Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Cough and shortness of breath. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary Basinger also within normal limits. Streaky right basilar opacities. No pleural effusion or pneumothorax.

Output: Streaky right basilar airspace disease may represent atelectasis, less likely developing infection. Consider follow-up two-view chest.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: evaluate for metastasis History: hx of renal cell carcinoma Calcified granuloma again noted at the right lung base. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography. No convincing evidence of active metastatic disease to the thorax on radiography.


Instruction: Generate impression based on medical findings.

Input: Heart valve replacement and shortness of breath Unchanged cardiopulmonary appearance with decreased volumes, patchy densities in both bases representing suspected atelectasis with small effusion.Prosthetic aortic valve unchanged. Numerous calcified hilar lymph nodes compatible with old granulomatous disease exposureLeft subclavian dual port similar position

Output: Suspected basilar atelectasis essentially unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: eval for source of infection History: fever, tachy No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: elevated troponin History: confusion Streaky basilar subsegmental atelectasis or scarring, otherwise unremarkable.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ET placement, aspiration History: as above Lines and tubes are unchanged. Patchy bibasilar opacities again noted, likely atelectasis or scar. Unchanged cardiomegaly. No pneumothorax. No large pleural effusion.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for woresening effusions infiltrate History: sob Interval increase in right pleural effusion. Remaining findings of cardiac megaly and vascular congestion with basilar opacities are unchanged. Hero catheter unchanged in appearance.No pneumothorax.

Output: Interval increase in right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia History: hypoxia with increased work of breathing Small lung volumes with bilateral patchy opacity more severe in the left lung, increased compared to previous.Catheter tip in the SVC.

Output: New patchy airspace opacities with nodular components suspicious for infection.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: 72 yo F w/ hx of PAH 2/2 SLE on remodulin admit with sepsis 2/2 line infection vs cellulitis History: see above Mild to moderate cardiomegaly. Mild lower lung zone interstitial opacities which may in part be chronic as they are similar to the prior study, although superimposed edema and atelectasis behind the heart are likely.Small pleural effusions.Right subclavian catheter, tip in SVC.Multiple vertebral plasties have been performed.

Output: Cardiomegaly and primarily chronic pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma No cardiopulmonary abdomen the observed. No discrete osseous lesions are also identified, however please correlate with pending bone exam due to greater sensitivity.Midline sternotomy with prosthetic mitral valve

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: sign of infection History: febrile Lower lung zone opacities suggestive of edema and/or aspiration, increasing in the left lower lobe.Unchanged tubes and devices.

Output: Increasing left lower lobe consolidation suggestive of infection or aspiration with underlying edema.


Instruction: Generate impression based on medical findings.

Input: COPD with wheezing and cough Semiupright positioning limits sensitivity. Questionable new patchy opacities in both lung bases are superimposed upon previously described scarring and extensive emphysema. Subsequent images demonstrate baseline appearance. Please correlate with follow-up study

Output: Extensive COPD and emphysematous changes


Instruction: Generate impression based on medical findings.

Input: Reason: residual pneumonia? History: conversational dyspnea, cough and URI symptoms Heart size upper normal. Bilateral venous catheters extending to the SVC and right atrium. Small lung volumes with marked elevation of the right hemidiaphragm suggestive of phrenic nerve paralysis.Bilateral streaky pulmonary opacities of uncertain chronicity compatible with atelectasis and infection.

Output: Small lung volumes with probable right phrenic nerve paralysis, and bilateral pulmonary opacities compatible with atelectasis and infection.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: hypotension History: see above Left lower lobe consolidation and left pleural effusion has improved. Mild right-sided edema has resolved.Moderate cardiomegaly stable.Left subclavian ICD, leads unchanged in position.

Output: Interval improvement in effusions and left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: 28 years old Male. Reason: post op cardiac surgery History: cticu patient. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. Small amount of bilateral pleural effusions are noted. The tubes and lines are stable in position.

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


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Stable cardia mediastinal silhouette.The lungs are clear.No pleural effusions.Again noted are degenerative changes and kyphosis of the thoracic spine.

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


Instruction: Generate impression based on medical findings.

Input: POD 2 open heart surgery. Low endotracheal tube with tip about 2 cm above the level of the carina. ECMO cannulae unchanged in position allowing for slight rotation. Right jugular Swan-Ganz catheter can be followed to the pulmonary outflow tract. Retained lap pads projecting over the mid mediastinum and cardiac base, presumably intentional.Extensive high density material or rim calcification projecting throughout the upper abdomen unchanged, of unclear etiology.Right basal atelectasis or scarring unchanged. Retrocardiac atelectasis on the left, slightly worse. There may be a left pleural fluid collection.Pneumomediastinum is no longer visible.

Output: Low endotracheal tube. No significant change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: Fever unknown origin History: as above Moderate cardiomegaly.Increased basilar opacities most likely artifact of overlying soft tissue as there is no specific evidence of pneumonia.

Output: Cardiomegaly with low lung volumes, but no reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: assess for aspiration History: fever Small lung volumes, with nonspecific left lower lung zone opacity unchanged.No reliable evidence of infection although aspiration is possible in the left base.Right jugular catheter, tip in SVC.Status post extubation.A Dobbhoff tube extends below the lower margin of the image.

Output: Mild nonspecific left basilar opacity which could be the result of aspiration. Status post extubation.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval CT, s/p OHT History: sob Interval removal of subxiphoid mediastinal drains and right basilar chest tube. Right IJ sheath and amputated electrode remain in place. Sternal hardware remains well aligned.Persistent left lower lobe consolidation and atelectasis. Right infrahilar opacities of atelectasis and loculated fluid. No pneumothorax is present.

Output: No pneumothorax following chest tube and mediastinal drain removal.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male post thoracentesis. Right IJ Swan-Ganz catheter tip unchanged in the right main pulmonary artery. IABP marker in the proximal descending thoracic aorta 5 cm below the top of the aortic arch.Slightly improving bilateral pulmonary opacities and right pleural effusion. No new pulmonary opacities. No pneumothorax. Unchanged heart size. Unchanged lucencies in the left axilla and upper left hemithorax adjacent to surgical staples.

Output: Improving pulmonary opacities and right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Lung evaluation. Interval removal of one of the mediastinal drains, other hardware and devices similar in position. Tiny right apical pneumothorax. Moderate pleural effusions with basal atelectasis about the same.

Output: No significant change in cardiopulmonary appearance. Tiny right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p chest tube removal r/o pneumo History: chest tubes removed Interval removal of chest tubes with no residual pneumothorax or other acute change.PICC line terminating in the area of the left axilla and retained ICD generator projected over the left upper lung.No new findings.

Output: Interval removal of chest tubes with no residual pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: interval balloon pump History: IABP Balloon catheter marker at the level of the aortic arch with the inflated balloon in the descending aorta.ICD leads unchanged.No acute pulmonary abnormalities.

Output: Balloon catheter in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Evaluate for cardiopulmonary pathology History: sudden onset right-sided pleuritic chest pain, history of high risk pregnancy The heart size is within normal limits. No pleural effusion or pneumothorax. No specific radiographic evidence of infection.

Output: No acute cardiopulmonary abnormality. Please see chest CT from same date for further findings.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: RIJ line position History: RIJ line Unchanged pulmonary opacities and pleural effusions.ET tube tip approximately 3 cm above the carina.NG tube in position, the tip at the hemidiaphragm level.Right jugular catheter, tip in SVC.Markedly gas distended bowel noted.

Output: Marked bowel distention. Unchanged basilar opacities and pleural effusions. The NG tube terminates above the diaphragm level.


Instruction: Generate impression based on medical findings.

Input: Low WBC. Question pneumonia. Upper normal heart size.. No focal airspace opacities, pleural fluid or pneumothorax. Mild bronchial wall thickening, nonspecific. Minimal hazy opacity in the right upper lobe favored to reflect atelectasis but nonspecific.

