Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: post op History: post op Interval placement of right IJ central venous catheter tip at cavoatrial junction, and left apical chest tube.Basilar atelectasis and septal thickening suggestive of minimal pulmonary edema.Low lung volumes likely related to postoperative state.

Output: Interval placement of right central venous catheter and left chest tube. Low lung volumes with basilar atelectasis and minimal pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: 31 y/o with congenital heart disease and cardiomyopathy now s/p BI-V pacemaker History: complete heart block, rule out pneumothorax Cardiomegaly with a wide mediastinum consistent with congenital heart disease and complete heart block as discussed in the clinical history.Pulmonary edema is present, but no pneumothorax or pneumonia.Right subclavian biventricular dual chamber pacemaker, leads in appropriate positions, without pneumothorax.

Output: Pulmonary edema. Cardiomediastinal abnormalities consistent with congenital heart disease. No significant pneumothorax following ICD placement.


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: FemaleReason for Study: Reason: tb skin test History: eval for active tb 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, 61 years old.Reason: respiratory insuff History: see above Stable cardiac and mediastinal silhouettes. Edema superimposed on emphysema, increasing compared to prior. Bilateral small pleural effusions.

Output: Increasing edema and pleural effusions superimposed on emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Hypoxia, pleural effusions Support to this is unchanged in position.Bilateral pleural effusions with adjacent atelectasis are not significantly changed since the prior exam.No pneumothorax. Cardiomediastinal silhouette is unchanged.

Output: No significant change in bilateral pleural effusions with adjacent atelectasis.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: eval acute process History: syncope Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: swan placement History: see above Swan-Ganz has been retracted into the high right atrium.

Output: Swan-Ganz has been retracted into the high right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o PNA/acute abnormality History: cough, low-grade fevers Unremarkable cardiac and mediastinal silhouettes. No pulmonary or pleural abnormality.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: chest pain History: chest pain Cardiomegaly and subsegmental atelectasis.No specific evidence of infection or edema.Right upper quadrant cholecystectomy clips noted.

Output: Mild cardiomegaly, but no acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Shortness of breath, cough, fever. Rightward curvature of the thoracic spine and chronic stable deformity of the left upper ribs are again noted. The skeletal defects may be postoperative versus congenital in etiology. Cardiomediastinal silhouette is within normal limits. No pneumothorax or significant pleural effusion. There are diffuse chronically abnormal interstitial opacities that appear increased compared to prior examination. Palpable right upper lobe emphysema.

Output: Diffuse chronically abnormal interstitial opacities are mildly increased compared to prior examination without focal airspace opacity. Recommend repeat PA/lateral if symptoms persist.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with metastatic breast cancer CHEST:LUNGS AND PLEURA: A new hazy 5-mm nodule seen in the left upper lobe on series 5; image 31 (not present on the prior study after reviewing the 1 mm slices).MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The left port terminates in the right atrium.Skin thickening over the right breast remains. The right breast mass is only partially included.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: 13 x 9 mm periportal lymph node (series 3; image 83), stable and not enlarged.BOWEL, MESENTERY: Small periumbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large submucosal uterine fibroid on the right, unchanged.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: New, small subcentimeter left upper lobe nodule.Otherwise, stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: r/o infiltrate History: cough and SOB Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Preop MVR History: Preop MVR Heart size upper normal with small pleural effusions and retrocardiac scarring or subsegmental atelectasis.No specific evidence of infection or edema.Moderate to severe thoracolumbar scoliosis.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: PNA History: cough, SOB Moderate cardiomegaly.No pleural effusion or pneumothorax. Ill-defined nonspecific basilar opacities may reflect pulmonary edema.

Output: Cardiomegaly with ill-defined nonspecific basilar opacities which may reflect pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: nausea, distended abd. eval gastric distention History: distention No significant cardiopulmonary abnormalities.Small amounts of bowel gas in the upper abdomen but no evidence of gastric distention.Surgical drain in the left upper quadrant of the abdomen.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with history of primary hyperparathyroidism now with lung nodule and possible left adrenal mass CHEST:LUNGS AND PLEURA: Branching dilated left upper lobe segmental bronchi with air fluid levels. An endobronchial obstructing lesion cannot be excluded. Focal nonspecific ground glass opacity left upper lobe distal to this area. No other lung nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Medial aspect of the spleen is lobular in contour. An isodense focal lesion the spleen that location such as a hemangioma cannot be excluded due to quantum lobulations.PANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral adrenal glands and specifically the left adrenal gland is unremarkable.KIDNEYS, URETERS: Punctate right renal stone without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Focally dilated bronchi in the left upper lobe associated with air fluid levels. These findings may be secondary to allergy bronchopulmonary aspergillosis, however, a mechanical obstruction cannot be excluded. Further evaluation with endoscopy may be helpful.No evidence of left adrenal mass.Chondromalacia in the medial aspect of the spleen. No definite focal lesions are noted. However if clinically indicated MRI may be helpful for further evaluation of the spleen.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Swan-Ganz catheter Cardiomegaly with family right-sided parenchymal and pleural opacities are stable. Right Swan-Ganz catheter tip over the right main pulmonary artery. Left ICD is stable. Other right jugular catheter tip appears over the SVC. No pneumothorax.

Output: Cardiomegaly with stable right-sided pulmonary opacities. Lines are stable including right Swan-Ganz catheter with tip over the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: where is swan? History: s/p swan Pulmonary edema superimposed on fibrosis, unchanged.No Swan-Ganz catheter identified.Right jugular catheter tip in SVC. ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.

Output: Edema with underlying fibrosis. No Swan-Ganz catheter identified.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: eval for pathology History: SOB, CP Mild cardiomegaly.No specific evidence of infection or edema.

Output: Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 68 y/o with CLL hx of lung ca with SOB History: sob Volume loss and interstitial opacity in the right hemithorax with basilar atelectasis and possibly pleural effusion.Multiple surgical clips and staples in the right mid lung area.Moderate nonspecific mediastinal widening suggestive of lymphadenopathy.Nodular opacities in this area may represent recurrent tumor or postoperative hematoma and scarring.Increased opacity in the/overlying the right hilum may also be related to recurrent tumor or postoperative scarring and atelectasis.Port catheter with its tip in the SVC.Multiple small poorly defined nodules in the left lung, suggestive of metastases.

Output: Extensive abnormalities consistent with a history of known lung cancer, likely metastatic. Correlation with any available outside imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: cough, chest pain, eval for pNA History: chest pain, cough, eval for pna Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 22 years old Reason: VPS malfunction? Headache, nausea History: headache SHUNT DEVICE: Ventriculostomy tube tip in the middle cranial fossa is unchanged in position. No kinking or discontinuity of the visualized radiopaque shunt tubing. Tubing courses along the soft tissues of the right neck, chest and into the left abdomen. Shunt tip is in the left lower quadrant. No displacement of bowel loops about the distal shunt.SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: No focal lung opacity, pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal.ABDOMEN: Nonobstructive bowel gas pattern.

Output: No kinking or discontinuity of the visualized shunt catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old. Left jugular catheter tip in the SVC with no pneumothorax or other complications.Markedly elevated left hemidiaphragm with overlying opacity compatible with subsegmental atelectasis. Blunting of both costophrenic angles suggestive of small pleural effusions.No specific evidence of pneumonia.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval swan placement History: chf Stable position of Swan-Ganz catheter. Stable position of central venous line.Interval improvement in basilar opacities and effusion.

