Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of colon carcinoma, resected in 2006. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: Previously seen solitary pulmonary nodule in right middle lobe appears stable in comparison to previous exam (series 4, axial image 51/107).Apical bullae noted and remain stable.MEDIASTINUM AND HILA: Right hilar node (series 3, axial image 42/217) measures 1.4 cm x 2 cm and remains stable.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Previously noted punctate hypodense lesion within the liver remains unchanged (series 3, axial image 95/217) and is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: Bowel anastomotic site is identified in the left hemipelvis (series 3, axial image 161/217). There is no evidence of recurrent local tumor.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Incidentally noted is mild dilatation of the right common femoral vein of uncertain etiology (series 3, axial image 192/217; also seen on coronal image 61/102).

Output: 1.No evidence of local tumor recurrence or metastasis.2.Solitary pulmonary nodule in right middle lobe remains stable on comparison to previous exam.3.Stable right hilar pulmonary lymph node as detailed above.4.Stable apical pulmonary bullae.5.Mild dilatation of right common femoral vein of uncertain etiology.6.7.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: eval for aortic pathology History: pulses unequal, vss Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Two right jugular catheters, Dobbhoff and Swan-Ganz are all unchanged. ICD similar to prior.Underlying cardiopulmonary appearance is also unchanged with diffuse moderate opacities and pleural effusions greater on the right and in both bases. Moderate nonspecific cardiomegaly

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: Patient with chronic cough and congestion History: as above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: is there an infiltrate History: cough with left flank pain Chronic elevation left hemidiaphragm.Lungs clear.Heart size normal.No pneumothorax. No pleural effusion.

Output: Stable chronic elevation left hemidiaphragm with no specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: 15-year-old male with history of biphenotypic leukemia status post stem cell transplant in 5/07 with history of GVHD. Progressive shortness of breath for 2 to 3 weeks. LUNGS AND PLEURA: Diffuse ground glass opacities have improved significantly from the previous exam. Multiple nodular opacities are improved, but are still seen throughout both lungs, left greater than right. Dense left lower lobe consolidation has resolved.Postsurgical changes in the right upper lobe are reidentified. Left pleural effusion has resolved.MEDIASTINUM AND HILA: Left internal jugular central venous catheter tip is in the right atrium. The endotracheal tube has been removed. Stable cardiomegaly.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: A moderate amount of perihepatic and perisplenic free fluid is seen in the upper abdomen, that is increased when compared to previous exam.

Output: 1.Residual bilateral ground glass opacities and nodular airspace opacities; although these findings are improved when compared to the previous exam.2.Increased free fluid in the upper abdomen.3.Resolved left pleural effusion.4.Resolved left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: History of left ear cancer. LUNGS AND PLEURA: Multiple calcified and noncalcified micronodules in both lungs. Peripheral nodular opacity in the right upper lobe (image 52, series 5) is contiguous to the pleura, and is likely a scar. No nodules suspicious for metastatic disease are identified.MEDIASTINUM AND HILA: No significant abnormality noted. Mildly calcified coronary arteries. A few calcified mediastinal lymph nodes, suggestive of prior granulomatous disease.CHEST WALL: Degenerative disease in the T1/2, lower thoracic spine and lumbar spine. Scoliosis in the thoracic spine.UPPER ABDOMEN: Incompletely visualized gallbladder demonstrates a possible calculus.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: evaluate ETT, lung fields History: s/p LVAD placement Support devices unchanged with ET tube tip 6 cm above the carina and Swan-Ganz catheter with its tip in the pulmonary artery.Stable cardiomediastinal silhouette.Mild perihilar interstitial opacities similar to the prior exam.No new pulmonary opacities.Small pleural effusions unchanged.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: post-bronch for hemoptysis evaluation History: wheezing Marked hilar and mediastinal lymphadenopathy again noted. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p chest tube removal; s/p MVR History: NA Interval removal of right chest tubes with no significant residual pneumothorax.Interval extubation.Persistent bilateral effusions, greater on the right, with underlying atelectasis.

Output: Status post chest tube removal and extubation with no pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Cough and shortness of breath. Extensive calcified mediastinal lymphadenopathy is unchanged. Left lung interstitial opacities and volume loss appears similar compared to prior with interval increase atelectasis/scarring in the left lung base. Subtle bronchial thickening in the right lung base. Round density projecting over the right upper quadrant is compatible with a nipple shadow. Right upper quadrant surgical clips compatible with cholecystectomy.

Output: Stable calcified mediastinal lymphadenopathy. Left lung interstitial opacities and volume loss compatible with fibrosis with increased atelectasis/scarring in left lung base.


Instruction: Generate impression based on medical findings.

Input: Female, 41 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: 85 year old male transferred from outside hospital for possible left lung decortication. LUNGS AND PLEURA: Bilateral pleural effusions with adjacent atelectasis/consolidation. The right sided effusion appears free flowing. The left pleural effusion appears to be loculated in the major fissue and also contains air. Centrilobular emphysema. Multiple pulmonary micronodules, the largest of which measures 4 mm.MEDIASTINUM AND HILA: Mild pericardial effusion. Multiple small mediastinal lymph nodes not enlarged by CT criteria. Atherosclerotic calcifications of the aorta including the origins of the SMA and celiac trunk. Tracheal debris compatible with aspiration.CHEST WALL: Well-defined hypodense lesion within T2 vertebral body of uncertain etiology (image 11, series 3). Left anterior chest wall subcutaneous multifocal air densities may be related to recent intervention.UPPER ABDOMEN: Multiple well-defined hypodense renal lesions bilaterally are incompletely evaluated but most likely simple cysts. G-tube in expected location.

Output: 1. Small left-sided loculated hydropneumothorax in major fissure.2. Right sided free-flowing pleural effusion.3. Emphysema.4. Multiple, nonspecific pulmonary micronodules.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: f/u RUQ lung collapse History: f/u RUQ lung collapse Right upper lobe reexpanded.Basilar atelectasis persists unchanged.NG tube removed.

Output: Right upper lobe reexpanded. Stable basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with peritoneal mesothelioma found in umbilical hernia sac status post colonic perforation and resection CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There are multiple hypodense lesions in both lobes of the liver. This single phase CT is not adequate for characterization of these lesions. Index lesion in the right lobe measures 1.9 by 1.7 cm on image number 100, series number 4. Fatty infiltration of the liver.SPLEEN: Not visualized. Postsurgical changes in the left upper quad and around the pancreatic tail. An index nodular area which may represent postsurgical changes versus neoplasm in the left upper quadrant anterior to the left kidney measures 1 x 1 cm image number 106, series number 4.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy. No evidence of bowel obstruction.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: Multiple hypodense lesions in the background of liver with fatty infiltration. MRI of the liver is recommended for further characterization of these lesions.Status post splenectomy. Postsurgical changes in the left upper quadrant and around the pancreatic tail. A subcentimeter index nodule is measured in left upper quadrant for follow-up purposes.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Pneumothorax Left chest tube in place with no appreciable pneumothorax. Small left pleural effusion. No new focal airspace opacity.Cardiomediastinal silhouette is normal.

Output: Left chest tube with no appreciable pneumothorax identified. Small left pleural effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: ETT History: as above Right central venous catheters been placed with its tip in the SVC.ET tube and enteric tubes unchanged.No evidence of pneumothorax.Stable cardiac enlargement.Pleural effusions and perihilar/basilar opacities similar in appearance to prior exam.

