Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Tracheostomy cannula assessment. Adequate position of tracheostomy cannula terminating in the mid trachea. The left upper lobectomy PICC overlies the superior to 12 junction.Persistent very low lung volumes and signs of interstitial fibrosis with basilar predominance, not significantly changed. Superimposed right basilar heterogeneous opacities may represent subsegmental atelectasis.Possible trace right pleural effusion. No pneumothorax.

Output: Adequate position of support apparatus.Signs of advanced interstitial fibrosis, unchanged from recent comparisons. Resolving right basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.History of asthma, sudden onset DOE rule out pneumothorax. Normal heart size. Bronchial wall thickening and endobronchial debris in the mid and lower lung zones more than expected with asthma.No pneumothorax, visible pneumomediastinum or pleural fluid.

Output: Severe bronchial wall thickening with endobronchial debris more than what is expected in the setting of asthma and may indicate infectious bronchitis/bronchiolitis. No visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: assess for effusion History: crackles on exam, persistent O2 requirement post-surgically Bilateral pleural effusions left larger than right, with overlying atelectasis.Heart size normal.Right jugular catheter, tip in SVC.Cholecystectomy clips.

Output: Bilateral pleural effusions left larger than right, with overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female. Evaluate right upper lobe nodule and history of pelvic kidney. Patient is being evaluated for heart and kidney transplant. This study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Scarring in the right apex and bilateral emphysema are unchanged. Four coil, patchy air space densities in the left lower loop lobe adjacent to the fissure is smaller and may represent a resolving pneumonia and/or atelectasis. Right middle lobe atelectatic changes are unchanged.MEDIASTINUM AND HILA: Cardiomegaly, severe.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: Both kidneys are pelvic in location and appears to be fused. No evidence of hydronephrosis.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: Left adnexal fat-containing mass measuring 4.8 x 4.7 cm consistent with a dermoid cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: Limited study due to lack of IV and oral contrast. Right upper lobe scarring is unchanged.Consolidation along the left major fissure is smaller and may represent a resolving pneumonia or atelectasis. Bibasal or atelectasis.Severe cardiomegaly.Bilateral fused pelvic kidneys.Left ovarian dermoid cyst.


Instruction: Generate impression based on medical findings.

Input: Reason: n/a History: stroke Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.History: cough, congestion, pleuritic chest pain, subjective fevers The heart size is normal. No pleural effusion or pneumothorax. No focal pulmonary consolidation.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: placement of LIJ TLC History: re-wiring of line Interstitial and airspace opacities remain moderate to severe consistent with edema or ARDS.Left jugular catheter tip in left brachiocephalic vein at the midline.A Dobbhoff tube extends below the lower margin of the image.Tracheostomy tube tip approximately 6 above the carina.

Output: Unchanged left jugular catheter. Previous loop in the Dobbhoff in the neck region is not included on this image and could still be present.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with hemothorax status post liver biopsy. Now with decreased blood pressure and dizziness and complaint of increased abdominal size. Evaluate for continued bleeding. CHEST:LUNGS AND PLEURA: Persistent large amount of fluid in the right pleural space with underlying atelectasis or consolidation.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast.LIVER, BILIARY TRACT: No significant abnormality noted. Specifically, no evidence of perihepatic or subcapsular fluid.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. No evidence of free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the cul-de-sac, unchanged from prior exam. No evidence of layering to suggest blood specifically.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small amount of fluid in the cul-de-sac, unchanged. Persistent large right sided hemo-or hydro-thorax with underlying atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: cough History: cough Clear lungs. No pleural effusion or pneumothorax. Mild cardiomegaly. Large patient body habitus. Prominent epicardial fat pads.

Output: No acute cardiopulmonary process on radiography. Large patient body habitus.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: MaleReason for Study: Reason: chest pain, hx of sickle cell History: chest pain Stable cardiomediastinal silhouette.Mild parenchymal and pleural scarring at the left lung base similar to the prior exam.No new pulmonary opacities identified.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: wheezing, SOB. Etiology? History: wheezing Cardiomegaly, with a tortuous aorta, unchanged.Equivocal basilar edema stable.No evidence of infection.Right jugular catheter, tip in SVC.Gastrostomy tube identified.

Output: Cardiomegaly and equivocal edema, but no sign of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: PNA? PCP? History: cough Known left lower lung cyst, but no evidence of acute infection.Heart size normal.

Output: Known left lower lung cyst, otherwise unremarkable. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: acute abnormality History: fall with posterior left rib pain Apparent nodular density projecting over the right anterior fourth rib is felt to be related to the patient's extensive osseous metastatic disease, rather than a pulmonary parenchymal lesion. Multiple healing rib fractures are again noted, but no acute rib fracture is evident. There is no focal consolidation, pleural effusion or pneumothorax is evident. Convex enlargement of the upper left paraspinal region appears similar to the prior study, consistent with the known paraspinal mass. The cardiac contours are within normal limits for size.

Output: Extensive osseous metastatic disease and left paraspinal mass similar to prior. Healed rib fractures, but no acute rib fracture pneumothorax is evident on limited chest radiography.


Instruction: Generate impression based on medical findings.

Input: Right jugular catheter placement Interval new right jugular catheter placed with tip projected into the right atrium. Persistent decreased lung volumes with basilar changes suggesting atelectasis and less likely aspiration. Serial imaging may be indicated to ensure clearance if of concern. Upper lungs are clear.

Output: Right jugular catheter placed without apparent complication


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old. Reason: r/o free air in abdomen, dilated bowels. Immunocompromise s/p renal transplant, with refractory c diff Multiple mildly prominent small bowel loops within the midabdomen. Gas seen within the colon.Colonic mucosal edema compatible with known colitis.No free air seen on upright imaging. No intramural air noted.The cardiomediastinal silhouette is within normal limits.No focal airspace abnormality. No pleural effusion or pneumothorax.Extensive vascular calcifications.

Output: Findings compatible with colitis and ileus pattern, without evidence of obstruction or free air.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of rectal cancer CHEST:LUNGS AND PLEURA: Postoperative changes of right middle lobectomy are unchanged. Left lower lobe. Linear atelectasis, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver is unchanged. Changes secondary to resection are again noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left-sided hydronephrosis and hydroureter are stable. Right kidney is unremarkable.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: Postsurgical changes involving the rectum. Perirectal and presacral soft tissue thickening is unchanged and encases the left ureter adjacent to the left common iliac vessels on image number 167, series number 3 and likely causes The left-sided hydronephrosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Again noted is a left common iliac vein stent.

Output: Stable exam with left-sided hydronephrosis, postsurgical changes in the pelvis and fatty infiltration of the liver.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Lung cancer status post robotic assisted vats right upper lobectomy on 12/29/2014, S.O.B. Persistent, slightly improved diffuse subcutaneous emphysema. A right anterior chest tube is present. Now with the benefit of a lateral radiograph, the tip is seen projecting just inside of the bony thorax but the sidehole straddles the bony thorax external to the pleural space.Postoperative volume loss on the right compatible with right upper lobectomy. Architectural distortion of the right hilum, especially on the lateral radiograph, nonspecific in the post operative setting and may be followed on the patient's regularly scheduled exams. Air space opacity in the anterior lung field may represent contusion or aspirate. No pleural fluid. Moderate right apical pneumothorax with maximal pleural separation from the chest wall of 21-mm.

Output: 21-mm right apical pneumothorax. The anterior right chest tube the sidehole is appears to be straddling the bony thorax, external to the pleural space. Sara Gaines (covering 8467) notified via text page at 2:45 p.m. on 1/23/2015.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: line, swan, ETT placement, any effusions/pulmonary contusion History: critically ill, received chest compressions The right IJ Swan-Ganz catheter has been retracted by one to 2 cm, within the mid right pulmonary artery. Interval placement of a Dobbhoff tube which terminates inferior to the caudal margin of the image. Remaining support devices are in stable position.Improved retrocardiac aeration with residual atelectasis. No pneumothorax.

Output: Slight improved aeration left lower lobe. Dobbhoff tube terminates inferior to the caudal margin of the image. No pneumothorax following chest compressions.


Instruction: Generate impression based on medical findings.

