Instruction: Generate impression based on medical findings.

Input: Upper airway wheezing Borderline cardiomegaly with mixed interstitial airspace opacities in both bases is somewhat streaky distribution. Appearance suggest possible aspiration, however atelectasis or even chronic change cannot entirely be excluded. No definite effusions. Serial imaging will be helpful and if the patient can perform dedicated two-view imaging this would also be helpful. In addition, prominent pulmonary arteries, concerning for possible hypertension2-lead left subclavian ICD with lead tips in the expected locationsNear severe osteoarthritic changes involving both shoulders greater on the right with more complete evaluation. Possible loose body observed in the left in the inferior aspect of the shoulder soft tissues. This may also represent an old calcified lymph node

Output: Questionable aspiration and prominent pulmonary arteries, concerning for possible hypertension


Instruction: Generate impression based on medical findings.

Input: Reason: eval for line placement History: picc line moved PICC line tip in the area of the left axillary vein.Cardiomegaly, ICD leads and diffuse chronic interstitial disease unchanged.

Output: Catheter tip in the left axillary vein.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: endotracheal tube position History: s/p advancement ET tube overlying the mid trachea, in adequate position. Additional support apparatus is in stable position.Persistent left hemithorax diffuse opacification with minimally improved aeration of the left apex,.Very limited assessment of the right lung due to motion artifact

Output: Adequate position of support apparatus.Minimally improved aeration of the left apex although persistent diffuse opacification of the left hemithorax.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: s/p chest tube, eval for appropriate placement and interval pleural effusion resolution History: above New right chest tube partially draining a right pleural effusion, with no significant pneumothorax.Unchanged pulmonary opacities suggestive of edema or aspiration.ET tube tip approximately 5 cm above the carina.NG tube, tip at hemidiaphragm level.Right subclavian catheter, tip in SVC.

Output: New right chest tube with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Hypoxic respiratory failure. Right jugular introducer unchanged.Layering pleural fluid with atelectasis not significantly changed.

Output: Unchanged pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Cough, shortness of breath, chest pain, evaluate for pneumonia Elevation of the left hemidiaphragm is of unknown chronicity. Dilated colonic loop in the left upper quadrant.Basilar atelectasis without evidence of superimposed infection, edema, or effusions. The cardiac and mediastinal silhouette is unremarkable.

Output: 1.Elevation of the left hemidiaphragm without evidence of acute cardiopulmonary abnormality.2.Dilated left upper quadrant colonic loop; a dedicated abdominal radiograph series is suggested.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: hypoxia, effusion History: hypoxia, effusion Motion limits sensitivity.Support devices unchanged.Stable cardiopulmonary appearance with extensive pulmonary opacities and pleural effusions.Left retrocardiac consolidation/atelectasis.No new pulmonary opacities identified.

Output: Support devices unchanged with right-sided chest tube and no evidence of a pneumothorax. Stable cardiopulmonary appearance with extensive pulmonary opacities and pleural effusions, right greater than left.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Intubated, s/p kidney transplant History: Intubated, s/p kidney transplant Lines and tubes are unchanged. Improvement in patchy left basilar opacity. No new focal pleural parenchymal opacity. Small left pleural effusion again noted. Unchanged mild cardiomegaly. No pneumothorax.

Output: No new focal pleural parenchymal opacity. Improvement in patchy left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: stroke History: same Possible subsegmental atelectasis left lower lung zone.Elsewhere, the lungs are unremarkable.Heart size normal.

Output: Possible left basilar atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 46 years, Female. Reason: Please eval for obstruction, eval for stool burden History: vomiting, s/p EGD found to have mallory weiss tear. Also has a history of chronic constipation, gastroparesis Right chest port with tip at the cavoatrial junction. Coronary artery stents and/or calcifications. Normal heart size. No focal airspace opacities or pleural effusions.Paucity of abdominal bowel gas but no specific evidence of obstruction. Average stool burden. Pelvic phlebolith.Unchanged deformity of the right femoral head.

Output: Nonobstructive bowel gas pattern. Average stool burden.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: intubated History: intubated Support devices unchanged.Large lung volumes compatible with COPD, diffuse bronchiectasis. Increasing bilateral lower lobe consolidation suggestive of aspiration. Small pleural effusions. No pneumothorax.

Output: Progressive lower lobe opacities suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval for infection History: eval for infection No significant cardiopulmonary abnormality.Shunt tubing overlies the right side of the chest.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: eval for effusions History: shortness of breath Right port terminates at the level of the azygos vein.Mild left ventricular enlargement with small hiatal hernia. Relatively low lung volumes with basilar opacities of subsegmental atelectasis. Interval decrease opacities the right base. Nodular opacity projecting over the posterior right eighth rib is likely a nipple shadow.

Output: Improved aeration at the right base. Residual streaky basilar opacities represent subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.History of sickle cell disease with new chest pain. Mild cardiac silhouette enlargement, unchanged. There is mild basilar interstitial opacity. A retrocardiac opacity is also present which may reflect acute infection. No pleural effusions or pneumothorax.

Output: Focal retrocardiac opacity may reflect acute infection or infarct in a sickle cell patient with acute chest pain. These findings were discussed with Dr. Sakaria (ER Physician) at 1020 on 04/14/2015.


Instruction: Generate impression based on medical findings.

Input: 40-year-old female with left upper lobe infiltrate. Left upper lobe groundglass opacity unchanged. Persistent low lung volumes. Unchanged cardiomediastinal silhouette.

Output: Left upper lobe opacity nonspecific but most concerning for infection given the nodular appearance and short time frame.


Instruction: Generate impression based on medical findings.

Input: Reason: 59yo F w/ resp failure requiring intubation History: as above ET tube tip approximately 3 cm above the carina.Left jugular catheter tip in the left innominate vein.Large lung volumes consistent with COPD.Multiple healed rib fractures.No sign of pulmonary edema or pneumonia.

Output: COPD with no acute change.


Instruction: Generate impression based on medical findings.

Input: Pneumothorax check Unchanged left apical small and suspected loculated hydropneumothorax, air fluid level currently is not well appreciated likely due to semiupright positioning.Underlying cardiopulmonary appearance otherwise unchanged with a well-positioned tracheostomy tube. G-tube projects over mid upper lateral abdomen

Output: Unchanged cardiopulmonary appearance with a small left apical pneumothorax


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: CHF, R pleural effusion History: SOB Cardiac enlargement with moderate sized pleural effusion similar to the prior exam.Mild increased interstitial opacities stable.No new pulmonary opacities.

Output: Cardiomegaly and right pleural effusion without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: 87yoM hypoxia, wheezing after platelet transfusion History: hypoxia Left subclavian catheter tip in the mid SVC.New nonspecific basilar opacities.Right paratracheal thickness appears increased, even accounting for slight rotation.Stable cardiomediastinal silhouette.

Output: Nonspecific opacities may represent edema/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: upright chest, eval for free air History: 45481 No significant cardiopulmonary abnormality.

Output: No significant abnormality. No free intraperitoneal air identified.


Instruction: Generate impression based on medical findings.

Input: Patient pulling at central line, check position Mildly shifting atelectasis with persistent decreased lung volumes and redistribution accountable by patient semiupright positioning. No new discrete mediastinal or cardiac contour change given positioning.Right jugular catheter remains in the upper SVC at the confluence with the left innominate

Output: Suspected basilar atelectasis and no definitive changes to support edema or pneumonia, however exam limited


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: PNA? edema? effusion? History: cough, elevated CRP, histoplasmosis Streaky opacities in the lungs, likely atelectasis or scar. No focal lung consolidation. No pleural effusion or pneumothorax. Moderate cardiomegaly again noted. Right paratracheal fullness again noted, likely representing lymphadenopathy. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: r/o infection, mass History: chronic 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, 72 years old.Reason: lung nodule History: lung nodule status post VATS wedge resection 9/2016 Spinal fixation hardware unchanged.The cardiomediastinal silhouette appears stable with a multinodular thyroid goiter and calcified hilar nodes.Chronic elevation of the right hemidiaphragm.No focal pulmonary opacities or pleural effusions.

