Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: eval line placement History: eval line placement Right IJ central venous catheter with tip overlying the cavoatrial junction.Stable cardiomediastinal silhouette. Bilateral low lung volumes with interval worsening in bibasilar predominant opacities. No pneumothorax.

Output: Cardiomegaly with interval worsening in bibasilar opacities compatible with edema or aspiration. Correlate with fluid status.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Pronounced COPD changes with underlying grossly similar scarring, specifically no new superimposed focal airspace abnormality. Particular attention is again made of a nodular focus along the left major fissure, previously described and observed by CTModerate nonspecific cardiomegaly with extensive annular calcifications.

Output: Extensive chronic appearing changes including COPD and a left known suspicious nodular focus, however no superimposed new acute airspace abnormalities. Specifically no findings to suggest volume overload as requested


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: cough, compare to CXR 5/19 History: see above Basilar atelectasis possibly from aspirated secretions or mucous plugging, unchanged.Slightly dilated bowel loops in the left upper quadrant noted.Right jugular catheter, tip in SVC.

Output: Unchanged basilar atelectasis. Left upper quadrant bowel dilation.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with history of pancreatic adenocarcinoma CHEST:LUNGS AND PLEURA: Large left-sided pleural effusion which has significantly increased in size compared to previous study. Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Again noted no static lesions in the liver. Index lesion in segment 6 now measures 9 x 10 mm image number 105, series number 4, not significantly changed from previous study. Second index lesion in the left lobe is slightly smaller measuring 8-mm in diameter image number 104, series number 4.SPLEEN: Small hypodense lesion in the lower pole of the spleen is unchanged and most likely benign.PANCREAS: Patient's known pancreatic mass is slightly smaller measuring 4.9 by 4.9 cm on image number 110, series number 4 when measured in a similar fashion to the prior exam. This cystic component in the tail of the pancreas has increased in size now measuring 2.7 x 4 cm on image number 113, series number 4. Vascular encasement of retroperitoneal vessels are again noted. Splenic vein is thrombosed.Solid mass anterior to the cystic component of patient's known pancreatic carcinoma is also slightly smaller.ADRENAL GLANDS: The mass in the left adrenal gland has increased in size and now measures 2.9 x 3.4 cm in image number 107, series number 4. Right adrenal gland is unremarkable.KIDNEYS, URETERS: Interval development of left-sided hydronephrosis. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy is unchanged. Index left para-aortic node measures 1.9 x 1.1 cm on image number 127, series number 4.Left psoas muscle is asymmetrically and heterogeneously enlarged compared to the right side suspicious for infiltration by the patient's known cancer.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse increased density of the subcutaneous tissues of the anterior abdominal wall associate with small amount of air likely represents changes secondary to injection, new from previous study.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Ill-defined, and new soft tissue density along the right side of the pelvis is also suspicious for a peritoneal deposit and measures 2.6 x 1.9 cm in image number 176 on series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: New, small amount of ascites, associate with mild nodularity in the pelvis suspicious for peritoneal carcinomatosis.

Output: Interval decrease in the size of the solid component of patient's known pancreatic cancer.Hepatic metastases are grossly unchanged.Interval increase in the amount of the left-sided pleural effusion.New peritoneal carcinomatosis, left adrenal metastases, hydronephrosis and enlargement of the left psoas muscle suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 49 year-old female with history of sarcoidosis and chest pain/hemoptysis. PULMONARY ARTERIES: Infusion of diagnostic quality. No PE.LUNGS AND PLEURA: Mild dependent atelectasis bilaterally. Few scattered calcified granulomas. No evidence of infection or interstitial lung disease. Upper airways are patent.MEDIASTINUM AND HILA: Bilateral calcified hilar lymph nodes, unchanged, suggestive of prior granulomatous disease.CHEST WALL: Well-circumscribed cystic lesions in both breasts are unchanged from prior, compatible with benign cysts as seen on recent mammogram.UPPER ABDOMEN: Cholecystectomy clips. Multiple subcentimeter well-circumscribed hypoattenuating lesions in the liver are too small to characterize, but likely represent benign hepatic cysts.

Output: No PE. No acute findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.History of abdominal pain. Rule out acute process. Scarring at the right lung base. Granulomas. No signs of pulmonary edema or focal airspace opacity. No visible pleural fluid. Surgical clips in the projection of the GE junction. Normal heart size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Tube in place. Dobbhoff tube tip just above the level of the GE junction. Other hardware and devices unchanged. Lower lobe atelectasis, left greater than right and small pleural effusions unchanged.

Output: Dobbhoff tube tip just above the GE junction.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with lung cancer status post 6 cycles of chemotherapy. Now needs disease evaluation. CHEST:LUNGS AND PLEURA: Left suprahilar mass (series 4, image 26) remains partially obscured by surrounding radiation reaction and slightly increased adjacent atelectasis; it measures 22 mm in short axis, unchanged.Numerous pulmonary nodules bilaterally compatible metastases, the majority of which are grossly unchanged but several of which appear slightly smaller. Reference right middle lobe nodule (series 5, image 70) measures 9 x 9 mm; previously 10 x 10 mm.MEDIASTINUM AND HILA: Supraclavicular (series 4, image 4) and subcarinal lymphadenopathy (series 4, image 44), unchanged. Reference right hilar lymph node (series 4, image 43) measures 7 x 8 mm; previously 10 x 11 mm.Heart size normal with small amount of pericardial fluid. Coronary and aortic calcifications.CHEST WALL: Multilevel mixed sclerotic and lytic lesions in the thoracic spine compatible with metastases, appearing similar to prior study.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small hypoattenuating lesion in the right lower renal pole is too small to characterize but is unchanged.RETROPERITONEUM, LYMPH NODES: IVC filter, likely containing thrombus (series 4, image 127). Atherosclerotic calcifications of the descending aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel mixed sclerotic and lytic lesions in the thoracic spine and L1 vertebral body compatible with metastases.

Output: No significant change in left suprahilar mass with stable to slight interval decrease in size of mediastinal and pulmonary metastases. Multilevel vertebral metastases, similar to prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Chest pain. Normal heart size. No pleural fluid or pneumothorax. Large pericardial fat pad in the right, appearing similar when compared with coronal images of CT dated 11/2/2014. No focal air space opacities.

Output: No new focal air space opacities. Differences in appearance of prominent right sided pericardial fat pad are most likely related to patient positioning however if this is in the area of patient's discomfort a follow-up PA and lateral chest radiograph may be obtained for confirmation.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: follow up on RLL pneumonia History: cough Mild bibasilar subsegmental atelectasis or scarring. Near complete resolution of right lower lobe pneumonia. No large pleural effusion or pneumothorax. Normal heart size.

Output: Near complete resolution of right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Swan placement. Right jugular Swan-Ganz catheter tip at the right main pulmonary artery level. Left subclavian ICD unchanged. Moderate cardiomegaly. Basal atelectasis or scarring on the right with blunting of the costophrenic angle unchanged over multiple prior films. No convincing evidence of pulmonary edema. No focal airspace opacities.

Output: Swan-Ganz catheter tip at the right main pulmonary artery level.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: MaleReason for Study: Reason: h/o chf, worsening sob r/o PNA History: worsening sob Stable cardiac enlargement with pulmonary vascular redistribution. The lungs are clear.No pleural effusions.

Output: Stable cardiomegaly without interval change. No acute cardiopulmonary abnormality. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/p cabg History: s/p cabg Global cardiomegaly.Moderate left pleural effusion is unchanged from prior. No pneumothorax.Limited assessment of the left lung. Left retrocardiac consolidation may represent left lower lobe atelectasis.

Output: Moderate left pleural effusion. No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: evaluate lung fields and lines History: BiVAD Interval development of complete opacification of the left hemithorax. Mild improvement in edema. Line position otherwise stable.Patient has been extubated.Support devices stable.

