Instruction: Generate impression based on medical findings.

Input: 63 year old male with colorectal cancer and a single lung lesion. Please evaluate. CHEST:LUNGS AND PLEURA: There is a right middle lobe nodule measuring 6 mm x 7.5 mm (image 46, series 4), which is enlarged compared to prior study. Linear scarring, atelectasis, and surgical sutures in the left lower lobe represent the patient's prior wedge resection. MEDIASTINUM AND HILA: Thrombus is noted in the right SVC.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Surgical clips are seen at the margin of the left lower lobe, representing the patient's prior partial hepatectomy, and is unchanged from prior study. Also, in the right posterior hepatic lobe there is a homogeneous hypoattenuating area with multiple surgical clips, consistent with the patient's prior surgery and remains unchanged. No new parenchymal lesions are visualized.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is hydronephrosis and hydroureter of the left kidney, which appears similar to the prior study. The distal right ureter appears normal, but disappears at image 167, series 3, and possible tumor recurrence cannot be completely excluded.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: There is concentric rectal wall thickening, which was seen on the prior study and remains unchanged.Small fat-containing right inguinal hernia with no evidence of obstruction appears similar to the study.BONES, SOFT TISSUES: Presacral soft tissue is likely due to postsurgical changes and is unchanged compared to the prior study.A metallic right total hip arthroplasty with adjacent streak artifact is again seen.OTHER: No other significant abnormality noted.

Output: 1.Right middle lobe nodule appears enlarged from the prior study suspicious for metastatic disease.2.Small, nonocclusive Thrombus noted in the right SVC3.Stable left hydronephrosis and hydroureter.


Instruction: Generate impression based on medical findings.

Input: Reason: swan and iabp position History: swan and iabp Swan-Ganz catheter tip in the right main pulmonary artery.Balloon catheter in the descending aorta with a marker at the level of the aortic arch.Catheter tip in the SVC.Cardiomegaly with no sign of edema or infection.

Output: Swan-Ganz catheter in the right main pulmonary artery and balloon catheter in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: 71 yo M w/ worsening chest pain, known pneumomediastinum, eval for worsening SQ air History: see above Pneumomediastinum and subcutaneous emphysema about the same. Small, fibrotic lungs. Trace extrapleural air, but no pneumothorax.

Output: Unchanged subcutaneous emphysema and pneumomediastinum, no conclusive pneumothorax.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Status-post BAL. Diffuse mild interstitial abnormality is new from previous and may reflect interstitial fluid/edema post BAL. No airspace consolidation or pneumothorax. Heart size within normal limits. ET tube is 2 cm above the carina. NG tube curled in the proximal stomach.

Output: New mild diffuse interstitial fluid post BAL.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male presents for LVAD check. Cardiomediastinal silhouette is unchanged.No focal pacity, pleural effusion, or pneumothorax.ICD overlies the left chest wall with single lead intact. Median sternotomy fixation hardware in place. LVAD in place.

Output: Unchanged LVAD and ICD.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: cause of hypoxia History: hypoxia Large right pleural effusion. Small left pleural effusion. Right upper lobe mass highly suggestive of malignancy.

Output: Large right pleural effusion. Small left pleural effusion. Right upper lobe mass highly suggestive of malignancy.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: intubated, advanced ET tube History: intubated, advanced ET tube. Endotracheal tube tip approximately 5-6 cm from the carina.No focal air space opacity.No pneumothorax, pulmonary edema, or significant pleural effusion.Unremarkable cardiomediastinal silhouette.

Output: Endotracheal tube 5-6 cm above the expected level of the carina..I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.COPD and hypoxemia. High peak pressures on vent. Tracheostomy tube tip 4 cm above the level of the carina.Large volume of loculated pleural fluid on the right unchanged. Minimal improvement in edema-like opacity in the left lung. Minimal pleural fluid on the left, unchanged.

Output: Minimal improvement in edema-like opacity but otherwise no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: evaluate for interval change History: hypoxia Small pleural effusions with increasing basilar opacities are consistent with infection or aspiration.

Output: Increasing basilar opacities.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female, ETT Tracheostomy tube tip approximately 3 cm above the carina. Feeding tube tip extends beyond the inferior margin of the image.Right central venous catheter extends to at least the SVC as the tip is not visible due to the motion artifact. Patchy right-sided airspace opacities have increased from prior study compatible with pneumonia likely due to aspiration. No large pleural effusion. No pneumothorax.Moderate cardiomegaly.Focal metallic opacity in the right axilla present since at least 2012 likely an airgun pellet.

Output: Increasing patchy right-sided airspace opacities compatible with pneumonia, likely due to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: Rule out aspiration History: 31 y/o with cerebral palsy with hematemesis for 3 days. Concern for aspiration Cardiac mediastinal silhouette is unchanged.Lungs are clear with persistent and unchanged partial effacement of the left hemidiaphragm.Redemonstration of pronounced S-shaped scoliosis of the thoracolumbar spine status post posterior fusion. PEG tube in place.

Output: No evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Lymphoma No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: confirm stable IABP and swan placement History: advanced heart failure Support devices are unchanged in position.Cardiomegaly stable. There complete resolution of previous pleural effusions. The lungs are clear. No pneumothorax.

Output: Trace pleural effusions without edema.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: intubated , unstable postop Endotracheal tube tip is approximately 2 cm above the carina. Right internal jugular catheter is kinked with tip overlying the right supraclavicular area. Persistent moderate left lung atelectasis. No pneumothorax. Cardiac silhouette cannot be fully evaluated on this radiograph.

Output: 1.Endotracheal tube is in adequate position.2.Persistent moderate left lung atelectasis3.Right internal jugular catheter is kinked with tip overlying the right supraclavicular area.


Instruction: Generate impression based on medical findings.

Input: Evaluate ileus Suboptimal study secondary to patient motion artifact. Enteric tube seen with side-port at level of gastric fundus/body. Few scattered clips. Mild bowel gaseous dilatation, appearance most consistent with diffuse ileus. No specific evidence of bowel obstruction. Moderate to large stool located at level of rectal vault. Gastric calcifications noted. Spinal degenerative disease. Possible left basilar/retrocardiac airspace disease.

Output: Suboptimal exam secondary to patient was artifact. Enteric tube as above.Moderate to large stool located at level of rectal vault. Mild diffuse bowel dilatation seen otherwise, appearance most consistent with diffuse ileus.


Instruction: Generate impression based on medical findings.

Input: Reason: assess lines History: as above Aortic balloon catheter marker at the level of T11.ET tube and Swan-Ganz catheter are unchanged.Layered out pleural effusions and atelectasis, also unchanged.

Output: Proximal location of the aortic balloon catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: pna? Aspiration? History: confusion, sz Very small left pleural effusion and basilar subsegmental atelectasis.Possible small right pleural effusion.Heart size normal.

Output: Minimal atelectasis and small pleural effusions, but no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with hemoptysis. Endotracheal tube tip at the thoracic inlet. Swan-Ganz catheter tip likely within the left pulmonary artery with evidence of looping of the catheter within the left pulmonary artery. Right sided central venous catheter with tip in the right atrium. Postoperative changes of median sternotomy. LVAD is noted. Unchanged positioning of the right chest tube with side port outside the pleural space.Increasing retrocardiac opacity may represent atelectasis with underlying aspiration/infection not excluded. Unchanged right-sided pulmonary opacities. Small right apical pneumothorax has decreased in size compared to the previous examination.

Output: 1.Interval decrease in size of small right apical pneumothorax. 2.Increasing retrocardiac opacity may represent atelectasis with underlying aspiration/infection not excluded. 3.Swan-Ganz catheter either looped in left main PA or entering a lower lobe branch.4.Right chest tube side port outside the pleural space.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent large right effusion with suspected loculation and underlying compression atelectasis/consolidation. Again increasing parahilar and basilar interstitial opacities with a small additional left effusion, most and best appreciated on the left. Again this is most concerning for increasing edema and CHF superimposed upon previously described nodular changes representing known both primary lung and metastatic foci.Right chest tube, right jugular port are otherwise unchanged.Mild cardiomegaly

Output: Right chest tube unchanged yet the underlying cardiopulmonary appearance demonstrates increasing findings suggesting edema partially obscuring the previously observed nodular primary lung and metastatic foci


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Chest pain. Right bundle branch block. Cardiomegaly. Coronary stents. Sternotomy hardware similar in alignment.No focal pulmonary opacities or pleural fluid. No pneumothorax. No evidence of pulmonary edema.Chronic healed rib deformities bilaterally.