Output: Interval placement of right central venous catheter without complication. ET tube with its tip 5 cm above the carina. Stable cardiopulmonary appearance with cardiomegaly, pulmonary edema, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: History of renal cancer assess baseline tumor. Noncontrast enhanced scan requested. CHEST:LUNGS AND PLEURA: Numerous small and some large nodules bilaterally consistent with diffuse metastatic disease. For baseline purposes a right paracardiac lung lesion seen on series 3 image 64/222 is measured at 2.5 x 2.4 cm.MEDIASTINUM AND HILA: Extensive posterior mediastinal adenopathy and some small middle mediastinal nodes. Large nodes are seen in the para-aortic area bilaterally and paraesophageal area. For baseline purposes a lower left periaortic node is seen on series 3 image 83 to measure 2.2 x 2.1 cm.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast. Given that limitation the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The right kidney is normal in size and contour. Left kidney is been surgically removed and there is extensive lobular irregular shaped soft tissue density in the left renal bed with loss of fat plane portal aorta and left paravertebral muscles. Conglomerate masses seen on series 3 image 111/2 22 measures 6.5 x 3.2 cm.RETROPERITONEUM, LYMPH NODES: Clusters of aortocaval and left para-aortic nodes and retrocaval nodes.Extensive atherosclerotic disease. No evidence of aneurysm.BOWEL, MESENTERY: Colonic diverticulosis. Small bowel normal. Small portacaval nodes and nodes in the celiac area.BONES, SOFT TISSUES: Postsurgical changes. No lytic or blastic disease.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted

Output: Diffuse lung metastasis. Adenopathy posterior mediastinum retroperitoneum left renal fossa. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: assess for acute lung changes, worsening of right sided process Back lines and tubes backward diffuse Unchanged cardiomegaly. Small pleural effusions. No pneumothorax.

Output: No substantial change in diffuse pulmonary opacities given differences in inspiration.


Instruction: Generate impression based on medical findings.

Input: 68-year-old with history of non-small cell lung cancer. Has previous radiation and chemotherapy and gamma knife. Compare with prior. LUNGS AND PLEURA: Extensive centrilobular emphysema. The reference right lower lobe mass is ill-defined and difficult to measure due to different phases of inspiration, now measuring approximately 3.6 x 2.7 cm (image 43/111). The soft tissue in this location a series approximately similar to prior exam. Stable appearance of loculated apical pleural effusion with moderate right lower pleural effusion. Stable left lower lobe pulmonary nodule adjacent to the major fissure (image 38/111).Paramediastinal fibrosis in the right lung is stable with continued volume loss of the right upper lobe. No left pleural effusion.MEDIASTINUM AND HILA: Normal cardiac size. Stable moderate pericardial effusion. The reference right hilar low density lymph node is similar in morphology measuring 1.9 x 1.5 cm (image 43/111). Additional soft tissue density and enhancing nodes in mediastinum are stable. No significant left hilar lymphadenopathy.CHEST WALL: Stable bilateral breast prosthesis with rim calcification on the left. Stable appearance of mid thoracic vertebral body compression deformities.UPPER ABDOMEN: Extensive atherosclerotic calcifications of the abdominal aorta with eccentric plaque the is incompletely evaluated.

Output: 1. Taking into account the difficulty in obtaining reproducible measurements due to respiratory variation, the right hilar and right lower lobe mass are unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: Follow PTX History: none Moderate left pneumothorax, slightly increased from previous, with a pleural drain in place.Moderate right pleural effusion and basilar atelectasis.ICD leads unchanged.

Output: Increased left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval for effusions History: AMS Chronic elevation of the right hemidiaphragm. No consolidation, pneumothorax or edema.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: eval lung fields for pna, here w/ sob, wheezing History: sob, wheezing There is moderate cardiac enlargement with pulmonary vascular redistribution.Prominence of the central pulmonary vasculature may represent pulmonary arterial hypertension.No focal areas of consolidation.No large pleural effusions.

Output: Cardiac enlargement without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: 18 months s/p right upper lobectomy for T1bN0M0 stage IA adenocarcinoma History: follow up Mild right hemithorax postsurgical volume loss, and left apical chronic fibrosis, otherwise unremarkable.No evidence of recurrent tumor or other significant abnormality.

Output: Status post resection, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: chest tube placement History: s/p laparoscopic completion gastrectomy, roux en y reconstruction, esophagjejunostomy, LLL lobectomy Left chest tubes with no large pneumothorax. Mild left base subsegmental atelectasis following left lower lobectomy.NG tube, side port above the hemidiaphragm level.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Enteric tube placement, history of uterine malignancy Side-port of enteric tube located in distal esophagus and further advancing by approximately 12 cm recommended. Remainder of exam without significant change, including multiple midline and pelvic surgical clips. Also seen dilated small bowel (measuring up to 5.5 cm) with small amount of colonic gas. Based on this bowel gas pattern, a partial small bowel obstruction is a consideration. Left greater than right pleural effusions and left basilar opacity partially imaged.

Output: Enteric tube, remainder of exam without significant change, see above.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female pancreatic CA presenting with BRBPR x 1. Please evaluate progression of disease. CHEST:LUNGS AND PLEURA: Left low lobe nodule image 55/90 increased slightly in size. A few other possible micronodules.MEDIASTINUM AND HILA: Small mediastinal nodes. Index node in the precarinal area measures 1.5 x 1.1 cm on image 38/2 to 23. No new nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multifocal liver lesions have increased significantly in size and some new lesions are seen.Index lesion in the lateral segment of left lobe seen in image 81/2 to 23 and measures 7.4 x 5.6 cm.Index lesion in the right lobe image 104/223 measures 2.7 x 2.4 cm.Some areas of focal mild biliary dilatation is seen. No evidence of venous thrombus but there is compression of vasculature bladder tumors.. Some of the lesions are causing vascular flow phenomenon as well.SPLEEN: No significant abnormality.PANCREAS: Postsurgical changes. Perivascular infiltration with soft tissue density in the region of the hepatic artery celiac axis superior mesenteric artery portal and redemonstrated, unchanged.ADRENAL GLANDS: No significant abnormality.KIDNEYS, URETERS: A calcification medial aspect left kidney unchanged following nephrolithiasis. Several small lesions bilaterally likely cysts.RETROPERITONEUM, LYMPH NODES: Nonpathologic sized return the amount.BOWEL, MESENTERY: Surgical anastomoses. No evidence of obstruction.BONES, SOFT TISSUES: Scoliosis and degenerative changes. No lytic or blastic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction. Small amount of ascites in the dependent portions the pelvis, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Progression of disease in the liver. A small lung nodule more conspicuous. Minimal ascites unchanged. Other sites are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Postop History: Postop The right thorax and right upper quadrant are excluded from the field-of-view.ET tube tip terminates 1 cm above the carina. Right central venous line tip is in the proximal SVC. Left chest port tip in the distal SVC.Small lung volumes. Stable cardiomediastinal silhouette with cardiomegaly. Evaluation is noted by severe leftward patient rotation. Bibasilar opacities could be better evaluated on follow-up imaging.

Output: ET tube in low position.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiopulmonary process History: leukocytosis Unremarkable cardiac and mediastinal silhouette. Port catheter with its tip in the SVC.Small focal scar like opacity at right base.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: confirm stable lines and tubes History: h/o pulmonary hypertension with septic/cardiogenic shock ET tube tip approximately 4 cm above the carina.Cardiomegaly with left lower lobe retrocardiac atelectasis and consolidation, likely secondary to aspirated secretions.PICC line extending to the SVC.No new findings.

Output: Persistent left lower lobe atelectasis without significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for infiltrates History: intubated ET tube tip approximately 3 cm above the carina.Persistent extensive atelectasis in the right lower lobe, slightly improved.Mild opacity in the posterior basal segment of the left lower lobe, also compatible with aspirated secretions.NG tube coiled in the stomach.

Output: Persistent bilateral lower lobe opacity with atelectasis, likely related to aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old Reason: Evaluate line placement History: s/p R subclavian line placement Right central venous catheter tip in the SVC. ET tube tip approximately 2 cm above the carina. Enteric tube incompletely visualized.Bibasilar atelectasis. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unchanged.

