Instruction: Generate impression based on medical findings.

Input: 74 years old Female. Reason: rule out infiltration History: fever. The cardiac silhouette appears enlarged. There are small bilateral pleural effusions, left greater than right. The Port-A-Cath tip projects over the SVC. There is no evidence of for pneumothorax.

Output: Cardiomegaly and bilateral small pleural effusions, unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: ET tube placement History: as above Cardiomediastinal silhouette is normal in size.Interstitial opacities, septal lines and small pleural effusions appears increased from prior. No pneumothorax.Central venous catheter tip is at the level of the distal SVC. ET tube is proximally 4 to 5 cm above the carina. Enteric tube tip is at the level of the GE junction.

Output: 1. Worsening pulmonary edema.2. Enteric tube tip is at the level of the GE junction. Recommend advancing prior to use.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: acute desat w tachycardia, extubated today, AMS History: above Status post extubation with persistent left lower lobe collapse.Other tubes and devices stable.

Output: Persistent left lower lobe complete atelectasis following extubation.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Pt is a 62 yo male w/ hx of lymphoma; pre-asct evaluation History: evaluate No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: bladder cancer r/o mets History: bladder cancer r/o mets The lungs and pleural spaces are clear. The heart size remains stable. No evidence of pulmonary nodule.

Output: No visualized pulmonary nodule.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: eval for IABP placement History: as above IABP marker remains in satisfactory position overlying the aortic knob. Right IJ Swan-Ganz catheter is unchanged. Stable left subclavian single chamber ICD.Cardiac silhouette is stable in size. No focal consolidation, sizable effusion or pneumothorax.

Output: IABP marker in stable position overlying the aortic knob.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Patient with altered mental status, evaluate ET tube placement. Patient intubated with ET tube tip approximately 8 cm above the carina. Enteric tube with tip coiled in the stomach fundus.The cardiomediastinal silhouette is unchanged.There is right hemithoracic volume loss with complete right middle lobe atelectasis.Basal opacity on the left also consistent with aspirate.

Output: 1.ET tube tip approximately 8 cm above the carina, recommend advancing.2.Complete right middle lobe atelectasis and left basilar opacity, likely the result of aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiac History: CP Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: 81F w/ history of aortic dissection s/p reconstruction History: - Limited by patient rotation. Swan-Ganz catheter, right jugular introducer sheath, and chest tubes unchanged. Severely widened mediastinum with tortuous aorta as on prior. Bilateral pleural effusions as on prior. Mild pulmonary edema. No new opacity.

Output: Severely widened mediastinum with tortuous aorta as on prior. Bilateral pleural effusions as on prior. Mild pulmonary edema. No new opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Post heart transplant History: Surveillance Stable heart size. No new focal lung consolidation. No pleural effusion or pneumothorax. Surgical clips again noted within the right hemithorax. Patient is status post sternotomy.

Output: Unchanged heart size. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Dyspnea Low lung volumes without specific evidence of infection or edema. Basilar scarring/atelectasis is unchanged. The cardiac silhouette is unchanged.

Output: No acute cardiopulmonary abnormality without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: pneumoniae History: fever cough Normal heart size with sternal fixation devices intact and the retained ICD coil in the area of the left brachiocephalic vein.No significant pulmonary abnormalities.

Output: No evidence of pneumonia


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: r/o worsening ptx History: worsening tachypnea, hypoxia Lines and tubes are unchanged. Diffuse pulmonary opacities, unchanged. Unchanged cardiomegaly. Very small medial left-sided pneumothorax.

Output: Unchanged diffuse pulmonary opacities. Very small left-sided pneumothorax. Left chest tube remains in place.


Instruction: Generate impression based on medical findings.

Input: Fever No acute cardiopulmonary abnormality. Right jugular catheter again terminates in mid SVC unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: edema, infiltrate History: HTN emergency with flash pulm edema Significant improvement in prior edema like opacities.Heart size normal.No new findings.

Output: Significant improvement in prior edema, residual opacities present in the right lower lung zone.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with metastatic breast cancer currently receiving treatment CHEST:LUNGS AND PLEURA: Calcified granuloma in the right lung base. No pulmonary nodules are seen.MEDIASTINUM AND HILA: Calcified mediastinal and right hilar lymph nodes.Coarse calcification within the left lobe of the thyroid gland, unchanged.CHEST WALL: Right breast mass with small adjacent fluid collection remains. The mass is grossly unchanged, measuring 25 x 15 mm (series 3; image 47), previously 22 x 12 millimeters when remeasured.12-mm right infra-axillary lymph node is unchanged. Several other prominent lymph nodes on the right are stable.ABDOMEN:LIVER, BILIARY TRACT: Cysts are again seen in the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered right cortical scarring and bilateral small calcifications, stable.Retroaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Prominent para-aortic lymph node is stable from 4/06.BOWEL, MESENTERY: Ileocolic anastomosis in the right mid abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate atherosclerotic disease.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small lymph nodes are identified along the obturator regions and external iliac chains bilaterally. A reference left external iliac lymph node measures 18 x 8 mm, not significantly changed since 2006.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination without new sites of disease. Mildly prominent para-aortic lymph node and borderline enlarged pelvic lymph nodes are stable from 4/06.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Status post cardiac surgery postoperative day #1. Right jugular introducer, left chest tube and drain projecting over the lower thorax crossing the midline from left to right unchanged in position. Large left and moderate right pleural effusions. Diminished lung volumes compared to previous. Partial clearing of previously seen edema. Mild gaseous distention of the stomach.