Output: Mild, nonspecific wall thickening and hazy right upper lobe opacity which may be due to aspiration or bronchitis. If patient remains symptomatic, short-term plain film follow-up may be obtained to exclude development of pneumonia. If there is clinical concern for opportunistic infection, CT may be obtained.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: eval for worsening SOB in pt with lung ca History: SOB Right pleural effusion unchanged. Patchy airspace and interstitial opacities are unchanged. Probable small left pleural effusion also stable. Support hardware unchanged.

Output: Right pleural effusion unchanged. Patchy airspace and interstitial opacities are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: PNA, edema History: SOB new O2 requirement Increase in lung volumes. Decreased bibasilar opacities. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Incorrect count, missing "raytec" Per radiology resident note, left chest and costophrenic angle are excluded of the field-of-view per attending surgeon request. No unexpected radiopaque foreign bodies.Tracheostomy cannula in place. Left neck surgical clips and drain. Staples projecting over the chest confirmed to be in the surgical drapes.

Output: No unexpected radiopaque foreign bodies.Findings were discussed via phone with Dr. Gooi, the attending surgeon, on 11/16/2016 at 20:06 hours by radiology resident on call Dr Kayleen Jahangir


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: Shortness of breath Moderate cardiomegaly.Diffuse interstitial opacity with septal lines.Bilateral pleural effusions with underlying atelectasis, unchanged or slightly improved compared to previous.

Output: CHF with pulmonary edema and pleural effusions. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: oht 2/19 History: as above Open sternotomy wound with Ray-Tec sponges and surgical drains.Small lung volumes with left basilar consolidation.Multiple chest tubes with no pneumothorax.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.IABP catheter distal marker 8 cm below the top of the aortic arch.

Output: No pneumothorax. Open sternotomy wound with retained Ray-Tec sponges.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Dysphagia. Small lung volumes with nonspecific basilar subsegmental atelectasis.No specific evidence of infection or edema.A Dobbhoff tube terminates in the stomach.Tracheostomy tube tip approximately 6 above the carina.Gastrostomy tube newly placed with a postprocedure pneumoperitoneum.

Output: Postprocedure pneumoperitoneum from gastrostomy tube placement. Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: ett tube Tracheostomy tube unchanged. Dobbhoff tube tip in the gastric body. Metallic density projects over the left chest, confirmed to be rosary external to patient. Upper lobe volume loss, fibrosis, and bronchiectasis is unchanged. No new focal opacity or pneumothorax. Cardiomediastinal silhouette is unchanged.

Output: Unchanged volume loss, fibrosis and bronchiectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: ET tube placement History: Intubated Cardiomegaly with retrocardiac atelectasis and a small left pleural effusion, unchanged.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Left subclavian ICD, leads unchanged in position.LVAD unchanged.

Output: Unchanged cardiomegaly with retrocardiac atelectasis, and stable support devices. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: assess lines and tubes History: as above Aortic balloon catheter marker projected at the level of the top of the aortic arch and Swan-Ganz catheter tip in the area of the main pulmonary artery.Interval removal of a right jugular catheter.Moderate cardiomegaly with a probable small right pleural effusion mild basilar atelectasis.

Output: Aortic balloon catheter and Swan-Ganz catheter without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: status post lung biopsy History: pneumothorax Left pleural thickening consistent with known mesothelioma. Right port tip in SVC. Emphysema. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? acute path? History: chest pain with coughing, h/o htn and breast ca Persistent diffuse mainly interstitial opacity in the right mid lung and bilateral nodules, suspicious for metastatic disease.The diffuse interstitial abnormality in the right lung is suspicious for lymphangitic spread of tumor, in view of a history of breast cancer in the presence of additional nodules. The lack of interval change over the past 6 days also favors metastatic disease over infection.

Output: Findings consistent with metastatic disease with probable lymphangitic spread of tumor in the right lung. A CT scan is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male status post PICC placement. Unchanged cardiomediastinal silhouette.Bibasilar atelectasis and bilateral pleural effusions. No pneumothorax.Right IJ central venous catheter in place with tip in the distal SVC. Right-sided PICC with tip in the proximal SVC. Interval removal of endotracheal tube.

Output: Right-sided PICC with tip in the proximal SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube History: chest tube Interval removal of a right chest tube with a remaining chest tube extending to the apex.ModerateRight apical pneumothorax. Extensive opacity in the right lung consistent with nonspecific atelectasis and consolidation as well as a moderate pleural effusion.

Output: Persistent moderate right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.UTI and concern for acute cholecystitis. Cardiothoracic ratio appears enlarged.Hazy dependent lung opacity most consistent with layering pleural fluid and atelectasis, not significantly changed.

Output: No significant change in layering pleural fluid and atelectasis. Cardiothoracic ratio may be slightly enlarged for patient's age. In the acute setting, this may be correlated with echocardiogram to exclude possibility of pericardial fluid if required.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: volume overload with CHF History: CHF, O2 requirement Median sternotomy with mild to moderate cardiomegaly.Small lung volumes are present with basilar edema and atelectasis and pleural effusions.Right jugular catheter, tip in SVC.

Output: CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: renal mass History: renal mass Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: DHT placement History: DHT placement Feeding tube extends inferiorly off the field-of-view and is likely postpyloric. Left IJ sheath is in place. Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable mild pulmonary edema. Small right pleural effusion, as before. No pneumothorax. Unchanged heart size.

Output: Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: bilat lung transplant 1 year Patient is status post clamshell sternotomy for bilateral lung transplant. Scattered surgical clips in the mediastinum.Cardiomediastinal silhouette is within normal limits. Slightly decreased lung volumes. No pleural effusions or pneumothorax. Elevation of right hemidiaphragm, as before.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Leukemia and histiocytosis LUNGS AND PLEURA: Reidentification of old previews described lung nodules unchanged or slightly decreasing size. A new lung nodule 049 mm in diameter is localized at the left lower lobe (image 51, series 4).MEDIASTINUM AND HILA: Left paramediastinal calcified mass is slightly decreased in size. Central line unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Decrease in size of old previous described lung nodules and left paramediastinal mass. New lung nodule of the left lower lobe as described.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Follow-up pleural effusions. Acute respiratory failure. The endotracheal tube has been retracted, now at the thoracic inlet level, suggest repositioning.Left jugular catheter and visualized portion of the NGT unchanged.Lung volumes remain markedly low. Retrocardiac opacity nonspecific and unchanged, largely due to atelectasis.No visible pleural fluid. Faint residual perihilar opacity suggestive of aspirate.

Output: No visible pleural fluid. Near-extubation; consider repositioning of endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: Female 33 years old Reason: rt subclavian line History: Cerebral artery occlusion, central venous catheter placement. Low lung volumes.Unremarkable cardiomediastinal silhouette.Right subclavian central venous catheter is at the confluence of the left brachiocephalic and left subclavian veins.Mild blunting of the left costophrenic angle may be related to technique.No significant pneumothorax or pleural effusion is identified.

Output: 1. Malpositioned right subclavian central venous catheter at the confluence of the left brachiocephalic and left subclavian veins.2. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Right-sided empyema LUNGS AND PLEURA: Large right-sided fluid collection (effusion and or empyema) with underlying lung atelectasis and possible necrotizing pneumonia. No loculation are visualized. Left lower lobe air space opacity like atelectasis.MEDIASTINUM AND HILA: Minimal amount of mediastinal fluid most likely reactional.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Right-sided necrotizing pneumonia with large effusion/empyema.Small of, likely reactional mediastinal fluid.Left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: sob, tachypnea History: as above Moderate cardiomegaly with small pleural effusions.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.A Dobbhoff tube extends below the lower margin of the image.

Output: Cardiomegaly and small pleural effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Increasing leukocytosis with confusion. Please evaluate for pneumonia No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax. Patient again status post CABG. Loop recorder device again noted overlying the left hemithorax, shift in position due to patient positioning.

Output: No new focal pleural parenchymal opacity. Unchanged cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Hypotension; Assess for infection vs pulmonary edema/cardiac decompensation History: as above Hypoinflated lungs with elevation of right hemidiaphragm. Stable prominence of the brachiocephalic vessels. New patchy opacity in the right middle lung zone. Cardiac silhouette appears prominent but which is incompletely evaluated.