Output: Right central venous catheter tip in the SVC. ET tube tip approximately 2 cm above the carina. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated. interval change in ETT or lung opacities/effusions? History: as above ET tube tip approximately 4 cm above the carina. NG tube tip in the stomach.No significant pulmonary abnormalities are visible effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 82 year old female with vocal cord paralysis LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant mediastinal, or hilar lymphadenopathy. Heart size is normal without pericardial effusion. There are coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: A well-defined, low-density lesion in the liver, most like represents a cyst

Output: No significant pleural or pulmonary abnormalities within the chest


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: h/o CML on dasatinib which can cause pleural effusions; patient has SOB; assess for infection vs effusions vs heart failure History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old. New left jugular catheter with its tip in the left innominate vein.No pneumothorax or other complications. Other findings unchanged.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Chest pain and left-sided numbness. Normal heart size with mildly tortuous aorta. Median sternotomy hardware. Calcified granuloma in left upper lobe is unchanged. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: fever, past hx of intubation History: fever, chills, weakness Small lung volumes.Mild bronchial wall thickening.No specific evidence of infection or edema.Cholecystectomy clips.

Output: Mild bronchial wall thickening, which can be seen in asthma or chronic bronchitis, or viral infection. No other evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Evaluate for pneumonia History: Cough, wheezing Patchy bibasilar opacities. Small pleural effusions versus thickening. ICD lead, unchanged. Unchanged mild cardiomegaly. No pneumothorax.

Output: No convincing evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: SOB, Leukocytosis History: as above Study limited by leftward patient rotation and low lung volumes. Left basilar subsegmental atelectasis or scarring. Bullet fragments overlie the right hemithorax superiorly. Normal heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: HFrEF, assess volume status. +IABP placement History: as above IABP pump marker in the proximal descending aorta. Coronary stent noted.The cardiac silhouette is mildly enlarged.There are bilateral perihilar reticular opacities. No large pleural effusions.

Output: 1.Signs of interstitial pulmonary edema.2.IABP marker in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: possible right lobe consolidation History: possible right lobe consolidation No change in the sizable left pleural effusion and left-sided nodules from known lung cancer.No change in the opacity seen at the left apex.No pneumothorax. No new abnormality.

Output: No change in appearance of left effusion and left-sided nodules. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: 61M with ICM and IABP, assess placement History: IABP ICD leads and aortic balloon catheter unchanged.No reliable evidence of edema or infection.

Output: Balloon catheter and ICD leads unchanged with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with shortness of breath, rule out pneumothorax. Mild basilar reticulation, left greater than right, suggests atelectasis/scarring, appearing similar to prior.The cardiomediastinal silhouette is normal.No pneumothorax.

Output: Mild basilar atelectasis/scarring without significant change. No evidence of pneumothorax as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old. Status post AKA. Markedly limited film quality.Interval removal of left jugular catheters. Endotracheal and Dobbhoff tubes similar in position. Lung volumes remain markedly low with basal atelectasis/consolidation and possible small pleural effusions.

Output: Limited examination. No acute change in atelectasis. Possible small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: assess for stent placement History: s/p tracheal stent Patient has been extubated. Stable superior mediastinal widening, better evaluated on previous chest CT. No new focal lung consolidation. No definite pleural effusion or pneumothorax. No acute bony abnormality.

Output: Patient has been extubated. No new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrate History: dizziness; SOB Mild cardiomegaly with mild compressive atelectasis in the left lower lobe.Moderate elevation of the right hemidiaphragm, likely not clinically significant.No sign of pulmonary edema or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: ET in place? History: ET in place s/p transport Support devices are unchanged.The patient is rotated to the left. Progressive left lower lobe consolidation and atelectasis, consider interval aspiration. No pneumothorax.

Output: Progressive left lower lobe consolidation and atelectasis, consider aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, hx of CHF, eval for ADHF History: SOB, hx of CHF, eval for ADHF Moderately severe cardiomegaly with pulmonary vascular redistribution.Lower zone interstitial opacity compatible with edema and small bilateral pleural effusions.No significant interval change.

Output: CHF, unchanged from previous.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: interval change in size of lung fields or pulmonary edema History: continued diuresis and aggressive PT to help expand lung volumes Support devices unchanged with right IJ Swan-Ganz tip in the pulmonary artery.6. Stable marked cardiac enlargement.Interstitial opacities compatible with edema.Pleural effusions and left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: cough History: cough Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of neuroendocrine tumor. Evaluate for abscess or cause of purulent drainage from catheter site ABDOMEN:LUNGS BASE: Right lower lobe scarring and atelectasis is unchanged.LIVER, BILIARY TRACT: Unchanged multiple metastatic lesions in the liver. Reference hypodense lesion near the dome of the liver on image number 24, series number 3 is stable measuring 17 x 17 mm previously 18 x 17 mm. Multiple other hypodense lesions through the liver representing a combination of metastatic disease and debris and air in dilated ducts/abscesses, predominantly in the right lobe of the liver have not significantly changed. Largest air containing cystic lesion measures 4.2 x 2.7 cm previously 4.4 x 2.8 cm in the right lobe of the liver.An internal/external biliary drainage catheter extends into the duodenum through the metallic stent is unchanged in position.SPLEEN: Chronic splenic vein thrombosis with collaterals between the stomach and spleen.PANCREAS: Patient's ill-defined hypodense mass in the and of the pancreas measures 4.9 x 3.3 previously 4.8 x 3.3 cm, not significantly changed from previous study.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nodular soft tissue density between the left kidney and spleen is unchanged and measures 13 x 10 previously 13 x 11 mm image number 50, series number 3.RETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm is unchanged. Reference aortocaval lymph node is unchanged measuring 15 x 8 mm previously 14 by 8mm image number 61, series number 3.BOWEL, MESENTERY: Unchanged mild ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study. No new fluid collection. Multiple hypodense lesions, ill-defined pancreatic head mass, mediastinal lymph nodes are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: increased work of breathing History: as above Small lung volumes with basilar opacity compatible with effusions and atelectasis.A more recent radiograph has been interpreted.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: Evidence of infection History: Neutropenic fever Normal heart size with evidence of previous median sternotomy.Catheter tip in the SVC.Small calcified granuloma in the left lower lung.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: rule out pneumonia History: desaturation, tachypnea Cardiomediastinal silhouette is normal in size.Interval improved aeration of left lung base and interval resolution of left pleural effusion. Patchy bibasilar opacities appears increased at the right lung base. No pneumothorax.

Output: Patchy bibasilar opacities appears increased at the right lung base, likely atelectasis or aspiration. Interval improved aeration of left lung base and interval resolution of left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia Persistent large left over right pleural effusions with underlying atelectasis. Borderline cardiomegaly.Tracheostomy tube, bilateral jugular catheters and two enteric tubes are all unchanged

Output: Large effusions without interval change, greater on the left


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: s/p Aortic Dissection; f/u Pulmonary Effusion History: SOB Left greater than right pleural effusions and bibasilar opacities again noted. Unchanged cardiomegaly. Widening of the superior mediastinum again noted consistent with history of aortic dissection. No pneumothorax.

Output: No substantial difference in left greater than right pleural effusions and bibasilar opacities given change in patient orientation.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: assess for recurrent PTX, patient with worsening hypoxia History: s/p L chest tube for recurrent L PTX Left chest tube and other support hardware unchanged. Trace left pneumothorax unchanged.

Output: Trace left pneumothorax unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: Hx of lung ca History: sob Large posterior right lung mass was associated rib destruction, slightly increased since the previous radiograph compatible with known primary carcinoma.Additional small nodules in the upper lobes, compatible with metastases as characterized on the previous chest CT scan. Unremarkable cardiac and mediastinal silhouette. No evidence of pulmonary edema or pneumonia.

