Instruction: Generate impression based on medical findings.

Input: Check for neoplasm. Robotic excision of an adenoma Interval removal of left chest tube. Persistent moderate left pleural effusion with underlying compression of the lobe. More mild changes on the right. Upper lungs are clear

Output: Left chest tube removed


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: chest pain, eval PNA, fx History: worse with breath Cardiac silhouette is normal in size. Mildly prominent thoracic aorta is seen with calcified aortic knob.Question left apical nodular opacity. Lungs are otherwise clear.

Output: Question left apical nodular opacity may represent infectious process or potentially malignancy. The possibility of overlapping of shadows is not entirely excluded. Correlate clinically and consider dedicated CT chest imaging for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Transplant History: Transplant f/u Unchanged basilar opacities and pleural effusions.Left subclavian and right jugular catheters are unchanged in position.

Output: Stable pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia, lung mass History: hemoptysis Dense opacity at the right base consistent with atelectasis and pleural effusion possibly with an underlying mass.Subcarinal opacity and splaying of the carina suggestive of subcarinal lymphadenopathy. Mild right paratracheal widening is also present suggestive of lymphadenopathy.

Output: Mediastinal, pulmonary and pleural abnormalities as described suspicious for neoplasm. Comparison with outside imaging and/or a CT scan is recommended.


Instruction: Generate impression based on medical findings.

Input: Mild shortness of breath. Fever Diffuse mild to moderate interstitial changes observed representing questionable mild edema superimposed upon chronic change previously observed. Mild cardiomegaly with mildly decreased lung volumes. Questionable mild CHF, serial imaging will be needed to confirm.Focal thickening observed along the upper right lateral chest wall, presumably old scarring given contour and prior loculated fluid in this area observed in 2014Bilateral breast implants

Output: Questionable mild CHF


Instruction: Generate impression based on medical findings.

Input: Heart failure and dyspnea on exertion Mildly retracted Swan-Ganz, yet tip remains in the main right pulmonary outflow tract. ICD unchangedIABP remains 3 to 4 cm from the aortic archModerate nonspecific hepatomegaly with otherwise essentially clear lungs that are mildly decreased in volume which may partially represent semiupright technique

Output: Swan-Ganz catheter repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval for PAC positioning History: ectopy, PAC in place Left hemithorax opacification consistent with prior pneumonectomy.Unremarkable right lung.Left jugular Swan-Ganz catheter, tip in right pulmonary artery.Right jugular catheter, tip in SVC.Mitral valve prosthesis.

Output: Left jugular Swan-Ganz catheter, tip in right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: 67yr old male with history of MM; pre-auto sct evaluation History: evaluate Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Azygos pseudolobe, normal variant.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 95-year-old female status post right upper lobectomy. Annual follow-up. Unchanged cardiomegaly.Unchanged postoperative changes including volume loss and architectural distortion of the right lung. No new nodules. No pleural effusion or pneumothorax.Right hilar calcified lymph nodes compatible prior granulomatous disease.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: OSH transfer, intubated, ?h/o pneumonia, eval ET tube, dialysis line, infiltrates History: see above Right IJ central venous catheter with tip in the superior vena cava.ET tube located 3 cm above the level of carina.Cardiomediastinal silhouette is unremarkable.Mild edema. Central opacity in the left lung. No pleural effusions or pneumothorax.

Output: Devices as noted above. Central opacity in the left lung, consistent with pneumonia or aspiration; consider further evaluation with PA and lateral radiograph for confirmation as this may be artifactual. Mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p MVR History: chest tube removal Right chest tubes removed with loculated pleural fluid but no reliable evidence of pneumothorax.Bilateral atelectasis is unchanged.Right jugular catheters been removed.

Output: Chest tube removal, without reliable evidence of a pneumothorax although there is atelectasis and pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: VQ scan History: sob Moderate emphysema noted.Streaky basilar opacities could be in part fibrosis with superimposed atelectasis.Heart size normal, the aorta tortuous.

Output: Emphysema, and basilar opacities which could be the result of aspirated secretions or mucous plugging, although right basilar infection is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Evaluate ETT, lung fields History: s/p AVR Endotracheal tube tip has been advanced, 2 cm above the carina.Interval placement of left sided chest tube, with its tip directed toward the left apex.Transesophageal ultrasound probe has been removed.Right internal jugular approach pulmonary artery catheter and sheath, with the tip of the catheter in the main pulmonary artery.Median sternotomy wires and hardware. Mediastinal drains. Epicardial pacer wires and mediastinal clips.The heart size is normal. Interval decrease in left lower lobe subsegmental atelectasis, with streaky retrocardiac opacities remaining. The right lung is clear. No large pleural effusion.

Output: Interval placement of left chest tube with decreased lucency overlying the left lung base.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: eval for infiltrate History: fever, SOB The cardiac mediastinal silhouette is unremarkable.Multiple bilateral pulmonary nodules similar to the prior exam.No new focal airspace consolidation.No pleural effusions.

Output: Diffuse pulmonary metastatic disease without significant interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: pre kidney transplant evaluation, r/o infiltrate, r/o cardiomegaly History: pre kidney transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Cough. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Tracheostomy status. S.O.B. and tachypnea. Tracheostomy tube tip at the level of the clavicular heads. The remainder of the cardiopulmonary monitoring and support devices are similar in position. Moderate layering pleural fluid collections, right greater than left, about the same. Dependent basal atelectasis. No pneumothorax.

Output: No acute change in the pleural effusions or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: nausea History: nausea 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: Age: 78 yearsGender: FemaleReason for Study: Reason: r/o pneumonic process History: Persistant leukocytosis A persistent small right apical pneumothorax.Stable cardiomediastinal silhouette.Small bilateral pleural effusions and left retrocardiac consolidation/atelectasis similar to the prior exam.Median sternotomy is intact.

Output: Small persistent right apical pneumothorax. Bilateral pleural effusions and left retrocardiac consolidation/atelectasis unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Weakness rule out infection. Right upper quadrant surgical clips related to prior right nephrectomy. Costophrenic angle blunting bilaterally consistent with small pleural effusions and diaphragmatic flattening.Heart size is at least upper normal.No specific signs of pulmonary edema.Numerous tiny subsolid nodular opacities bilaterally, probably present previously, some of which correlates to the numerous subcentimeter calcified and noncalcified nodular densities seen on CT of the lung bases from 2009, of indeterminate etiology but probably chronic.Degenerative changes spine mild thoracic kyphosis, osteopenia and multilevel vertebral body height loss.

Output: Small pleural effusions with innumerable noncalcified pulmonary micronodules of indeterminate etiology, some of which are chronic. Differential considerations include granulomatous disease, smoking related lung disease, or metastases. If the referring clinical service can obtain and submit more recent outside prior studies to prove stability, an addendum to this report can be provided. Otherwise, suggest thoracic CT. ED notified via stat consult webpage dialogue.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Evaluate left-sided chest tubes. Pleural effusion. Interval removal of a left-sided chest tube. The remaining left chest tubes are unchanged in position. No pneumothorax. Low lung volumes. Pleural thickening and possibly loculated fluid on the left unchanged. Bilateral dependent basal consolidation, suspicious for pneumonia.

Output: No pneumothorax post chest tube removal. Persistent basal consolidation suspicious for infection. Pleural thickening on the left nonspecific and could be the result of current or prior infection in the pleural space.


Instruction: Generate impression based on medical findings.

Input: Chest tube check Unchanged right chest tube projected towards the apex with an underlying loculated pneumothorax and postsurgical changes. Extensive chest wall and neck emphysema is observed bilaterally also similarLeft lung appears grossly clearCardiac imaged on contours are roughly within limits

Output: Right chest tube unchanged with loculated pneumothorax and extensive subcutaneous /overlying intramuscular emphysema


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: cp, eval for pna, edema, effusion, widened mediastinum History: cp Sternotomy sutures are noted. The upper mediastinum that is widened, compatible with patient's known dissection. There is left basilar subsegmental atelectasis and elevation of the left hemidiaphragm. No focal pulmonary opacity suspicious for infection.