Output: New patchy opacity in the right upper lung zone, which can be due to edema or inflammatory change. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female. Lung nodule noted on chest x-ray. History of interstitial fibrosing lung disease, abdominal mass 50-pound weight loss over two years. CHEST:LUNGS AND PLEURA: Increased bronchiectasis and fibrotic changes in both lung bases. Some mild fibrotic changes in the periphery of the upper lobes with small irregular opacity in the right upper lobe appears to be fibrosis rather than a nodule. No definite lung masses are seen. No effusions.MEDIASTINUM AND HILA: Heavy calcifications in the aorta and coronary arteries. Clusters of nodes in the pretracheal and AP window. For baseline purposes cluster of nodes in the precarinal area series 3 image 36 measure 1.7 x 2.2 cm.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the bowel a solid organs due to lack of oral or intravenous contrast. Given those limitations, the following observations are made.LIVER, BILIARY TRACT: Normal variant small right lobe liver with retrohepatic gallbladder unchanged and 2007.SPLEEN: No significant abnormality noted.PANCREAS: Atrophy with mild pancreatic ductal dilatation unchanged and 2007.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic calcifications aorta and branch vessels. Note evidence of aneurysm. Splenic artery calcification but no evidence of aneurysm.BOWEL, MESENTERY: Partial intrathoracic stomach. This is unchanged and 2007.BONES, SOFT TISSUES: Scoliosis and degenerative changes.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: Scoliosis and degenerative changes. Nonobstructive mild bulging lower pelvic wall near the right groin represent early mild hernia formation since image 161.OTHER: No significant abnormality noted.

Output: No definite evidence of malignancy. Fibrotic changes in lungs. Right upper lobe focal fibrotic change favored. Clusters of mediastinal nodes. Atherosclerotic disease. Intrathoracic stomach. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: ETT placement Nonspecific mixed interstitial and airspace opacities greater in both bases and on the left. Layered small to moderate effusions also greater in the left with mild cardiomegaly. Subsequent images interpreted.ETT placed, tip projects 5 cm above the carina.

Output: ETT placement


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: please evaluate for pneumothorax s/p right sided PPM History: right sided pacemaker implantation Bilateral pleural effusions and basilar opacities unchanged, accompanied by mild cardiomegaly.Status post sternotomy.New right subclavian dual-chamber pacemaker placed without pneumothorax or other complication.

Output: No pneumothorax following right subclavian pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: effusion, severe PH History: above Right pleural effusion with overlying consolidation unchanged.Cardiomegaly with severely enlarged pulmonary arteries, unchanged.Soft tissue opacity projected over the left scapula not as evident as before.Left jugular Swan-Ganz catheter tip looped in the left pulmonary artery.

Output: Unchanged right pleural effusion, right basilar opacity and Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.New fever and leukocytosis rule out pneumonia. Right jugular introducer unchanged. Mediastinal venous distention. Interval near complete resolution of acute edema pattern, with mild residual opacity on the right abutting the fluid layering in the major fissure. Lung volumes remain low.

Output: Resolution of edema. Right pleural effusion which extends into the major fissure. Abutting the fissure there is some nonspecific opacity which could reflect compressive atelectasis however infection cannot be entirely excluded. Continued plain film follow-up suggested.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with history of scleroderma who presents with dysphagia to solids and liquids. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a mild motor abnormality with proximal escape.TOTAL FLUOROSCOPY TIME: 7:01 minutes

Output: Mild motor abnormality. Otherwise, normal esophagram.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ET in place? History: ET in place Support devices are unchanged in position.Diffuse reticulonodular opacities suggestive of edema not significantly changed. No interval pneumothorax. Heart size is normal.

Output: Persistent reticulonodular opacities favoring edema.


Instruction: Generate impression based on medical findings.

Input: Female 2 days old Reason: 23 week infant, clinically unstable , with pneumothorax and chest tube History: pneumothorax, chest tubeVIEW: Chest and abdomen AP (2 views) 4/23/2016 at 1447 hours. Right mainstem bronchus intubation. NG tube, umbilical lines and right-sided chest tubes are unchanged.Cardiac silhouette size is normal. Bilateral diffuse lung haziness and right-sided subpulmonic pneumothorax unchanged.Almost gasless abdomen.

Output: Misplaced ET tube.Bilateral diffuse lung haziness and right-sided subpulmonic pneumothorax unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: hypoxemia requiring increased FiO2 History: hypoxemia Tracheostomy, enteric tube, and left IJ venous catheter unchanged.Stable cardiomediastinal silhouette.Diffuse pulmonary opacities compatible with edema similar in appearance to the prior exam.No new pulmonary opacities identified.Again noted are innumerable surgical staples overlying the thorax.

Output: Support devices unchanged. Stable cardiopulmonary appearance with diffuse pulmonary opacities compatible with edema/ARDS.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: intubated post-op. The patient is rotated. There is stable cardiomegaly. No endotracheal tube is seen. The enteric tube most proximal side-port is within the stomach. The sternotomy wires and hardware, aortic stents, numerous surgical clips throughout the chest and upper abdomen are unchanged. New skin staples can be seen in the upper abdomen. Pneumoperitoneum is seen, consistent with recent surgery. The left-sided PICC is in the left subclavian vein. There is subsegmental atelectasis lower lobe likely from compression.

Output: Postoperative pneumoperitoneum. No endotracheal tube is seen.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: ETT History: ETT Gradually worsening of pulmonary opacities suggestive of edema and/or aspiration.ET tube tip 7 cm above the carina.An NG tube terminates in the stomach, the side port at or above the GE junction.

Output: Gradually worsening pulmonary opacities suggestive of edema and/or aspiration. ET tube tip 7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: eval for acute process History: fever, cough, wheezing, long time smoker Metallic fragments in the soft tissues of the anterior chest may represent bullet fragment.The cardiomediastinal silhouette and vasculature are normal. Lungs are clear airspace and interstitial opacities. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: rule out pneumonia History: short of breath, productive cough No acute cardiopulmonary abnormality.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.History: End-stage renal disease. Pretransplant evaluation. Right jugular dialysis catheter terminating in the distal SVC. Unremarkable cardiomediastinal silhouette.No pulmonary or pleural abnormalities.

Output: Right jugular dialysis catheter terminating in the distal SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: 27F hx ESRD 2/2 lupus, presenting with fever and chest pain History: fever and chest pain No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax. Unchanged central venous catheter.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: ? PNA History: fever Right chest port catheter tip in the SVC.The heart size is at the upper limit of normal. Tortuous thoracic aorta. Enlargement of the pulmonary vasculature, suggestive of pulmonary arterial hypertension. No focal airspace opacities, pleural effusion, or pneumothorax.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infectious etiology History: ab pain, elevated WBC Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.History of multiple myeloma, pre-auto SCT evaluation. Normal heart size. A partially circumscribed spherical nodular opacity seen on the lateral radiograph overlying junction of the left atrium/suprahepatic IVC may correlate to a fat density lesion arising from the right pericardial fat seen on the localizer CT from PET scan dated 2/10/2015. This most likely represents a pericardial lipoma. No focal air space opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: FemaleReason for Study: Reason: interval changes History: as above Right Port-A-Cath tip in the RA.Stable cardiac enlargement.Bilateral air space opacities , right greater than left, similar to the prior exam.Small pleural effusions.Osseous abnormalities compatible with sickle cell disease.

Output: Stable cardiopulmonary appearance with cardiomegaly and air space opacities suggestive of edema. However, infection cannot be excluded


Instruction: Generate impression based on medical findings.

Input: Chest pain question infection Scarring or residual subsegmental atelectasis at the lung bases, significantly improved from the prior study. Lung volumes have also improved. There is some residual opacity in the periphery of the right midlung, abutting the major fissure. No pleural fluid or pneumothorax.

Output: Residual opacity in the periphery of the right lung which correlates to wedge-shaped subpleural lesion seen on same day abdominal CT. Differential considerations include septic emboli or infarct. If patient is immunocompromised, angioinvasive fungal infection would also be included in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: rule out aspiration History: emesis Mild cardiomegaly.Left upper lobe nodular opacity likely associated with the first costochondral junction although an underlying nodule is in the differential diagnosis.Patchy right basilar opacity could be result of aspiration.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: Right basilar opacity. Possible left upper lobe nodule, most likely artifact.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrates or free air History: nausea vomiting x 2h, h/o chf Cardiomegaly with evidence of previous median sternotomy.Small lung volumes with mild lower zone interstitial opacity of uncertain chronicity.Notice specific evidence of pneumonia and no visible free air in the abdomen and PA and lateral radiographs would be helpful for further evaluation.