Input: DHT positioning Dobbhoff tube seen curled at junction of gastric fundus/body. Gas containing small and large bowel without significant change from prior study, may reflect diffuse ileus. Left ventricular assist device seen overlying cardiac apex/left upper quadrant. Mild curvature of spine towards right and spinal degenerative disease seen. Pelvic tube. Please see same day chest radiography for additional findings.

Output: Enteric tube as above, interval retraction. Persistent diffuse ileus.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: 74 m new onset sob likely asthma History: see above No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: r/o infection History: sob and rales heard Multiple bilateral rib deformities compatible with callus of fractures. Right infrahilar opacities of retained secretions or atelectasis. No specific evidence of infection or edema. The heart size is normal. Several calcified mediastinal lymph nodes are present.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: eval L side opacification / BiVADs History: sob Improved aeration of left lung, though there is a significant residual left pleural effusion.Support hardware unchanged.

Output: Improved aeration of left lung, though there is a significant residual left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with history of lung cancer CHEST:LUNGS AND PLEURA: Small left-sided pleural effusion. Volume loss involving the left hemithorax with areas of scarring. Left lower lobe, irregular soft tissue density likely represents a combination of patient's lung cancer and atelectasis. Irregular thickening of the left-sided pleura with patchy calcifications. Atelectasis of the left lower lobe.MEDIASTINUM AND HILA: Left hilar soft tissue density measuring 1.9 x 1.9 cm on image number 31, series number 3 which may represent a lymph node.Left-sided port catheter with its tip in the in the superior SVC.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 7-mm hypodense lesion in the right lobe liver image number 70, series number 3.2.4 x 1.5 cm hypodense lesion in the right lower liver in image number 100, series number 3. This lesion cannot to optimally characterize on this single phase CT. MRI of the liver may be helpful for further evaluation.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: Para-aortic adenopathy measuring 1.2 x 1 cm image number 118, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Abdomen two stripe is dilated. Correlation with patient's menstrual cycle is recommended.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic left iliac bone lesion, nonspecific.OTHER: Small amount of free fluid.

Output: Ill-defined soft tissue density involving the left lower lobe that cannot be differentiated from the surrounding atelectasis and scarring likely representing patient's known lung cancer. Left hilar adenopathy. Left-sided pleural effusion.Small, Indeterminate liver lesions. Further evaluation with MRI of the liver may be helpful, if clinically indicated.Nonspecific para-aortic adenopathy.Dilated endometrial stripe. Further evaluation with pelvic ultrasound and correlation with menstrual cycle is recommended.


Instruction: Generate impression based on medical findings.

Input: Metastatic pancreatic cancer. CHEST:LUNGS AND PLEURA: Numerous scattered bilateral pulmonary nodules on a background of fibrotic lung disease are not significantly changed from prior CT. Reference right upper lobe nodule measures 8 x 9 mm on image number 30, series number 3. A reference left upper lobe nodule measures 11 x 10 mm image number 42, series number 3.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Mild intrahepatic biliary dilatation pneumobilia is unchanged. Metallic common bile duct stent and cholelithiasis are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Large soft tissue mass in the head of the pancreas measures 4.4 x 2.9 cm image number 92, series number 3. The mass again encases the surrounding vasculature.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Ill-defined multiple retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Pancreatic head mass and lung nodules, not significantly changed from previous CT.


Instruction: Generate impression based on medical findings.

Input: 57 year old female with history of esophageal cancer. CHEST:LUNGS AND PLEURA: Biapical scarring. Left upper lobe 5-mm nodule (series 4 image 8), unchanged. Few scattered micronodules are unchanged. Small subpleural nodular opacity right upper lobe posteriorly (series 4 image 35) likely post inflammatory.MEDIASTINUM AND HILA: Thickened or edematous patulous esophagus with air-fluid level, increased. Right thyroid lobe calcification, unchanged. Small pericardial effusion.CHEST WALL: Bilateral breast prosthesis with surgical clips in the right breast parenchyma. Borderline enlarged right axillary lymph nodes, similar to prior.ABDOMEN:LIVER, BILIARY TRACT: Scattered hypodense lesions, unchanged from prior amount, likely representing benign hepatic cyst.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Previous identified lymph node in the porta hepatis (series 3 image 87), now measures 11 x 8 mm (previously 15 x 13 mm).BOWEL, MESENTERY: Asymmetric enhancing wall thickness of the second part of the duodenum (coronal series image 52) is similar to prior, cannot exclude a small bowel malignancy.BONES, SOFT TISSUES: Moderate vascular calcifications.OTHER: No significant abnormality noted.

Output: 1) Subtle interval increased esophageal thickeness/edema with no discrete mass.2) Possible enhancing duodenal mass, cannot exclude small bowel malignancy. 3) Decrease in size of gastrohepatic lymph node.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: PTX History: above Left chest tube placed alleviating a left pneumothorax.Left chest wall soft tissue emphysema noted.Basilar subsegmental atelectasis is present.

Output: Left chest tube, left pneumothorax resolved.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: s/p chest surgery History: see above The cardiomediastinal silhouette is unremarkable.Small left pleural effusion.The lungs are clear.Median sternotomy is intact.

Output: No acute cardiopulmonary abnormalities identified. Small persistent left pleural effusion postoperatively.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history metastatic prostate cancer. Assess for disease progression. Vague bony aches/pains. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules bilaterally, grossly unchanged in size and number. Reference right middle lobe lesion (series 5, image 40) measures 2.1 x 2.2 cm (stable).Stable right apical scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Marked mitral annular and coronary artery calcifications.Right perihilar soft tissue mass containing punctate calcification (series 3, image 40) measures 2.6 x 2.4 cm, which is unchanged when accounting for differences in technique; using similar measurement techniques this lesion previously measured 2.6 x 2.4 cm as well.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Diffuse fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: Focal hypoattenuating lesion in the pancreatic head again measures 1.2 x 1.2 cm (series 3, image 106).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small low-density lesions in the kidneys remain too small to characterize but are grossly unchanged in size. Nonobstructing renal stones again seen bilaterally.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. Penile prosthesis with reservoir in left anterior abdomen reidentified.BLADDER: No significant abnormality noted.LYMPH NODES: Reference right external iliac node (series 3, image 165) measures 0.8 x 0.6 cm (stable).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic changes in the right sacrum and pubic symphysis.

Output: 1. Stable pulmonary and osseous metastases. No new sites of disease identified.2. Low-density lesion in the pancreatic head is also unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: s/p intubation History: s/p intubation Unchanged loculated right pneumothorax with multiple chest tubes.Stable diffuse left-sided pulmonary opacities consistent with edema or ARDS, unchanged.Prior pneumoperitoneum no longer visible.ET tube tip approximately 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheters terminating in the SVC and at the RA level.

Output: Unchanged loculated right pneumothorax. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval ETT History: eval ETT Improvement in left upper lobe dense airspace opacity, although this persists in the bases with pleural effusions.ET tube tip approximately 2 cm above the carina.Right jugular catheter, tip in SVC.IVC filter.A surgical drain is projected over the right side of the chest, possibly in the soft tissues.

Output: Improvement in airspace opacities. ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: ET placement History: Intubated Bilateral pleural effusions and basilar opacities including consolidation unchanged.ET tube tip approximately 5 cm above the carina.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: S/P OHT History: Routine surveillance for infection or neoplasms Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Unchanged heart size. Patient status post sternotomy, as before.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: 7 days of uri symptoms History: cough, congestion, rhinorrhea Patchy left perihilar airspace opacity consistent with pneumonia.Elsewhere, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Left-sided pneumonia, probably affecting the superior segment of the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p LVAD s/p sternal wound closure 10/14 History: sig drop in Hgb Enlarged cardiac silhouette with perihilar opacities suggestive of edema, generally unchanged.Interval removal of sternal fixation devices.ICD lead, LVAD and surgical drains in place.Moderate bilateral pleural effusions.

