Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: fluid overload History: SOB and hx of CHF Basilar interstitial abnormalities compatible with edema. Previous bilateral pleural effusions are no longer present. Heart size is mildly enlarged.

Output: Mild edema. Heart size upper limits normal.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.History of multiple myeloma status post central line insertion. Right central venous catheter tip near the confluence of the internal jugular and subclavian veins, unchanged. Stable cardiomegaly. Unchanged left mid lung calcified granulomas. Streaky basilar opacities are not appreciably changed. No new airspace opacity or pleural effusion.Numerous myelomatous deposits are present in the visualized bones.

Output: 1.Right central venous catheter tip unchanged in position, near the confluence of the internal jugular and subclavian veins.2.No appreciable change in mild basilar edema.


Instruction: Generate impression based on medical findings.

Input: Neck pain, right leg pain and shortness of breath. Rheumatoid arthritis Chest: Borderline cardiomegaly without additional distinct cardiopulmonary abnormalityFemur: Moderately medially angulated femoral neck fracture with superimposed moderate osteoarthritic changes of the joint. Distal femur other than degenerative changes of the knee remains otherwise unremarkableC-spine: Straightening of the cervical spine is observed with incomplete visualization of the lower levels, C7 distally. Superimposed mild to moderate degenerative changes most pronounced at C5-6. Soft tissues unremarkable

Output: Moderate degenerative changes of the cervical spine and a right hip fracture


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: abnormal lung sounds No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged cardiomegaly. Patient again status post sternotomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: H/o ILD, CHF, ESRD, eval for volume status History: see above Right jugular catheter and ICD lead unchanged. Small lung volumes with diffuse interstitial opacity, unchanged from previous.No new findings.

Output: Diffuse interstitial disease, partially chronic possibly with a component of superimposed edema.


Instruction: Generate impression based on medical findings.

Input: Age: 42 yearsGender: MaleReason for Study: Reason: sob History: sob ET tube and enteric tube have been removed.The heart and mediastinal silhouette is unremarkable.Right CP angle not included on the image.No large pleural effusions.Bullet fragments again identified overlying the right apex.

Output: Interval extubation and removal of enteric tube. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: MaleReason for Study: Reason: asthma History: asthma The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: hypoxia History: hypoxia Lower lung zone predominant coarse interstitial opacities suggestive of edema or aspiration, with very small pleural effusions.Heart size normal.

Output: Interstitial opacities suggestive of edema or aspiration, with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Mild cardiomegaly.The lungs are clear.No pleural effusions or pneumothorax.Focal opacity overlying the heart on the lateral view is favored to represent a pulmonary vein.

Output: Mild cardiomegaly. No specific radiographic evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: et tube History: et tube Endotracheal tube is 2 cm above the carina, slightly retracted when compared to prior. Nasogastric tube terminates inferior to the caudal margin of the image.Persistent retrocardiac consolidation and atelectasis with pleural effusion. Right subsegmental basilar opacities of subsegmental atelectasis unchanged. Patient is rotated to the left. No interval pneumothorax.

Output: Endotracheal tube is now positioned 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: asssss pulm/edema, pneumonia History: SOB Moderate cardiomegaly with a tortuous aorta.No evidence of CHF or other acute process.Stimulator device in the spine at the level of T 11.

Output: Stable cardiomegaly without evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: pre OLT evaluation History: cirrhosis, ascites TIPS present. No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval PNA History: cough, sob, wheezing, hemoptysis Left-sided airspace opacity suggestive of infection or aspiration. This should be followed for resolution.Cardiomegaly and a tortuous aorta.The chest is distorted by a moderate to severe thoracolumbar scoliosis.

Output: Left-sided air space abnormality suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Status post pleural effusion drainage, VATS, pleurodesis and chest tube placement. Small left hydropneumothorax with maximal pleural separation at the apex of about 1 cm.Postoperative contusion and atelectasis in the right lower lung. New air and fluid filled collection in the posterior aspect of the right major fissure, annotated by arrows. Left basal scarring, the left lung is otherwise unremarkable. Subcutaneous emphysema near chest tube insertion site. Chest tube tip at the level of the right 6/7th rib interspace.

Output: Small right hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 20 days old with increasing abdominal distention, discolored abdomen and the history of perforation. Evaluate for perforation and NEC.VIEW: Abdomen AP (one view) 8/3/2000 1618:23 NG tube tip is in the stomach. Multiple dilated loops of bowel in the mid abdomen appear similar to the previous study. The dilated loops in the right lower quadrant are no longer seen. No pneumatosis intestinalis, pneumoperitoneum, or portal venous gas is identified. Opacities in both lung bases are similar to on the prior abdominal radiograph but were better evaluated on the same day chest radiograph.

Output: A few dilated loops of bowel but no pneumatosis or pneumoperitoneum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: Hx of ALS w/ respiratory failure History: sob Decreased lung volumes with stable cardiomediastinal silhouette.Left retrocardiac consolidation/atelectasis and pleural effusions similar to the prior exam.No new pulmonary opacities identified.G-tube in place.

Output: Stable cardiopulmonary appearance of pleural effusions and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: 61 year old female with anal cancer. Evaluate for recurrent disease LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Chest pain history of atherosclerosis and aortic stenosis. Evaluate for widened mediastinum or cause for chest pain. Low lung volumes with mild cardiomegaly.Mild patchy subsegmental atelectasis in the lower lobes. No specific signs of pulmonary edema. No pleural fluid or pneumothorax. Surgical clips project over the retroperitoneum.

Output: Mild basal subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with metastatic colorectal cancer CHEST:LUNGS AND PLEURA: Index left upper lobe lesion with surrounding groundglass opacity is unchanged measuring 2.3 by 2-cm image number 46, series number 4. Reference right upper lobe nodule measures 3.2 x 2.3 cm image number 46 on series number 4, stable. Left lower lobe nodule in the left posterior costophrenic angle measures 2.1 x 2 cm on image number 82, series number 4. Left infrahilar soft tissue is also stable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small left renal cyst is unchanged.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: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes involving the rectum and presacral soft tissues. New air within the presacral soft tissues, suggestive of a fistulous convocation between the rectum and presacral soft tissue. Overall, the size of the presacral soft tissues stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Index lesions in the lungs and left infrahilar lymph node are stable.Interval development of air in the presacral soft tissue, posterior to the rectum, suspicious for a fistulous communication between the rectum or infection. The amount of soft tissue changes is stable.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o cause of neutropenic fever History: neutropenic fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Bilateral venous catheters extending to the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.History: COPD, ESRD. Symptoms: Cough. Right central venous catheter with tip in the right atrium. No pneumothorax.Severe apical predominant bullous emphysema, not significantly changed from previous study. Recurrent air fluid levels and multiple bullae observed on several comparison studies. New air-fluid level within a bulla in the right lower lobe.Unchanged bilateral lower zone predominant interstitial abnormalities.New focal patchy opacity in the right lower lobe.Stable cardiomediastinal silhouette.No pleural effusion.

Output: Stable apical predominant bullous emphysema. Bilateral lower zone predominant interstitial abnormalities and new air-fluid level within the right lower lobe, compatible with fluid overload state, however infection is a possibility. New focal right lower lobe opacity, recommend further evaluation with CT to exclude malignancy.


Instruction: Generate impression based on medical findings.

Input: Reason: pre liver transplant History: pre liver transplant Heart size about upper normal with increased upper zone blood flow but no sign of pulmonary edema.Interval clearing of basilar opacity that may have been due to edema or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for PNA, several days of increasing left upper chest discomfort History: chest pain Unremarkable cardiac and mediastinal silhouette. Focal scar like opacities at the cardiophrenic angles and posterior costophrenic angles.No sign of pneumonia or acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: infiltrates History: dyspnea 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, 52 years old.Reason: r/o TB, job screening History: none, h/o positive PPD Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography. Specifically, no evidence of active tuberculosis on radiography.