Output: Progression of primary mass and metastatic nodules.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Motion degrades sensitivity.Decreased lung volumes with streaky patchy densities in both bases suggests atelectasis, however a superimposed process such as aspiration or even multifocal infection cannot entirely be excluded. Serial imaging may be indicatedBorderline cardiomegaly with mediastinal contours are otherwise unremarkable for semiupright portable techniquePossible mild scoliosis. Cholecystectomy clips

Output: Nonspecific patchy opacities in both bases, although possibly atelectasis, aspiration or infection cannot be excluded


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of colorectal cancer, hemicolectomy. Right liver lobe metastatic lesion CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Right liver lobe hypodense mass measuring 4.4 x 2.8 cm on image number 91, series number 12. This lesion is in segment 8. There is a large cystic lesion in the posterior segment of the right lobe measuring 4.6 x 4.8 cm on image number 91, series number 12. This may represent a large complex cyst, however, biliary cystadenoma cannot be excluded.There is a 1.1 x 1 cm hypodense lesion in the left lobe liver image number 88, series number 12 suspicious for metastatic disease.A subcentimeter lesion in the right lobe on image number 88, series number 12 is too small to accurately characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The penile left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large metastatic lesion in the right lower liver. Small metastatic lesion in the left lobe of the liver. Large cystic lesion in the right lobe. Biliary cystadenoma cannot be excluded. Subcentimeter lesion in the right lobe which is too small to accurate characterize.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Pre kidney transplant evaluation, end stage renal disease. Rule out cardiomegaly and infiltrates. History: Pre-Kidney Transplant. Cardiomediastinal silhouette within normal limits.No acute focal airspace opacity.No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: rule out pneumonia History: rhonchi on auscultation No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: interval change? History: rij tlc, chf, liver failure Cardiomegaly with ICD lead and venous catheter unchanged.Decreased lung volumes with increased basilar opacity compatible with atelectasis and possibly mild pulmonary edema.

Output: Cardiomegaly with basilar atelectasis and possibly edema.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: PNA History: SOB Tracheostomy tube and left-sided ICD unchanged.Stable cardiac mediastinal silhouette.Left retrocardiac consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Persistent left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: wheezing, hx of asthma and HFrEF eval for pulmonary edema History: above Left chest ICD in place with tips superimposing the right atrial appendage, right ventricular apex, and coronary sinus.The cardiomediastinal silhouette is enlarged. Diffuse nodular opacities and vascular indistinctness may be consistent with pulmonary edema in the correct clinical context. This finding is unchanged since the prior radiograph. Small right-sided subpulmonic effusion. No pneumothorax.

Output: Constellation of findings consistent with CHF / pulmonary edema; no substantial change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumothorax History: chest pain Moderate cardiomegaly, unchanged.Mild basilar scarring and no acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: cough x 5 weeks, evaluate for abnormal finding History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Chest tube placement post esophagectomy. Right apical chest tubes unchanged in position. Small 3-4 mm right apical pneumothorax.Enteric tube in the medial esophagus terminates below the GE junction.Small to moderate volume of pleural fluid with associated atelectasis and consolidation at the lung bases, left greater than right. IVC filter partially imaged.

Output: Small 3 to 4 mm right apical pneumothorax. Nonspecific basal atelectasis and consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: ng tube placement History: no ng tube on abdominal xray Feeding tube tip in the stomach.Tracheostomy tube and left jugular catheter unchanged.Small lung volumes with diffuse nonspecific interstitial and airspace opacity, unchanged from previous.

Output: Feeding tube tip in the body of the stomach.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.ARDS, ETT readjustment. Endotracheal tube tip 3.5 cm above the level of the carina. Left jugular introducer unchanged in position. Cardiothoracic ratio enlargement similar to previous. Interval worsening of mixed interstitial and airspace opacities bilaterally. Retrocardiac paramediastinal consolidation bilaterally unchanged.

Output: ETT 3.5 cm above carina. Worsening pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old. SOB status post 7 L of fluid. Unremarkable cardiac and mediastinal silhouette.Mild basilar interstitial opacities, likely scarring, unchanged. No reliable evidence of infection or edema.

Output: No reliable evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: 84 yo female with weakness, pt had prior PNA with similar weakness, assess for PNA History: weakness No significant cardiopulmonary abnormality.No specific evidence of infection or edema.Tortuous aorta.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Status post intubation, concern for pneumonia. Interval extubation and removal of feeding tube. Swan-Ganz catheter from an IVC approach remains looped proximally in the right atrium with tip in the projection of the right descending pulmonary artery. Right jugular catheter tip at the SVC/RA junction, no pneumothorax.Lung volumes remain low. Diffuse interstitial opacities with bronchial wall thickening and atelectasis, about the same. Right basal opacities appear improved.

Output: Pulmonary fibrosis with bronchial wall thickening and small peripheral peribronchial opacities, nonspecific but could in the appropriate clinical context represent acute or chronic bronchitis exacerbation. Although the this infection of the airways is not excluded, no focal air space opacities to suggest pneumonia are appreciated.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Exposure to tuberculosis. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB identified.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: fever, eval for pna History: fever Low lung volumes with basilar atelectasis. No specific evidence of infection or edema.No pneumothorax.

Output: Basilar atelectasis without evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and cough Nonspecific mixed but largely interstitial abnormality observed in all 4 quadrants with mild cardiomegaly. No definite distinct effusions although bases are cut off. Superimposed calcified granuloma. Borderline cardiomegalyRight subclavian 2-lead ICD with lead tips in the expected locations

Output: Nonspecific and largely interstitial abnormality most concerning for acute minimal edema and probable mild CHF. Serial imaging will be needed


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with metastatic colon cancer. CHEST:LUNGS AND PLEURA: Again noted innumerable pulmonary nodules suspicious for metastatic disease. Reference right upper lobe nodule measures 13 x 12 minutes on image number 35, series number 7. Other nodules are also increased in size and number. Dependent bilateral atelectasis.MEDIASTINUM AND HILA: Reference left paratracheal node now measures 18 x 13 mm image number 27, series number 5, not significantly changed from previous study.CHEST WALL: Bony metastases are again noted and there more prominent on the current study.ABDOMEN:LIVER, BILIARY TRACT: I. lobe aquatic metastases. Reference lesion in the right lobe measures 3.2 x 2 .7 cm, image number 55, series number 5. Today's CT is postcontrast, therefore, numerous hepatic metastases are better seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference left aortocaval lymph node measures 19 x 14 mm image number 121, series number 5, not significantly changed. Multiple other enlarged retroperitoneal nodes are also not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bone metastases involving the pelvic bones, and the lumber spine are slightly more prominent.OTHER: Increase amount of ascites. Peritoneal carcinomatosis is unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left obturator lymph node is unchanged in size, now measuring 2 x 0.6 centimeters.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Metastatic bone lesions.OTHER: Ascites.

Output: Interval increase in the size and number of the lung metastases. Hepatic metastases, Pergonal carcinomatosis and retroperitoneal adenopathy stable. Bone metastases and ascites are increased in size.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Fever Right sided central venous line tip in the SVC stent. Surgical clips noted in the left upper quadrant.Large lung volumes compatible with COPD. Bibasilar linear opacities likely subsegmental atelectasis/scarring. Thickened septal lines also seen. Small left pleural effusion. Cardiac size is within normal limits.

Output: Bibasilar linear opacities likely subsegmental atelectasis/scarring. Mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: eval infection, edema, effusion History: hypoxia, sickle cell pain Stable cardiomegaly. No new opacity to suggest pneumonia.

Output: Stable cardiomegaly. No new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 49 year-old female status post surgical removal of large facial tumor two days ago, now persistently tachycardic. Please evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: Groundglass and air space opacities with septal thickening involving a significant portion of the left lung as well as small, scattered portions of the right lung. Left greater than right pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Borderline enlarged left axillary lymph nodes are likely reactive in etiology.UPPER ABDOMEN: No significant abnormality noted.

Output: Air space opacities bilaterally most likely representing significant aspiration pneumonia/pneumonitis given the clinical context. However, an atypical edema pattern is a less likely consideration.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Evaluate lung fields status post subclavian balloon pump placement. IABP marker about 4 cm below the top of the aortic arch in the projection of the proximal descending thoracic aorta.Endotracheal tube tip 4 cm above the level of the carina. Interval placement of a right jugular introducer which terminates at the level of the right brachiocephalic vein, no pneumothorax. Left PICC tip at the confluence of the brachiocephalic veins.Large right and moderate left pleural effusions with associated atelectasis. No evidence of pulmonary edema.

Output: No signs of pulmonary edema. Moderate to large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: ETT adjusted History: as above Endotracheal tube has been pulled back and now terminates approximately 5 cm from the carina. Small effusions and bibasilar opacities unchanged. Unchanged heart size. No pneumothorax. Diffuse pulmonary opacity again noted with relative sparing of the left upper lung zone.