Output: Cardiomegaly, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: eval ETT placement History: ETT pulled back Endotracheal tube tip now 3 cm superior to the carina. Right IJ central venous catheter and left IJ dialysis catheter as well as enteric tube remain unchanged.Stably enlarged cardiac silhouette.Bilateral pulmonary opacities remain grossly unchanged and again suggest pulmonary edema.

Output: Endotracheal tube tip now 3 cm superior to the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: eval septic emboli History: as above ICD with leads unchanged. ICD obscures evaluation of the lower lung zone.Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax. Horizontal linear opacity in the right midlung may represent atelectasis along the minor fissure. Left apex asymmetric opacities again noted. No new pulmonary opacities suspicious for septic emboli as clinically queried.

Output: Persistent left upper lobe opacity. Atelectasis without new opacities suspicious for septic emboli. Consider CT.


Instruction: Generate impression based on medical findings.

Input: Lung nodule. LUNGS AND PLEURA: Right apical nodular opacities unchanged, compatible with scarring.6 mm subpleural right lower lobe ground glass nodule (70/108) unchanged.MEDIASTINUM AND HILA: No significant lymphadenopathy.Variant right middle lobe pulmonary venous drainage.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Nonspecific subcentimeter hypodense lesions, compatible with cysts and hypodense area adjacent to the falciform ligament, compatible with focal fat.

Output: Persistent unchanged 6-mm right lower lobe ground glass nodule with a differential diagnosis that includes atypical adenomatous hyperplasia, adenocarcinoma in situ and focal nodular fibrosis. Annual follow-up is recommended for 3 years from the time of detection to confirm stability.


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of right video-assisted thorascopy 3 1/2 years ago, right lower lobectomy for management of restage non-small cell lung cancer. CHEST:LUNGS AND PLEURA: Postsurgical changes from right lower lobectomy are unchanged in configuration and morphology with mild right pleural thickening also unchanged. Few scattered micronodules, unchanged. No suspicious nodules, masses, or pleural effusion.Emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Reference low right paratracheal lymph node (series 3, image 35) measures 8 x 12 mm (not significantly changed since study from October 2009).Heart size normal without pericardial effusion. Coronary and aortic calcifications.CHEST WALL: Degenerative changes of the spine. ABDOMEN: LIVER, BILIARY TRACT: Probable fatty infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst, unchangedRETROPERITONEUM, LYMPH NODES: Marked atherosclerotic calcifications of the descending aorta and major branch vessels. Aneurysmal dilatation of the proximal celiac artery, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of tumor recurrence or metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval for effusions History: fever, ams NG tube extends beyond the inferior margin of the image. Cardiomegaly, unchanged. Elevation of the right hemidiaphragm with overlying atelectasis and trace pleural effusion, unchanged. No new pulmonary findings.

Output: Elevation of the right hemidiaphragm with overlying atelectasis and trace pleural effusion, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: Neutropenic fever History: fever Unremarkable cardiac and mediastinal silhouette. Decreased lung volumes with mild interstitial opacity at both bases and subsegmental atelectasis.No specific evidence of pneumonia.

Output: Mild nonspecific interstitial opacity and subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: large volume resuscitation, new onset atrial flutter History: atrial flutter, hypoxia Slight increase in basilar opacities suggestive of edema or aspiration with subsegmental atelectasis. Heart size normal. Right jugular catheter tip at cavoatrial junction level.

Output: Slight increase in basilar opacities suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for edema History: chf, sob Mild cardiomegaly with ICD leads in place, unchanged from previous. Epicardial pacer leads are also present.Blunting of the left costophrenic angle, slightly increased compared to previous, suggestive of a small pleural effusion.No sign of pulmonary edema.

Output: Possible small left effusion but no sign of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 23-year-old female with history of asthma who presents with cough for 3 months. Cardiomediastinal silhouette is unremarkable.No consolidation, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 61 year old male with IABP. IABP marker unchanged in projection of the aortic arch. Left sided ACID leads unchanged. Right PICC tip slightly retracted in the right axilla. No focal airspace opacities. No pleural effusion or pneumothorax. Stable cardiomediastinal silhouette. A portion of the left upper lobe is obscured by the pulse generator.

Output: IABP marker unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: Intubated History: Intubated Unchanged edema like opacities and right pleural effusion.Spinal stabilization hardware obscures the ET tube tip, but most likely it is 6 to 7 cm above the carina.An NG tube terminates in the stomach.Right jugular Swan-Ganz catheter tip in mid right lung.

Output: ET tube tip partially obscured, likely 6-7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: eval post op History: eval post op Left-sided pleural effusion decreased from the prior exam. Mild left basilar atelectasis improved from the prior exam.The cardiomediastinal silhouette is unremarkable.Right lung is clear.

Output: Interval improvement in the left pleural effusion and left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Decreased breath sounds left base. Dyspnea. Bilateral basilar atelectasis with superimposed left lower lobe focal consolidation and moderate effusion. Concern for pneumonia. Left apical opacity correlates with previously described mass on CT. Mild cardiomegaly. Unchanged mild tortuosity of the aorta.

Output: New left lower lobe focal opacity and effusion concerning for pneumonia in the appropriate clinical setting and/or extension of the known left upper lobe apical mass


Instruction: Generate impression based on medical findings.

Input: Reason: r/o cardiopulm abnormality History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Tachycardia Interval increasing opacification of the left lower lobe with suspected atelectatic collapse. Small effusion and perihilar changes again suggest mild edema.Dobbhoff projects beyond the inferior edge of the image. Right jugular catheter is new terminating in the proximal SVC. No additional immediate postprocedural complications

Output: Right jugular catheter placed with increasing left lower lobe opacification, likely atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: patient with reported pleural effusion at OSH ER, treated with Abx, evaluate for resolution History: patient with reported pleural effusion at OSH ER, treated with Abx, evaluate for resolution Apparent nodular opacity projected over the left lung base, similar to the prior study. An abdominal CT performed 6/7/2016 failed to reveal a pulmonary nodule and most likely this is a summation artifact.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality. No pleural effusion as questioned in the clinical history provided.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: s/p AVR/MVR with CT Removal - PTX / Pulm Edema? History: SOB Unchanged cardiac leads. Right-sided PICC again terminates in the right axilla. Unchanged left basilar pleural-parenchymal opacities. No significant pneumothorax. Unchanged heart size.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: MaleReason for Study: Reason: evaluate ETT placement History: interval change Port device is unchanged with ET tube tip 3 cm above the carina.Stable cardiomediastinal silhouette.Mild basilar scarring/discoid atelectasis.No new pulmonary opacities identified.

Output: Support devices unchanged with ET tube tip 3 cm above the carina. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 67 years old Female. Reason: Evaluate for mass, source of ?SVC syndrome History: LUE and neck swelling. Doppler suggestive of ?proximal obstruction. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. The tip of the venous catheter projects over the right atrium.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: eval for PNA History: hypoxia Left-sided pacemaker unchanged. The cardiomediastinal silhouette is unremarkable.Bilateral interstitial/airspace opacities slightly increased from the prior exam.Possible small effusions right greater than left.

Output: Mild interval progression in the bilateral air space/interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Rule out pneumonia, effusion, cardiomegaly History: found unresponsive at home for 30 min. now alert x 3. concern for stroke/seizure workup The lungs and pleural spaces are clear. Multilevel degenerative osteophytes are present. The heart size is within limits of normal.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with non-Hodgkin lymphoma. CHEST:LUNGS AND PLEURA: Stable bilateral subcentimeter nodules.MEDIASTINUM AND HILA: Small pericardial effusion 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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable scattered subcentimeter mesenteric lymph nodes. Inflammation in the mesentery is also stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: sp placement of left IJ CVC History: none Unchanged basilar opacities possibly aspirated secretions or mucous plugging.ET tube tip approximately 4 cm above the carina.Left jugular catheter, tip in SVC.

