Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Shortness of breath, elevated white count, assess for pneumonia Lower cervical spinal fusion hardware.Left PICC tip in the left axillary vein.Stable cardiomediastinal silhouette. Lung herniation noted along the right lateral hemithorax persists. Left pleural effusion or pleural thickening. No new focal consolidation or pneumothorax.

Output: No specific evidence of pneumonia.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, 78 years old.Reason: RIJ dialysis line placement History: new line New right jugular catheter poorly seen though the tip appears to be in the SVC. No evidence of pneumothorax. Other findings stable in short interval.

Output: New right jugular catheter poorly seen though the tip appears to be in the SVC. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval for structural abnormality in lower left lung/diaphragm/ribs History: left sided pain x 5 years with nausea, swelling over left lower ribs The lungs and pleural spaces are clear. No displaced rib fracture is identified. The heart size is normal.

Output: No displaced rib fracture. Lungs and pleural spaces remain clear.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: post-op History: sob Increased basilar atelectasis and pleural effusions, which may be the result of aspirated secretions or mucous plugging.Hiatal hernia less gas-filled than before.

Output: Worsening basilar atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female patient with history of benign intracranial hypertension. Evaluate ventriculoatrial and lumboperitoneal shunts. SHUNT DEVICE: An intracranial shunt exits the skull via a left parietal burr hole. The draining catheter courses down the scalp and neck terminating in the cavoatrial junction. Portions of the shunt overlying the skull are radiolucent and difficult to evaluate but we see no complications. The notch on the pressure valve is directed posteriorly and appears similar to that seen on the prior study.A spinal shunt is noted with its tip at the level of T10. The catheter courses inferiorly and exits the lumbar spinal canal at the level of L1/L2. It then courses within the right flank entering the abdomen and terminating in the pelvis. The notch on the pressure valve now points inferiorly, whereas it previously pointed to the left, although the valve is not seen in its entirety due to overlying surgical clips. Portions of the shunt device are relatively radiolucent and hence difficult to evaluate, but the appearance is similar to that seen on the prior study. We see no radiographic evidence of complication.SKULL: There are surgical changes of a suboccipital craniectomy, unchanged.CERVICAL SPINE: Degenerative disc disease affects the lower cervical spine.CHEST: Blunting of the left costophrenic angle likely represents an effusion and there is scarring of the left lung, which appears similar to the prior study.ABDOMEN: Surgical clips project in the right upper quadrant. Non-obstructive bowel gas pattern.

Output: 1. Ventriculoatrial and lumboperitoneal shunts, appearing similar to the prior study, although the notch of the lumboperitoneal shunt now points inferiorly.2. Left pleural effusion and scarring appearing similar to the prior study.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Essentially unchanged diffuse airspace and interstitial opacities most pronounced in the left upper lobe consistent with previously suspected PJP pneumonia. No new superimposed focal abnormalities. Small effusions again cannot be excludedCardiac and mediastinal contours appear grossly within limits

Output: Unchanged pulmonary appearance consistent with suspected PJP pneumonia


Instruction: Generate impression based on medical findings.

Input: Reason: f/u for SOB History: f/u for SOB Small lung volumes with mild atelectasis at the left base.No specific evidence of pneumonia or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Device placement No immediate gross interval change in the 2-lead left subclavian ICD. Lead tips appear similar given mild differences in patient positioning. No immediate additional postprocedural complication.Underlying lungs again demonstrate mixed interstitial and patchy opacities in both lung bases mildly greater on the right with moderate nonspecific cardiomegaly. Concern for mild edema again remains high superimposed upon atelectasis, however aspiration must also be considered.

Output: Stable cardiopulmonary appearance without interval postprocedural complication. See details provided


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: MaleReason for Study: Reason: evaluate for infection, acute chest syndrome History: sickle cell pain, hypoxia Interval clearing of the right basilar consolidation and right pleural effusion.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: Evaluate for SOB. s/p heart transplant History: SOB Median sternotomy.Heart size normal, and the lungs unremarkable.

Output: No significant abnormality following heart transplant.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: pna History: cough No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Supine positioning. Cardiomegaly with slight interstitial edema pattern and small pleural effusions is stable. Right jugular Swan-Ganz catheter appears minimally more proximal within the main pulmonary artery. No pneumothorax. Left jugular catheter tip over the innominate vessels. No pneumothorax.

Output: Mild interstitial edema pattern, stable. Right jugular Swan-Ganz catheter now slightly more proximal in the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Chest tube check Persistent right chest tube with overlying moderate chest wall emphysema and a small insignificant pneumothorax. Right jugular catheter again extends into the proximal SVC.Underlying cardiopulmonary appearance also similar without new superimposed focal abnormalities

Output: Right chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: assess for pneumothorax History: h/o CF, respiratory failure, hypoxia No evidence of pneumothorax. Other findings stable in short interval.

Output: No evidence of pneumothorax. Other findings stable in short interval.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: s/p LUL History: post op Left chest tube with its tip at the lung apex.Unremarkable cardiomediastinal silhouette.Postsurgical changes in the left hemithorax. Streaky subsegmental atelectasis at the lung bases. Small bilateral pleural effusions.Probable small pneumothorax anteriorly which is not measurable.Subcutaneous gas noted in the neck.

Output: Small anterior pneumothorax, not measurable.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: pleural effusion History: shortness of breath Left PICC line with its tip in the SVC.Stable cardiac enlargement and/or pericardial effusion.Pleural effusions, left greater than the right and left retrocardiac consolidation/atelectasis are similar to the prior exam allowing for differences in patient positioning.No new pulmonary opacities identified.

Output: Pleural effusions and left retrocardiac consolidation/atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reduced breath sounds. Evaluate for left pleural effusion. Left chest port with catheter tip in the SVC. Bilateral basilar opacities compatible with pleural effusions,, edema and retrocardiac consolidation/atelectasis. No pneumothorax.

Output: No significant interval change in bilateral pleural effusions, edema and retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: ? Cause of SOB History: dyspnea, likely reactive airway disease. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: rib pain History: rib pain The lungs and pleural spaces are clear. The heart size is normal. No displaced rib fractures identified.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Fever on chemo, r/o pneumonia Cough, sinus congestion Right chest port terminates at the atriocaval junction. No pleural effusion or pneumothorax. No focal pulmonary opacity. Heart size is within normal limits.

Output: No cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Pulmonary edema, effusions ongonig diuresis History: as above The endotracheal tube has been advanced and now is localized approximately 4 cm above the carina. Right IJ venous catheter overlying the SVC.Stable global cardiomegaly.Limited assessment of the lungs due to extensive respiratory motion artifact. Suggestion of persistent multilobar atelectasis and possible interstitial pulmonary edema.Stable small right heart. The left pleural effusions. No signs of pneumothorax.

Output: Assessment by respiratory motion. Persistent bilateral pleural effusions.Adequate repositioning of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: daily ccu cxr; assess for interval changes History: mixed shock s/p intubation and swan catheter Severe interstitial and airspace opacities gradually worsening consistent with ARDS/edema.Small pleural effusions are present.IVC Swan-Ganz catheter looped in the right atrium before terminating in the right interlobar pulmonary artery.ET tube tip approximately 6 cm above the carina.An NG tube terminates in the stomach.

Output: Worsening pulmonary opacities. Swan-Ganz catheter still looped in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Productive cough and SOB evaluate for infection. No focal airspace opacities, pleural fluid or pneumothorax. No signs of pneumonia.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Intubated, pulmonary edema evaluate lung fields. Tubes and lines unchanged in position.Large layering right greater than left pleural fluid collections with edema and atelectasis not appreciably changed.

Output: No acute change in pleural fluid, edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Sick sinus syndrome persistent A. fib. Evaluate new device. Left subclavian pacemaker leads unchanged in position. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.Normal heart size. Low normal lung volumes. No pneumothorax. Minimal atelectasis at the right base new from prior. Mild scoliosis and degenerative changes of the spine.