Output: Line position stable. Interval improvement in basilar opacities and effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval for effusions History: ETT present Persistent right lower lobe consolidation suggestive of infection or aspiration.Mild subsegmental atelectasis left lower lobe.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Right basilar consolidation consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with generalized tonic-clonic seizures. Multiple enhancing lesions on brain MR CHEST:LUNGS AND PLEURA: 2.7 x 2.6 cm mass in the right lower lobe.MEDIASTINUM AND HILA: Mediastinal and large right hilar adenopathy. Reference precarinal adenopathy measures 3.2 x 2.3 cm. (Image number 34, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver with mild hepatomegaly..SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is not visualized. Ovaries are likely unremarkable.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: Right lower lobe mass, suspicious for a primary bronchogenic carcinoma. Metastatic adenopathy in the mediastinum, and right hilum.Fatty infiltration of the liver with hepatomegaly.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: MaleReason for Study: Reason: ACS? History: sickle The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 74 year-old female with lung cancer status post chemotherapy. Please compare with prior study evaluate disease status. CHEST:LUNGS AND PLEURA: Previously seen left upper lobe lobulated mass measures 50 x 45 mm, relatively stable accounting for differences in technique. Area of adjacent consolidation is again visualized and appears unchanged.Multiple right lung lesions also remain relatively stable in size and appearance. Anteriorly in the right upper lobe, a non-solid nodular opacity measures 11 x 15 mm (previously 11 x 18 mm), series 5, image 24. More inferiorly, a solid, lobulated lesion at the margins of a bulla measures 14 x 16 mm (previously 14 x 19 mm), series 5, image 34.Nonspecific micronodules unchanged. No new suspicious nodules or masses.MEDIASTINUM AND HILA: Previously referenced right paratracheal lymph nodes have decreased in size, now measuring 12 x 8 mm (previously measuring 19 x 18 mm), series 3, image 38. The conglomerate of necrotic subcarinal lymph nodes remain stable in size, measuring 24 x 34 mm (previously measuring 20 x 33 mm), series 3, image 55.Stable chronic calcifications. Stable inhomogenous thyroid enlargement.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hepatic cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable multiple bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative changes of the spine.

Output: Stable left upper lobe primary lesion and contralateral mediastinal nodal involvement. Stable right lung nodules.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: FemaleReason for Study: Reason: sarcoma surveillance History: sarcoma surveillance The cardiomediastinal silhouette is unremarkable.Mild increased lung volumes compatible with COPD.No focal airspace opacities.No suspicious pulmonary nodules or masses.Kyphosis of the thoracic spine with stable partial collapse of a mid thoracic vertebrae.

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


Instruction: Generate impression based on medical findings.

Input: 6-month-old female status post G-tube.VIEW: Chest and abdomen AP (2 views) 6/6/2016, 17:16. Cardiothymic silhouette is at the upper limits of normal. Streaky opacities are seen at the left lung base.ETT tube tip is below the thoracic inlet. There has been interval removal of the left central venous catheter. Gastrostomy tube is in the stomach.The bowel is arranged in a disorganized pattern with mild gaseous distention. Radiopaque foreign body overlying the right lower quadrant may be external to the patient.

Output: Gastrostomy tube is in the stomach.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Chest pain question pneumonia. Upper normal heart size. Left lower lobe opacity improved from previous and may reflect scarring rather than infection. No specific signs of pulmonary edema.9 mm nodular opacity in the left upper lobe new from previous.

Output: Faint 9 mm left upper lobe nodular opacity. This is new from a chest CT dated 11/28/2015 and in the appropriate clinical context could be infectious. If the patient is neutropenic or septic CT may be considered. Otherwise, follow-up PA and lateral radiographs recommended in 6 weeks.


Instruction: Generate impression based on medical findings.

Input: "NG tube placement" A right jugular catheter is again observed with the tip projected into the right atrium, however no nasogastric tube is observed.Underlying cardiopulmonary appearance remains significant for mixed interstitial and airspace opacities greater on the left in both bases with associated effusions, greater on the right.

Output: Unchanged right jugular catheter


Instruction: Generate impression based on medical findings.

Input: Reason: post op cardiac surgery History: post op cardiac surgery Cardiopulmonary monitoring and support devices, unchanged.Mild basilar opacities compatible with edema and atelectasis and probable small right effusion. No pneumothorax or other acute change.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT, lung fields History: s/p ASD repair ET tube tip approximately 2 cm above the carina.Basilar streaky opacities compatible with subsegmental atelectasis and probably small effusions. A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with shortness of breath. Evaluate for left lung mass. CHEST:LUNGS AND PLEURA: Severe bullous emphysema at the upper lobes. Left perihilar mass in the upper lobe contiguous with the hilum (series 3, image 53) measures approximately 5.3 x 3.2 cm. Smaller adjacent masses and satellite nodules, some of which in a peribronchovascular distribution. A lingular mass (series 5, image 76) measures 3.1 x 3.3 cm.Severe bronchial wall thickening bilaterally. There is marked peribronchovascular interstitial pattern in addition to the bronchial wall thickening (particularly in the right lung) which raises the question of sarcoidosis as well.Air space opacity in the right middle lobe is nonspecific, but may represent infection.MEDIASTINUM AND HILA: Lack of IV contrast limits evaluation of lymphadenopathy. However, left perihilar fullness probably in part reflects lymphadenopathy. An AP window lymph node (series 3, image 48) measures 9 mm in short axis.Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Multiple left lung masses highly suspicious for malignancy in this patient with severe COPD/emphysema. Recommend PET/CT for further evaluation.2. Severe bronchial wall thickening and additional peribronchovascular interstitial pattern, on the right, which raises the question of sarcoidosis, in addition to bronchitis.


Instruction: Generate impression based on medical findings.

Input: Reason: ? CHF History: Cough and LE edema Normal heart size and mediastinal contours.Scarring and volume loss in the right upper lobe with probable bronchiectasis, unchanged.No evidence of CHF or pneumonia.Large air-filled hiatal hernia.

Output: Chronic right upper lobe scarring and bronchiectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.s/p bilateral lung tx Moderate left apical pneumothorax, unchanged. Subcutaneous emphysema within the chest wall, unchanged. Worsening of bilateral pulmonary opacities.

Output: Unchanged moderate left apical pneumothorax. Worsening diffuse bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Check for pneumothorax. Device placement Unchanged to lead left subclavian ICD without evidence of interval associated superimposed complication. Specifically lungs remain clear and well expanded. See subsequent reportCardiac and mediastinal contours remain within normal limits

Output: Left subclavian ICD placed without complication


Instruction: Generate impression based on medical findings.

Input: Reason: weakness History: weakness Normal heart size with a tortuous aorta.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: s/p PICC placement, pulled line back 4cm History: as above Interval removal of enteric tube. Retraction of the left PICC, now terminating at the azygos vein.The lungs and pleural spaces remain clear. Heart size is normal. Right costophrenic angle excluded from the field-of-view. No pneumothorax.

Output: Left PICC now terminates at the level of the azygos vein. No evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Chest pain. Lungs are clear. Heart is normal in size. No pneumothorax. No significant cardiopulmonary abnormality.

Output: No significant cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval lung fields History: s/p CABG, intubated Cardiomegaly with lower lung zone edema left greater than right and pleural effusions, unchanged.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image. Left jugular and right jugular catheters both terminate in the SVC.

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


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: ICU survey; evaluate lung fields and lines History: s/p OHT Right IJ sheath remains in place. Increased linear opacity at the right lung base, likely atelectasis. Small pleural effusions. Unchanged left basilar opacity. No pneumothorax. Unchanged heart size. Abandoned cardiac leads again noted.

Output: Increased probably atelectasis at the right lung base. Small pleural effusions with persistent left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: 24 year-old female with diabetes, chronic leg pain and C. difficile with pleuritic chest pain beneath the left breast. PULMONARY ARTERIES: Technically adequate examination with no evidence of pulmonary embolus.LUNGS AND PLEURA: Right upper lobe and right middle lobe micronodules, both less than 4 mm in diameter, are nonspecific and likely reflect prior infection or granulomatous disease. In a low risk patient, no CT follow-up is required.No focal consolidation, edema or pleural effusion. No pneumothorax.MEDIASTINUM AND HILA: Cardiac size is top normal. No pericardial effusion. No significant hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.LOWER EXTREMITIES: Questionable filling defect in the right popliteal vein most likely represents a flow artifact. No definite DVT seen.