Output: Left jugular catheter, tip in SVC. Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: PNA History: tachypnea Small lung volumes with nonspecific basilar interstitial opacities suggestive of edema or aspirated secretions.No reliable evidence of infection.Tracheostomy tube tip approximately 3 cm above the carina.

Output: Nonspecific basilar interstitial opacities unchanged, suggestive of aspirated secretions or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: abnormality History: tenderness s/p mvc Heart size upper normal.Tortuous brachiocephalic vessels causing apparent widening of superior mediastinum.Minimal basilar subsegmental atelectasis and a small right pleural effusion are present.

Output: Heart size upper normal, with tortuous brachiocephalic vessels mimicking a mediastinal mass. Small right pleural effusion, suggestive of borderline CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: dyspnea History: as above Moderate cardiomegaly and a tortuous aorta, unchanged from previous.No evidence of pulmonary edema or pneumonia.

Output: Cardiomegaly with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: assess for interval change in pneumothorax History: pneumothorax s/p chest tube Unchanged left chest tube with no change in the left pneumothorax.Unchanged basilar opacities suggestive of atelectasis.

Output: Unchanged left pneumothorax. Suboptimal image quality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: reasess History: acute worsening hypoxia No pneumothorax. No significant change in the bibasilar lung opacities.Stable cardiac silhouette

Output: No significant change in right basilar lung opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out acute chest syndrome History: hgbss presents c/o chest pain Normal heart size with slightly increased upper zone blood flow consistent with chronic anemia.Skeletal findings consistent with sickle cell disease.No acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Reference right hilar lymph node measures 9 x 5 Moores on image number 44, series number 3, smaller compared to previous study.CHEST WALL: Left scapular metastatic focus has increased in size compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortocaval reference lymph nodes is stable measuring 7 x 7 mm image number 119, series number 4. Other retroperitoneal lymph nodes are also stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval increase in the size of the some of the previously seen metastatic lesions.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cholecystectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable multifocal sclerotic foci in the pelvic bones.OTHER: No significant abnormality noted

Output: Interval increase in the size of some of the sclerotic bone lesions. No other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Acute exacerbation of COPD post procedure rule out pneumothorax. Right lower lobe endobronchial valves with slight improvement in associated atelectasis. No pneumothorax. Severe emphysema. Apical calcific scarring.Multilevel vertebral compression fractures. Lower thoracic spine vertebroplasty material. Normal heart size. Atherosclerotic calcification of the thoracic aorta.

Output: No pneumothorax. Slight improvement in atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: dyspnea probable HFpEF evaluate, known H.H History: DOE Large hiatal hernia.Heart size normal.No significant pulmonary or pleural abnormality.Left subclavian pacemaker, leads unchanged in position.

Output: Large hiatal hernia, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 55 old male with history of lymphoma. CHEST:LUNGS AND PLEURA: Unchanged, scattered bilateral micronodules.MEDIASTINUM AND HILA: 13 x 14 mm of adenopathy in the prevascular space on image number 33, series number 3 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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: 3.6 x 3 cm cystic, well-defined lesion in the right caliculus minimus muscle is unchanged in size compared to previous study. However, it is increased in size compared to CT dated 1/12/2007 where it was measuring 2 x 1.3 cm. This may represent a bursa, however, if there is a clinical concern, further evaluation with pelvic MR may be helpful.A smaller, hypodense lesion within the left iliopsoas muscle may also represent a smaller bursa. And is unchanged from previous study, but new from CT dated 1/12/2007.OTHER: No significant abnormality noted

Output: No significant change from previous study.MRI of the pelvis may be helpful for further evaluation of the benign appearing intramuscular cystic lesions, if clinically relevant..


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: check for ptx on right s/p biopsy History: lung nodules Trace right sided pneumothorax.

Output: Trace right sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 64 years, Male. Reason: placement of new ng tube History: new ngt Limited visualization of abdomen. Pelvis is excluded from view. Enteric tube tip is seen in the distal gastric body. Additional enteric tube tip seen with tip in the distal third portion of the duodenum, similar to prior study. Please refer to same day chest radiography for further findings.

Output: Enteric tube tip seen in the distal gastric body.


Instruction: Generate impression based on medical findings.

Input: Male 37 years old Reason: S/p subcutaneous ICD History: None Left chest wall ICD with pre-sternal lead to the left of midline.Cardiac silhouette size is mildly enlarged. No specific evidence of edema or infection.

Output: Status post left chest wall ICD placement, no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: 25 y/o M with CHF eval swan History: swan Swan-Ganz catheter from the right jugular is blurred by cardiac pulsation and only partially visible in the area of the main pulmonary artery. Marked cardiomegaly with a presternal ICD lead in place.No pneumothorax or other complications.

Output: Poorly visualized Swan-Ganz catheter extending at least to the main pulmonary artery and possibly further distally.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with cholangiocarcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Prominent intrapedicular tree with pneumobilia is unchanged. Patient's known portacaval node is slightly smaller measuring 10 x 9 mm on image number 99, series number 10. Other lymph nodes are also slightly smaller. Hazy soft tissue surrounding the hepatic vasculature at the level of the hepatic hilum is again noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described obstruction has resolved.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Slight interval increase in the size of the mesenteric lymph nodes, best seen on image number one and 6 on series number 10.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal interval decrease in the size of the reference lymph nodes.Interval increase in size of some of the pelvic mesenteric lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: r/o acute cardiopulmonary process History: SOB New opacification of the left lung base consistent with atelectasis and pleural effusion. Mild interstitial pulmonary edema.Cardiomediastinal silhouette is unremarkable.Lung volumes are normal. No pneumothorax.

Output: New left atelectasis and effusion, cannot exclude concomitant infection. Mild interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval for infiltrate, has hx of lung ca and RUL removed in 2008 or 2009 at Stroger History: cough for 2 weeks Normal cardiomediastinal silhouette.Postsurgical changes and volume loss in the right hemithorax related to previous right upper lobectomy.Linear opacities in the right lung likely represents scarring.No significant pleural effusion or focal consolidation.

Output: Postsurgical changes in the right hemithorax without specific evidence of acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with history of lung cancer status post palliative radiation to the right hilar mass. Cough, exertional shortness breath. CHEST:LUNGS AND PLEURA: Marked interval decrease in the size of known right hilar mass, which is currently difficult to measure. However, it measures approximately 2.6 x 1.8 cm; previously measuring approximately 4.2 x 2.8 cm.Marked centrilobular and paraseptal emphysema.Interstitial thickening and ground glass opacities in the right upper lobe likely reflect sequela of radiation therapy.MEDIASTINUM AND HILA: Reference precarinal lymph node (series 3, image 40) measures 1.2 x 1.2 cm; previously measuring 1.4 x 1.2 cm. Heart size normal without pericardial effusion. Severe coronary calcifications.CHEST WALL: Degenerative changes of the spine.ABDOMEN: LIVER, BILIARY TRACT: Reference metastatic lesion in the right hepatic lobe (series 3, image 92) has increased in size. It measures 1.6 x 1.6 cm; previously measuring 1 x 0.8 cm.Two new confluent metastatic deposits are seen more anteriorly in the right hepatic lobe (series 3, image 93) as well. Line stable intra-and extrahepatic biliary ductal dilatation.SPLEEN: New large hypoattenuating lesion at the splenic hilum (series 3, image 90) measures 3.9 x 2.2 cm and is suspicious for new metastasis.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts bilaterally, unchanged.RETROPERITONEUM, LYMPH NODES: Marked atherosclerotic disease of the descending aorta and iliac arteries.BOWEL, MESENTERY: Fat-containing right posterolateral lumbar hernia, unchanged (series 3, image 124). No evidence of bowel involvement.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: 1. Interval decrease in size of the recently radiated right hilar mass.2. Increasing liver metastases.3. New lesion in the splenic hilum is suspicious for a metastatic focus.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Reason: Is ETT is correct position? History: Ventilated Endotracheal tube terminates 6 cm above carina. Successful advancement is documented on subsequent radiograph. The nasogastric tube is coiled in the gastric fundus.Persistent right-sided opacities concentrated in the right middle and lower lobes of aspiration or infection. Heart size is normal. Small right pleural effusion suspected.