Output: Although the pleural fluid and degree of atelectasis appears slightly worse this is at least partially accounted for by the decrease in lung volumes. Pulmonary edema is improving.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Preoperative evaluation for aortic and mitral valve replacement. Moderate cardiomegaly with prominent pulmonary vasculature. Tortuous aorta.No acute focal pulmonary opacities, pleural effusions, or pneumothorax. Likely right apical pleural scarring and right lower lung calcification.

Output: Moderate cardiomegaly with prominent pulmonary vasculature.


Instruction: Generate impression based on medical findings.

Input: Reason: assess central line placement History: central line Catheter tip in the SVC.Moderate cardiomegaly with diffuse pulmonary opacity compatible with edema, and small pleural effusions.No significant interval change.

Output: CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: h/o polycythemia and smoking, please eval for lung disease History: polycythemia, tobacco use history Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: s/p OHT History: s/p OHT Interval removal of right lower extremity Swan-Ganz catheter and interval placement of right jugular Swan-Ganz terminating in the proximal right main pulmonary artery. Interval placement of mediastinal drains, chest tube, and endotracheal tube which terminates about 8 cm above the carina. Sternotomy intact.Left pleural effusion has increased. Unchanged cardiomegaly. Interstitial opacities consistent with edema.

Output: Increasing left pleural effusion with support devices as above.


Instruction: Generate impression based on medical findings.

Input: LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Mild focal pleural thickening left posterior base is unchanged. MEDIASTINUM: Stable small mediastinal and hilar nodes, not pathologically enlarged by CT size criteria. Atherosclerotic calcifications of the aorta and coronary arteries. Heart size upper normal. No pericardial fluid. CHEST WALL: Small lymph nodes in the low right neck are unchanged, please refer to separately reported neck CT for significance (image 8/142). Vertebral body hemangioma. No osseous metastases. UPPER ABDOMEN

Output: 1. No suspicious pulmonary nodules or masses. 2. No pathologically enlarged mediastinal or hilar lymph nodes; however imaging follow-up is suggested.


Instruction: Generate impression based on medical findings.

Input: Age: 42 yearsGender: FemaleReason for Study: Reason: PNA, interval changes, RIJ placement History: AMS, HHS, Hypotension with sepsis workup Right IJ venous catheter with its tip in the area.NG tube with its tip in the stomach.Stable cardiomediastinal silhouette.There are decreased lung volumes with nonspecific perihilar/basilar opacities.No focal areas of consolidation.

Output: No significant interval change. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with history of breast cancer, asthma. Presents with shortness of breath and severe respiratory distress. Cardiomediastinal silhouette is within normal limits.Right lower lobe bronchial wall thickening.Large lung volumes with flattening of the diaphragm.No focal pulmonary consolidation or pleural effusion.Surgical clips project over the left axillary region.Calcified mediastinal lymph nodes likely from prior granulomatous disease.

Output: Right lower lobe bronchial wall thickening may reflect asthma or bronchitis.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with history of diverticulitis and right shoulder pain, evaluate for perforation. Interval removal of right IJ catheter.No evidence of free peritoneal air.Redemonstration of streaky bibasilar opacities.No new focal airspace opacities.Mild left ventricular and left atrial dilation.

Output: No evidence of perforation.


Instruction: Generate impression based on medical findings.

Input: Chest tube removal Persistent moderate unchanged since suspected loculated left pneumothorax without additional cardiopulmonary interval changes. Left bronchial stent is similar to prior exam. Tracheostomy tube remains well-positioned terminating 3 cm above the carina.G-tube projects over left upper quadrant

Output: Moderate and suspected loculated left pneumothorax unchanged


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: pneumonia History: weakness, hypotension Right central venous catheter with its tip in the SVC.Mildly decreased lung volumes.Stable cardiac mediastinal silhouette.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: endotracheally intubated History: as above Changed basilar opacities suggestive of edema.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: tube placement History: tube placement ET tube tip 5-6 cm above carina. Cardiomegaly. Moderate right pleural effusion. Mild pulmonary edema. NG tube tip in stomach. Venous catheter unchanged.

Output: ET tube tip 5-6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: ards on trach, reassessment History: shortness of breath Small lung volumes with moderate interstitial and air space opacities consistent with known ARDS.Tracheostomy tube tip approximately 4 cm above the carina.Right jugular catheter, tip in SVC.Prior right PICC removed.

Output: No change in pulmonary opacities and cardiomegaly, consistent with known ARDS.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for worsening basilar opacities, swan in place History: as above Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with pulmonary edema and small pleural effusions, not significantly changed allowing for pulmonary inflation.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: hypoxia, altered mental status History: hypoxia No pleural effusion or pneumothorax. Cardiomegaly with increasing airspace and interstitial opacities compatible with edema. Vascular redistribution.Endotracheal tube terminates about 5 cm above the carina. Enteric tube extends inferiorly off the field-of-view.

Output: Cardiomegaly and findings compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath No significant pneumothorax.Right upper lobe cavitary lesion less circumscribed and dense.Persistent left lower lobe atelectasis with pleural effusions.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: ACS History: CP Slightly increased lung volumes may reflect COPD. No focal consolidation, pleural effusion or pneumothorax is evident. Scattered calcified pulmonary nodules consistent with granuloma. The cardiac and mediastinal contours are within normal limits for size. The bones and soft tissues are unremarkable.