Output: Interval extubation with development of complete opacification of the left hemithorax. No other significant change.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of GBM now with thrombocytopenia and 6 unit bleed. Please evaluate for bleeding site. CHEST:LUNGS AND PLEURA: Bilateral small pleural effusions. Bibasilar compressive atelectasis.MEDIASTINUM AND HILA: Small pericardial effusion. The left lobe the thyroid is enlarged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large fluid attenuating lesion in the liver measuring 12 x 10 cm likely representing a simple cyst. Other smaller lesions in both lobes of the liver. Lack of IV contrast precludes further characterization of these lesions.There is new site of hemorrhage, adjacent to and within the lateral segment of the left hepatic lobe extending extrahepatically and into the peritoneal cavity. Hemorrhage is seen at the spleen and extending into the pelvis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube is in expected position. New since the prior examinationBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with calcifications..BLADDER: Foley catheter is present in the decompressed urinary bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New left hepatic lobe hemorrhage extends to right > left paracolic gutters and pelvis. Stable bilateral small pleural effusions and pericardial effusion.Large right lobe hepatic simple cyst. Smaller hepatic lesions which cannot be further characterized due to lack of IV contrast.Enlarged left lobe of the thyroid.No other evidence of intrathoracic or intra-abdominal bleeding.


Instruction: Generate impression based on medical findings.

Input: Age: 36 yearsGender: MaleReason for Study: Reason: swan placement given SVT History: swan placement given SVT Imaging Swan-Ganz with its tip in the right pulmonary artery.IVP marker in the distal aortic arch.Stable cardiac enlargement.The lungs are clear.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: ? pneumonia History: sob Nonspecific pulmonary opacities most likely fibrosis, localized the right upper, left mid and left lower lung zones.Atypical infection is in the differential diagnosis, however.Heart size normal.Large central pulmonary arteries may indicate pulmonary arterial hypertension.

Output: Nonspecific pulmonary opacities likely chronic although thoracic CT may be helpful to exclude infection.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cardiac surgery History: s/p cardiac surgery Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly and postoperative mediastinal widening.Bilateral nonspecific opacities compatible with edema and effusions, greater on the right.No pneumothorax or other acute change.

Output: Pulmonary edema and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for PNA. History: SOB Moderate cardiomegaly with vascular redistribution, moderate pleural effusions and mild basilar edema.Left lower lobe opacity compatible with compressive atelectasis and edema.No specific evidence of pneumonia.Catheter tip in the SVC.

Output: Findings consistent with CHF but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Shortness of breath. ICD leads are unchanged. Mild right-sided pleural thickening, right rib fractures, and right sided surgical clips are again noted. Patchy right basilar reticulonodular interstitial opacities noted, and do not appear significantly changed from prior examination, favored to be chronic. There is no pleural effusion or pneumothorax. Cardiomegaly is unchanged.

Output: Chronic appearing reticulonodular interstitial opacities without acute change. Etiology of this abnormality is unclear and CT may be obtained if patient has abnormal pulmonary function testing.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: right lung biopsy ? ptx History: right lung biopsy ? ptx No significant change in right pleural effusion from prior examination. Adjacent compressive atelectasis. No new from pulmonary opacities. Cardia mediastinal silhouette is stable. No pneumothorax.

Output: No significant change from prior examination. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Left basilar and perihilar scarring similar to prior. There is no pneumothorax. Mild left-sided pleural thickening unchanged. The cardiac and mediastinal contours are within normal limits for size.

Output: Unchanged left basilar/perihilar scarring, without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Normal heart size with pacemaker leads in place, unchanged from previous.Focal right perihilar opacity suggestive of subsegmental atelectasis or scarring, not significantly changed.Mild blunting of the right costophrenic angle laterally and posteriorly compatible with a small pleural effusion or scarring, unchanged.No specific evidence of metastatic disease.

Output: Possible small right pleural effusion or scarring and no specific evidence of metastases in the chest.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: intubated History: intubated Support devices stable in position.No change in cardiomegaly and pulmonary edema.

Output: Support devices unchanged. No change in cardiomegaly and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: ett placement, lung fields History: ett Interval extubation.Venous catheter and bilateral airspace opacities unchanged.A more recent radiograph has been interpreted.

Output: Interval extubation.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Status post decortication with chest tube. 2 apically directed right-sided chest tubes are unchanged with a small, stable pneumothorax and small amount of subcutaneous emphysema in the right chest wall.There is stable right pleural effusion and patchy opacity of the right lung. The left lung is clear.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval for PNA or pulmonary edema History: SOB Limited study due to patient rotation. Cardiomediastinal silhouette is unremarkable.Bilateral lower lung zone opacity, right more than left, which could represent atelectasis/aspiration.Possible small pleural effusions.No pneumothorax.

Output: Bilateral lower lung zone opacity which could represent atelectasis/aspiration, further evaluation with PA and lateral views would be of benefit.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with margin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Small pericardial effusion, unchangedCHEST WALL: Reference left axillary node measures 13 x 9 mm on image number 14, series number 5. Bilateral left axillar adenopathies unchanged.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly, unchanged. Cholelithiasis without evidence of cholecystitis.SPLEEN: Spleen measures 14.7 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral double-J stents. Stable bilateral hydronephrosis and hydroureter.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal adenopathy. Reference left para-aortic lymph node measures 25 x 13 mm on image number 101, series number 5.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 interval change in confluent retroperitoneal and pelvic adenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable study with axillary para-aortic and pelvic adenopathy as described above.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Moderate nonspecific cardiomegaly without distinct additional cardiopulmonary abnormality

Output: Cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: eval for infection History: copd intubated Severe emphysema.Heart size normal, the aorta tortuous.No specific evidence of infection or edema.ET tube tip at least 9 cm above the carina.An NG tube terminates in the stomach.

Output: High ET tube. Severe emphysema noted.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax History: sob Interval removal of the looped right PICC line.Pericardial drain in place.Large pleural effusions with underlying atelectasis.Multiple cavitary pulmonary nodules consistent with metastases.No pneumothorax or other acute change.

Output: Extensive bilateral abnormalities consistent with metastatic disease, with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: worsening hypoxia, sob, tachycardia, eval for worsening edema or effusion History: sob, hypoxia Right internal jugular port catheter tip at the atriocaval junction.Stable enlargement of the cardiomediastinal silhouette.Moderate sized right pleural effusion and right basilar atelectasis/consolidation, with increased size of the loculated peripheral component.No change in interstitial pulmonary edema pattern.No pneumothorax.

Output: Mild interval increase in size in the loculated component of the right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Status post surgery. Second abdominal drain placement.VIEW: Abdomen and chest AP (2 views) 11/18/2016 at 1146 hours. ET tube tip is below thoracic inlet. NG tube terminates at the stomach. Left upper extremity PICC tip is at the left subclavian vein. 2 abdominal Penrose drains are noted. Soft tissue edema persist.Cardiac silhouette size is normal. Bilateral diffuse, coarse lung haziness with pattern of PIE. No focal opacities, effusions or pneumothorax.Gasless abdomen.

Output: Second drain placement.Bilateral diffuse, coarse lung haziness with pattern of PIE.Gasless abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: eval for PNA History: sob Cardiomediastinal silhouette is within normal limits.No focal airspace abnormality. No pleural effusions.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Empyema and chest tube.VIEW: Chest AP (one view) 12/30/15, 0821 Left chest tube remains in place. Soft tissue swelling is noted adjacent to the chest tube. A small amount of subcutaneous emphysema is seen.Opacities in the left lung base with silhouetting of the hemidiaphragm and a portion of the left heart border continue. Apical pleural effusion is again seen. Opacity in the medial right base continues. Mediastinum is slightly shifted to the right. Cardiac silhouette size is normal.

Output: Unchanged appearance of chest.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: s/p HD line palcement for exchange transfusion, evalaute placement and r/o PTX History: as above Right jugular catheter extending to the area of the SVC.Marked cardiomegaly with bilateral nonspecific perihilar and lower zone opacities, slightly increased from previous.Focal consolidation in the superior segment of the right lower lobe and to a lesser extent on the left side, compatible with aspiration and infection.Basilar interstitial opacities and septal lines are also present, compatible with edema.No pneumothorax.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: PNA History: Fall No significant cardiopulmonary abnormality.No evidence of infection.No displaced rib fractures.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old. Reason: IABP, swan, check placement and interval change History: see above Left subclavian ICD is unchanged in position.IABP catheter distal tip 3 cm below the top of the aortic arch.Swan-Ganz catheter with tip in the main pulmonary artery.Unchanged cardiomegaly.No specific evidence of edema.No large pleural effusion or pneumothorax.