Output: No focal pulmonary opacity or acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval for PNA. Immunocompromsied heart transplant pt with new cough. History: as above Status post sternotomy. No new opacity to suggest pneumonia. Borderline heart size.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: Developmental delay, concerns for aspiration with fever, fatigue and increased oxygen requirements. Limited examination due to suboptimal position with patient rotation. The neurostimulator device is seen overlying the chest.Grossly stable cardiac silhouette.The lungs are hypoinflated with elevation of the right hemidiaphragm and likely significant adjacent atelectasis. Mild perihilar vascular congestion without frank edema. No large pleural effusion or pneumothorax.

Output: Limited examination with low lung volumes and elevated right hemidiaphragm with adjacent opacity likely atelectatic in nature. Recommend continue clinical followup and consider followup imaging as warranted.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, 73 years old.Reason: Infiltrates History: fever Previously seen large goiter inseparable from the aortic arch has enlarged further deviation of the trachea.Left basilar atelectasis is unchanged with possible small left pleural effusion.Mild cardiomegaly.

Output: Enlarging goiter inseparable from the aortic arch. A follow-up CT is recommended to verify that there is no underlying or new aortic abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ett History: pt intubated ET tube tip approximately 6 cm above the carina.Catheter from the right arm extending to the right subclavian vein.Increased opacity at the right base consistent with atelectasis in the right lower and middle lobes, likely secondary to aspirated secretions.Moderate atelectasis medially in the left lower lobe, unchanged.

Output: Increasing right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cabg and avr History: s/p cabg and avr ET tube tip in the proximal right main bronchus. This has been adjusted on the subsequent radiograph.Swan-Ganz catheter directed towards a left upper lobe branch of the pulmonary artery.Balloon catheter with its tip at the level of the aortic arch.Nonspecific opacity in the left hemithorax consistent with consolidation and atelectasis.Surgical sponge markers projected over the mediastinum, presumably in an open sternotomy wound.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: eval cause of hypoxemia, hardware History: post op aortic dissection Support devices are unchanged.No change in bilateral lung opacities. Especially described loculated right basilar pneumothorax cannot be excluded.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Male, 6 years old. Intubated. Evaluate ET tube is.VIEW: Chest AP (one view) 3/23/15, 2048 ET tube tip is at the level of the thoracic inlet. Enteric tube curled within the stomach.The cardiac silhouette is mildly enlarged. Persistent bilateral airspace opacities and pleural effusions, compatible with acute chest syndrome, not significantly changed from the prior exam.

Output: Unchanged bilateral pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for latent TB History: (+) quantiferon Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: New RLL consolidation on portable CXR History: Cough, rhinorrhea Unremarkable cardiac and mediastinal silhouette. Small linear scar in the right lower lung but no acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 11 years old, with history of neuroblastoma status post stem cell transplant. Evaluate for disease. CHEST:LUNGS AND PLEURA: Streaky linear opacities in the anterior upper lobes, more so on the left, likely represent atelectasis. Dependent atelectasis is also evident at the lung bases. No suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Subcentimeter hypoattenuating focus within the spleen is unchanged. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See below.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A large fecal load is present within the colon, similar to the prior exam.BONES, SOFT TISSUES: No significant abnormality noted

Output: 1.No evidence of recurrent or metastatic disease in the chest, abdomen or pelvis.2.Large colonic fecal load.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: worsening hypoxia Unchanged central venous catheters. Improvement in lung volumes. Elevation left hemidiaphragm, as before. Improvement in right basilar opacity. No new focal pleural parenchymal opacity. Unchanged heart size.

Output: Improvement in right basilar opacity which may represent aspiration. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: concern for cause of slight hemoptysis, given recent travel, chills, and h/o lung nodule worked up at U of C History: fever, chills, reports of few drops blood on tissue this AM The cardiac mediastinal silhouette is unremarkable. Ill-defined nodular opacity in the left mid/upper lung, representing the patient's known left upper lobe nodule. No additional nodules or masses are identified. No focal consolidation, pleural effusion, or pneumothorax.

Output: Nodular opacity in the left mid lung, consistent with the known left upper lobe nodule. No additional focal opacities are identified.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, 66 years old.Reason: r/o pneumonia History: cough/fever Mild left base scarring or subsegmental atelectasis, the lungs otherwise unremarkable.No specific evidence of infection.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with rising white count, posterior blood cultures, looking for possible source of infection CHEST:LUNGS AND PLEURA: Endotracheal tube is in place. 10-mm right upper lobe nodule in image number 27, series number 5. This nodule has a small central cavitation. Left lower lobe 2 x 1.7 cm wedge-shaped air space opacity. Another nodule central cavitation is noted in the left lower lobe image number 65, series number 5.Right lower lobe wedge shaped air space opacity and trace pleural effusion. These may be secondary to aspiration.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: The tip of the NG tube is in the duodenum.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: Rectal tube is in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral, well defined nodular opacities with subtle central cavitation. These are suggestive of septic emboli.Right lower lobe wedge-shaped air space opacity and trace pleural effusion may be secondary to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: assess IABP, swan, pulmonary edema History: s/p IABP and swan Adequate position of ET tube, enteric tube and Swan-Ganz catheter, the latter overlying the proximal right pulmonary artery. The tip of the IABP radiopaque marker is localized approximately 5.5 cm below the top of the aortic arch.Persistent small right pleural effusion and right basilar discoid atelectasis. No signs of pulmonary edema.Pigtail catheter projection of left pleural space. No pneumothorax.

Output: Line position stable. No change in right basilar opacity and effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: Fever History: Fever and Tachycardia Once again, poor lung volumes with basilar opacities which could represent aspiration or atelectasis. No other evidence of acute abnormality.

Output: Nonspecific basilar opacities with low lung volumes, representing atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: eval for PNA History: cough, new dx leukemia Mild left basilar atelectasis and left pleural effusion.Heart size upper normal.Left subclavian single chamber ICD, leads in appropriate position.

Output: Left basilar opacity and left effusion suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of right breast mastectomy for cancer in 2015 followed by chemotherapy and hormonal therapy, now presenting with palpable mass in the right upper chest area. A targeted right ultrasound was performed for the palpable area of concern. There are multiple complex, heterogeneous masses in the right upper chest; the largest measures 2.1 x 1.1 cm, suggestive of fat necrosis. Additional smaller cystic lesions in the region likely represent oil cysts.

Output: Multiple heterogeneous masses in the right chest, likely reflecting fat necrosis. Follow-up ultrasound in 6 months is recommended to confirm stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: 46-year-old male, status post transplant, presents for evaluation of shortness of breath. Unchanged large left and moderate right pleural effusions. Underlying compression atelectasis in left lung base is also stable. No focal consolidation. No pneumothorax. Prominent central pulmonary vessels is again suggestive of pulmonary hypertension. Midline sternotomy and vertebroplasty are unchanged.

Output: No significant interval change.Persistent large left and moderate right pleural effusions with underlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: FemaleReason for Study: Reason: r/o infection History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with history of tongue cancer. Status post surgery. Evaluate extent of residual disease. Rule out lung metastases. LUNGS AND PLEURA: Interval development of tree in bud opacity at the left base with additional patchy groundglass and air space opacity. Stable multiple calcified granulomas in the right upper lobe. No new suspicious pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: Normal cardiac size. No pericardial effusions. Calcified mediastinal nodes from prior healed granulomatous disease.CHEST WALL: No significant axillary lymphadenopathy. Stable appearance of multiple linear lucent regions in the thoracic spine which may be secondary to hemangiomas or normal trabecular pattern.UPPER ABDOMEN: Gastrostomy tube. Interval resolution of free air and ascites. Stable appearance of irregular hypodense area in the left kidney which may be from prior radiofrequency ablation of renal tumor, incompletely evaluated. Stable granulomatous calcification in the spleen. Stable appearance of hypervascular lesion in the right lobe of the liver near the dome (image 80/11) which may represent a hemangioma. This appears unchanged since 6/27/08.