Output: Cardiomegaly, pulmonary edema and moderate pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: dobhoff tube coiling in esophagus? History: see above Enteric tube traversing the esophagus with its tip below the inferior margin of the radiograph. Catheter tip in the SVC. No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Shortness of breath. Evaluate for pneumonia, pulmonary edema. Interval increase in diffuse right lung predominant heterogeneous opacities consistent with asymmetric alveolar pulmonary edema. Moderate right and small left pleural effusion is again noted.Unchanged cardiomegaly.Interval placement of a right IJ HD catheter with tip overlying the cavoatrial junction.

Output: Interval worsening of asymmetric pulmonary edema. Appropriate position of new right IJ HD catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: hypoxia, requiring HF NC after extubation History: as above Moderate lower lung zone edema with pleural effusions, not significantly changed, consistent with CHF.Heart size near upper normal.NG and ET tubes removed since the prior study.

Output: No significant change in CHF following extubation.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: FemaleReason for Study: Reason: chest pain History: same Motion limits sensitivity. Aortic stent graft unchanged allowing for differences in patient positioning.Stable cardiac enlargement.Pleural effusions with pulmonary edema and basilar atelectasis probably increased from the prior exam.No new pulmonary opacities identified.

Output: Aortic stent graft unchanged. Pulmonary edema, basilar atelectasis, and pleural effusions probably increased from the prior exam..


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: monitor pneumothorax History: pneumothorax post PM plcmt Slight increase in size of left apical pneumothorax now measuring 4.2 cm compared to 2.6 cm previous study. Otherwise, no substantial difference compared to last study.

Output: Slight increase in size of left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: chest pain History: left sided chest pain x 3 days, hx of CAD Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Cervicothoracic spine stabilization hardware.No evidence of traumatic injury.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: swan position History: swan reposition Right IJ Swan-Ganz catheter has been retracted, terminating in the subvalvular right ventricular outflow tract. The intra-aortic balloon pump tip is low, inferior to the left mainstem bronchus. Endotracheal tube terminates 3 cm above the carina. The remaining support devices are unchanged in position.Basilar opacities of atelectasis are stable. No interval pneumothorax. Heart size unchanged.

Output: Swan-Ganz catheter terminates in the subvalvular right ventricular outflow tract. Intra-aortic balloon pump is low. Both support devices have been successfully repositioned on subsequent imaging.


Instruction: Generate impression based on medical findings.

Input: Male, 98 years old.Mechanical intubation. Low endotracheal tube with tip approximately 1.5 cm above the carina. Enteric tube projects in the retrocardiac region, probably within a hiatal hernia.Low lung volumes with basal atelectasis, layering pleural effusions and scattered foci of hazy opacity consistent with aspirated secretions. Patient is rotated.

Output: Low endotracheal tube. Pleural fluid, atelectasis and signs of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Hypoxemia. ICU. Moderate pleural effusions with associated atelectasis. Left greater than right basal atelectasis disproportionate to volume of pleural fluid. Right infrahilar/interlobar lymphadenopathy.Aortic and carotid vascular calcifications.

Output: Moderate pleural effusions with significant basal atelectasis, correlating with extensive debris seen within the lower lobe airways bilaterally on a recent abdomen CT scan. This should be followed to complete radiographic resolution.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube History: s/p chest wall resection with reconstruction Chest tube extending to the right apex with no pneumothorax. Additional drains projected over the right chest wall. Basilar opacity compatible with effusions and atelectasis.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: Chest pain, worse when sitting forward No interval cardiopulmonary change. Specifically no acute new abnormality. Questionable mild redistribution to the upper lungs the changes minimal and stable in appearance. Early mild hypertension cannot be excluded.Osseous structures are unremarkable

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: eval for PNA History: cough, hx of COPD, crackles Chronic appearing basilar opacities suggestive of fibrosis, also seen on prior CT.Heart size normal. No specific evidence of infection or edema.

Output: Chronic fibrosis, but no acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Productive cough. Evaluate for infection. No focal lung opacity, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: r/o PNA History: productive cough x 1 month Unremarkable cardiomediastinal silhouette.No focal pulmonary opacities, pneumothorax, or pleural effusions.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: evaluate PICC line position History: see above The right upper extremity PICC tip has been retracted slightly, terminating in the right subclavian vein. The left chest wall AICD device lead position is unchanged. Numerous surgical clips project over the mediastinum.Unchanged small right pleural effusion and basilar interstitial opacities and septal lines consistent with mild pulmonary edema. Additional streaky bibasilar opacities suggests aspiration/atelectasis, left greater than right. No pneumothorax. Unchanged cardiomegaly.

Output: 1.Right upper extremity PICC tip terminates in the right subclavian vein.2.Small right pleural effusion and mild bibasilar pulmonary edema similar to prior.3.Streaky bibasilar opacities, left greater than right, suggests aspiration/atelectasis.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with ethanol abuse and diarrhea for two days. Abdominal pain. CHEST:LUNGS AND PLEURA: Scattered micronodules in the right middle lobe. 8 mm nodule in image number 49/104, series number 5. Small bilateral pleural effusions.MEDIASTINUM AND HILA: Stents of mediastinal and bilateral hilar adenopathy. A reference subcarinal adenopathy measures 2.2 x 2.1 cm on image number 45/230. Right hilar adenopathy measures 2.8 x 2.1 cm on image number 40 slashed on the 30.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of liver without any focal lesions. No evidence of biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: Pancreases is edematous with peripancreatic inflammatory changes consistent with acute pancreatitis. Enhancement of the pancreas is unremarkable in the body and tail. A focal area of decreased enhancement in the tail of the pancreas may represent a small necrotizing component. Pancreatic duct is unremarkable.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: Small amount of fluid and inflammatory changes along the bilateral anterior pararenal fascia, around the pancreas and in the retroperitoneum.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: Small amount of ascites.

Output: Mediastinal and hilar adenopathy.Subcentimeter lung nodules in the right lung of unknown etiology. A follow up chest CT is recommended in 6 months.Acute pancreatitis with inflammatory changes in the abdomen. Small, focal necrotizing component in the tail is possible.


Instruction: Generate impression based on medical findings.

Input: 62 years old Female. Reason: r/o acute infection History: hypotension. There is left pleural thickening/pleural effusion. Decreased volume of left lung is noted. Paramediastinal opacities are seen in the left lung. Patchy opacities are seen in the right middle lobe.The tip of the right IJ catheter projects over the right atrium. A vascular stent is seen in the junction of the SVC and right atrium.

Output: Patchy opacity in the right middle lobe and left paramediastinal opacity and pleural thickening/pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval lung fields History: s/p MVR, maze Median sternotomy with cardiac megaly status post valve replacement.Unchanged interstitial opacities suggestive of edema, with small pleural effusions.Unchanged chest tubes with no pneumothorax.ET tube tip 3 cm above the carina.Right jugular Swan-Ganz catheter with tip in main pulmonary artery.Left subclavian pacemaker, leads unchanged in position.A Dobbhoff tube extends below the lower margin of the image.

Output: Cardiomegaly and mild edema, unchanged. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: 12-year-old female with history of recurrent neuroblastoma. Status-post chemotherapy, radiation therapy, stem cell transplant, and surgical resection. CHEST:LUNGS AND PLEURA: Previously identified 5-mm lung nodule at the left lung base is unchanged (image 57/81 series 4). No new lung nodules or masses are identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Previously identified soft tissue mass adjacent to the posteromedial left sixth rib is larger on the current study measuring 1.3 x 3.3 cm (image 42/169 series 3). A new soft tissue mass adjacent to the posteromedial right sixth rib is also identified measuring 2.4 x 0.6 cm (image 43/169 series 3).ABDOMEN:LIVER, BILIARY TRACT: Reference lesion in the posterior right hepatic lobe has increased in size measuring 1.3 x 1.4 cm (image 77/169 series 3). Multiple new hypodense lesions are seen scattered throughout both lobes of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal gland is surgically absent. No significant abnormality noted in the right adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple bone lesions appear unchanged, including lesions in the sternum, manubrium, multiple vertebral bodies, and throughout the pelvis.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See bone findings under abdomen.OTHER: No significant abnormality noted.