Output: IABP catheter distal tip 3 cm below the top of the aortic arch.Swan-Ganz catheter with tip in the main pulmonary artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Sepsis, likely cellulitis. HIV not adherent to medication. Nonspecific volume loss in the left lung associated with some faint peripheral opacity. The lateral radiograph is obscured by the patient's upper extremity extremity, limiting assessment. There appears to be mild bronchiectasis in the right lung base, unchanged, with associated atelectasis or scarring..

Output: Opacities in the left lung are most consistent with atelectasis or scarring however an early or resolving infectious process cannot be excluded. Consider a baseline unenhanced CT, the referring clinical service is able to obtain and submit outside films for comparison.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Possible sepsis History: Tachpnea Basilar opacities are essentially unchanged which again can represent developing pneumonia or edema.No pleural effusions or pneumothorax. Line position stable.Stable cardiomegaly

Output: Basilar opacities are essentially unchanged which can represent pneumonia or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Reason: pna History: ams Moderate cardiomegaly with new left lower lobe consolidation and pleural effusions left greater than right.No reliable evidence of edema.

Output: Cardiomegaly with new left lower lobe consolidation suggestive of infection or atelectasis from aspiration/mucous plugging.


Instruction: Generate impression based on medical findings.

Input: 77 years old Female. Reason: infection History: chest pain, tachy. Again seen is a chronic elevation of the right hemidiaphragm. Bibasilar atelectasis. Cardiomediastinal silhouette is unchanged. No focal airspace opacity, large pleural effusion, or pneumothorax.

Output: Stable elevation of the right hemidiaphragm with bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.NG tube Enteric tube tip is in the proximal third of the esophagus.Moderate cardiomegaly. No pneumothorax.Left lower lobe opacity compatible with effusion and atelectasis.

Output: Enteric tube tip is in the proximal third of the esophagus.Findings discussed with Dr. Fintel (pager 1730) at 1027 on 9/25/15.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.PICC placement left upper extremity catheter has been slightly retracted with tip projecting over the SVC, however tortuosity of its central course could indicate placement in the azygos. Line lung lungs remain low with large layering pleural fluid collections and dense retrocardiac opacity. VP shunt catheter tubing on the right. Gastrostomy tube retention device projects left upper quadrant. The visualized colonic loops are mildly prominent and appear effaced.

Output: Left upper extremity PICC tip in projects over the superior mediastinum in the projection of the SVC or alternatively the azygos due to its tortuous central course. If this is a new line from 1/8/15, the latter is more likely.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: r/o Pneumothorax ; shortness of breath History: post bronch Increase in interstitial and airspace opacities suggestive of edema.No significant pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: eval for acute cardiopulm abnormality History: cp Stable cardiomediastinal silhouette. Soft tissue opacities bilaterally most likely represent overlying soft tissue.Left lower lobe atelectasis cannot be excluded.Median sternotomy is intact with surgical clips most likely related to prior CABG.

Output: Limited exam due to significant overlying soft tissue. Recommend upright PA and lateral views for better evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: rule out pneumo/infection History: right sided chest pain and back pain Large right-sided pneumothorax with mild leftward mediastinal shift as well as mild inferior displacement of the hemidiaphragm. Small pleural fluid collection noted at the right inferior hemithorax. Calcified left hilar lymph nodes again noted. Nodular lesion in the lower aspect of right hemithorax, almost certainly representing nipple shadow given incomplete border.

Output: Large right-sided hydropneumothorax with mostly gas component. Apical blebs were noted on previous CT neck studies. Findings were verbally discussed with Dr. Chloe Huang at approximately 9:25 AM on day of study.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: Leukocytosis, r/o infection History: Leukocytosis, r/o infection Interval removal of left central venous line.Scarring right midlung.Heart size normal.Lungs clear.No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Dyspnea, cough productive of sputum for 3 days. Cardiomegaly and chronic interstitial opacities. Thickening of the fissures consistent with acute edema component. Chronic pleural fluid or thickening on the right unchanged.11 mm nodular opacity in the left upper lobe additional scattered nodular opacities in the right lung are new.

Output: New nodular opacities measuring up to 11 mm could be secondary to pneumonia. Given the patient's extensive smoking history, follow-up PA and lateral chest radiographs recommended in 6 weeks to assess for resolution. Chronic interstitial abnormality, cardiomegaly and pleural fluid consistent with acute on chronic edema.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with cough and URI symptoms. Evaluate for pneumonia versus CHF. Cardiomediastinal silhouette within normal limits.Mildly ectatic thoracic aorta with mild atherosclerotic calcifications.No acute focal airspace opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with metastatic prostate cancer CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left upper lobe on image number 13, series number 4 is unchanged. Bilateral minimal pleural effusions, more on the right than on the left, minimally increased compared to previous study.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter nearly isodense, round exophytic lesion arising from the posterior aspect of the right lobe of the liver is unchanged and measures 1.1-cm in diameter image number 98, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 2 x 1.6 cm peripherally enhancing fluid collection in the left lower anterior abdominal wall.Extensive sclerotic bone metastases affecting the entire skeleton are 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: Extensive sclerotic bone metastases are unchanged.OTHER: No significant abnormality noted

Output: No significant change from previous study. Extensive bone METs are unchanged.


Instruction: Generate impression based on medical findings.

Input: Metastatic small cell cancer CHEST:LUNGS AND PLEURA: Previously described right upper lobe mass has significantly increased in size and now measures 4-cm in AP dimension and 6.3-cm in transverse dimension on image number 38, series number 6. It was measuring 2.4 x 3.6 cm.Interval increase in the airspace opacities in the right upper lobe which likely represents postobstructive pneumonia. There are additional new subcentimeter round nodules in the right upper lobe suspicious for metastatic disease. A reference nodule measures 9 mm in diameter image number 42, series number 6.Emphysema effecting both lungs is unchanged.MEDIASTINUM AND HILA: Reference pretracheal lymph node now measures 2.2 x 2 cm image number 28, series number 6, slightly enlarged. Other mediastinal lymph nodes are also slightly enlarged compared to previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal mass is enlarged measuring 3.6 x 2.3 cm image number 100, series number 6. Left adrenal mass measures 2.3 x 1.3 cm image number 112, series number 6, not significantly changed.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measuring 3.1-cm in greatest AP dimension is unchanged.Scattered small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions in the pelvic bones and some of the vertebral bodies are 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: Sclerotic lesions in the pelvic bones are unchanged.OTHER: No significant abnormality noted

Output: Interval increase in the size of the right upper lobe mass and mediastinal adenopathy. New nodules in the right upper lobe suspicious for metastatic disease. Interval increase in the right upper lobe air space opacity suspicious for postobstructive pneumonia.Interval increase in the size of the right adrenal mass. Left adrenal mass is stable.Sclerotic lesions in the bones suspicious for metastatic disease are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Endotracheal tube placement History: ETT placement Lower lung zone edema with pleural effusions and left lower lobe consolidation have progressed compared to the prior study.ET tube tip approximately 4 cm above the carina.NG tube coiled in hypopharynx before extending into the proximal stomach with the side port above the GE junction.Right jugular catheter tip at cavoatrial junction level.

Output: Worsening pulmonary opacities. NG tube coiled in hypopharynx, the side port above the GE junction.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: 23M with SCD admitted with ACS, now with worsening chest pain and SOB but not hypoxic, ?worsening ACS that might require exchange transfusion History: 23M with SCD admitted with ACS, now with worsening chest pain and SOB but not hypoxic, ?worsening ACS that might require exchange transfusion Significant interval increase in basilar opacities likely representing aspiration and or pneumonia. Some degree of atelectasis is present as well.No change in cardiac silhouette. No pneumothorax.

Output: Interval progression of basilar opacities. Suspicious for infection


Instruction: Generate impression based on medical findings.