Output: Cardiomegaly and mild interstitial opacity, of uncertain chronicity, compatible with either chronic interstitial disease or mild CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: pna Mild basilar interstitial opacities, unchanged from previous, compatible with atelectasis and scarring.Catheter tip in the SVC.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Altered mental status rule out pneumonia. Right apical opacity identified on CT of 2008 incompletely visualized, however its lateral aspect appears similar in size, the remainder of the abnormality cannot be accurately assessed.Severe multichamber cardiomegaly. Patient is rotated. Retrocardiac opacification of unclear etiology. Severe bronchial wall thickening bilaterally. Low lung volumes.

Output: Exam limited by patient rotation and position. Bilateral retrocardiac opacity nonspecific; on the left infection cannot be excluded. Severe bronchial wall thickening may reflect acute or chronic bronchitis, infection cannot be excluded.. Right apical lesion incompletely visualized. If the patient can tolerate, correlation with erect PA and lateral chest radiographs are recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Endotracheal tube position History: s/p Endotracheal intubation Severe central airspace opacities with subpleural sparing consistent with acute pulmonary edema, although hemorrhage or aspiration are in the differential diagnosis.Mild cardiomegaly.ET tube tip approximately 2 cm above the carina.Right jugular catheter, tip in SVC.An NG tube terminates in the stomach.

Output: ET tube tip approximately 2 cm above the carina. Acute pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: mediastinal widening? pna? edema? History: HTN, parkinson's disease, chest pain, shortness of breath Cardiac silhouette is borderline enlarged. No focal consolidation, sizable effusion or pneumothorax is present.Few surgical clips overlie the right axilla, unchanged.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Presenting with a history of PSC and Crohn's disease in the context of severe right upper quadrant pain. Please rule out pneumoperitoneum. Sensitivity for detecting free air on semierect film is limited. In this context, no free air is visualized. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality or evidence of free intraperitoneal air.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: 86yo F with dementia and findings on CXR, repeat with lateral film. History: comparison study Heart size upper normal with a tortuous aorta.No specific evidence of infection or edema.Left subclavian pacemaker, leads unchanged in position.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Swan History: Swan Stable position of support devices.Persistent low lung volumes with basilar opacities of subsegmental atelectasis. Small pleural effusions. No pneumothorax.

Output: Stable position of Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: assess lung nodule Improvement in lung volumes. Calcified right basilar granuloma and calcified right hilar lymphadenopathy consistent with previous granulomatous disease. Scarlike opacities in the lower aspect left lung and upper aspect of the right lung. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Calcified right basilar granuloma and calcified right hilar lymphadenopathy consistent with previous granulomatous disease.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: PNA History: cough and fever Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.Elevation of the left hemidiaphragm with air-filled dilated loops of large bowel identified within the upper abdomen similar to the prior exam.

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


Instruction: Generate impression based on medical findings.

Input: Acute respiratory distress. Check vascular access New right jugular catheter extends into the mid SVC without associated postprocedural complication. Dobbhoff, tracheostomy tube and left jugular catheter are all otherwise unchanged.Motion degrades sensitivity, however within this limitation the moderately decreased lung volumes with superimposed changes suggesting ARDS appear similar. Specifically no new superimposed focal airspace process. Moderate nonspecific cardiomegaly

Output: New right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old. New Swan-Ganz catheter from a left Checker vein with its tip in the right upper lobe branch of the pulmonary artery.ICD leads unchanged.No significant pulmonary abnormalities.

Output: New Swan-Ganz catheter with its tip in a right upper lobe branch of the pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: effusion History: new oxygen requirement Mild cardiomegaly. No focal pulmonary opacities, pleural effusion, or pneumothorax. No convincing evidence of pulmonary edema.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male who presents after a fall with loss of consciousness. Heart size is normal.No focal consolidation, pneumothorax, or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: ro TB, may get infliximab History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right axillary surgical clips.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with history of breast cancer with one month of cough and hemoptysis. Evaluate for PE or mass. PULMONARY ARTERIES: No evidence of pulmonary emboli.LUNGS AND PLEURA: Diffuse bilateral cystic lung changes consistent with periseptal and centrilobular emphysema. A 5.6 x 3.9 cm superior segment left lower lobe mass is poorly marginated, and is contiguous with the left hilum.MEDIASTINUM AND HILA: Subcarinal and AP window adenopathy is present but too ill-defined to measure.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. A large solid left perihilar/LLL mass with subcarinal lymphadenopathy consistent with lung cancer.2. No evidence of PE.3. Diffuse mixed emphysema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? effusion? edema? History: Trach, vent, report of infiltrate and effusion on outside hospital CXR, abnormal labs Small lung volumes with nonspecific basilar atelectasis and consolidation, likely secondary to aspirated secretions.Tracheostomy tube in place with a relatively over inflated cuff.A more recent radiograph has been interpreted.

Output: Basilar atelectasis and consolidation consistent with aspirated secretions and possibly infection.


Instruction: Generate impression based on medical findings.

Input: Male, 92 years old.Reason: sob, hx chf History: sob. Normal WBC. Moderate cardiomegaly with small left and moderate right pleural effusions, similar to prior. Bibasilar scarring and volume loss which may be seen in the setting of chronic aspiration. Air is also noted esophagus. Patchy new airspace opacity in one of the lower lobes on the lateral radiograph may reflect acute aspiration or infection.No specific evidence of pulmonary edema.

Output: Air in the esophagus with consistent bilateral basal volume loss and pleural fluid in a pattern suspicious for sequela of chronic or chronic recurrent aspiration. There is some patchy airspace opacity in the lower lobes on the lateral radiograph which is new and may reflect acute aspiration. Suggest follow-up PA and lateral chest radiographs to exclude development 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: 46 years old Male. Reason: eval for worsening opacities, ETT placement History: intubated. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Mild cardiomegaly. Spinal fixation hardware is noted. The ET tube and NG tube are stable in position.

Output: Mild cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Cough and wheezing No cardiopulmonary abnormality other than mild COPD

Output: Questionable mild COPD given mildly enlarged lung volumes


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. Left-sided ICD unchanged.Right IJ Swan-Ganz with its tip in the pulmonary artery.Stable cardiac enlargement.Diffuse interstitial opacities suggestive of edema similar in appearance to prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiac enlargement and interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Reason: any abnormality? sorry i know that's a bit vague History: persistent SOB for several months, hx poorly controlled DM and changes on EKG Unremarkable cardiac and mediastinal silhouette.Mild blunting of the right lateral costophrenic angle, unchanged, compatible with scarring.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Post single chamber ICD implantation via left axillary vein History: None New single-lead ventricular defibrillator.The heart is enlarged but stable.There are bilateral reticular interstitial opacities with prominent septal lines. Additionally, there is a new, more focal right upper lobe airspace opacity. No pneumothorax. No large pleural effusions.

Output: 1.Single lead defibrillator without evidence of complication.2.Cardiomegaly and pulmonary edema suggestive of CHF.3.More focal right upper lobe airspace opacity which could represent focal edema, however aspiration or early pneumonia cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: monitoring pneumothorax s/p bilateral chest tube History: see above Unchanged right pleural drain with no pneumothorax.Stable left pleural drain.Mild right lower lung zone atelectasis.Tracheostomy tube tip approximately 7 cm above the carina.Esophageal probe tip in upper esophagus.Questionable pneumoperitoneum.

Output: No significant pneumothorax. Possible pneumoperitoneum developing.


Instruction: Generate impression based on medical findings.

Input: Reason: Chest tube placement History: White out lung on CXR Complete atelectasis and consolidation of the left lung with a minimal apical pneumothorax.Chest tubes and jugular catheter unchanged.Small right pleural effusion and basilar atelectasis.A more recent radiograph has been interpreted.