Output: No pneumothorax. Left subclavian pacemaker unchanged in position.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of treatment with chemotherapy for locally advanced gastric cancer CHEST:LUNGS AND PLEURA: Biapical scarring. Wedge-shaped air space density in the left upper lobe likely representing a small focal atelectasis. Small left-sided pleural effusion.MEDIASTINUM AND HILA: Minimal pericardial effusion.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: NG tube is in place. Stomach demonstrates wall thickening mostly involving the body and proximal antrum. No evidence of gastric mass extending beyond the wall into the surrounding organs.Round predominantly fat density lesion with extremely thin, linear peripheral rim in the greater omentum best seen on image number 120, series number 4 likely represents a small omental infarct.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: Small left-sided pleural effusion and pericardial effusion. No definite CT evidence of metastatic disease.Wall thickening of the distal stomach.


Instruction: Generate impression based on medical findings.

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

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old, with AML, pancytopenic, getting chemo for allogenic stem cell transplant. History of fungal pneumonia. LUNGS AND PLEURA: Patchy opacities in both lungs, more severe on the left, have not significantly changed and probably represent infection. Left pleural effusion is larger and a small right pleural effusion is new.MEDIASTINUM AND HILA: Right jugular catheter, tip in the SVC.Small pericardial effusion. The cardiac size is otherwise normal.CHEST WALL: Lucencies diffusely throughout the thoracic and lumbar spine are unchanged and probably represent bony disease involvement.UPPER ABDOMEN: No significant abnormality noted.

Output: Stable pulmonary opacities but worsening pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old. Left jugular catheter tip in the SVC and feeding tube tip in the gastric fundus.Mild opacity of the right costophrenic angle consistent with a small effusion and atelectasis.

Output: Catheter tip in the SVC with no visible complications.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female metastatic melanoma. Please measurable lesions in two dimensions particularly right axillary lymph node right subcutaneous chest wall nodule, left dorsal subcutaneous chest wall nodule left anterior chest wall nodule possible. Compared to prior scans 1/4/2008. CHEST:LUNGS AND PLEURA: Punctate nodules in the right upper lobe is stable in size and number.There are new small bilateral pleural effusions.MEDIASTINUM AND HILA: Clusters of nodes in the prevascular space are stable. No evidence of hilar nodes.CHEST WALL: High right axillary node image 24/250 and measures 1.3 x 0.8 cm.Caudal to it is another measured axillary node on image 32/250 and measures 1.3 x 1 cm.The left axilla is normal.Clusters of right cardiophrenic nodes are slightly increased. Previously measured node seen on image 72/215 and measures 1.1 x 0.9-cm.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 new massive ascites and extensive solid carcinomatosis in the distribution of the omentum. This pattern is unusual for melanoma correlate clinically as to the possibility of an ovarian neoplasm.The small bowel is intrinsically normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: There is some soft tissue prominence in the distribution of the left adnexa. It is questionable whether this could represent some implants inseparable from the left ovary.BLADDER: No significant abnormality noted.LYMPH NODES: Previously measured index node in the right common iliac artery distribution as seen in image 150/215 and measures 1.5 x 1.3 cm. No new nodes are seen.BOWEL, MESENTERY: Massive generalized ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Progression of disease based on findings of massive generalized ascites and carcinomatosis. Pattern would be somewhat unusual for metastatic melanoma.The lymph nodes are generally stable with measurements as above.


Instruction: Generate impression based on medical findings.

Input: Mitral valve replacement New mild changes in both bases suggesting edema with interval increased mild nonspecific cardiomegaly. Mildly decreased lung volumesRight subclavian catheter extends into the right atrium and 2 right jugular sheath terminating in the upper SVC. ETT terminates 5 cm above the carina

Output: Well-positioned ETT and catheters with questionable mild pulmonary edema and possibly early CHF


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Chest pain rule out pneumonia Normal heart size. No focal pulmonary opacities or pleural fluid. No pneumothorax. Mild degenerative changes of the spine with osteophyte formation.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 51 years, Female. Reason: 51F s/p ex lap with reduction of paraduodenal hernia now with ileus and conttinued high output from NGT History: Bilious output; delayed bowel function Chest: There is subsegmental basilar atelectasis but no acute cardiopulmonary abnormality.Abdomen: Enteric tube tip is within the proximal stomach body with side port just above the GE junction. Dilated loops of small bowel are again seen organizing in the left upper quadrant with minimal distal gas. Midline surgical staples are noted.

Output: No significant change in small bowel gas pattern which may represent obstruction or postoperative ileus. Stable position of enteric tube which has side-port above the GE junction.


Instruction: Generate impression based on medical findings.

Input: Reason: post op History: n/a Moderate cardiomegaly with streaky lower zone opacities compatible with atelectasis.Catheter tip in the SVC.Minimal residual left apical pneumothorax.Probable small pleural effusions.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: MaleReason for Study: Reason: acute chest (SCD) History: chest pain, back pain Right Port-A-Cath with its tip in the RA.Stable cardiac enlargement with enlargement of the pulmonary artery.Mild chronic appearing interstitial opacities unchanged.No new airspace opacities.No pleural effusions.

Output: Stable cardiac enlargement with marked prominence of the pulmonary artery. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Reason: ARDS s/p trach, now off ECMO History: as above Feeding tube tip in the upper esophagus.Tracheostomy tube in place with its tip about 4 cm above the carina.PICC line tip in the left axilla.Diffuse nonspecific airspace opacity compatible with the clinical diagnosis of ARDS.

Output: Feeding tube tip in the esophagus.


Instruction: Generate impression based on medical findings.

Input: Line placement Right jugular catheter placed with tip ejected into the proximal SVC. Pronounced kinking is observed at the skin entry pointDecreased lung volumes with questionable mild cardiomegaly. Streaky densities in both bases more pronounced on the left concerning for atelectasis, however partial consolidation cannot be excluded given questionable air bronchogram. Associated left effusion with loculation projected over the left apex correlates with recent prior CT exam.

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: fever, suspect aspiration PNA History: fever, suspect aspiration PNA Venous catheter is unchanged.Multiple pulmonary nodules with patchy airspace opacity are unchanged. Mediastinal lymphadenopathy.

Output: No change in widespread pulmonary nodules. No new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 72-year-old man with metastatic prostate cancer. Please compare to prior scans. CHEST:LUNGS AND PLEURA: Reference pleural-based plaque-like lesion has decreased slightly in size and currently measures 1.3 x 0.67 m (image 82; series 5). Right upper lobe linear atelectasis is unchanged.MEDIASTINUM AND HILA: Coronary artery calcifications. No adenopathy.CHEST WALL: New sclerotic lesion in an upper thoracic vertebral body (image 25; series 3) compatible with a metastasis. Correlate with bone scan.ABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver, unchanged. Status post cholecystectomy. Mild intra-and extrahepatic biliary prominence is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: New vertebral body bony metastasis at the level of the SMA (image 107; series 3). Correlate with today's bone scan.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Status post left hip replacement. Left iliac metastasis is difficult to visualize secondary to streak artifact from the arthrodesed. There is a new 9.6 x 3.1 x 16 cm fluid collection lateral to the musculature of the left hip that is presumably post operative in nature (image 178; series 3) and could represent a hematoma or seroma in the absence of findings of infection. If the patient has signs or symptoms of infection, an abscess is a consideration and percutaneous drainage should be considered.OTHER: No significant abnormality noted

Output: 1. Progression of bony metastatic lesions. Correlate with today's bone scan. 2. Left pleural-based spiculated lesion has decreased slightly in size. 3. Status post left hip replacement with fluid collection in the subcutaneous tissues described above; in the absence of signs and symptoms of infection, this probably represents either a hematoma or seroma. If the patient has signs or symptoms of infection, an abscess is a consideration. The collection is amenable to percutaneous drainage as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: sob History: sob No significant cardiopulmonary abnormality.IABP distal tip 2 cm below the top of the aortic arch.

Output: No significant abnormality. Unchanged IABP.


Instruction: Generate impression based on medical findings.