Output: Interval progression of disease. This includes enlargement of soft tissue mass adjacent to the left posteromedial sixth rib, new soft tissue mass adjacent to the right posteromedial sixth rib, enlargement of reference lesion in the right posterior hepatic lobe, and multiple scattered new hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with known pancreatic mass. Compare to prior. CHEST:LUNGS AND PLEURA: Emphysematous changes, similar to prior.MEDIASTINUM AND HILA: Few mildly enlarged mediastinal lymph nodes. Enlarged heterogeneous right thyroid lobe extends into the middle mediastinum and causes mass effect on the trachea and adjacent vasculature.CHEST WALL: Few mildly large right axillary lymph nodes are nonspecific.ABDOMEN:LIVER, BILIARY TRACT: Moderate intrahepatic biliary ductal dilatation, similar to prior. Markedly hepatic biliary ductal dilatation with common bile duct measuring 1.8 cm (previously 2.1 cm).SPLEEN: No significant abnormality notedPANCREAS: Ill-defined predominate hypoattenuating pancreatic head mass (series 3 and image 122) measures approximately 3.8 X 2.8 cm (previously 4.3 x 4.3 cm). The medial border of this mass is not well defined, while the caudal and uncinate borders are more obviously lower attenuating than surrounding tissue. The celiac trunk and SMA are patent with preservation of the adjacent fat planes. The portal vein is patent. There is slight interval decrease in pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cysts, similar to prior. Nonobstructive right nephrolithiasis, unchanged. RETROPERITONEUM, LYMPH NODES: Index portacaval lymph node (series 3, image 111) measures 3.2 x 1.2 cm (previously 3.4 x 1.3 cm).Index aortocaval node (series 3, image 121) measures 1.2 x 1.6 cm (previously 1.2 x 1.1 cm). Index left peri-iliac node (series 3, image 142) measures 1.0 x 0.9 cm (previously 1.2 x 0.8 cm). Additional retroperitoneal lymph nodes are similar to prior. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Round lucency of the T11 vertebral body is similar to prior and of uncertain clinical significance.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is mildly enlarged with a few patchy calcifications.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Subcentimeter sclerotic foci in the pelvic bones, likely represent benign bone islands. OTHER: No significant abnormality noted

Output: 1) Slight interval decrease in pancreatic mass size. 2) Stable to slightly improved retroperitoneal lymphadenopathy.3) Heterogenously enlarged thyroid- Recommend follow-up ultrasound examination. 4) Nonspecific mediastinal and right axillary slight lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: worsening dyspnea History: dyspnea Cardiomegaly with small bilateral pleural effusions and basilar opacity compatible with edema and atelectasis.No new findings.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: eval for ptx History: line exchange Swan-Ganz catheter appears to been pulled back with termination not well demonstrated possibly within the RA. Other iatrogenic devices, unchanged. Low lung volumes with diffuse pulmonary edema again noted, likely accentuated by lower lung volumes. Small pleural effusions are likely. Unchanged heart size. No pneumothorax.

Output: Swan-Ganz catheter appears to been pulled back with termination not well demonstrated possibly within the RA.Low lung volumes with diffuse pulmonary edema again noted likely accentuated by lower lung volumes. Small pleural effusions are likely. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: ? Pulmonary infarct History: s/p PE Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Status post effusion, shortness of breath There is a small right pneumothorax with pulmonary opacity at the peripheral right upper lobe which may represent edema or hemorrhage. Scarlike opacities and atelectasis at the left mid zone and small pleural effusions are unchanged. The heart size is normal.

Output: Right small pneumothorax with associated pulmonary edema or contusion of the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Evaluate for PNA History: SOB, COPD Large lung volumes compatible with COPD. Ill-defined, asymmetric opacity at the right steer 4/5 rib interspace which may represent scarring. Recommend energy subtracted PA and lateral radiograph for further evaluation. No evidence of edema or infection. The heart size is normal.

Output: Large lung volumes compatible with COPD. Ill-defined opacity at the right apex. Recommend energy subtracted PA and lateral radiograph.


Instruction: Generate impression based on medical findings.

Input: Reason: Lung nodule- s/p lung resection x1 week History: Lung nodule-s/p lung resection x1 week Interval removal of a right chest tube with no significant residual pneumothorax.Basilar opacities compatible with atelectasis and small effusions.No new findings.

Output: Basilar atelectasis and small effusions, but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: PNA? History: SOB Sternotomy, valvular prosthesis, and tunneled left IJ dialysis catheter with tip at the confluence of the brachycephalic veins.No new focal airspace opacity.Mild cardiomegaly with vascular congestion.Goiter with leftward tracheal deviation.

Output: Mild cardiomegaly with vascular congestion but no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: cough r/o pneumonia History: cough Severe cardiomegaly with trace pleural effusions, no associated pulmonary edema.

Output: Severe cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: mechanically ventilated, pneumonia ET tube tip approximately 1 cm above the carina.Bilateral nonspecific airspace and interstitial opacities as previously characterized by CT scan. No new findings.

Output: Extensive nonspecific pulmonary opacity compatible with the clinical diagnosis of pneumonia, without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old. Reason: s/p central line placement History: ARDS, Intubated, Right IJ line terminates in the SVC. No pneumothorax. Other lines and tubes, unchanged. Diffuse pulmonary opacities again noted. Small pleural effusions. No pneumothorax. Unchanged heart size.

Output: Right IJ line placement without evidence of pneumothorax. Diffuse pulmonary opacities consistent with diffuse alveolar damage again noted.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with geo-cell carcinoma CHEST:LUNGS AND PLEURA: Reference right middle lobe lesion is less well-defined but measures the same measuring 8 x 9 mm. Other small metastatic lesions are also unchanged in size. No evidence of new lodges. Emphysema is unchanged.MEDIASTINUM AND HILA: Stable right hilar lymph node.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference cystic metastatic disease in the right lobe is smaller measuring 17 x 16 mm on image number 87, series number 4. Other numerous metastatic lesions are unchanged or slightly smaller. No new hepatic lesions.SPLEEN: Ill-defined hypodense splenic lesion is unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of tumor recurrence in the nephrectomy site.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous bone metastases throughout the vertebral bodies and other bones.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic lesions in the pelvic bones and pathologic fracture in the left humerus bone unchanged.OTHER: No significant abnormality noted.

Output: Lung metastases are unchanged. Some of the liver metastases are smaller, most are unchanged. Extensive bone metastases are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: eval for PNA History: AMS Heart size normal with a tortuous aorta.No focal air space opacity to suggest infection.Bilateral apical scarring is unchanged.

Output: No no acute abnormality and without interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: Left Lower Lung Resection History: Left Lower Lung resection Chest tubes extending to the left apex with no significant pneumothorax.Small left pleural effusion and volume loss in the left hemithorax.

Output: Postoperative findings on the left with a small effusion but no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: FemaleReason for Study: Reason: r/o effusion History: SLE flare, chest pain Interval increasing cardiac size is may represent pericardial effusion.The lungs are clear.No focal areas of consolidation.No pleural effusions.

Output: Increasing cardiac size which may represent cardiomegaly and/or pericardial effusion. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female metastatic ACC lung cancer. Pregnant. Status post two cycles chemo. Reassess CHEST:LUNGS AND PLEURA: Emphysematous changes. The lymph node along the fissure in the right base MIP image 42/69, unchanged. No new nodules.MEDIASTINUM AND HILA: Right paramediastinal mass is visually similar in extent. It is very irregular in shape making comparison of measurements difficult. I remeasured on image 16/203 is 2.5 x 1.9 cm. No new sites of disease.Index lesion in the right hilum, image 43, 1.3 x 0.9 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: A new lesion is seen in segment 6, image 102/203 and measures 3.1 x 2.2 cm. On very narrow windows it is possible this lesion may have been present previously. Remainder of the liver is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small lesions unchanged likely cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta with some ulcerated plaques are demonstrated. Some eccentric neural thrombus in the distal abdominal aorta where an ulcerated plaque, unchanged. No pathologic sized retroperitoneal nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Probable progression of disease in the liver. Other lesions are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.ET tube. ET tube tip is 5 to 6 cm above the carina. Cardiomediastinal silhouette is within normal limits. The patient is severely rotated and there is a right paratracheal opacity. Surgical drain projects over the cervical spine.