Output: 1. Interval development of a bronchiolitis pattern in the left lower lobe likely from aspiration.2. No evidence of metastatic disease in the lungs.3. Stable hepatic enhancing lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: r/o pneumonia, pneumo History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male 58 years old Reason: Pre-Kidney transplant evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. Vascular stent projects over the left axilla. Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Chest pain. Evaluate for pneumonia. Right-sided chest port tip in the right atrium. Right basilar scarring versus small effusion is unchanged compared to recent prior examinations. Minimal left basilar scarring versus atelectasis. Cardiomediastinal silhouette is unchanged. H shaped vertebral bodies compatible with sickle cell anemia. No new focal airspace opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.A. Fib RVR with SOB and crackles left lower. Bronchial wall thickening and atelectasis, right greater left. No visible pleural fluid or pneumothorax.

Output: Bronchial wall thickening nonspecific but in the absence of history of aspiration or bronchitis may reflect axial interstitial thickening from edema.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: eval pneumothorax History: SOB Left chest tube, the left apical pneumothorax slightly larger than before. Left mid to lower lung zone edema like opacities are stable. Dense fibrotic native right lung unchanged.Left subclavian introducer sheath unchanged.

Output: Slight increase in size of left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: FemaleReason for Study: Reason: r/o pna History: fever Stable cardiac enlargement.Interstitial and air space opacities with bronchial wall thickening slightly improved from the prior exam.No no focal areas of consolidation.No pleural effusions.

Output: Continued interval improvement in the bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: s/p RLL for T1aN0M0 IA adeno History: none Stable cardiomediastinal silhouette.Right pleural effusion and volume loss in the right lung unchanged from the prior exam.No new pulmonary opacities identified.

Output: Right pleural effusion and volume loss in the right lung without significant interval change. No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 84 yearsGender: MaleReason for Study: Reason: assess volume status History: as above Left-sided pacemaker with lead wires in the right atrial appendage and right ventricle.The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Malignant pleural effusion evaluate for change. Slight interval decrease in volume of partially loculated right pleural fluid collection. Septal thickening and nodularity bilaterally unchanged. Right perihilar mass and pulmonary nodules similar to previous. Left pleural fluid volumes slightly increased. Right Pleurx catheter unchanged in position.

Output: Slight decrease in right pleural fluid volume with improved aeration of the lung base. The left pleural fluid collection however is slightly larger.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Hypoxia Median sternotomy fixation plates and wires, epicardial pacer leads, CABG clips and mitral valve prosthesis are noted.Interval removal of a right internal jugular catheter. A loop recorder device projects over the left chest.Unchanged elevation of the right hemidiaphragm with adjacent atelectasis and pleural effusion.Subsegmental atelectasis in the left lung base. No pleural effusion or pneumothorax.

Output: Pleural effusion and subsegmental atelectasis not significantly changed since the prior examination.


Instruction: Generate impression based on medical findings.

Input: ARDS Persistent pulmonary opacities with relative sparing of the upper right lobe and left lower lobes unchanged. Diffuse appearance again suggests ARDS without new superimposed focal airspace process. Marked nonspecific cardiomegaly.Left PICC line unchanged terminating in the upper SVC. Right jugular sheath removed

Output: Right jugular sheath removed without complication


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: 71F w/ port preparing to initiate TPN, need to verify central location History: Port Free air under the right diaphragm consistent with pneumoperitoneum.Cardiomediastinal silhouette appears unremarkable.Lungs volumes decreased. Stable bilateral lower lung opacities consistent with atelectasis.Right central venous catheter with tips and SVC. Enteric tube tip outside the imaged window.

Output: Right-sided pneumoperitoneum. No other acute cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Reason: c/f aspiration cough History: cough Heart size about upper normal.Very mild basilar interstitial opacities, unchanged from previous possibly related to aspiration.No new findings.

Output: Mild nonspecific basilar interstitial opacity compatible with aspiration but not specific.


Instruction: Generate impression based on medical findings.

Input: Reason: 51yr old female with history of MM; pre-auto sct evaluation History: evaluate Heart size and upper normal or mildly enlarged.No significant pulmonary or pleural abnormalities.Partial collapse of several upper lumbar vertebrae.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for edema/infiltrate History: sob/co The right costophrenic angle is excluded from the field-of-view.Interval opacity at the right base may represent aspiration with atelectasis. Blunting of the left costophrenic angle suspicious for small effusion with atelectasis. Cardiomegaly is unchanged.

Output: Interval appearance of right lower zone opacity suspicious for aspiration or early edema with atelectasis. Small pleural effusions with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain, endocarditis on pulmonary valve. Venous anatomy for possible CT surgery (valve repair/replacement); pancreatitis flair changes. Multiple DVTs in IVC filter in 2001. Right IJ thrombectomy in 2008. CHEST:LUNGS AND PLEURA: In the left apex, an irregular opacity measuring 22 x 20 x 29-mm with cavitation and air bronchogram is noted, which is new since 3/2009. This lesion may represent septic embolus, fungal or mycobacterial infection cannot be excluded.Previously (3/2009) seen patchy groundglass and air space opacities in the left lobe are not present. Bibasilar scarring/atelectasis likely due to prior infection, unchanged.MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. Normal cardiac size. No free pericardial effusion.Left IJ line tip in the right atrium. Right IJ and right brachiocephalic veins are not opacified. Right subclavian vein is poorly opacified. Left subclavian vein is poorly opacified, which could be due to contrast injection from the left IJ catheter. SVC reconstitutes with inflow from a dilated azygos and left brachiocephalic vein. Dilated hemiazygos vein flows to the left brachiocephalic vein. Numerous collateral vessels are evident within the chest wall as seen on the prior study in 3/2009.CHEST WALL: Status post medium sternotomy. Port in the left chest wall.ABDOMEN:LIVER, BILIARY TRACT: Patient status post cholecystectomy. No focal liver lesions identified. Air bubble in the intra and extra hepatic biliary tract. No intra-or extrahepatic biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No new findings suggestive of pancreatitis. No pseudocyst or free fluid collections. Postsurgical changes consistent with Whipple surgery, unchanged. Multiple calcifications are noted in the residual pancreatic head, compatible with known history of chronic pancreatitis, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.VASCULATURE: IVC filter is again noted. BOWEL, MESENTERY: NG tube tip in the stomach. Surgical changes consistent with Whipple procedure. No intraperitoneal fluid collection.SOFT TISSUES: No significant abnormality noted.

Output: 1. A new irregular opacity with cavitation in the left apex, which may represent septic embolus, fungal or mycobacterial infection cannot be excluded.2. No change in thrombosis or stenosis of the right internal jugular vein and right brachiocephalic vein.3. Status post Whipple procedure. No evidence of acute pancreatitis.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Chest pain, SSD, concern for ACS. Initially with hypoxia but now resolved. Unchanged cardiomegaly. New ovoid nodular opacity right upper lobe lateral to the hilum on the frontal radiograph.. Unchanged heart size. No signs of pulmonary edema or pleural fluid. Osseous stigmata of sickle cell disease.

Output: New focal nodular opacity right upper lobe. Differential considerations include early infection or less likely, a tiny infarct from in situ thrombus related to sickle cell disease, though the latter is considered unlikely based on the location of the lesion. Suggest short-term PA and lateral chest film follow-up.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old Reason: 69y/o male with femur fracture heading to surgery History: surgery No focal consolidation, pleural effusion or pneumothorax is identified. The left costophrenic angle is excluded from the field-of-view. Oval density projecting over the left lung apex is likely external to the patient. Aortic tortuosity likely accentuated by low lung volumes and unchanged, correlate for systemic hypertension. The heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: leukocytosis; evaluate for pneumonia History: as above Small lung volumes with basilar atelectasis and pleural effusions, new since the prior study.No reliable evidence of infection, however.Heart size normal.

Output: Basilar atelectasis and pleural effusions, but no reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Status post thoracentesis, pneumonia, CHF. Moderate to large right pleural fluid collection similar in volume. Smaller volume of pleural fluid on the left.Coarse interstitial and airspace opacities bilaterally probably similar to prior allowing for motion. Unchanged cardiomegaly. Left lower lobe is better expanded compared to prior. No pneumothorax.