Output: 1.No PE or DVT.2.Nonspecific micronodules.3.No acute pulmonary abnormality.A preliminary interpretation of this exam was provided to the clinical service by the radiology resident on call. No significant discrepancy between preliminary and final interpretation.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant Unchanged or recurrent patchy left basilar opacities and small left effusion suggestive of aspirated secretions.Small left pleural effusion.Status post clamshell sternotomy for lung transplant with bilateral bronchial stents.Right jugular catheter, tip in SVC.

Output: Unchanged patchy left basilar opacity likely atelectasis with a small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old. Reason: pna, History: dizziness and vomiting Mild cardiomegaly with tortuous aorta, unchanged.Scar-like opacity in the right lower lobe as seen on prior chest CT. No new focal pulmonary opacity, pleural effusion or pneumothorax. Hiatal hernia is present.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Evaluate SWAN-GANZ position, evaluate interval change History: SOB AICD leads unchanged in position. IABP marker in the proximal descending aorta, unchanged. Interval adjustment of Swan-Ganz catheter, now with tip in the right main pulmonary artery.Stable cardiomegaly.No new focal air space abnormality. No large effusions.

Output: Swan-Ganz catheter tip in the right main pulmonary artery. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of renal cell cancer CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules, some of which are calcified are unchanged.MEDIASTINUM AND HILA: Calcified perihilar nodes.CHEST WALL: No significant abnormality notedABDOMEN:The study is limited due to lack of IV contrast. Given this limitation,LIVER, BILIARY TRACT: No focal lesions in the liver are noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Left nephrectomy bed is clear without evidence of recurrence.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval lung fields History: s/p CABG Interval removal of left chest tube. Marked cardiomegaly unchanged. Left pleural effusions with associated atelectasis appears mildly increased. Mild interstitial opacities suggestive of edema.

Output: Increasing left pleural effusions with associated atelectasis. Mild interstitial opacities suggestive of edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusions History: intubated ET tube tip approximately 3 cm above the carina.Streaky left lower lobe opacities compatible with atelectasis and scarring, unchanged from previous.Blunting of the left costophrenic angle compatible with a small effusion, unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval ICD placement History: s/p lead displacement in past with chest pain Heart size upper normal without acute edema or pneumonia. Large lung volumes suggest COPD.Left subclavian ICD, leads unchanged in position.

Output: No acute abnormality. Stable ICD, leads intact in appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: SOB, pleuritic chest pain, elevated WBC History: sob, chest pain Unchanged lung metastases.No specific evidence of infection or edema.Left subclavian catheter, tip in SVC.

Output: No specific evidence of infection or edema. Unchanged lung metastases.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with history of bladder cancer. Status post cystectomy with ileal conduit CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Not enlarged, small mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Surgical clips in the gallbladder fossa, which may be secondary to cholecystectomy. Calcification in the gallbladder fossa represent residual stone in the cystic duct stump or calcified adenopathy. This is unchanged from previous study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nephrectomy. No evidence of left hydronephrosis.RETROPERITONEUM, LYMPH NODES: Reference porta hepatis lymph nodes stable measuring 17 x 14 mm image number 84, 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: Status post cystectomy. Ileal conduit is seen in the left lower quadrant.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Herniating bowel loops into the left lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Intubated History: Intubated Persistent multilobar consolidative opacities with mid lung and basilar predominance, obscuring the cardiomediastinum.Interval appearance of air bronchograms represent progressive atelectasis and bronchial dilation.Moderate left and small right pleural effusions again noted. No supine pneumothorax.The position of the ET tube in the right IJ venous catheter are unchanged.

Output: Persistent bilateral midlung consolidative opacities possibly representing pulmonary edema. Stable position of support apparatus.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with history of AML. Pre-transplant evaluation. LUNGS AND PLEURA: Few scattered micronodules bilaterally are nonspecific, likely represent intrapulmonary lymph nodes.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant findings.


Instruction: Generate impression based on medical findings.

Input: 45 year old male presents with SOB, syncope and chest pain. This study was performed for the evaluation of pulmonary embolism, mass, or infiltrate. PULMONARY ARTERY: There is no evidence of pulmonary embolism in both sides.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Soft tissue density in the anterior mediastinum, which is likely due to residual thymic tissue. Otherwise no significant abnormality noted. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: In the segment 4 of the left lower lobe of liver there is hypervascular area which may represent a hypervascular tumor. Suggest further evaluation with dedicated liver protocol. The upper portions of the kidneys, pancreas, adrenal glands, and spleen are not remarkable.LOWER EXTREMITY VEINS: No DVT identified.

Output: No evidence of DVT or pulmonary embolism. Hypervascular lesion in the liver, suggest further evaluation with dedicated liver protocol.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Fluid overload. Lines and hardware are unchanged in position. Stable mild cardiomegaly. Diffuse hazy opacity of left lung believed to represent layering effusion, and is unchanged from the prior study. Lingular opacity silhouetting the left cardiac border is unchanged. Lung overall improved from the previous day.

Output: Interval improved aeration of the lungs. Remainder of cardiopulmonary findings and lines/hardware are unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: PNA History: SOB Interval extubation. Remaining support devices are unchanged.Increasing left lower lobe opacities atelectasis, likely interval aspiration. Small left pleural effusion.

Output: Left lower lobe opacities atelectasis, likely interval aspiration.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with history of respiratory failure status post central line placement. Left internal jugular central venous catheter with tip located at the midline, likely in the left brachiocephalic vein. NG tube tip outside the field of view. Endotracheal tube tip at the level of the thoracic inlet. Stable cardiomediastinal silhouette. Healing rib fractures again noted. No specific evidence of edema, infection, or postprocedural pneumothorax. Chronic diffuse reticular opacities.

Output: Interval placement of left internal jugular central venous catheter with tip projecting over the midline, likely in the left brachiocephalic vein, without evidence of postprocedural pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: FemaleReason for Study: Reason: 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: Dyspnea. Pleural effusion. Peripheral catheter from the left terminates at the SVC. Tracheostomy tube tip at the clavicular head level. Left Pleurx catheter has been removed in the interim.Interval increase in circumferential pleural fluid bilaterally, right greater than left. Interstitial and airspace opacities bilaterally about the same. Static appearance atypical for cardiogenic edema and may be the result of metastatic disease or other pathology.Diffuse skeletal sclerosis, presumably metastatic disease.

Output: Chronic pleural fluid, interstitial and airspace opacities atypical for cardiogenic edema given relatively static appearance and may be the result of metastatic disease or drug reaction. Pleural fluid on the left may have slightly increased in volume post Pleurx catheter removal although exact comparison is difficult due to differences in patient positioning.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: ETT, resp failure History: as above Moderate left pleural effusion, larger than before, further compressing the left lung.Unremarkable right lung.Tubing is in the hypopharynx could be a malpositioned NG tube.ET tube tip approximately 3 cm above the carina.Left subclavian catheter, tip in SVC.

Output: 1. NG tube likely coiled in the hypopharynx.2. Enlarging left pleural effusion further compressing the left lung.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: evaluate right lung History: right chest pain, pleural There is a right basilar chest tube in place, unchanged in position. No residual pneumothorax.Persistent moderate left and small right pleural effusions. The right pleural effusion has slightly decreased in the interval.The cardiac and mediastinal contours are partially obscured.Right IJ port catheter in place overlying the distal SVC.Known neoplastic pleural nodules and internal mammary lymphadenopathy, seen on prior chest CT are not assessed.