Output: Left basilar subsegmental atelectasis and chronic elevation of the hemidiaphragm.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: check ett placement History: check ett placement Mild basilar atelectasis left greater than right, and small pleural effusions.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 5 cm above the carina. Mild basilar atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: effusions History: no Persistent bilateral pleural effusions. Support hardware unchanged.

Output: Persistent bilateral pleural effusions


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: sp cabg mvr vad History: vad Right IJ Swan-Ganz and chest/mediastinal tubes have been removed.Right IJ introducer in place.Stable cardiac enlargement with basilar/perihilar opacities compatible with pleural effusions, edema, and atelectasis.

Output: Interval removal of Swan-Ganz catheter and chest/mediastinal tubes. Persistent cardiomegaly, pulmonary edema, basilar atelectasis, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.History: Atrial fibrillation, CAD, hypertrophic cardiomyopathy, CHF. Symptoms: Rapid ventricular response, hypoxemia. Redemonstrated cardiomegaly with patchy airspace opacities and a moderate right pleural effusion, with no significant interval change.Defibrillator pad over right anterior chest wall.ET tube with tip 4 cm above the carina.Two right central catheters with tips at the confluence of the right internal jugular vein and right brachiocephalic vein.Midline mediastinal drain.No pneumothorax.

Output: No significant interval change in patchy airspace opacities and moderate right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Neutropenic fever. Leukemia. Lungs are clear. Left PICC line tip again left of midline in the left brachiocephalic vessels. No pneumothorax.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: Chest pain, cough eval for PNA History: Chest pain, cough eval for PNA Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 73 years old Male. Reason: evaluate for pneumonia, pulmonary edema History: altered mental status, aphasia. There is a questionable patchy opacity in the retrocardiac area at paraspinal region in the left lower lobe. The cardiac silhouette is normal. Linear densities are seen in the lower lungs, which are consistent with atelectasis. There is no evidence of pneumothorax.

Output: Questionable patchy opacity in the left lower lobe at retrocardiac area. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: S/P LVAD. Eval for pleural effusion History: Repeat CXR to eval for pleural effusion Right-sided ICD and LVAD device unchanged.Lung volumes are decreased.The loculated left pleural effusion with adjacent atelectasis appears unchanged.There is no change in the subsegmental atelectasis on the right side. There is possible right-sided effusion.

Output: No significant interval change in the cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 22 year old male with history of Stage 3 Melanoma status post interferon therapy. Please evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Several subcentimeter pulmonary nodules noted throughout right lung. These are unchanged from prior study in 2009.MEDIASTINUM AND HILA: Small amount of thymic tissue noted in anterior mediastinum. No other significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered, subcentimeter, mesenteric lymph nodes again identified. These appear unchanged when compared to prior study.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: Tiny sclerotic focus in posterior aspect of right acetabulum likely represents benign bone island. Stable when compared to prior study.OTHER: No significant abnormality noted

Output: Unremarkable exam.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with hereditary paraganglioma syndrome with history of early onset RCC (papillary type) NECK: No abnormality notedCHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Postsurgical changes in the right shoulderABDOMEN:LIVER, BILIARY TRACT: Unchanged subcentimeter T2 hyperintense cystic lesions in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post right adrenalectomy.KIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination without findings to suggest malignancy.


Instruction: Generate impression based on medical findings.

Input: 86 year old male patient with thyroid cancer status post surgery, positive uptake in nodes and left lung. Question of areas of uptake after therapy. There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. There are two foci of iodine avid tissue within the lower neck. There is are two foci of uptake within the left perihilar region. A focus of uptake in the right lower leg is non-specific.

Output: Functioning thyroid tissue within the lower neck and left perihilar region.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: pna/effusion History: cancer, hypoxia, hemoptysis Diffuse known thyroid metastases possibly progressed although comparison is difficult between radiograph and CT.No specific evidence of infection or edema.Mild cardiomegaly.

Output: Diffuse thyroid metastases, probably progressed.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p LVAD History: above Aortic balloon catheter marker 7 cm from the top of the aortic arch.ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter in the right descending pulmonary artery.Other devices including LVAD, unchanged.Mild retrocardiac left lower lobe atelectasis, unchanged.

Output: Balloon catheter located slightly more distally in the descending aorta and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Shortness of breath, subjective fevers Moderate cardiomegaly.No pneumothorax or large pleural effusion.Nonspecific patchy basilar predominant airspace opacities.

Output: Nonspecific patchy basilar predominant airspace opacities may represent edema or atelectasis. Underlying infection cannot be entirely excluded without follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: postop resp failure History: intubated ET tube tip approximately 4 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Impella device with its tip in the left ventricle.Interval removal of aortic balloon catheter.Bilateral opacity compatible with pleural effusions, atelectasis and edema.

Output: New Impella device with its tip in the apex of the left ventricle.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Surgery greater than eight hours triggering of RFO. Status post median sternotomy with multiple chest tubes and no pneumothorax.Moderate right pleural effusion and smaller left, with basilar atelectasis postop.No significant pneumothorax.ET tube tip approximately 4 cm above the carina.Status post mitral valve replacement.Right jugular Swan-Ganz catheter tip in right ventricular outflow tract.Second right jugular introducer, tip in right brachiocephalic vein.

Output: No significant pneumothorax. No retained instruments. Findings were discussed by the radiology resident on call with Dr. Balkhy at 10:51 PM 3/23/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: CHF History: CHF Cardiac size mildly enlarged.Prominence of central pulmonary arteries.No definite evidence of pleural effusions.No pneumothorax or other focal opacities.

Output: Cardiac enlargement without evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: dyspnea History: dyspnea, hx copd, esrd Sternotomy wires remain well aligned.Stable cardiomegaly. Mild vascular redistribution without edema. Questionable small pleural effusions. No pneumothorax.

Output: No evidence of edema. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: on ventilator ET tube tip approximately 1.5 cm above the carina.Bilateral pleural effusions and underlying nonspecific pulmonary opacities, slightly improved in the right lung.Pleural catheter at the left base, unchanged.

Output: Slightly low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Development of pulmonary infiltrates, on ventilation History: on mechanical ventilator Right pleural effusion and lung opacities are unchanged. Stable line position.

Output: No change in effusions and lung opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: s/p TECAB History: s/p TECAB Right IJ introducer and left sided chest tube removed.The cardiac mediastinal silhouette is unremarkable.Small pleural effusions and basilar atelectasis.

Output: Interval removal left-sided chest tube. No evidence of a pneumothorax. Persistent small pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval placement of R IJ trialysis History: central line placement Right jugular central venous catheter terminates in the SVC. Other support devices are unchanged, including a right PICC terminating in the right axillary vein. Left pleural effusion with left greater than right diffuse patchy airspace opacities.

Output: Left pleural effusion with left greater than right with worsening diffuse patchy airspace opacities. Right central venous catheter terminates in the SVC.


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with cough and chills. Evaluate for pneumonia. Nonspecific bilateral hilar fullness/opacity may be due to enlarged central pulmonary arteries or lymphadenopathy. Early edema or infection are also considerations.

Output: Nonspecific bilateral hilar fullness/opacity may be due to enlarged central pulmonary arteries or lymphadenopathy. Early edema or infection are also considerations.


Instruction: Generate impression based on medical findings.

Input: 20 year-old male with AMI, TTP, invasive aspergillosis now febrile increased hypoxia. Evaluate for other sources of fungal infection, sinuses, lungs. CHEST:LUNGS AND PLEURA: Large bilateral pleural effusions with underlying atelectasis or consolidation at the bases. Patchy irregular spiculated areas of consolidation in both upper lobes primarily on the right.. The pattern would be consistent with fungal infection.MEDIASTINUM AND HILA: ET tube. NG tube. Central lines.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites.BONES, SOFT TISSUES: Marked generalized anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted

Output: Anasarca. Bilateral pleural effusions with extensive basilar consolidation or atelectasis. Patchy airspace disease consistent with history of fungal infection. No obvious other source of fungal infection. Minimal amount of ascites.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Chest pain evaluate lung fields. Surgical clips project over the right chest wall.Normal heart size.No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: DAH hypoxia. Sarcoidosis. Diffuse airspace opacities superimposed upon emphysema without significant change. Upper hilar retraction and architectural distortion consistent with history of sarcoidosis. There is a small left apical cavity with adjacent suture material. No visible internal filling defects.