Output: Improved atelectasis in the left base, otherwise unchanged cardiopulmonary appearance with diffuse abnormalities and pleural fluid. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: chest pain/sob, r/op pneumonia History: chest pain Small lung volumes.No specific evidence of infection or edema.Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval for pulmonary edema History: dyspnea, chest pain Loop recorder projects over the right inferior hemithorax. Several inferior fractured sternotomy wires without interval diastases. Cardiomegaly without specific evidence of infection or edema. No pneumothorax.

Output: No pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Shortness of breath. Long h/o smoking, d/c 20 years ago. History: Shortness of breath. Long h/o smoking, d/c 20 years ago. Normal heart size and mediastinal silhouette with a mild scoliosis.Mild apical scarring and no acute pulmonary abnormalities.Marked compression deformity of a lower thoracic vertebra at about the level of T12, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Renal transplant, line placement Motion degrades sensitivityRight jugular catheter extends into the proximal SVC without postprocedural immediate complicationMildly decreased lung volumes with vascular redistribution partially due to semiupright technique. Borderline cardiomegaly. Serial imaging is needed if concern for CHF exists

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Renal mass. Evaluate for metastatic disease. Cardiac size is upper limit of normal. No focal airspace opacity, pleural effusion, or pneumothorax. No suspicious pulmonary nodules.

Output: No suspicious pulmonary nodules.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: to evaluate pulmonary function History: Malignant neoplasm of the upper lobe. Status post chemoradiation. Normal heart size with a tortuous aorta.Port catheter with its tip in the SVC.Linear scarring at the lung bases and no acute findings.

Output: Mild basilar scarring and no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: s/p trauma History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No traumatic abnormality identified.


Instruction: Generate impression based on medical findings.

Input: 88 years old Female. Reason: Eval for pleural effusions, infection History: Leukocytosis, bibasilar crackles. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is mildly enlarged. Streaky opacities seen in the right middle lung field.

Output: Cardiomegaly. Streaky opacity in the right middle lung field, which are consistent with atelectasis or scar.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: follow up pneumothorax. History: head and neck cancer, pneumothorax. Interval removal of left upper extremity PICC. Tracheostomy unchanged with thin tubing now projecting over the right apical region.Stable cardiomediastinal silhouette.Unchanged loculated gas along left major fissure.Bibasilar atelectasis with question left pleural thickening.No large pleural effusion.

Output: Unchanged loculated gas along left major fissure.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.MVR. Small right pleural fluid collection.Mitral valve prosthesis.No pneumothorax or focal airspace opacity. Previously seen basal opacities on the right have cleared.

Output: Small right pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pleural effusion History: pleural effusion Moderately larger right pleural effusion, not significantly changed.Underlying nodular opacities compatible with metastatic disease.No other significant change.

Output: Moderately large right pleural effusion with underlying metastatic disease, not significantly changed following for differences in position and projection..


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Previously described right middle lobe nodule is increased in size and now measures 1.7 x 1 .4 cm on image number 81, series number 5. This may represent a metastatic lesion or bronchogenic carcinoma. Left apical scarring is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Stable, expansile sclerotic right fifth rib lesion. Stable thoracic vertebral sclerotic foci.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cysts solid lesions are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic bone lesions appear more prominent on today's study compared to previous study.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: Sclerotic bone lesions appear more prominent on today's study compared to previous study.OTHER: No significant abnormality noted

Output: Sclerotic lesions appear more dense and prominent compared to previous CT.Interval increase in the size of the right middle lobe nodule which may represent metastatic disease or primary bronchogenic carcinoma.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with newly diagnosed diffuse large B-cell lymphoma. CHEST:LUNGS AND PLEURA: new patchy groundglass opacities in the right upper lobe peripherally. This appearance is nonspecific and may represent infection drug reaction and much less likely lymphoma involvement.MEDIASTINUM AND HILA: Esophageal varices unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic appearance of the liver is unchanged. No focal liver lesions. Cholelithiasis is unchanged.SPLEEN: Splenomegaly, unchanged. 2.2 cm splenic artery aneurysm is increased in size compared to previous study where it was measuring 1.8-cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: 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: Previously mentioned left-sided loculated fluid collection is no longer visualized. Previous ascites is resolved. Wall thickening of the sigmoid with extensive diverticulosis is unchanged.

Output: Interval increase in the size of the splenic artery aneurysm. This aneurysm may be amenable to interventional embolization.New nonspecific groundglass opacities in the right upper lobe.Interval resolution of pelvic loculated fluid collection.Changes of cirrhosis, portal hypertension and cholelithiasis are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: acute lung change assessment History: post op respiratory failure Global enlargement of the cardiac silhouette.The left chest tube has been removed. No pneumothorax.Trace bilateral pleural effusions and signs of pulmonary edema again noted.Interval extubation and removal of the enteric tube. Stable position of right IJ venous catheter overlying the SVC.

Output: No residual pneumothorax after removal of the chest.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Evaluate for pulmonary edema, PNA History: Hx pulmonary HTN, COPD, HF, p/w shortness of breath x24 hours; URI symptoms. Exam most c/w COPD exacerbation No significant cardiopulmonary abnormality.Left subclavian single lead ICD, lead tip in the expected location of the RV apex.Status post right shoulder arthroplasty.

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


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Cough, fever. Evaluate for pneumonia. Low lung volumes without focal lung opacity, pleural effusion, or pneumothorax. The heart size is normal.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: Evaluate for lung infiltrate History: HIV, cough, low grade fever Cardiomegaly, with a lower lung zone predominant interstitial abnormality.No pleural effusions or focal consolidation.

Output: Unchanged cardiomegaly with lower lung zone interstitial opacities suggestive of CHF although pneumocystis pneumonia is in the differential diagnosis given the patient's clinical history of HIV.


Instruction: Generate impression based on medical findings.

Input: Chest tube check Left chest tube continues to project towards the apex without associated post procedural or associated complication. ICD unchanged.Underlying cardiopulmonary appearance significant for increased retrocardiac opacity representing probable atelectasis, however aspiration or evolving infection cannot entirely be excluded. Consider serial imaging to ensure clearance. Mild cardiomegaly

Output: Chest tube unchanged with new left lower lobe nonspecific opacity, see detail provided


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: pna History: SOB The cardiomediastinal silhouette is normal.Large lung volumes and COPD changes with minimal right basilar linear scarring. No focal pulmonary opacity, pleural effusion or pneumothorax

Output: Large lung volumes compatible COPD. No acute cardiopulmonary findings.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, 77 years old.Dyspnea. History of pleural effusion and needing thoracentesis, dyspnea. Moderate to large left and moderate right pleural fluid collections, increased on the left.Diffuse edema-like opacities bilaterally are worse.Diffuse skeletal metastases. Bilateral nephroureteral stents and axillary dissection clips.

Output: Moderate to large left pleural fluid collection has increased in volume since the prior examination. Additionally, diffuse edema-like opacities have worsened.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: please r/o infiltrate History: diaphoretic Moderate to severe cardiomegaly status post median sternotomy and aortic valve replacement.Persistently wide mediastinum, unchanged.Mild interstitial edema unchanged.No specific evidence of infection.An NG tube extends below the lower margin of the image.

Output: Cardiomegaly with pulmonary edema consistent with CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with seminoma status post resection. CHEST:LUNGS AND PLEURA: A few right and left lower lobe micronodules, unchanged.MEDIASTINUM AND HILA: Trace pericardial effusion, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Upper limit of normal in size.SPLEEN: Upper limit of normal in size subcentimeter hypodensity at the inferior pole of the spleen (series 3, image 111) is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered 4-5 mm lymph nodes inferior to the left renal vessels, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Right orchiectomy.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: intubation History: intubation Endotracheal tube terminates within 1 cm of the carina. The remaining support devices are unchanged in position.Slight increased opacities suggestive of edema. Moderate layering pleural effusions with cardiomegaly. No pneumothorax.

Output: Increasing opacities suggestive of edema with basilar atelectasis and layering pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male 40 years old Reason: icu History: icu Interval extubation. Remaining lines and tubes are unchanged. Status post mitral valve repair.Cardiomediastinal silhouette is upper limits of normal. No pleural effusion, pneumothorax or new pulmonary opacity.Possible pneumoperitoneum.