Input: Dobbhoff tube placement Enteric tube seen with distal tip extending into stomach, beyond edge of submitted image.Mild interval increase in size of partially loculated right pleural effusion. Please refer to concomitant chest radiography from same day for additional findings. Remainder of exam without significant change.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Shortness of breath r/o CHF exacerbation vs. PNA History: SOB, cough Moderate to severe cardiomegaly unchanged.New pulmonary edema and focal airspace opacity in the right upper lobe, either localized edema or pneumonia.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: New pulmonary edema and possible right upper lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: chf? Pneumonia? History: sob No pleural effusion or pneumothorax. No focal pulmonary abnormality. Septal lines, not significantly changed from prior indicative of mild pulmonary edema. Cardiomediastinal silhouette is within normal limits. Degenerative changes of thoracic spine, unchanged.

Output: Trace residual pulmonary edema, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Eval effusion vs atelectasis vs infection History: Post-op hypercapnic respiratory failure Small lung volumes nonspecific subsegmental atelectasis.No specific evidence of infection.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: etiology for tachypnea History: worsening tachypnea, increased work of breathing Bilateral pleural effusions and basilar atelectasis with edema, unchanged.Left PICC, tip in the SVC.Right jugular catheter and NG tube withdrawn.

Output: Pleural effusions and basilar opacities suggestive of edema and atelectasis are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: lung cancer History: s/p lung resection Jan 2016, recent IP for PNA, status post left upper lobe wedge resection, adenocarcinoma, anthracotic lymph nodes Postsurgical changes following left upper lobe wedge resection, with left-sided volume loss and elevation of the left hemidiaphragm. There is a small left apical loculated hydropneumothorax. Small left pleural effusion. The heart size is normal.

Output: Postsurgical changes following left upper lobe with resection, including small left apical hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: s/p left upper lobe History: s/p left upper lobe Status post left upper lobectomy for nodule resection.Two left chest tubes are present with no significant pneumothorax.Right hemithorax unremarkable.

Output: Two left chest tubes following resection, with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: rule out infection given possible locus minorus History: RUE weakness No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Central line placement New left central venous catheter tip terminates at the superior cavoatrial junction. ET tube tip approximately 3 cm above the carina, unchanged.Dobbhoff just below the GE junction, suggest advancement.Patchy bilateral opacities compatible with atelectasis and effusions, not appreciably changed from previous exams. No pneumothorax.Subcutaneous emphysema in the right chest wall again observed.

Output: Central venous catheter in acceptable position. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old Reason: pna? History: weakness, questionable multiple sclerosis. Cardiomediastinal silhouette is within normal limits.No focal opacity or pleural effusion is identified.

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


Instruction: Generate impression based on medical findings.

Input: Age: 35 yearsGender: MaleReason for Study: Reason: Evaluate for pulmonary edema History: Dyspnea Stable cardiac enlargement.Interval improvement in the interstitial pulmonary edema.No focal areas of consolidation.No pleural effusions.

Output: Interval improvement in pulmonary edema and comparison to the prior exam..


Instruction: Generate impression based on medical findings.

Input: Reason: swan History: swan Swan-Ganz catheter tip in the right descending pulmonary artery, unchanged.Globular cardiomegaly with multiple external artifacts superimposed on the thorax.No specific evidence of pulmonary edema or infection.

Output: Marked cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: ACS History: CP Cardiothoracic ratio unchanged. Small right pleural effusion. No pneumothorax. No focal airspace opacities or convincing evidence of pulmonary edema.

Output: Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT History: ETT ET tube tip approximately 1 cm above the carina.Small lung volumes with streaky lower zone opacities compatible with atelectasis and consolidation, unchanged.NG tube tip in the gastric antrum.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: eval for edema History: SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: sob History: sob, tachypnea Moderate cardiomegaly appears similar to prior.Patchy left upper and lower lobe opacities are new from prior. No dense consolidation, pleural effusion or pneumothorax.Left-sided 3-lead ICD appears unchanged. LVAD is unchanged in position.

Output: Left upper and lower lobe subsegmental atelectasis. No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: Eval line History: central line Interval adjustment of left IJ central venous catheter, now with tip in the left brachiocephalic vein.Stable cardiomediastinal silhouette.No focal air space abnormality. No significant pleural effusions.

Output: Left IJ central venous catheter with tip in the left brachiocephalic vein.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old Reason: pulmonary edema, pneumonia History: Shortness of breath Right upper and middle lobe airspace opacities most consistent with infection, however in absence of infection acute pulmonary edema such as in the setting of acute mitral regurgitation be seen in this way. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal.

Output: Right upper and middle lobe airspace opacities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old. 2 intraoperative views demonstrate a double-lumen ET tube with its tips 3 cm above the carina and within the proximal left mainstem bronchus.Multiple surgical clips are identified in the mediastinum and left hilum.There is volume loss in the right lung is decreased aeration of the right lung.Small left pleural effusion noted.No unexplained radiopaque intraoperative objects identified.

Output: Intraoperative images demonstrate no evidence of an unexplained radiopaque foreign object. Findings were discussed with attending surgeon Dr. Wigfield.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval lung fields History: s/p MVR, now w/ hypotension and anemia Significant interval improvement in right basilar atelectasis although low lung volumes and basilar compressive atelectasis persists.No pneumothorax. No pleural effusions. Stable cardiomediastinal mediastinal silhouette.

Output: Significant interval improvement in the right lower lobe atelectasis. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: infection History: fever, hyperglycemia Unremarkable cardiac and mediastinal silhouette.Moderate perihilar bronchial thickening suggestive of bronchitis.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with colorectal cancer CHEST:LUNGS AND PLEURA: No change in the nodule measuring 8mm abducting the right fissure on image number 56, series number 5.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 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: Presacral soft tissue density encasing the rectum and containing small amount of air is unchanged. This may represent scarring, however, neoplasm cannot be excluded.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Reason: yes History: cough/fever/tachycardia Normal heart size and mediastinal contours.Diffuse severe chronic interstitial lung disease with extensive fibrosis and honeycombing.No specific evidence of pneumonia, though it is difficult to exclude infection in the presence of such extensive underlying disease.

Output: Severe chronic interstitial disease with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of metastatic thyroid cancer. Compare previous measurements. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules bilaterally and right infrahilar mass compatible metastatic disease are reidentified, many of which continue to decrease in size. Reference measurements as follows:1] left upper lobe nodule (series 5, image 20) measures 9 x 5 mm; fusion measuring 11 x 6 mm.2] second left upper lobe nodule (series 5, image 24) measures 4 mm (stable)3] left lower lobe nodule (series 5, image 32) measures 11 x 9 mm; previously measuring 14 x 11 mm.4] right infrahilar mass (series 5, image 51) measures 38 x 16 mm; previously measuring 42 x 20 mm.No new or enlarging nodules identified.No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Lytic lesion in the inferior aspect of the sternum (series 3, image 50) is unchanged from prior study. Left chest pacemaker as seen previously.ABDOMEN: LIVER, BILIARY TRACT: Diffuse fatty infiltration. No focal hepatic lesions identified. The portal and hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass (series 3, image 84) measures 28 x 24 mm; previously measuring 29 x 25 mm (overall stable accounting for differences in technique).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: 1. Continued decrease in size in pulmonary metastases. No new sites of disease identified.2. Stable left adrenal mass.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: c/o SOB History: c/o SOB No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 97 years old.Intubated with shortness of breath. Tubes and lines unchanged in position. Large layering pleural effusions unchanged, with associated atelectasis. No new findings.

Output: Unchanged pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 99 years old.Reason: eval for focal process/effusion History: SOB Large lungs consistent with COPD.No specific evidence of infection or edema.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Cardiac surgery. Lines/hardware are grossly unchanged in position. Stable massive cardiomegaly. No new air space opacity.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of carcinoid tumor metastatic to liver CHEST:LUNGS AND PLEURA: Stable micronodules. Stable mosaic attenuation of the lungs. Superimposed groundglass opacity in the right lower lobe has resolved..MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Bulky hepatic metastases in bilateral lobes are again noted. Reference left lobe mass measures 12 x 6.9 cm in image number 91, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is displaced anteriorly by the large retroperitoneal mass which cannot be differentiated from head enhancement process of the pancreas. The mass contains central calcifications and measures 10.1 x 7 cm on image number 118, series number 3, not significant changed from pre-study.ADRENAL GLANDS: Right adrenal mass measures 5.9 x 2.6 cm on image number 100, series number 3.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: See discussion on the pancreas title.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable anterior wedge compression fracture at L1.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: Limited study the lack of IV contrast. Stable study with hepatic retroperitoneal and right adrenal metastatic lesions.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Chest pain and shortness of breath. Lungs are clear. Heart size within normal limits. No pneumothorax.