Output: No acute change in diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: evaluation of IABP History: post op cardiac patient Cardiomegaly without acute edema.IABP catheter proximal marker 3 cm below the top of the aortic arch.Left subclavian ICD, leads unchanged in position.Right jugular Swan-Ganz catheter, tip still peripherally in the right interlobar pulmonary artery.Right PICC, tip in axillary region.

Output: Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval for rib fx History: R sided chest wall pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of a displaced refracture.No significant pneumothorax. .

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Multiple myeloma, evaluate for pneumonia. Cough. Right chest port tip in the cranial aspect of the right atrium. Normal heart size. Low lung volumes. Faint patchy airspace opacity with atelectasis in the lung bases.Skeletal stigmata of multiple myeloma.

Output: No new pulmonary opacities. Basal abnormalities are nonspecific, possibly related to aspiration, and can be followed by PA and lateral chest radiographs if the patient remains symptomatic.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: swan iabp History: swan iabp Cardiomegaly and mild edema unchanged.IABP catheter tip 2 cm below the top of the aortic arch. Right jugular Swan-Ganz catheter, tip in left descending pulmonary artery.Right subclavian ICD unchanged in position.

Output: IABP tip 2 cm below the top of the aortic arch. Stable mild edema and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: eval pna History: sob Status post valve replacement and pulmonary artery stenting for correction of a tetralogy of fallot.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.

Output: Correction of known congenital heart disease, with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: please assess chest tube placement History: SOB Left basilar chest tube remains in place. Improvement in left basilar pneumothorax with no substantial change in left basilar pleural fluid, at least partially loculated. Increase in right pleural effusion with increased right basilar opacity. Unchanged heart size.

Output: Left basilar chest tube remains in place. Improvement in left basilar pneumothorax with no substantial change in left basilar pleural fluid, at least partially loculated. Increase in right pleural effusion with increased right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: evaluate lung fields s/p heart transplant History: intubated s/p heart transplant Median sternotomy with chest tubes and a small left apical pneumothorax, improved.Postoperative pneumomediastinum and pneumopericardium diminished.Stable basilar opacities and pleural effusions.ET tube tip about 8 cm above the carina.IABP proximal marker about 4 cm below the top of the aortic arch.Right jugular Swan-Ganz catheter tip in pulmonary outflow tract.

Output: Improvement in left apical pneumothorax and pneumomediastinum. Unchanged support devices in basilar opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: PICC line placement New left PICC line placed with tip projected into the mid subclavian vein. No additional cardiopulmonary changes or new abnormality

Output: Left PICC line placed


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Hypoxemia and decreased breast sounds left side evaluate for abnormalities. Left hemithorax volume loss with nodular pleural thickening/fluid and coarse interstitial abnormality, about the same.Left upper lobe paramediastinal opacity unchanged.Signs of emphysema on the right, but no acute abnormality.A drain projects over the subpulmonic pleural space on the left. No pneumothorax.

Output: No acute change in pleural or parenchymal findings in the left lung consistent with known neoplasm.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Bilateral lung transplant, tracheostomy status. Left jugular catheters and tracheostomy tube unchanged in position lung volumes remain low. Small to moderate bilateral pleural effusions and associated atelectasis about the same. No new findings.

Output: No acute change in pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Pneumonia, cardiomegaly, effusion. Generalized weakness, AMS, confusion. No focal airspace opacities, pleural fluid or pneumothorax. Normal heart size. Scarring at the right base unchanged.

Output: No signs of pneumonia or pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval ETT, eval for PNA History: intubated, leukocytosis Left basilar subsegmental atelectasis over an elevated left hemidiaphragm, unchanged.No specific evidence of infection or edema.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Left jugular catheter tip at cavoatrial junction level.

Output: Unchanged left base subsegmental atelectasis but no evidence of pneumonia. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: chronic cough, RA - eval for etiology History: as above Stable mild cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Stable mild cardiac enlargement without acute abnormalities. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval for infection History: hypotension, concern for sepsis in neutropenic pt Dual-lumen right-sided port with catheter terminating in the midsuperior vena cava. Heart size is normal.Multiple posterior left rib deformities compatible with callus from prior fractures. No evidence of infection. The pleural spaces are clear.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with esophageal cancer. CHEST:LUNGS AND PLEURA: Multiple micronodules are unchanged. No new suspicious nodules or masses. No focal consolidation, edema or pleural effusion. Questionable paramediastinal fibrosis may reflect prior radiation therapy.MEDIASTINUM AND HILA: The esophagus is air filled throughout its course with marked wall thickening inferiorly (axial image 68/141). No significant interval change has occurred.Small, focal outpouching of the right posterior lateral trachea (axial image 33/141) may represent a diverticulum or a form fruste tracheal bronchus.Left peritracheal lymphoid tissue is unchanged in size (axial image 19/141).Cardiac size is normal with no pericardial effusion. Evidence of mitral valve replacement. Left atrial appendage-associated abnormality as noted on the prior exam is of uncertain etiology but has not changed in the interval.CHEST WALL: Evidence of prior, healed median sternotomy. Degenerative changes affect the spine.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions within the liver. The largest lesion measures 2.3 cm on axial image 112/141 and has increased from 1.8 cm on the prior exam.Multiple calcified gallstones noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cystic lesions unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: A gastrohepatic lymph node has increased in size and measures 10 x 14 mm on axial image 90/141 (measured 7 x 9 mm previously).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted

Output: 1.Stable thickening of the esophageal wall compatible with history of esophageal cancer.2.Stable micronodules with no evidence of disease progression in the chest.3.Interval progression of a hepatic lesion as well as enlargement of a gastrohepatic lymph node suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 64 years, Male. Reason: DHT placement? History: DHT in place Enteric tube tip is coiled in the proximal gastric body. Right iliac catheter is in place. Prominent loops of bowel are seen in the right lower quadrant likely representing a mild focal ileus.

Output: 1.Dobbhoff tube coiled in the proximal half of the gastric body.2.Mild focal ileus in the right lower quadrant.


Instruction: Generate impression based on medical findings.

Input: Female; 35 years old. Reason: 35 F s/p PICC line placement History: s/p PICC line placement Right PICC tip in SVC.Mild to moderate bibasilar opacities, right greater than left, compatible with effusions with underlying atelectasis as seen on preceding CT abdomen. Normal heart size.

Output: Right PICC tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: cardiomegaly, effusion History: new onset afib No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: intubated at OSH, Check ET tube and pneumonia History: ET TUbe, also report of inhaled tooth in lungs No change in pulmonary opacities but enlargement of pleural effusions.Radiodense object at the carina consistent with history of inhaled tooth.ET tube tip approximately 3 cm above the carina.Left jugular catheter, tip in SVC.Right jugular catheter tip at right atrial level.An NG tube extends below the lower margin of the image.

Output: Radiodense object at the carina consistent with the history of an inhaled tooth. Pleural effusions and basilar opacities. ET tube tip approximately 3 cm above the carina. This was discussed with Dr. Kress who was aware of the findings.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: pna History: sepsis, unknown etiology, right upper quadrant/flank pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Cough, evaluate for infiltrate or edema. Normal heart size. Eventration of the right hemidiaphragm. Partially circumscribed retrocardiac nodular density of about 2.5 cm in size of unclear etiology etiology, possibly variant pulmonary vein anatomy with a large common ostium or tortuosity of the aorta seen on-end, though the finding is nonspecific by plain film.No focal airspace opacity or pneumothorax. Mild bronchial wall thickening and atelectasis posterior lungs.