Output: 1.Interval extubation.2.Possible pneumoperitoneum may be be related to recent surgery.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: r/o PNA History: SOB, cough, fever Findings of sarcoidosis are unchanged including right mid to lower lung zone volume loss.Slightly increased opacities in right lower lung zone could indicate superimposed infection or aspiration.

Output: Known sarcoidosis with possible right basilar superimposed infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 18 yearsGender: FemaleReason for Study: Reason: pneumothorax History: respiratory failure ET tube, right-sided chest tube, and right central venous catheter unchanged.No significant pneumothorax identified.Cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: Support devices unchanged. No significant pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Prekidney transplant. Rule out cardiomegaly or infiltrates. Right jugular catheter tip at the SVC. No focal airspace opacity, pleural fluid or pneumothorax. Normal heart size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: r/o acute process History: dizziness Mild cardiomegaly with a moderately tortuous aorta, but consistent with age.No significant pulmonary or pleural abnormality.

Output: Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: post-op reevaluation, assess for pulmonary edema. History: crackles on auscultation. Small right-sided pleural effusion versus pleural thickening. Mild patchy bibasilar opacities. Moderate cardiomegaly. Cardiac leads, unchanged. LVAD in place. No pneumothorax. IVC filter noted within the upper abdomen, incompletely visualized.

Output: No evidence of overt left-sided heart failure. Small right pleural effusion or pleural thickening noted, improved from last study. Moderate cardiomegaly, as before.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: possible obstruction History: hypoxia, s/p bronch showing mucous plugging and partial compression of RLL from tumor Mild pulmonary edema. Bibasilar opacities and reticulation again noted. Small pleural effusions. Unchanged heart size. PICC line again noted overlying the lateral right hemithorax. No pneumothorax.

Output: Worsening mild pulmonary edema. Unchanged bibasilar opacities and reticulation with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Concern for movement of the ET tube (previously left mainstem) based on ABG changes Stable appearance of right apical cavity with multiple coils in place.Signs of emphysema and residual pulmonary edema again noted.New basilar consolidative opacities are noted, which may represent alveolar hemorrhage in the setting of hemoptysis or pneumonia.Low-lying ET tube, localized in the proximal left mainstem bronchus (intentional replaced in this position)

Output: Intentional placement of ET tube in the left mainstem bronchus.Right basilar consolidative opacities, new from prior and which could represent pneumonia, aspiration or focal areas of alveolar hemorrhage.


Instruction: Generate impression based on medical findings.

Input: 60 old female with cervical cancer CHEST:LUNGS AND PLEURA: Postsurgical changes in the right lung. No effusions are masses are identified . Possible intrapleural lymph node is unchanged. The right apical scarring is unchanged.MEDIASTINUM AND HILA: Right carinal lymph node on image number 43, series number 3 is slightly smaller measuring 8 by 8-mm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hypodense lesions in the liver. Largest lesion in the left lobe measures 2.4 x 1.8 cm in on the night, series number 3. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue prominence along the prior surgical scar of the anterior abdomen on image number 172, series number 3 is unchanged.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: Right wall lesion is unchanged measuring 2.8 x 2.5 cm image number 198, series number 3.

Output: Interval minimal decrease in the size of the precarinal lymph node, otherwise no other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Fever, assess for infection. Interval development of the left greater than right basal bronchial wall thickening and coarse peribronchial opacities. There is also some solid and nodular appearing airspace opacity in the left lower lobe. Findings are most compatible with pneumonia.Minimal pleural fluid on the right.Normal heart size.

Output: Left lower lobe opacities most likely represent bronchopneumonia. Six-week follow-up PA and lateral chest radiographs recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: s/p chest tube removal History: NA Right chest tube removed with no pneumothorax.Unchanged basilar subsegmental atelectasis.Status post mitral valve repair, heart size normal.Prior right jugular introducer catheter is removed.

Output: Basilar atelectasis. No pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Female 20 months old with shortness of breath and cough. Evaluate for foreign body.VIEW: Abdomen supine AP (one view) chest AP and lateral (2 views) 3/7/2016 No focal opacities within the lungs. Cardiothymic silhouette is within normal limits. No pneumothorax or pleural effusion. A penny is present in the stomach. Small to moderate amount of feces is noted within the colon.

Output: Penny in the gastric body.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: 57M with Swan in CCU, ?placement History: 57M with Swan in CCU, ?placement Left-sided ICD and right IJ Swan-Ganz unchanged.Decreased lung findings with stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.

Output: Support devices unchanged with Swan-Ganz tip in the pulmonary artery. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/p airway stent placement History: lung CA w/ tracheal invasion Right upper lobe mass unchanged with extensive emphysema and a normal-sized heart.ET tube tip approximately 3 cm above the carina.An airway stent described in the clinical history is not visible.

Output: No change in emphysema and right upper lobe mass. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: SOB History: Above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Acute respiratory failureVIEW: Chest AP 2/23/15 Bilateral chest tubes are present. Left upper extremity PICC with tip in the right atrium. Cardiothymic silhouette cannot be evaluated. Bilateral lung opacities right greater than left not significantly changed. There is a small left-sided pleural effusion unchanged. No evidence of pneumothorax.

Output: Bilateral lung opacities not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with history of desaturation. Evaluate lung function. Tracheostomy tube tip 6 cm above the carina. Surgical clips, subcutaneous emphysema and drain overlie the right neck. Enteric tube extends beyond the inferior margin of the study. Surgical clips overlie the left upper mediastinum.Postsurgical changes in the left hemithorax with associated volume loss. Probable pleural effusions and underlying atelectasis without significant interval change. No pneumothorax.

Output: Postsurgical changes without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Status post MVR. Interval removal of right-sided chest tubes without significant pneumothorax. Loculated right pleural fluid collection similar in volume with compressive atelectasis of the adjacent lung. Mitral prosthesis noted. Left lung with basal atelectasis and a small left pleural fluid collection, unchanged.

Output: No significant pneumothorax post chest tube removal. Persistent nonspecific loculated pleural fluid collection on the right.


Instruction: Generate impression based on medical findings.

Input: PICC placement for TPN. Left PICC tip projects over the SVC. Enteric tube tip overlies the gastric fundus. Left nephroureteral catheter, and 2 right-sided ureteral catheters incompletely visualized.Basilar scarring. Interval near complete resolution of pneumoperitoneum. No pneumothorax.

Output: Left PICC tip overlying the SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: eval for acute chest History: chest pain, sob Small lung volumes with basilar opacities left more extensive than right, suggestive of left lower lobe pneumonia or aspiration.The heart appears large at this may be magnification artifact.

Output: Left basilar consolidation suggestive of infection or infarction, with small lung volumes.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: persistent hypoxia after extubation History: above Interval extubation. Venous catheter and NG tube unchanged. Improved aeration of lung bases. No new opacity.

Output: Improved aeration of lung bases. No new opacity.


Instruction: Generate impression based on medical findings.

Input: Effusion and chest tube placement.VIEW: Chest AP (one view) 02/27/15, 1659 Tracheostomy tube tip is below the thoracic inlet. A gastrostomy tube is present. Right chest tube remains in place. Right thoracic and left thoracolumbar curves are noted.A moderate right pleural effusion is seen. Small to moderate left pleural effusion is present. Right upper lung opacity has decreased. Opacities in both medial bases continue. Cardiac silhouette size is normal.