Output: No significant cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old with chronic cough.History of calcification in the lungs. Question of Histoplasma or microlithiasis. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease. No evidence of calcification within the lungs.

Output: No significant cardiopulmonary abnormalities and without evidence of calcifications.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval for PTX (left) History: s/p thoracentesis (diagnostic) Pulmonary nodules unchanged, somewhat obscured by interstitial and airspace opacities.Increasing basilar consolidation and moderate pleural effusions unchanged.No pneumothorax following thoracentesis.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female presents with shortness of breath. Changes of a prior median sternotomy and mitral valve replacement. Suture lines are noted overlying the right lung.The cardiomediastinal silhouette is enlarged, stable. Chronic right lung volume loss with linear scarring and/or atelectasis appears largely unchanged. Bilateral septal thickening consistent with superimposed pulmonary edema. Cephalad redistribution of the vascular pedicles noted. Right-sided apical cap is stable.No pneumothorax.

Output: Pulmonary edema pattern. Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.History of chest pain. Stable mild to moderate left ventricular enlargement. Mild tortuosity of the thoracic aorta.Lung volumes are normal. No abnormal focal lung parenchymal opacities.The pleural spaces are within normal limits.Diffuse osteopenia and mild degenerative changes of the thoracic spine. Thoracolumbar scoliosis again noted.The right upper extremity PICC terminates in the right subclavian vein.

Output: No radiographic findings to suggest pneumonia or pulmonary edema.Stable adequate position of right upper extremity PICC.


Instruction: Generate impression based on medical findings.

Input: Reason: removal of right pleural chest tube and mediastinal chest tubes x 2. History: removal of right pleural chest tube and mediastinal chest tubes x2 Mild postoperative mediastinal widening compatible with hematoma.Moderate pleural effusions, greater on the left, with underlying atelectasis.Interval removal of surgical drains and Swan-Ganz catheter.Minimal residual right apical pneumothorax.

Output: Minimal residual right apical pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: History of leukemia status post allogenic bone marrow transplant with chronic graft-versus-host disease. History of right superficial thrombus, chronic. New onset oxygen requirement. LUNGS AND PLEURA: Large bilateral pleural effusions are evident with compressive atelectasis of the lung. Multiple foci of airspace disease and nodular opacities are superimposed on diffuse, bilateral groundglass opacity which spares the periphery of the lung. All of these findings are new when compared to the prior exam. Please note that this study is inadequate for the detection of pulmonary emboli given the lack of IV contrast.MEDIASTINUM AND HILA: A left IJ central venous line terminates in the right atrium. Minimal pericardial effusion is evident. The cardiac size is otherwise normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Large bilateral pleural effusions with diffuse ground glass and focal airspace disease as described above compatible with drug reaction versus CMV or other opportunistic infections.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with history of COPD status post lung resection. 2 drains project over the right hemithorax with their tips near the right apex. Increased density in the upper right hemithorax likely reflects postoperative hematoma/hemothorax. Minimal bibasilar subsegmental atelectasis is seen. No focal pulmonary opacity or definite pleural effusions. No pneumothorax.

Output: 2 drains with their tips near the right apex with suspected postoperative change in this location. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: r/o infection History: Sepsis Right central venous catheter terminates in the SVC. Small, bilateral pleural effusions. Density overlying the right lateral midlung likely overlies the patient. Mild cardiomegaly.

Output: Small bilateral effusions and mild cardiomegaly without other specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval infection History: AMS Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild spinal curvature. Surgical hardware noted in the left mandible.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Patient is having abdominal pain, bloating, h/o ileocolonic Crohn's, concerning for partial SBO. Evaluate for obstruction and other acute changes History: Abdominal pain, bloating. Nonobstructive bowel gas pattern. Moderate stool noted in ascending colon. Right lower quadrant and pelvic postsurgical anastomotic material. No free air seen on upright imaging. No focal consolidation or pleural effusion seen. Electrodes project over thoracolumbar spine and generator device overlies left lower quadrant, similar in appearance to prior exam. Spinal degenerative disease.

Output: Nonobstructive bowel gas pattern, additional findings as above.


Instruction: Generate impression based on medical findings.

Input: 21-year-old female with history of shortness of breath. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Chest tube check Interval placement of a left chest tube projecting towards apex without significant underlying pneumothorax. Minimal chest wall emphysema. LVAD and ICD are unchanged. ETT extends to 2 centimeters from the carina. Swan-Ganz projects into the right pulmonary artery orifice. See subsequent reports.

Output: Left chest tube placed


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: aspiration History: LOC Moderate left ventricular cardiomegaly with a tortuous aorta.Small lung volumes with no significant abnormalities. Specifically no sign of aspiration.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Chest pain. Evaluate for pneumothorax. No focal airspace opacity, pleural effusion, or pneumothorax. Linear bibasilar opacities most consistent with scarring/atelectasis.The cardiomediastinal silhouette is within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: ngt position History: ngt pulled back NG tube tip in gastric antrum.Venous catheter extending to the SVC.Small lung volumes with subsegmental atelectasis.

Output: NG tube tip in the gastric antrum.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/p chest tube removal. Evaluate for significant pneumothorax. History: As above Interval removal of a left chest tube.Persistent low lung volumes with mid to lower zone subsegmental atelectasis. Retrocardiac consolidation slightly decreased. Small bilateral pleural effusions, left greater than right. No significant pneumothorax.

Output: No significant pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: 56F intubated in CCU, assess tube placement History: ETT, CHF ET tube with its tip 3 cm above the carina.NG tube with its tip in the stomach. The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

Output: ET tube in satisfactory position with its tip 3 to 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: leukocytosis; eval for infection The lungs and pleural spaces are clear. The heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#1 Lines and tubes increased in loculated right pleural effusion at the right apex. Diffuse opacities in the right lung, likely edema. Left lung remains clear. Unchanged heart size. Mild right-sided subcutaneous emphysema again noted, slightly increased.

Output: Expected postoperative appearance status post right lung transplant.


Instruction: Generate impression based on medical findings.

Input: Chest tube removal.VIEW: Chest AP (one view) 02/26/16, 1440 Left chest tube has been removed. No pneumothorax is identified. No focal lung opacity is seen. Cardiac apex and aorta are right-sided. Cardiothymic silhouette is upper limits of normal in size to mildly enlarged.Endotracheal tube tip is below thoracic inlet. Right internal jugular line tip is in a right-sided superior vena cava. Epicardial pacer leads and atrial line are again visualized. The mediastinal drain is not seen. Right chest tube remains in place. Feeding tube tip is in gastric antrum of left-sided stomach. Defibrillator pads obscure the right side of the chest.

Output: Removal of left chest tube and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with known esophageal adenocarcinoma status post chemo and RT. CHEST:LUNGS AND PLEURA: Stable right upper lobe fibrosis and bronchiectasis, likely post radiation in etiology.Inferior lingular micronodule (axial image 68/57) which measures approximately 1 mm and is stable since 7/2/07. This finding is nonspecific, and continued follow-up is recommended. No focal consolidation, edema or pleural fluid. MEDIASTINUM AND HILA: The upper esophagus shows wall thickening with increased outer dimension measuring approximately 47 x 37 mm on axial image 24/157 whereas, on the prior exam, a similar region measured approximately 40 by 26 mm. A posterior mediastinal fatty mass with soft tissue components is negative on a prior PET scan and thus is most likely benign in etiology, although a low-grade liposarcoma is a remote possibility. Recommend follow-up.CHEST WALL: Right sided rib deformities compatible with prior thoracotomy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal soft tissue clips noted in the posterior compartment as well as the perirenal compartment. Correlate with surgical history.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Interval increase in esophageal mass.2.Lingular micronodule.3.Stable fatty retroperitoneal mass as above.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Status post aortic mass removal. Epicardial pacing lead. Normal heart size. No pneumothorax. Small pleural fluid collections, right greater than left, with associated atelectasis. There is a subsolid peripheral subpleural area of consolidation in the posterior right lower lobe. Paramediastinal atelectasis bilaterally.