Instruction: Generate impression based on medical findings.

Input: 20-year-old female with history of chest pain, rule out infection or pneumothorax Normal cardiac and mediastinal silhouette. Lungs and pleura are unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: Evaluate tube placement History: intubated Left IJ line has been repositioned and now terminates in the SVC. Endotracheal tube terminates approximately 5.5 cm from the carina. No pneumothorax. Right-sided basilar opacity and pleural fluid collections again noted. Left lung remains essentially clear. Unchanged heart size.

Output: Lines and tubes, as above. Unchanged right pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Fever and cough evaluate for infiltrate. Left jugular catheter and IVC filter noted.Moderate cardiomegaly. No focal airspace opacity, pleural fluid or pneumothorax.

Output: No signs of pneumonia. Cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumonia History: chest pain, shortness of breath Unremarkable cardiac and mediastinal silhouette. Small lung volumes with no gross abnormalities allowing for morbid obesity and under inflation.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: assess for edema History: worsening SOB Unchanged small pleural effusions and mild right basilar subsegmental atelectasis.Heart size upper normal.Left jugular catheter tip at cavoatrial junction level.

Output: Unchanged mild CHF.


Instruction: Generate impression based on medical findings.

Input: Female; 33 years old. Reason: chest pain History: chest pain Stable moderate cardiac enlargement.Mild blunting of the left costophrenic angle, either due to small effusion or pleural thickening.The left hemidiaphragm is not well seen, most likely due to motion artifact.No specific evidence of edema or infection.

Output: Cardiomegaly without specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Right pleurodesis check for pneumothorax. Dense, enlarging right apical fluid collection suspicious for expanding hematoma. Right chest tube unchanged in position. Small air foci are seen layering anterior to the fluid collection at the right apex. Consolidation abutting the right apical suture line appears worse, however this could be the result of superimposed compressive atelectasis.Basal opacity on the right suspicious for prior aspiration, now with atelectasis and resolving hazy opacity. Left lung is clear.

Output: Dense, enlarging right apical collection suspicious for expanding loculated pleural or extrapleural hematoma. Small right apical pneumothorax component.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Evaluate for pulm edema, shortness of breath The heart size appears enlarged. There is a suggestion of redistribution of the pulmonary vasculature. Mediastinal widening, consistent with mediastinal lipomatosis, unchanged Mild bibasilar airspace opacities, likely representing subsegmental atelectasis. No pneumothorax or large pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.On chemotherapy presenting with fever. Right lower lobe opacity. Small pleural effusions. Normal heart size. Bronchial wall thickening noted in the right middle and lower lobes with adjacent opacity. Left lower lobe scarring.

Output: Right lower lobe opacity suspicious for pneumonia. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: source of infection History: elevated WBC, sinus tachycardia, elevated BP Stable cardiomegaly. No specific evidence of infection or edema.No pleural effusion. No pneumothorax.Nasogastric tube has been placed with tip beyond caudal extent of the film.

Output: Stable cardiomegaly with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: Evaluate for acute chest History: cough, SCD The cardiomediastinal silhouette is normal. Right basilar opacity unchanged and likely scarring. No focal pulmonary opacity suggestive of pneumonia. No pleural effusion or pneumothorax.Very mild spinal deformities suggestive of sickle cell disease are compatible with provided history.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: assess for congestion History: as above Moderate cardiomegaly status post sternotomy, with large central pulmonary arteries suggesting pulmonary arterial hypertension.Minimal right pleural effusion.No reliable evidence for edema or pneumonia.

Output: Cardiomegaly with a small right pleural effusion but no reliable evidence for edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of thick sputum and hypoxia. Evaluate for infection or edema. Cardiomediastinal silhouette is unchanged. The lungs are underinflated. No specific evidence of edema or infection.

Output: No specific evidence of edema or infection. The posterior costophrenic angles are not well-visualized. PA and lateral chest radiographs can be obtained if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: 38 y/o swan change History: sob Low lung volumes. Swan-Ganz catheter has been pulled back and now terminates in the distal aspect of the right pulmonary artery. Cardiac lead, unchanged. Left lower lobe opacity again noted. Enlarged central pulmonary arteries, as before. Cardiomegaly unchanged. No pneumothorax.No definite pleural effusion.

Output: Swan-Ganz catheter has been pulled back and now terminates in the distal aspect of the right pulmonary artery. Low lung volumes.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: infection History: SOB and wheezing for 1 week Increase in bibasilar subsegmental atelectasis or scarring. No new focal lung consolidation. No pleural effusion or pneumothorax. Unchanged heart size.

Output: Increased bibasilar subsegmental atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Evaluate for pneumothorax. Postdevice placement. Left chest wall single lead ICD, unchanged. No focal consolidation, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No pneumothorax, or other acute finding.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, 75 years old.Reason: re-eval ARDS History: known ARDS Support devices are unchanged. Markedly limited technique due to motion.No significant change in the bilateral air space opacities and cardiac contour.

Output: Within the limitation of technique due to motion, no significant change.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with chest pain. Evaluate heart and lung fields. No focal airspace opacities. No pleural effusion or pneumothorax.Borderline cardiomegaly.

Output: Borderline cardiomegaly, otherwise the lungs are clear.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: infection? History: hypotension known pancreatic cancer. Small and volumes with interstitial opacities suggestive of edema versus lymphangitic tumor, with small pleural effusions left larger than right.Multiple upper abdominal drainage stents.

Output: Interstitial opacities with effusions left large the right consistent, consistent with edema and/or lymphangitic tumor given the patient's history of pancreatic cancer.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: effusion History: sob Lines and tubes are unchanged. Resolution of left-sided pneumothorax. Low lung volumes with mild pulmonary edema and basilar opacities, as before. Unchanged heart size.

Output: Resolution of small left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 52 year-old female with history of AML in remission status post stem cell transplant, recent EBV viremia, rule out lymphadenopathy. Respiratory symptoms only, no palpable nodes. CHEST:LUNGS AND PLEURA: There are new extensive areas of groundglass opacities diffusely with some areas particularly dense in the right middle lobe and left upper lobe. There is a background of several scattered micronodules and intrapulmonary lymph nodes the latter unchanged from the prior exam.Opacities could be due to infection including viral pneumonia, PCP and other infections and drug reaction.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes have increased in size since 2009. Prevascular lymph node is measured on series 3 image 27, 2.4 x 0.8 cm previously 1.1 x 0.4 cm. The of the mediastinal nodes have also similarly increased compared to the prior exam.CHEST WALL: No significant abnormality noted. No evidence of axillary lymph nodes.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given that limitation, the following observations made.LIVER, BILIARY TRACT: Cholecystectomy clips. No focal liver lesions.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: Atherosclerotic changes aorta no evidence of aneurysm. Small shotty nodes not pathologic in size. The baseline purposes largest node is a left periaortic node measuring 1.2 x 0.9 cm series 2 image 109.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable micronodules in the lung but new areas of scattered ground glass opacities some somewhat dense differential diagnosis as above. Small mediastinal nodes increased compared to 2009. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Infection versus aneurysm. Syncope and weakness. No abnormal focal lung parenchymal opacities. No pleural effusion or pneumothorax. Atherosclerotic calcification of the aortic arch. Normal cardiomediastinal silhouette. Degenerative changes of the thoracic spine.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube plcmt, aspiration History: as above ET tube tip approximately 3 cm above the carina.ICD leads unchanged.Cardiomegaly with basilar atelectasis and consolidation and bilateral pleural effusions, suggestive of CHF.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: assess ETT position History: ETT resposition ET tube tip approximately 3 cm above the carina.Right jugular catheter tip in the right brachiocephalic vein.Small lung volumes with basilar consolidation and atelectasis likely related to aspirated secretions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: evaluate for PNA, RLL crackles History: dyspnea No significant cardiopulmonary abnormality.Right ventricular and scapular stabilization hardware.