Output: ET tube tip 5 to 6 cm above the carina. The patient is severely rotated and the right paratracheal opacity most likely represents vascular summation. However, short-term follow-up is recommended to exclude a hematoma or other abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 25 years old Reason: r/o PNA History: cough No focal opacity, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Status post ICD. Left subclavian ICD while projects over the right ventricle directed towards the apex. No pneumothorax. Probable cardiomegaly. Mild dependent atelectasis bilaterally.

Output: Left subclavian ICD terminates in the projection of the right ventricle. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 74 year-old female with non-small cell lung cancer status post 10 cycles of therapy. CHEST:LUNGS AND PLEURA: Right middle lobe mass compatible with patient's known lung cancer measures 30 x 19 mm (unchanged).Upper lobe predominant emphysema and scattered micronodules unchanged. No new suspicious nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy without significant change with reference subcarinal lymph node (series 3, image 50) measuring 21 x 15 mm (unchanged).Heart size normal without pericardial effusion. Coronary and aortic calcifications.Nodular thyroid gland.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Multiple hypoattenuating lesions bilaterally, the larger of which are again compatible with hepatic cysts. The other multiple smaller lesions are too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass (series 3, image 95) measures 32 x 23 mm (unchanged accounting for differences in technique).KIDNEYS, URETERS: Multiple renal cysts bilaterally, unchanged.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of the descending aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: 1. No significant change in right middle lobe mass and mediastinal adenopathy, compatible with patient's known lung cancer.2. Left adrenal metastasis, unchanged.3. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: s/p open heart surgery History: s/p open heart surgery A right internal jugular central venous catheter terminates in the distribution of the right ventricle. An additional right IJ catheter terminates in the right atrium. ECMO cannulae are present terminating in at the inferior atriocaval junction and right pulmonary artery. Endotracheal tube tip is approximately 3 cm above the carina. Two mediastinal drains and two catheters are noted. Lap pads project over the upper mediastinum and inferior heart border.Low lung volumes with bibasilar opacity, left greater than right, likely reflecting atelectasis. Extensive abdominal calcifications are noted.

Output: 1. Low lung volumes with bibasilar atelectasis.2. Iatrogenic devices and lap pads as above.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Hypoxia evaluate for pneumonia or effusions. Low lung volumes. Patient is rotated, limiting assessment. Dense opacities in the projection of the right apex poorly assessed. No significant pneumothorax or visible pleural fluid.

Output: Dense opacities at the right apex are poorly visualized. Recommend a follow-up examination preferably with erect PA and lateral technique for further evaluation. Differential considerations include summation artifact, infection or non-benign process.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: PNA, with worsening pleural effusion collections History: Cough, SOB, oxygen requirement Increasing interstitial and airspace opacities suggestive of edema or aspiration, as well as increased basilar consolidation and pleural effusions.Moderate cardiomegaly.

Output: Worsening pulmonary opacities consistent with a combination of infection/aspiration and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: sinus tach Unremarkable mediastinum except for dextroscoliosis.Focal streaky and nodular opacity in the right mid lung, better characterized on previous CT scans, unchanged.Large lung volumes consistent with COPD.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: metastatic lung cancer, dyspnea, evaluate for lobar collapse History: dyspnea Marked tumor progression, with a new large right pleural effusion, right perihilar tumor and a mass projected superior to the aortic arch.Right pleural lobulation could indicate underlying tumor.Heart size normal.

Output: Marked tumor progression. A thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 35 yearsGender: MaleReason for Study: Reason: hypoxia History: hypoxia IJ venous catheter, ET tube, and enteric tube unchanged.Contrast noted within the stomach.Decreased lung volumes with stable cardiac enlargement.Perihilar/basilar opacities compatible with atelectasis.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: History of rhabdomyosarcoma, off therapy assessment LUNGS AND PLEURA: No significant abnormality noted. There is a diffuse is slight hazy groundglass appearance throughout both lungs especially in the lower lobes, though improved since the last study.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of pulmonary or mediastinal metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.SOB and tachypnea question pleural effusion or edema. Venous access devices unchanged in position.Moderate volume of pleural fluid bilaterally, similar to previous. Extensive bronchial wall thickening and associated opacity consistent with aspirated secretions, not significantly changed. Probable mild associated pulmonary edema.

Output: Moderate pleural fluid, mild pulmonary edema. Extensive opacities consistent with aspiration of secretions


Instruction: Generate impression based on medical findings.

Input: Elevated white count Layered moderate pleural effusions with largely collapsed left lower lobe and bilateral basilar nonspecific opacities. Probable hiatal herniaNo definite superimposed new airspace pulmonary processes

Output: Persistent changes most consistent with moderate CHF, without significant interval change. However in the absence of discrete findings and given patient history, infection again cannot be excluded. Continued serial imaging is needed to confirm


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Status post PICC placement. Left upper extremity PICC tip projects over the superior vena cava. The cardiomediastinal silhouette is within normal limits. No focal airspace opacity, significant pleural effusion, or pneumothorax. Probable granulomas noted over the right lung. Splenomegaly is noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Cardiogenic shock Resolving a persistent moderate right effusion with decreasing edema. Improved aerationMyocardial megaly.Swan-Ganz, ICD are otherwise unchanged

Output: Resolving edema and decreasing effusions


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old. Right chest tube in place with no significant pneumothorax.Opacity at the right base compatible with atelectasis and small effusion.Mild residual subsegmental atelectasis on the left.

Output: Basilar atelectasis unchanged with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: assess ETT position History: ETT advanced 1-2cm ET tube tip approximately 2.5 cm above the carina.Severe diffuse bilateral airspace opacities compatible with known ARDS, little interval change.Removal of right-sided chest tube with no evidence of pneumothorax.

Output: No significant interval change in appearance of ARDS. Interval removal of chest tube.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: evaluate for pneumonia History: above Mildly increased lung volumes suggestive of COPD.No focal airspace opacities.The cardiac mediastinal silhouette is unremarkable.No pleural effusions.Moderate scoliosis of thoracolumbar spine.

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


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Swan placement. Interval retraction of right jugular Swan-Ganz catheter with tip now at the main pulmonary artery level.Large left pleural fluid collection with associated atelectasis and moderate pulmonary edema about the same.

Output: Right Swan-Ganz catheter tip has been pulled back, now the level of the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.ADHF, BiVAD placement, pulmonary edema. Evaluate for other cause of hypoxemia, hardware positioning. Cardiomyopathy. Interval removal of enteric tube. Other cardiopulmonary monitoring and support devices are similar in position. Surgical staples project over the right chest wall. Sternal fixation wires and surgical staples appearing in alignment allowing for patient rotation.No pneumothorax. The cardiomediastinal silhouette is similar in appearance. Coarse interstitial opacities bilaterally, about the same. Mild basal atelectasis on the right. Nonspecific retrocardiac opacity.

Output: No acute change in hardware positioning. Severe, diffuse edema-like-like opacities similar to yesterday's exam but may be slightly increased when comparing back to earlier films.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Reason for hoarseness, feeling SOB, tracheal injury s/p intubation yesterday? History: Feeling like trachea swollen, SOB No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 74 year-old female metastatic urothelial cancer with vaginal recurrence status post resection. Evaluate for progressive disease. CHEST:LUNGS AND PLEURA: Fibrosis right lower lobe. No nodules or effusions.MEDIASTINUM AND HILA: Small mediastinal nodes not pathologic in size and unchanged the prior exam. Some arterial vascular calcification coronary arteries and aorta.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: Nonspecific hepatomegaly 25 cm in length coronal image 71/117. Gallstones. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ostomy right abdomen.BONES, SOFT TISSUES: Broad-based incisional hernia, nonobstructive.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Surgically absent. Nodularity seen along the left aspect of the vagina at the perineum measures 2.7 x 1.8 cm probably unchanged in the prior exam with its full extent cannot be visualized on the scan.BLADDER: Surgically absent. A cortical a specifically is no evidence of the newLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes right hip. No lytic or blastic disease.OTHER: No significant abnormality noted.

Output: Nonspecific hepatomegaly. Cholelithiasis. Stable nodularity in the vaginal area.