Output: Complete atelectasis of the left lung with a new minimal apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: CTICU History: daily Right chest tubes status post right lung and chest wall resection.No change in patchy atelectasis and pleural effusions.ET tube tip approximately 5 cm above the carina.A Dobbhoff tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Renal osteodystrophy noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: ? pna History: right sided cp/ cough Right lower lobe airspace opacity worse than on the prior CT consistent with acute pneumonia.Mild bronchial wall thickening noted.Heart size normal.

Output: Right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: assess for pulmonary edema History: hypoxia Small lung volumes with nonspecific basilar atelectasis.No specific evidence of infection or edema.Mild/moderate cardiomegaly noted.

Output: Basilar atelectasis and small lung volumes.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Evaluate for opacity or other signs of aspiration History: Status epilepticus Endotracheal tube terminates 5 cm above the carina. Nasogastric tube side hole is positioned just the GE junction. Embolization coils occupy the left thoracic inlet.Large lung volumes. Bilateral rib deformities compatible with prior fracture. The lungs and pleural spaces remain clear. The cardiomediastinal silhouette is unremarkable.

Output: No evidence of aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: eval chest tube, ptx History: pneumothorax Increased right pneumothorax with the apex of the lung approximately 5 cm from the chest wall.Small lung volumes with basilar opacity, greater on the right, consistent with atelectasis.Right jugular catheter extending to the SVC. Chest tube projected over the right lung base this tip directed medially and inferiorly.

Output: Increased right pneumothorax with chest tube in place.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Pulmonary edema History: Increasing oxygen requirement Basilar subsegmental atelectasis or scarring.Heart size normal.Right jugular catheter tip at cavoatrial junction.

Output: Basilar subsegmental atelectasis, but no evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Eval for PTX History: SOB Very large right-sided pleural effusion again noted. Right basilar Pleurx catheter remains in place. Left lung remains clear. Unchanged heart size. No pneumothorax.

Output: No substantial change in right-sided pleural effusion, very large in size. Right basilar Pleurx drain remains in place.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Right internal jugular line placement Right internal jugular central venous catheter tip is in the right atrium. Enteric tube tip courses below the field of view. Right upper extremity PICC tip is at the axilla.Mild cardiomegaly.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: Right internal jugular central venous catheter tip is at the right atrium.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: shortness of breath History: shortness of breath Mild basilar subsegmental atelectasis and small pleural effusions are present.Mild cardiomegaly.Equivocal edema.

Output: Mild CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: R/O Active TB PPD History: R/O Active TB PPD 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: Intubated postop. End-stage renal disease. ETT tip 5 cm above the level of the carina.NGT sidehole above the GE junction and may be advanced.Surgical staples and catheters projecting over the upper abdomen are incompletely visualized.Moderate right pleural fluid collection loculated laterally about the same. Associated opacities suggestive of scarring and atelectasis about the same.There is at least a small volume of intraperitoneal air which may be postoperative.

Output: ETT tip 5 cm above the level of the carina. Unchanged pleural fluid on the right.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for fragment/device and DHT History: eval for fragment/device and DHT No significant cardiopulmonary abnormalities.Feeding tube tip in the gastric fundus.

Output: Temperature tip in the gastric fundus.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: infiltrates History: cough Low lung volumes makes detailed cardiopulmonary assessment difficult. Patchy opacities in the upper aspect of the right lung and right lung base. Likely normal heart size given low lung volumes and AP projection. Atherosclerotic aorta. No large pleural effusion or pneumothorax.

Output: Patchy opacities within the right lung consistent with aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Emphysema status post pigtail removal question pneumothorax Interval removal of left-sided pleural catheter with a small (6 mm) left apical pneumothorax.Left-sided bronchial valves noted. Asymmetric lung volumes, right greater than left with severe emphysema in the right lung base.Diffuse bronchial wall thickening and atelectasis in the left lower lobe lingula perhaps slightly improved.Nodular opacity abutting the fissures on the 8 nonspecific, please refer to recent CT. Mild bronchial wall thickening on the right unchanged, with opacity in the lower lobe airways consistent with debris.

Output: Small 6 mm left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with renal cell cancer. CHEST:LUNGS AND PLEURA: Multiple metastatic nodules have increased in size and number, even though the reference lesion is unchanged measuring 12 x 12 mm image number 72/216.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: One enlarged mediastinal lymph node is unchanged. Right-sided rib and chest wall metastases have also increased in size and number.ABDOMEN:LIVER, BILIARY TRACT: Numerous metastatic lesions throughout the liver have increased in size and number. Reference lesion in the left lobe measures 2.2 x 2.9 cm image number 87/216.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence.RETROPERITONEUM, LYMPH NODES: Upper para-aortic metastatic adenopathy. In reference lesion measures 19 x 18 mm image number 101/Conus is seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subtle lytic lesion on the right side of the L3 vertebral body is unchanged.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: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the lung, liver and right-sided chest wall and rib metastases and increase in size of the upper para-aortic adenopathy


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: neutopenic fever History: occasional cough and fever No significant interval change in appearance of the bilateral rib fractures with associated lytic lesions as well as the scattered other bony abnormalities.No change in linear opacity and left mid lung zone. No new lung opacities. No pneumothorax. Heart size normal.

Output: No interval change in the multiple bony abnormalities previously described. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Failure to thrive. Anorexia check for pneumonia No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Bronchiectasis exacerbation versus pneumonia. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary vasculature are also within normal limits. No airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: pericarditis vs pneumonia History: hypoxemia Cardiomegaly with improving left lower lobe consolidation, and persistent mild interstitial edema.Right jugular catheter tip at cavoatrial junction.

Output: Cardiomegaly, with improving left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with myelofibrosis status post bone marrow transplant, presenting with abnormal breathing pattern and cough. Lack of IV contrast limits evaluation of lymph nodes and solid organs.LUNGS AND PLEURA: Right upper lobe micronodule appears smaller to unchanged. No new lung nodule. No pleural effusion.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy is evident. .Heart size is normal. Hypoattenuation of the intracardiac blood pool indicates anemia. Moderate pericardial effusion. Mild to moderate atherosclerotic calcification of the coronary arteries.Interval removal of left internal jugular central line.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Limited images of the upper abdomen. Lack of PO contrast was evaluation of the bowel.Interval decrease in liver and spleen size. Spleen size is now within normal limits.

Output: 1.No specific findings to explain the patient's symptoms.2.Persistent moderate pericardial effusion.3.Interval decrease in liver and spleen size, now within normal limits.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: pna? Acute path? Air under diaphragm? History: hypotension, initial complaint of g tube dislodgement Previously seen pleural effusions have enlarged, the right more so than the left, and there is persistent retrocardiac atelectasis.IVC filter and right ureteral stent noted.

Output: Enlarging pleural effusions with persistent retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: 25 years old Male. Reason: eval for fracture, contusion, PTX History: R chest wall tenderness; hemoptysis. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Metastatic renal cancer, on therapy, evaluate for change CHEST:LUNGS AND PLEURA: Previously described right lower lobe patchy air airspace and interstitial opacity has regressed. However, new and similar findings are present in the left lingula. Additionally, there are two new micronodules in the right middle lobe (image 47 and 42; series 4) which should be followed. MEDIASTINUM AND HILA: Enlarged mediastinal lymph nodes appear stable. A reference right pretracheal lymph node again measures 1.4 x 1.1 cm (image 38, series 3). Extensive atherosclerosis of the aortic arch and severe coronary artery calcifications as described previously. Trace pericardial effusion is slightly more prominent on today's exam compared to prior.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating hepatic lesions, most likely represent simple cysts and are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left hyperattenuating renal lesion, measuring 4.7 x 3.5 cm (image 125, series 3) is compatible with renal cell carcinoma and unchanged. Symmetric perinephric fat stranding is also stable. Right upper and lower pole hypodense lesions measure water density and likely represent simple cysts. RETROPERITONEUM, LYMPH NODES: Stable enlarged conglomerate left retroperitoneal lymph nodes are compatible with metastatic disease. A reference lesion measures 6.0 x 5.9 cm (image 124, series 3). Atherosclerotic disease of the abdominal aorta. Unchanged infrarenal abdominal aortic aneurysm measures 3.7 cm in diameter. Unchanged bilateral iliac artery aneurysms measuring up to 2 cm.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: Degenerative changed affect the lower lumbar spine.OTHER: No significant abnormality noted

Output: 1. Stable left lower pole hyperattenuating renal mass is compatible with the patient's history of renal cell carcinoma.2. Stable conglomerate left retroperitoneal lymph nodes are compatible with metastatic disease. 3. Right lower lobe patchy airspace and interstitial opacity has regressed but new similar findings in the left lingula have developed as well as 2 micronodules in the right middle lobe which should be followed.4. Unchanged infrarenal abdominal aortic aneurysm and common iliac artery aneurysms.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: report of nodules and effusions on OSH CXR; new transfer History: see above Right side predominant edema like opacities as well as probable right pleural effusion. Heart size upper normal.Left PICC, tip in the SVC.