Output: Endotracheal tube has been pulled back and now terminates 5 cm from the carina. Otherwise, no substantial change in diffuse pulmonary opacities, pleural effusions, and bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: sob History: sob Minimal streaky basilar opacity likely due to atelectasis. No evidence of edema or focal consolidation to suggest pneumonia. Heart size normal.

Output: Minimal streaky basilar opacity likely due to atelectasis. No evidence of edema or focal consolidation to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check ETT has been placed 5 cm above the carina. A new Swan-Ganz extends into the right pulmonary outflow tract. NG terminates in the mid to distal esophagus.Right chest tube projects towards the upper right hilar region unchanged. No significant associated pneumothorax or complicationUnderlying cardiopulmonary appearance continues to demonstrate largely diffuse bilateral interstitial opacities without new superimposed focal process.

Output: ETT and Swan-Ganz placement


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: malignant pleural effusion History: malignant pleural effusion Cardiomegaly with a mild edema pattern as well as further consolidation and left lower lung zone with a left pleural effusion.Left subpulmonic pleural drain.

Output: Pulmonary edema and left effusion, with a left pleural drain unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: heart failure History: abnormal lung sounds Widening of the mediastinum again noted. No new focal lung opacity. Left-sided pleural thickening again noted. Old left-sided rib fractures, as before. Sternotomy wires are again and midline though one of them is again fractured. No large pleural effusion or pneumothorax. Aortic atherosclerosis.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: r/o acute process History: sob Low lung volumes. The cardiomediastinal silhouette is within normal limits.Mild bibasilar segmental atelectasis.No significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormalities noted. Low lung volumes. 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, 67 years old.Reason: interval change in opacities History: worsening hypoxemia in pt w/ CHF Iatrogenic devices are unchanged. Slight increase in diffuse pulmonary opacities. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: Increased interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval History: food impaction; rib tip; how high? Left hemithorax volume loss.Otherwise, the lungs are unremarkable.Heart size normal.No evidence of esophageal dilation.

Output: Mild left lung scarring and volume loss, otherwise unremarkable. A CT would be more sensitive if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Connective tissue disease. Chest wall sarcoma Persistent postsurgical changes with distortion, rib resection and volume loss in with mediastinal shift of the left upper lung and chest wall. No evidence to support new interval abnormality and interval resolution of overlying chest wall emphysema. Chest port unchanged. Right lung remains clear.

Output: Postsurgical changes without evidence of immediate acute superimposed abnormality


Instruction: Generate impression based on medical findings.

Input: 89 years old Female. Reason: Sepsis of unclear source History: see above. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema, improved as compared with prior study. Small amount of bilateral pleural effusions are noted.

Output: The above findings are consistent with severe congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o pneumothorax History: s/p chest tube removal Cardiomegaly, status post sternotomy.No pneumothorax following chest tube removal.Small lung volumes with pleural effusions and minimal edema unchanged.

Output: No pneumothorax following chest tube removal. Stable opacities and pleural effusions as well as cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: assess for opacities and ETT placement History: intubated ET tube tip 4 cm from the carina.Other support devices unchanged.Basilar edema, atelectasis, and layering effusions.Moderate cardiomegaly.Wide mediastinum likely accounted for by rotation.

Output: ET tube tip in acceptable position.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 93 yearsGender: FemaleReason for Study: Reason: eval pleural effusion History: effusion Moderate to large sized right pleural effusion slightly decreased in size since the prior exam. Stable cardiac enlargement with pulmonary vascular redistribution.Left basilar opacity and small left pleural effusion redemonstrated.

Output: Moderate to large sized right pleural effusion, slightly decreased from the prior exam. Interval increase in the left pleural effusion and left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Chest pain History: chest pain (ribs and heart) Large lung volumes with mild chronic appearing basilar opacities.Status post median sternotomy and aortic valve replacement.Probable skeletal metastases are better seen on CT.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: ng tube placement History: ng tube placement abdominal pain Enteric tube tip and sidehole projecting over the gastric body.Unchanged cardiomediastinal silhouette. Calcified hilar lymph nodes and scattered calcified pulmonary nodules are compatible with prior granulomatous disease. Mild bibasilar subsegmental atelectasis is again seen. Left apical ill-defined pulmonary opacities are again appreciated, and while these may reflect summation artifact, the possibility of nodules in these locations cannot be excluded.

Output: NG tube tip in stomach.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval for ptx History: mvc with chest pain No significant cardiopulmonary abnormality.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: cticu patient, lung field eval History: s/p lung transplant Large bilateral pneumothoraces significantly increased from the prior exam with cupping collapse of both lungs.Chest tubes are still in place bilaterally unchanged.Subcutaneous emphysema noted along the right lateral chest wall.Stable cardiomediastinal silhouette.

Output: Interval development of large bilateral pneumothoraces with marked compression of both lungs. The service was notified by phone at 10:10 AM. Subsequent imaging demonstrates partial expansion of both lungs.


Instruction: Generate impression based on medical findings.

Input: 88 year-old female with lung cancer, preop evaluation. Evaluate for changes since last CT. History given on prior report of scleroderma. CHEST:LUNGS AND PLEURA: Stable previously described right upper lobe nodule contiguous with the pleura currently measures 19 x 18 mm, (image 26, series 5) previously 18 x 18 mm (image 20, series 7). Other scattered small nodular opacities are unchanged.Diffuse interstitial lung changes with associated groundglass abnormalities, microcystic honeycombing and traction bronchiectasis have not changed. MEDIASTINUM AND HILA: Dilated esophagus with an air-fluid level consistent with scleroderma unchanged. Coronary artery calcifications are present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Large calcified gallstones. No other significant abnormality noted.

Output: 1. Unchanged interstitial lung disease.2. Stable right upper lobe nodule consistent with lung cancer.


Instruction: Generate impression based on medical findings.

Input: Sickle cell disease with hypoxemia, possible PE LUNGS AND PLEURA: Several factors, including patient motion during triggering, limited this examination which is nondiagnostic for PE due to poor opacification, no gross pulmonary embolism is identified up to the lobar arteries. No pericardial or pleural effusions. Bibasilar streaky opacities either atelectasis or scarring.MEDIASTINUM AND HILA: Mild cardiomegaly.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Nondiagnostic study for PE as described.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: Shortness of Breath, non productive cough History: non productive cough shortness of breath Small bilateral pleural effusions with adjacent atelectasis. Basilar interstitial and airspace opacities compatible with edema appearing somewhat less pronounced compared to previous exam.

Output: CHF with mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.History of bladder cancer. Evaluate for metastatic disease. No focal lung consolidation, pleural effusion, or pneumothorax. There is a subcentimeter nodular opacity in the left midlung. The heart size is normal.

Output: Nodular opacity in the left midlung is unlikely to represent metastatic disease, however, follow up radiograph is recommended in 3 months to prove stability/resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: Eval for acute cardiopulmonary process History: ams Innumerable bilateral nodular opacities consistent with pulmonary metastatic disease, as seen on CT dated 7/17/2016.No pneumothorax.Normal cardiomediastinal silhouette..

Output: Innumerable bilateral metastatic pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval lung fields History: s/p MVR, TVR, CABG Enteric tube side port is at the gastroesophageal junction and could be advanced. Other lines and tubes, unchanged. Leftward patient rotation again noted. No substantial change in diffuse pulmonary opacities given differences in inspiration. Basilar pleuroparenchymal opacities, not substantially changed. Unchanged cardiomegaly. No significant pneumothorax.

Output: Enteric tube side port is at the gastroesophageal junction and could be advanced. Other lines and tubes, unchanged. Leftward patient rotation again noted. No substantial change in diffuse pulmonary opacities given differences in inspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: ET in place? History: ET in place Small lung volumes with small pleural effusions and basilar atelectasis.Mild cardiomegaly.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: pneumonia History: atrial fibrillation, weakness No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Evaluate for fluid overload History: History of CHF, SOB, mult presentations, worsening PND, orthopnea The cardiac silhouette is enlarged. Mild interstitial edema and thickening of the fissures. No pleural effusion, focal consolidation, or pneumothorax.