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


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Chest pain. Assess for intrathoracic process. No pneumothorax or pleural fluid. No focal airspace opacity. Normal heart size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: evaluate lung fields History: s/p left VATS Trace residual left apical pneumothorax with stable position of left chest tube.No signs of pleural effusion.Left suprahilar consolidative opacities with bandlike morphology likely represent postsurgical atelectasis and contusions adjacent to the suture line, in the setting of recent VATS resection. Attention on follow-up.

Output: Trace residual left apical pneumothorax with stable position of left chest tube.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: eval lung fields History: subjective fever/chills, tachycardia No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Chest discomfort rule out infection. Malaise and fatigue. Right jugular catheter distal tip low in the right atrium. Lung volumes remain low. No conclusive new pulmonary opacities within the limitation of considerable artifact from soft tissues and presumed sheeting overlying the patient. Mild blunting of the left costophrenic angles nonspecific. Retrocardiac opacity present on multiple prior studies and could reflect scarring but is incompletely assessed.

Output: No conclusive signs of pneumonia however examination is somewhat limited. Mild, nonspecific blunting of the left costophrenic angle may be secondary to atelectasis. Correlation with erect PA and lateral chest films may be of use when feasible if patient remains symptomatic.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: ESRD History: above Cardiac size mildly increased from the prior exam.Bilateral pleural effusions with left retrocardiac consolidation/atelectasis.

Output: Mild cardiac enlargement with bilateral pleural effusions and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT remains 3 cm above the carina. Dobbhoff and the right jugular and left subclavian catheters are otherwise similar in position.Persistent decreased lung volumes with patchy streaky densities likely subsegmental atelectasis persist with borderline cardiomegaly, however no specific new findings to suggest change.

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Fever, tachycardia, sepsis. Severe scoliosis with spinal fixation rods causes obscuration of the mediastinum and architectural distortion, limiting evaluation. Tracheostomy tube tip in expected position. No focal airspace opacities. No visible pleural fluid. Unchanged cardiomegaly.

Output: Limited exam, no visible signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: pulm edema History: new oxygen requirement New airspace opacities throughout the right hemithorax are suggestive of infection. Trace pleural fluid on the right.There is complete opacification of the left hemithorax with rightward mediastinal shift, not significantly changed from the prior examination. Multiple masses are again appreciated within the right hemithorax. There is no right-sided pleural effusion.

Output: 1. New airspace opacities throughout the right hemithorax are suspicious for pneumonia. Serial imaging follow-up suggested to exclude alternate etiology such as drug reaction or hemorrhage. 2. Large left pleural effusion with complete opacification of the left hemithorax and rightward mediastinal shift, not perceptibly changed the prior radiograph.3. Multiple pulmonary masses within the right hemithorax compatible with metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax History: chest tube clamped at 11am. Checking to see if pneumothorax Chest tube at the right apex with severe bullous emphysema but no visible pneumothorax. Opacity in both lower lungs, greater on the right, consistent with consolidation, atelectasis and small effusions. No new findings.

Output: Severe bullous emphysema with a chest tube in place but no visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: New daily cough with history of lung CA post right upper lobectomy History: cough Mild right hemithorax postsurgical volume loss.Left lung unremarkable.Heart size normal.No specific evidence of infection or failure.

Output: No specific evidence of infection or failure. No evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Overall stability in appearance of the extensive confluent multinodular bilateral metastatic disease involving both lungs greater both bases. Larger more peripheral densities limit sensitivity for superimposed processes, specifically in the left retrocardiac and peripheral lung base. Questionable small effusions, again greater on the right.A new small focal lucency is observed overlying the right lung base peripherally and adjacent to the unchanged Pleurx catheter portal over the right lung base. This finding is new and although likely related to the catheter, adjacent infection cannot entirely be excluded. Service contactedMild cardiomegaly with otherwise stable appearing mediastinal contours with atherosclerotic disease and tortuosity.

Output: Overall gross stability in appearance, however a focal gas collection is observed involving the right lung base peripherally. Likely related to the overlying Pleurx catheter however adjacent infection cannot be excluded, possibly warranting dedicated imaging. Pager 1154 contracted


Instruction: Generate impression based on medical findings.

Input: PICC placement. Left PICC extends to the SVC. Right jugular catheter also terminates at the SVC level. Bilateral basal scarring. Upper abdominal surgical staples.No specific evidence of pulmonary edema.

Output: Left PICC tip at the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Chest tubes. Persistent moderate right apical pneumothorax, with maximal pleural separation from chest wall of 6cm. The adjacent lung is atelectatic.Two right-sided chest tubes in place, unchanged in position. The NG tube tip terminates above the level of the GE junction, appearing similar to the prior study. Persistent bibasilar opacity compatible with atelectasis and small pleural effusions.

Output: 1. Persistent moderate loculated right apical pneumothorax.2. NG tube tip terminates above the expected level of the GE junction.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: ETT placement? History: see above ET tube tip approximately 3 cm above the carina.NG tube doubled back in the stomach.Left lower lobe atelectasis, unchanged, likely related to aspirated secretions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma. CHEST:LUNGS AND PLEURA: Multiple, subcentimeter nodules in the right middle lobe are unchanged . Some of the nodules are within the fissure.MEDIASTINUM AND HILA: Bilateral hilar and mediastinal adenopathy is again seen. And has slightly increased in size. Reference subcarinal adenopathy measures 3.5 x 1.8 cm image number 49, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subtle lytic lesion in the L4 vertebral body is unchanged. The etiology is unknown.OTHER: No significant abnormality noted.

Output: Slight interval increase in the size of the mediastinal adenopathy. Micronodules in the right middle lobe are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Heart size is within normal limits.Left basilar consolidation / subsegmental atelectasis. No pleural effusion.

Output: Left basilar consolidation / subsegmental atelectasis is new from 9/30/2015 and may be a source of infection or related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: sob History: cough Large lung volumes consistent with COPD.Linear basilar opacities consistent with subsegmental atelectasis.Heart size normal.No specific evidence of infection or edema.

Output: COPD with nonspecific basilar subsegmental atelectasis. No evidence of infection or edema, however.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Atrial fibrillation evaluate lung fields. Low lung volumes. Increased in bilateral groundglass opacity, bronchial wall thickening and atelectasis. Normal heart size. No pneumothorax.

Output: Decreased lung volumes since the prior study. Development of bilateral groundglass opacities and bronchial wall thickening is suspicious for mild edema, though the appearance is likely exaggerated by under inflation artifact.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old with Hx of heart transplant, productive cough concerning for PNA, and shortness of breath Median sternotomy wires noted.Stable cardiomediastinal silhouette with upper limits of normal heart size. No focal airspace opacities. No pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with history of large B cell non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anterior compression of L3 vertebral body, unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal cystic lesion is slightly enlarged no measuring 3.1 x 2.6 cm on image number 157, series number 3. Further evaluation with pelvic ultrasound in 6 months may be helpful.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: Slight interval increase in the size of the left adnexal cystic lesion. Further evaluation with ultrasound may be helpful.


Instruction: Generate impression based on medical findings.

Input: Female 81 years old Reason: eval shunt patency History: syncope vs seizure episode, patient with transient amnesia and unresponsiveness episode, known VP shunt and prior CVAs, no current deficits SHUNT DEVICE: Ventriculostomy catheter exits the skull via a right frontal borehole and courses down the scalp, soft tissues of the anterior neck, and anterior chest wall, entering the abdomen and coiling in the right upper quadrant. There are radiolucent portions of the shunt tubing overlying the calvarium which is difficult to evaluate, but the remainder of the radiopaque shunt catheter tubing is without evidence of kinking or fracture.SKULL: Left frontal craniotomy unchanged from the prior. The patient is edentulous.CERVICAL SPINE: Severe multilevel degenerative disc disease affects the cervical spine.CHEST: No acute cardiopulmonary abnormality. Rib fractures unchanged.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Ventriculoperitoneal shunt without radiographic evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Chest pain. Low lung volumes. Normal variant azygos lobe.No focal pulmonary opacity to suggest infection. Minimal bilateral pleural effusions. Heart size is within normal limits.

