidence of infection, fluid accumulation History: worsening cough, sob Persistent right pleural effusion with fibrotic changes in the native right lung. A small left pleural effusion is noted, no new opacity affects the transplanted left lung.

Output: Persistent bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval ETT placement History: eval ETT placement Endotracheal tube tip approximately 4 cm above the carina.Interval development of cardiomegaly with basilar opacities. Likely small pleural effusions.No pneumothorax.

Output: Interval development of mild cardiomegaly and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: Previously measured precarinal lymph node, which is no longer pathologically enlarged, is unchanged from a measured 11 x 8 mm (series 3; image 37).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomySPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic disease.PELVIS:UTERUS, ADNEXA: Calcified uterine fibroidBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: DiverticulosisBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination without definite measurable disease


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: sob History: sob Significant interval opacification of the right hemithorax related to both effusion and atelectasis. No change in the prison described left lung masses and pulmonary nodules related to metastatic disease.

Output: Significant increase in opacification of the right hemithorax likely related to both effusion and atelectasis. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: O2 requirement History: as above Interval removal of right pleural drain.No pneumothorax.Bilateral small-to-moderate pleural effusions with underlying bilateral atelectasis in the lower lobes.

Output: Slight improvement in bilateral pleural effusions and basilar atelectasis, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: VOC, r/o acute chest History: Low grade fever, tachycardia. No chest pain, SOB Low lung volumes makes detailed cardiopulmonary assessment difficult. Unchanged port catheter. Increased basilar atelectasis. 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: Reason: r/o pneumonia History: same Cardiopulmonary monitoring and support devices, unchanged.Bilateral opacity compatible with edema, atelectasis and pleural effusions.No significant interval change.

Output: Nonspecific opacity compatible with edema and atelectasis without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: cough and potential aspiration r/o fld overload or pna. History: cough Calcified granuloma at the right peripheral upper lobe. Heart size is normal. Multiple osteophytes are noted at the thoracic spine.

Output: No evidence of pneumonia or fluid overload.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: VAD History: vad Left IJ venous catheter is been removed.LVAD unchanged.New left PICC line with its tip in the left subclavian vein.Stable cardiac enlargement.Left retrocardiac atelectasis and left pleural effusion similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: New left PICC line in place with its tip in the subclavian vein. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: FemaleReason for Study: Reason: missed multiple dialysis, eval for fluid overload History: shortness of breath Right central venous catheter with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Right basilar scarring/discoid atelectasis.No focal areas of consolidation.Probable right pleural effusion.

Output: No reliable evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with increased shortness of breath. Evaluate for interstitial pulmonary fibrosis. Evaluate for infectious source. CHEST:LUNGS AND PLEURA: Peripheral, subpleural groundglass opacities with architectural distortion and bronchiectasis, all of which are predominantly in the lower lobes. Note is made of mild microcystic honeycombing, particularly in the lung bases as well.No significant airtrapping.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild enlargement of the main pulmonary, compatible with pulmonary hypertension.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: Findings compatible with pulmonary fibrosis; favor fibrosing NSIP pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Infectious w/u History: Weakness No acute cardiopulmonary abnormality. No change from prior.

Output: Stable radiograph with no evidence of pneumonia


Instruction: Generate impression based on medical findings.

Input: Chest pain No acute cardiopulmonary abnormality. Persistent mildly decreased lung volumes with minimal basilar changes compatible scarring.

Output: Minimal scarring without acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: MaleReason for Study: Reason: s/p CABG History: s/p CABG ET tube with its tip 3 cm above the carina.Right IJ Swan-Ganz with its tip in the pulmonary artery.Chest tubes in place without evidence of a significant pneumothorax.IABP marker in the mid descending aorta.Decreased lung volumes with stable cardiac enlargement.Basilar opacities compatible with atelectasis and small effusions.New median sternotomy with evidence of a CABG.

Output: Postoperative chest without complication.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.History of cystic fibrosis. Evaluate for pneumonia. Bronchial dilatation, thickening and an impaction predominantly affecting the right upper lobe and left midlung compatible with provided history of cystic fibrosis. No significant pleural effusions.

Output: No significant interval change in the chronic pulmonary opacities. No reliable evidence of acute infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Shortness of breath. The cardiomediastinal silhouette is unremarkable.Patchy opacities in the left costophrenic angle have improved and are likely related to atelectasis or scarring. No evidence of pneumonia. No pleural effusion or pneumothorax.

Output: Improved patchy left basilar opacities likely reflects atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: ETT placement History: ETT Placement Endotracheal tube tip 5 cm above the carina.SVC stent unchanged.Multiple coils are present over the mediastinum, unchanged.Surgical clips in the upper abdomen.Minimally improved aeration of the right lung with improved airspace opacity in the left lung. Persistent bilateral pleural effusions not significantly changed.

Output: 1. ET tube in acceptable position.2. Minimally improved pulmonary opacities with persistent pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old Reason: 77 y/o with RA c/o cough evaluate Streaky left basilar opacity suggests atelectasis/scarring.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is normal.