Input: Preoperative dyspnea No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 34 year old female 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. Double contrast evaluation of the hypopharynx did not reveal any abnormalities such as Zenker's diverticulum, esophageal web, or cricopharyngeal bar. During the exam, one episode of provoked gastroesophageal reflux was observed to the level of the upper esophagus. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. The 13 mm barium pill passed through the patient's esophagus and entered the stomach without delay. TOTAL FLUOROSCOPY TIME: 4:58 mm:ss

Output: One episode of provoked GE reflux to the level of the upper esophagus, but otherwise unremarkable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval for pna History: sob Median sternotomy for CABG, with a large pulmonary trunk which could indicate PA hypertension.Small lung volumes.Patchy subtle ground glass opacities are present, which could represent atypical pneumonia.No large pleural effusions are seen.

Output: Patchy pulmonary opacities. The differential diagnosis includes atypical infection, but consideration should be given to other etiologies which include pulmonary hemorrhage or aspiration. In addition, the patient has a history of pulmonary sarcoidosis. A thoracic CT could be helpful.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: chest tube History: sq emphysema No significant pneumothorax.Severe soft tissue emphysema is stable.Left chest tube in place with persistent left lower lobe consolidation and patchy left upper lung zone opacities.Right jugular catheter, tip in SVC.

Output: Stable pulmonary opacities. but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: cough, congestion, eval for PNA History: cough, congestion, eval for PNA Right retrodiaphragmatic lower lobe consolidation, best seen on lateral radiograph, most consistent with pneumonia/aspiration. No large pleural effusion pneumothorax. Normal heart size.

Output: Probable right lower lobe pneumonia given history. Chest radiographic follow-up in 8 weeks is suggested to ensure resolution. This finding was verbally discussed with Dr. Lindsey at 9:00 AM on 3/4/2016.


Instruction: Generate impression based on medical findings.

Input: Extubation. Pleural effusion.VIEW: Chest AP (one view) 01/17/16, 0504 Endotracheal tube has been removed. Right upper extremity PICC has its tip in superior vena cava. A right chest tube is in place. There is a gastrostomy tube. Right thoracolumbar curve continues.Right pleural effusion is almost completely resolved. Opacities in the lung bases continue, right worse on left. Cardiothymic silhouette is normal.

Output: Almost complete resolution of right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: IABP, check placement History: see above Left AICD electrodes remain in stable position. Intra-aortic balloon pump marker is positioned within the distal transverse arch.Left ventricular enlargement without interval pulmonary edema. No pneumothorax.

Output: Intra-aortic balloon pump marker is positioned within the distal transverse arch.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated. post-op History: intubated. post-op ET tube at the level of the carina with the neck in a flexed position.Small lung volumes with mild basilar atelectasis.A more recent radiograph has been interpreted.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female; 64 years old. Reason: lung infiltrate History: cough; SOB Mild nonspecific left lower lobe consolidation has resolved since prior study, with minimal residual subsegmental atelectasis above a mildly elevated left hemidiaphragm. Stable mild streaky right basilar opacity, suggestive of subsegmental atelectasis and/or scarring. No new pulmonary opacities. Mild cardiac enlargement, similar to prior study.Status post median sternotomy.

Output: Mild nonspecific left lower lobe consolidation has resolved with mild residual subsegmental atelectasis. No new pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: ? PTX History: CP Cardiothymicsilhouette is normal in size and configuration.Lungs are clear. No pneumothorax.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: COPD and shortness of breath Persistent mild basilar scarring and/or small effusions with atelectasis and/or aspiration, unchanged. No discrete new superimposed airspace processBorderline cardiomegaly given technique

Output: Questionable basilar aspiration versus atelectasis.


Instruction: Generate impression based on medical findings.

Input: Edema Interval clearance of the underlying bilateral and larger left effusions. Mild COPD changes without additional new superimposed abnormality

Output: Interval resolution of the effusions


Instruction: Generate impression based on medical findings.

Input: Male 54 years old Reason: r/o pneumonia History: SOB, leukocytosis. Cardiomediastinal silhouette is unremarkable.No focal airspace opacity pleural effusion, or pneumothorax.Emphysema and biapical scarring, right greater than left, is unchanged.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval sgc History: eval sgc Cardiopulmonary monitoring and support devices, unchanged.Moderate cardiomegaly with small lung volumes.No specific evidence of pulmonary edema or infection.

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


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: ETT position History: as above Moderate to severe cardiomegaly and/or pericardial effusion with mediastinal fat deposition, unchanged.Small lung volumes.No specific evidence of infection or edema.ET tube tip approximately 2 cm above the carina.

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


Instruction: Generate impression based on medical findings.

Input: 82 years old Female. Reason: cardiopulmonary process History: chest pain. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Unchanged mild cardiomegaly and tortuous aorta.

Output: Mild cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: assess for PNA History: assess for PNA Cardiomegaly, small effusions and left lower lobe consolidation are unchanged.Right jugular Swan-Ganz catheter removed leaving the venous access sheath.Remnants of a left subclavian ICD remain in place.Left jugular catheter tip at cavoatrial junction.

Output: Swan-Ganz catheter removal. Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: hx of bladder cancer s/p radical cystectomy evaluate for metastatic disease Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

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


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz placement Right jugular Swan-Ganz advanced, tip currently demonstrates redundancy within the pulmonary artery with the tip reflected back towards the heart. Subsequent images are interpreted. No additional interval changes observed including a stable and well-positioned ETT and mediastinal chest tubes

Output: Repositioning of the Swan-Ganz catheter


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: post-cardiac surgery lung eval day 2 History: post-cardiac surgery lung eval day 2 Line position stable.No pneumothorax.Pulmonary opacities unchanged.

Output: No change in pulmonary opacities


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: SOB History: SOB Bilateral pleural effusions and basilar opacities, which are suggestive of CHF.Heart size is slightly large.Small lung volumes.

Output: Pleural effusions and basilar opacities likely the result of CHF although infection is also in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: 1-day-old former 25 week gestational age patient with respiratory distress. Line adjustment.VIEWS: Chest and abdomen AP (two views) 12/20/15, 0519 Endotracheal tube tip is below thoracic inlet. Left chest tube remains in place. Umbilical venous line has its tip in right atrium. Umbilical arterial line tip is at T6.Soft tissue edema is developing.Left pneumothorax is much larger and pneumomediastinum is present. Gas is seen extending into the left and right neck. Mediastinum is shifted to right. Lung volumes are large with right hemidiaphragm between ninth and 10th posterior rib and left between 10th and 11th. Cardiac silhouette size cannot be evaluated. Interstitial emphysema is noted bilaterally.Less bowel gas is present. No gas is seen in the right abdomen or pelvis.

Output: Worsening pneumothorax. Pneumomediastinum and subcutaneous emphysema. Less bowel gas. Soft tissue edema.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old; Reason: s/p Left thoracotomy, rib resection and pleurodesis History: post-op, need baseline CXR Interval removal of a left chest tube. Postsurgical changes of the left hemithorax including left volume loss, elevation of the left hemidiaphragm, and rib resection is unchanged. The right lung field is without focal opacity.

Output: Removal of left chest tube without large pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: hypoxia, hx liver/kidney failure; long hospitalization. eval for volume overload History: as above Right IJ venous catheter with its tip in the SVC.Left PICC line with its tip in the RA.Decreased lung volumes with cardiac enlargement.Perihilar/basilar opacities compatible with edema.Probable pleural effusions.

Output: Findings compatible with CHF/volume overload.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: r/o PNA, infection History: cough, fever The heart is normal in size.Lung volumes are normal. No abnormal focal lung opacities.The pleural spaces and visualized bones are within normal limits.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: per cardiothoracic surgery History: none New tracheal stent extending to within about 2 cm of the carina.Other catheters and devices unchanged.Moderate pleural effusions and underlying nonspecific opacity compatible with edema and atelectasis.

Output: New tracheal stent and no other acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT No significant cardiopulmonary abnormality.Coronary calcification noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Presurgical evaluation. SOB. Nonrheumatic aortic valve stenosis. Mild bronchial wall thickening and volume loss in the lower lung zones. No focal airspace opacities, pleural fluid or pneumothorax. Normal heart size. No evidence of CHF or pneumonia.