Output: Decrease in size of the right pleural effusion, now small small. The right basilar chest tube is unchanged in position.Moderate left pleural effusion, unchanged from prior.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Tachypnea; new trach placed 1/30 History: as above Tracheostomy tube is in place.Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Left lower lobe atelectasis with bilateral basilar scarring/atelectasis. Chronic interstitial changes are unchanged.

Output: Left retrocardiac atelectasis with bibasilar scarring/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: Tachycardic, prostate cancer with metastasis Numerous ill-defined nodular opacities throughout both lungs are nonspecific and could represent atypical infection or metastatic disease.Multiple osseous sclerotic lesions in the left clavicle, right scapula, ribs, and T11 vertebral body likely represent metastatic prostate cancer.Bibasilar scarring. No pleural effusion or pneumothorax.The heart size is within normal limits.

Output: 1. Numerous nodular opacities may represent metastatic disease and could be further evaluated by CT scan.2. Sclerotic bony lesions consistent with history of metastatic prostate cancer.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Cardiogenic shock, atrial fibrillation. Evaluate IABP position, rule out effusions-volume overload. Large right and small left pleural fluid collection, volume of pleural fluid on the left has slightly improved.IABP marker is unchanged in position projecting over the proximal descending thoracic aorta about 4 cm below the top of the aortic arch. Interval extubation. Left PICC and right jugular introducer unchanged in position. No pneumothorax. Dependent and basal atelectasis, but no specific signs of pulmonary edema.

Output: Large right and small left pleural effusions with associated atelectasis. No specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.History of angina for pre-op CABG. No pulmonary effusion or pneumothorax. No focal lung opacity. No cardiomegaly.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with rales. Evaluate for pneumonia versus CHF. Cardiomediastinal silhouette is unremarkable.No pneumothorax, pleural effusion, or consolidation.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: follow up post removal of pleurx on the right. has had bilateral pleurodesis History: none Interval removal of right Pleurx catheter. No significant change in right pleural effusion. Small left pleural effusion also stable.Nonspecific pulmonary opacities including basal atelectasis and right midlung focal peripheral consolidation are stable.

Output: No significant change in right pleural effusion. Small left pleural effusion also stable.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for infection or effusion History: SOB, bibasilar crackles, LE edema Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with shortness of breath, evaluate for progression of pulmonary nodules. LUNGS AND PLEURA: Interval improvement in diffuse reticulonodular abnormality in the majority of the right upper lobe with interval worsening in the right lower lobe and focally in the right apex. Slight interval improvement in reticulonodular abnormality in the left lung.MEDIASTINUM AND HILA: Stable lymphadenopathy within the mediastinum. The reference pretracheal lymph node measures 11 x 9 mm (series 3 image 26), previously measured 9 x 11 mm. Enlarged main pulmonary artery compatible with severe pulmonary arterial hypertension. Severe cardiomegaly. Tracheostomy in place. Large heterogeneous thyroid. Atherosclerotic calcifications noted in the aorta. Mild to the mediastinum to the left.CHEST WALL: Surgical clips again noted in the right axilla. Minimal degenerative change noted in the spine.UPPER ABDOMEN: Small hiatal hernia.

Output: 1. Interval improvement in reticulonodular abnormality in the left lung. In the right lung there are areas of improving and worsening reticulonodular abnormalities. The differential diagnosis includes diffuse pulmonary lymphoma, disseminated granulomatous infection or CMV.2. Stable mediastinal lymphadenopathy over short term follow-up.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with esophageal cancer with question of left lower lung nodule on previous study dated 12/9/2009 CHEST:LUNGS AND PLEURA: Previously described left lower lobe peripheral, wedge shaped consolidation has resolved. Calcifications involving the right pleura is unchanged. There is a peripherally calcified centrally lucent right-sided pleural based nodule which is unchanged from previous study.MEDIASTINUM AND HILA: Loculated fluid collection in the lower posterior mediastinum.CHEST WALL: A fistulous tract extends to the left side of the superior anterior chest wall from the superior mediastinum. Exact communication with the esophagus is not clear what likely.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas, otherwise unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Punctate calcifications scattered in the peritoneum in the upper abdomen predominantly along the stomach and hepatic flexure and around the liver. Left lower quadrant percutaneous jejunostomy catheter is in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval resolution of the left lower lobe consolidation.Loculated collection in the posterior lower mediastinum.Widespread calcifications involving the right pleura, part of the pericardium and upper abdomen peritoneum.Upper chest fistula extending from the mediastinum and possibly esophagus to the skin.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: MaleReason for Study: Reason: eval for consolidation, edema History: SOB, recent extubation, Hx of aspiration ET tube has been removed.Right IJ venous catheter with its tip at the SVC/RA junction.Stable cardiomediastinal silhouette.Interstitial and airspace opacities and bilateral pleural effusions similar to prior exam.

Output: Interval extubation. Stable cardiopulmonary appearance with pleural effusions and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out pna History: cough Normal heart size with a tortuous aorta suggestive of hypertension.Focal scarring at the right costophrenic angle.No sign of pneumonia or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: on vent History: on vent Support devices unchanged.Stable cardiomediastinal silhouette.Extensive airspace and interstitial opacities in both lungs compatible with edema/ARDS.No new pulmonary opacities identified.

Output: Port device unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: cough, tachy Bilateral pulmonary nodules compatible with metastases, increased from previous.No evidence of pneumonia or other acute change.

Output: Pulmonary metastases but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: sob History: sob Stable dual chamber ICD with additional ICD lead again noted. The right atrial lead has changed in position from radiographs years prior, dislodged from the right atrial appendage. The cardiomediastinal silhouette is stable. No focal pulmonary opacity, pleural large effusion, or pneumothorax.

Output: No acute cardiopulmonary disease. The right atrial lead has changed in position from radiographs years prior, dislodged from the right atrial appendage.


Instruction: Generate impression based on medical findings.

Input: 86-year-old male with bladder cancer metastatic to nodes. Small pulmonary nodes seen on CT abdomen/pelvis. Please further evaluate. CHEST:LUNGS AND PLEURA: Scattered nodules and micronodules, many of which are calcified are seen bilaterally. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Severe calcifications of the right coronary, left circumflex, and LAD arteries as well as the aortic annulus.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Cholelithiasis without evidence of acute inflammation

Output: Scattered nodules and micronodules in both lungs, many of which are calcified (including the reference left lower lobe nodule identified on recent CT abdomen/pelvis). Findings are statistically most likely benign and compatible with postinfectious/postinflammatory nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval for SOB History: cough, progressive worsening SOB over 2 weeks; malaise Heart size normal.Basilar predominant interstitial opacities. No pneumothorax.

Output: Persistent basilar opacities with no other change.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: confirm PICC line placement History: new PICC Left PICC tip in SVC. Left pleural effusion with left basilar consolidation.

Output: Left PICC tip in SVC. Left pleural effusion with left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: 93 years old Female. Reason: PNA vs effusion History: SOB and chest pain. The cardiac and mediastinal silhouette is mildly enlarged. Interstitial changes are seen in both lungs. There are small bilateral pleural effusions. There is interval improvement of the patchy opacities in the lower lungs.

Output: Cardiomegaly with interstitial changes and pleural effusions, consistent with the CHF, and interval improvement of the patchy opacities in the lower lungs.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p CABG/AVR; ?Pulm Edema History: SOB Patchy left basilar opacity, again noted. Marked cardiomegaly again noted. No definite pleural effusion. No pneumothorax.

Output: No substantial difference compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: pneumonia, chf History: wheezing Stably enlarged cardiac silhouette.No focal consolidation, sizable effusion or pneumothorax.Remote fracture deformed of the left eighth rib again seen.