Output: Right-sided opacity and right pleural effusion, possible aspiration in etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: infection History: SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Cough. History of swallowing foreign body.VIEWS: Chest AP/lateral (two views) 03/31/16 Cardiothymic silhouette and pulmonary vascularity are normal. The aortic arch, cardiac apex, and stomach are left-sided.Mild peribronchial thickening is seen. Lung volumes are increased; hemidiaphragms are flattened and AP diameter of the chest is increased.No asymmetric aeration is identified. No foreign body is seen.

Output: Airway hyperreactivity/bronchiolitis pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Struck by car. Chest pain on inspiration. Normal cardiomediastinal silhouette. No pneumothorax or pleural fluid.Right 12th posterior medial rib medially is angulated in an asymmetric fashion compared to the left and an adjacent parenchymal opacity is seen in the lung on the lateral radiograph which may reflect atelectasis or contusion, correlate for site of pain as this may reflect a fracture.

Output: Poorly visualized possible rib angulation and adjacent parenchymal opacity involving the posterior medial right 12th rib, correlate for site of patient's pain as this could reflect a nondisplaced fracture. Further assessment may be made with dedicated rib series if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: MaleReason for Study: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Left apical 5 cm mass identified and may represent either primary or metastatic neoplasm.The cardiac mediastinal silhouettes unremarkable.No pleural effusions.Degenerative changes in thoracic spine with mild anterior wedging of several mid thoracic vertebrae.

Output: Left apical mass compatible with a primary or metastatic neoplasm. CT the chest with IV contrast is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Neutropenic fever History: As above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Skeletal abnormalities of the known myeloma are present.Right jugular catheter, tip at cavoatrial junction.

Output: Known myelomatous skeletal lesions. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: ET tube Lines and tubes are unchanged. No substantial change in diffuse pulmonary opacities given differences in inspiration except for improvement in left basilar atelectasis. Unchanged cardiomegaly.

Output: Lines and tubes are unchanged. Diffuse pulmonary opacities may represent edema, diffuse infection, and/or diffuse alveolar damage.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval for infiltrate History: fever No significant cardiopulmonary abnormality.Thoracolumbar spine stabilization hardware.

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


Instruction: Generate impression based on medical findings.

Input: History of tonsil cancer in 1995. Rule out recurrence and lung metastasis. LUNGS AND PLEURA: No lung nodules are identified. Paramediastinal fibrotic changes in lung apices are most likely secondary to radiation. MEDIASTINUM AND HILA: No significant abnormality noted. No lymphadenopathy.CHEST WALL: Mild degenerative changes in bilateral sternal clavicular joints, right greater than the left. A focal area of sclerosis in the proximal right clavicle, which likely represents a bone island or sclerosis related to previous radiation. UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Concern for PNA History: cough \T\ AMS Faint right basilar airspace and interstitial opacity which may be due to atelectasis, aspiration, or pneumonia

Output: Faint right basilar airspace and interstitial opacity which may be due to atelectasis, aspiration, or pneumonia


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: cardiomegaly, widened mediastinum, pneumonia, effusion History: acute chest pain since 1am this morning The cardiac and mediastinal silhouette is normal. No significant pulmonary or pleural abnormality. Healed rib fractures on the left.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: eval for foreign body in esophagus, chicken bone History: dysphagia, emesis, foreign body sensation in throat since eating chicken wings Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No radiopaque foreign object.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: Pre-Op Evaluation History: SOB Cardiac silhouette is borderline enlarged.Right apical, hilar and likely retrosternal calcified granulomas.Minimal blunting of the right costophrenic angle likely related to pleural thickening. No focal consolidation or pneumothorax.

Output: Mild cardiomegaly. No radiographic evidence of acute cardiopulmonary process.Sequela of granulomatous disease.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with metastatic sarcoma. Evaluate disease status. CHEST:LUNGS AND PLEURA: Diffuse bilateral pulmonary metastases are slightly larger. 12 x 12 mm left upper lobe nodule (series 4, image 40); left upper lobe nodule in the parahilar region (series 4; image 40) measuring 14 x 14 mm; 10 x 10 mm right middle lobe nodule (series 4; image 49); 9 x 9 mm right middle lobe nodule (series 4; image 62). The other nodules are stable to minimally increased in size.MEDIASTINUM AND HILA: Calcified right hilar lymph nodesCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Calcified hepatic granulomas. Hypoattenuating lesions in the liver, the largest in the left lateral segment measuring 11.3 cm diameter at axial image 90/203 of series 3 is probably due to a simple cyst. Cholelithiasis. SPLEEN: Splenic granuloma. Soft tissue density posterior to the spleen is increased in size, and measures 2.8 x 3.4 cm. This lesion is probably metastatic given the changing size. A few scattered splenic hypodensities are stable.PANCREAS: The main pancreatic duct is dilated in the head and neck, measuring up to 4 mm in greatest diameter, not significantly changed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate calculus in the lower pole of the left kidney, unchanged, without evidence of obstruction.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter nodule in the anterior abdominal subcutaneous tissues on the left has decreased in size, and is barely detectable.Partial resection of the right sacrum and ilium with extensive metallic hardware. 19 x 17 mm lytic lesion in the right acetabular posterior column (series 3; image 175) has not significantly changed. Similar lesions are effect the ischia bilaterally. A small fluid collection is suspected in the postsurgical bed has resolved. 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: Posterior fixation hardware is again noted in the lower lumbar spine and pelvis.OTHER: No significant abnormality noted.

Output: Lack of IV contrast limits evaluation.No new lesions. Overall minimally increased size of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval for pneumonia History: SOB Right lower lobe calcified granuloma.Heart size upper normal.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate for pulmonary edema History: SOB, heart failure Mild cardiomegaly.No specific evidence of infection or edema.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Anasarca, history CHF. Shortness of breath. Motion artifact degrades the lateral radiograph, limiting assessment.Moderate cardiomegaly unchanged. Superior mediastinal widening similar to earlier previous study of 5/16/2014 and suggestive of central venous distention. The central pulmonary vasculature is also enlarged, compatible with pulmonary arterial hypertension. No pleural fluid.Background of diffuse pulmonary opacities, previously suspected to be the result of ARDS, with mild superimposed pulmonary edema.

Output: At least mild CHF/hypervolemia superimposed upon chronic lung disease and pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.SOB rule out acute chest. Right peripheral catheter is looped in the axilla, terminating lateral to the bony thorax.Mild cardiomegaly, about the same.Vascular unsharpness lower lung zones suggestive of edema. This is superimposed upon chronic interstitial abnormality. No focal airspace opacities. Trace pleural fluid on the right.

Output: No focal airspace opacities, however there is minimal pleural fluid and an edema-like abnormality at the right base. Right-sided peripheral catheter is not in a central vein and appears to be redundant in the axilla.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: PNA, effusion History: 79yoM admitted from OSH for persistent VT, recently intubated 1 week respiratory failure. Interval removal of nasogastric tube. Other support hardware is stable.Basilar airspace opacities are unchanged. Small left pleural effusion with atelectasis unchanged.