Output: No acute findings seen to account for the patient's chest pain.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP placement History: As above Marked cardiomegaly, unchanged.Aortic balloon catheter with its marker in the proximal descending aorta and single ICD lead extending to the right ventricle, unchanged.

Output: Cardiomegaly with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval lung fields History: eval lung fields Interval advancement of the Dobbhoff tube which terminates inferior to the caudal margin of the image. The remaining support devices are unchanged in position.Partial clearing of pulmonary opacities with residual basilar atelectasis and small pleural effusions. No pneumothorax.

Output: Successful advancement of Dobbhoff tube. Continued improvement of pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with abdominal pain and distention status post neobladder. CHEST:LUNG BASES: Right greater than left pleural effusions with associated compressive atelectasis.ABDOMEN:LIVER, BILIARY TRACT: Soft tissue density is seen layering within the gallbladder, likely representing noncalcified gallstones. No evidence of acute gallbladder inflammation.SPLEEN: Probable splenic artery aneurysm (series 3, image 48), approximately measures 1 x 1 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right hydronephrosis, chronicity of which is unknown. Please correlate with pre-operative history. Focus of air within the right renal pelvis is consistent with patient's surgical history.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Foley catheter seen within a decompressed neobladder. A JP drain is also noted in the right lower quadrant.Mild mesenteric stranding seen in the right lower abdominal quadrant reflects recent surgery. No evidence of bowel obstruction or bowel wall thickening. No abnormally organized fluid collections to suggest abscess.BONES, SOFT TISSUES: Midline surgical staples.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Postsurgical changes from neobladder construction as described above. No evidence of bowel obstruction or abnormal wall thickening. Note is made of right hydronephrosis, the chronicity of which is not known; please correlate with pre-operative history.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: Eval for Effusion History: R sided effusion after heart surgery Unchanged cardiomediastinal silhouette status post sternotomy.Bilateral effusions, right greater than left, and basilar airspace opacities, which are not significantly changed.No significant pneumothorax.

Output: Persistent bilateral effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: acute liver failure History: acute liver failure, hypoxia, sob Low lung volumes with streaky basilar opacities of atelectasis. No evidence of infection or edema. The heart size is normal.

Output: Basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 59 year-old woman with breast cancer and bone METs. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous metastatic lesions in the liver suspicious for metastatic disease. These are new from previous study. There frustration in the right lobe measures 2.9 x 3 cm image number 80, series number 3.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: Extensive metastatic disease involving the entire skeleton significantly progress from prior CT.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive metastatic disease involving the entire skeleton significantly progress from prior CT.OTHER: Small amount of fluid in the pelvis.

Output: Extensive metastatic disease involving the entire skeleton significantly progress from prior CT.New extensive hepatic metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer evaluate for metastatic disease. Normal heart size. No suspicious pulmonary nodules or masses are identified. No acute pulmonary abnormality. Mild degenerative changes of the spine.

Output: No visible pulmonary nodules or masses by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval lung fields History: cough, sob Scoliotic curvature of the the thoracolumbar spine.The cardiomediastinal silhouette is otherwise unremarkable. Lungs are clear of air space and interstitial opacities. No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: HF and Afib; desaturation with movement, eval for pulm edema History: above No change in degree of cardiomegaly. No specific evidence of pulmonary edema or infection. No pneumothorax.

Output: Cardiomegaly with no specific evidence of pulmonary edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: is there an infiltrate History: fever and cough Cardiomediastinal silhouette is normal. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Is there pulmonary edema? History: SOB Feeding tube tip in the stomach.Severe diffuse airspace opacities and pleural effusions, without significant interval change.

Output: No change in diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female. Prekidney transplant evaluation. The heart size is mildly enlarged. No focal air space opacities, pleural effusions, or pneumothorax. Calcified thoracic aorta.

Output: Mild cardiomegaly without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evaluate lungs History: hx of lung transplant Multifocal airspace and interstitial opacities and pleural effusions, not significantly changed.Tracheostomy tube tip approximately 4 cm above the carina. Enteric tube tip projects inferiorly beyond the visualized fields. Right pleural drain, unchanged in position. Median sternotomy hardware appears intact. Mediastinal clips again noted.

Output: Multifocal airspace interstitial opacities and bilateral pleural effusions, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: 17-year-old female with history of sickle cell anemia with fever. Evaluate for acute chest.VIEW: Chest AP (one view) 2/8/2016 0933 Cardiac size is mildly enlarged, consistent with history of sickle cell anemia. Pulmonary vasculature is mildly increased. Ill-defined left lower lobe opacity may represent pneumonia or acute chest.

Output: Ill-defined left lower lobe opacity may represent pneumonia or acute chest.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: evaluate for infiltrate History: hypoxia, crackles on lung exam Interval removal of central venous catheter.Cardiomediastinal silhouette is normal.Bilateral interstitial opacities representing fibrosis or atelectasis.No pneumothorax. No pleural effusion.

Output: Stable bilateral interstitial opacities likely representing fibrosis or atelectasis with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Bilateral lung transplant, "washout". Bilateral chest tubes terminate in the lateral costophrenic sulci. Trace pneumothoraces. Moderate volume of pleural fluid bilaterally in. Compressive atelectasis right lung base. Left lower lobe airspace opacity appears more diffuse, and may reflect bronchial washing superimposed upon aspiration or infection. Tracheostomy tube and left jugular catheter is unchanged in position.