Output: Small pleural effusions with associated atelectasis. Wedge-shaped subsolid area of consolidation in the posterior right lower lobe nonspecific and could reflect atelectasis, evolving infarct or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Dyspnea and COPD. Normal heart size. Enlarged central pulmonary vasculature suggesting pulmonary hypertension.Basal atelectasis and scarring. Dependent opacities in the posterior lung fields most suggestive of atelectasis.

Output: Signs of pulmonary hypertension. Multifocal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Thoracotomy and resection of osteosarcoma metastasis.VIEW: Chest AP (one view) 04/02/16, 0558 Left chest tube remains in place. Small subcutaneous emphysema is noted in left lateral chest wall. A tiny left apical pneumothorax is present.Cardiothymic silhouette is normal. No focal lung opacity is seen.

Output: Persistent tiny left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: r/o edema History: LE edema, elevated BNP No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: hypoxia History: hypoxia Persistent patchy left basilar opacity. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Unchanged port catheter.

Output: Persistent patchy left basilar opacity consistent with aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz catheter Swan-Ganz extends into the right middle lobe pulmonary artery, unchanged.2. Right jugular catheters are also similar positionUnderlying cardiopulmonary appearance otherwise remains significant for diffuse mixed interstitial and airspace opacities scattered in all 4 quadrants with partial sparing of the right lower lung. In particular more focal area with a questionable focal lucency is observed in the peripheral mid left lung, concerning for cavitary lesions must now be entertained. Again overall appearance is concerning for multifocal infection in the appropriate clinical setting.

Output: Persistent and grossly unchanged diffuse airspace opacities suspicious for infection and/or less likely hemorrhage. Hardware unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: evaluate pleurx/pleural effusion History: decreased drainage Unchanged appearance of left chest tube, terminating at the left apex.Stable cardiomediastinal silhouette.Interval improvement of left pleural effusion and bibasilar atelectasis.

Output: Stable appearance of left chest tube. Interval improvement of left pleural effusion and bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: post lung tx History: same Feeding tube terminates within the proximal aspect of the stomach. Other iatrogenic devices, unchanged. Diffuse pulmonary opacities, right greater than left, not substantially different. Unchanged heart size. No definite pneumothorax.

Output: Diffuse pulmonary opacities, right greater than left, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: FemaleReason for Study: Reason: assess pulmonary status History: assess pulmonary status Increasing volumes with stable cardiac enlargement and atherosclerotic changes of the aorta.Diffuse upper lobe predominant pulmonary opacities similar appearance to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with diffuse pulmonary opacities compatible with ARDS


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: eval lung fields, chest tubes History: s/p AVR The transesophageal ultrasound probe has been removed. The endotracheal tube tip terminates approximately 4 cm above the carina. The right internal jugular Swan-Ganz catheter tip terminates in the proximal right main pulmonary artery. Mediastinal and right basilar chest tubes remain in place. The sternotomy hardware is intact. Prosthetic aortic valve in place.Low lung volumes. Streaky bibasilar opacities consistent with atelectasis. There is a small left pleural effusion. No pneumothorax is evident.Mild cardiomegaly persists.

Output: Persistent bibasilar atelectasis and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Patient fell with contusions. Check for pneumonia Mild cardiomegaly without additional cardiopulmonary stent focal acute abnormality. Mild vascular redistribution is however observed, concerning for possible early pulmonary hypertension

Output: Mild cardiomegaly without superimposed acute pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed diffuse large B-cell non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Subcentimeter nonspecific nodule in the right upper lobe, image number 41. Lungs are otherwise unremarkable.MEDIASTINUM AND HILA: Multiple mediastinal borderline enlarged lymph nodes. Largest is in the pretracheal region measuring 13 by 8mm on image number 36.CHEST WALL: Left axillary adenopathy. A reference to measuring 2.2 x 1.3 cm on image number 19, series number 4.ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary dilatation. Distal common bile duct is invaded by the large peripancreatic and retroperitoneal mesenteric mass.SPLEEN: No significant abnormality notedPANCREAS: Large retroperitoneal, peripancreatic adenopathy likely invading the pancreas.KIDNEYS, URETERS: Bilateral punctate stones without hydronephrosis. Simple left renal cyst.ADRENAL GLANDS: Bilateral adrenal glands are enlarged and ill-defined due to the extensive surrounding retroperitoneal adenopathy.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy. The previously described and measured mass now measures 14.4 x 8.9 cm and is slightly increased from previous study. Adenopathy extends to the pelvis and bilateral inguinal regions. The adenopathy also extends to the small bowel mesentery. Bilateral retrocrural adenopathy.BOWEL, MESENTERY: Large retroperitoneal/ mesenteric mass as described above.BONES, SOFT TISSUES: Lytic lesion in the L2 vertebral body with fine trabeculation likely representing a hemangioma.OTHER: No significant abnormality notedPELVIS:Images of the pelvis are significantly degraded by the streak artifacts from bilateral hip prosthesis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral enlarged inguinal, external iliac and obturator adenopathy is present. A reference right obturator lymph node measures 2.5 x 1.5 cm on image number 194. This lymph node is also slightly enlarged and was previously measuring 1.9 x 9 mm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the intra-abdominal and pelvic adenopathy. Minimal intrahepatic biliary dilatation caused by invasion of the distal common bile duct by the mesenteric/retroperitoneal large condylar moderate adenopathy.Left axillary adenopathy and borderline enlarged mediastinal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: r/o PNA History: 87M AMS, weak, not eating, recently treated CAP Increased patchy bibasilar no pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild spinal curvature again noted.

Output: Increased patchy bibasilar opacity which may represent aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: Pt w/ renal transplant. P/w fevers. Eval for pneumonia History: Fever Basilar opacities suggestive of subsegmental atelectasis and possible edema.No specific evidence of infection.Heart size upper normal.

Output: No evidence of infection. Possible basilar edema with areas of atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Patient with short bowel syndrome, please evaluate line placement. Port catheter is seen with tip in the SVC.The cardiomediastinal silhouette is normal.There are no focal pulmonary opacities or large pleural effusions.

Output: Port catheter tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Evaluate endotracheal tube placement. The endotracheal tube tip is approximately 4 cm above the carina. The proximal side port of the enteric tube is at the gastroesophageal junction. Persistent perihilar airspace opacity and trace effusions. Mild cardiomegaly, unchanged.

Output: Interval repositioning of endotracheal tube.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Short of breath status post thoracentesis. Partial reexpansion of the right lung, though the volume of pleural fluid remains large with adjacent compressive atelectasis. No pneumothorax. Atelectasis and pleural fluid on the left about the same.

Output: No pneumothorax. Improved aeration of the right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: evaluate for infiltrate History: febrile, aspiration risk Increasing right basilar opacity which may be due to pneumonia, atelectasis, or aspiration. Enteric tube extends beyond the field-of-view of study.

Output: Increasing right basilar opacity which may be due to pneumonia, atelectasis, or aspiration.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT is been advanced, tip projects at least 3 cm into the right mainstem bronchus. New left jugular catheter or sheath terminating in the proximal innominate. Interval increasing left pleural fluid may represent associated hemothorax with associated compression of the left upper and lower lobes. Persist and small lung volumes. See subsequent report

Output: Left jugular catheter placed in ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: Eval for evidence of volume overload and ETT placement History: 78F x/p resection of cecal volvulous, in septic shock ET tube tip 3 cm above carina. NG tube tip in stomach. Venous catheter tip at RA/SVC junction.Lungs hypoinflated. Right upper lobe opacity slightly improved. Nonspecific left basilar opacities are unchanged.

Output: ET tube tip 3 cm above carina. Right upper lobe opacity slightly improved. Nonspecific left basilar opacities are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.HD. Weakness. Small pleural effusions. Subsegmental atelectasis left lower lobe and lingula. Prominent central pulmonary vasculature suggesting pulmonary hypertension. IVC filter noted.