Output: Tiny effusions, but no pulmonary opacity to suggest infection.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old, with lung cancer. CHEST:LUNGS AND PLEURA: A left upper lobe reference micronodule measures 5 x 5 mm on axial image 24/109 and is unchanged. A lingular opacity anterior to the cardiac margin on axial image 64/109 is new but may represent a scar. Scar like opacities at the medial left base are unchanged. Scattered additional micronodules, some of which are calcified, are unchanged. Mild centrilobular emphysema is noted.MEDIASTINUM AND HILA: A reference precarinal node measures 10 mm in short axis diameter on axial image 36/150, not significantly changed. Scattered small mediastinal lymph nodes, some calcified, are unchanged.The cardiac size is normal. No pericardial fluid. Coronary and aortic atherosclerotic calcifications are evident.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Splenic calcifications likely reflect prior granulomatous disease.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No definite evidence of disease progression.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of metastatic melanoma status post two cycles of chemotherapy. Evaluate for response. CHEST:LUNGS AND PLEURA: Two right lung metastatic lesions have decreased in size since prior study. Reference right lower lobe mass (series 5, image 48) measures 3 x 3 cm in the axial plane; previously measuring 3.6 x 3.4 cm.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Reference segment 6 hepatic lesion (series 3, image 105) is stable in size, again measuring 2.8 x 2.1 cm. No new focal hepatic lesions identified. The portal and hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left-sided colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Left-sided colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Interval decrease in size of pulmonary metastases. Stable hepatic metastasis. No new lesions identified.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with right pleuritic chest pain and abdominal pain. Atrial fibrillation. Rule abdominal bleeding, assess aorta. Blood per rectum. Guaiac-positive. History of PE, off Coumadin for two months. Right flank pain. Urine culture is positive for pseudomonas. Evaluate for pyelonephritis. This examination is limited by the absence of oral and intravenous contrast.CHEST:LUNGS AND PLEURA: Scarring, dependent atelectasis, and a calcified granulomas again noted.MEDIASTINUM AND HILA: Coronary artery calcifications as described previously. No evidence of aneurysm or dissection. Calcified mediastinal lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LUNG BASES: Small bilateral pleural effusions have resolved since the prior study. Bibasilar infiltrates are increased, possibly due to aspiration.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Several calcified granulomata in the spleen are present.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple scattered bilateral renal cysts similar in size and number.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Decreasing colonic wall thickening noted previously has resolved Decreasing dependent fluid in the paracolic gutters and pelvis. Ventral hernia without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No evidence of aortic aneurysm or dissectionPELVIS:UTERUS, ADNEXA: Uterus atrophic or absent. Ovaries not visualized.BLADDER: Foley catheter decompresses the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Presumed gluteal hematoma has nearly completely resolved. Small residual collection has resolved.OTHER: No significant abnormality noted

Output: 1. No evidence of aortic dissection or hematoma.2. Colitis seen on prior exam has resolved.3. No acute new findings.


Instruction: Generate impression based on medical findings.

Input: 73 year old female with bladder cancer 2006 status-post cystectomy and chemotherapy The examination is limited by lack of IV contrast.CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Calcified left hilar node. Calcification of the aortic archCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal adenoma, unchangedKIDNEYS, URETERS: Mild hydronephrosis with moderate hydroureter, unchanged. Ileal conduit with right upper quadrant ostomy.Subcentimeter exophytic cyst projects off the lower pole of the left kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small umbilical hernia containing a sidewall of transverse colon without evidence of obstructionBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality.BLADDER: CystectomyLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the right hip and spine.OTHER: No significant abnormality noted.

Output: Stable examination without evidence of recurrence.Mild right hydronephrosis/moderate hydroureter, unchanged status post ileal conduit.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: evaluate pleural effusion History: sob Right dual-lumen port remains accessed with the catheter terminating at the level of the right mainstem bronchus in the SVC. Left basilar chest tube and Pleurx catheter unchanged in position.Interval decreased lung volumes with progressive retrocardiac consolidation and atelectasis. Right infrahilar airspace opacities are suspicious for ongoing infection, likely related to aspiration. Small pleural effusions.

Output: Progressive retrocardiac consolidation and atelectasis. Right infrahilar opacities suspicious for infection from aspiration.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with metastatic colon carcinoma CHEST:LUNGS AND PLEURA: Subcentimeter lung nodule on image number 64, series number 4 in the right lower lobe. Right apical irregular shaped airspace density which may represent scarring versus a lung nodule.Linear left lower lobe atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Lack of IV contrast severely limits evaluation of the liver for focal lesions. Patient's known hypodense lesions likely representing cysts unchanged. Cholelithiasis without biliary dilatation is unchanged.SPLEEN: No significant abnormality notedPANCREAS: Patient's known pancreatic mass cannot be well visualized due to lack of IV contrast, however, significant ductal dilatation the body and tail of the pancreas is unchanged.ADRENAL GLANDS: And diffuse thickening of the left adrenal gland is unchanged.KIDNEYS, URETERS: Right kidney is atrophic. Patient's known hyperdense lesion in the posterior aspect of the right kidney is unchanged measuring 13 by 8mm. Left renal cyst is unchanged. Patient's known solid left renal mass is not well seen on this noncontrast CT.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: Enlarged prostate is unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Heterogeneous, mixed lytic and blastic changes in the pelvic bones, sacrum and lumber vertebral bodies are unchanged. Metastatic disease cannot be excluded. Further evaluation with bone scan is recommended.OTHER: No significant abnormality noted

Output: Limited study due to lack of IV contrast. Subcentimeter, nonspecific nodules in the right lobe. Follow-up CT is recommended. No significant change in the pancreatic and renal lesions, however, lack of IV contrast precludes although evaluation of these lesions.Bone scan is recommended for further evaluation of the bone lesions in the pelvis, sacrum and lumber vertebral bodies.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: 58 yo M s/p right thoracentesis, eval for ptx History: eval for ptx Cardiomegaly with mild lower lung zone edema increased since the prior study.Left lower lobe consolidation and pleural effusions persist.ET tube tip approximately 6 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Gradually worsening pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male status post lung transplant with chest/sternum mass. LUNGS AND PLEURA: Centrilobular emphysema is evident. A right upper lobe calcified nodule may represent prior granulomatous disease (axial image 29/111). Few, scattered micronodules noted, some of which are calcified. A left upper lobe nodule measures approximately 11 x 11 mm on axial image 60/111 and possibly demonstrates both a feeding artery and draining vein which probably represents an AVM. A right lower lobe cyst or pneumatocele is evident. Scattered subsegmental atelectasis noted. No other focal consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes may represent prior granulomatous disease. Atherosclerotic calcifications noted. The cardiac size is normal with no pericardial effusion. Surgical clips evident about the esophagus.CHEST WALL: Multiple sternal sutures in place, all of which appear intact. A wire projects anteriorly from one of the sutures (axial image 39/111) producing a masslike contour to the chest wall. Soft tissue prominence in this area may represent a small amount of granulation tissue or reactive inflammation. No localized abscess is identified.Scoliosis is evident.UPPER ABDOMEN: Punctate splenic calcifications noted. Surgical clips in the vicinity of the second portion of the duodenum of uncertain etiology.