Output: Endotracheal tube terminates 6 cm above carina, successfully advanced on subsequent radiograph.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: post-op liver transplant, acute respiratory insufficiency, ventilator dependent, line eval History: respiratory insufficiency, pigtail catheter present No change in pulmonary opacities including interstitial edema like findings and left lower lobe consolidation.Tracheostomy tube tip approximately 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.An NG tube terminates in the stomach.Left subclavian catheter, tip in left brachiocephalic vein near the midline.Previously questioned catheter-like opacity projected over the right thoracic inlet level is no longer visible.

Output: Unchanged pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.History of bladder cancer, evaluate for metastatic disease. Normal heart size. Sternotomy changes. Moderate hiatal hernia.Blunting of the costophrenic angles similar to outside PET/CT compatible with scarring. Sharply marginated right lower lobe masslike opacity appearing similar to prior outside PET/CT and most compatible with a focus of rounded atelectasis. No suspicious pulmonary nodules or masses.

Output: Right lower lobe masslike opacity most compatible with rounded atelectasis without additional suspicious nodules or masses.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: HF signs History: Hypotension initiated that only the setting. We only didn't like today as abdomen: Same definitely not the MR basically advanced years and some many of those there are Low lung volumes persist. Lines unchanged.Minimal improvement in basilar opacities.No pneumothorax.

Output: Low lung volumes with basilar opacities persist.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: chest pain History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 57F with esophageal GIST tumor s/p stent placement, concern for aspiration of blood History: Aspiration pneumonia concern Streaky bilateral pulmonary opacities consistent with areas of subsegmental atelectasis and focal consolidation which may be secondary to aspiration.Midline retrocardiac opacity consistent with distal esophageal mass. Right middle lobe lung nodule as previously described.

Output: New focal pulmonary opacities compatible with atelectasis and possibly aspirated material.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with cough, nasal congestion and fever. Questionable opacity in the medial right upper lobe. No pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: Questionable opacity in medial right upper lobe which could be due to pneumonia in the appropriate clinical setting. Consider follow-up within the next 3 months ensuring resolution of symptoms.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.History of LVAD placement with leukocytosis and fever. Defibrillator leads unchanged in position. LVAD noted. Sternotomy fixation hardware unchanged.The cardiomediastinal silhouette is normal.Patchy opacities in the bilateral lung bases are stable. There are no new focal pulmonary opacities or pleural effusions.Degenerative changes noted in the spine.

Output: Chronic basilar scarring/atelectasis without acute cardiopulmonary abnormality. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of bladder cancer s/p radical cystectomy with ileal conduit urinary diversion, evaluate for metastatic disease History: see above Unremarkable cardiac and mediastinal silhouette. Large lung volumes suggestive of COPD with no acute findings.

Output: COPD with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval tube placement, cxr History: cardiac arrest No pneumothorax.Perihilar opacities suggestive of aspiration with focal consolidation in the superior segments of the lower lobes.Septal lines at the periphery suggestive of interstitial edema. ET tube tip approximately 3 cm above the carina.NG tube traversing the esophagus with its tip in the stomach.A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: 75M intubated in CCU, ?ETT, ?airspace opacity progression, ?pleural effusions History: fever, hypoxia, respiratory failure Endotracheal tube terminates 4 cm above the carina. The remaining support devices are unchanged in position.Increasing airspace and interstitial opacities, now visible in the left midlung. No pneumothorax is present. Cardiac silhouette is obscured.

Output: Increasing bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.SOB with history of heart failure. Severe multichamber cardiomegaly about the same. Globular cardiac configuration suspicious for pericardial fluid. Superior mediastinal widening present previously and not significantly changed. The aortopulmonary window region remains enlarged as to the pulmonary hila. Mild pleural thickening and fluid. Left lower lobe opacity was present previously and may reflect compressive atelectasis in the absence of signs of infection. Mild chronic and diffuse density of the lung parenchyma likely a combination of soft tissue summation artifact and sequela of chronic CHF. No acute signs of pulmonary edema are appreciated.

Output: 1. Unchanged globular multichamber cardiomegaly and/or pericardial fluid.2. Mild mediastinal widening present previously.3. Signs of chronic CHF and pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: infiltrate History: SOB Marked volume loss in the right lung with shift of mediastinum from left to right and evidence of a prior right upper lobectomyFoci of air at the right lung base and loculated pleural effusion similar to the prior exam.The left lung is clear without evidence of acute abnormality.Embolization coils noted in the right upper lobe.

Output: Significant chronic abnormalities in the right lung unchanged. No acute abnormality noted in the left lung.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Pneumonia at outside hospital. Presenting with history of lung transplant. Partial clearance of left basal opacity. Right basal opacity, most suggestive of atelectasis, about the same. Pleural thickening on the right unchanged. Probable emphysema in the left lung with atelectasis but no convincing signs of edema. Cardiomegaly. Central pulmonary vasculature appears enlarged, unchanged. Wireless pacemaker.

Output: Improvement in left basal opacity, otherwise, no acute change or signs of edema. Follow-up PA and lateral chest radiographs suggested in 4-6 weeks to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: Rt lung abscess and pna History: shortness of breath A pigtail catheter has been placed in a loculated pleural fluid and air collection or lung abscess, posteriorly and inferiorly in the right hemithorax.Left lung unremarkable.

Output: Pigtail catheter placement with a loculated hydropneumothorax or lung abscess.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old with a history of lung cancer now with shortness of breath. Evaluate for pleural effusion. Stable cardiomediastinal silhouette with right paramediastinal opacity. Small right pleural effusion. No new pulmonary opacity or pneumothorax.

Output: Stable right lower opacity compatible with evolving radiation reaction possibly with superimposed infection with small right pleural effusion. Current tumor is also in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: desaturation postop History: desaturation Slight improvement of basilar consolidation with stable pleural effusions. Right chest wall soft tissue emphysema.No abnormalities.

Output: Slight improvement in basilar consolidation with stable pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: MaleReason for Study: Reason: Evaluate for line position, s/p adjustment History: s/p adjustment to previously place LIJ line Left IJ venous catheter has been repositioned with the tip now in the proximal SVC.Stable cardiac enlargement.Pleural effusions, pulmonary edema, and basilar atelectasis similar in appearance to the prior exam.

Output: Repositioning of left IJ venous catheter. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Rule out stroke. Aspiration risk. The cardiomediastinal silhouette is within normal limits. The pulmonary vasculature is also within normal limits. Calcified left hilar lymph nodes, and scattered calcified granulomas most notable at left base. No airspace opacity, large pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary process. Calcified subcentimeter nodule at left base likely represents granuloma. Follow-up CT thorax in 3-6 months recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: ETT History: ETT ET tube tip in right main bronchus, subsequently repositioned.An NG tube terminates in the stomach.Unchanged basilar atelectasis left greater than right.Mild cardiomegaly.

Output: ET tube tip in right main bronchus, subsequently repositioned.


Instruction: Generate impression based on medical findings.

Input: Reason: ev al of lung fields History: s/o RLL Extensive opacity and volume loss in the right hemithorax with a large pleural effusion.Underlying opacity in the right perihilar region consistent with radiation reaction, better shown on a previous CT scan.No pneumothorax.

Output: Large right pleural effusion with underlying radiation reaction and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Reason: 93yoF here w/ possible sepsis, check for PNA History: possible PNA Mild cardiomegaly and a tortuous aorta.Nonspecific retrocardiac opacity could represent infection or aspiration, or simply be chronic.Degenerative abnormalities affect both shoulders.

Output: Possible early left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: 80-year-old female evaluate for ET position. Exam is limited by overlying equipment and severe scoliosis.Interval retraction with ET tube tip approximately 1.5 cm from the carina.Enteric tube tip extends beyond the lower margin of the image.Right lung volume loss with pleural effusion, increased from prior. Unchanged left basilar opacity compatible with scarring/atelectasis. Old healed left posterior rib fracture.

Output: Right lung volume loss with pleural effusion, increased from prior. Interval retraction with ET tube tip approximately 1.5 cm from the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: volume vs consolidation Lines and tubes are unchanged. Improved aeration of the right lung. Postoperative changes in the right hemithorax, not substantially changed. Small right apical pneumothorax again noted. Probable mild left basilar subsegmental atelectasis. Unchanged heart size.