Output: Small pleural effusions. No. See evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Repositioned central line. Left IJ central venous catheter has been pulled back with tip in the superior vena cava. ET tube tip is approximately 3 cm above the carina. Enteric feeding tube tip projects over the gastric body. Multifocal airspace opacities are not significantly changed from prior. There is no pneumothorax. Shunt tubing is again noted.

Output: Central venous catheter tip in the superior vena cava. No pneumothorax.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: r/o mets History: none Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography. No convincing evidence of metastatic disease on radiography.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer Persistent mildly decreased lung volumes with basilar scarring and/or atelectasis, however no superimposed new acute abnormalities

Output: Atelectasis or scarring without superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for effusion and atelectasis History: S/P Heart Transplant Heart size but upper normal with previous median sternotomy.Streaky basilar opacities compatible with subsegmental atelectasis and small pleural effusions.No new findings.

Output: Mild atelectasis and small effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Chest pain evaluate for infection, pneumo, effusion. Large substernal right paratracheal mass without significant change from prior study, most likely a goiter. No focal airspace opacity, pleural fluid or pneumothorax. Normal heart size. Mildly tortuous thoracic aorta.

Output: Right paratracheal mass, most likely a substernal goiter. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: F/u pleural effusion, s/p Thora History: Hypoxia, Pleural effusion Right central venous catheter unchanged.The cardiac mediastinal silhouette is unremarkable.Bilateral pulmonary opacities similar to the prior exam.Right pleural effusion slightly less postthoracentesis.No evidence of a pneumothorax.No new pulmonary opacities identified.

Output: Bilateral airspace opacities and right pleural effusion slightly decreased postthoracentesis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Eval for thoracic aneurysm, abnormalities History: Hx of thoracic AAA (4.5x4.3cm), renal mass Heart size normal, the aorta tortuous but unchanged.Mild left base scarring or subsegmental atelectasis.No specific evidence of infection or edema.No sign of metastases.

Output: No significant abnormality, except for a tortuous aorta.


Instruction: Generate impression based on medical findings.

Input: Reason: intubation History: post intubation ET tube tip approximately 2 cm above the carina.Mild cardiomegaly.Diffuse bilateral mainly interstitial opacity with multiple septal lines consistent with pulmonary edema.Small radiopaque artifact projected over the heart consistent with previous valve surgery.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval for volume status History: SOB Diffuse pulmonary opacities again noted. Unchanged cardiomegaly. No pneumothorax. Very small pleural effusions. Iatrogenic devices, unchanged.

Output: Diffuse pulmonary opacities again noted, unchanged.


Instruction: Generate impression based on medical findings.

Input: AV canal repair. Respiratory distress.VIEW: Chest AP (one view) 09/15/16, 1925 NAVA catheter tip is distal to proximal body of stomach and not included on image. Right chest tube remains in place. Epicardial pacer leads and pacemaker device is again noted. Right atrial line continues in position. Lower extremity PICC has its tip to the left of midline, probably within the right ventricle. There is a gastrostomy tube. Mediastinal surgical clips are again seen.Small left pleural effusion is a new finding. Cardiothymic silhouette is upper limits of normal in size. Increased perihilar opacities are noted. Pulmonary vascularity remains increased.

Output: Increase in atelectasis and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Dyspnea. Diffuse pulmonary opacities. Small pleural effusions again noted. Otherwise no substantial difference.

Output: No significant interval change. Diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: severe COPD, dyspnea History: see above Large lung volumes consistent with COPD.Mild left lower lobe scarring.No specific evidence of infection or edema.Heart size normal.Right shoulder arthroplasty.

Output: Lower lobe scarring or subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male evaluate metastatic renal cell carcinoma. CHEST:LUNGS AND PLEURA: Right middle lobe nodule 8 mm diameter series 5 image 52. No new nodules. No effusions.MEDIASTINUM AND HILA: Coronary artery calcifications redemonstrated. No pathologic size lymph nodes. CHEST WALL: Healed rib fractures on the left. No lytic or blastic disease.ABDOMEN:LIVER, BILIARY TRACT: Three small hypodense lesions in the liver all unchanged and nonspecific. Postsurgical changes. Pneumobilia consistent with choledochoenterostomy.SPLEEN: No significant abnormality.PANCREAS: Status post Whipple procedure. Soft tissue mass abutting superior mesenteric vein is increased in size now measured on series 4 image 127 is 4.3 x 3.5 cm. Air is seen in the pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrectomy. Extensive clips around the inferior vena cava. Left kidney normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Fluid to the right of the urinary bladder is likely part of the prosthesis in unchanged.

Output: Slight increase in size of soft tissue mass near superior mesenteric vein. No new sites of disease. Right middle lobe pulmonary nodule as measured above. Expected postsurgical changes.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: 59 yo, recent intubation, now hypoxic History: hypoxia Mild to moderate cardiomegaly with gradually developing edema with underlying emphysema. Small pleural effusions.

Output: Cardiomegaly with developing edema/CHF, with underlying emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: fever, eval for pneumonia, atalectasis History: fever Near complete resolution of small right pleural effusion. Dense left lower lobe opacity and left pleural effusion again noted. Unchanged cardiomegaly. Central venous catheter again terminating at the cavoatrial junction. No pneumothorax.

Output: Near complete resolution of small right pleural effusion. Dense left lower lobe opacity and left pleural effusion again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: Rule out infiltrate History: cough/fever The heart size is normal. The lungs are clear. No pleural effusion or pneumothorax. No specific radiographic evidence of infection.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 65 year old female. Metastatic GIST, status post 2 cycles of sorafenib. Disease status evaluation. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple metastatic lesions in both lobes of the liver. A reference metastatic lesion measures 4.4 x 6.9 cm on image number 112/217. A simple cyst is present in the left lobe.SPLEEN: Spleen is not visualized. Enhancing soft tissue density lesions in the left subdiaphragmatic space likely represent splenules.. In addition, several hypodense focal lesions in the left subdiaphragmatic space are also present. There reference hypodense lesion measures 14 by 26 mm on image number 75/217. These are suspicious for metastatic disease. PANCREAS: Pancreatic head and body are unremarkable. Pancreatic tail is not well visualized and patient may be status post distal pancreatectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral multiple parapelvic cysts. Punctate stones in the right kidney.RETROPERITONEUM, LYMPH NODES: Hepatic gastric, peripancreatic adenopathy. A reference lymph node anterior to the pancreas measures 2.6 x 2 cm at image number 97/217. Adenopathy is also present in the left adrenal gland and stomach.BOWEL, MESENTERY: Multiple peritoneal deposits throughout the abdomen. The anterior reference lesion measures 2.8 x 4.4 cm at image number 100/217.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There reference peritoneal metastatic deposit measures 2.9 x 2.5 cm on image number 177/217. Multiple other peritoneal deposits are also present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Increase size of diffuse peritoneal and hepatic metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Productive cough and SOB rule out pneumonia. Scarring in the right lung and multiple nodular opacities bilaterally unchanged over several years consistent with sarcoidosis. Costophrenic angle blunting and diaphragmatic elevation on the right is chronic. Partially calcified mediastinal and hilar lymph nodes unchanged.No signs of a superimposed acute process.

Output: Chronic abnormalities related to sarcoidosis. No signs of pneumonia or other acute process.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: eval for infiltrates, last CXR showed RML pna History: nausea, vomiting, weight loss, smoking hx, prod cough. Resolution of prior pulmonary opacities. Heart size normal.No new findings.

Output: No significant abnormality. Resolution of prior opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Dysphonia, assess for pneumonia. There appear to be new internal stents in the left carotid distribution.Left subclavian pacemaker unchanged in position.Right subclavian catheter tip at the SVC/RA junction.No pneumothorax.Large layering left pleural fluid collection is new, with associated atelectasis. Possible small volume of pleural fluid on the right.Groundglass opacities suggestive of edema.

Output: New large left pleural effusion, edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: evaluate for atelectasis History: cough Cardiac silhouette is within normal limits in size. Elongated and tortuous thoracic aorta.Lungs are clear. Skin fold projects over the right upper lung region. Bilateral breast implants.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Left lower lobe crackles. Elevated WBC. Left subclavian pacemaker unchanged. Severe scoliosis. Lateral view limited by technique. Left lower lobe opacity may be a combination of atelectasis and infection.