Output: Cardiomegaly with no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: r/o pneumonia History: fever , hx of GI lymphoma There may be a small pneumoperitoneum, see prior abdomen radiograph for clarification.Small left pleural effusion and left basilar subsegmental atelectasis.Heart size normal.

Output: Possible small pneumoperitoneum. Please refer to prior abdomen radiographs or obtaining a CT.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: intubated pt, trach History: intubated pt, trach Endotracheal tube tip approximately 3 cm above the carina. Enteric tube most proximal sidehole is at the GE junction. Right apical chest tube is unchanged.Stable mediastinal shift.Postsurgical volume loss with apical loculated pneumothorax and pleural thickening, unchanged. Slight increase in aeration of the right lung. Left lung is unchanged.

Output: Slight increase in aeration of the right lung.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.ET tube placement Endotracheal tube difficult to visualize as it parallels an overlying lead, but terminates about 2.5 cm above the level of the carina. Right jugular catheter tip overlies the right atrium. Enteric tube projects over the stomach.Moderate layering pleural fluid on the left. Extensive interstitial and airspace opacities bilaterally, appearing slightly worse.

Output: ETT tip about 2.5 cm above the level of the carina. Worsening pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Questionable small recurrent right effusion with persistent collapse of the right upper lobe. Masslike opacity and postobstructive changes are again of concern. Left lung remains clear.Cardiac silhouette is within limits

Output: Persistent right upper lobe volume loss and partial consolidation again concerning for an obstructive cause. An underlying mass cannot be excluded


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for cardiomegaly History: palpitations, chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: eval for edema History: pt with history of pulmonary htn and sob Focal lucency again noted within the upper aspect of the left lung. No new focal lung consolidation. Mild bibasilar subsegmental atelectasis or scar. No large pleural effusion or pneumothorax. Mild cardiomegaly, as before. Large patient body habitus.

Output: No acute cardiopulmonary process on radiography. Focal lucency in the upper aspect of the left lung again noted, presumably due to Mosaic attenuation as noted on CT from 5/2015.


Instruction: Generate impression based on medical findings.

Input: Male; 77 years old. Reason: Evaluate positioning of IABP, check for pulm edema History: CHF s/p IABP IABP marker now projects in the proximal descending thoracic aorta. Stable Swan-Ganz extending into the right pulmonary outflow tract. Stable ICD leads.Lungs remain clear. Stable mild cardiomegaly.

Output: IABP marker in the proximal descending aorta. No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Pneumothorax; Post device placement in EP Lab Cardiac lead, unchanged. No pneumothorax. No new focal pleural parenchymal opacity. Unchanged cardiomegaly.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Outside hospital PICC Right PICC tip at the superior cavoatrial junction.Unremarkable cardiomediastinal silhouette.No evidence of infection or edema.

Output: Right PICC identified.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: r/o bronchitis History: cough with yellow phlegm Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Has SOB and cough, history of COPD/bronchiectasis/diastolic dysfunction/HTN; mild lower extremity swelling and bilateral crackles. Elevated JVP. Cardiothoracic ratio mildly enlarged, increased from the exam of 4/2014. Mild blunting of the posterior costophrenic angles is new and may indicate trace pleural fluid. No conclusive pulmonary edema. No focal air space opacities.

Output: Cardiomegaly and possible trace pleural fluid, but no signs of pulmonary edema. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male history of lung cancer. Status post chemotherapy. CHEST:LUNGS AND PLEURA: Moderate centrilobular and paraseptal emphysema with apical and basilar scarring, similar to prior.New peripheral branching opacities in the left lung base, likely post infectious/inflammatory. No lesions suspicious for metastatic disease within the lung parenchyma.MEDIASTINUM AND HILA: Referenced measurement of right paratracheal mass which encases and narrows the SVC (series 3 image 29), is unchanged in size, measuring 41 x 29 mm. However, extension of this lesion anterior to the confluence of the innominate veins (series 3 image 25) is increased, now measuring 17 x 14 mm (previously 8 x 10 mm).Right hilar mass (series 3 image 40) encases and now narrows the right mainstem bronchus with interval increase in size, measuring 28 x 25 mm (previously 20 x 17 mm). The right upper lobe arteries passing through this lesion previously are now severely attenuated.Moderate coronary artery calcifications. No pericardial effusion.CHEST WALL: Left axillary lymph node (series 3 image 16) measures 18 x 16 mm (previously 12 x 14 mm).ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions seen on current study to correspond with FDG avid lesions on recent PETCT.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule with peripheral enhancement (series 3 image 108) measures 12 x 8 mm, unchanged from prior, suspicious for metastatic disease.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Porta hepatis lymph node adjacent to the pancreatic head (series 3 image 114) now measures 36 x 20 mm (previously 24 x 20 mm). Focal dilatation of the infrarenal abdominal aorta above the iliac bifurcation (series 3 image 144) measuring 26 mm.BOWEL, MESENTERY: Few slightly prominent mesenteric lymph nodes are stable to slightly decreased in size from prior.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.

Output: 1) Slight interval progression of metastatic disease in the chest and upper abdomen as above.2.) Tumor narrows the SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate lung fields History: postop ET tube tip approximately 2 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Chest tubes in place with no pneumothorax.Right basilar opacity compatible with atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: chest pain History: concern for acs, chest pain diaphoresis The lungs and pleural spaces are clear. Mild tortuosity of the thoracic aorta. The heart size is within limits of normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Intubated ET tube tip is approximately 3 cm above the carina. Iatrogenic devices are otherwise unchanged.Low lung volumes. Moderate to severe cardiomegaly is unchanged.Increase in interstitial opacities in the mid to upper lung zones. Persistent basilar interstitial and airspace opacities compatible with pulmonary edema, moderate to large layering pleural effusions. Interval improvement of left basilar atelectasis.

Output: No significant change in pulmonary edema pattern. Interval improvement of left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female; 28 years old. Reason: Patient with suspected lymphoma. Cervical lymphadenopathy, headaches/low-grade fever CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Upper limits of normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant findings.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Small lung volumes.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.Left subclavian dual-chamber pacemaker, leads in appropriate position.

Output: No significant abnormality. No sign of metastases. However, please refer to a follow-up abdomen CT which revealed a right basilar nodule which may be partially calcified.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of recurrent oropharyngeal cancer. Status post left neck dissection evaluate for pulmonary metastases LUNGS AND PLEURA: Scattered small calcified granulomas are noted. No pulmonary or pleural masses can be identified. No pleural effusions are present.MEDIASTINUM AND HILA: There is demonstration of a minimally prominent right hilar lymph node, unchanged in comparison with the examination.there is no evidence of a pericardial effusion. There is redemonstration of atherosclerotic changes of the coronary arteries and aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: There is a gastrostomy feeding tube. A small cyst is noted in the upper pole left kidney.

Output: There is no evidence of metastatic disease. There has been no interval change in comparison to the exam dated 6/29/09


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Shortness of breath rule out pneumothorax. Trace right pneumothorax, unchanged. Bilateral chest tubes, tube on the left has been replaced since the prior study. Left jugular catheter, IVC filter and sternotomy hardware similar in position.Moderate bilateral pleural fluid collections. Improving left lower lobe consolidation. Unchanged pulmonary nodules. Vascular unsharpness suggestive of edema.

Output: Trace right pneumothorax. Moderate pleural fluid. Pulmonary nodules described previously as metastases. Improving retrocardiac atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Infection, stem cell transplant patient History: chest pain No significant cardiopulmonary abnormality.Right jugular catheter, tip at cavoatrial junction.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: patient with IABP. History: IABP, heart failure Intra-aortic balloon pump again overlies aortic arch. Unchanged left IJ line. Focal nodular opacity again noted at the right lung base. Mild atelectasis or scarring again noted at the left lung base. Unchanged cardiomegaly. No pneumothorax.