Output: Improved aeration of the remaining right lung.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: chest pain, r/o pneumonia History: chest pain Mild basilar subsegmental atelectasis, improved compared to the prior study.Focal diaphragmatic eventration.Upper lobe emphysema noted.Heart size normal.No specific evidence of infection or edema.

Output: Emphysema, but no evidence of infection. Improved basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p epicardial LV lead placement History: NA Cardiomegaly with ICD and epicardial leads unchanged.Mild blunting of the left costophrenic angle compatible with a small pleural effusion or scarring, not definitely changed allowing for projection and inflation.No new findings.

Output: Epicardial and transvenous pacemakers, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Hypoxia, history of cystic fibrosis on EMR ET tube tip is 5 cm above the carina. An enteric tube courses below the field of view. Right upper cavity PICC tip is in the subclavian vein.Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.Patchy diffuse airspace opacities and bronchiectasis compatible with mucus impaction of cystic fibrosis.

Output: Patchy diffuse airspace opacities and bronchiectasis compatible with mucus impaction of cystic fibrosis.


Instruction: Generate impression based on medical findings.

Input: Cough Marked focal opacity in the right upper lobe with elevation of the minor fissure and volume loss are observed. Density projects towards the hilar region with mild retraction as well as deviation of the tracheaRight lung base other than volume loss and minimal atelectasis in the left lung are otherwise clearCardiac and mediastinal contours are grossly within limits

Output: Appearance of the right upper lung with extension into the adjacent hilar region and volume shift, suggesting post radiation changes. Please correlate with CT scans for measurements


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath History: as above Unremarkable cardiac and mediastinal silhouette. Large lung volumes suggestive of COPD.No sign of pneumonia or other acute change.

Output: COPD with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: eval for pneumonia, or focal abnormality, hx of liver transplant on immunosuppresion. History: bradycardia, nausea, vomiting Mild cardiomegaly.No specific evidence of infection or edema.Left subclavian central venous catheter seen with tip in projection of superior vena cava.No pleural effusion. No pneumothorax.Right subclavian venous stent noted.

Output: Mild cardiomegaly with no specific evidence of infection or edema. Additional findings as above.


Instruction: Generate impression based on medical findings.

Input: Reason: S/p trach History: s/p trach Tracheostomy tube, venous catheter and NG tube unchanged.Bilateral diffuse airspace opacities, not significantly changed since the previous radiograph.No new findings.

Output: Tracheostomy tube in appropriate position with no visible complications. Diffuse nonspecific airspace opacity with no acute change.


Instruction: Generate impression based on medical findings.

Input: Tachycardia and jaw pain Mild COPD changes without superimposed acute cardiopulmonary abnormality

Output: No acute disease superimposed on mild COPD


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Weakness. Evaluate for pulmonary edema. Low lung volumes. Unchanged basilar atelectasis and small pleural effusions. Minimal pulmonary edema.Cardiomediastinal silhouette is unchanged. Severe kyphosis.

Output: Unchanged basilar atelectasis and small pleural effusions. Minimal pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Pt with bacteremia, want to rule out pneumonia History: bacteremia The cardiomediastinal silhouette is normal. Left chest portacatheter terminates in the right atrium. No focal opacity, pleural effusion or pneumothorax. Incompletely visualized catheter is within the abdomen. Density in the lumbar spine is consistent with known metastatic disease, unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: needs routine chest x-ray for outpatient HD chair, r/o TB History: ESRD, initiation of HD Severe cardiomegaly, worse than on the prior study.No specific evidence of infection or failure.Left upper quadrant stent.

Output: Severe cardiomegaly, worse than before, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: preop cxr; left upper chest pain with movement History: pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: MV and AoV endocarditis. History: SOB Right IJ line terminates near the cavoatrial junction. Diffuse pulmonary opacities. Small pleural effusions with basilar atelectasis. No pneumothorax.

Output: Congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: Rule out infection. Leukocytosis and Tachycardia. On immunosuppression. History of Crohn's disease with acute edematous interstitial pancreatitis. Stable elevation of the right hemidiaphragm with adjacent atelectasis or scarring. No pleural effusion or pneumothorax. The lungs are clear. Right internal jugular catheter tip projects over the right brachiocephalic vein. Status post median sternotomy.

Output: Stable elevation of the right hemidiaphragm with adjacent atelectasis/scarring. No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: chest pain, cough, eval for PNA/PTX History: chest pain, cough, eval for PNA/PTX No acute cardiopulmonary abnormality. Heart size normal. Thoracic scoliosis.

Output: No evidence of pneumonia or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: volume status History: sob Increased lung volumes and signs of emphysema again noted. No evidence of overt pulmonary edema.Known left upper lobe spiculated solid pulmonary nodule is again visualized.No pleural effusion or pneumothorax.Cardiomegaly. Severe calcification of the mitral anulus again noted.

Output: No radiographic findings to explain acute shortness of breath.Left upper lobe spiculated solid nodule is again visualized, previously characterized on chest CT dated 6/16/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval lung and heart History: ICU Support devices are unchanged in position. A focal radiopaque structure projects over the left clavicular head, possibly a snap that is external to the patient. This was discussed with the floor nurse caring for the patient and a repeat radiograph will be performed after readjustment of the patient's gown.Mid to lower zone subsegmental atelectasis with small pleural effusions. Small amount of subcutaneous emphysema left inferolateral chest wall. No interval pneumothorax. Mild mediastinal widening and enlargement of the cardiac silhouette, suspected secondary to underinflation with a component of postoperative fluid

Output: Mid to lower zone subsegmental atelectasis without interval pneumothorax. Repeat radiograph will be obtained, as above.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: fever, post-transplant History: fever post transplant Right central venous catheter with its tip in the SVC.The decreased lung volumes with mild basilar scarring/discoid atelectasis.No focal airspace consolidation.The cardiomediastinal silhouette is unremarkable.The large pleural effusions.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: cough for 2 1/2 wks History: above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Large right anterior hemidiaphragmatic eventration again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is multilevel disk space narrowing, most prominent at C3-C4 where it is moderate-severe in degree. There is mild heterogeneous appearance of the marrow signal throughout the visualized cervical spine, with more homogeneous fat signal in the visualized clivus and calvarium. This is a nonspecific finding. There is additional severe endplate marrow changes predominantly involving C3 inferiorly. The spinal cord is of normal caliber and signal.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is a mild posterior osteophyte disk complex and bilateral uncovertebral hypertrophy. There is resultant mild central spinal canal stenosis and bilateral foraminal narrowing. There is minimal flattening of the ventral cord.At C4-C5, there is a diffuse posterior osteophyte disk complex with superimposed central disk protrusion as well as ligamentum flavum thickening. There is bilateral minimal uncovertebral hypertrophy with overall moderate central spinal canal stenosis. There is indentation of the right paramedian ventral cord and mild right foraminal narrowing.At C5-C6, there is a mild diffuse posterior osteophyte disk complex with right greater than left uncovertebral hypertrophy. There is mild to moderate spinal stenosis with flattening of the right ventral cord. There is moderate right and mild to moderate left foraminal narrowingAt C6-C7, there is a shallow central disk protrusion in the right paramedian location. There is indentation of the ventral thecal sac without stenosis. There is also mild ligamentum flavum thickening.At C7-T1, there is no significant disk pathology or stenosis.There is partial visualization of the maxillary sinuses, with suggestion of near complete opacification of the left with aerated secretions dependently as well as an air-fluid level. There is mild mucosal thickening in the visualized right maxillary sinus with a focal mucosal retention cyst or polyp.

Output: 1. Mild-moderate scattered multilevel spondylotic changes within the cervical spine, with findings most prominent at C4-C5 where there is moderate central spinal canal stenosis and indentation of the right paramedian ventral cord due to a prominent central disk protrusion, with impingement of the right ventral C5 nerve root. Please correlate with clinical symptoms.2. Near complete opacification of the visualized left maxillary sinus with suggested air-fluid level and aerated secretions. Please correlate clinically for possible acute sinusitis.3. Slightly heterogeneous marrow signal within the cervical vertebrae which is nonspecific.


Instruction: Generate impression based on medical findings.

Input: Concern for aortic dissection CHEST:MRA

Output: No aortic dissection within the limitations of a non-enhanced MRA.Cardiomegaly with suspected biventricular hypertrophy. Main pulmonary artery enlargement suggestive of pulmonary arterial hypertension.