Output: Bilateral pleural effusion. Decrease in right upper lung opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: abnormality History: cough The cardiomediastinal silhouette is normal. There are no pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Status post lung transplant, annual testing Postsurgical transplant changes without underlying acute cardiopulmonary abdomen analysis

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Abnormal findings on prior CT, recommended follow up. History of wedge biopsy for right upper lobe nodule in 5/2007, with result of necrotic granulomas. LUNGS AND PLEURA: Scarlike opacity in the left upper lobe (image 16, series 4) has decreased in comparison to the prior study.Moderate centrilobular emphysema. Postsurgical volume loss in the right upper lobe, with a minimal amount of soft tissue with calcifications, unchanged.Multiple scarlike opacities seen bilaterally (right lower lobe on image 37, left apex on image 13, left upper lobe on image 18) are unchanged.Peribronchial thickening in the left lower lobe consistent with chronic aspiration, unchanged.A micronodule in the lingula, unchanged since 11/09.MEDIASTINUM AND HILA: Debris in the proximal trachea. Asymmetry in the larynx, stable since 2005, which might be accessible by direct visualization.Unchanged ascending aortic graft extending to the level of the aortic arch. Atherosclerotic calcifications of the aorta, unchanged. Mild coronary artery calcifications, unchanged. Normal heart size.CHEST WALL: Gynecomastia, left more than right, unchanged. Multiple nondisplaced healing rib fractures on the left, with callus formation.UPPER ABDOMEN: Limited images of the upper abdomen.

Output: Interval decrease in size of the scarlike opacity in the left upper lobe. Unchanged other scarlike opacities. Recommend 6 months follow up.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.CHF and IABP IABP radiopaque marker projects over the aortic arch. Right jugular central line terminates at the SVC level. Unchanged multichamber cardiomegaly and ICD device. No signs of pulmonary edema, and no visible focal airspace opacities. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: No specific signs of CHF. IABP marker at the aortic arch level.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o infiltrate History: tachypnea Patchy upper lobe dominant air space opacities continue to worsen consistent with infection or aspiration.ET tube removed.A Dobbhoff tube terminates in the stomach.Left PICC, tip in the innominate vein at the midline.

Output: Worsening pulmonary opacities consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Postpartum shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: et tube History: et tube Interval removal of ET tube.An oropharyngeal airway overlies the lower neck on the first of 2 radiographs obtained on 4/25/2016 and is probably external to the patient cannot completely exclude that it is in the hypopharynx on this image.Marked cardiomegaly with resolving lower zone opacities compatible with atelectasis and aspirated secretions.Catheter tip in the SVC.

Output: Interval extubation. Oropharyngeal airway device overlying the hypopharynx on one of the radiographs, possibly external to the patient.A text page was sent to Dr. Rebeiz at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Tachypnea Persistent large layered right pleural effusion with underlying compression. No definite distinct superimposed new abnormality, however motion degrades sensitivity. Borderline cardiomegaly and decreased lung volumesRight jugular port unchanged

Output: Essentially unchanged right layered pleural effusion given more upright positioning


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: ICD lead position History: change in lead parameters Stable position left univentricular ICD electrode.Calcified granuloma right upper lobe unchanged. No interval pulmonary edema, pleural effusion or pneumothorax. Mild degenerative changes of the thoracic spine. Heart size is within limits of normal.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 35 years old Female. Reason: abnormality History: right cp with inspiration and sob. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. Mild apical pleural thickening.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male 15 years old Reason: HFOV, s/p arrest History: intubated/ventilatedVIEW: Chest AP (one view) 10/15/2015, 1717 ET tube tip is above the thoracic inlet. An enteric tube has been placed since the prior exam with the sidehole in the gastric body. Left chest tubes are unchanged, with one of them remaining kinked.Left hydropneumothorax and diffuse bilateral lung opacities are not significantly changed. Cardiac silhouette size is normal.

Output: Left hydropneumothorax and lung opacities, not significantly changed. ET tube tip above the thoracic inlet.Findings text paged to Dr Asad Qadir pager 1120 at 6:03pm on 10/15/2015.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with diffuse large B-cell lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Borderline enlarged nonspecific mediastinal lymph nodes (is prevascular and precarinal are unchanged.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: Left adrenal nodule is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node is unchanged measuring 11 by 6-mm image number 112, series number 3.Lymph node adjacent to the terminal ileum is unchanged measuring 13 x 11 mm image number 137, series number 3.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: Sclerotic right iliac bone is unchanged.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Infiltrates History: fever No acute abnormality.No specific evidence of infection.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old. Reason: pna History: nausea/vomiting Left internal jugular central venous catheter with tip in the SVC. Cardiomediastinal silhouette is unremarkable. Minimal streaky retrocardiac opacity likely represents subsegmental atelectasis.No pleural effusion or pneumothorax.Calcified shunt tubing projects over the right hemithorax and is unchanged in appearance.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 30 year-old male with lung cancer status post chemotherapy. Compare to outside exams. CHEST:LUNGS AND PLEURA: Left upper lobe heterogenous mass extending into the mediastinal fat (series 3 image 26) measures 6.4 x 4 cm in axial dimension (unchanged from prior), but with increased consolidation from prior. Few bilateral pulmonary nodules, new or slightly increased in size from prior, highly concerning for metastasis. Largest nodule in the left base (series 5 image 54), measures 11 x 9 mm (previously 4 x 3 mm). Small left effusion, similar to prior. Elevation of the left hemidiaphragm may indicate phrenic nerve injury. MEDIASTINUM AND HILA: Right paratracheal lymph node (series 3 image 26) measures 15 mm in short axis dimension, unchanged from prior.No cardiomegaly or pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal hypoattenuating lesion (series 3 image 86) measures 24 x 12 mm (previously 18 x 12 mm), compatible with FDG-avid metastatic disease on recent PET.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter lesion with peripheral sclerosis in the L3 vertebral body, unchanged from prior, favors benign lesion. OTHER: No significant abnormality noted.

Output: Progression of metastatic disease with new/increasing pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: 77 years old, Female, Reason: syncope History: ? pericardial effusion No definite evidence of pericardial effusion as clinically questioned. The heart size is borderline. However in the absence of prior comparison examination radiographs are insensitive for the detection of pericardial effusion. Echocardiography can be considered for further evaluation if clinically warranted. No pulmonary opacity to suggest infection or edema. There are surgical clips overlying the left chest wall.

Output: No definite evidence of pericardial effusion as clinically questioned. The heart size is borderline.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Shortness of breath evaluate for worsening infiltrates, monitor ETT. Hypoxia with MRSA pneumonia. Interval retraction of the right jugular Swan-Ganz catheter with tip now projecting over the proximal right main pulmonary artery. Endotracheal tube and Dobbhoff tube unchanged in position, the Dobbhoff tube tip projects over the proximal stomach.Moderate volume of pleural fluid bilaterally, about the same. Patchy air space opacities throughout the right lung and in the left lung base slightly worse.

Output: Repositioning of right jugular Swan-Ganz catheter with tip now at the level of the right main pulmonary artery. Worsening air space opacities. No significant change in pleural fluid volume.


Instruction: Generate impression based on medical findings.

Input: Age: 89 yearsGender: MaleReason for Study: Reason: PNA, Cardiomegaly, Effusion History: Recent dx of PNA, treated with 1 week of levaquin. presenting with cough, sob, gen weakness, continued lower extremity edema Stable cardiac mediastinal silhouette.Chronic interstitial opacities with evidence of bronchiectasis and bronchial wall thickening in the lung bases.Interval improvement in aeration of the left lower lobe.No focal areas of consolidation.No pleural effusions.

Output: Findings compatible with bronchiectasis and bronchial wall thickening. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: eval for possible malignancy Low lung volumes. No focal lung consolidation. Moderate-sized right anterior hemidiaphragmatic eventration. No pleural effusion or pneumothorax. No acute bony abnormality. Large patient body habitus.

Output: Low lung volumes. No convincing evidence of acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.History of trauma Cardiomediastinal silhouette is within normal limits. No focal airspace opacity, pleural effusion, displaced rib fracture, or pneumothorax.

Output: No acute cardiopulmonary abnormality or displaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: pneumothorax History: s/p thoracentesis R sided Stable cardiomediastinal silhouette.Slight interval decrease in right pleural effusion with persistent bibasilar atelectasis.Left vascular port with tip at the cavoatrial junction.Status post right breast mastectomy with associated surgical clips in the right chest wall subcutaneous tissues.

Output: Slight interval decrease in right pleural effusion with persistent bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: Status post TEVAR and intubated in the SICU History: as above Study limited by leftward patient rotation. Endotracheal tube terminates 2.5 cm from the carina. Large aortic stent graft is noted. Patient is status post sternotomy. Low lung volumes.. Small left pleural effusion with left basilar opacity. However mediastinal hematoma noted along the descending thoracic aorta.