Output: CHF and mild interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: eval for infiltrate History: cough, sob Cardiac size is within normal limits. No large pleural effusions or pneumothorax. Mild atelectasis right lower lobe. Small nodular opacity in the right cardiophrenic angle could reflect pulmonary vein seen on end, but a nodule cannot be excluded.

Output: Mild atelectasis. No specific findings of pneumonia. Small nodular opacity in the right cardiophrenic angle could reflect pulmonary vein seen on end, but a nodule cannot be excluded; recommend PA and lateral chest films when feasible.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent left lower lobe focal opacity with mild CHF like changes in both bases. Again concern for possible consolidation and infection. Mild thyromegaly

Output: Unchanged left lower lobe focal opacity concerning for possible partial consolidation and less likely atelectasis


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: pneumo after lung bx History: pneumo (small to medium by limited CT) Persistent moderate-sized right apical pneumothorax.Right middle lobe nodule again identified.Cardiac mediastinal silhouettes are unremarkable.No new pulmonary opacities noted.

Output: Right apical pneumothorax unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: cough History: cough Moderate to severe cardiomegaly with the suggestion of basilar edema.No significant sized pleural effusions and no sign of pneumonia.Left PICC, tip in left axillary region.

Output: Cardiomegaly with the suggestion of basilar edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: r/o cardiac etiology History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: 70 y/o man w/ HTN and AMS History: 70 y/o man w/ a hx of HTN who p/w AMS. The cardiomediastinal silhouette is within normal limits.Mild hyperinflation of lung fields. No airspace or interstitial opacities.  No evidence of pneumothorax. No pleural effusions.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: 16-year-old male status post port removal, evaluate retained catheter.VIEWS: Chest AP/lateral (two views) 1/19/2015 The retained left chest wall Port-A-Cath fragment has migrated proximally, with the catheter tip now residing within the high right atrium. The cardiothymic silhouette is normal. No focal airspace opacity is seen.

Output: Proximal migration of the retained central venous catheter, with the tip now residing in the high right atrium.These findings were discussed with Kelly Kramer at 11:50 on 1/19/2015 via telephone.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: LUL Nodule; further evaluate History: as above 14 mm left upper lobe nodule confirmed, not calcified.Large lung volumes consistent with COPD, heart size normal but small pleural effusions present.

Output: Small pleural effusions and a left upper lobe nodule which should be evaluated by CT.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: ETT placement, ?ARDS History: n/a ET tube, left IJ catheter, and enteric tube stable in position.Cardiomegaly is stable.Bilateral pulmonary opacities appear similar to the prior examination with dense pulmonary opacity in the right middle lobe. Loculated left pneumothorax appears similar to prior exams.Dense vertebral bodies compatible with renal osteodystrophy.

Output: Stable appearance of severe, nonspecific airspace opacities compatible with clinical diagnosis of ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Intubated Lines and tubes are unchanged. Interstitial pulmonary edema pattern, unchanged. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged heart size. Right-sided pleural effusion/thickening again noted.

Output: Lines and tubes are unchanged. Mild interstitial pulmonary edema pattern again noted. No substantial change in bibasilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.SOB rule out edema or infection. Low lung volumes. Right middle and lower lobe atelectasis and/or scarring nonspecific as to etiology. Bilateral basal bronchiectasis. Normal heart size.On lateral radiograph, there is a subpleural nodular opacity in an anterior upper lobe, probably related to the left costochondral articulation of the first rib, but nonspecific. Small subpulmonic effusion on the right.

Output: Small right subpulmonic fluid collection. Bilateral basal bronchiectasis and scarring, likely chronic. On the right, platelike atelectasis is of unclear chronicity. No signs of pulmonary edema or conclusive signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: upright History: upright CXR Diffuse opacification of the right hemithorax again noted. Left lung is unchanged. Unchanged heart size. NG tube remains in place. IVC filter, incompletely visualized.

Output: Persistent complete opacification right hemithorax likely representing a combination of pleural effusion and atelectasis. Superimposed consolidated lung cannot be excluded on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: chest tube placement History: pleural effusion Lines and tubes are unchanged. Left pleural effusion and left lower lobe opacity noted. Patchy right basilar opacity, unchanged. Heart size unchanged. No pneumothorax.

Output: No substantial difference compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: Swan placement, PNA, effusion History: ADHF awaiting IABP placement Swan-Ganz catheter tip in the main pulmonary artery. ICD leads unchanged.Mild cardiomegaly and no significant pulmonary abnormalities.

Output: Swan-Ganz catheter tip in the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 94 years old.Reason: chest pain History: acute onset of left sided chest pain since yesterday Persistent elevation of the left hemidiaphragm.Left basilar passive subsegmental atelectasis again noted. No additional abnormal lung parenchymal opacities.The cardiac and mediastinal contours are partially obscured.No signs of pneumothorax.

Output: Persistent left hemidiaphragmatic elevation. No abnormal radiographic findings to explain patient's chest pain.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Pleurodynia- posterior right pain for the past 4 days with cough. Cardiomegaly with eventration of the right hemidiaphragm.Nonspecific right paramediastinal/retrosternal opacity nonspecific, statistically most likely a goiter.No pleural fluid or pneumothorax.

Output: No pneumothorax or other visible abnormalities to account for the patient's symptom of pain.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Infiltrates History: fever No acute abnormality.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old. New right jugular catheter extending to the SVC and PICC line tip also in the SVC.Right upper lobe airspace opacity, compatible with infection, not significantly changed since the previous day.Chronic abnormalities consistent with sickle cell disease, unchanged.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Check for aspiration. Vomiting Stable-appearing cardiopulmonary appearance including suspected subsegmental perihilar and basilar opacities again likely aspiration versus atelectasis. No pleural effusions. Persistent decreased lung volumesRight jugular catheter unchanged, tip extends into the mid SVC. Recently placed Dobbhoff coiled in the proximal stomach.

Output: Dobbhoff tube placement


Instruction: Generate impression based on medical findings.

Input: 54 year-old female with follow up for pulmonary micronodules in the previous CT, history of asthma, rheumatoid arthritis, previous methotrexate use LUNGS AND PLEURA: Stable scattered micronodules with the previously identified 5-mm nodule in the left lower lobe demonstrating no interval change.Basilar scarring and bronchial wall thickening is similar to the prior exam and is compatible with chronic bronchitis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Stable pulmonary micronodules, and left lower lobe 5-mm nodule. No further follow up imaging is recommended.2.Basilar scarring and chronic bronchitis or similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: ventilator changes Tracheostomy and esophageal stent are unchanged. Mediastinal surgical clips are again noted. Interval removal of left chest tube. Diffuse pulmonary opacities are not significantly changed. No pneumothorax or pleural effusion. Borderline cardiomegaly, unchanged.

Output: Diffuse pulmonary opacities, not significantly changed since prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ETT placement and is there improvement in LLL opacity. Endotracheal tube terminates approximately 4 cm from the carina. Low lung volumes makes detailed cardiopulmonary assessment difficult. Increase in basilar opacities, likely atelectasis or aspiration. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: Apparent increase in basilar opacities, likely atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with history of sarcoma and metastases are nearly diagnosed colon cancer CHEST:LUNGS AND PLEURA: Right upper lobe nodule measures 3.1 by 1.2-cm image number 21, series number 4, smaller compared to previous study. Left upper lobe nodule measures 1.3 by 1.1 cm on image number 21, series number 4, minimally increased in size.Left lower lobe nodule measures 9 by 7 mm on image number 50, series number 4, not significantly changed. There is new scarring and atelectasis surrounding the right upper lobe nodule. Right lower lobe atelectasis is unchanged.MEDIASTINUM AND HILA: Right infrahilar lymph node is stable measuring 11 mm on image number 42, series number 3. It is not well seen due to of IV contrast.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is colocolonic intussusception involving the distal transverse colon. There is also suggestion of a large lobulated mass in the distal transverse colon. Correlation with endoscopy is recommended. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mixed response are of lung nodules. Stable infrahilar lymph node.Colocolonic intussusception likely caused by a large transverse colonic mass. Further evaluation with endoscopy is recommended.Dr. Undevia was notified and acknowledged about the above findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: Pt w/ sickle cell. Assess for Pneumonia/acute chest History: Chest pain Moderate cardiomegaly with cephalization of the pulmonary blood flow.No specific evidence of infection or edema.No evidence of infarction.Right jugular catheter, tip in SVC.