Output: Lines and tubes, as above. Focal nodular opacity again noted at the right lung base.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Eval for etiology of tachypnea, including infectious vs inflammatory. Pt has a h/o of sarcoid History: SOB, tachypnea Moderate cardiomegaly is unchanged. Perihilar fullness indicates prominence of the pulmonary arteries, consistent with pulmonary hypertension. Tortuous brachiocephalic vessels. There is no evidence of active sarcoidosis. There is no evidence of pneumonia. Hiatal hernia is noted, as seen on chest CT dated 8/22/2010. Calcified loose bodies within the left shoulder joint are noted.

Output: Pulmonary hypertension and tortuous brachiocephalic vessels. There is no evidence of active sarcoidosis. There is no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: cough x 1 week in a CHF patient, assess for PNA vs volume overload History: cough Stable cardiac enlargement with pulmonary vascular redistribution. Left mid lung scarring/atelectasis. No pleural effusion or pneumothorax. No radiographic evidence of infection.

Output: Cardiomegaly without radiographic evidence of pulmonary edema or infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval shunt -- also need to look at skull valve (ask patient to show where this is) History: ha, dizzyness SHUNT DEVICE: Right frontal ventriculostomy catheter tip is near the midline. Catheter traverses the right neck, anterior right chest, and terminates in the pelvis. No kinking or discontinuity is seen in the radiopaque portions of the shunt catheter. Orphaned tubing is noted within the anterior chest wall and in additional spinal catheter is unchanged in appearance.SKULL: Aforementioned intracranial shunt exiting the skull via a right frontal burr hole.CERVICAL SPINE: No significant abnormality noted.CHEST: No significant abnormality noted.ABDOMEN: No significant abnormality noted.

Output: No kinking or discontinuity is seen in the radiopaque portions of the shunt catheter.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: chest pain, productive cough, SCD Cardiomegaly with vascular redistribution consistent with sickle cell disease.Mild basilar scarring but no acute findings.Skeletal findings compatible with sickle cell disease.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with postprocedural pneumothorax. Evaluate progression of pneumothorax. Small right apical pneumothorax has improved which now measures approximately 13 mm, compared to 23 mm on prior exam. Cardiac silhouette is normal. No abnormal focal pulmonary opacity. No pleural effusions.

Output: Improving small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female. Mesothelioma. CHEST:LUNGS AND PLEURA: There are metastatic pleural implants are now seen in the right hemithorax, predominantly posteriorly. The largest measures 13 mm in thickness (series 3; image 65).Large right pleural effusion, increased.MEDIASTINUM AND HILA: Calcified left hilar and mediastinal lymph nodes remain.Reference cardiophrenic lymph node measures 24 x 12 mm, previously 20 x 8 mm (series 3; image 61). Internal mammary lymph nodes on the right have increased in size.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: A large cystic lesion with circumferential mural nodularity which impresses upon the dome of the liver has developed. This lesion may represent a cystic peritoneal mass versus loculated fluid with peritoneal metastases involving the peritoneal layers (series 80216; image 67).SPLEEN: Multiple granulomata. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 14 x 14 mm left adrenal nodule (series 3; image 101), unchanged.KIDNEYS, URETERS: Punctate nonobstructive left nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are seen.BOWEL, MESENTERY: Reference right upper quadrant soft tissue nodule measures 23 x 16 mm (series 3; image 91), previously 27 x 16 mm. Other scattered soft tissue deposits in the peritoneum, omentum and mesentery (for example, adjacent to the caudate lobe) are unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of ascites, stablePELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The peritoneum remains thickened in the lower pelvis. Rectosigmoid sutures.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Marked progression of pleural and peritoneal disease.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: concern for pneumonia History: tachypnea, elevated white count Dobbhoff tube tip beyond the caudal margin of the film. Stent projects over the right upper quadrant. Surgical staples project over the upper abdomen.Interval development of pleural fluid, atelectasis and airspace opacity at the left lung base suspicious for aspiration and infection. Mild patchy atelectasis or scarring near the right base.Cluster of small nodular opacities projecting over the right upper lobe new from CT of 7/12/2016 and may be postinflammatory.

Output: No change in left basilar consolidation, likely representing infection.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Small right pneumothorax with the margin of the upper lobe a few millimeters from the chest wall.Bilateral pleural effusions, larger on the right, with underlying airspace opacity and atelectasis.

Output: Small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: placement of ET tube History: per above Mild cardiomegaly.Small lung volumes with unchanged pulmonary opacities including basilar fibrosis.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter tip at cavoatrial junction level.

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


Instruction: Generate impression based on medical findings.

Input: Thoracentesis Persistent moderate bilateral pleural effusions without evidence of postprocedural complication. See subsequent report

Output: Persistent small-to-moderate pleural effusions


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of intubation. ET tube and support devices unchanged.Bibasilar opacities and layering pleural effusions appearing similar to prior.

Output: Bibasilar opacities and pleural effusions without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: hx of COPD p/w productive cough; eval for PNA History: SOB and productive cough The heart is normal in size.Signs of upper lobe predominant emphysema. Diffuse bronchial wall thickening and bilateral lower lobe predominant and coarse reticular and heterogeneous opacities, stable from prior studies and consistent with history of chronic bronchitis.There is a nodular opacity in the anterior segment of the right upper lobe, which most likely represents focal mucoid impaction, as seen on prior cross-sectional imaging, although exact nature is unclear. This opacity has been partially visualized since 2015.No pleural effusion or pneumothorax.Mild degenerative changes of the thoracic spine.

Output: Signs of upper lobe predominant emphysema, chronic bronchitis and multilobar bronchiectasis again noted. Subpleural focal nodular opacity possibly in the anterior segment of the right upper lobe, present since 2015, may represent mucoid impaction and scarring. In the setting of smoking, consider nonemergent assessment with chest CT to characterize this lesion.No findings to suggest acute pneumonia, considering limitations for assessment in the setting of chronic multilobar scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: 28 yo M with CF here with exacerbation History: CF exacerbation Multifocal bronchiectasis and mucous plugging again noted, focal left lower lobe consolidation may represent focal pneumonia or aspiration. Port catheter, unchanged. No pneumothorax or large pleural effusion. Heart size again at the upper limit of normal.

Output: Stable findings of cystic fibrosis. Focal consolidation in the left lower lobe may represent aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: hypoxia History: hypoxia Median sternotomy with moderate cardiomegaly, lower lung zone edema and right basilar atelectasis, unchanged.Right jugular Swan-Ganz catheter, tip in right interlobar pulmonary artery.Left jugular catheter, tip in SVC.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: Unchanged pulmonary edema and support devices.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with metastatic endometrial cancer , assess response to treatment CHEST:LUNGS AND PLEURA: Several tiny nodules are seen in both lungs, several of which are calcified. They are unchanged in appearance. No new nodules identified.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes. Stable heterogeneous appearance of the thyroid glandCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval resolution of left-sided hydronephrosis. Bilateral nephroureteral stents terminate within the urinary bladder. RETROPERITONEUM, LYMPH NODES: The reference retroperitoneal lymph node just caudal to left renal vein measures 1.4 x 0.9 cm (image 117, series 3), reduced in comparison with prior study, when it measured 1.6 x 1.2 cm. There is a retroaortic left renal vein. Vena caval filter is stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Post hysterectomy.BLADDER: Bladder cannot be well evaluated due to lack of IV contrast. In particular, the bladder mass previously described cannot be adequately measured. Few pockets of air noted within the bladder.LYMPH NODES: Right external iliac lymph node has decreased in size, measuring 1.8 x 1.6 cm (image 176 premises 3), previously measured 2.1 x 2.0 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited exam due to lack of IV contrast. Mild decrease in size of retroperitoneal and pelvic reference lymph nodes.Interval resolution of left sided hydronephrosis. Bilateral percutaneous nephroureteral stent in appropriate location .