Output: Left lower lobe opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: r/o acute abnormality, CP History: CP Small lung volumes.Left subclavian catheter, tip in SVC.

Output: Small lung volumes otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Liver transplant Surgical drains and chest tubes project over right upper quadrant. Associated Dobbhoff, NG under advanced as well as bilateral vascular catheters and ETT are all otherwise unchangedRight basilar atelectasis with a questionable small effusion without additional pulmonary abnormality. Cardiac and mediastinal contours are within limits

Output: ETT remains well-positioned


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent decreased lung volumes with moderate cardiac enlargement and is essentially a large right pleural effusion and basilar edema. No discrete new superimposed focal airspace process

Output: Suspected asymmetric CHF without interval change


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of anal cancer CHEST:LUNGS AND PLEURA: Reference left lower lobe nodule has been excised within the internal. Postsurgical changes involving the left lower lobe.Right upper lobe nodule near the midline has increased in size and now measures 6 by 8 mm on image number 18, series number 4. Previously fuzz measuring 5 mm in diameter image number 22, series number 3.MEDIASTINUM AND HILA: Subcarinal reference lymph nodes is stable measuring 9 by 5 mm on image number 37, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, 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: Interval resection of the left lower lobe nodule. Post surgical changes involving the left.Slight interval increase in the size of the right upper lobe nodule near the midline.


Instruction: Generate impression based on medical findings.

Input: Male 71 years old; Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab. Interval removal of the left chest wall AICD. Coiled drainage catheter is present within prior device location. Median sternotomy and surgical clips are unchanged.The cardiomediastinal silhouette is stable. No pneumothorax or pleural effusion is identified.

Output: Interval removal of AICD without pneumothorax


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: eval lead placement History: ICD placed 11/28 Cardiomegaly.Scarring or atelectasis right lung base, but no reliable evidence of edema or pneumonia.Left subclavian ICD lead still directed towards the right ventricular outflow tract, unchanged.Right PICC, tip just entering the SVC region.

Output: Unchanged support devices. Cardiomegaly with right basilar scarring or subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: assess pneumothorax History: pneumothorax Right pneumothorax enlarged to 26 mm from 17 mm.Diffuse interstitial opacities are unchanged.Right lower lung zone endobronchial valves stable.Right chest tube unchanged in position corrected towards the apex.

Output: Enlarging right pneumothorax, stable right chest tube.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: IABP use History: As above. Left-sided ICD change.IABP marker in the proximal descending aorta.IVC Swan-Ganz with its tip in the right pulmonary arteryStable cardiac enlargement. Mild nonspecific interstitial opacities similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance. Support devices unchanged.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with vocal cord squamous cell cancer. Evaluate for metastases. LUNGS AND PLEURA: Moderate centrilobular emphysema with small right apical bulla and bibasilar scarring. Irregular soft tissue nodule in the right lower lobe (series 5 image 40) measures 10 x 6 mm. Calcified granulomas in the lower lobesSlight dependent atelectasis bilaterally.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes compatible with healed granulomatous disease. Left vertebral artery arises directly from arch, normal anatomic variant.CHEST WALL: Punctate calcifications in breast tissue bilaterally with slightly prominent right axillary lymph node can be better evaluated by mammography.UPPER ABDOMEN: Focal fat along the falciform ligament.

Output: 10 mm irregular nodule in right lower lobe. This is nonspecific and may represent a scar but a primary lung cancer cannot be excluded. Continued CT follow up is recommended. It is not typical of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: presence of pneumonia History: altered mental status Electronic device projecting over the left upper quadrant likely represents a loop recorder. Stable cardiomediastinal silhouette in size and configuration. Tortuous thoracic aorta again seen.Calcified left perihilar lymph nodes and granulomas correlating with remote granulomatous disease.Apparent nodular density projecting over the right upper lung region likely related to first costochondral junction.

Output: Stable appearance of the chest with no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of stem cell transplant and multiple myeloma. COPD. History of pneumonia. LUNGS AND PLEURA: The peripheral right upper lobe and right middle lobe reticular opacities are unchanged and likely scar. Several millimeter sized nodule along the right major fissure on image 36/121 is nonspecific, but may represent an intrapulmonary lymph node or an additional focus of scarring. Calcified right upper lobe granuloma again noted. Basilar opacity is improved and could represent scarring.MEDIASTINUM AND HILA: Coronary artery atherosclerotic calcifications.CHEST WALL: Right chest wall Port-A-Cath with tip terminating in the SVC. Partial visualization of cervical spine orthopedic hardware. Lucent lesions in the right clavicle and scapula are likely related to myeloma.UPPER ABDOMEN: No significant abnormality noted.

Output: Slight improvement in right basilar opacities. No sign of active infection.


Instruction: Generate impression based on medical findings.

Input: Worsening hypoxia. Evaluate for pulmonary edema. Cardiomegaly, small right pleural effusion, and mild bibasilar interstitial opacity is not significantly changed.Right IJ catheter tip is at the superior atriocaval junction.

Output: No significant change in mild interstitial opacity, which may represent mild edema or scarring, and a small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval ETT History: intubated Diffuse pulmonary opacities suggestive of edema and possible aspiration particularly in the upper lobes, unchanged.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: SOB History: ? PNA Atelectasis or scarring again noted at the lung bases. Large hiatus hernia again noted. No large pleural effusion or pneumothorax. Unchanged heart size. Unchanged port catheter. Distal left clavicular fracture, chronic, again noted.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old. Moderate cardiomegaly with than ICD lead extending to the area of the apex of the right ventricle.Focal streaky left lower lobe opacity, best seen on the lateral view, consistent with atelectasis and possibly pneumonia and/or aspiration, slightly increased compared to previous.

Output: Increased left lower lobe opacity, suspicious for pneumonia/aspiration. No sign of pulmonary edema. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: post op vad History: post op vad Basilar opacities worse than before, suggestive of edema and atelectasis.Status post LVAD and ICD placement, unchanged.ET tube tip approximately 3 cm above the carina.Right jugular Swan-Ganz catheter, tip in pulmonary outflow tract.

Output: Worsening basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: assess placement of ETT after advancing by 2 cm History: as above ET tube with its tip 7 cm above the carina.Left IJ venous catheter with its tip in the innominate.NG tube with its tip in the margin of the image.Stable cardiac enlargement with right pleural effusion and right basilar opacity similar to the prior exam.No new pulmonary opacities identified.

Output: ET tube with its tip 7 cm above the carina. Right pleural effusion and right basilar opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Productive cough. Surgical clips are noted in the left neck. Mild cardiomegaly and signs of pulmonary hypertension, unchanged.No focal pulmonary opacities, pleural effusion or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: MaleReason for Study: Reason: cp History: cp The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with dysphagia and weight loss. Evaluate for stricture or other pathology. Scout radiograph of the chest show no focal consolidation, significant pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. Double contrast evaluation of the esophagus revealed no mucosal or mural abnormalities. No hiatal hernia was identified. No gastroesophageal reflux was identified.Fluoroscopic evaluation of esophageal peristalsis demonstrated a primary peristaltic wave with proximal escape while in the prone position and a compensatory secondary wave. There was mildly delayed emptying of the esophagus in the prone position which spontaneously cleared. No tertiary wave was identified. Of note, patient had moderately delayed swallowing initiation and coordination with trace penetration.

Output: Mild esophageal dysmotility with proximal escape of primary peristaltic wave and compensatory secondary wave. Of note, patient had moderately delayed swallowing initiation and coordination with trace penetration during exam.Results were discussed with Dr. Tenney on 10/23/2015 at 3:45 PM


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: CP/SOB, c/f occult infection vs cardiopulm disease (pt w/ sig FHx of CM) 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: Reason: eval lung fields History: hypoxia, DOE Moderately severe cardiomegaly with small lung volumes.Bilateral perihilar and basilar streaky opacities suggestive of atelectasis.Catheter tip in the SVC. NG tube tip in the stomach.

Output: Cardiomegaly and streaky opacities suggestive of atelectasis, possibly secondary to aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: cardiomegaly, pneumonia, effusion History: palpitations, shortness of breath Low lung volumes with basilar atelectasis. Lungs otherwise clear.Heart size at upper limits normal.No pleural effusion. No pneumothorax.