Output: Mild nonspecific bronchial wall thickening of unclear chronicity. No signs of pneumonia, CHF or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.History of multiple myeloma with shortness of breath. Cardiac pacer lead unchanged in position. Left port catheter tip at the RA/SVC junction. There is an interval placement of a left chest tube with tip directed apically.The cardiomediastinal silhouette is unchanged.Left pleural effusion with adjacent atelectasis is unchanged. No pneumothorax.Subchondral cysts noted in the left humeral head.

Output: Interval placement of left chest tube with no significant change in left pleural effusion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with history of bladder cancer. Evaluate for metastatic disease. The cardiomediastinal silhouette is normal. Mild diffuse interstitial opacities are nonspecific; likely reflect chronic bronchitis or sequelae of smoking rather than pulmonary edema. Bibasilar atelectasis. Subtle right apical nodular density is grossly unchanged since prior examination.

Output: Grossly stable appearance of the chest, including subtle right apical nodularity likely pleuroparenchymal scarring. If there is strong clinical concern for pulmonary metastases, then further evaluation with a chest CT may be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Hypoxemia, please evaluate for focal infiltrate. Unchanged support devices and surgical sequelae from sternotomy. Decreased lung volumes with stable cardiomediastinal silhouette. Increasing left basilar atelectasis. Increasing right perihilar and right upper lobe opacity.

Output: Increasing left basilar atelectasis. Increasing right perihilar and right upper lobe opacity could represent developing infection. Recommend continued imaging for follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: eval volume status History: renal failure No acute abnormality.Heart size upper normal.

Output: No acute abnormality. No sign of edema or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: preop History: Fracture of neck of femur. Unremarkable cardiac and mediastinal silhouette. Mild scarring at the left base, unchanged.Surgical clips in the chest wall bilaterally.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Follow-up of left pleural effusion. Improvement in now minimal left pleural effusion. Left basilar atelectasis/scarring. No focal consolidation or pneumothorax. Left chest tube tip adjacent to the aortic arch.Diffuse skeletal sclerosis and expansile lesions of left clavicle and several ribs compatible with known metastatic breast cancer. Complete collapse of a lower thoracic vertebral body with associated acute kyphosis.

Output: Minimal residual left pleural effusion and osseous changes related to metastatic breast cancer.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: r/o fracture History: right anterior lower rib pain s/p fall There are decreased lung volumes with mild left basilar scarring/discoid atelectasis.Stable cardiomediastinal silhouette.No focal areas of consolidation.No pleural effusions.No obvious rib fracture.No evidence of pneumothorax.Bilateral shoulder arthroplasties are new from the prior exam.

Output: No acute cardiopulmonary abnormalities are identified. No obvious rib fracture identified. If clinically indicated dedicated rib views may be obtained.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath, aortic valve disorder No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of osteosarcoma and known mets to the chest wall and lung, new loculated pleural effusion. LUNGS AND PLEURA: A large, loculated pleural effusion is evident on the right with adjacent compressive atelectasis. Pleural fluid extends into the right costovertebral angle where it contains several foci of air, likely iatrogenic. Thickening of the pleura in the region of the right costophrenic angle may reflect tumor involvement. Hazy interstitial opacity within the remaining aerated right lung may reflect atelectasis or infection.Extensive, lobular and calcified pleural-based masses on the left cause significant volume loss and compressive atelectasis. These masses extend to the sternum anteriorly and into the posterior mediastinum where they nearly completely encase the aorta. A small amount of loculated pleural fluid is evident on the left.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion. Mildly prominent mediastinal lymph nodes are. An esophageal stent is in place demonstrating occlusion of the lumen at the distal tip. The calcified pleural-based masses exert significant mass effect in the region of the esophagus likely causing extrinsic compression distal to the stent.CHEST WALL: Extensive pleural-based masses as above with lateral and posterior chest wall invasion. Questionable invasion of a left lateral rib (axial image 78/108) by the adjacent pleural mass lesion.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Extensive calcified pleural-based masses on the left compatible with the patient's history of metastatic osteosarcoma.2.Large loculated pleural effusion on the right. 3.Occlusion of the esophageal stent with likely extrinsic compression effect on the more distal esophagus.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Lung transplant with trach. Bilateral chest tubes. Sternotomy hardware, tracheostomy tube and left jugular catheters noted.Bilateral pleural fluid without significant pneumothoraces. Compressive atelectasis at the lung bases. Within the left lower lobe, there is significant atelectasis/consolidation, present over several films.

Output: Persistent left lower lobe opacity suspicious for pneumonia. Opacities at the right lung base have partially cleared over time and presumably reflect atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old, status post stem cell transplant and history of upper respiratory infection. There has been interval removal of a central venous catheter.Cardiac silhouette is normal in size. The aorta is tortuous but is unchanged.There is interval resolution of left upper lobe consolidation seen on the prior CT and chest x-ray. Streaky retrocardiac opacities are again present. Haziness overlying the right lung base medially likely overlying soft tissues. No pneumothoraxCervical hardware remains stable.

Output: No specific evidence of pneumonia. Haziness overlying the right lung base medially likely overlying soft tissues. Correlate clinically and consider follow-up imaging as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o VP shunt malfunction History: HA, dizziness SHUNT DEVICE: A shunt catheter with tip in the left middle cranial fossa exits the skull via a left parietal burr hole. The catheter courses down the soft tissues of the left scalp, neck, thorax, and enters the abdomen in the left upper quadrant with catheter tip coiled in the pelvis. We see no fracture or kink.SKULL: No significant abnormality noted.CERVICAL SPINE: Alignment is within normal limits. Vertebral body and intervertebral disc heights are preserved.CHEST: No focal air space opacities.ABDOMEN: Nonobstructive bowel gas pattern. IUD is noted.

Output: Ventriculoperitoneal shunt catheter without fracture or kink.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old. Reason: r/o fracture, infection History: R sided rib pain s/p fall Cardiomediastinal silhouette is unremarkable. No focal pulmonary opacity, pleural effusion or pneumothorax. No evidence of displaced rib fracture, however please note that technique limits sensitivity for detection of fracture and the ribs are incompletely visualized.

Output: No specific evidence of pneumonia. No visible displaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: s/p right chest tube insertion History: s/p right chest tube insertion Persistent marked subcutaneous emphysema without significant interval change.Right central venous catheter has been removed.Unchanged cardiomediastinal silhouette.Interval insertion of right chest tube with tip at the cardiophrenic angle. Slightly improved but persistent right pneumothorax.

Output: New right chest tube, with slightly improved right pneumothorax. Marked subcutaneous emphysema is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Chest pain r/o abnormality History: chest pain Low lung volumes. Linear perihilar and basilar opacities favor atelectasis or scarring.Cardia mediastinal silhouette within normal limits.No pneumothorax. No pleural effusion.

Output: Linear perihilar and basilar opacities favor atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: eval ett History: resp failure Improvement but not yet resolution of right midlung coarse opacities suggestive of infection or aspiration with underlying emphysema.Mild right base edema and smallPleural effusions are present. Moderate cardiomegaly.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Improving right midlung opacity suggestive of infection or aspiration with underlying emphysema. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female presenting with newly diagnosed endometrial cancer. Evaluate for staging. CHEST:LUNGS AND PLEURA: Left upper lobe subpleural micronodule is likely due to an infectious or inflammatory process.MEDIASTINUM AND HILA: Status post partial left thyroidectomyCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Fatty infiltration of the liver parenchyma is noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A low attenuation, round lesion is noted in the right kidney and most likely represents a simple cyst. A similar low attenuation round lesion is noted in the left kidney and also most likely represents a simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Midline abdominal scar is consistent with recent surgery.BONES, SOFT TISSUES: Sclerotic focus at the anatomical neck of the right proximal femur is likely a bone island.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Patient is status post total abdominal hysterectomy and bilateral salpingooophorectomy. There is bandlike, heterogeneously enhancing, soft tissue prominence in the surgical bed between the bladder and the rectum. This soft tissue mass measures approximately 6.2 x 2.3 cm (series 3, image 171). Given that surgery was approximately a month ago, we favor residual disease over postoperative changes.BLADDER: No significant abnormality noted.LYMPH NODES: Borderline lymphadenopathy is noted in the bilateral iliac and obturator regions. Index lesion measures 9 x 10 mm (series 3, image 166).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic focus at the anatomical neck of the right proximal femur is likely a bone island.OTHER: No significant abnormality noted.