Instruction: Generate impression based on medical findings.

Input: Reason: eval IABP placement History: IABP in place Balloon catheter marker in the proximal descending aorta, unchanged from previous.Cardiomegaly with pleural effusions, edema and atelectasis, not significantly changed.

Output: CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Hip fracture. Preoperative clearance. Streaky right basilar subsegmental atelectasis without evidence of infection or edema. No large pleural effusion or pneumothorax. Mild tortuosity of the aorta. The heart size is normal. Skin fold on the right.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: sp thoracotomy History: none Two right chest tubes are in place, with only a small subpulmonic pneumothorax.Right chest wall soft tissue emphysema is present.Right hemithorax volume loss but unremarkable left lung.

Output: Very small right subpulmonic pneumothorax following surgery.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: s/p thoracentesis, evaluate for fluid reaccumulation History: s/p thora Bilateral pleural effusions and basilar opacities are unchanged.Mild cardiomegaly.Left subclavian pacemaker, leads unchanged in position.Aortic replacement and mitral repair.

Output: Unchanged pleural effusions with no pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: FemaleReason for Study: Reason: Temp PM History: Temp PM Central venous catheters unchanged.Temporary pacemaker lead removed.Right-sided pacemaker placed with the lead wire in the right ventricle.Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.No evidence of a pneumothorax.

Output: Right-sided pacemaker placed without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: s/p endobronchial valves x 3 in RUL; evaluate R PTX and L PTX History: s/p endobronchial valves x 3 in RUL; evaluate R PTX and L PTX Suboptimal technique however no apparent change in pulmonary opacities in the right subpulmonic hydropneumothorax. Line position stable.

Output: No apparent change in pulmonary opacities in the right subpulmonic hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval line position History: ng tub placement Enteric tube side port terminates at the gastroesophageal junction and could be advanced if clinically indicated. This may be partially looped within the hypopharynx proximally. Direct inspection is suggested. Question of mild interstitial pulmonary edema. No large pleural effusion or pneumothorax. Normal heart size. High aortic arch, as before.

Output: Enteric tube side port terminates at the gastroesophageal junction and could be advanced if clinically indicated. This may be partially looped within the hypopharynx proximally. Direct inspection is suggested.


Instruction: Generate impression based on medical findings.

Input: 27 year male with Hodgkin's lymphoma status post chemo. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable to decreased size of AP window soft tissue mass (series 3 image 31) measuring 1.5 x 2.3 cm (previously 1.9 x 2.2 cm). Mild right hilar lymphadenopathy, unchanged. Mild pericardial thickening, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Mild splenomegaly, measuring 13.5 cm, unchanged.PANCREAS: Apparent low-attenuation within the uncinate process, likely represents volume averaging through the peripancreatic fat plane.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable to slightly decreased size of mediastinal soft tissue mass. No new lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p left lower lobectomy, left chest tube History: left chest tube Left-sided chest tube remains in place. No evidence of pneumothorax. Bibasilar opacities again noted. Left-sided subcutaneous emphysema, unchanged. Unchanged heart size.

Output: No substantial change.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: r/o pneumonia History: AMS Mild cardiomegaly.Small bilateral pleural effusions versus pleural thickening. No specific evidence of infection or edema.No pneumothorax.

Output: Mild cardiomegaly with small bilateral effusions or pleural thickening but no specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: 59 years, Female. Reason: r/o obstruction, ileus History: constipation Enteric tube tip overlies the gastric body. Spinal fixation device in place. Mild gaseous distention of the small bowel loops in the left upper quadrant, which may represent focal ileus. Right femoral line in place which may be kinked. Please see same day chest radiograph report for thoracic findings.

Output: Enteric tube overlies the gastric body. Mild gaseous distention of the small bowel loops in the left upper quadrant, which may represent focal ileus.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old. Reason: s/p AVR; ?PTX History: SOB Interval removal of chest tubes, without development of pneumothorax.Stable cardiomediastinal silhouette with mild cardiomegaly. Significant improvement in lower lung zone airspace and interstitial opacities compatible with edema. New focal right middle lobe discoid atelectasis. Likely small bilateral pleural effusions.Median sternotomy hardware appears intact.

Output: Interval removal of chest tubes, without development of pneumothorax. Improving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 84 year-old female with vomiting and epigastric pain. Evaluate for biliary stent or bowel obstruction. ABDOMEN:LUNG BASES: Linear atelectasis versus scarring in the lung bases. Small herniation of fat through the posterior right diaphragm.LIVER, BILIARY TRACT: There is a hypodense lesion in segment VIII, recently characterized on CT, which is concerning for a metastatic lesion. A simple cyst in the superior portion of segment VIII. There is a stent within the common bile duct. There is still contrast in the gallbladder, presumable from ERCP on 3/2/12, which indicates a degree of biliary stasis. There is also mild biliary ductal dilatation seen in segments 5/6. SPLEEN: No significant abnormality notedPANCREAS: Ill-defined lesion in the pancreatic head with resultant dilatation of the pancreatic duct appears unchanged. See examination on 3/6/12 for further characterization with arterial enhanced images.ADRENAL GLANDS: Nonspecific thickening of both adrenal glands.KIDNEYS, URETERS: Small bilateral hypodensities in the kidneys, which are likely simple cysts.RETROPERITONEUM, LYMPH NODES: Enlarged metastatic portal lymph node is unchanged. Abdominal aortic atherosclerotic calcifications.BOWEL, MESENTERY: Hiatal hernia. No other significant abnormality.BONES, SOFT TISSUES: Thoracic spine degenerative changes.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Calcified fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Residual contrast in the gallbladder, presumably from ERCP on 3/2/12, which suggests biliary stasis. Mild biliary ductal dilatation in the inferior right lobe. 2. Mass in the pancreatic head and mesenteric lymphadenopathy are unchanged.3. Liver lesion, suspicious for metastasis, unchanged.4. Hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: post op, eval lung fields History: s/p MVR ET tube has been removed.Right central venous catheter and/mediastinal tubes unchanged.Are decreased lung volumes with stable cardiac enlargement.Mitral valve replacement and identified.Median sternotomy intact.Mild basilar atelectasis and small effusions improved from the prior exam.

Output: Interval extubation. Improvement in basilar edema/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Evaluate ETT. ETT approximately 5 cm above the carina. NGT courses through stomach, tip distal to caudal margin of film.3 lead ICD in distribution of the right atrial appendage, right ventricle, and coronary sinus.Basilar opacities consistent with pleural effusions, atelectasis/consolidation. Right hemidiaphragm elevation.

Output: ETT tip 5 cm above the carina. Basilar opacities consistent with pleural effusions and atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia Interval increasing patchy nonspecific opacities greater on the left with mild cardiomegaly. Increasing pulmonary edema, infection or even ARDS must be considered.ETT remains 4 cm above the carina. NG is under advanced the side-port seen two to 3 cm above the GE junction. Right jugular catheter terminates in the mid SVC. Left PICC line extends into the right atrium

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Spinal stenosis lumbar region. Intubated. Low endotracheal tube with tip about 15mm above the carina, Claire Phelps notified via text page.Left jugular catheter unchanged in position.Left pleural effusion and nonspecific retrocardiac opacity about the same. Elevation of the left hemidiaphragm. Bronchial wall thickening and volume loss in the right lung unchanged. Moderate volume of pleural fluid on the right. Enteric tube projects over the stomach. IVC filter and surgical staples noted.