Output: Worsening left lower lobe opacity could reflect bronchial washing in the appropriate clinical context; underlying pneumonia cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Shortness of breath evaluate lung fields Mild pulmonary edema and small pleural effusions. Mild cardiomegaly. Coarse reticulonodular appearance of the lung parenchyma is chronic.

Output: Mild CHF.


Instruction: Generate impression based on medical findings.

Input: 60 year old female with persistent cough x 1 month No focal airspace opacities. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male 29 years old Reason: sob History: sob Prominent perihilar confluent interstitial and airspace opacities.Mild cardiomegaly. Left costophrenic angle excluded from the field-of-view, but no large pleural effusion.Osseous chronic sickle cell disease noted.

Output: Prominent perihilar confluent interstitial and airspace opacities with associated mild cardiomegaly suggestive of edema, although hemorrhage and atypical infection are not excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: central line placement intra-op History: line placement Mild to moderate cardiomegaly.Small lung volumes.No specific evidence of infection or edema.Right jugular port catheter tip at cavoatrial junction.Right jugular sheath, tip in right brachiocephalic at the level of the clavicle.

Output: Right jugular vascular sheath placed. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval for edema/infiltrate History: vtach Small lung volumes.Status post sternotomy for CABG and status post coronary stent placement.Heart size normal.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: AML. Line placement Minimal repositioning and advancement of the PICC line, tip projects into the mid SVC in good position.No underlying cardiopulmonary abnormality or new findings given semiupright technique

Output: Right PICC line mildly repositioned


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with history of bladder cancer. Evaluate for possible changes. CHEST:LUNGS AND PLEURA: Severe emphysema. Focal calcified plaque in the right diaphragm is unchanged. A noncalcified plaque posteriorly in the right lower lobe is also unchanged.Previously described anterior right upper lobe spiculated mass has been resected within the internal. Postsurgical changes in the right upper lobe. No evidence of new nodules.Subcentimeter nodule in the right upper lobe on image number 6, series number 8, 0229 is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Nonspecific, punctate hypodensities in the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval development of right hydronephrosis with undilated right ureter. Presumed left-sided parapelvic cysts are unchanged. No evidence of hydronephrosis or hydroureter on the left side.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes. A reference left para-aortic lymph node now measures 5 noted on image number 137, series number 3. Previously present measuring 6-mm image number 139, series number 3. No evidence of enlarged lymph nodes in the retroperitoneum or pelvis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cholecystectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Right lower quadrant ileostomy and ileal conduit.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the most inferior aspect of the pelvis posterior to the symphysis pubis.

Output: Interval development of right-sided hydronephrosis and hydroureter. Right ureter is dilated throughout its course up the level of the anastomosis. Left ureter is normal in size. The etiology for the dilatation of right ureter is not certain.Interval resection of right upper lobe mass without evidence of recurrence.Subcentimeter right upper lobe nodule is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: DHT placement, evaluate. Dobbhoff tube tip terminates in the stomach.Cardiomediastinal silhouette is unremarkable. There is marked improvement in left lung atelectasis and aeration of the left lung. Bilateral pleural effusions are noted.

Output: 1.Dobbhoff tube tip terminates in the stomach.2.Marked interval improvement in left lung atelectasis and aeration.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Intubated. ET tube is about 3.5 cm superior to the carina. Bilateral right greater than left pleural effusions remain. Slight increase in left basilar probable atelectasis. Bilateral jugular venous catheters are unchanged in position. NG tube tip is not visualized.

Output: ET tube tip approximately 3.5 cm superior to the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 59M s/p cystectomy in 4/2015. Evaluate for metastatic bladder cancer. History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out infection History: altered mental status, resp distress Moderately severe cardiomegaly.Bilateral perihilar and lower zone airspace and interstitial opacity with several septal lines at the periphery and thickening of the pleural fissures, compatible with edema.Probable small pleural effusions.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: pna? History: seizure vs pseudoseizure No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old. Reason: abnormality History: chest pain The cardiomediastinal silhouette is within normal limits.No focal airspace opacity. No pleural effusions or pneumothorax. No displaced rib fracture is identified.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chf? History: crackles L base, edema Moderate cardiomegaly with bilateral mainly perihilar interstitial opacity compatible with edema.Bilateral calcified pleural plaques suggestive of previous asbestos exposure.

Output: Cardiomegaly and pulmonary edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with metastatic neuroendocrine tumor CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Bilobar hypodense lesions in the liver consistent with patient's known history of metastatic disease. Index lesion in the left lobe measures 2.6 x 2.6 cm in image number 17, series number 7. This lesion was measuring 2.6 x 3.3 cm on the previous study. Other hepatic lesions are also stable to minimally decreased in size compared to previous study.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: Prominent lymph node in the right lower quadrant is unchanged on image number 141, series number 7.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hepatic metastases be stable to minimally decreased in size compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: ? effusion History: cough and wheezing Very small pleural effusions, otherwise unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Minimal pleural effusions, less likely pleural scarring, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Check for aspiration, altered mental status Persistent decreased small lung volumes without specific superimposed focal airspace abnormality. Mild perihilar changes again suggest edema. Small effusions cannot be excluded. Borderline cardiomegalyNGT projects beyond the inferior to the image, replacing a Dobbhoff that have been removed

Output: Dobbhoff removal and NG tube placed


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: lung transplant with decreasing spirometry, history of cystic fibrosis, lung transplant Status post clam shell sternotomy.The heart size is normal. Mild linear bibasilar atelectasis/scarring. No pleural effusion. No pneumothorax.