Output: Cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: pna? History: AMS Small lung volumes.No specific evidence of infection or failure.Heart size normal.

Output: Small lung volumes, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: post op cardiac surgery History: post op cardiac surgery Median sternotomy with chest tubes but no pneumothorax.Lower lung zone edema and pleural effusions are stable.ET tube tip approximately 3 cm above the carina.NG and Dobbhoff tubes extend below the lower margin of the image.Circulatory assist cannula are present.Right jugular catheter, tip in SVC.Left jugular introducer unchanged.

Output: No pneumothorax with stable basilar edema.


Instruction: Generate impression based on medical findings.

Input: Gait imbalance, positive paraneoplastic syndrome antibody. Occult neoplasm? CHEST:LUNGS AND PLEURA: Bilateral numerous subcentimeter nodules pain random distribution suspicious for hematogenous spread of infection versus metastatic disease.MEDIASTINUM AND HILA: Prevascular and bilateral hilar borderline enlarged lymph nodes. Reference right hilar lymph node measures 12 x 11 mm in image number 50, series number 3.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: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral numerous subcentimeter nodules are suspicious for metastatic disease versus hematogenous spread of infection. Borderline enlarged bilateral hilar and prevascular lymph nodes


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: sob History: as above Right chest wall deformity unchanged from multiple fractures.No specific evidence of infection or edema.No significant sized pleural effusions.Mild cardiomegaly.

Output: Cardiomegaly without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: eval dobhoff History: - T tube with its tip 4 cm splenic carina.Dobbhoff tube with its tip in the stomach.Volume loss in the right lung.Unremarkable cardiomediastinal silhouette.Multiple surgical clips identified in the right hilar region.No large pleural effusions.

Output: ET tube and Dobbhoff tube in satisfactory positions. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 97 years old.Hypoxia, volume overload Stable cardiomegaly. Comparison with prior study is limited by marked difference in position; within this limitation, there is interval increase in the right perihilar opacity. Large bilateral pleural effusions.

Output: Dense perihilar opacity compatible with aspiration or infection. Large bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Intubation Interval ETT placed, tip projects 4 cm above the carina. NG well positioned with termination beyond the inferior edge of the imageUnderlying cardiopulmonary appearance is overall grossly similar with marked cardiomegaly and a moderate left effusion with suspected consolidation and/or left lower lobe mass. Multiple right rib fractures, please see pending CT report due to greater sensitivity

Output: ETT placed


Instruction: Generate impression based on medical findings.

Input: 59 years old Male. Reason: interval change History: trach. Supporting devices are unchanged. Stable bilateral lung opacities and bilateral pleural effusions as well as decreased lung volume.

Output: Stable bilateral pleural effusions, bilateral lower lung opacities and hypoinflated lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: evaluate lung fields, evaluate ETT History: s/p OHT, poor oxygenation The patient has been intubated with ET tube approximately 2.5 cm above the carina. Swan-Ganz catheter, mediastinal drain, epicardial pacing leads, right chest tube, and sternotomy hardware noted. Defibrillator has been removed.The cardiac silhouette is normal.Fine nodular airspace opacities are seen bilaterally. No large pleural effusions.

Output: Postoperative findings with new pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 76 year old woman with RCC status post 10 cycles chemo. Evaluate disease status comparison measure. CHEST:LUNGS AND PLEURA: Several scattered lung nodules are seen bilaterally unchanged. The index lesion in the left base is also unchanged seen on image 62/108 measuring 7 x 5 mm. No effusions.MEDIASTINUM AND HILA: Superior mediastinal mass slightly smaller seen on image 16/186 measuring 2.0 x 3.1 CM. No new lesions is seen. Prominent pericardial fluid in the pericardial recesses is noted again. Atherosclerotic calcification is seen in the coronary arteries.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Previously seen are a few scattered punctate lesions are reidentified, unchanged. No new lesions are seen. These are too small to measure. There is no significant biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Markedly atrophic. Markedly fatty replaced. Small mass presumably metastasis in the body of the pancreas is identified on image 87 measuring 1.5 x 1.3 cm.Complex solid and cystic peripancreatic mass is identified and remeasured on image 105/189 as 6.7 x 3.7 cm. It compresses adjacent structures but there is no evidence of venous thrombosis. Surgical clips are identified in the region.ADRENAL GLANDS: Left adrenal nodule unchanged. Right adrenal gland presumably surgically resected along with the right kidney.KIDNEYS, URETERS: Right kidney surgically absent. Left kidney normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. A rim- enhancing retrocaval mass is smaller as seen on image 106/189BOWEL, MESENTERY: Mesenteric root mass as measured aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: All lesions stable or slightly decreased in size. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Evaluate for infection versus fluid overload, heart size. Shortness of breath, new onset chest pain. Unchanged appearance of the cardiomediastinal silhouette over multiple prior studies this year. Mediastinal prominence and subpleural fat deposition most consistent with lipomatosis. Basal and dependent scarring. No pneumothorax or convincing evidence of CHF. No signs of pneumonia.

Output: No convincing evidence of CHF or acute pulmonary abnormality. Low normal lung volumes with basal scarring/atelectasis is chronic and not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: s/p ct biopsy on right check for ptx History: s/p ct biopsy on right check for ptx No evidence of pneumothorax. Known mass was better seen on prior CT.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: mass? Nodules? Cavitary lesion? Pna? History: fever, chills, weight loss, neck mass Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: inc sob--change from baseline? History: sob and chest tightness No significant cardiopulmonary abnormality.No significant change.No findings to account for shortness of breath.

Output: No significant abnormality. No significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: patient with night sweats evaluate for pulmonary lesion history of smoking History: night sweats Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: pneumonia? History: neutropenic fever Central venous line terminates in the mid SVC. Mild atelectasis or scar at left lung base. No focal lung consolidation. No large pleural effusion or pneumothorax. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval for pneumothorax s/p thoracentesis History: s/p thora No pneumothorax following thoracentesis.Small pleural effusions and right hemithorax volume loss unchanged.Heart size normal.Right jugular catheter, tip at cavoatrial junction.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for infiltrate History: cough Normal heart size within moderately tortuous and ectatic aorta, unchanged.Mild scarring in the left midlung.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Shortness of breath, bilateral wheeze, hypoxemia. Evaluate for pneumonia versus pulmonary edema. Coarse interstitial markings bilaterally with areas of volume loss in the right upper lobe, left upper lobe and lingula. Septal thickening seen on the left. Small pleural effusions. Mass in the superior left lower lobe.

Output: Mild pulmonary edema. Left lower lobe mass. Bilateral patchy areas of atelectasis.


Instruction: Generate impression based on medical findings.

Input: 69 year-old female with metastatic thyroid cancer. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are unchanged. A right lower lobe nodule measures 6 x 7 mm on axial image 23/73 (measured 6 x 6 mm previously). No new pulmonary nodules or masses are identified. No focal consolidation, edema or pleural effusion.High attenuation foci along the pleura in the right base are unchanged and may reflect pleural calcification, talc from prior pleurodesis, or a staple line. Correlation with clinical history recommended.MEDIASTINUM AND HILA: Calcified left hilar lymph node measures 9 x 12 mm on axial image 25/136 and is slightly smaller (measured 11 x 13 mm previously). No new pathologically enlarged hilar or mediastinal lymph nodes evident.Cardiac size is normal with no significant pericardial effusion. Atherosclerotic calcifications evident.CHEST WALL: A large right subscapular lipoma is grossly unchanged. An additional lipoma adjacent to the right chest wall at the level of the upper poles of the kidneys is also unchanged.ABDOMEN: Evaluation of the abdomen is limited due to lack of IV contrast enhancement. Within the limitation, the following observations are made.LIVER, BILIARY TRACT: Punctate calcified gallstone unchanged.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left upper pole hypoattenuating lesion is incompletely evaluated on this noncontrast exam but could represent a simple cyst. No interval change noted.PANCREAS: Calcifications within the pancreas are likely vascular.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small, fat-containing ventral hernia with adjacent stranding is nonspecific and unchanged unchanged, possibly representing fat necrosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable pulmonary nodules with no evidence of disease progression in the chest or upper abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: ? MI History: CP Heart size upper normal status post sternotomy and CABG.Minimal lower lung zone edema accompanied by small pleural effusions.No specific evidence of infection.