Output: No evidence of edema and no specific signs of pneumonia. Mild basal atelectasis. Nodular retrocardiac opacity is nonspecific by plain film but is most likely a variant of normal anatomy. Follow-up PA and lateral chest radiographs are suggested in 2-3 months.


Instruction: Generate impression based on medical findings.

Input: ECMO for diaphragmatic hernia.VIEW: Chest AP (one view) 04/07/15, 0815 Endotracheal tube tip is above the thoracic inlet. Feeding tube tip is in stomach with side port in lower esophagus. ECMO cannulas remain in place. Right chest tube is again seen. Umbilical venous line tip is at level of hepatic vein/IVC. Umbilical arterial line tip is at T10.Soft tissue edema persists.Decreased opacity is seen in the right hemithorax periphery, laterally and inferiorly.. Left hemithorax is almost completely tubular lucencies are noted just left of midline, this is most likely air in bowel. Mediastinum is slightly shifted to right.

Output: Some aeration of right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Urothelial cancer with cough and dyspnea. Low lung volumes. Normal heart size. No pleural fluid or pneumothorax. No focal airspace opacity. Degenerative changes of the spine.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: chest pain History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for causes of hypoxia History: new hypoxia Port catheter with its tip in the SVC.Mild thickening of the minor fissure, new from previous, may reflect interstitial edema.No other significant findings.

Output: Possible mild interstitial edema. Erect radiographs are recommended when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: desaturation History: desaturation Right port unchanged.Large hiatal hernia with no change in chronic basal interstitial abnormality.

Output: Large hiatal hernia with no change in chronic basal interstitial abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain in SCD History: ? acute chest New right upper lobe focal airspace opacity, suggestive of pneumonia.PICC line tip in the SVC.Moderate cardiomegaly and chronic skeletal abnormalities consistent with sickle cell disease.

Output: Right upper lobe airspace opacity compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with metastatic renal cell carcinoma on treatment holiday status post Nexavar toxicity CHEST:LUNGS AND PLEURA: No gross change in the innumerable, bilateral pulmonary metastases. The reference nodule in the right middle lobe measures 8 x 6 mm (series 4; image 70) and the left lower lobe reference nodule measures 10 x 10 mm (series 4; image 94), unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Lytic lesion in the scapula on the left was not included on the prior study, precluding evaluation of chronicity.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic hypodensities are unchanged from 2005, compatible with cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. The two soft tissue nodules in the nephrectomy bed are unchanged, the larger measuring 2.1 x 1.2 cm (series 3; image 133).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion in L3, unchanged.OTHER: The infrarenal abdominal aorta 2.5 centimeters in greatest transverse dimension, unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/p intubation History: s/p intubation Endotracheal tube terminates 4 cm above the carina. Nasogastric tube has been placed which terminates inferior to the caudal margin of the image.Persistent mid to lower zone opacities, decreased on the left. Moderate layering pleural effusions. No interval pneumothorax.

Output: Diffuse bilateral pulmonary opacities compatible with edema. Moderate pleural effusions with improved aeration of the left lung.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: metastatic thymic cancer, Left-sided hydropneumothorax, History: none Left chest tube removed, with a residual left effusion partially located in the fissure.Small right pleural effusion.

Output: Left chest tube removed with no pneumothorax. Residual left pleural effusion partially located or loculated in the fissure. Small right pleural effusion may be new.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval for acute cardiopulm abnormality History: SOB Increased cardiomegaly and/or pericardial fluid accumulation.Very small right pleural effusion but no other evidence of edema.Right jugular catheter tip in SVC.

Output: Worsening cardiomegaly and a new small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval for infiltrate History: COPD exacerbation Right hilar fullness, likely related to low lung volumes. No new focal lung consolidation. No large pleural effusion or pneumothorax. Question mild cardiomegaly.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Hypoxemia. Cardiac size upper limit of normal. Nonspecific opacities in the posterior bilateral lower lobes could represent atelectasis or infection. Moderate left greater than right pleural effusions are new compared to prior examination. Retrocardiac opacity nonspecific. Patchy areas of subsegmental atelectasis.

Output: 1.New moderate bilateral pleural effusions.2.Nonspecific opacities in the posterior lower lobes bilaterally could represent atelectasis or infection.3.Enlarging cardiothoracic ratio raises question of pericardial fluid/uremic pericarditis.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated History: Intubated ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.NG tube tip in the stomach with the sidehole at the GE junction.Small lung volumes with nonspecific basilar opacity compatible with atelectasis and consolidation.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: s/p trach History: see eval A tracheostomy tube has been placed with its tip 6 cm above the carina.Left-sided pacemaker unchanged.Stable cardiomediastinal silhouette.Continued improved aeration of left lung.

Output: Interval placement of a tracheostomy. Continued improved aeration of the left lung.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: PNA History: SOB The heart is normal in size. Tortuosity of the thoracic aorta.Increased lung volumes and mild flattening of both hemidiaphragms, as may be seen in the setting of COPD. Discoid atelectasis in the medial segment of the right middle lobe adjacent to prominent epicardial fat pad again noted. There are no radiographic findings to suggest pneumonia.The pleural spaces are within normal limits.Mild degenerative changes of the thoracic spine.

Output: No radiographic findings to suggest pneumonia.Increased lung volumes, as may be seen in the setting of COPD. Correlate with patient's history.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: eval ptx History: s/p L thoracentesis Marked interval reduction in the large left pleural effusion postthoracentesis.No pneumothorax identified.Persistent left basilar consolidation/atelectasis.Diffuse interstitial opacities suggestive of edema improved from the prior exam.

Output: Significant interval reduction in the large left pleural effusion postthoracentesis. No pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: 54 years old Female. Reason: Evaluate for effusion or pneumonia. History: new oxygen requirement. There is a mild cardiomegaly. There is no evidence of acute infiltrate. There are questionable bilateral small pleural effusions.

Output: Small bilateral pleural effusions and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: Tachypnea History: Tachypnea Mild basilar interstitial opacities suggestive of edema.Mild/moderate cardiomegaly.

Output: CHF with edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Status post gunshot wound to the back. Metallic fragments project over the left posterior chest wall at the level of T6-T7, compatible with history of gunshot wound. There is no evidence of a rib fracture or pneumothorax. The cardiac size is upper limit of normal.

Output: Bullet fragments project over the left posterior chest wall without evidence of rib fracture or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Preoperative evaluation for malignant neoplasm of connective/soft tissue of lower limb. Normal heart size. Patchy airspace opacities at the medial right lung base with blunting of the adjacent cardiophrenic angle chronic opacity in the right upper lobe and presumably represent scarring.

Output: Airspace opacities at the right lung base suspicious for aspiration or infection; follow-up with serial chest radiographs to complete resolution is suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: ETT History: same Lines and tubes are unchanged with side port of the enteric tube at the gastroesophageal junction. Low lung volumes. Probably mild pulmonary edema. No focal lung consolidation. Patchy right basilar opacity with right pleural effusion. Unchanged heart size. No pneumothorax.

Output: Probable mild pulmonary edema without focal lung consolidation. Patchy right basilar opacity with right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.With increasing oxygen requirements and diminished breath sounds in the bases. Please rule out edema, infection, and atelectasis. Redemonstration of small bilateral pleural effusions with bibasilar atelectasis. No focal lung consolidation to indicate pneumonia. No pneumothorax.

Output: Left basilar atelectasis but no new opacity to suggest pneumonia or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: pna? History: cough, tachycardia The cardiomediastinal silhouette normal. There are no pulmonary or pleural abnormalities.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: Dyspnea, chest pain - Assess for volume overload vs pneumonia History: Chest pain, dyspnea Unchanged mild cardiomegaly and vascular stent.Interval development of nonspecific left lower lobe atelectasis/consolidation,No specific evidence of pulmonary edema.

Output: New left lower lobe opacity, which may represent infection in the appropriate clinical setting. No specific evidence of failure.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Status post clamping of chest tube evaluate for pneumothorax progression. 4 mm right apical pneumothorax. Right chest tube unchanged in position. No pleural fluid. The lungs are clear.