Output: The lungs are unremarkable and unchanged.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of +PPD Stable cardiomediastinal silhouette.No focal pulmonary opacity or pleural effusion.

Output: No evidence of active TB.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.SOB Previously noted bulging along the right cardiomediastinal silhouette is not seen on the current exam. Mild diffuse interstitial opacities. Worsening of small right pleural effusion.

Output: Mild pulmonary edema and small bilateral effusions with worsening on right.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: assess for metastatic disease History: history of metastatic kidney cancer Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax. No evidence of metastatic disease.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Dyspnea and shortness of breath. Mesothelioma Unchanged appearance with nodular pleural thickening observed throughout the right hemithorax with decreased volume and elevated hemidiaphragm. Underlying interstitial changes observed in both lung bases, nonspecificLeft subclavian single port unchangedCholecystectomy clips

Output: No interval new abnormality and underlying changes throughout the right hemithorax compatible with known mesothelioma. No specific changes or findings to suggest pneumonitis, however appearance remains nonspecific


Instruction: Generate impression based on medical findings.

Input: 67-year-old male restage lymphoma. CHEST:LUNGS AND PLEURA: Stable centrilobular emphysema primarily affects the upper lobes. Scattered micronodules are unchanged when compared to the prior exam.MEDIASTINUM AND HILA: Small mediastinal and hilar lymph nodes are unchanged. The reference precarinal lymph node measures 1.7 x 0.7 cm (image 45, series 3) compared to 1.8 x 0.8 cm previously.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The hepatic parenchyma enhances homogeneously, without evidence of a focal lesion. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of hydronephrosis, hydroureter and nephrolithiasis. Bilateral accessory renal arteries are noted.RETROPERITONEUM, LYMPH NODES: Small portocaval lymph node is stable. No evidence of enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: Stable lipoma in the third portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered diverticula without evidence of diverticulosis.BONES, SOFT TISSUES: Cortical defect in the right ileum with sclerotic borders is unchanged since 2009 and likely benign in etiology. OTHER: No significant abnormality noted

Output: 1. Stable exam, reference measurements as above.2. Stable centrilobular emphysema.3. Cholelithiasis


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Status post lobectomy Diffuse bilateral interstitial opacities are stable and may again reflect edema. Right pleural fluid with scattered right airspace opacities could represent superimposed infection or aspiration but are stable. Right-sided chest tube with small right apical pneumothorax are also unchanged.

Output: Stable small right apical pneumothorax. Stable bilateral interstitial and airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: c/f pneumonia History: worsening SOB Persistent patchy basilar opacities suggestive of aspiration with underlying bronchiectasis. Heart size normal.No significant sized pleural effusions.

Output: Persistent basilar opacities suggestive of aspiration with underlying bronchiectasis. Superimposed infection is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.History of shortness of breath. Mild cardiomegaly with mild basilar predominant opacities consistent with small effusions and mild edema/atelectasis. No pneumothorax.

Output: Cardiomegaly with basilar opacities consistent with edema and small effusions.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of bladder cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild caliectasis of both kidneys, new on the left side and minimally increased on the right side. Bilateral small hypodensities in both kidneys, some of the more to small to accurate characterize but are most likely cysts.RETROPERITONEUM, LYMPH NODES: Stable aneurysmal dilatation of the proximal right common iliac artery measuring up to 2.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Stable neobladder. No bladder is significantly distended. This may explain the new caliectasis in both kidneys.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Distended neo bladder causing bilateral mild caliectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for etiology of R chest pain History: R chest pain after ACS in patient Wtih VOC/SCD Persistent right upper lobe airspace opacity, unchanged or slightly improved compared to previous.PICC line tip in the SVC.Moderate cardiomegaly and skeletal findings consistent with sickle cell disease.

Output: Right upper lobe airspace opacity with slight interval improvement.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: ETT eval History: trach Left chest tube with no pneumothorax.Unchanged pleural effusions with basilar consolidation right greater than left.Right PICC, tip at cavoatrial junction level.Tracheostomy tube tip 7 cm above the carina.

Output: Unchanged pleural effusions and basilar opacities. Tracheostomy tube tip 7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Left bundle branch block No interval acute cardiopulmonary change. Lungs remain clear.Moderate tortuosity of the aorta with an unremarkable cardiac silhouette. Midline sternotomy. Prosthetic heart valve and ICD unchanged

Output: No acute disease or postprocedural complication


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: 82M with pleuritic chest pain, getting V/Q to assess for PE. Need CXR within 24h History: ordering v/q scan No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Status post NGT placement for encephalopathy. Cirrhosis. NGT tip in the proximal stomach with sidehole at the GE junction. TIPS projects over the right upper quadrant. Sternotomy wires.Large right pleural fluid collection with significant associated atelectasis. Minimal pleural fluid on the left unchanged. Mild vascular redistribution and mild thickening of the fissures consistent with mild hypervolemia/CHF. Improved inflation of the left lung.