Output: Status post TEVAR. Study limited by rightward patient rotation. Endotracheal tube terminates 2.5 cm from the carina. Small left pleural effusion with left lower lobe atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with cholangiocarcinoma/ampullary cancer on chemotherapy. Evaluate for interval change. CHEST:LUNGS AND PLEURA: Minimal emphysema and right lower lobe calcified granuloma unchanged. Pleural thickening at the left base also unchanged. No suspicious nodules or masses. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Calcified right hilar lymph nodes are unchanged and likely represent prior granulomatous disease.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Previously referenced lesion in the dome of the left lobe is visualized only subtly due to volume averaging and thus an accurate measurement is not possible. The size of the lesion is roughly estimated at 1.2 x 0.8 cm on axial image 77/224. No new lesions. A common bile duct stent is in stable position with pneumobilia indicating stent patency.SPLEEN: Splenic calcifications likely reflect prior granulomatous disease.PANCREAS: Soft tissue mass in the head of the pancreas as noted on the prior CT of 11/19/07 is not clearly discernible from the normal pancreatic parenchyma and thus cannot be measured. Fat stranding about the pancreas is probably postoperative.ADRENAL GLANDS: Bilateral subtle adrenal thickening is unchanged.KIDNEYS, URETERS: Bilateral renal hypoattenuating lesions are unchanged and probably represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A right abdominal wall stomal hernia contains nonobstructed bowel and is unchanged. Two additional left abdominal incisional hernias also contain nonobstructed bowel and are unchanged.No ascites evident.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: 1.The biliary stent is stable and patent.2.Referenced left lobe liver lesion is poorly visualized on today's exam. No new liver lesions evident.3.Stable ventral hernias.4.No specific evidence of disease progression.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Patchy infiltrates at outside hospital Cardiomediastinal silhouette is normal. Minimal basilar interstitial opacity without specific evidence of infection or edema. No pleural effusions. NG tube with side-port just distal to the GE junction.

Output: Minimal basilar interstitial opacity without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: confirm picc line placement Right central venous catheter terminates in the right atrium. Interval removal of enteric tube. Basilar interstitial opacities with mild bronchial thickening, unchanged. Cardiomediastinal silhouette is unchanged.

Output: Interval removal of enteric tube and interval placement of right central venous catheter terminating in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Concern for pneumonia Stable cardiomegaly. Tortuosity and atherosclerotic calcification of the thoracic aorta. Coronary stent is noted.No abnormal radiographic findings to suggest pneumonia.Bilateral apical capping again noted. No pneumothorax or pleural effusions.The known sclerotic lesion in the left humeral neck is partially excluded from the field-of-view.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Verify PICC placement. Interval removal of previously seen right-sided PICC. New left upper extremity PICC extends cranially into the neck in the projection of the left jugular vein.Lung volumes remain low with multifocal areas of atelectasis and patchy opacity, possibly the result of aspiration but not specific.

Output: Left PICC extends cranially into the cervical portion of the left jugular vein, suggest repositioning.


Instruction: Generate impression based on medical findings.

Input: Possible retained foreign body. ET tube tip approximately 4 cm above the carina.Swan-Ganz catheter tip in the left main pulmonary artery.Catheter from the right jugular with its tip projected over the area of the right ventricle, subsequently removed.Extensive atelectasis on the left and diffuse opacity in the right compatible with edema.No unexpected radiopaque foreign bodies.

Output: Postoperative findings with no sign of a radiopaque foreign body.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Cough History: see above Sternotomy wires remain in stable position.Mild bronchial wall thickening without consolidation or edema. Elevation left hemidiaphragm. Tortuosity descending thoracic aorta. Heart size remains stable. No pneumothorax.

Output: Bronchial wall thickening may represent bronchitis or asthma.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: aspiration pna History: Aspiration pna Lines and tubes are unchanged. Increased basilar opacities and pleural effusions. Unchanged heart size. No pneumothorax.

Output: Increased basilar opacities and pleural effusions which may represent pulmonary edema, aspiration, and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: s/p l thoracotomy resection of hilar massVIEW: Chest AP Cardiothymic silhouette normal. There is a left chest tube in place. There is a small left apical pneumothorax. Minimal subcutaneous emphysema in the left lateral chest wall.

Output: Left apical pneumothorax with minimal subcutaneous emphysema in the left lateral chest wall.


Instruction: Generate impression based on medical findings.

Input: 21 years old Female. Reason: Eval for opacities/PNA History: Fever prior to admission. There are questionable multifocal opacities in the right lung. The cardiomediastinal silhouette is normal.

Output: Questionable multifocal opacity seen right lung, which can be due to infection. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusion History: pleural effusion Interstitial pulmonary edema with multiple septal lines, and small bilateral pleural effusions, not significantly changed.PICC line tip in the right axillary vein.

Output: Pulmonary edema with small pleural effusions and no significant change.


Instruction: Generate impression based on medical findings.

Input: Check cardiac device and chest tube Motion degrades sensitivity.Left basilar chest tube or mediastinal chest tube unchanged with tip projected along the medial margin of the left lower lobe.Underlying cardiopulmonary appearance otherwise similar with patchy mixed interstitial and airspace opacities in both lung bases with mild cardiomegaly.

Output: Left basilar chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Possible AA, tracheal deviation History: As above Enlarging pleural effusions and increasing basilar consolidation.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.

Output: Enlarging pleural effusions and increasing basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Postop hypotension and inadequate response of blood products. TEVAR stent graft at the level of the aortic arch. The saccular aneurysm lateral to the area of the stent appears similar by chest radiograph. Normal heart size.Bilateral lower lobe atelectasis and peribronchial opacities most consistent with prior aspiration.Mild elevation of the left hemidiaphragm.

Output: Basal opacities and atelectasis consistent with prior aspiration. No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Cardiomegaly Persistent mildly decreased lung volumes without associated cardiopulmonary new acute abnormality.

Output: Mildly decreased volumes


Instruction: Generate impression based on medical findings.

Input: 40 year-old female status post Whipple surgery for locally advanced carcinoma of the pancreas CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small, nonenlarged mediastinal lymph nodesCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Severe fatty infiltration of the liver. Hepatomegaly. No focal hepatic lesions. Heterogeneous hyperdense areas anterior to the main portal vein and around the liver hilum may represent areas of focal sparing. No evidence of biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple surgery. Residual pancreas is slightly atrophic with minimal ductal prominence, otherwise unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate left renal stone. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small mesenteric and peripancreatic lymph nodes. A reference node measures 10 x 10 mm image number 96, series number 3.BOWEL, MESENTERY: Ill-defined, soft tissue density 16 x 13 mm hypodense area inferior to the right lobe liver suspicious for peritoneal carcinomatosis. Are there subcentimeter peritoneal nodules are also present scattered throughout the abdomen.BONES, SOFT TISSUES: Ill-defined, irregular shaped enhancing soft tissue density along the incision in the anterior abdominal wall measures 4.3 x 2.4 cm image number 94, series number 3. This represents scarring secondary to incision, however, given the history of invasion of abdominal wall, recurrent mass is also possible. This area is amenable for percutaneous biopsy.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal cystic lesion which represents ovarian cyst. Measures 2.7 x 2.6 cm. Further evaluation with pelvic ultrasound is recommended.Left ovary also contains a cystic lesion measuring 2.2 x 2.4 cm. Again pelvic ultrasound may helpful for further evaluation. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of fluid in the pelvis.