Output: 4 mm right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with mass in the colonic hepatic flexure with numerous liver lesions and a small right lower lobe pulmonary nodule CHEST:LUNGS AND PLEURA: Bilateral moderate sized pleural effusions. Emphysema. 1.5 x 1.6 cm right lower lobe nodule. Dependent bilateral atelectasis.MEDIASTINUM AND HILA: Right bronchopulmonary adenopathy measuring 2.5 x 1.2 cm in diameter image number 55, series number 3. Additional paracardiac adenopathy is also present.CHEST WALL: True fluid attenuation lesions with rim enhancement in the superior posterior chest wall, best seen on image number two, series number 3. Larger one measures 3 x 2.3 cm.ABDOMEN:LIVER, BILIARY TRACT: Extensive bilobar metastatic disease. Large left lobe lesion measures 11.4 by 8.3 cm on image number 91, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse nodularity of the peritoneum is consistent with peritoneal carcinomatosis. Small amount of air containing ascites is present. Air is likely secondary to presence of a right lower quadrant percutaneous drainage catheter.Large pancreatic adenopathy measuring 4.5 by 3.3-cm image number one on the ankle series number 3. Patient's known hepatic flexure mass is not well visualized due to poor opacification of the right sided colon but is likely best seen on image number 139, series number 3. There multiple enlarged mesenteric nodes in that location in the ascending mesocolon on image number 146, series number 3, measuring 3.3 x 2.9 cm.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: Moderate amount of ascites.

Output: Extensive hepatic metastases. Right lower lobe nodule suspicious for metastatic disease. Posterior mediastinal and paracardiac likely metastatic adenopathy.Peritoneal carcinomatosis, retroperitoneal and mesenteric adenopathy.Air within the ascites is likely secondary to the right lower quadrant percutaneous drainage catheter.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cardiac surgery History: s/p cardiac surgery ET tube tip approximately 3 cm above the carina. Swan-Ganz catheter tip in the right main pulmonary artery.Chest tubes and ECMO cannulae in place, unchanged.Nonspecific pulmonary opacity compatible with edema and atelectasis with a layered out right effusion and smaller left effusion.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Heart lung transplant 2002 annual check. Cough. Severe cystic lung disease with possible superimposed bronchiectasis. Large apical bullae. Hazy opacity in the medial and inferolateral aspects of the left upper lobe bullae most likely represents pleural calcification, unchanged. Cardiomediastinal silhouette with postsurgical changes similar in appearance. No pleural fluid.Intrapleural calcification along the left major fissure. Reticular opacities could reflect chronic bronchiolitis however is beyond the resolution of plain film for accurate characterization.

Output: No significant change in chronic abnormalities suggestive of bronchiolitis, bronchiectasis and cystic lung disease.


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary evaluate

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.History of chest pain in the right side, rule out pneumonia or pneumothorax. Interval removal of the left central venous catheter and chest wall drain with placement of a right central venous catheter with the tip terminating near the cavoatrial junction. Interval improvement of right lower lobe atelectasis and right pleural effusion is decreased in size. There is improved aeration in the left lower lobe with a stable pleural effusion. No pneumothorax. Postsurgical staples overly the chest. Partially imaged cervical hardware appears unchanged.

Output: Interval resolution of pulmonary edema with improvement in right lower lobe atelectasis. Small right pleural effusion. Moderate left pleural effusion is stable in size with some improvement in aeration at the left base.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: night sweats, r/o lymphadenopathy, infection 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: Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant Normal heart size with a moderately tortuous aorta.Right jugular catheter tip at the SVC/RA junction.No significant pulmonary disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: hx nsclc with new cough and fever ro pneumonia History: hx nsclc with new cough and fever ro pneumonia Reticulonodular opacities within the right mid and lower lung with more defined pulmonary nodules appears mildly progressed from the prior CT. No focal lung opacity on the left. Moderate right pleural effusion. No pneumothorax. Heart size is normal.

Output: Mildly progressed right lung nodular opacities with a moderate right pleural effusion could represent progression of tumor and/or superimposed infection. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.New subclavian line placement. Left subclavian central line tip at the superior cavoatrial junction. Swan-Ganz catheter is been removed. Left peripheral catheter terminates in the projection of the lateral aspect of the left subclavian vein.Patchy groundglass opacities and consolidation bilaterally about the same. LVAD, valve prostheses and sternal hardware similar to prior.

Output: Left subclavian central line tip at the superior cavoatrial junction, no pneumothorax. Extensive pulmonary opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Fluid overload. Replacement of the Dobbhoff with nasogastric tube; distal tip and side hole in the epigastrium. The cardiomediastinal silhouette is within normal limits in size. Multifocal patchy alveolar opacities are again seen throughout both lungs. Left PICC unchanged in position. Apparent interval improvement disease at left base; however, this may reflect differences in exposure.

Output: Apparent interval improvement disease at left base; however, this may reflect differences in exposure. Replacement of Dobbhoff tube with nasogastric tube.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: intubated History: intubated Bilateral pleural effusions with basilar consolidation, not significantly changed.ET tube tip approximately 2 cm above the carina.An NG tube terminates in the stomach. Left subclavian catheter, tip in SVC.Right PICC, tip at cavoatrial junction.

Output: ET tube tip approximately 2 cm above the carina. Stable pleural effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: SOB, increased WOB History: SOB, increased WOB Cardiomediastinal silhouette size is at the upper limits of normal.Perihilar interstitial opacities with septal lines and small pleural effusions. No pneumothorax.

Output: Moderate acute 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: 65-year-old female with rectal cancer and lung metastasis. CHEST:LUNGS AND PLEURA: Interval increase in the size and number of bilateral numerous lung nodules consistent with metastatic disease. Fat referenced nodule in the right lower lobe measures 10 by 8mm on image number 40, series number 3. It was previously measuring 7 x 5 mm image number 24, series number two.MEDIASTINUM AND HILA: Ill-defined left paratracheal soft tissue density increased in size and now measures 2.6 x 1.7 cm in image number 20, series number 3. Previously it was measuring 2 x 1.4 cm on image number 12, series number two.Left hilar soft tissue density is also slightly increased in size. Prevascular lymph node is also slightly enlarged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter lesion in the left lobe of the liver likely representing a small cyst is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ostomy.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: Status post rectal surgery. Postsurgical changes in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size and number of the lung nodules.Interval increase in the size of the left paratracheal infiltrative soft tissue density and left hilar adenopathy


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: Weakness, chest pain concern for dissection. The cardiomediastinal silhouette is normal. No focal opacity, pleural effusion or pneumothorax.

Output: No abnormal radiographic findings considering the limitations of plain radiograph for detecting aortic dissection. If there is persistent clinical concern for aortic dissection a chest CTA should be obtained.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: routine CXR for CT ICU post-op patient History: routine CXR for CT ICU post-op patient Median sternotomy with left hemithorax volume loss, cardiomegaly and edema.Stable left lower lobe consolidation.Multiple support devices unchanged including circulatory assist catheters and a left subclavian ICD.

Output: No change in pulmonary opacities and cardiomegaly. Stable support devices.]


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: r/o pneumonia History: fever chills cough SOB Right hilar fullness, likely artifactual in nature. No focal lung consolidation. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: preexisting line please check positioning History: preexisting line Unchanged right midlung scarlike opacity status post resection.Elsewhere, the lungs are unremarkable.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: mitral valve repair History: mitral valve repair Chest tubes no pneumothorax postop, but new basilar atelectasis.ET tube tip approximately 4 cm above the carina.Two right jugular catheters terminate in the right innominate vein region.

Output: Postop basilar atelectasis, but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for infiltrate History: chest pain and productive cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: infiltrate, acute chest History: sickle cell, history of acute chest, with cough and mild SOB Cardiac silhouette is again enlarged.Low lung volumes with chronic vascular and interstitial prominence remain unchanged. No focal consolidation, sizable effusion or pneumothorax.