Output: 1.Heterogeneously enhancing soft tissue mass within the surgical bed is concerning for residual disease. Given that this patient is now one month post-operative, we favor residual disease over postoperative changes.2.Diffuse fatty infiltration of the liver is noted.3.Borderline pelvic lymphadenopathy with reference node measured as above.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Weakness, rule out infiltrate Low lung volumes. No specific evidence of infection or edema. The cardiomediastinal silhouette is within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: Metastatic sarcoma to the lung. Treated with hyperfractionated radiation therapy. Evaluate for changes. CHEST:LUNGS AND PLEURA: Tiny micronodules unchanged. The reference left lower lobe nodule has enlarged and currently measures 3.2 x 2.7 cm (image 45; series 3). This lesion is heterogeneous, contains fat, consistent with a metastasis from the patient's known myxoid liposarcoma.MEDIASTINUM AND HILA: Nonocclusive thrombus in the SVC probably still present likely representing a residual fibrin sheath. Is difficult to evaluate on today's exam secondary to contrast infusion from the right arm causing streak artifact.CHEST WALL: Hiatal hernia.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypodensities in segment 4 of the liver again evident but poorly characterized on today's exam (image 82). The etiology of these small hypodensities is unknown. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The infrarenal inferior vena cava remains occluded by a metastatic implant (as identified by the fat content).PELVIS:UTERUS, ADNEXAE: Ovarian varices again noted. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval progression of disease with enlargement of pulmonary nodule and complete thrombosis of the infrarenal inferior vena cava by a metastatic implant.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Worsening hypoxia, pulmonary cyst History: Hypoxia Unchanged interstitial opacities with cyst formation projected over the left perihilar region.A Dobbhoff tube terminates in the stomach.An NG tube terminates in the stomach.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip at cavoatrial junction.

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


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Cough rule out acute process Normal heart size with unchanged appearance of the mediastinal silhouette. The central pulmonary vasculature appears prominent, and moderate bronchial wall thickening persists. No pleural fluid or pneumothorax. Large lung volumes consistent with COPD. Probable skeletal infarct in the right humeral neck region. Degenerative changes of the spine with loss of intervertebral disc space in the mid thoracic spine.

Output: Bronchial wall thickening suggestive of chronic bronchitis. Question of enlargement of central pulmonary vasculature. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Sjogren's disease end ILD. New fatigue. Checker change. Shortness of breath. LUNGS AND PLEURA: Subcentimeter nonspecific right upper lobe nodular opacity unchanged as compared to the previous examination. Stable basilar interseptal and intraseptal interstitial abnormality.There is no air trapping on the expiration views, and the above abnormalities fail to resolve on the prone images. There is no honeycombing or confluent consolidation. No pleural effusion. MEDIASTINUM AND HILA: No lymphadenopathy. The heart size is normal with a small amount of anterior and inferior pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Limited evaluation of the upper abdomen is unremarkable.

Output: Basilar interstitial abnormality is unchanged compared to recent exams and is not characteristic of, but is not inconsistent with, cryptogenic organized pneumonia as reported in previous clinical histories.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: pneumonia History: cough x 3 weeks Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: SOB and incr BP History: ? pulmonary edema Stable cardiomediastinal silhouette.Increased lung volumes compatible with COPD.No focal airspace opacities.No pleural effusions.Dextroscoliosis of thoracic spine redemonstrated.

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


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Evaluate pneumo status post trauma to left chest. SOB. No pneumothorax. Upper normal heart size. Coarse interstitial markings with reticulation at the lung bases, left greater than right.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Scoliosis with osteophyte formation.

Output: No pneumothorax. Nonspecific basal opacities may be the result of chronic lung disease with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Presenting with hematuria and chest pain CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules suspicious for metastatic disease. There efferents nodule measures 5-mm image 46, series number 3.Small right pleural effusion.MEDIASTINUM AND HILA: Left lower lobe bronchopulmonary adenopathy. Lymph node measures 24 x 23 mm, image number 60, series number 3. Distal esophageal wall thickening consistent with patient's known history of cancer. Right anterior third rib metastases causing pleural bulging anteriorly. Proximal esophagus is slightly dilated.CHEST WALL: Right axillary adenopathy. A reference necrotic lymph node measures 11 by 11 image image number 20, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Multiple metastatic lesions in the liver. There efferents lesion in the right lobe measures 31 x 30 mm image number 84, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule measuring 36 x 19 mm. Left adrenal gland is nodular and diffusely thickened.KIDNEYS, URETERS: Heterogeneous, ill-defined focal area of hypodensity in the left lower pole. This may represent focal pyelonephritis. Although, much less likely, Metastatic disease or a primary renal cell carcinoma cannot entirely exclude. Follow-up imaging is recommended for further evaluation. 10-mm heterogeneous round high density lesion in the upper pole of the left kidney. This represent a complex cyst or a small solid lesion. This lesion is too small to accurately characterize.Minimal fat stranding in the left-sided retroperitoneal fat associated with the left psoas muscle atrophy. Etiology is uncertain.RETROPERITONEUM, LYMPH NODES: Borderline enlarged lymph nodes.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: Bilateral borderline enlarged pelvic lymph nodes. A left external iliac lymph node measures 18 x 9 mm image number 177, series number 8, 0268.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Hepatic, pulmonary and right rib metastases. Mediastinal adenopathy. Distal esophageal wall thickening.Presumed right adrenal metastasis.Ill-defined hypodense focus in the left lower pole which represent pyelonephritis. Possibility of metastatic disease or primary renal cell carcinoma although less likely, cannot be excluded.Small complex lesion in the upper pole. The left kidney. This lesion is too small to accurate characterize, but has high density, and may represent a complex cyst or small solid neoplasm. Borderline enlarged pelvic and retroperitoneal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Elevated white blood cell count status post heart transplant Abandoned left chest wall cardiac device. Median sternotomy wires and surgical staples.Cardiomediastinal silhouette is normal.Bibasilar opacities compatible with pleural effusions and adjacent atelectasis/consolidation.No pneumothorax.

Output: Bibasilar opacities compatible with pleural effusions and adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: 57-year-old woman with neuroendocrine carcinoma. Evaluate disease status post chemoembolization. CHEST:LUNGS AND PLEURA: Improvement in right lower lobe atelectasis. Persistent atelectasis of the right middle lobe. Right hilar mass is difficult to measure but grossly unchanged. Scattered micronodules in the right lung. New minimal right pleural effusion.MEDIASTINUM AND HILA: High the left paratracheal noted series 4 image 17 again measures 11 x 7 mm. Right paratracheal node series 4 image 24 slightly increased, now measuring 18 x 17 mm, previously 16 x 15 mm. Other scattered precarinal, AP window, and anterior mediastinal nodes grossly unchanged from prior.Pericardial effusion is increased.CHEST WALL: Right thyroid hypodense nodule unchanged.ABDOMEN:LIVER, BILIARY TRACT: No gross change in multiple hepatic lesions. For example the lesion in segment 7 on series 4 image 74 and now measures 4.1 x 4.0 cm, previously 4.3 x 4.2 cm. The large cystic lesions with rim-like calcification are stable. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy unchanged.BOWEL, MESENTERY: Stable minimal ascites in the upper abdomen.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the dependent portions of the pelvis.BONES, SOFT TISSUES: Increased sclerosis of T10 vertebral body T10. Right ilium sclerotic lesion unchanged.OTHER: No significant abnormality noted.