Output: NGT sidehole at the level of the GE junction, suggest slight advancement. No acute change in pleural fluid, atelectasis or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: infection and picc position History: sob Median sternotomy with mild cardiomegaly and the suggestion of basilar edema with underlying fibrosis.Small pleural effusions.No reliable evidence of infection.Left subclavian dual-chamber pacemaker, leads in appropriate position.No PICC identified.

Output: CHF with edema. No PICC identified.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: congestive heart failure History: SOB Lungs and pleural spaces are clear. The heart size is normal.

Output: No evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for interval change in IABP placement History: IABP Balloon catheter in the descending aorta with itscephalad marker at the level of the top of the aortic arch. ICD leads unchanged.No significant pulmonary abnormalities.

Output: Balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: IABP History: IABP Mild/moderate cardiomegaly and left basilar subsegmental atelectasis.No specific evidence of infection or edema.IABP repositioned, the proximal marker projected over the aortic arch.Left subclavian ICD, leads unchanged in position.Left jugular introducer.

Output: IABP repositioning, the proximal marker projected over the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: hx of bilateral renal masses, evaluate for disease History: see above Stable opacity in the right upper thorax, reflecting tortuous right brachiocephalic vessels as seen on prior CT.No visible pulmonary nodules.No new focal pulmonary opacity, pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with history of Sjogren's syndrome. History of carcinoid syndrome CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter nodule in the right middle lobe on image number 55, series number 9. Nonspecific pleural/subpleural densities predominantly in the left lower lobe.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous masses, best seen on arterial phase images replacing most of the liver parenchyma consistent with carcinoid cancer metastases. Index left lobe metastatic lesion measures 6.2 by 4.9 cm on image number 30, series number 6. These lesions become isodense to the liver on portal venous phase images. Arterial phase CT images or MRI is recommended for follow-up of these lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass measuring 2.8 x 2.6 cm on image number 52, series number 6. Right adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Peripancreatic adenopathy measuring 2.3 by 2.2 cm on image number 60, series number 6. Other retroperitoneal enlarged lymph nodes are also present.BOWEL, MESENTERY: There is an enhancing mass at the level of the terminal ileum/cecum measuring 2.2 x 1.4 cm on image number 87, series number 6. This likely represents patient's primary carcinoid tumor. A large adenopathy near this lesion measures 4.6 x 3.8 cm on image number 81, series number 6. and extends superiorly to the level of the uncinate process of the pancreas.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enhancing mass at the junction of cecum and terminal ileum consistent with carcinoid tumor. Associated metastatic mesenteric adenopathy, retroperitoneal adenopathy and numerous liver metastases.Left adrenal mass off indeterminate etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: pneumonia vs reactive airways History: sob The cardiopulmonary appearance is unchanged. No specific evidence of infection or edema.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: S/P thoracentesis today History: see above Right IJ central venous catheter tip again overlies the SVC and is slightly tortuous.Stable cardiomediastinal silhouette.Extensive bilateral COPD/emphysematous changes with bullous component. Mild interval decrease of interstitial prominence. Bibasilar pleural thickening with probably trace pleural effusions, decreased on the left. No pneumothorax.

Output: Bibasilar pleural thickening with probably trace pleural effusions, decreased on the left. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old. Right IJ venous catheter has been placed with its tip in the SVC.No evidence of a pneumothorax.Stable marked cardiac enlargement.The lungs are clear.

Output: Placement of right IJ venous catheter without complication. Severe cardiac enlargement unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Unintentional weight loss and smoking history evaluate for malignancy. Normal heart size. No visible lymphadenopathy. Calcified right hilar lymph nodes unchanged. No visible suspicious pulmonary nodules or masses. Eventration of the right hemidiaphragm. Degenerative changes of the spine with osteophyte formation.

Output: No visible pulmonary nodules or masses. If there is a high level clinical suspicion, CT may be obtained


Instruction: Generate impression based on medical findings.

Input: Patient with DGS, concern for spontaneous repositioning of stimulators Marked scoliosis without superimposed acute cardiopulmonary abnormality.Of particular note are 2 generators projected over both right and left upper lungs in which both devices have been exchanged since the prior study in 2010. It is difficult to determine or comment on whether there has been interval acute change such as totaling without prior for comparison.

Output: Bilateral upper chest wall stimulation devices as described


Instruction: Generate impression based on medical findings.

Input: New leukocytosis on BiPAP evaluate for pneumonia. Unchanged cardiomegaly, signs of hypervolemia, diffuse interstitial opacities, patchy basilar airspace opacities and consolidation, left greater than right. No pneumothorax.

Output: No acute change in cardiopulmonary appearance; basilar opacities may represent infection.


Instruction: Generate impression based on medical findings.

Input: 90 years old Male. Reason: fall History: above. Chronic appearing interstitial opacities are again noted. No specific evidence of acute superimposed abnormalities. No large pleural effusion or pneumothorax. Cardiomediastinal silhouette is stable. No evidence of rib fracture in the imaging field-of-view.

Output: Stable appearing interstitial opacities


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Reason: Line placement History: above Right lateral thorax has been excluded from view. Right IJ line terminates in the brachiocephalic vein. Guidewire is noted which coils within the right atrium. Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable mild interstitial pulmonary edema again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Right IJ line terminates in the brachiocephalic vein. Guidewire is noted which coils within the right atrium. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Hemoptysis. Per EMR: Patient reports significant occupational exposure to dust. No cardiopulmonary abnormalities.