Instruction: Generate impression based on medical findings.

Input: Dobbhoff tube placement Dobbhoff tube located in gastric fundus. Right mid abdominal surgical clips. Small amount of residual contrast, primarily seen in collapsed colon, colonic diverticulosis. Radiodense ovoid structure in right abdomen nonspecific and may reflect contrast containing bowel (favored, particularly given patient's OPM performed on 9/17/15) versus somewhat low-lying right kidney with contrast retention, correlation with patient's clinical history/lab values recommended.Please refer to concomitant chest radiography from same day for additional findings.

Output: Enteric tube as above, additional details as above.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old. Reason: iabp History: iabp Cardiomegaly, stable.IABP catheter proximal marker 1 cm below the top of the aortic arch, unchanged.Right-sided PICC with tip overlying the axilla, unchanged. Left subclavian ICD with tip in the right ventricle, unchanged.

Output: IABP device unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: IABP Balloon catheter marker at the level of the aortic arch, unchanged.Venous catheter and ICD lead also unchanged.No significant cardiopulmonary abnormalities.

Output: Balloon pump catheter in the proximal descending aorta with no significant change.


Instruction: Generate impression based on medical findings.

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

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: 57M in CCU with PICC placed for central access for inotropes, ?placement History: 57M in CCU with PICC placed for central access for inotropes, ?placement Interval adjustment of the right PICC line with its tip now in the area of the SVC.Cardiomegaly and ICD leads unchanged.No new findings.

Output: PICC line tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male 4 years status post right lower lobe lobectomy for stage IA squamous cell carcinoma. CHEST:LUNGS AND PLEURA: Unchanged postsurgical changes from right lower lobe resection. No suspicious nodules. Small loculated chronic right pleural effusion in the costophrenic angle with adjacent pleural thickening unchanged.Emphysema.MEDIASTINUM AND HILA: Reference right hilar lymph node (series 3, image 46) measures 12 x 10 mm; unchanged. Reference paraesophageal lymph node (series 3, image 49) measures 8 x 6 mm; previous measuring 11 x 8 mm. Right retrocrural lymph node (series 3, image 91) measures 7 mm in short axis; previously 9 mm.Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Degenerative changes of the spine. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 18 x 15 mm, unchanged from exam from January 2008.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: 1. Postsurgical changes in right hemithorax with no evidence of pulmonary metastases.2. Left adrenal nodule unchanged since January 2008.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with hypercapnia requiring BiPAP. Cardiomediastinal silhouette is unchanged.Right hydropneumothorax is again seen without significant mediastinal shift. Collapse with possible superimposed consolidation of the right lung is again seen as confirmed on recent CT. Right-sided chest tube with tip terminating in the region of the right apex. The left lung remains clear.

Output: Unchanged right hydropneumothorax without significant mediastinal shift.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with development of intra-abdominal collection or loculated pleural effusion as source for ongoing leukocytosis CHEST:LUNGS AND PLEURA: A tracheostomy tube is in place. Bilateral large pleural effusions and atelectasis at lung bases. The amount of pleural effusions is minimally increased compared to previous study.There is patchy groundglass opacity in the left upper lobe on image number 52, series number 7, which may represent early pneumonia. Smaller patchy groundglass opacities are also noted in the right upper lobe and middle lobe.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in the left lobe is unchanged. Periportal edema. Multiple acromegaly. Mildly dilated distal common bile duct is unchanged. Loculated collection anterior to the left lobe. The liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Poor enhancement of the kidneys is unchanged. Subcentimeter noncystic lesions in both kidneys are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate ascites with thickening and enhancement of the peritoneum suggestive of peritonitis is unchanged. Largest loculation is anteriorly in the lower abdomen and pelvis. Gastric wall thickening and wall thickening of some of the small bowel loops are unchanged. Proximal small bowel loops are distended, measuring up to 4.7 cm. Distal ileal loops are smaller in caliber. Generalized anasarca and poor opacification of the bowel wall limits optimal evaluation of the mesentery and bowel segments.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Inguinal adenopathy, unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Previous described left sided fluid collection in the pelvis is unchanged measuring 3.6 x 2.2 cm on image number 191, series number 5.

Output: Bilateral large pleural effusions and dependent atelectasis which is slightly increasing size compared to previous study. Bilateral patchy groundglass opacities may represent early pneumonia. Ascites surrounded by enhancing peritoneum suspicious for peritonitis.Left pelvic fluid collection, unchanged. Generalized anasarca, unchanged.Mild distal small bowel obstruction versus ileus.


Instruction: Generate impression based on medical findings.

Input: 3 month old female, former 27 wks. Evaluate lines and tubes; F/U left pleural effusionVIEW: Chest and abdomen AP (two view) 3/10/2015, 1113 ET tube tip below the thoracic inlet and above the level of the carina. Enteric tube terminates in the antropyloric region. Left chest tube is unchanged in position. Right IJ catheter tip in the right atrium.Cardiothymic silhouette is normal.Bilateral patchy pulmonary opacities. No significant pleural effusion.Nonspecific abdominal gas pattern.

Output: Changes of chronic lung disease without significant pleural effusion. Nonspecific abdominal gas pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for placement of new quinton line History: as above Right IJ line is difficult to assess given large patient body habitus but appears to terminate within the right atrium approximately 4 cm from the cavoatrial junction. No pneumothorax. Improvement in nodular opacities in right lung. Diffuse reticular abnormality in the left lung, unchanged.

Output: Interval placement of IJ catheter without evidence of pneumothorax. Right lung opacities are clearly improved since previous study suggesting response to treatment.


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: sob Diffuse interstitial and airspace opacity throughout the right lung with a nodular component, suggestive of aspiration pneumonia and bronchiolitis.These findings have developed since the previous CT scan of 1/2/2016.Pacemaker leads and port catheter unchanged.Tracheostomy and gastrostomy tube in place.

Output: Diffuse airspace and interstitial opacity throughout the right lung, most marked in the right lower lobe, suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.History of mediastinal mass. Masslike enlargement of the left hilum not appreciably changed and was previously described by CT as conglomerate lymphadenopathy. Large pericardial fat pad on the right. No visible pulmonary nodules. Heart size.

Output: Stable masslike enlargement of the left hilum, previously reported to be possible Castleman's disease.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Swan inserted, one to ensure it is in the right place. Heart failure. Right jugular Swan-Ganz catheter tip in the right main PA projection. No pneumothorax.Right basal scarring and emphysema.Coarse interstitial and airspace opacities with bronchial wall thickening in the lower lung zones about the same. This is somewhat atypical for edema and a distal airways inflammatory or infectious process may be considered in the appropriate clinical context.

Output: Right jugular Swan-Ganz catheter tip in the right main pulmonary artery projection.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Presyncopal episodes, right-sided chest tenderness, unknown injury to the area. No focal airspace opacities, pleural fluid or pneumothorax. Mild cardiomegaly, unchanged. Degenerative changes of the spine with lateral osteophyte formation.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Within this limitation, no grossly displaced rib fractures are appreciated.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Nausea with vomiting evaluate for right pneumothorax status post right nephrectomy. Free intraperitoneal air, presumably postoperative. No pneumothorax. Compressive atelectasis at the lung bases. Gaseous dilatation of the stomach.

Output: Free intraperitoneal air, presumably postoperative, but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer CHEST:LUNGS AND PLEURA: Right middle lobe subcentimeter nodule is stable. Several other subcentimeter nodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cysts without evidence of solid lesions or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Changes from prostatic brachytherapy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Osteoblastic lesion in the right ischium is again noted. Small sclerotic lesions in the iliac bones L3 vertebral body and multiple other small lesions in scattered through the vertebral bodies, right scapula suspicious for metastatic disease are unchanged.OTHER: No significant abnormality noted

Output: Bone metastases, subcentimeter lung nodules are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: assess progression of pneumonia History: hypoxia, HIV, tonsillar CA, pneumonitis seen on chest CT Coarse basilar interstitial opacities are suggestive of aspiration bronchiolitis with bronchiectasis, as seen on a follow-up abdomen CT.Very small left pleural effusion noted.Heart size normal.Prior right jugular port catheter removed.