Output: 1. Increased right pleural and pericardial effusions. 2. Increased sclerosis of T10 vertebral body. Otherwise, grossly stable metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.SOB history of COPD and ICD. Posterior mediastinal contour abnormality just above the GE junction nonspecific by plain film but most likely reflects a hiatal hernia. Left subclavian ICD with coils in the projection of the right ventricular apex. Normal heart size. The pulse generator obscures a portion of the left upper lobe which cannot be assessed. Basal scarring or atelectasis on the left. The lungs are otherwise unremarkable in appearance, the lung volumes are low.Healed rib fracture deformities on the right. Mild degenerative changes of the spine.

Output: Low lung volumes but no acute pulmonary opacity. Posterior mediastinal contour abnormality incompletely assessed by plain film technique, but statistically most likely represents a hiatal hernia. This can be confirmed with cross-sectional imaging if required.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: pigtail catheter location eval History: has pigtail catheter Right pleural pigtail catheter superimposes the right inferior chest wall, likely in the loculated pleural effusion. Surgical clips superimpose the right upper quadrant of abdomen.The cardiomediastinal silhouette is unchanged given variations in technique. Again seen is a loculated right-sided pleural effusion. Patchy airspace and interstitial opacity seen throughout the right lung correlate to abnormality seen on chest CT performed 2 days prior. No new focal pulmonary opacity suggestive of pneumonia. No pneumothorax.

Output: Right pleural pigtail catheter superimposes the right inferior chest wall, likely in the loculated pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female 21 years old Reason: cough, fever Cardiomediastinal silhouette is normal. No focal airspace opacity, pleural effusion or pneumothorax.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: s/p TECAB History: NA Heart size stable and upper limit of normal.Bilateral pleural effusions appear unchanged compared to the previous exam.Improvement in the previously noted atelectasis.

Output: Persistent pleural effusions, improvement of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Shortness of breath rule out pneumothorax. No pneumothorax. Coarse granular opacities are noted diffusely with relative sparing of the apices. This is similar to a recent CT scan.

Output: No acute pulmonary abnormality. No pneumothorax. Fine granular parenchymal abnormality described as probable sarcoidosis on a recent CT.


Instruction: Generate impression based on medical findings.

Input: 77 year old female intubated for RF. ETT placement, interval changes in lung fields. ET tube tip approximately 4 cm above the carina. Right central venous catheter, and NG tube unchanged.Bronchial wall thickening and probable pleural effusions unchanged.Cardiomediastinal silhouette unremarkable.

Output: ET tube tip approximately 4 cm above the carina. Bronchial wall thickening and probably pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.With chest pain. No pleural effusion on pneumothorax. Cardiomediastinal silhouette is unremarkable. No focal lung opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: line position History: IABP, RIJ The lung catheter tip in the descending aorta, projected 7 cm below the top of the aortic arch. Interval removal of the Swan-Ganz catheter with a catheter sheath in the area of the right jugular vein.Moderate cardiomegaly with hazy lower zone opacity compatible with atelectasis and small effusions.

Output: Balloon catheter tip in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: SOB History: As above Acute appearing interstitial opacities with pleural effusions suggestive of edema and CHF.Heart size difficult to assess because of the pulmonary opacities.Right spleen being catheter, tip at right atrial level.

Output: Findings suggestive of acute CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: pls eval for aspiration PNA History: tachycardia, pt w/o good swallow fxn rales on exam PICC line with its tip in the axilla.Stable cardiac mediastinal silhouette.Basilar opacities and pleural effusions similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with basilar opacities suggestive of edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of hypotension. Evaluate for pneumonia. Interval replacement of left IJ central venous catheter with tip in the right atrium. There has been a prior sternotomy.Right-sided pleural effusion has decreased in size. Unchanged bibasilar streaky opacities likely represent atelectasis or scarring.

Output: Interval decrease in size of right pleural effusion with no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval for PNA History: URI sxs No focal pulmonary opacity, pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: fluid overload? History: dialysis, vomiting No significant cardiopulmonary abnormality.Left jugular catheter tip at cavoatrial junction.

Output: No significant abnormality. No evidence of edema or significant sized pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with metastatic renal cancer. CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules have decreased in size. The reference right middle lobe nodule measures 9 x 8 mm, previously 12 x 12 mm (series 5; image 63).MEDIASTINUM AND HILA: Decrease in mediastinal and right hilar adenopathy. The reference prevascular lymph node measures 2.8 x 2.8 cm (series 3; image 40), previously 3.8 x 3.7 cm. The right infrahilar lymph node measures 3.4 x 1.9 cm (series 3; image 64), previously 4.7 x 3.5 cm. The right paraesophageal lymph node measures 2.2 x 1.4 cm (series 3; image 87), previously 3.3 x 2.0 cmCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Gallbladder calculi remain. Numerous hypodensities are again noted within the liver, unchanged, the largest of which definitively represent cysts.SPLEEN: No significant abnormality notedPANCREAS: Lesion in the pancreatic tail measures 3.4 x 3.2 cm (series 3; image 105), previously 3.7 x 3.2 cmADRENAL GLANDS: Right adrenalectomy.KIDNEYS, URETERS: Status post right nephrectomy.Solid lesion in the midpole the left kidney measures 16 x 14 mm (series 3; image 116), previously 21 x 21 mm.RETROPERITONEUM, LYMPH NODES: Ectasia of the infrarenal abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Regression of disease in the thorax and abdomen


Instruction: Generate impression based on medical findings.

Input: 83 old female with overnight hemoglobin dropped. The study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions, more on the left than on the right. Biapical scarring. Emphysema. Calcified nodule in the right middle lobe. Linear atelectasis at the lung bases.7-mm nodule in the right lower lobe. Follow up imaging is recommended for further evaluation. Other smaller nodules are also present in the right lower lobe.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis no CT evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal stones without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No evidence of retroperitoneal hemorrhage.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Round hypodensity within the uterus measuring up to 2-cm may represent a dilated endometrial cavity versus a fibroid. Further evaluation with ultrasound is recommended.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: Right lower lobe nodules. Etiology may be infection versus neoplasm. Follow-up CT imaging in 3 months is recommended.Cholelithiasis and right nephrolithiasis.Pelvic ultrasound is recommended for evaluation of the endometrial stripe.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated Complete atelectasis of the left lung, increased since the previous radiograph, with opacification of the left hemithorax.Tracheostomy tube and port catheter unchanged.No other significant change.A text page was sent to Dr. Swei at the time of reporting.

Output: Increased atelectasis of the left lung, likely secondary to bronchial mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: r/o pneumonia History: 1551 Apparent upper lobe ill-defined nodular opacities likely are skeletal in nature rather than pulmonary, especially involving the anterior aspect of the left second rib.Mild atelectasis right lung base.Heart size normal.

Output: No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval effusion History: leukocytosis, oxygen requirement Left lower lobe consolidation and left pleural effusion unchanged allowing for differences in patient positioning. Right lung unremarkable.Heart size normal.

Output: Unchanged moderate left pleural effusion and left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Status post PICC line placement. Right upper extremity PICC with tip in the axillary/subclavian venous confluence. Right central venous catheter with tip in the SVC. Unchanged mediastinal drains. Postoperative changes of median sternotomy.Mild cardiomegaly. No significant change in bilateral basilar opacities compatible with pleural effusions with possible underlying atelectasis.

Output: 1.Right PICC tip in the axillary/subclavian confluence.2.Unchanged cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: FemaleReason for Study: +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: Male, 55 years old.Shortness of breath. Presurgical evaluation. Normal heart size. No focal air space opacity, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: ro asp pna History: sob Unremarkable cardiac and mediastinal silhouette. Perihilar bronchial thickening and apical scarring, unchanged.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: O2 requirement Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with bilateral nonspecific opacity compatible with edema and infection.Partial clearing of bilateral lower lobe consolidation.No new findings.