Output: 1.A sternal suture wire projects anteriorly causing a small soft tissue mass in the anterior chest wall. No abscess is identified.2.Emphysema.3.Scattered pulmonary nodules, some of which are calcified, as above.4.Probable left lower lobe pulmonary AVM.5.Postsurgical changes noted about the esophagus and in the right upper quadrant.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: r/o infiltrate History: fever Diffuse reticular nodular opacities throughout the right lung suspicious for infection. Small bilateral pleural effusions. Lobular contour at the right cardiophrenic angle may be related to pericardial cyst or prominent fat pad which can be further delineated with cross-sectional imaging.No pleural effusion. No pneumothorax.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: edema History: chf,sob Left sided ICD with right ventricular electrode unchanged in position.Cardiomegaly is not significantly changed. The lungs and pleural spaces are clear.

Output: No evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.IABP placement. Interval extubation.IABP markers at the aortic arch and approximately the L2 levels.Other tubes and lines unchanged.Increasing left retrocardiac opacity, suggestive of pleural fluid and atelectasis.Improving pneumomediastinum.

Output: Increasing left pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 94 yearsGender: MaleReason for Study: Reason: Eval resolution/improvement in fluid overload History: sob Pleural effusions right greater than left slightly decreased from the prior exam although partially, 4 by differences in patient positioning.Stable cardiomediastinal silhouette.No new pulmonary opacities identified.Again noted is bullet fragment within the L1 vertebrae.

Output: Interval improvement in the pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: s/p 3/24 VATS RLL wedge History: follow up Right chest tube removed with no pneumothorax.Right wedge resection and right pleural thickening.No new findings.

Output: No pneumothorax or other complication of recent surgery.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Op Clearance for Liposuction Surgery in the Dominican Republic. Scheduled for next week. History of Asthma. History: Pre-Op Clearance for Liposuction Surgery in the Dominican Republic. Scheduled for next week. History of Asthma. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pneumonia, hx of URI and wnezing, cough with bi-basilar crackles History: above Heart size about upper normal.Small lung volumes with streaky basilar opacities compatible with atelectasis and scarring.No specific evidence of pneumonia.Anterior dislocation of the left humeral head.

Output: Basilar atelectasis but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: COPD, worsening SOB History: see above Large lung volumes consistent with COPD.Otherwise, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with history of hemoptysis for 3 days. Positive recent travel. Rule out PE. PULMONARY ARTERIES: Pulmonary embolism protocol performed with diagnostic technique. No evidence of pulmonary embolus. Pulmonary arteries including main, segmental and subsegmental arteries appear patent.LUNGS AND PLEURA: Small scattered nodular opacities with upper lobe predominance and peribronchial thickening. Multiple small ill-defined cavitary lesions, the largest of which measures 4 mm, MEDIASTINUM AND HILA: No mediastinal or paratracheal adenopathy noted. Heart size within normal limits. No pericardial effusion.CHEST WALL: No axillary adenopathy.UPPER ABDOMEN: No significant abnormality noted.

Output: Multiple, small ill-defined cavitary lesions predominantly in the upper lobes with underlying emphysema.  If the patient is a smoker and does not have signs or symptoms of infection, the appearance is radiographically compatible with pulmonary Langerhans cell histiocytosis, however this entity does not typically present with hemoptysis.If the patient has signs and symptoms of infection, then active infection should be considered, especially given the recent travel history. The differential diagnosis includes tuberculosis, Coccidioidomycosis another atypical infection.CT follow-up recommended after appropriate clinical management of the patient.The results of these findings were discussed with emergency room physician Dr. Blumen.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Chest pain reproducible with movement and palpation. Lungs are clear. Heart size within normal limits. No pneumothorax. No fractures are visualized.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Chest pain history of severe CHF rule out edema. Unchanged cardiomegaly, scarring on the left and basal opacities likely reflecting atelectasis. No pleural fluid or specific signs of CHF.

Output: Cardiomegaly and minimal basal atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: PNA History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: 25-year-old female presents with shortness of breath. Evaluate for pneumonia and pulmonary edema. The cardiomediastinal silhouette is unremarkable. No focal pulmonary opacity. Peribronchial cuffing noted. No large pleural effusion or pneumothorax.

Output: Bilateral mild peribronchial thickening as can be seen with reactive airway disease or bronchitis pattern.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with history of epiglottic cancer. Please evaluate. CHEST:LUNGS AND PLEURA: Paramediastinal pulmonary fibrosis and scarring likely reflect sequela of prior radiation therapy. No suspicious nodules, masses, or pleural effusion.Debris in trachea compatible with aspiration.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild coronary calcifications.Interval increase in asymmetric thrombus just distal to the origin of the left subclavian artery with near total occlusion (series 3, image 24).CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Right renal cyst is partially visualized. Several subcentimeter hypodensities in the liver are too small to characterize but stable.

Output: 1. No evidence of metastatic disease.2. Near-total occlusion of the left subclavian artery just distal to its origin.3. Aspirate debris in trachea.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o infection History: sob, rigors Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: s/p RLL wedge History: s/p RLL wedge Status post right lower lobe wedge resection. Right chest tube with no pneumothorax.Large lung volumes suggestive of COPD.

Output: No pneumothorax following right lower lobe wedge resection.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: pna? History: chest pain Low lung volumes with basilar atelectasis but no specific evidence of infection or edema.Heart size normal.No pleural effusion. No pneumothorax.

Output: Basilar atelectasis with no evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval for acute process History: near syncope followed by chest pain No pleural effusion or pneumothorax. Mild bronchial wall thickening, unchanged from prior. The cardiomediastinal silhouette is within normal limits. No new focal pulmonary opacity.

Output: Mild bronchial wall thickening, similar to prior examination.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices ICD lead in place, unchanged.Interval removal of right jugular catheter and left chest tube with no sign of residual pneumothorax. Moderate cardiomegaly and mild residual interstitial opacity compatible with resolving edema.

Output: Resolving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: r/o pneumonia History: multiple myeloma pt with fever, tachycardia b/l lower extremity weakness. Cardiomegaly, with small lung volumes but no reliable evidence of edema or pneumonia.

Output: Small lung volumes, but no reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Shortness of breath. Evaluate for pulmonary edema, pneumonia. No specific evidence of infection or edema. The cardiomediastinal contours are normal and unchanged. Median sternotomy hardware is noted.

Output: No specific evidence of infection or edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Right middle lobe lung cancer Continued improvement and decrease in the right pleural effusion largely resolved. Decreased fluid along the minor fissure with residual minimal scarringMild basilar atelectasis superimposed upon mild emphysematous changes

Output: Persistent scarring and resolved right pleural effusion


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: Rule out pneumonia History: Cough, febrile, leukocytosis Left lower lobe consolidation consistent with pneumonia. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Left lower lobe consolidation consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: 65yo M with SCC of head and neck and h/o laryngeal edema with new worsening hypoxia. History: hypoxia Tracheostomy tube and right Port-A-Cath unchanged.Stable cardiomediastinal silhouette.Basilar opacities are compatible with atelectasis and pleural effusions.G-tube identified.

Output: Basilar opacities compatible with atelectasis and pleural effusions similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: rule out pneumonia History: fever No new focal lung consolidation. Right hemidiaphragm again mildly elevated. Left-sided PICC again terminates within the axilla. Unchanged heart size. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female; 65 years old. Reason: Eval for change in effusions History: L greater than R sided Effusions No significant interval change in large left and small right pleural effusions with underlying atelectasis.Stable left jugular central venous catheter with tip in persistent left SVC.Retained ICD coil and leads.