Output: Basilar opacities suggestive of aspiration bronchiolitis with bronchiectasis, with a very small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: check device/lead placement History: PPM, planned extraction Left-sided pacemaker unchanged.Right upper lobe and left basilar scarring similar in appearance the prior exam.No new pulmonary opacities identified.Median sternotomy is intact with evidence of an aortic valve prosthesis.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and HIV No definite cardiopulmonary abnormalities,, however a faint nonspecific streaky opacity in the right lung base cannot entirely be excluded. No effusions. Possible aspiration versus early infection warranting serial imaging if concern remains high clinically.Small focal sclerotic abnormality within the posterior right fifth rib unchanged, nonspecific, probable infarct.

Output: Nonspecific right basilar faint and questionable opacity, serial imaging may be indicated.


Instruction: Generate impression based on medical findings.

Input: 89-year-old male with shortness of breath. Evaluate for volume overload versus infection. Stable cardiomegaly status post annuloplasty. No evidence of pulmonary edema or focal opacity to suggest pneumonia.Subclavian ICD is present with leads unchanged in position.

Output: Stable cardiomegaly without edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with history of cough for 3 months. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax. Mild right upper lobe volume loss.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: intubated, hypoxia History: post-procedure hypoxia, now intubated ET tube tip 5 cm above carina.Lungs hypoinflated with nonspecific basilar opacities.

Output: ET tube tip 5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Reason: daily am cxr History: Left lower quadrant pain. Small lung volumes with basilar opacities compatible with atelectasis and effusions, not significantly changed.Catheter tip in the SVC.No new findings.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Chest pain Stable cardiomediastinal silhouette. No evidence of focal consolidation, significant pleural effusion, or pneumothorax. Scoliosis is again noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: swan placement History: swan placement Moderate cardiomegaly without pulmonary edema. Right jugular Swan-Ganz catheter tip in proximal right interlobar pulmonary artery slightly pulled back.Left subclavian ICD, leads unchanged in position.Left PICC, tip in the SVC region.

Output: Swan-Ganz catheter slightly pulled back, the tip still in the proximal right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Effusion Persistent right basilar focal opacity with a moderate effusions with associated mild left to right mediastinal shift. The appearance suggests volume loss and probable atelectasis, however the associated focal opacity overlying the hilar region represent suspected mass and malignancy is observed and correlates with more recent CT evaluation.

Output: Right middle lobe focal changes with an effusion on the right largely unchanged from prior CT. No new superimposed suspicious focal air space process


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: assess pleural effusion History: cardiogenic shock, s/p CABG Right IJ venous catheter, tracheostomy tube, and enteric tube unchanged.Decreased lung lines with stable cardiac enlargement.Perihilar/interstitial edema increased from the prior exam.Left retrocardiac consolidation/atelectasis and probable left pleural effusion similar in appearance to prior exam.

Output: Persistent left retrocardiac consolidation/atelectasis and left pleural effusion. Increasing perihilar interstitial opacities suggestive of edema/volume overload.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Status post thoracotomy. Question right pneumothorax. Retrocardiac opacity which may represent atelectasis and/or small effusion is stable. Lungs are otherwise clear. No pneumothorax. NG tube tip below the diaphragm.

Output: No pneumothorax. Stable retrocardiac opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.With weight loss and productive cough. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity. Emphysema.

Output: No acute cardiopulmonary abnormality. No focal pulmonary opacity. Emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess for pna History: vent dependence ET tube tip is 5 cm above the carina.Bilateral mainly perihilar opacities suggestive of edema with a moderate right pleural effusion and probable smaller left effusion.Right basilar consolidation is not significantly changed since the prior exam.

Output: Right basilar opacity may represent atelectasis or infection, with underlying edema.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: assess for worsening pneumonia History: hypoxia Increase in diffuse, opacities. Unchanged cardiomegaly. Double small left pleural effusion. No pneumothorax. Enteric tube terminates within the body the stomach.

Output: Increase in diffuse pulmonary opacities consistent with pulmonary edema, aspiration, and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Evaluate for chest pain. History of PE and CHF. Right basilar pleural thickening. Right middle and lower lobe subsegmental atelectasis/scarring. No new focal consolidation, effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: assess for acute process - chest pain History: chest pain Unremarkable cardiomediastinal silhouette.Lungs clear.The thorax. No pleural effusion.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna History: see above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Trialysis Line placement- RIJ History: TTP Right internal jugular catheter tip projects over the SVC.The cardiomediastinal silhouette is unremarkable.No large pleural effusion or pneumothorax.

Output: Right internal jugular catheter tip projects over the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: assess for pulm infection History: fevers, SOB, hypoxia Chronic right hemidiaphragm elevation with basilar subsegmental atelectasis.Heart size upper normal.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: Heart size upper normal, and chronic right hemidiaphragm elevation with basilar subsegmental atelectasis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Cough, Hypoxia, evaluate for PNA History: as above Severe multifocal, right greater than left, airspace and interstitial opacity which may be due to infection or edema. There is small associated pleural effusion. Borderline heart size.

Output: Severe multifocal, right greater than left, airspace and interstitial opacity which may be due to infection or edema. Some of the areas of opacity have a nodular/focal appearance. Given the patient's age this should be followed to resolution to exclude underlying pulmonary nodules or masses.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Pneumonia, atelectasis, effusion History: hypoxia Interval resolution of right lung collapse. Persistent bilateral basilar segmental and subsegmental atelectasis.Small right larger than left pleural effusions noted.The mediastinal contours are partially obscured. The heart is normal in size.Enteric tube coursing below the diaphragm.

Output: Interval resolution of right lung collapse. Residual bilateral basilar subsegmental atelectasis.Small right larger than left pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: intubated History: as above No change in support hardware with persistent mild bibasilar edema or atelectasis.

Output: No change in support hardware with persistent mild bibasilar edema or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Status post TPA. Facial weakness and concern for stroke No cardiopulmonary abnormality given portable supine imaging. Decreased lung volumes

Output: Decreased lung volumes secondary to stated technique


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: patient with balloon pump, eval placement History: as above Abp marker in the proximal descending aorta.Pleural effusions and basilar atelectasis somewhat increased allowing differences in patient positioning.Stable cardiomediastinal silhouette.

Output: Slight increase in right effusion. Line position stable.


Instruction: Generate impression based on medical findings.

Input: Reason: INTUBATED History: INTUBATED ET tube about 8 cm above the carina.Catheter tip in the SVC.New right middle and lower lobe atelectasis, likely secondary to aspirated secretions.Left lower lobe atelectasis has partially cleared. Cardiomegaly with interstitial opacities compatible with edema with upper lobe emphysema.

Output: New right lower and middle lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: h/o pneumonia History: cough Study is limited by lordotic orientation of the patient. No focal lung opacity. No large pleural effusion or pneumothorax. Mild to moderate cardiomegaly, likely accentuated by lordosis. Aortic atherosclerosis. Asymmetric sclerosis of the left scapula relative to the right. Consider correlation with dedicated PA left shoulder radiograph for further characterization.

Output: No focal lung opacity. Asymmetric sclerosis of the left scapula relative to the right. Consider correlation with dedicated PA left shoulder radiograph for further characterization. Findings were verbally discussed with Bara Fintel at 8:30 AM on 11/19/2015


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: is there pul edema History: sob, history copd Basilar scar like opacities slightly worse on the left where there may, be superimposed atelectasis.Heart size normal.Emphysema.

Output: Mild fibrosis and new left base subsegmental atelectasis, otherwise unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: assess volume status History: increased oxygen requirement Line position stable.No change in bilateral pleural effusions and basilar opacities. No pneumothorax.

Output: No significant change in pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: intubated History: as above The endotracheal tube tip terminates approximately 5 cm above the carina. The NG tube tip terminates out of the field of view inferiorly. The left upper extremity PICC tip terminates at the cavoatrial junction.Stable cardiomediastinal silhouette. Minimal small right pleural effusion. Bilateral perihilar and bibasilar atelectasis (right greater than left), stable from prior exam.