Output: Stable stigmata of sickle cell disease. No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Status post device. Presternal ICD in expected position. No pneumothorax or focal pulmonary opacity. Sternotomy wires. Right peripheral catheter has been removed in the interim.

Output: Interval placement of presternal ICD without pneumothorax or acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Patient presented with altered mental status, evaluate for pneumonia or edema. Cardiomediastinal silhouette is unremarkable. Tortuous aorta is again identified. No focal airspace opacity, pleural effusion, or pneumothorax.Epigastric surgical clips and IVC filter are again noted. The lesion with rim of calcification in the right upper quadrant is again identified and is unchanged, better visualized on recent CT abdomen and pelvis. Multiple foci of high density in the left upper quadrant likely suggest barium collection in the diverticula, better visualized on the recent CT abdomen and pelvis.

Output: No acute cardiopulmonary abnormalities with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old. History of GERD, ILD with worsening SOB. Mild bibasilar interstitial opacities consistent with chronic interstitial lung disease/fibrosis, as seen on prior CT, unchanged. No new focal pulmonary opacity. No pleural effusion. No evidence of infection or edema.Stable cardiomediastinal silhouette.

Output: Mild basilar opacities consistent with interstitial lung disease, not significantly changed. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reevaluate position of ETT. ETT is been slightly retracted but remains low in position, less than 1 cm above the level of the carina.Right jugular catheter and visualized portion of the Dobbhoff tube unchanged. There is an additional large caliber catheter projecting over the midline upper abdomen.Low lung volumes with coarse interstitial opacities bilaterally unchanged.

Output: ETT remains low, suggest repositioning.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female status post tracheostomy. Evaluate. Interval removal of the endotracheal tube. Interval removal of right-sided central venous catheter. Interval placement of tracheostomy tube with tip immediately below the thoracic inlet. Left central venous catheter with tip at the confluence of the brachiocephalic veins. Enteric tube with tip beyond the field of imaging.There has been interval improvement of bilateral basilar opacities compatible with improving pleural effusions. Persistent patchy multifocal opacities and retrocardiac opacity.

Output: 1.Improving bilateral basilar opacities compatible with improving pleural effusions. 2.Persistent patchy and retrocardiac opacities.3.Tracheostomy tip immediately below thoracic inlet.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.History of congestive heart failure with dyspnea and chest pain, evaluate for fluid overload. Stable cardiomegaly.Basilar opacities and left pleural effusion similar to prior.There is no pneumothorax.

Output: Cardiomegaly with persistent basilar opacities and left pleural effusion compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Female; 69 years old. Reason: 69 y/o woman with cardiomyopathy s/p new BI-V ICD placement History: Syncope, palpitations New left ICD/pacemaker with leads in the expected locations of the right atrium, right ventricle, and overlying the left ventricle via the coronary sinus. No pneumothorax. Mildly increased streaky right basilar opacity, which may be due to subsegmental atelectasis or aspiration. Stable cardiomediastinal silhouette.

Output: New ICD/pacemaker as above. No pneumothorax. Mildly increased right basilar opacity may be due to subsegmental atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: FemaleReason for Study: Reason: eval lung fields History: s/p heart transplant Right IJ Swan-Ganz and chest/mediastinal tubes unchanged.Stable Carty mediastinal silhouette with basilar opacities compatible with atelectasis/edema similar to the prior exam.No new pulmonary opacities identified.No evidence of pneumothorax.

Output: Support devices unchanged. Stable cardiopulmonary appearance with nonspecific basilar opacities compatible with atelectasis. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: crackles left base, URI symptoms and cough, R/O pneumonia History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male 45 years old Reason: chest congestion, cough Low lung volumes. Tortuous aorta. Cardiac silhouette size is normal. Basilar atelectasis. No pleural effusion or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Intubated with ECMO cannula in place. Endotracheal tube tip 3.5 cm above the level of the carina.Intracardiac portion of the ECMO cannulae not entirely visualized; the proximal cannula projecting over the right jugular vein can be followed to the SVC level and the distal cannula projecting over the level of the tricuspid valve extends inferiorly overlying the IVC, these were previously overlapping.Enteric tube sidehole projects beyond the GE junction, the tip is off the caudal margin of the film.Peripheral catheter from the right can be followed to the subclavian vein level but the tip is not visualized.Complete opacification of the left hemithorax.Extensive consolidation of the right upper lobe and patchy consolidation in the right lung elsewhere with increase in right pleural fluid volume since prior study.

Output: Apparent retraction of the right jugular cannula to the SVC level; a follow-up film is recommended for confirmation of position. Complete opacification of the left hemithorax with increase in pleural fluid on the right.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: patient with history of non CF bronchiectasis with cough and chest pain Extensive severe dominantly lower zone cystic bronchiectasis, not significantly changed.Unremarkable cardiac and mediastinal silhouette. New focal opacity medially in the apical posterior segment of the left upper lobe suggestive of bronchial mucus plugging and distal consolidation. The differential diagnosis includes allergic bronchopulmonary aspergillosis (ABPA).

Output: New left upper lobe dense opacity suggestive of mucoid impaction and focal consolidation. The differential diagnosis includes ABPA.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval for rib fx History: s/p physical assault Flat diaphragms consistent with COPD.No displaced rib fracture, pneumothorax or other significant abnormality.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Headache. NPH. SHUNT DEVICE: Again seen is an intracranial shunt that exits the skull via a right frontal burr hole and courses down the right scalp, neck and anterior chest wall, entering the abdomen and terminating in the right lower quadrant. Portions of the shunt overlying the calvarium are relatively radiolucent and hence difficult to evaluate, but I see no specific radiographic features of shunt complication.SKULL: The previously seen skin staples have been removed.CERVICAL SPINE: No significant abnormality noted.CHEST: The lungs are clear and the cardiomediastinal silhouette appears normal. Orthopedic fixation of the lower thoracic spine appears similar to that seen on the prior study. Mild degenerative disc disease affects the thoracic spine.ABDOMEN: There is a nonobstructive bowel gas pattern. Orthopedic fixation of the lumbosacral spine appears similar to that seen on the prior study. Skin staples have been removed.

Output: VP shunt without radiographic evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: evaluate for pneumonia History: cough x 1 month Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with prostate cancer. End stage renal disease. Evaluate disease status. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Heterogeneous left lobe of the thyroid extending retrosternally. Extensive coronary artery calcifications. Mild cardiomegaly.CHEST WALL: Gynecomastia. Left-sided venous access device is in expected position. There are venous collaterals at the right chest wall. The superior vena cava appears narrowed, probably due to partial occlusion.ABDOMEN:LIVER, BILIARY TRACT: Several hepatic cysts are again noted. The cyst in the left lobe is unchanged. Scattered hepatic calcifications, probably due to old granulomatous disease.SPLEEN: Multiple punctate calcifications, probably due to old granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral thick and nodular adrenal glands, unchanged.KIDNEYS, URETERS: Atrophic kidneys with multiple cysts, unchanged. Changes are compatible with history of end stage renal disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse duodenal wall thickening, especially in the second and third parts, suggests duodenitis. The appendix is diffusely enlarged measuring up to 1.8 cm in diameter seen best on axial images 126 -- 141/204. This appendiceal enlargement was present on the prior examination and appears unchanged.BONES, SOFT TISSUES: Sclerotic lesion in T11 vertebral body is unchanged. Punctate sclerotic focus in the left femoral neck and left ischium are unchanged.OTHER: Nonobstructive umbilical hernia contains nondilated small bowel loops.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder is small and has a thick wall, which may be secondary to radiation therapy or cystitis or chronic disuse.LYMPH NODES: Left inguinal adenopathy measures 3 x 4.2 cm on image number 192 is not significantly changed. Right inguinal adenopathy is larger.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of lumbosacral spine and pelvis.OTHER: Fat-containing inguinal hernias.

Output: Increased bilateral inguinal adenopathy and stable T11 vertebral body lesion.Duodenal wall thickening is new. Enlarged appendix is stable.No other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: New L subclavian central line placement; confirm position History: see above Mild basilar interstitial edema, with basilar atelectasis and pleural effusions.Right jugular catheter, tip in SVC.New left subclavian catheter tip at cavoatrial junction.Status post extubation.An NG tube terminates in the stomach.