Output: Low endotracheal tube with tip less than 15 mm above the level of the carina. Moderate left pleural fluid collection with adjacent nonspecific opacity possibly reflecting atelectatic lung. Dependent atelectasis in the right lung with bronchial thickening suggesting aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: ng History: ng Basilar atelectasis.Unchanged left chest tube with no pneumothorax.NG tube tip in distal esophagus, replacing a feeding tube that was doubled back upon itself.Bilateral catheters unchanged.

Output: NG tube tip in distal esophagus, replacing a feeding tube that was doubled back upon itself.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with history of AML status post stem cell transplant. This non-contrast-enhanced examination is insensitive for the evaluation of solid organ pathology. Within that limitation, the following observations are made.CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: A reference prevascular lymph node measures 1.6 by 3.4 cm on axial image 42/223 and has decreased in size from the prior exam where it measured 2.6 x 3.8 cm. No evidence of new mediastinal or hilar adenopathy. A small pericardial effusion is grossly unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Pericholecystic fluid is nonspecific given the presence of ascites as described below.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: Diffuse colonic wall thickening is evident with associated inflammatory infiltration of the mesentery and a small amount of free intraperitoneal fluid. No intramural or free intraperitoneal air.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.Pan-colitis probably represents an infectious process and would be an atypical manifestation of AML.2.Interval improvement in prevascular lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: pneumonia History: congestion Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: ? rib fracture History: back left chest wall pain after MVC Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of traumatic injury.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: vented pt History: none ET tube is between the thoracic and the carina. Enteric tube overlies the gastric fundus.The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: ET tube in appropriate position. No acute cardiopulmonary abnormality.


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 Chronic blunting right costophrenic angle.No other significant pulmonary or pleural abnormality.Heart size upper normal.Upper abdominal surgical clips.

Output: No significant abnormality. Heart size upper normal.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: MaleReason for Study: Reason: pna, cardiomegaly, effusion History: urosepsis, febrile, tachy, hypotensive. The cardiomediastinal silhouette is unremarkable.Decreased lung volumes with mild basilar subsegmental atelectasis.No focal areas of consolidation.No large pleural effusions.

Output: Mild basilar atelectasis without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: 2 days post-partum, fever to 102, cough productive of green sputum History: productive cough, fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with chest pain. Cardiac cath in 8/11/08 was negative. Patient has positive d-dimer. Evaluate for PE. PULMONARY ARTERY: In this technically adequate study, no pulmonary emboli identified.LUNGS AND PLEURA: Minimal paraseptal emphysema in the apices. No suspicious pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: Stable left thyroid hypodensity likely a cyst. Mild cardiomegaly. Coronary stent in the distribution of the LAD. Coronary artery calcifications. No pericardial effusions. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant axillary lymphadenopathy. Bulky osteophytes are seen to bridge several vertebral bodies in the mid and upper thoracic spine.UPPER ABDOMEN: Nonspecific hypodense lesion in the superior pole of the spleen (image 258/265).LOWER EXTREMITY: No DVT. Fat stranding identified in the right groin likely from recent cardiac cath.

Output: 1. No PE or DVT.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, 72 years old.Reason: 72F with bladder mass; staging evaluation History: none Low lung volumes with bibasilar opacities likely reflecting atelectasis. No large pleural effusion or pneumothorax. Heart size is upper limits of normal.

Output: Low lung volumes with bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 77 years Female Reason: s/p incisional hernia repair with mesh with bowel obstruction History: nausea and vomiting No focal airspace opacity. Unremarkable cardiomediastinal silhouette.Enteric tube coiled in the stomach with tip in the gastric fundus. Contrast material in the colon reveals marked, extensive diverticulosis. Few persistently dilated loops of small bowel in the left upper quadrant may reflect mild focal ileus or partial obstruction.

Output: Few persistently dilated loops of small bowel in the left upper quadrant may reflect mild focal ileus or partial obstruction.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with history of mesothelioma. Six-week follow-up. Please evaluate for disease using protocol 1A compare with previous CT. CHEST:LUNGS AND PLEURA: Mild pleural thickening on the left is again seen. Clear right lung.Reference lesions:1. At the level of the aortic arch (series 3, image 28), the 10 o'clock position, the pleura measures 2 mm (stable).2. At the level of the pulmonary artery (series 3, image 40), 10 o'clock, the visceral surface measures 2 mm (stable).3. At the level of the aortic root there continues to be no measurable disease.No new masses or pleural effusion.MEDIASTINUM AND HILA: Previously noted left hilar lymph node is not as well identified but appears to be smaller, measuring 8 x 7 mm (series 3, image 41). Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Fatty replaced.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of aorta.BOWEL, MESENTERY: No significant abnormality of the visualized portions of the bowel.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable exam with reference measurements as above.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.History: COPD. Signs and symptoms: Dyspnea. Query pneumothorax. Right central line unchanged in position. Large right upper lobe bulla, no appreciable change. No pneumothorax. Alignment Bibasilar and right perihilar opacities persist over multiple prior films, as does the background of hazy airspace opacity in the mid and lower lungs which may be chronic.

Output: Large right upper lobe bulla with no appreciable change. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: r/o ptx History: chest trauma Median sternotomy for aortic valve replacement.Mild basilar interstitial opacities are suggestive of edema.No specific evidence of infection.No significant pneumothorax.

Output: Mild interstitial edema. No evidence of traumatic injury, however.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Swan-Ganz catheter placement. The left costophrenic angle is excluded from the field-of-view.Right IJ catheter has been removed. Right-sided PICC with tip in distribution of right axilla, unchanged. Right subclavian ICD partially imaged. Interval placement of Swan-Ganz catheter with tip in the main pulmonary artery.Probable small effusions and mild basilar edema appearing similar to prior.

Output: New Swan-Ganz with tip in main pulmonary artery. Right PICC tip in the axilla. Cardiomegaly and mild edema, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 96 years old.Reason: eval edema History: LE edema No significant cardiopulmonary abnormality except for the heart size upper normal.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: Micronodular in the right major fissures unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference left retroperitoneal lymph node measures 9 by 7 mm on image number 143, series number 3, unchanged.BOWEL, MESENTERY: Ill-defined low attenuation within the mesentery of the small bowel likely representing mesenteric fluid is unchanged. Multiple small clustered mesentery lymph nodes are unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites, unchanged.

Output: Stable CT findings.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Palpitations/atrial fibrillation. No pulmonary or pleural abnormalities.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: Multiple myeloma presenting with hypercalcemia History: Shortness of breath Cardiomegaly.No specific evidence of infection or edema.Known myeloma with multiple lytic lesions.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: evalaute ETT position History: above ET tube tip approximately 4 cm above the carina.Right jugular catheter and feeding tube unchanged.Extensive bilateral nonspecific airspace opacity, not significantly changed.Marked elevation of the right hemidiaphragm.

Output: No change in line position and bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Cough Course interstitial basilar changes again observed with decreased overall volumes and small to moderate bilateral effusions.The cardiac and mediastinal contours are within limits. Bilateral jugular catheters are unchanged and both remain in the upper SVC.

Output: New bilateral effusions and basilar minimal edema


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube placement History: et ET tube tip less than 2 cm above the carina.Catheter tip in the area of the SVC.Diffuse opacity on the right suggestive of layered out effusion and atelectasis.Focal atelectasis and consolidation at the left base.

Output: Slightly low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: eval for infection History: sickle cell crisis, new fever Small lung volumes with unchanged scarlike opacities and atelectasis.Chronic left hemidiaphragm elevation.No reliable evidence of pneumonia.Mild cardiomegaly.

Output: Chronic scarring and atelectasis but no evidence of infection or significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Chest pain for one month. Low lung volumes. Normal cardiomediastinal silhouette. No pneumothorax, pleural fluid or focal airspace opacity.

Output: Low lung volumes, but no acute pulmonary abnormality.