Output: Severe fatty infiltration of the liver. Heterogeneous enhancing areas in the central liver lesion likely represents areas of focal fatty sparing. Fat infiltration limits evaluation of the liver for possible small metastatic disease.Changes secondary to Whipple surgery. Irregular enhancing area in the anterior abdominal wall around the incision is suspicious for recurrent tumor. This area is amenable for percutaneous biopsy, if clinically indicated.Small enhancing foci throughout the peritoneum are suspicious for peritoneal carcinomatosis.Small peripancreatic and mesentery nodes. Follow-up imaging is recommended.Pelvic ultrasound is recommended for further evaluation of bilateral cystic ovarian lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Testicular mass Cardiomediastinal silhouette is within normal limits. No pleural effusions or pneumothorax. No focal pulmonary opacity. No suspicious nodules or masses.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with rising white count, posterior blood cultures, looking for possible source of infection CHEST:LUNGS AND PLEURA: Endotracheal tube is in place. 10-mm right upper lobe nodule in image number 27, series number 5. This nodule has a small central cavitation. Left lower lobe 2 x 1.7 cm wedge-shaped air space opacity. Another nodule central cavitation is noted in the left lower lobe image number 65, series number 5.Right lower lobe wedge shaped air space opacity and trace pleural effusion. These may be secondary to aspiration.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: The tip of the NG tube is in the duodenum.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: Rectal tube is in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral, well defined nodular opacities with subtle central cavitation. These are suggestive of septic emboli.Right lower lobe wedge-shaped air space opacity and trace pleural effusion may be secondary to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval ET tube History: ET tube pulled back 3 cm Interval repositioning of endotracheal tube which is now 2 cm above the carina. No change in basilar opacities.

Output: Successful repositioning of endotracheal tube. Basilar opacities persist.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: inc congestion, frequent NT suctioning History: as above Probable moderate cardiomegaly.NG tube tip in the stomach.Small lung volumes with perihilar and basilar nonspecific opacity, increased from previous.Differential diagnosis includes aspiration and infection.

Output: No change in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.SOB, chest tightness, wheeze, URI symptoms, cough with sputum. Unchanged cardiomegaly and low lung volumes. Probable small pleural effusions with associated dependent atelectasis.Thickening of the fissures. Motion artifact degrades the lateral radiograph, limiting interpretation.

Output: Low lung volumes with signs of mild hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Unremarkable mediastinal contours and cardiac silhouette.Bronchial wall thickening suggestive of asthma or chronic bronchitis.No specific evidence of infection or edema.

Output: Bronchial wall thickening suggestive of asthma or chronic bronchitis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Right IJ triple-lumen placement. Right jugular catheter tip at the SVC/RA junction. Cardiomegaly with enlargement of the central pulmonary vasculature and tortuosity of the thoracic aorta unchanged. Lung volumes remain low. Basilar scarring unchanged. No pneumothorax. Blunting of the left costophrenic angle unchanged and may be due to pleural thickening or fluid.

Output: Appropriate position of right jugular catheter, no pneumothorax. Possible pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Chest pain, shortness of breath, history of bronchitis. Evaluate for infection, atelectasis, pneumothorax. No focal lung opacity, pleural effusion, or pneumothorax. The heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: RUL for management of T1bN0 Stage IA adenocarcinoma History: complaining of persistent right anterior chest wall pain despite pain medication Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with newly diagnosed lymphoma. CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral axillary adenopathy. Reference left axillary lymph node measures 2.2 x 2.2 cm on image number 26, series number 3 bilateral supraclavicular and neck adenopathy is also present.ABDOMEN:All of the intraperitoneal visceral organs and pancreas are displaced by the large retroperitoneal adenopathy.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Displaced anteriorly by the retroperitoneal mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Large conglomerated adenopathy measuring 13.5 x 8 cm on image number 119/211 at the level of the lower pole of the kidneys. The adenopathy displaces and compresses the IVC. Inferiorly it extends to the level of the aortic bifurcation. Stomach and duodenum are severely displaced by this retroperitoneal mass.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Neck, supraclavicular, axillary, mediastinal and retroperitoneal adenopathy


Instruction: Generate impression based on medical findings.

Input: 53 year old female with history of indeterminate Quantiferon Gold, r/o active pulmonary process. No focal airspace opacities. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormalities. No evidence of active TB.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: s/p chest tube placement assess for pneumothorax History: none Severe interstitial lung disease with small lung volumes unchanged.Stable right chest tube with no pneumothorax.Unchanged right chest wall soft tissue emphysema.

Output: Right chest tube with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: r/o infiltrate History: dyspnea, palpitations The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.History of shortness of breath and chest pain. Evaluate for pneumonia. The heart size is within normal limits. A stable AP window calcified lymph node is present likely representing sequela from prior infection. No pneumothorax or focal airspace opacities.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.History of shortness of breath. Evaluate for pneumonia. Cardiac silhouette normal in size with stable aortic tortuosity.Large lung volumes consistent with COPD. No focal airspace opacities, pleural effusions, or pneumothorax

Output: COPD without specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p afib ablation Catheter tip in the SVC.Chest tube projected over the mediastinum. Extremely minimal residual bilateral pneumothoraces.Mild retrocardiac opacity compatible with atelectasis and aspirated secretions.

Output: Minimal residual apical pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: 37 year-old female with elevated d-dimer and atrial flutter. Technically adequate exam.PULMONARY ARTERIES: No PE.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Evaluation of solid organs is limited by arterial phase enhanced imaging. No significant abnormality noted.

Output: No PE. No other significant findings.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia? History: fever New bilateral basilar airspace opacity suggestive of aspiration and infection. Tracheostomy tube in place. Feeding tube tip in the area of the stomach.

Output: New basilar airspace opacities compatible with infection and aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Bladder cancer surveillance. Calcified micronodules at the right lung base unchanged since 2014. No new or suspicious nodules or masses. Normal heart size. No visible hilar lymphadenopathy or pleural fluid.

Output: No signs of metastatic disease or acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Postop. Essential hypertension. Hardware and devices unchanged.Patchy peripheral airspace opacity in the left lung. Small to moderate left pleural effusion. Hazy opacity on the right is slightly improving.

Output: Slight increase in pleural fluid and peripheral opacity in the left lung. Continued improvement in edema and atelectasis on the right.


Instruction: Generate impression based on medical findings.

Input: CHF Persistent moderate nonspecific cardiomegaly with otherwise gross clear lungs demonstrating mild hyper expansion. Suspected COPD changes.ICD unchanged. IABP marker remains 1 cm from the aortic archRight axillary surgical clips

Output: Unchanged IABP marker


Instruction: Generate impression based on medical findings.

Input: 49 years, Female. Reason: obstruction History: abdominal pain No evidence of intramural air or free air. Nonobstructive bowel gas pattern. Cholecystectomy clips.Bibasilar opacities consistent with atelectasis. Correlate to rule out aspiration or infection Small right pleural effusion versus pleural thickening. Port-A-Cath right chest wall tip projects in region of SVC RA junction.

Output: Bibasilar lung opacities correlate to rule out infection. Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: Evaluate hx of asthma, CT with c/f ILD vs. Organizing pna History: Hypoxia, groundglass opacities on CT Low lung volumes makes detailed cardiopulmonary assessment difficult. Diffuse lung opacities with relative sparing of the lung apices, not substantially different compared to last study except at the left lung base where it is slightly worse. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Diffuse lung opacities with relative sparing of the lung apices, not substantially different compared to last study except at the left lung base where it is slightly worse.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: pnuemonia History: shortness of breath LVAD in place. Status post mitral valve replacement. Global cardiomegaly is noted.Unchanged position of ICD/pacemaker.The right IJ venous catheter there is seen as far as the distal SVC.No signs of pulmonary edema. Limited assessment for pleural effusions possible left pleural thickening. No supine evidence of pneumothorax.

Output: Stable global cardiomegaly. No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: please evaluate for pneumothorax in patient with subclavian area surgery History: desaturation, history of TEVAR and left carotid subclavian bypass, status post left subclavian artery ligation and saccular aneurysm of the aortic arch coil embolization of the proximal subclavian, history of COPD Stable enlarged cardiomediastinal silhouette.New embolization coils seen along the margin of the left subclavian artery and numerous new surgical clips representing recent coil embolization.Stable bibasilar atelectasis/scarring. Mildly improved aeration of the right lung base.No pneumothorax or pleural effusion.Aortic endograft again seen.Dilated loops of bowel are nonspecific and could be better evaluated with dedicated abdominal radiographs.

Output: 1. Postoperative findings consistent with coil embolization of the left subclavian artery without pneumothorax.2. Dilated loops of bowel are nonspecific and could be better evaluated with dedicated abdominal radiographs.