Instruction: Generate impression based on medical findings.

Input: The 93-year-old male with diffuse large B-cell lymphoma jaw and FL and bone marrow. Anemia, weight loss, fatigue CHEST:LUNGS AND PLEURA: Severe emphysematous changes, which have progressed from the prior study. Small bilateral pleural effusions are identified with rounded atelectasis in the left lung base. Scattered pleural plaques are seen, one of which is calcifiedMEDIASTINUM AND HILA: Extensive bilateral axillary, bilateral supraclavicular, left internal mammary, and mediastinal adenopathy has developed. For reference purposes, a left internal mammary lymph node measures 2.7 x 1.5 cm (series 3; image 46) and a left anterior diaphragmatic lymph node measures 2.4 x 1.5 cm (series 3; image 84). CHEST WALL: The port terminates at the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are identified.RETROPERITONEUM, LYMPH NODES: Massive conglomerate mesenteric and retroperitoneal adenopathy is identified. For reference, one of the mesenteric lymph nodes on the left measures 6.6 x 4.5 cm (series 3; image 104). Of note, other conglomerate lymph nodes are largerBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is greatly enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Heterogeneous sclerosis of the right hemipelvis is unchangedOTHER: Trace free fluid in the pelvis.

Output: Marked progression of disease.


Instruction: Generate impression based on medical findings.

Input: 80 opacity pulmonary fibrosis, unilateral lung transplant Mildly improving lung aeration in lungs that remain decrease in overall volume. 3 chest tubes on the right and 3 on the left remain unchanged. ETT terminates 3 cm above the carina.The cardiac and mediastinal contours are grossly within limits

Output: Improved aeration with unchanged bilateral numerous chest tubes


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Shortness of breath and fever. History of sickle cell. Persistent left basilar atelectasis. New mild right basilar opacity which is nonspecific but could represent atelectasis or infection. Cardiomegaly. Osseous changes of sickle cell disease.

Output: Persistent left basilar atelectasis, New mild right basilar opacity which is nonspecific but could represent atelectasis or infection.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: FemaleReason for Study: Reason: eval for casue of fever History: fever The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 78 year-old male with COPD and worsening dyspnea Median sternotomy wires and aortic valve prosthesis. Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.Basilar atelectasis and/or scarring. Resolution of retrocardiac consolidation/atelectasis.

Output: No specific evidence for infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval for pna, edema History: sob, abd pain Mild cardiomegaly stable. No large pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: Mild cardiomegaly. No other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: face/neck swelling and fever with new o2 req History: r/o pneumonia Right chest wall port terminates in the superior vena cava.Cardiomediastinal silhouette is unremarkable. Mild bibasilar atelectasis appears slightly improved. No pleural effusion or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Cough and shortness of breath. Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Moderate cardiomegaly. Lungs have normal volume. Thickening of fissures consistent with borderline edema. No pneumothorax.Thoracic degenerative changes are noted

Output: Moderate cardiomegaly, borderline pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: 81 y/o with head/neck CA, new fever; please eval for pna or aspiration History: fever No significant cardiopulmonary abnormality.Left subclavian catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: post-thoracentesis. Eval pneumothorax History: dyspnea No pneumothorax following thoracentesis.Unchanged pleural effusions, that on the left now extending into the fissure, with a left Pleurx catheter.Stable mediastinal widening from known lymphadenopathy.Unchanged basilar opacities.

Output: No pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: s/p left lung transplant History: decreased spirometry volume Status post left lung transplant. Stable fibrosis and volume loss in the right hemithorax compatible with known interstitial lung disease involving the native right lung.Unchanged left basilar opacity compatible with effusion and atelectasis/consolidation.No new focal opacities or pneumothorax.Multiple surgical sutures and staples in the abdomen.

Output: Left basilar effusion and atelectasis/consolidation, not significantly changed allowing for differences in patient positioning. No new focal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p Myxoma removal History: s/p Myxoma removal Chest tubes removed with no pneumothorax.Unchanged basilar atelectasis.Left subclavian ICD, leads unchanged in position.

Output: Unchanged basilar atelectasis. No pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: 28F with vaso-occlusive crisis and new CP. History: 3352 Cardiomegaly, unchanged. Right central venous catheter has been removed. Minimal bronchial wall thickening. Basilar subsegmental atelectasis/scarring. No evidence of acute chest syndrome. No large pleural effusions or pneumothorax.

Output: Interval removal of right central venous catheter. No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Patient with heart failure status post pacemaker placement, evaluate. There has been interval placement of left chest wall ICD with leads in the right atrial appendage, and left ventricular wall. Stable cardiomegaly and sternotomy wires and clips are noted. Bilateral pleural effusions and pulmonary opacities are unchanged. No pneumothorax is identified.

Output: Interval placement of left chest wall ICD without evidence of complications.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with history of COPD and lung cancer status post right pneumonectomy presenting with increasing shortness of breath. Prior CT from 10/26/2010 showed enlarged mediastinal nodes. Evaluate for malignancy. CHEST:LUNGS AND PLEURA: Status post right pneumonectomy. Moderate centrilobular emphysema and calcified granuloma the left lung, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Calcified lymph nodes compatible prior granulomatous disease are unchanged. The previously referenced partially calcified right para-tracheal node (series 4, image 22) measures 22 x 18 mm; previously measuring 26 x 20 mm. No new, pathologically enlarged lymph nodes identified. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Degenerative changes of the spine. UPPER ABDOMEN: Atherosclerotic calcifications of the descending aorta and its major branches, including the origin of the left renal artery. Punctate, nonobstructing renal stones bilaterally. Subcentimeter renal hypodensities are too small to characterize. Cholelithiasis.Compression of the right heart by intrathoracic location of the liver as seen previously.

Output: No evidence of tumor recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Status post tracheal stent placement for tracheal esophageal fistula. The previously seen tracheal stent has been exchanged. The inferior aspect of the new stent is now approximately 2 cm above the carina.Right-sided apically directed chest tubes not significantly changed.Persistent partial opacification of the right hemithorax and retrocardiac subsegmental atelectasis appears similar to prior. Partial surgical resection of the lateral third right rib. Adjacent chest wall soft tissue thickening similar to 5/31/2015 and may reflect hematoma or seroma.

Output: 1.Interval exchange of tracheal stent with inferior most aspect of the tracheal stent now approximately 2 cm above the carina.2.Cardiopulmonary appearance otherwise similar to prior including partial opacification of the right hemithorax.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Please eval for consolidation vs new infiltrates History: new onset CP with dyspnea Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: pna History: sz wkup Low lung volumes. No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unchanged.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: r/o pna History: productive cough, chills, immunosuppressed 2/2 kidney transplant Patchy opacities within the right lower lobe. No pleural effusion or pneumothorax.Post median sternotomy and prosthetic valve. Mildly enlarged cardiomediastinal silhouette, unchanged.