Output: Heart size upper normal with minimal pleural effusions and basilar edema.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p AVR; ?PTX History: SOB Status post median sternotomy for CABG.Moderate cardiomegaly.No specific evidence of infection or edema.Minimal pleural effusions noted.

Output: Cardiomegaly and minimal effusions. No pneumothorax following right chest tube removal and resolution of prior basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: evidence of hemothorax History: previous bleeding it lung txp, restarted subq heparin yesterday Small lung volumes with pleural effusions and atelectasis, not appreciably changed.Cardiopulmonary monitoring and support devices, unchanged.No pneumothorax or other acute change.

Output: Effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of breast cancer status post neoadjuvant and adjuvant chemotherapy. Evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Multiple, ill-defined nodules in the right upper lobe (series 4, images 35 and 43 for example). Findings may be infectious in etiology, and while atypical in appearance for metastatic disease, follow-up imaging is recommended to confirm benignity/resolution.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Surgical clips in right axilla. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter, hypoattenuating lesions in the liver are too small to characterize. No intra-or extrahepatic biliary ductal dilatation. Hepatic vasculature is patent. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Multiple, ill-defined nodules in the right upper lobe. Findings may be infectious in etiology, and while atypical in appearance for metastatic disease, follow-up imaging is recommended to confirm benignity/resolution. Otherwise, no definite evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: chest tubes History: esophagectomy c/b TEF s/p closure, lat flap The support devices, including tracheal stent, are unchanged in position.Postsurgical appearance compatible with gastric interposition. Near complete opacification of the right hemithorax is unchanged. Small pleural effusions. No significant pneumothorax.

Output: Right sided opacification unchanged. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: please eval volume status History: SOB Right chest tube unchanged in position with a stable small 1 cm right apical pneumothorax.No significant pleural effusions.Minimal stable interstitial opacities suggestive of edema.Moderate cardiomegaly unchanged.Right jugular catheter tip in SVC/right junction level.IABP catheter proximal marker 2 cm below the top of the aortic arch.

Output: No change in minimal edema and small right apical pneumothorax. No new findings.


Instruction: Generate impression based on medical findings.

Input: 19 years, Female. Reason: obstructions History: obstruction No evidence of free air. Nonobstructive bowel gas pattern. Right lower quadrant ostomy. Surgical clips in the pelvis.Note that the chest radiograph is flipped. See left marker near the left shoulder. No acute cardiopulmonary abnormality in the chest.

Output: 1.Nonobstructive bowel gas pattern. No free air.2.Note that the chest radiograph is flipped. See left marker near the left shoulder. No acute cardiopulmonary abnormality in the chest.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: OSH transfer, confirm tube and line placement History: respiratory failure and shock Cardiomegaly with left lower lobe subsegmental atelectasis.ET tube tip approximately 6 cm above the carina. An NG tube extends below the lower margin of the image.Left PICC, tip in the SVC.

Output: Cardiomegaly with minimal left base subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: r/o mets History: none The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: post pneumo History: post pneumo Right pleural catheter unchanged.Right apical pneumothorax decreased in size from the prior exam.Stable cardiomediastinal silhouette with decreased lung volumes.Left basilar scarring/discoid atelectasis similar to the prior exam.

Output: Mild interval decrease in size of the right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Evaluate trach. ARDS. Tracheostomy tube tip 3.5 cm above the level of the carina.Dobbhoff tube tip in the distal stomach.Right jugular ECMO cannula extends to the IVC, with sidehole projecting over the mid-right atrium.Left PICC terminates in the peripheral aspect of the left subclavian vein.Lung volumes remain low.Multifocal airspace opacities bilaterally without acute change.

Output: Unchanged diffuse airspace opacity. Tracheostomy tube tip 3.5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Follow-up placement of lines. Intubated, sedated and septic. ETT tip 3.5 cm above the level of the carina. Dobbhoff and nasogastric or orogastric tube tips below the caudal margin of the film but can be followed at least the level of the stomach. There continues to be high density foreign material in the left upper quadrant in the projection of the stomach which has been present since the patient's admission radiograph and most likely represents retained, inspissated oral barium contrast in the stomach.Moderate left pleural effusion with associated atelectasis. Shifting atelectasis on the right, now in the middle and lower lobes with associated groundglass opacity, consistent with aspiration of secretions. Left lower lobe opacities consistent with atelectasis and aspirate however underlying pneumonia cannot be excluded.

Output: ETT tip 3.5 cm above carina. Signs of aspiration. Retrocardiac opacity on the left nonspecific and infection cannot be entirely excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 64 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: Female, 53 years old.Reason: History of pneumonia History: Cough and congestion Medial linear opacity in the right lower lobe, likely atelectasis or scarring. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old with 6 days of cough and fever and rales at the right lung base. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax. Mild bronchial wall thickening.

Output: Mild bronchial wall thickening suggestive of reactive airway disease such as asthma. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: ? Pneumonia History: cough, congestion, rhonchi at right lower lung field Nonspecific opacity left lower lung zone could reflect subsegmental atelectasis or scarring.No reliable evidence of pneumonia or edema, and no significant pleural effusions.Heart size normal.

Output: Nonspecific left base opacity likely scarring or subsegmental atelectasis, without reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Patient w/ sepsis, cardiogenic shock, intubated, has PA catheter, please check line placement and interval change in pulmonary opacities/ edema History: As above Poor technique excludes portion of the right chest however there is significant increase in bilateral pleural effusions. Line position otherwise stable. No change in basilar opacities.

Output: Interval increase in bilateral pleural effusions. No change in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: 23 y/o with SLE c/o pleuritic chest pain eval History: pleurisy symptoms Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of middle lobe of right lung (SCC). Additional history of esophageal cancer. Mild elevation of the right hemidiaphragm consistent with volume loss from right middle lobectomy. No visible signs of localized recurrence at the right middle lobectomy site by plain film technique. No suspicious pulmonary nodules or masses. No pleural fluid. Heart size is normal. Assessment for esophageal pathology not reliable by plain film technique.

Output: No acute pulmonary abnormality. No visible signs of recurrent or metastatic disease of the patient's right middle lobe tumor by plain film technique.


Instruction: Generate impression based on medical findings.

Input: 48 years old Female. Reason: evaluate for mediastinum, etc History: Chest pain. Widening of the cardiomediastinal silhouette is unchanged. There is interval worsening of the interstitial opacity in the lower lower lungs. No evidence of pneumothorax or pleural effusion.

Output: Cardiomegaly and mild interstitial changes in the lower lungs, which can be due to heart failure. Suggest clinical correlation.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p TLC placement History: s/p TLC placement via cordis Catheter tip in the SVC.No pneumothorax or other complications.Bilateral pulmonary opacity compatible with edema and effusions, greater on the right, slightly improved compared to previous.Skinfold over the left lung but no pneumothorax.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.CHF, IABP. Mild cardiomegaly. Left subclavian ICD similar in position. IABP marker projects over the descending thoracic aorta approximately 4.5-cm below the top of the aortic arch level.Mild groundglass opacity in the right lung, possibly dependent atelectasis though not specific, correlate for aspiration.Right PICC tip projects over the right subclavian vein.

Output: Unchanged position of IABP. Faint opacity in the right lung suggestive of dependent atelectasis.