Output: No significant interval change in large left and small right pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of chest CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple large metastatic lesions throughout the liver are again noted. Index left hepatic lobe lesion measures 9.5 by 9.8-cm on image number 23, series number 3, slightly increased compared to previous study. However the amount of enhancement of the lesion is decreased. Other lesions are also slightly increased to unchanged in size.SPLEEN: No significant abnormality noted.PANCREAS: Index lesion abutting pancreas is smaller measuring 2.6 x 1.7 cm in image number 105, series number 3.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal and mesenteric adenopathy is again noted. IVC is compressed by the large retroperitoneal masses.BOWEL, MESENTERY: Numerous peritoneal based masses are again noted. Ascites is increased within the internal. Overall the size of peritoneal masses have slightly decreased compared to previous study.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: Extensive peritoneal masses are again noted with overall minimal decrease in size and interval increase in the amount of ascites.BONES, SOFT TISSUES: Generalize anasarca.OTHER: No significant abnormality noted.

Output: Interval increase in the amount of ascites. Some of the index lesions and some of the peritoneal masses have minimally decreased in size compared to previous study as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Left Chest tube placement History: Left Chest tube placement New left chest tube, with a persistent left pneumothorax slightly smaller, as well as a pneumomediastinum.

Output: New left chest tube, improvement in left pneumothorax. Pneumomediastinum present as well.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female, assess for metastatic cervical cancer. CHEST:LUNGS AND PLEURA: Small subpleural subcentimeter micronodules are seen on images 15 and 77 of series 5. These are nonspecific and should be followed radiographically. Additionally, scarring in the right middle lobe and left lung base is visualized.MEDIASTINUM AND HILA: Two borderline enlarged lymph nodes noted in the mediastinum. One nodule measures 1.1 cm x 1.4 cm (image number 36, series number 3). Another subcarinal lymph node measures 0.6 cm x 1.5 cm (image number 45, series number 3).CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Small hypodense lesion in the right hepatic lobe is too small to characterize and likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The cervix is enlarged and heterogeneous in appearance. The fat plane between the cervix and rectum is obliterated. Round cystic mass in the vagina likely represents a benign finding such as a Bartholin's cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount of intraperitoneal fluid in the pouch of Douglas is seen.

Output: 1. No definite evidence of metastatic disease.2. Nonspecific subpleural micronodules in the lungs as described above. Recommend surveillance imaging.


Instruction: Generate impression based on medical findings.

Input: Known metastatic melanoma, evaluate Extensive numerous and confluent metastatic nodules observed bilaterally with the larger nodules observed in both bases. Appearance grossly similar yet progressed from 10/28/2016. Small to moderate left over right effusions. No additional cardiopulmonary abnormality observedRight axillary surgical clips

Output: Extensive bilateral pulmonary nodules consistent with known metastatic melanoma


Instruction: Generate impression based on medical findings.

Input: Male 62 years old with bilateral decreased air entry at bases Right PICC is unchanged in position. Stable cardiomediastinal silhouette. Minimal left basilar atelectasis/scarring and without focal consolidation. No pleural effusions.

Output: Stable exam without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with nodular lymphoma CHEST:LUNGS AND PLEURA: Stable biapical scarring. Stable emphysema.MEDIASTINUM AND HILA: Reference subcarinal lymph node best seen on image number 50, series number 4 has significantly increased in size and now measures 2.4 x 1.9 cm. Other mediastinal adenopathy has also increased in size.Bilateral retrocrural adenopathy is also increased in size.CHEST WALL: Several increase in the size and number of axillary adenopathy. A reference left axillary lymph node measures 15 x 10 mm image number 26, series number 4.ABDOMEN:LIVER, BILIARY TRACT: Stable right lobe subcentimeter benign lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference portacaval lymph node is significantly increased in size now measures 4.2 x 1.5 cm image number 94, series number 4. Other retroperitoneal adenopathy is also significantly increased in size and extends throughout the aorta into the pelvis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Stable leiomyomatous uterus. 5 x 3 cm right ovarian cystic mass is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: Increase in the size of the pelvic adenopathy. Reference left external iliac lymph node measures 3 x 1.5 cm image number 172, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval progression of disease as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: sob Mild cardiomegaly with perihilar bronchial thickening and mild peripheral interstitial opacity.No pleural effusions and no sign of pneumonia.

Output: Mild cardiomegaly and possible mild interstitial edema versus chronic interstitial disease.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Fever and neutropenia. Evaluate for pneumonia. Right-sided chest port tip in the superior vena cava. Cardiomediastinal silhouette is within normal limits. No focal airspace opacity or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: s/p intubation; tube check History: see above Endotracheal tube terminates approximately 5.3 cm from the carina. Other lines and tubes, unchanged. Diffuse pulmonary opacities, as before. Small pleural effusions unchanged. Unchanged cardiomegaly.

Output: Lines and tubes, as above. Stable diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: chest wall pain, left-sided Clear lungs. Probable nipple shadow overlies the right lower hemithorax. 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: Male, 69 years old.Reason: pre-op TECAB History: NA Diffuse interstitial opacities suggestive of edema with minimal pleural effusions.Heart size normal.No specific evidence of infection.

Output: Interstitial opacities suggestive of edema with small pleural effusions, although the heart is not very large.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: evaluate for PNA History: desaturation O2 Stable position of support devices.Partial clearing of the previous airspace opacities, right greater than left. Small right pleural effusion. No interval pneumothorax. Heart size remains normal.

Output: Improving right greater than left pulmonary opacities and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Ureteral cancer No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with history of ovarian cancer. Patient is neutropenic with pneumonia. Please evaluate chest for fungal infection and abdomen and pelvis for progressive disease. CHEST:LUNGS AND PLEURA: Interval development of bilateral pleural effusions, left greater than right, with atelectasis of the left lower lobe.Right lower lobe pulmonary micronodule appears slightly larger compared to previous.MEDIASTINUM AND HILA: Dilated esophagus containing debris. Aberrant right subclavian artery passes posterior to the esophagus.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Metastatic implants noted on the liver; increased compared to previous. Numerous gallstones noted within the gallbladder; appears similar to previous.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left hydronephrosis; increased from previous.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple loops of increasingly dilated small bowel; likely due to peritoneal disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval increase in ascites.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Inguinal lymph nodes noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Increasingly dilated small bowel; likely due to peritoneal disease. Increasing ascites.2. Increasing size of implants on the surface of the liver.3. Increasing left pleural effusion with atelectasis. Slightly increasing right pulmonary micronodule.4. Increasing, mild left hydronephrosis.5. Dilated esophagus with intraluminal debris.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: AM CXR History: AM CXR One of the two right basilar chest tube has been removed.Subcutaneous emphysema noted along right lateral chest wall.Moderate size right apical pneumothorax prior exam.Stable cardiomediastinal silhouette.Mild basilar atelectasis.

Output: Interval removal of one of the right basilar chest tubes. Moderate-sized right apical pneumothorax increased from the prior exam.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with unexplained weight loss, ex-smoker. Evaluate for malignancy. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the lingula on image number 35/104.MEDIASTINUM AND HILA: Enlarged left lobe of the thyroid extending retrosternally into the superior mediastinum. Right lobe of the thyroid also contains nodules. Several nonenlarged mediastinal lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Multiple parenchymal calcifications in the atrophic pancreas suggestive of chronic pancreatitis. No focal pancreatic masses.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Several nonenlarged bilateral para-aortic lymph nodes are present. The etiology is unknown.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: Enlarged thyroid gland with retrosternal extension. A thyroid neoplasm cannot be excluded.Chronic pancreatitis. Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: category P History: fever/son Minimal nonspecific basilar interstitial opacities but no sign of edema or pneumonia.Heart size normal.

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


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: S/p CT removal. Eval for interval change. History: asx Stable position of support devices. A percutaneous gastrostomy balloon is noted at the inferior field of view in the left abdomen. There is a bioprosthetic valve in the aortic position.Increasing pleural effusions with associated subsegmental atelectasis and basilar edema. No interval pneumothorax. Extensive mitral annular calcification is present.

Output: Increasing pleural effusions with basilar opacities compatible with mild edema and subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: MaleReason for Study: Reason: For V/Q scan History: SOB Stable cardiac enlargement.Decreased lung volumes with minimal basilar atelectasis.No focal airspace opacities.No pleural effusions.