Output: Pleural effusions and basilar opacities unchanged. New left subclavian catheter, tip at cavoatrial junction level.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: pneumonia? History: shortness of breath Right pleural effusion and right perihilar mass with right basilar consolidation/atelectasis similar to the prior exam.Stable cardiomediastinal silhouette.Left lung is clear.

Output: Large right pleural effusion and right perihilar mass unchanged. No new pulmonary opacities noted. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female evaluate for right lung empyema and groin abscess CHEST:LUNGS AND PLEURA: Large right sided pleural effusion. Pleural effusion demonstrates loculations. Empyema cannot be excluded. Dependent atelectasis in the right lung base. Superimposed pneumonia cannot be excluded. Linear atelectasis in the right middle lobe and upper lobe.Groundglass opacities in the left lower lobe is nonspecific may represent edema.MEDIASTINUM AND HILA: Cardiomegaly. Multiple borderline enlarged mediastinal lymph nodes. A precarinal enlarged lymph node measures 21 x 11 mm on image number 29, series number 3.CHEST WALL: Right axillary adenopathy measuring 13-mm.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: Small infrarenal abdominal aortic aneurysm is again identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: An enlarged bilateral inguinal lymph nodes, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen large hematoma around the fem-fem graft and the fem-fem graft itself are not visualized. Small amount of collection with air and tissue defect on the left side likely representing postop changes are present. Collection measures 5 x 1.5 cm on image number 169, series number 3 in the subcutaneous tissues anterior to the symphysis pubis.OTHER: No significant abnormality noted.

Output: Interval excision of the fem-fem graft and the surrounding collection. Small collection and postsurgical changes are noted in the pelvis wall as described above.Large right sided pleural effusion demonstrating loculations. Right lower lobe consolidation which may represent pneumonia. Empyema cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: s/p hemicolectomy, History: daily cxr for ETT placement ET tube tip 4-5 cm above carina. Venous catheter is unchanged.Persistent pleural effusions with pulmonary edema.

Output: ET tube tip 4-5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with metastatic epithelial hemangioendothelioma 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: Multifocal hypodense lesions are scattered in the liver. Reference hepatic lesion is relatively unchanged and measures 3 x 2.3 cm image number 89, series number 3. The other lesions also appear similar in size and number.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral ovarian cysts are again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.Pelvic ultrasound is recommended for further evaluation of the ovarian cystic lesions..


Instruction: Generate impression based on medical findings.

Input: Male 48 years old Reason: icu History: icu ET tube tip approximately 5 cm above the carina. The feeding tube has been removed from the left lower lobe bronchus. Additional support devices are unchanged.Stable cardiomegaly/pericardial effusion.Small left greater than right bilateral pleural effusions and basilar subsegmental atelectasis. No pneumothorax.The left costophrenic angle is outside of the field of view.

Output: Interval removal of feeding tube from the left lower lobe bronchus. Otherwise stable cardiopulmonary appearance with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p temporary dialysis cath placement History: s/p temporary dialysis cath placement Right jugular catheter with tip in SVC. No pneumothorax.Heart size normal.Low lung volumes with bibasilar opacities compatible with edema, atelectasis and small pleural effusions.

Output: Bibasilar edema, atelectasis, and small pleural effusions compatible with hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: s/p AVR, trach History: trach No significant change in lower lung zone opacities and pleural effusions, although the lungs are slightly better inflated than on the prior study.Tracheostomy tube tip approximately 5 cm above the carina.Right jugular catheter, tip in SVC.Second right jugular dialysis catheter tip at the cavoatrial junction.

Output: Slightly improved inflation, otherwise unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male; 67 years old. Reason: Swan ganz placement History: HF New right jugular Swan-Ganz catheter tip in left main pulmonary artery.Stable severe cardiac enlargement and/or pericardial effusion.No specific evidence of infection or failure.

Output: New right jugular Swan-Ganz catheter tip in left main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: r/o effusion or pna History: cough No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: s/p IVC filter, r/o PTX History: None Nonspecific basilar opacities suggestive of aspiration or scarring are unchanged.Mild cardiomegaly.Right jugular catheter tip at SVC/RA junction level.No significant pneumothorax.The superior most tip of an IVC filter is seen at the lower margin of the image.

Output: No change in basilar opacities and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Coarse breath sounds status post fluids. Question pulmonary edema or pneumonia. Peripheral venous catheter from the right terminates in the right atrium. Scratch that nonspecific retrocardiac opacity in the left lower lobe. Basal atelectasis on the right. No signs of pulmonary edema.

Output: Low position of peripheral venous catheter, consider repositioning. Nonspecific retrocardiac opacity, infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Bacteremia and heart failure. Right jugular catheter tip at the SVC/artery junction.Left subclavian ICD unchanged.Interval removal of right-sided PICC.Linear scarring at the left lung base.No specific signs of CHF or pneumonia, though nonspecific bronchial wall thickening is present.

Output: No specific signs of CHF or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with history of cervical cancer and new lung lesion CHEST:LUNGS AND PLEURA: Right apical scarring with calcification and retraction of the adjacent pleura containing some subpleural fat is not significantly changed from previous study. Right upper lobe irregularly-shaped lesion now measures 17 x 12 mm on image number 14, series number 7. Previously fuzz measuring 18 x 10 mm image number 17, series number 5. Other scattered calcified granulomas are also unchanged.A new mass within the right lower lobe measures 4 by 3.1-cm image number 56, series number 7.MEDIASTINUM AND HILA: Left thyroid cyst is unchanged. Scattered borderline enlarged mediastinal nodes have minimally enlarged unchanged. The index node on image number 24, series number 6 now measures 6 x 5 mm. Previously it was measuring 4 by 5 mm number 104, series number two.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: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New right lower lobe mass suspicious for primary lung malignancy.Minimal interval enlargement of the mediastinal lymph nodes.Right apical scarring, unchanged.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male status post laparoscopic cholecystectomy complains of pancreatitis ABDOMEN:LUNG BASES: Bilateral pleural effusions, more on the left than on the right.LIVER, BILIARY TRACT: Cholecystectomy clips and small amount of high density fluid around the liver likely representing small hematoma.SPLEEN: No significant abnormality notedPANCREAS: Pancreas does not demonstrate enhancement other than small patchy areas in the head and in detail. These findings are consistent with necrotizing pancreatitis. Pancreas is replaced by at 17.5 x 9.7 cm peripherally enhancing pseudocyst. Splenic vein is diminutive in size but patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis.

Output: Large pseudocyst replacing the necrotic pancreas consistent with necrotizing pancreatitis.The critical findings are discussed with Dr. Shim and acknowledged at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: r/o lung infection History: prod cough Cardiomediastinal silhouette within normal limits. Hyperexpanded lung fields with progression of bullous formation, findings compatible with emphysematous changes.No specific evidence of infection or edema. No pneumothorax.

Output: Severe emphysematous changes with no specific evidence of infection, edema or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: chest pain, N/V, dissection CT ordered History: chest pain Right chest port tip in SVC. Stable cardiomegaly. Right base slightly better inflated.

Output: Stable cardiomegaly but no new findings or evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval for focal infitrate History: cough, AMS Cardiomediastinal silhouette is within normal limits. Basilar and retrocardiac streaky opacities are compatible with atelectasis and/or aspiration, particularly dense in the retrocardiac space, and infection this location cannot be excluded. No large pleural effusions or pneumothorax. Irregularity of the right hemidiaphragmatic contour suggests mild right diaphragmatic eventration.Anterior wedging of a lower thoracic vertebral body, unknown chronicity.

Output: Basilar and retrocardiac streaky opacities compatible with atelectasis/aspiration, infection cannot be excluded without follow up.


Instruction: Generate impression based on medical findings.