Output: Low lung volumes with basilar atelectasis but no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 94 years old Female. Reason: et tube pulled History: 3cm pulled. There is no evidence for infiltrate in both lung, or pneumothorax. Cardiac silhouette is stable. The tip of the ET tube projects over the carina. Stable small left pleural effusion.

Output: Stable small left pleural effusion. Abnormal position of the ET tube. Subsequent chest x-ray has been reported after the correction of the ET tube position.


Instruction: Generate impression based on medical findings.

Input: Reason: post AVR / R/O change in r effusion History: sob Moderately large right pleural effusions with underlying atelectasis.Aortic valve prosthesis in place.No pneumothorax or other acute change.

Output: Moderately large pleural effusions and basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: fever workup History: chills Venous catheter tip in SVC. No new opacity to suggest pneumonia. Simon Nitinol type IVC filter

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Coarse breath sounds on the right question pneumonia Chronic interstitial abnormality suggestive of fibrosis superimposed upon emphysema. New patchy nodular opacities bilaterally. No pleural fluid or pneumothorax. Bronchiectasis.

Output: Interval progression of chronic interstitial process, now with nodular opacities, recommend correlation with thoracic CT when feasible to assess for opportunistic infection.


Instruction: Generate impression based on medical findings.

Input: 49 year old woman with breast cancer. Assess response to treatment. CHEST:LUNGS AND PLEURA: Stable post radiation changes in the anterior left upper lobe. The previously identified spiculated lesion in the superior segment of the left lower lobe appears smaller and less solid. The nodule in the right lower lobe is relatively stable in appearance and measures 6 x 5 mm as seen on image 53/91. New pleural-based nodule in the left lower lobe as seen on image 63/91. Multiple micronodules are reidentified.MEDIASTINUM AND HILA: Reference paratracheal lymph node measures 13 x 12 mm as seen on image 15/134 (previously 18 x 13 mm). The second reference prevascular conglomeration of lymph nodes measures 40 x 12 mm as seen on image 24/134 (previously 44 x 17 mm). Left hilar lymphadenopathy as seen in the aortopulmonary window is stable and encases the left pulmonary artery. No new enlarged lymph nodes are appreciated in the mediastinum or hila. The ascending aorta is mildly enlarged but stable in size from previous study.Right thyroid lobe is asymmetrically enlarged, however, stable in size from prior scan.CHEST WALL: Mildly enlarged lymph nodes are reidentified in the diaphragmatic space inferior to the heart. Skin thickening overlying the left breast. Multiple soft tissue densities identified within subcutaneous fat along the back and breasts, some of which are larger. Right axillary lymphadenopathy with surgical clips in the left axilla. The sclerotic lesion in the posterior right rib is stable as seen on image 74/134.ABDOMEN:LIVER, BILIARY TRACT: Smooth intrahepatic and extrahepatic ductal dilatation which has increased from prior exam. The extrahepatic common bile duct measures 21 mm in maximal diameter and terminates abruptly at its distal end. The pancreatic duct is not dilated. No calcified stones are visualized in the lumen of the common bile duct. No mass in the pancreatic head. Multiple calcified gallstones without evidence of cholecystitis.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Periaortic lymphadenopathy with reference lymph node as seen on image 80/134 measures 19 x 11 mm. Enlarged peripancreatic lymph nodes with reference node measuring 12 x 9 mm seen on image 112/134.BOWEL, MESENTERY: Multiple enlarged lymph nodes are seen in the mesentery of the small bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Interval progression of metastatic disease as evidenced by new pulmonary nodule, increased size of subcutaneous nodules, and abdominal lymphadenopathy.2. Intra and extrahepatic biliary ductal dilatation. Further evaluation is recommended with lab values and ERCP/MRCP.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: eval ETT, lung fields History: s/p CABG Right IJ venous catheter with this tip in the SVC.Bilateral chest tubes with their tips directed superiorly.No evidence of a pneumothorax.Markedly decreased lung volumes with stable cardiomediastinal silhouette.Basilar opacities are compatible atelectasis and probable small effusions.

Output: Postoperative chest without complications.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.History of sickle cell disease. Enlargement of the right atrium again noted. The right IJ port catheter terminates in the superior cavoatrial junction.Lung volumes are normal. Bilateral bronchial wall thickening. No abnormal focal lung parenchymal opacities. No signs of pulmonary edema.The pleural spaces are within normal limits.Diffuse stenosis scleroses, in keeping with history of sickle cell disease. Signs of prior subchondral necrosis of the right humeral head.IVC filter is noted. Status post cholecystectomy.

Output: No new abnormal radiographic findings to suggest pneumonia, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: eval for evidence of pulmonary edema History: volume overloaded on exam, on bumex, milrinone pump Interval removal of Swan-Ganz catheter. No specific evidence of infection or edema. No pneumothorax or pleural effusion. Pacer lead is stable in position

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Soft tissue sarcoma right forearm, evaluate for metastasis History: above No significant pulmonary or pleural abnormality.No evidence of metastases.Heart size normal, but there is pericardial calcification unchanged.

Output: Chronic calcific pericarditis. No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 101 years old.Reason: ? SHORTNESS OF BREATH History: ? PNA Cardiomegaly with the suggestion of mild interstitial edema.No specific evidence of infection.No large pleural effusions.

Output: Cardiomegaly and mild interstitial edema without infection.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: pna History: AMS Presumed metastasis destroying the posterior aspect of the left fifth rib.No specific evidence of infection or edema.Heart size upper normal.

Output: No acute abnormality. Large rib metastasis.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history COPD evaluate left lung nodule LUNGS AND PLEURA: Paraseptal emphysema is noted noted in the apices. Pleural and parenchymal scarring is noted in left upper lobe. No pulmonary nodule can be identified in the left lower lobe. There is elevation of the left hemidiaphragm with mild compressive changes in left lower lobe. No pleural effusion is noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Atherosclerotic changes are noted of the aortaCHEST WALL: Degenerative changes in the dorsal spineUPPER ABDOMEN: No significant abnormality noted.

Output: 1. No pulmonary nodule or mass could be identified in the left lower lobe. 2. There is elevation of the left hemidiaphragm with mild compressive changes in left lower lobe. 3. Bilateral apical emphysema


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: presence of pulmonary edema? History: CHF with volume overload Unchanged basilar opacities and small pleural effusions right larger than left.Support devices unchanged.

Output: Unchanged basilar opacities and pleural effusions, likely edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of multiple myeloma s/p stem cell transplant, COPD, and shortness of breath, evaluate for infection and pulmonary edema. Right IJ port tip within the right atrium and left IJ catheter tip within the IVC-atrial junction.Mild cardiomegaly.Stable scarring of left lung base.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: aseess for effusion History: aspiration PNA Small lung volumes with pleural effusion, partly loculated in the right major fissure.No specific evidence of pneumonia.

Output: Loculated effusion with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: renal mass, likely RCC, eval for chest metastasis History: newly diagnosed renal mass Cardiomediastinal silhouette is normal in size.Low lung volumes. Clustered calcified nodules in the left upper lobe. No focal airspace opacity, pleural effusion or pneumothorax.

Output: Clustered calcified nodules in the left upper lobe are likely granulomas but confirmation with noncontrast chest CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old Reason: Infiltrates History: fever Left-sided pacemaker with its leads in the right atrium and right ventricle. Right ventricular lead has shifted in position with tip now directed cranially. Right chest port terminates in the cavoatrial junction. Sternotomy wires are intact.Cardiomediastinal silhouette is within normal limits. No focal opacity or significant pleural effusion is identified.

Output: 1. No specific evidence of infection.2. Shift in position of right ventricular lead, which now appears to be directed cranially, not in the RV apex. Recommend confirmation of position with erect PA/lateral.The above findings were communicated to the primary service on 9/23/15 at 1039.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.History of cardiac device placement. Left-sided AICD/pacemaker is unchanged in position.Cardiomediastinal silhouette is unchanged.No pleural parenchymal opacity.No large pleural effusion or pneumothorax is identified.

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