Output: No cardiopulmonary abnormalities to explain episodic hemoptysis.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Shortness of breath. Left pleural effusion has decreased and are currently small bilaterally. Extensive bilateral interstitial and airspace opacities with cardiomegaly persist and may reflect edema or possibly infection. Right central line tip over the SVC. No pneumothorax.

Output: Some decrease in left pleural effusion. Cardiomegaly and extensive bilateral opacities otherwise persist and may reflect significant edema or possibly infection.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: s/p IABP please verify position History: s/p IABP New IABP catheter, the tip 3 cm below the top of the aortic arch.Cardiomegaly is present with mild basilar edema and large lung volumes.Left subclavian ICD, leads unchanged in position.IVC Swan-Ganz catheter tip in right interlobar pulmonary artery.

Output: New IABP catheter, placement appropriate.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old. Reason: pna?EFFUSION? History: sob Patchy pulmonary opacities with increasing retrocardiac and left upper lobe opacity. Multiple chest tubes in place without significant pneumothorax.Tracheostomy tube tip 4 cm above the carina.Interval removal of right central venous catheter.Left jugular introducer sheath remains in place with tip in the left brachiocephalic vein.NG tube is coiled in the stomach with tip in the gastric fundus.

Output: Increasing retrocardiac and left upper lobe opacities.Removal of right central venous catheter without significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: AM CXR History: AM CXR Unchanged right subpulmonic effusion with overlying atelectasis.Small lung volumes.Moderate cardiomegaly.

Output: No change in right subpulmonic effusion with overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Chest pain No new superimposed acute cardiopulmonary abnormality. Mild cardiomegaly with unchanged ICD and previously described leads.Lungs remain clear focal acute changes other than more chronic appearing interstitial opacities representing suspected old remote failure and scarring.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: infection? History: hypotension Increase in dense left lower lobe opacity. Small left pleural effusion again noted. Right lung remains clear. No pneumothorax.

Output: Increase in dense left lower lobe opacity consistent with consolidated lung and/or atelectasis. Small left pleural effusion again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.ET tube. ET tube tip is 4 cm above the carina. The enteric feeding tube tip is looped in the stomach with sidehole projecting over the gastric body and tip beyond the margin of the image. Esophageal temperature probe is at the GE junction. Patchy atelectasis and airspace opacities bilaterally are not significantly changed from prior.

Output: ET tube tip 4 cm above the carina.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: worsening hypoxia, eval for worsening pul edema or other process History: sob, hypoxia New near complete collapse of left lung likely from mucous plugging/bronchial obstruction.Bilateral pleural effusions are present as well as right basilar opacity.A Dobbhoff tube terminates in the stomach.

Output: New near complete left lung atelectasis from bronchial obstruction, most likely mucus plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Swan placement Right jugular Swan-Ganz catheter tip in the projection of the proximal right superior pulmonary artery.No pneumothorax.Unchanged cardiomegaly.Hazy opacity suggestive of mild pulmonary edema.

Output: Mild pulmonary edema. No pneumothorax. Swan-Ganz catheter tip in the projection of the proximal right superior pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with chest pain and pressure. Rule out PE. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Stable type A aortic dissection, which begins at the distal aspect of the ascending aorta and terminates near the origin of the celiac trunk, is stable. Aneurysmal dilatation of the thoracic aorta is stable when compared to prior exam.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Multiple subcentimeter hypodense hepatic lesions, which are too small to characterize, are reidentified.

Output: 1. No pulmonary embolus.2. Stable type A aortic dissection.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: New R PICC - check for placement for TPN History: PICC Small lung volumes with patchy basilar atelectasis, unchanged, possibly the result of aspirated secretions or mucous plugging.Right PICC, tip in the SVC.

Output: Stable basilar opacities. Right PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Desaturation Moderately decreased overall lung volumes, partially related to patient semiupright portable technique. Mild cardiomegaly with questionable suspected increased right-sided and left atrial enlargement.

Output: Nonspecific right basilar patchy opacity, concerning for possible aspiration or infection. Please correlate cardiac findings with recent ultrasound


Instruction: Generate impression based on medical findings.

Input: Enteric tube placement Enteric tube seen extending to level of gastric antrum. Mildly dilated small bowel noted centrally in abdomen. Air seen distally in colon. Pelvis excluded on current exam. Please refer to same day chest radiography for additional findings.

Output: Enteric tube as above.Findings suggestive of partial SBO versus ileus.


Instruction: Generate impression based on medical findings.

Input: Reason: volume overload History: sob Moderate cardiomegaly with small lung volumes.Perihilar streaky opacities suggestive of scarring and subsegmental atelectasis, not significantly changed.No specific evidence of pulmonary edema or pleural effusion.

Output: Cardiomegaly and chronic pulmonary abnormalities with no acute change.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with past medical history of time cancer and history of menstrual bleeding CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter nodular opacity in the left fissure likely representing intrapulmonary lymph node.Unchanged from prior study.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific punctate hypodense lesion in the caudate lobe of the liver on image number 88, series number 3, too small to accurately characterize but likely benign. Subcapsular lesion in the left lobe measuring 2 x 2.2-cm image number 73, series number 3 is unchanged.SPLEEN: Nonspecific punctate hypodensity in the spleen most likely benign.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Endometrial stripe is dilated. Correlation of this finding with pelvic ultrasound and menstrual history is recommended. Right ovarian cyst measuring 3 x 1.7 cm.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: Well-defined hypodense lesion in the left lobe of the liver is unchanged. MRI of the liver may be helpful for further characterization.Dilated endometrial stripe and right ovarian cyst. Pelvic ultrasound and/or histologic sampling may be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old Reason: lung infiltrate History: chest pain Normal heart size with aortic calcifications. Large lung volumes with flattened diaphragms consistent with COPD. No specific evidence of infection or edema. Nonspecific left apical pleural thickening.