Input: Male 76 years old Reason: s/p CABG History: SOB Median sternotomy hardware noted.Stable cardiomediastinal silhouette.Interval improvement in left retrocardiac and bibasilar opacities. No new focal airspace opacities.Loculated right pleural effusions not significant change from prior exam.

Output: Interval improvement in left retrocardiac and bibasilar opacities with stable loculated pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: s/p aortic dissection repair History: NA Improvement in lung volumes. Patchy bibasilar opacities and small pleural effusions again noted. Heart size is at the upper limit of normal. Postoperative changes again noted within the mediastinum. No acute bony abnormality. No large pneumothorax.

Output: Improvement in lung volumes. Persistent patchy bibasilar atelectasis or consolidation and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: r/o lymphadenopathy History: hx of bells palsy and optic neuritis, r/o sarcoid Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of sarcoidosis.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lung transplant History: lung transplant Small lung volumes with diffuse opacity compatible with edema, slightly improved.Interval right chest tube removal with no significant pneumothorax.Displaced fractures of the right and left third ribs related to recent surgery.Feeding tube tip in the gastric antrum.No new findings.

Output: Resolving pulmonary opacity compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: s/p STEMI, shortness of breath History: shortness of breath Interval decrease lung volumes with progressive basilar edema, atelectasis and pleural effusions. Partially calcified pleural plaque at the right hemidiaphragm and costophrenic angle. Mild left ventricular enlargement.

Output: Progressive pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: evaluate for signs of fluid overload History: o2 requirement Interval removal of right jugular catheter. Right PICC tip in right axilla.Lungs hypoinflated. Stable cardiomegaly but no evidence of significant pulmonary edema.

Output: No new opacity. No evidence of significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: eval lung fields History: as above No significant cardiopulmonary abnormality.No specific evidence of infection or edema.Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: impella, swan ganz History: impella, swan ganz Severe cardiomegaly.Small lung volumes with the suggestion of edema.Right jugular Swan-Ganz catheter tip directed towards the right main pulmonary artery.Right subclavian Impella device unchanged in position.

Output: No change in devices. Cardiomegaly with a suggestion of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old. Status post left thoracotomy. Evaluate chest tube and lung expansion. Left chest tube terminates in the medial left base. Left basilar opacity consistent with a small pleural effusion and overlying atelectasis. No significant pneumothorax.Midline skin staples. Right upper quadrant cholecystectomy clips. Left upper quadrant surgical sutures. Plate and screw devices in the lower cervical spine.

Output: Small left pleural effusion with overlying atelectasis. Left chest tube tip terminates at the medial base.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: Respiratory Failure 2/2 ARDS with worse leukocytosis, fever History: fever, tachycardia, tachypnea Tracheostomy tube, ECMO cannula, and Dobbhoff tube unchanged.Small lung volumes with diffuse predominantly interstitial opacity consistent with the clinical diagnosis of ARDS, not significantly changed.No new findings.

Output: Findings consistent with ARDS without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Cough and fever rule out infection Normal heart size. No focal air space opacities or pleural fluid. No pneumothorax.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: evaluate LLL opacity History: c/f infection versus malignancy, pt hypoxic, tachypnea, EtOH abuse so possible aspiration Low lung volumes. Patchy bibasilar opacities, slightly worse on the right and not substantially different on the left. These opacities are new compared to 2003. No large pleural effusion or pneumothorax. Normal heart size. No pneumothorax.

Output: Slight worsening right basilar opacities with stable patchy left basilar opacity which certainly may represent aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: SOB History: SOB Status post sternotomy. The 2 caudal most sternal wires are fractured but not displaced.Cardiomegaly with no acute cardiopulmonary abnormality.

Output: Cardiomegaly with no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.History of left upper quadrant pain status post PICC placement. New left PICC with tip in the SVC. Enteric tube is seen with tip in the stomach. Surgical staples noted over the mid abdomen.The cardiomediastinal silhouette is stable. Lung volumes are low and streaky bibasilar opacities are noted.

Output: Left PICC tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Check for cardiomegaly. End-stage renal disease No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Shortness of breath and elevated white count. New subtle mild nonspecific left basilar opacity. Otherwise the lungs are stable in appearance including a calcified right midlung granuloma.Stable cardiomediastinal silhouette with mild aortic calcification and right hilar calcified lymph nodes.

Output: New subtle nonspecific left basilar opacity. This may reflect atelectasis or aspiration. No convincing evidence of infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60 yo male with history of CLL pre-allo SCT evaluation History: evaluate Port catheter terminates in the SVC. Patchy left basilar opacity. No pleural effusion or pneumothorax. Normal heart size.

Output: Patchy left basilar atelectasis and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: weakness, hx chf History: weakness Decreased lung volumes with stable mild cardiac enlargement.Bilateral pleural thickening similar to the prior exam.Mild right basilar atelectasis.No focal areas of consolidation.No new pulmonary opacities.

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


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Right lower rib pain. Metallic artifact from and zipper/but projects over the midline upper abdomen.Cardiomediastinal silhouette appears similar to prior. Heart size appears at least upper normal.Scarring in the left costophrenic angle region unchanged. No pneumothorax.Degenerative changes of the glenohumeral joints and thoracic spine with lower thoracic spine anterior vertebral body wedging of unclear chronicity.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended.

Output: Right lower ribs are not adequately visualized to exclude fracture. Large lung volumes consistent with emphysema/COPD. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Chest tube in place. Malignant neoplasm of upper lobe. Increased volume of fluid in the right pneumonectomy cavity. Subcutaneous emphysema right chest wall appears increased. Postoperative or mediastinal shift.Severe emphysema in the left lung with subsegmental atelectasis and scarring at the lung base. Reticulonodular opacities seen previously have resolved, presumably aspirated secretions.

Output: Increasing right chest wall subcutaneous emphysema. Interval clearance of aspirate.


Instruction: Generate impression based on medical findings.

Input: 26 years old Female. Reason: evaluate for pneumomediastinum History: severe chest pain, prior vomiting. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: eval lung fields hx chf History: sob, cp Stable mild cardiac enlargement.Basilar interstitial opacities are compatible with mild edema.No focal areas of consolidation.No pleural effusions

Output: Cardiomegaly with mild basilar interstitial opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Acute respiratory failure with hypoxia.VIEW: Chest AP (one view) 2/26/2016 at 0554 hours NG tube terminates at the stomach. ET tube tip is below thoracic inlet. Both central lines terminates at the right atrium. Right-sided chest tube unchanged.Cardiac silhouette size is normal. Interval right-sided pneumothorax resolved. Persistent diffuse interstitial and airspace hazy opacities. Multiple bone metastases again noted.

Output: Interval resolution of right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Eval infiltrate, volume overload History: 56 yo hx of cabg p/w cp and sob Mild cardiomegaly status post sternotomy for CABG.Subtle basilar interstitial opacities without pleural effusions, only equivocal evidence of edema.No specific evidence of infection.

Output: Cardiomegaly status post CABG, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: s/p AVR and CABG History: -- Endotracheal tube tip approximately 2.3 cm above the carina. Right IJ Swan-Ganz catheter with tip overlying the RPA. Two mediastinal chest tubes are in place. Status post median sternotomy.Stably enlarged cardiac silhouette.Persistent bilateral low lung volumes with right midlung and bibasilar opacities likely representing pulmonary edema and atelectasis. Small pleural effusions are not excluded. No pneumothorax.

Output: Postoperative changes as above with no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: 49 year old female with new CKD, worsening resp distress, please eval for pulm edema vs infection History: shortness of breath Central venous catheter is in place with its tip in the SVC.Stable borderline cardiac enlargement.Interstitial opacities with septal lines and patchy airspace opacities suggestive of edema.No large pleural effusions.

Output: Interval placement of a right central venous dialysis catheter. Interstitial and airspace opacities suggestive of edema slightly increased from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: rule out infection History: first neutropenic fever Right central venous catheter terminates in the SVC. No pleural effusion or pneumothorax. No focal pulmonary abnormality. Mild right greater than left subsegmental atelectasis. Heart size is within normal limits.

Output: No acute cardiopulmonary abnormality.