Output: Mild basilar atelectasis, but no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 54 year old female with history of ovarian cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple perihepatic peritoneal metastases are again noted, grossly stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measures 3 x 1.7 cm on image number 93, series number 3, not significantly changed.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal carcinomatosis, slightly increased in size compared to previous study. Index lesion on the left side of the abdomen now measures 1.7 x 1.9 cm on image number 100, series number 3. Multiple other deposits are also noted throughout the abdomen, more on the left side and in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Right inguinal adenopathy measures 1.5 by 1.2 cm in image number 189, series number 3, slightly smaller compared to previous study.BOWEL, MESENTERY: Pelvic peritoneal metastases are again noted, increased in size compared to previous study. Previously measured left adnexal deposit now measures 3 x 1.8 cm on image number 177, series number 3. New ascites in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Progression of disease with interval increase in the amount of peritoneal carcinomatosis.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of respiratory failure. Followup tracheostomy. Tracheostomy tube tip at the level of the thoracic inlet. Dobbhoff tube tip projecting over the proximal gastric body. Right internal jugular central venous catheter with tip in the right atrium.Diffuse nonspecific air space opacities worse on the right compatible with patient's known ILD. Mild to moderate bilateral pleural effusions. Lucency at the left apex compatible with emphysema.

Output: ILD, emphysema, and bilateral pleural effusions appearing similar to prior. Improved aeration of the left lung. Tracheostomy tube tip at the level of the thoracic inlet.


Instruction: Generate impression based on medical findings.

Input: 89-year-old female with history of pleuritic left-sided chest pain. Evaluate for pneumonia. Cardiomediastinal silhouette is unremarkable. No focal air space opacities, effusions, or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: pna? History: chronic cough and sputum production, chest pain with cough Mild perihilar bronchial wall thickening best seen on the lateral view.No other evidence of infection.Unremarkable mediastinal contours and cardiac silhouette.

Output: Bronchial wall thickening suggestive of asthma or chronic bronchitis, but no reliable evidence of acute pneumonia. Coronary chronic whatever


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with metastatic prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Sclerotic T10 metastasis, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Stable numerous hepatic cysts. Index lesion followed up up in the lateral segment of the left lobe measures 8 x 8 mm on image number 100, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable bilateral adrenal nodules.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic left iliac lesions are unchanged.OTHER: No significant abnormality noted

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Eval for cardiopulmonary disease. History: SOB No pleural effusion or pneumothorax. No focal pulmonary abnormality. The cardiomediastinal silhouette is unchanged from prior examination.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with metastatic prostate cancer. Evaluate extent of disease. CHEST:LUNGS AND PLEURA: Scattered micronodules are nonspecific and unchanged. Focal thickening along the minor fissure is also unchanged (series 4, image 60).MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Multiple sclerotic lesions involving bilateral ribs, thoracic vertebral bodies, right clavicle, and the left scapula are compatible with metastasis. Lesions involving the right fifth and right 10th ribs have associated soft tissue masses, which have increased in size compared to the prior study. For example, the soft tissue mass associated with the right 10th rib now protrudes 11mm from the chest wall (previously 8 mm), and causes external compression on the liver (series 3, image 114).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The right kidney is atrophic with minimal perinephric fat stranding, unchanged compared to prior study. Left kidney upper pole hypodensity likely represents a benign cyst.RETROPERITONEUM, LYMPH NODES: Infrarenal left periaortic lymph node is new since the prior study and measures 1.5 x 1.5 cm (series 3, image 129). Infrarenal IVC filter is noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic lesions throughout the thoracic and lumbar spine are consistent with metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multiple sclerotic lesions throughout the lumbar spine and bony pelvis are consistent with metastatic disease.There is destruction of the right iliac wing with increased soft tissue component involving adjacent musculature (series 3, image 168).OTHER: No significant abnormality noted

Output: 1.Progression of metastatic lesions and new periaortic lymphadenopathy, consistent with worsening metastatic disease.2. Multiple sclerotic osseous metastases, some with associated soft tissue component, appearing worse compared to the prior studies and consistent with worsening metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: URI History: SOB Lungs clear.Heart size normal.Hyperexpansion lung fields, nonspecific.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: ptx History: ptx Left pleural drain with a persistent left pneumothorax and extensive chest wall soft tissue emphysema bilaterally.Stable left hemithorax volume loss with endobronchial valves.

Output: Unchanged left pneumothorax and severe soft tissue emphysema.


Instruction: Generate impression based on medical findings.

Input: 29 years old Male. Reason: eval infiltrate History: eval ACS/PNA, SSD. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is no evidence of acute infiltrate. There is a small effusion on the right.

Output: Cardiomegaly and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: 34y/o with runny nose and cough, background h/o AML, please evalute for infiltrates prior to starting chemotherapy History: cough, rhinorrhea Unremarkable cardiac and mediastinal silhouette. Right third rib and chest wall deformity, unchanged.No sign of pneumonia or other acute findings.

Output: No acute abnormalities.