Output: Nonspecific opacities within the right lower lobe, probably pneumonia. No specific evidence of heart failure. Serial imaging is recommended to exclude a mild acute process.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old with shortness of breath and chest pain. Evaluate for acute chest, infection, edema or effusion. Stable cardiomediastinal silhouette with marked cardiomegaly. No abnormal pulmonary opacity to suggest edema or infection. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality, no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Status post lung biopsy question pneumothorax. Poorly defined nodular opacity in the right middle lobe unchanged. Additional micronodules are nonspecific. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with newly diagnosed mantle cell non-Hodgkin's lymphoma. Initial staging. CHEST:LUNGS AND PLEURA: Moderate centrilobular emphysema. Diffuse interstitial opacities. Bilateral pleural effusions, right side greater than left, have improved from the prior examination of 4/19/05.MEDIASTINUM AND HILA: Bulky supraclavicular lymphadenopathy, worse on the right, exerting mass effect on the right internal jugular vein, is incompletely evaluated. Confluent subcarinal lymphadenopathy measures 5.4 x 2.3 cm on axial image 61/216. Bilateral hilar lymphadenopathy is evident as well. Cardiac size is normal. No pericardial fluid.CHEST WALL: A pathologically enlarged internal mammary lymph node measures 2.2 x 1.7 cm on axial image 52/216.ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged measuring 21.5 cm on coronal image 51/109. No focal liver lesions. No intrahepatic bilirubin or dilatation. The portal and hepatic vasculature is patent. Cholelithiasis without evidence of cholecystitis.SPLEEN: The spleen is enlarged measuring 16.8 cm on coronal image 51/109.PANCREAS: Distortion of the normal pancreatic anatomy by the large soft tissue mass as described below.ADRENAL GLANDS: The adrenal glands are not clearly separable from the soft tissue mass.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive, confluent soft tissue density is evident extending from the gastrohepatic ligament and porta hepatis encasing the aorta and its branches extending inferiorly into the mesentery. The conglomeration of masses at the level of the splenoportal confluence measures approximately 10.7 x 5.4 cm on axial image 134/216 which is inclusive of the vascular which the masses encase. Celiac, mesenteric and renal vasculature is displaced by this mass and the right renal vein is attenuated by this mass. The remainder of the vasculature however is patent.BOWEL, MESENTERY: Abnormal soft tissue mass extends inferiorly within the mesenteric displacing bowel loops and encasing the mesenteric vasculature. The conglomeration of masses within the pelvis on axial image 159/216 measures 11.1 x 5.2 cm. BONES, SOFT TISSUES: A levoscoliosis of the thoracolumbar spine is noted. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Prominent inguinal nodes bilaterally. BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted

Output: Extensive supraclavicular, mediastinal and mesenteric masses with reference measurements as described above.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with extensive stage small cell lung cancer status post 6 cycles of chemotherapy. Reevaluate. CHEST:LUNGS AND PLEURA: Complete resolution of the right lower lobe airspace opacities. The previously noted nodular opacity within the right major fissure is smaller and flattened as seen on image 39/91. The previously noted left upper lobe nodule is unchanged in appearance as seen on image 22/91. Micronodules measuring approximately 4 mm as seen on image 57 is unchanged in appearance from prior scan. Scattered additional micronodules appear unchanged.No pleural effusions.MEDIASTINUM AND HILA: The previously identified right paratracheal lymph node measures 13 x 20 mm as seen on image 30 (previously 12 x 21 mm). Right hilar lymphoid tissue is slightly smaller measuring 9 x 13 mm as seen on image 42 (previously 17 x 14 mm). Mass-effect from mediastinal lymphoid tissue on the carina and right main stem bronchus which is stable from prior scan.Cardiac size is normal with no pericardial effusion.CHEST WALL: Right-sided Port-A-Cath with its distal tip in the right atrium. Multiple metastatic lesions to the thoracic and lumbar vertebral bodies. Compression fracture of the lower thoracic vertebral body is unchanged in appearance. Metastatic lesions are also visualized in the sacrum and bilateral iliac wings which were not evaluated by prior studies.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule is stable measuring 13 x 13 mm on axial image 91.KIDNEYS, URETERS: Small bilateral renal cystlike lesions are unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Shotty periaortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal metastatic disease to the bones as above.OTHER: No significant abnormality noted

Output: 1. Complete resolution of right lower lobe air space opacities.2. Decrease in size of reference lymph nodes.3. No new metastatic foci of disease.


Instruction: Generate impression based on medical findings.

Input: Bradycardia, resp distress, and history of V tach in last 24 hrs.VIEWS: Chest and abdomen AP (two views) 9/27/2016, 23:10 ET tube is between thoracic inlet and carina. A gastrostomy tube is present. Right central venous catheter tip is in the SVC. Left upper extremity PICC terminates at the level of the left subclavian vein. External pacemaker/defibrillator pad overlies the mid chest.The cardiothymic silhouette is mildly enlarged. Residual coarse opacities are present on a background of persistent diffuse lung haziness. There is no pleural effusion or pneumothorax.There is no bowel gas. No free air or portal venous gas is present.Marked soft tissue edema has increased from the prior exam.

Output: Residual coarse opacities are consistent with subsegmental atelectasis on a background of persistent diffuse lung haziness. No bowel gas. Soft tissue edema has increased from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Cough Tracheostomy tube, Dobbhoff and right PICC line are all unchanged.Retrocardiac opacity and possible partial consolidation versus atelectasis of the left lower lobe is similar. Remaining lungs remain clear

Output: Left lower lobe nonspecific consolidation and possible probable atelectasis.


Instruction: Generate impression based on medical findings.

Input: 62-year-old man with history of asthma presents with cough and fever. Evaluate for pneumonia. Cardiac size is upper limits normal, unchanged. There are bilateral perihilar and basilar interstitial and airspace opacities compatible with a multifocal infectious process. No pleural effusions. No pneumothorax.

Output: Multifocal interstitial and airspace opacities are compatible with multifocal infectious process.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: assess for pulmonary edema History: high peep requirement Edema pulmonary edema and left lower lobe consolidation with a left pleural effusion, slightly worse than on the prior study.Tracheostomy tube, the tip at the level of the thoracic inlet.A Dobbhoff tube extends below the lower margin of the image.Right subclavian catheter, tip in SVC.

Output: Worsening pulmonary edema and persistent left basilar consolidation with a left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: left mucus plug, eval left opacity History: left opacity Partial reexpansion of the left upper lobe with persistent atelectasis and consolidation in the left lower lobe although with some new air bronchograms.No other significant change.

Output: Partial left upper lobe reexpansion.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Cough for 10 days with decreased breath sounds in the left lower lobe. No focal consolidation, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No evidence of infection or acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Screening CT in metastatic renal cell carcinoma workup. Please give IV contrast only no p.o. CHEST:LUNGS AND PLEURA: Micronodules unchanged. There is a previously described ill-defined irregular right middle lobe lesion has nearly completely resolved (image 75; series 4). Left lower lobe subsegmental atelectasis and pleural thickening is new.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN: LIVER, BILIARY TRACT: The two masses in the liver as noted previously. Reference lesion in the lateral segment of the left lobe measures 6.3 x 5.8 cm (image 94; series 3). This lesion is associated with intrahepatic ductal dilatation. Although this measurement is larger than reported previously, it is difficult compare to the prior exam since that exam was done without intravenous contrast. A second lesion in segment 7 appears roughly stable but is too indistinct to measure on today's examination (image 97; series 3).Biliary stent has been removed. Common bile duct metallic opacity described previously is unchanged. Air noted in the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy.Lobulated mass along the medial aspect of the right kidney measures approximately 5.2 x 2.9 cm (image 110; series 3). Again this is difficult compare the prior exam because that study was done without intravenous contrast. The intrarenal mass seen along the lateral aspect of the left kidney which was not able to be visualized on the prior study measures 1.9 x 1.6 cm (image 116; series 3).RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta and iliac arteries. Aorta is small. BOWEL, MESENTERY: Status post gastric stent with interval decompression of the stomach.BONES, SOFT TISSUES: Loss of height of several vertebral bodies chronic. Also see below.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Chronic bony changes of the ribs, lower spine, pelvis are again noted and have been described previously. These are stable.OTHER: No significant abnormality noted

Output: 1. Status post gastric stent with decompression of the stomach.2. Resolution of previously described inflammatory lung lesion.3. Stable bony findings.4. Liver and kidney lesions are roughly stable but difficult to compare to the prior examination because that exam was done without intravenous contrast.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Chest pain A poorly defined right apical nodular opacity overlies the right first rib at the confluence with the right clavicle, suggestive of a granuloma given density and well defined contours.No abnormal focal lung parenchymal opacities.The pleural spaces are within normal limits.

Output: Right apical nodular opacity suggestive of granuloma given density and well defined contours.No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: purulent chest tube drainage History: purulent chest tube drainage Multiple chest tubes with no significant pneumothorax.Stable pulmonary opacities and pleural effusions consistent with edema as well as possible infection or aspiration.IABP catheter.Right jugular Swan-Ganz catheter tip in main pulmonary artery.

Output: No pneumothorax. No change in support devices or pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: ET tube placement History: ET tube placement ETT tip 4 cm above the carina. Right internal jugular catheter line tip in the atriocaval junction. Left subclavian AICD leads in unchanged position. Median sternotomy wires. Enteric tube tip projects beyond the field of view.The heart size is normal. Progressive increase in patchy airspace opacities, worse in the right upper and lower lung zones with increasing right pleural effusion. There is no pneumothorax.