Output: Partial improvement in bilateral lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: 83-year-old male with high risk prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Moderate hiatal hernia.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple cystic lesions in both lobe of the liver, likely representing simple cysts. These are unchanged from previous CT dated 7/9/2004.SPLEEN: No significant abnormality notedPANCREAS: Severe fatty infiltration of the pancreas. Possible cystic lesion in the unicinate process of the pancreas measuring 2.4 x 1.7 cm in image number 102, series number 21 is unchanged, likely representing a benign IPMN.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm measuring 2.3-cm in AP diameter is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Significantly enlarged prostate indenting the bladder and multiple enhancing foci in the peripheral zone posteriorly bilaterally, consistent with prostate cancer.BLADDER: 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: Enlarged prostate gland. No evidence of metastatic disease. Hepatic cysts are unchanged.Cystic mass in the os necrosis of the pancreas, likely representing a benign IPMN, unchanged from CT dated 7/4/2004.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pneumothorax History: pneumothorax Persistent small right apical pneumothorax with a pleural drain in place.Diffuse interstitial opacity, unchanged.

Output: Persistent small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: swan ganz in place History: swan ganz in place No significant cardiopulmonary abnormality.Left subclavian ICD, leads unchanged in position.Right jugular Swan-Ganz catheter directed to the right interlobar pulmonary artery.

Output: No acute abnormality. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: New fever in neutropenic pt Right IJ line terminates in the SVC. Low lung volumes makes detailed cardiopulmonary assessment difficult. 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: Female, 52 years old.Reason: possible pneumonia History: productive cough, pleuritic chest pain Mild cardiomegaly with a tortuous aorta.No specific evidence of infection or edema.

Output: Cardiomegaly and a tortuous aorta, but no evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: breast cancer receiving neoadjuvant chemotherapy with new onset fevers History: neutropenic fevers Very large right paratracheal mass deviating the trachea to the left could be a goiter although metastases are also possible.No significant pulmonary or pleural abnormality.Right jugular catheter tip in SVC/RA junction level.Heart size normal.

Output: No specific evidence of infection. Very large right paratracheal mass deviating the trachea consistent with a massive goiter or lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: pls assess IABP and swan positioning History: cardiogenic shock Balloon catheter marker projected about 4 cm below the top of the aortic arch.Swan-Ganz catheter tip in the main pulmonary artery.ICD lead unchanged.Cardiomegaly with no sign of edema or infection.

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


Instruction: Generate impression based on medical findings.

Input: 75-year-old with CNS lymphoma CHEST:LUNGS AND PLEURA: Left lower lobe atelectasis. Minimal bilateral pleural effusions. NG tube is in place.MEDIASTINUM AND HILA: Thrombus in the right lower lobe pulmonary artery.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ill-defined small hypodense areas adjacent to the gallbladder bed from the right lobe best seen on image number 94 and 95, 99 series number 3. The etiology is unknown and may represent focal fat infiltration. Further evaluation with liver MRI may be helpful.SPLEEN: No significant abnormality notedPANCREAS: 10-mm cystic lesion in the tail of the pancreas, most likely benign.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral simple appearing renal cysts, largest measuring 6.4-cm on the left side.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enhancing focus in the right apical prostate. Correlation with prostate MR and PSA is recommended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Fat containing bilateral inguinal hernias, more prominent on the right compared to the left.

Output: Right lower lobe pulmonary embolus.Indeterminant likely benign liver lesions. Further evaluation with liver MRI is recommended.Small pancreatic cyst.Enhancing focus in the right apex of the prostate. Correlation with PSA and/or prostate MRI is recommended.Dr. Halpern was notified of knowledge about the pulmonary embolus in the right lower lobe although lung at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: AMS, syncope. Rule out drainage Exam extremely limited by patient positioning and single views of the skull, chest, and abdomen.2 radiopaque markers project posterior to the right orbital socket. Localization is limited due to the single, nonorthogonal projection of the skull. No radiopaque tubing is observed in the chest radiograph nor clearly observed in the single abdominal radiograph, which may indicate a nonradiopaque device or interval removal.Note is made of numerous gallstones in the right upper quadrant and a presumed extracorporal safety pin overlying the middle of the abdomen.

Output: 2 radiopaque markers project posterior to the right orbital socket. No radiopaque tubing is clearly observed, which may indicate a nonradiopaque device or interval removal. If concern remains high and confirmation is needed, CT evaluation may be required.


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary abnormality. Unchanged right jugular dialysis catheter extending into the mid SVC

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p esophagectomy History: tachy, low grade fever Cardiomediastinal silhouette is normal in size.The enteric tube has been removed and the gastric pull-up is now hugely distended.Left lower lobe atelectasis. No large pleural effusion or pneumothorax.Right chest wall subcutaneous emphysema has decreased from prior.The right chest tubes have been removed.

Output: 1. The gastric pull-up is now hugely distended status post enteric tube removal.2. Left lower lobe atelectasis.These findings were communicated to Dr. Frimpong at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: pna? History: altered mental status Mild cardiomegaly with subtle basilar interstitial opacities likely chronic.No specific evidence of infection or failure.Left subclavian pacemaker, leads unchanged in position.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Confirm Swan placement. Right jugular catheter tip projects over the right interlobar pulmonary artery. No pneumothorax.Worsening pleural fluid and pulmonary edema. IABP marker projects over the middescending thoracic aorta near the T7 vertebral level. Dense retrocardiac atelectasis. Extensive interstitial and airspace opacities bilaterally.

Output: Right jugular Swan-Ganz catheter pneumothorax. Worsening pulmonary opacities and pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Rising WBC, concern for pneumonia History: Elevated WBC Interval increase in bilateral pleural effusions. Increased bibasilar opacities which are likely due to atelectasis but superimposed infection or aspiration cannot be excluded. Heart size stable. Left PICC tip in left subclavian vein.

Output: Interval increase in bilateral pleural effusions. Increased bibasilar opacities which are likely due to atelectasis but superimposed infection or aspiration cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and asthma exacerbation No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.LVAD Feeding tube has been pulled back. Left IJ sheath has been removed. Cardiac leads and LVAD device again noted. Diffuse pulmonary opacities again noted, not substantially changed. Unchanged cardiomegaly. No pneumothorax.

Output: Iatrogenic devices, as above. Diffuse pulmonary opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: 77 years old Male. Reason: Hx of ESRD s/p kidney transplant admitted for new acute leukemia History: Dyspnea and increasing O2 requirement. Hypoinflated lungs. The right PICC line tip in the SVC. Small bilateral pleural effusions with associated compression atelectasis in both sides.

Output: Hypoinflated lungs with bilateral small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: evaluate for etiology of inc hypoxemia - 63 yo w B cell lymphoma, emphysema, pleural effusion, intubated History: intubated, dec sPo2 ] PICC line and tracheostomy tube unchanged.Extensive basilar atelectasis/consolidation and accompanying bronchiectasis.Left upper lobe scarring and subsegmental atelectasis redemonstrated.Probable pleural effusions right greater than left.

Output: Support devices unchanged. Stable cardiopulmonary appearance of pleural effusions and multifocal areas of atelectasis, bronchiectasis, and fibrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: r/o cardiomegaly, pulmonary edema History: new atrial fibrillation Mild cardiomegaly.No significant pulmonary or pleural abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: Swan positioning History: as above Mild interstitial opacities suggestive of edema.Heart size upper normal status post sternotomy.Right jugular Swan-Ganz catheter, tip in right pulmonary artery.

Output: Right jugular Swan-Ganz catheter, tip in right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with contrast allergy and large ventral hernia. Complains of abdominal cramping, nausea and constipation. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left upper lobe on image number 30/194.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large ventral hernia containing nonobstructed small and large bowel segments.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified fibroids.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: Large ventral hernia containing nonobstructed small and large bowel segments.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: esophageal cancer History: s/p neoadjuvant treatment followed by MIE for esophageal cancer Right pleural effusion with right basilar atelectasis improved.Left pleural effusion improved.Heart size normal.No new findings.Right jugular catheter, tip in SVC.

Output: Improving basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: evaluate for PNA History: SOB, cough, HIV patient Stable cardiomediastinal silhouette.Minimal basilar scarring.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Assess ILD. Low lung volumes with basilar predominant fibrotic appearing lung parenchyma unchanged. No visible superimposed acute abnormality.

Output: No acute change in interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: evaluate for edema/infiltrate History: sob No significant redirecting change in appearance of bilateral interstitial and airspace opacities with bilateral effusion. No pneumothorax.

Output: No significant change in bilateral opacities and pleural effusions.