Output: Basilar airspace opacities are unchanged. Small left pleural effusion with atelectasis unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: burn History: burn ET tube tip approximately 5 cm above the carina.Cardiomegaly with bilateral opacity compatible with edema, atelectasis and small effusions.A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: eval NJ tube History: placement Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Azygos lobe, normal variant.A Dobbhoff tube terminates in the distal stomach.Cholecystectomy clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Chest pain and lower extremity swelling, evaluate for a ADHF. Left subclavian ICD unchanged.Chronic elevation of the right hemidiaphragm.Normal heart size. Highly tortuous thoracic aorta, probably similar to exam of 2014.No visible pleural fluid or specific evidence of edema.Basal scarring, right greater than left.

Output: No convincing evidence of CHF. Tortuosity of the thoracic aorta is probably similar to earlier examinations of 8/19/2014 but please note that acute aortic pathology may not be visible by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: sob, concern for edema History: as above The cardiomediastinal silhouette is within normal limits. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: ETT History: ETT Endotracheal tube tip 3-cm above the level of the carina. Nasogastric tube tip off the caudal margin of the film.Unchanged lobular cardiomegaly, enlargement of the central pulmonary vasculature and apparent pulmonary vascular redistribution. Vascular unsharpness suggestive of edema and atelectasis. Opacity in the right lower lobe consistent with atelectasis however superimposed aspiration or infection in this region cannot be ruled out. Probable small pleural effusions

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Cordis, Swan History: Cordis, Swan Nasogastric tube sidehole now positioned at GE junction. Advancement recommended. Interval placement right IJ Swan-Ganz catheter terminating in the right pulmonary artery. Endotracheal tube is high, 6 cm superior to carina.Right greater than left pulmonary opacities favoring edema. Small pleural effusions. Retrocardiac consolidation and atelectasis. Heart size normal.

Output: Pulmonary edema with small pleural effusions. Advancement nasogastric and endotracheal tubes recommended.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with dizziness, weakness. Evaluate for infiltrates. Multiple pulmonary nodules in the right lung compatible with known metastatic disease. No pleural effusion or pneumothorax. Cardiomediastinal silhouette unremarkable.

Output: No interval change in cardiopulmonary appearance. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: is there an infiltrate History: cough, congestion, immunocompromised Chronic appearing basilar abnormalities, but no reliable evidence of infection or edema.Heart size normal.No large pleural effusions.

Output: No reliable evidence of edema or infection, although if the patient remains symptomatic a follow-up CT is recommended.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with prostate cancer CHEST:LUNGS AND PLEURA: Mild centrilobular and scattered paraseptal emphysema, unchanged. Scattered pulmonary micronodules are unchanged. Index right lower lobe nodule measures 9 by 8 mm on image number 55, series number 5. Previously, it was measuring 8 by 8 mm on image number 56 on series number 5.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes, stable. An index prevascular lymph node measures 16 x 13 mm on image number 32, series number 3. Previously this lymph node was measuring 15 by 11 mm on image number 36 series number 3.CHEST WALL: Widespread lytic and sclerotic metastases, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesions in the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Two high density hypodense lesions in the right kidney are unchanged. Follow-up of these lesions likely representing complex cysts is recommended. Upper pole cystic lesion measures 3 .6 x 3 cm on image number 102, series number 3. Other smaller hypodense lesions in both kidneys are also unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive sclerotic and lytic metastatic disease involving the vertebral bodies with significant vertebral compression fractures, stable. T2 and L2 vertebral body demonstrate more than 50% loss in height focally.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive lytic lesions and sclerotic lesions consistent with metastatic disease in the pelvic bones are unchanged.OTHER: No significant abnormality noted

Output: No significant change from previous study. Widespread sclerotic metastatic disease, small lung nodules, mediastinal lymph nodes are unchanged.Follow-up imaging is recommended for the high density lesions in right kidney.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with a history of a soft tissue sarcoma of the shoulder, evaluate for metastases LUNGS AND PLEURA: Stable scattered micronodules in both lungs. No new nodules or masses can be identified. No evidence of pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: There is no evidence of metastatic disease without interval change


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Hypotension rule out pneumothorax. Large layering right pleural fluid collection extending into the major fissure and producing compressive atelectasis of the adjacent lung not significantly changed in appearance. New airspace opacity and blunting of the cardiophrenic angle on the left in the medial aspect of the left lung base.Unchanged moderate to severe cardiomegaly. No signs of edema.

Output: No pneumothorax. New left basal opacities and pleural fluid suspicious for aspiration or infection. Large right hepatic hydrothorax not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: eval position of central line History: leaking from one port of central line Right central venous catheter tip in the SVC. Cardiomediastinal silhouette is within normal limits.No large pleural effusions or pneumothorax. Left lung base pulmonary opacity.

Output: Right central venous catheter tip in the SVC. Left lung base pulmonary opacity, possible infection.


Instruction: Generate impression based on medical findings.

Input: 87-year-old female with history of lung cancer status post two cycles of chemotherapy. Follow-up before radiation. CHEST:LUNGS AND PLEURA: Peripheral right upper lung nodule with tethering of the adjacent pleura appears similar to prior study (series 5, image 26); it measures approximately 16 x 8 mm, which is relatively unchanged accounting for differences in technique. Few focal ground glass opacities bilaterally are also unchanged.Left lower lobe nodule measures 9 x 7 mm (series 5, image 61); stable. No new nodules or masses are identified.Right basilar atelectasis/scarring as seen previously.MEDIASTINUM AND HILA: Stable mild mediastinal lymphadenopathy with reference precarinal lymph node measuring 12 x 12 mm (series 3, image 35), which is unchanged from prior study. Heart size normal without pericardial effusion.Heterogeneous thyroid gland. Atherosclerotic disease of the aorta.CHEST WALL: Right mastectomy.T6 and T11 vertebral body compression fractures unchanged.ABDOMEN:LIVER, BILIARY TRACT: Punctate calcification in the inferior liver, unchanged. No focal hepatic mass is identified. Prominence of the biliary system appears similar to prior study.SPLEEN: No significant abnormality noted.PANCREAS: Mild prominence of the pancreatic duct appears similar to prior study.ADRENAL GLANDS: Stable left adrenal thickening.KIDNEYS, URETERS: Renal cysts bilaterally, stable; including large right renal cyst with thin septation as well as the hyperattenuating left renal cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta.BOWEL, MESENTERY: Colonic diverticula without evidence of acute inflammation.BONES, SOFT TISSUES: Superior endplate depression of L3 vertebral body, unchanged. Degenerative changes throughout the spine.

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: s/p cabg History: SOB One left chest tube remains with no pneumothorax.Unchanged cardiomegaly and basilar atelectasis.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Respiratory distress. Is there pneumothorax?VIEW: Chest cross table lateral (one view) 04/20/16, 0134 No pneumothorax is identified. Lung volumes are large. Cardiothymic silhouette is normal.

Output: Large lung volumes with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 98 years old.Reason: hypoxia, labored breathing History: as above Unchanged patchy pulmonary opacities right upper lobe predominant.Stable moderate bilateral pleural effusions and cardiomegaly.

Output: Unchanged pulmonary opacities consistent with CHF and infection.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.History of intubation. Endotracheal tube and NG tube unchanged in position. NG tube sidehole remains near the gastroesophageal junction. Right central venous catheter unchanged.Mild interval increase in pulmonary opacities suspicious for edema/ARDS or infection. No pneumothorax.

Output: Mild interval increase in pulmonary opacities suspicious for edema/ARDS or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Status post recent intubation after self extubation. Endotracheal tube tip is just above the carina. Unchanged marked cardiomegaly. Possible subpulmonic left pleural effusion. No evidence of pneumothorax. Interval removal of Swan-Ganz catheter. Right central venous catheter tip in the SVC. Enteric tube tip is out of the field of view but traverses the esophagus. Unchanged sternotomy hardware and chest tube.

Output: Endotracheal tube tip is just above the carina.


Instruction: Generate impression based on medical findings.