Output: Stable cardiomegaly without acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: r/o pneumonia History: fever, cough Small lung volumes with nonspecific bronchial wall thickening which could be asthma or bronchitis.No specific evidence of infection.Heart size normal.

Output: No evidence of infection, although nonspecific bronchial wall thickening may indicate asthma or bronchitis.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Altered mental status question infection. Mild cardiomegaly. Tortuous thoracic aorta. No focal airspace opacities, pneumothorax or signs of pulmonary edema. Cholecystectomy clips.

Output: Mild cardiomegaly, but no visible signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: assess for infection History: assess for infection Right chest port tip at RA/SVC junction. Lungs hypoinflated. No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax History: hx of spontaneous pneumothorax, status post chest tube placement Large left pneumothorax with a margin of the left upper lobe 36 mm from the chest wall. A Left apical bleb which may be the source of the pneumothorax.Left chest tube in place with its tip directed superiorly adjacent to the mediastinum.

Output: Large residual left pneumothorax and apical bleb.


Instruction: Generate impression based on medical findings.

Input: Male; 56 years old. Reason: hypoxia, eval for focal infiltrate History: see above Diffuse pulmonary opacities and pleural effusions are unchanged and consistent with edema and possible pneumonia.Stable cardiomediastinal silhouette.A Dobbhoff tube extends below the lower margin of the image.

Output: Stable cardiopulmonary appearance with pulmonary opacities and pleural effusions, consistent with edema and possible pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: intubated History: intubated No change in left pleural effusion and left-sided opacities.A small right pleural effusion is now evident.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.ECMO catheters stable.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.Left subclavian pacemaker, leads unchanged in position.

Output: Stable tubes and devices. Unchanged left pleural effusion and now a small right is visible.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: fever, eval source History: as above Unchanged lines and tubes with right-sided PICC again the right axilla. Diffuse pulmonary opacities, unchanged. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No new focal pleural parenchymal opacity. Diffuse pulmonary opacities, as before, most consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: evaluate R pleural effusion History: right pleural effusion Right pleural effusion now layering posteriorly with basilar subsegmental atelectasis.No significant change.

Output: Moderate right pleural effusion now layering posteriorly, with basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Eval lines/tubes/devices History: ECMO Multiple surgical drains overlie the chest as well as chest tubes and ECMO cannulae.No significant pneumothorax.Unchanged pulmonary opacities.Status post extubation and NG tube removal.Right jugular Swan-Ganz catheter, tip in right main or interlobar pulmonary artery.

Output: Status post extubation and NG tube removal. Other support devices unchanged as are pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Ventricular assist device. Endotracheal tube terminates 7 cm from the carina. Left IJ sheath is noted. ECMO catheters are noted. Cardiac leads unchanged. Mediastinal drains and left chest tube noted. LVAD device overlies the lower thorax/upper abdomen. Mild mediastinal widening, likely postoperative in nature. Mild pulmonary edema. No significant pneumothorax.

Output: Iatrogenic devices, as above. No unexpected radiopaque foreign body. Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval for infiltrate History: cough, sob Focal nodule in the suprahilar region on lateral radiography. Question of hazy opacity overlying the mid thoracic spine which could represent confluence of shadows. Normal heart size. No large pleural effusion or pneumothorax.

Output: Focal nodule in the suprahilar region on lateral radiography. Question of hazy opacity overlying the mid thoracic spine which could represent confluence of shadows. Consider correlation with chest CT. Findings verbally discussed with Dr. Beiser from the emergency department at 10:00 AM on 4/16/2016


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.History of lung cancer, status post right middle and lower lobectomy 14 years ago. Cardiomediastinal silhouette is normal. Tortuous aorta.No pneumothorax. Small bilateral pleural effusions.Right rib deformities are unchanged.Fine nodular calcifications in the right base are not significantly changed since the prior exam. Findings were seen on prior CT dated 8/9/2011 and may represent postoperative or postinflammatory changes.Mild wedge deformity of multiple thoracic vertebra.

Output: No significant interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Cough, inhalation injury x1 week Cardiomediastinal silhouette is normal. Tortuous aorta.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 41 years old Reason: Eval for pneumothorax History: S/P Chest tube removal Slightly improved basilar opacities, left greater than right.Interval removal of the right chest tube, without pneumothorax.Sternal fixation hardware unchanged. Cardiomegaly unchanged with persistent pulmonary vascular redistribution.Right aortic arch.

Output: Persistent but slightly improved basilar opacities, left greater the right. Right chest tube has been removed, without pneumothorax.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, 50 years old.Reason: cough History: cough Left hemithorax volume loss and left perihilar opacity are unchanged. This could be the result of radiation for breast cancer, if the patient was irradiated.No specific evidence of infection or edema.Mild/moderate cardiomegaly unchanged.

Output: Left-sided presumed radiation fibrosis unchanged, without acute edema or pneumonia. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Crackles Cardiomegaly, unchanged. Tortuous aorta.Low lung volumes with bilateral areas of subsegmental atelectasis. Small to moderate sized left pleural effusion, increased compared to prior.

Output: Small to moderate sized left pleural effusion, increased compared to prior.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: new lung mets History: see above Small nodules seen on CT are not visible by radiography.Apparent right paratracheal widening is likely mediastinal fat deposition and was not seen on the recent CT.Heart size normal.No specific evidence of infection or edema.Upper abdominal surgical clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: r/o pneuomthorax after intercostal nerve block (T8-11 on the right) History: r/o pneuomthorax after intercostal nerve block (T8-11 on the right) No evidence of pneumothorax. Linear scarring and atelectasis with volume loss on the right is unchanged.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: cough History: fever Right subclavian Mediport remains unchanged. Surgical clips are again seen projecting over the left axilla.Stable cardiomediastinal silhouette.Left apical pleural parenchymal scarring remains unchanged. Increased right basilar bandlike opacity with atelectatic in nature. No large pleural effusion or pneumothorax.

Output: Right basilar bandlike opacity likely related to platelike atelectasis. Correlate clinically and consider follow-up imaging as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Reason: SGC in place History: SGC in place Swan-Ganz catheter tip located in a peripheral right lower zone branch of the pulmonary artery. Mild cardiomegaly but no sign of edema or visible effusion.

Output: Peripheral location of the Swan-Ganz catheter, possibly wedged.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: hemoptysis History: hemoptysis Mild cardiomegaly, with an aorta tortuous for age.No significant pulmonary or pleural abnormality.No sign of right lower lobe opacity seen on CT 1/14/2016.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: pna? pulmonary edema? acute process? History: sob Cardiomegaly status post median sternotomy for valve replacement.Small lung volumes with edema and small pleural effusions.Left subclavian ICD, leads unchanged in position.

Output: Pulmonary edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent and essentially unchanged moderate left pleural effusion with underlying streaky patchy densities in both lungs greater on the left. Retrocardiac opacity and suspected partial collapse of left lower lobe persists. Partial consolidation over remains suspectedLeft chest tube and/or drainage catheter projects over left upper quadrant or lower lung unchangedRight jugular single port and cholecystectomy clips in

Output: Persistent moderate left pleural effusion with retrocardiac nonspecific opacity


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: assess for causes of worsening hypoxia History: metastatic gi cancer recent stent placed by interventional gi - hypoxic to 70s Right Port-A-Cath with its tip in the RA.Stable cardiomediastinal silhouette.Marked interval increase in perihilar and upper lobe airspace opacities and diffuse increase in interstitial opacities compatible with edema infection/aspiration, or possible hemorrhage.Small bilateral pleural effusions and left retrocardiac consolidation/atelectasis.

Output: Significant interval increase in upper lobe airspace and diffuse interstitial opacities suggestive of edema, aspiration/infection, or possible hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: iabp History: iabp No acute abnormality.IABP proximal marker is projected over the aortic arch. Left subclavian ICD, leads unchanged in position.Right PICC, tip in right brachiocephalic vein.