Output: Increasing patchy airspace opacities throughout the right lung, consistent with infection or aspiration. Increasing right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with history of colorectal carcinoma CHEST:LUNGS AND PLEURA: Bilateral apical scarring is unchanged. No new nodules in the lung parenchyma.MEDIASTINUM AND HILA: Residual thymus in the anterior mediastinum is unchanged.CHEST 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: Bilateral, nonspecific hypodensities in both kidneys are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Long segment of distal ileal loops including the terminal ileum and cecum demonstrate significant wall thickening, associated mesenteric fat stranding, new from previous study. Interval takedown of the right lower quadrant ileostomy. There are borderline dilated small bowel loops in the lower pelvis, however, terminal ileum and distal most small bowel segments are decompressed.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: Please see the discussion above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis.

Output: Interval right lower quadrant ileostomy takedown.Interval development of distal ileal and cecal significant wall thickening and fat stranding with mildly dilated distal small bowel loops. Etiology is unknown and may include ischemia, radiation, infection or inflammation.These findings were discussed with Dr. Sadiq at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Reason: infiltrate History: SOB; cough Exam is limited by patient motion and patient's body habitus.Nonspecific basilar opacities are not well evaluated; infection is not excluded.Right lung nodules seen on prior CT are redemonstrated, more conspicuous than seen on prior chest radiographs. Mediastinal widening is redemonstrated, likely reflective of mediastinal mass seen on CT.Moderate to severe cardiomegaly is redemonstrated.

Output: Limited exam; infection not excluded.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: MaleReason for Study: Reason: r/o cardiopulm infiltrate History: shortness of breath The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Intubated, MICU check for pneumothorax. NGT has been advanced the stomach. Other tubes and lines unchanged in position.Diffuse interstitial and airspace opacities throughout the transplanted left lung unchanged. Moderate volume of pleural fluid on the left similar to previous. Fibrotic native right lung without acute change.No pneumothorax.

Output: Interval advancement of NGT to the stomach. No pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and thoracentesis Interval increasing and now moderate bilateral pleural effusions essentially unchanged on the left and larger on the right. Underlying compression atelectasis greater in a retrocardiac position, which additionally raises concern for possible aspiration or a superimposed partial consolidation of left lower lobe. Serial imaging is needed to confirm clearanceICD and mediastinal contours are otherwise unchanged

Output: Enlarging pleural effusions and questionable nonspecific partial consolidation of the left lower lobe, see detail provided


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: cough for 1 week Unremarkable cardiac and mediastinal silhouette.Mild tracheal deviation to the left at the thoracic inlet suggestive of a goiter.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT; ADMISSION TO ICU Two chest tubes on each side following lung transplant, with improvement in bilateral pneumothoraces, a small amount of fluid tracking over the lung apices.ET tube tip approximately 5 cm above the carina.Left subclavian Swan-Ganz catheter tip in main pulmonary artery.

Output: Improvement in pneumothoraces with no new findings.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: eval for infiltrate History: cough. Cardiomediastinal silhouette is within normal limits.New airspace opacity in the right lower lobe.No pneumothorax or pleural effusion is identified.

Output: Right lower lobe airspace opacity may represent infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval cp History: lung ca lobectomy, pw. chest pain Right hemithorax postsurgical volume loss with right hemidiaphragm elevation and a very small right pleural effusion or pleural thickening.Elsewhere, the lungs are unremarkable without evidence of tumor recurrence.Heart size normal.

Output: Unchanged right hemithorax postsurgical volume loss with no evidence of recurrent tumor, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 26 year old female with history of neuroblastoma, meningioma status status post resection, and paraspinal sarcoma evaluate for metastases, history of thyroid cancer, correlate with total body scan LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Surgical absence of the thyroid gland.CHEST WALL: Focal area of stable sclerosis and T4 vertebrae. Degenerative changes of T11 to 12 level.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: r/o infiltrate History: HIV w/ cough No focal consolidation, pleural effusion or pneumothorax. Increased convex enlargement of the right perihilar region consistent with aneurysmal dilatation of the ascending aorta. There is mild gaseous distention of several loops of bowel in the left upper quadrant.

Output: Increased convex enlargement of the right perihilar region consistent with within an enlarging ascending aortic aneurysm, correlation with echocardiography is suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: patient s/p EGD w/ dilation, please do upright film to eval for free air History: s/p dilation To distal esophageal stents, the initial that extends beyond the hemidiaphragm level is within a larger outer distal stent.No significant pulmonary or pleural abnormality.

Output: Esophageal stent, without complication such as free air or pneumomediastinum following dilation.


Instruction: Generate impression based on medical findings.

Input: Status post lung reduction surgery. Right lung is markedly hyperinflated consistent with severe emphysema. Trace, less than 2 mm lucency at the right apex, indeterminate and can be monitored.Endobronchial valves on the left. No pneumothorax.

Output: No significant sized pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with chest pain. The mediastinal silhouette is normal.No focal pulmonary consolidation or pleural effusion.No pneumothorax or obvious rib fractures.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: s/p R IJ TLC placement. Tip location History: none Cardiomegaly with mild interstitial edema pattern.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC. Unchanged edema like opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. 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: Enteric tube placement Suboptimal study secondary to patient motion artifact. Enteric tube seen extending towards ligament of Treitz. Right upper quadrant drain as well as pigtail drainage catheter. Residual contrast seen in bowel. Overall paucity of small bowel gas. Scattered clips. Amorphous lucency in right upper quadrant likely due in part to gas-containing collection. Small subcutaneous emphysema.

Output: Enteric tube and additional findings as above.


Instruction: Generate impression based on medical findings.

Input: Tachycardia PULMONARY ARTERIES: There is no filling defect within the pulmonary arterial system to suggest a pulmonary embolism.LUNGS AND PLEURA: There are small bilateral pleural effusions, new since prior study with biblasilar mild atelectatic changes. The lungs are otherwise clear.MEDIASTINUM AND HILA: There are no enlarged mediastinal or hilar lymph nodesCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Again noted is a large lateral hernia, similar to prior study. There is thickening of the mid and distal esophagus, nonspecific.

Output: 1.No pulmonary embolism. Stable appearance of large hilar hernia. New small bilateral pleural effusions2.Circumferential thickening of the mid/distal esophagus is nonspecific. Correlation with endoscopy if one has not been recently performed can be considered.


Instruction: Generate impression based on medical findings.

Input: Age: 35 yearsGender: MaleReason for Study: Reason: 35 y/o M with history of pancreatitis and SIRS, eval pulmonary status and lung function History: as above Enteric tubes and right IJ venous catheter unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Mild basilar atelectasis.No focal areas of consolidation.No large pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: prior latent TB diagnosis and treatment, assess for TB for clearance History: lantent TB Normal chest.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Reason: eval of lung fields History: postop cardiac pt ET tube tip within 1 cm of the carina with the neck in a flexed position.Swan-Ganz catheter tip in the main pulmonary artery.Small lung volumes with nonspecific basilar opacity compatible with atelectasis, consolidation and small effusions.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Normal chest.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Worsening productive cough. History of RSV. Right jugular chest port with tip at the SVC level.Normal heart size.Small right pleural effusion.Low lung volumes.No groundglass opacities or nodules to confirm RSV pneumonia, though it may not be visible by this technique.No focal airspace opacities.Mild degenerative changes spine.

Output: Small right pleural effusion, but otherwise no visible signs of pneumonia. Please note that RSV pneumonia may be beyond the resolution of plain film technique for detection and cannot be entirely excluded despite absence of significant findings on the chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Increasing oxygen requirement admitted for acute chest. Right jugular VAD unchanged in position.Motion artifact. Diffuse pulmonary opacities consistent with bronchial wall thickening, edema and atelectasis, about the same. Unsharpness of these opacities in the left lower lobe is suspicious for superimposed acute chest/infection. Small pleural effusions.

Output: Moderate CHF with left lower lobe opacities suspicious for acute/infection.