Output: (1) Endotracheal tube tip approximately 5 cm above the carina(2) Stable perihilar and bibasilar opacities (right greater than left), suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT terminates 2 cm above the carina unchanged. NG coiled in the proximal stomach. Right jugular catheter terminates in the mid SVC.Cardiopulmonary appearance is also similar with bilateral pleural effusions greater on the right with underlying patchy opacities in both bases suggesting atelectasis, however aspiration or even infection cannot entirely be excluded, specifically in the right lower lobe.Mildly retained contrast in partially visualized colonic segments

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for fluid overload History: Assess for fluid overload Bilateral interstitial and airspace opacity with multiple septal lines, highly compatible with pulmonary edema. Small bilateral pleural effusions.Heart size upper normal.

Output: Acute pulmonary edema with pleural effusions compatible with fluid overload.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: aspiration History: aspiration No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Pre-Kidney Transplant evaluation, r/o cardiomegaly r/o infiltrates History: Pre-Kidney Transplant. No focal air space opacity.No pneumothorax, pulmonary edema, or significant pleural effusion.Unremarkable cardiomediastinal silhouette.Left subclavian and innominate vein stents.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: tachycardic, tachypneic History: vague compliants, vs as above The heart is mildly enlarged. There is evidence of massive pulmonary arterial hypertension, worsened from the remote prior. Additional lymphadenopathy is likely.No large pleural effusions or pneumothorax.No focal airspace opacity.

Output: Evidence of marked pulmonary arterial hypertension and mild cardiomegaly without evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: pulmonary edema, widened mediastinum History: chest pain Right mid to lower zone reticulation of atelectasis and scarring with small pleural effusion unchanged. Left lung remains clear. No interval pneumothorax. No significant change in the appearance of the mediastinum. If there is high clinical suspicion for dissection, recommend ECG gated CTA of the thorax. Heart size is upper limits normal.

Output: Stable appearance of the mediastinum. If there is high clinical suspicion for dissection, recommend ECG gated CTA of the thorax.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Chest tube removal History: chest tube removal Right IJ dialysis catheter and central venous line remain unchanged. Interval removal of right basilar and mediastinal chest tubes. Left midlung chest tube is unchanged. Status post median sternotomy.Stably enlarged cardiac silhouette.Persistent mild pulmonary edema. Small right and moderate left pleural effusions with adjacent atelectasis remain grossly unchanged. No pneumothorax.

Output: Interval removal of mediastinal and right basilar chest tubes with no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Dyspnea and exertion with BNP elevation. Evaluate pulmonary edema. Chest pain. Unchanged mild to moderate cardiomegaly.Mild/moderate thickening of the fissures and axial interstitium with hazy perihilar groundglass opacity consistent with moderate pulmonary edema. Costophrenic angle scarring, right greater than left.

Output: Mild to moderate pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: infiltrate History: increased weakness, CIDP No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: r/o pneumonia History: cough No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: ett History: ett Endotracheal tube unchanged in position. Cardio mediastinal silhouette remains unremarkable. No focal airspace opacities or effusions. No pneumothorax.

Output: No acute abnormalities or interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Small right hemidiaphragmatic eventration again noted. Clear lungs. No pleural effusion or pneumothorax. Normal heart size.

Output: No convincing evidence of metastatic disease on radiography.


Instruction: Generate impression based on medical findings.

Input: 65 years old Female. Reason: effusion History: sob. There is interval worsening of the right pleural effusion. A stable left pleural effusion. Orphaned ICD with leads in the known obliterated right SVC. The catheter overlying with the left upper mediastinal silhouette is stable in position.

Output: Interval worsening of the right pleural effusion. Stable left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Metastatic disease check. Bladder cancer No cardiopulmonary abnormality other than bridging osteophytes observed throughout the thoracic spine

Output: Osseous degenerative changes without additional abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: 40M POD#3, now with unexplained fever History: fever Slight increase in basilar atelectasis with small pleural effusions. Heart size normal.

Output: Increased basilar opacities suggestive of aspirated secretions or mucous plugging postop.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: MaleReason for Study: Reason: eval line placement History: line Right IJ venous catheter with its tip in the RA.Stable cardiomediastinal silhouette.Mild basilar atelectasis.No new pulmonary opacities noted.

Output: Right IJ venous catheter with its tip still in the RA. Mild basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 69-year-old male status post abdominal aortic aneurysm repair, now with increasing white cell count CHEST:LUNGS AND PLEURA: Emphysema. Biapical scarring. Ill-defined groundglass opacity in the right middle lobe, nonspecific, may represent scarring versus atelectasis. Right basilar linear atelectasis.MEDIASTINUM AND HILA: Thyroid nodules. There is an irregular shaped saccular aneurysm at the level of the arch measuring 4.9 centimeter in its greatest dimension. Diffuse atherosclerotic changes throughout the aorta.Mediastinal adenopathy. Index pretracheal lymph node measures 2.2 x 2 cm on image number 31, series number 3. Paragraph there is also focal aneurysm in the distal descending thoracic aorta measuring up to 4.4 cm on image number 57 comes inCHEST 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: Solitary right kidney. Benign left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Status post abdominal aortic graft placement and aorto right iliac graft anastomosis. There is air fro enhancing fluid collection around the aorta suspicious for infected fluid. On image number 118, series number 3, the size of the collection measures 5.5 x 2.8 cm. Collection extends along the aorta and aortoiliac graft.Retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Transplanted kidney in the right iliac fossa. Small hypodense lesions likely representing cysts but are too small to accurately characterize

Output: Large, irregular saccular aneurysm involving the aortic arch. Distal descending thoracic aortic aneurysm.Postsurgical changes secondary to AAA repair and aorto right iliac graft placement. Peripherally enhancing collection along the aorta and aortoiliac graftMediastinal and retroperitoneal adenopathy.Nonspecific ground glass opacity in the right middle lobe. Early pneumonia cannot be excluded.Dr. Singh was notified and acknowledged at the time of dictation about the above findings.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Asthma and wheezing. Status post bronchial thermoplasty #2 of 3. Subsegmental atelectasis at the left base may be related to recent history of thermoplasty. No pneumothorax or pneumomediastinum.

Output: Segmental atelectasis on the left which may be related to recent bronchial thermoplasty.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: SOB, asthma exac, on BiPAP History: see above The peripheral pulmonary opacity identified in left midlung may represent overlying breast tissue.The right lung is clear.Stable cardiomediastinal silhouette.No pleural effusions.

Output: Questionable peripheral airspace opacity in the left midlung may represent overlying breast tissue. Recommend upright PA and lateral views for better evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: r/o TB, sarcoid, lymphadenopathy History: anterior uveitis, Small lung volumes with basilar subsegmental atelectasis or scarring.No evidence of sarcoidosis, or other significant abnormality.

Output: No evidence of sarcoidosis, although CT could be more sensitive if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Reason: patient intubated, eval of et tube History: see above ET tube tip approximately 5 cm above the carina. NG tube tip in the stomach.Small lung volumes with moderate pleural effusions and basilar atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Evaluate line placement The right internal jugular central venous catheter has been retracted now terminating near the cavoatrial junction. Other findings stable compared to the radiograph from 2:00 PM on the same date.

Output: The right internal jugular central venous catheter has been retracted now terminating near the cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and hypoxia Mixed interstitial and airspace opacities in all 4 quadrants with a more focal cavitary lesion in the left upper lung, similar to prior study overall again improved since last October. Partial cavitation again suspected. The diffuse background changes however are nonspecific and although possibly infection, aRDS must also be considered and less likely edema given relative sparing of the basesNo definite effusions or discrete cardiac or mediastinal contour abnormality. CT may be needed

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: Left sided effusion History: Left sided effusion Left-sided loculated hydropneumothorax noted. Left chest wall pigtail drain noted. Other lines and tubes, unchanged. Left basilar opacity, slightly increased. No new focal lung consolidation the right lung. Unchanged heart size.

Output: Left-sided loculated hydropneumothorax again noted. The left lung underlying this area may be trapped due to visceral pleural thickening. Increased left basilar opacity, likely superimposed atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: 87 yo F presenting with 3 days of weakness and decreased PO intake, ? PNA History: weakness, decreased PO intake Basilar atelectasis and small lung volumes.Heart size upper normal.Left subclavian pacemaker, leads unchanged in position, a single right atrial appendage lead.

Output: Basilar atelectasis which may be the result of aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: hypotensive, leukocytosis Cardiomediastinal silhouette is within normal limits. No pleural effusions pneumothorax.

Output: No acute abnormality.