Output: IABP catheter proximal marker projects over the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: check pulmonary status History: check pulmonary status Support devices are unchanged in position.Persistent low lung volumes. Increasing bilateral airspace opacities suspicious for progressive edema or infection. A skinfold is noted on the right; no pneumothorax is present. Moderate pleural effusions remains stable.

Output: Bilateral patchy airspace opacities slightly increased from prior. Stable moderate pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: chest pain, left leg pain History: chest pain, left leg pain Decreased lung volumes and mild cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Mild cardiac enlargement without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: interval change History: lung txp Extensive airspace opacities with pleural effusions not significantly changed.No pneumothorax.Right jugular catheter tip at right atrial level directed towards the ventricle.Left jugular introducer unchanged.Left PICC, tip in left subclavian.Tracheostomy tube tip approximately 4 cm above the carina.

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


Instruction: Generate impression based on medical findings.

Input: Age: 86 yearsGender: MaleReason for Study: Reason: post op, eval lung fields History: s/p CABG ET tube, right IJ venous catheter, and chest tubes unchanged.Subcutaneous emphysema noted along the left lateral chest wall.Small bilateral apical pneumothoraces with apical pleural calcifications.Cardiac size is normal.Diffuse air space interstitial opacities in the left lung with left basilar atelectasis improved from the prior exam.Left pleural effusion slightly decreased from the prior exam.

Output: Support devices unchanged. Small apical pneumothoraces. Interval improvement in the left-sided pulmonary edema and pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p desat, intubation, new trach History: desat Extensive new mediastinal, retroperitoneal and subcutaneous emphysema.New flexible tracheostomy tube with its tip about 2 cm above the carina.Venous catheters and pacemaker leads unchanged.Bilateral nonspecific pulmonary opacity compatible with edema and atelectasis but no visible pneumothorax.

Output: Tracheostomy tube in place with new mediastinal, subcutaneous and retroperitoneal emphysema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for abnormality History: chest pain and SOB Moderate cardiomegaly with an ICD deviceExtending to the area of the apex of the right ventricle. Small lung volumes with interval clearing of interstitial edema.

Output: Interval resolution of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female status post right IJ placement. Confirm involvement of pneumothorax. Right CVC tip is in the right internal jugular vein. Heart size is upper limits of normal. No focal airspace opacity, pleural effusion, or pneumothorax. Mild pulmonary edema.

Output: Right CVC in internal jugular vein. Mild pulmonary 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: Female, 47 years old.Reason: s/p CABG x 6; CT removal History: SOb Sternal wires and skin staples remain well aligned.Postoperative basilar subsegmental atelectasis and small pleural effusions remain. There may be a trace left apical pneumothorax, barely perceptible. Stable postoperative mediastinal widening.

Output: Linear opacity at the left apex may represent a trace residual left apical hydropneumothorax. Small pleural effusions are stable.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with history of renal cancer. Evaluate for metastatic disease. Patient is rotated.Heart is at the upper limits of normal, slightly increased in size compared to prior. Prominence of the subcarinal region may be due to atrial enlargement or prominent venous confluence but makes it difficult to exclude lymphadenopathy in this area.No focal opacity, pleural effusion, or pneumothorax.

Output: No sign of pulmonary metastases. Heart has slightly increased in size. Limited assessment for lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusions History: tachycardia Venous catheter and NG tube unchanged.Small lung volumes with increased opacity and volume loss on the left suggestive of liver due to pleural effusion and atelectasis.Probable small right pleural effusion.Mild cardiomegaly.

Output: Persistent left pleural effusion and atelectasis, and a smaller right effusion, with no acute change.


Instruction: Generate impression based on medical findings.

Input: 55 year old female with interstitial lung disease presents with shortness of breath and increasing O2 requirement. Technically adequate exam.PULMONARY ARTERIES: No evidence of PE.LUNGS AND PLEURA: Severe worsening basilar predominant honeycombing with reticular opacities, traction bronchiectasis. and architectural distortion slightly increased from prior, compatible with UIP or NSIP. No evidence of superimposed consolidation to suggest infection. MEDIASTINUM AND HILA: Pneumomediastinum with air tracking to the low anterior soft tissues of the neck. No cardiomegaly or pericardial effusion. Multiple slightly prominent mediastinal and hilar adenopathy stable to slightly increased.No significant air trapping on expiratory phase images.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1) No pulmonary embolism. 2) Pneumomediastinum3) Interval worsening of pulmonary fibrosis, compatible with UIP given history of mixed connective tissue disease, less likely fibrosing NSIP.4) No evidence of superimposed consolidation to suggest infection.


Instruction: Generate impression based on medical findings.

Input: Aortic valve disorder Unchanged mediastinal chest tubes and right jugular sheath extending into the proximal SVC. Retrocardiac opacity and superimposed mixed interstitial airspace opacities in both bases again suggests superimposed atelectasis, however partial consolidation cannot be excluded.

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: SOB History: SOB Large patchy opacities are noted in the right middle and lower lung field, new as compared with prior study. There is slight blunting of the right costophrenic angle, which can be due to small pleural effusion. Linear densities are noted in the left lower lung. The cardiac silhouette is normal. There is no evidence of pneumothorax.

Output: Consolidation in the right lung, suspicious for pneumonia. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: assess iabp position History: assess iabp position IABP marker unchanged in mid descending thoracic aorta.Edema and cardiomegaly unchanged.

Output: IABP marker unchanged in mid descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: follow up eval lung fields History: cough, sputum Stable cardiac enlargement.IABP marker unchanged in the aortic arch.Right PICC line with its tip in the right subclavian.Left surgical drain noted in the upper left hemithorax.Mild interstitial perihilar/basilar opacities suggestive of edema.No new pulmonary opacities identified.

Output: Mild perihilar/basilar interstitial opacities compatible with edema similar to the prior exam. IABP marker in the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Shortness of breath rule out pulmonary edema. Right jugular catheter tip right atrium. Left subclavian ICD unchanged in position.Unchanged cardiomegaly and mediastinal widening.Low lung volumes, decreased from earlier films, with coarse interstitial abnormality and ground glass opacity. Pleural thickening versus extrapleural fat deposition bilaterally.

Output: No acute change in chronic interstitial lung disease, but no specific signs of superimposed pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Shortness of breath rule out pneumothorax. Decreased volume of pleural fluid on left. Small left costophrenic angle pneumothorax.Moderate loculated fluid collection on the right similar in appearance.Improved aeration at the left base.Hardware and devices unchanged.

Output: Small left pneumothorax with decreased left pleural fluid volume.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Improving and decreasing atrophy mixed interstitial airspace opacities involving all 4 quadrants, greater improvement observed on the right. No superimposed acute focal airspace process. Cardiac and medius on contours are within limits.NG tube is been retracted, side-port 5 cm above the GE junction. Right PICC line extends into the mid SVC

Output: NG tube retracted with improving aeration bilaterally


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: pneumonia History: congestion w/ cough Severe left lower lobe collapse again noted. Small left pleural effusion or thickening, as before. Subtle hazy opacities at the right lung base again noted, perhaps minimally increased. Aortic atherosclerosis, again noted. Heart size again mildly enlarged. No pneumothorax. Healed right-sided rib fractures.

Output: Severe left lower lobe atelectasis again noted. Superimposed pneumonia may be present.Subtle hazy opacities at the right lung base again noted, perhaps minimally increased.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Outside transfer for small bowel obstruction. Left PICC tip at the SVC/artery junction. Enteric tube sidehole at the level of the GE junction, the tip is off the caudal margin of the film. Well-circumscribed nodule in the right upper lobe, probably a granuloma. Left apical scarring. No acute pulmonary opacities.

Output: No acute pulmonary abnormality.