Input: Hodgkin's disease. Status post 3 cycles of chemotherapy CHEST:LUNGS AND PLEURA: subcentimeter right middle lobe nodule. Right-sided pleural effusion and right lower lobe atelectasis is unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes. A reference peritracheal node measures 11 x 10 millimeter on image number 27/216. Thrombus in the main left pulmonary artery and in the left lower lobe pulmonary artery.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Significant biliary dilatation has developed since 12/15/07. Gallbladder and cystic duct are also distended. Previously described ill-defined heterogeneous area within the central portion of the liver extending into the right lobe has almost completely resolved.SPLEEN: No significant abnormality notedPANCREAS: Significant dilatation of the pancreatic duct. A 1.9 x 1.6 cm solid mass in the region of the pancreatic head, suspicious for a primary pancreatic adenocarcinoma.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Numerous peripancreatic and retroperitoneal adenopathy. At the level of the lright renal vein adenopathy measures 3.3 x 5 cm. Bilateral para-aortic adenopathy extends into the pelvis. At the level of the left renal artery and the adenopathy measures 1.7 x 1.5 centimeter.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: Reference node in the right common iliac region measures 14 x 9 mm. Extensive pelvic lymph nodes are smaller but are still seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the retroperitoneal, pelvic and peripancreatic adenopathy and hepatic and splenic lesions.Interval progression of biliary dilatation. Pancreatic ductal dilatation. Solid mass in the region of the pancreatic head is suspicious for pancreatic carcinoma.Left pulmonary artery embolus.Right-sided moderate pleural effusion.These findings were discussed with Dr. April Scott at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of metastatic melanoma CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Index pretracheal lymph node measures 1.5 x 0.9 cm on image number 20, series number 3, not significantly changed from previous study.CHEST WALL: Bulky right axillary adenopathy is again noted. Index right axillary lymph node measures 1.7 by wall .7 cm on image number 16, series number 3, not significantly changed from previous study. However, other larger lymph nodes have minimally increased in size. For reference, right axillary left node on image number 25, series number 3 now measures 3 x 2.9 cm. Previously was measuring 2.8 x 2.2 cm on image number 23, series number 4. Right subpectoral lymph nodes is stable. Smaller nodules in the anterior abdominal wall are also stable.Subcentimeter soft tissue nodule in the left breast on image number 24, series number 3, stable subcentimeter right breast nodule and ill-defined enhancing mass within the left pectoralis muscle are also grossly unchanged.Interval increase in the size of the left axillary and left subpectoral adenopathy. A reference node in the left axilla now measures 1.8 by 1.7 cm on image number 38, series number 3. Previously, it was measuring one by 1 cm on image number 44, series number 4.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland nodule is slightly smaller measuring 1.1 x 1.2 cm on image number 97, series number 3.KIDNEYS, URETERS: Left lower pole angiomyolipoma is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described multiple soft tissue masses involving the jejunal loops are grossly unchanged, however, there is very difficult to see.BONES, SOFT TISSUES: Slight interval increase in the thickness of the left rectus muscle, best seen image number 153, series number 3. Mild bulging is also noted within the left rectus muscle. This may secondary to mass within the muscle.Other subcentimeter nodules in the anterior abdominal wall are stable.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Right perianal nodule is stable in size measuring 1.3 x 0.9 cm on image number 206, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the bilateral axillary lymph nodesSmall bowel metastases, right perianal nodule, remaining of the anterior wall nodules are stable.Left renal angiomyolipoma is stable.Minimal interval decrease in the size of the right adrenal gland nodule.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: assess for PNA History: WBC Mild cardiomegaly with vascular congestion prominent interstitium of the lung bases may represent mild fluid overload. Follow-up recommended.

Output: Mild cardiomegaly with vascular congestion. Follow up recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: r/o acute process History: chest pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: increased SOB with pt with COPD History: SOB Stable cardiomediastinal silhouette.Increased lung vines compatible COPD.Calcified granuloma right lower lobe unchanged. No focal areas of consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: chronic cough History: cough 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: 88-year-old female with colon mass CHEST:LUNGS AND PLEURA: Right upper lobe. Micronodular is unchanged, measuring 4-mm in diameter. Other 1 -- 2-mm micronodules unchanged.Unchanged peripheral scarlike abnormality. The left lower lobe contiguous with the lateral pleural surface.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter hypodensities in the liver are unchanged. Cholelithiasis is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged. Punctate calcifications in the right kidney, likely representing stones. Lack of IV contrast limits the evaluation of some of the hypodense lesions in the kidneys.They are grossly stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant wall thickening involving the distal transverse colon image number 100, series number 4 and is consistent with patient's known history of colon cancer. Associated borderline enlarged lymph nodes in the mesentery surrounding the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Distal transverse colon carcinoma associated with small lymph nodes in the colonic mesentery.No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male; 48 years old. Reason: eval acute process History: SOB Stable cardiopulmonary appearance with persistent right upper lobe atelectasis, subsegmental atelectasis in the remainder of the right lung and left lung base, and moderate bilateral pleural effusions.

Output: Persistent right upper lobe atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: s/p 2/27 Flexible bronchoscopy, Bronchoalveolar lavage (left), Stent revision (proximal position readjustment). History: follow up Esophageal stent, left bronchial stent, and endoscopic clip are unchanged. Additional surgical hardware and postsurgical changes are similar to the prior exam. Gastrostomy tube tip is coiled in the stomach.Unchanged left hemithorax volume loss. Unremarkable right lung.

Output: Unchanged left bronchial stent.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Left upper lobe mass, biopsy organizing pneumonia. Additional history of right upper lobectomy for NSCLC and colorectal cancer. Left apical nodular consolidation, slightly less prominent. Right upper lung mass, probably in the superior segment of the lower lobe this patient post lower lobectomy, unchanged. Nodularity in the right costophrenic angle on the lateral radiograph. Normal heart size. Hiatal hernia.

Output: Decreased conspicuity of left apical mass. Mass in the superior segment of the right lower lobe unchanged plain film, incompletely assessed by this technique and may be followed by CT.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: s/p a bilateral lung transplant in 2/2015 History: none The tracheostomy tube has been removed.Clamshell sternotomy and evidence of a bilateral lung transplant.Pleural effusions and basilar atelectasis similar to the prior exams.No new pulmonary opacities identified.

Output: Tracheostomy tube removed. Pleural effusions and basilar atelectasis similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval lung fields History: eval lung fields Cardiomegaly with mild basilar opacities suggestive of atelectasis, unchanged.Right jugular catheter tip in SVC, and a right PICC also in the SVC/RA junction region.Right subclavian pacemaker, leads unchanged.NG tube removed.

Output: Unchanged cardiomegaly and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Evaluate Pulm Effusion/Edema History: SOB No change in cardiomegaly, lower lung zone opacities suggestive of edema, left pleural effusion and retrocardiac atelectasis.Median sternotomy.

Output: No change in pulmonary opacities and pleural effusions cardiomegaly consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Reason: Eval infection History: above Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.The thoracolumbar scoliotic curvature.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Fever, SOB, chest pain and cough. Interval development of left lower lobe opacity, most compatible with pneumonia. Atelectasis and probably lingula. Scarring at the right lung base. Small volume of pleural fluid on the left. Cholecystectomy clips.

Output: Left lower lobe opacity most consistent with pneumonia. Follow-up PA and lateral chest radiographs may be obtained in 6 weeks to assess for resolution if symptoms persist.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Patient status post extraction of intracardiac leads. The ICD has been removed and no fractured leads are evident.The cardiac silhouette is enlarged but stable.There is no pneumothorax. Subsegmental left basilar atelectasis but no focal pulmonary opacities or large pleural effusions identified.

Output: ICD removed without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: acute chest? History: SOB, chest pain, SCD Port tip in high right atrium. Stable cardiomegaly. No new opacity to suggest pneumonia.

Output: No new opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab No acute abnormality.Left subclavian ICD, leads unchanged in position.No pneumothorax following ICD placement.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: Worsening Pneumothorax? Proper 2nd chest tube placement History: worsening PTX on last CXR. Now s/p 2nd chest tube New left chest tube alleviating a left pneumothorax.New left chest wall soft tissue emphysema is present.Basilar consolidation is present, worsening on the left.

Output: New left chest tube, alleviating a left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: Hx of work in county jail, +Quantiferon History: COPD -- no fever/sweats Heart size normal.No specific evidence of infection or edema. No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.