Output: COPD without superimposed infection.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: r/o infiltrate History: cough; malaise Interval development of left basilar opacity representing atelectasis or infection.Heart size at upper limits normal.No pneumothorax. No pleural effusion.

Output: Nonspecific left basilar opacity representing infection or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: assess for infection History: bradycardia Cardiomegaly, unchanged. There is no evidence of acute infiltrate, pleural effusion or pneumothorax. ASD closure device unchanged in position.

Output: No evidence of pneumonia. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with appendiceal carcinoma CHEST: Right thyroid nodule is unchanged.LUNGS AND PLEURA: Mild emphysematous changes.MEDIASTINUM AND HILA: No adenopathy. The pulmonary artery remains dilated, consistent with pulmonary arterial hypertension.Dense coronary artery calcifications. Calcifications affecting the aortic arch.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged without focal lesion. Borderline peritoneal thickening around the liver remains. The bile ducts are at the upper limit of normal status post cholecystectomy.SPLEEN: A few small splenic hypodensities are stable.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst, stable. Scattered scarring affects both kidneys, left greater than right.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 17 x 12 mm (series 3, image 96), not significantly changed when remeasured (previously 16 x 12 mm). Reference intra-aortic caval lymph node measures 15 x 10 mm (series 3, image 105), previously 15 x 12 mm.Few scattered mesenteric nodes remain.BOWEL, MESENTERY: Evidence of prior bowel resection.Focal, concentric narrowing of the mid transverse colon (series 3, image 108) is noted. No evidence of obstruction is seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evidence of prior bowel resection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of new disease.Focal, concentric narrowing in the mid transverse colon. Colonoscopy may be beneficial for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: ETT pulled back, re-evaluate position History: see above Mild/moderate interstitial opacities left greater than right, unchanged.ET tube tip approximately 1 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Low ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Hypoxemia. Unchanged pericardial drain.Additional support devices are unchanged.Diffuse pulmonary opacities compatible with edema, similar to prior.Unchanged cardiomegaly.

Output: Diffuse pulmonary opacities compatible with edema, similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old. Catheter tip in the SVC.No pneumothorax or other complications.Nonspecific basilar opacity consistent with atelectasis, consolidation and possibly small effusions.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Reason: neutropenic fever History: fever Normal cardiac and mediastinal silhouette except for a moderate dextroscoliosis.Catheter tip in the SVC.Surgical clips in the area of the left axilla.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Dyspnea. Productive cough. Cardiomegaly stable. Right infrahilar opacity is stable. Linear left retrocardiac atelectasis or small consolidation slightly progressed. No pneumothorax.

Output: Small retrocardiac opacity slightly progressed and could represent atelectasis or possibly small consolidation. Otherwise stable chest.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Acute on chronic chest pain No specific evidence of pneumonia. Soft tissue retrocardiac opacity on the lateral view may correlate with varices seen on recent CT scan. Unremarkable cardiomediastinal silhouette. No pleural effusion or pneumothorax. No signs of pulmonary edema. Cholecystectomy clips.

Output: 1. No specific evidence of pneumonia or other acute pulmonary abnormality2. Faint retrocardiac opacity on the lateral view may correlate with distal esophageal varices seen on recent CT scan.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with shortness of breath and history of COPD. Evaluate for worsening of edema/effusion. Stable moderate cardiomegaly.Near resolution of right lung base opacity with some residual multifocal bibasilar subsegmental atelectasis/consolidation.Improvement of bilateral pleural effusion with residual small left pleural effusion.ICD is unchanged in position.

Output: Improving bibasilar multifocal opacities and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval for pneumonia, pulm edema History: shortness of breath, on bipap, known asthma and +smoker No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Assess for foreign objects intraoperatively. No unexpected radio opaque foreign objects.ET tube 3 to 4 cm above the carina. Low lung volumes. Right IJ central venous catheter, tip in the SVC.Mild bilateral atelectasis present.Bilateral chest tubes in place, no evidence of pneumothorax.

Output: These findings were discussed by telephone with OR nurse. Attending physician was paged on 8/26/2015 4:15 PM.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: severe dyspnea, query recurrent pleural effusion R History: dyspnea Extensive pulmonary metastases, possibly progress.Decreased lung volumes since the prior study with basilar opacities suggestive of edema with small pleural effusions.Right jugular catheter, tip at SVC/RA junction level.

Output: Pulmonary metastasis, possibly progress, and or increased superimposed edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: ACS History: CP/SOB Cardiomegaly with diffuse interstitial opacities and small pleural effusions.No specific evidence of infection.Shot fragments are projected over the upper chest and neck.

Output: CHF with cardiomegaly, pulmonary edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: hx of CHF, pleuritic CP and SOB History: hx of CHF, b/l LE edema Mild right basilar scarring or subsegmental atelectasis.Heart size normal.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: AI, MR. Moderate left and very small right pleural fluid collections with associated atelectasis. Mild chronic interstitial lung abnormality with perhaps minimal pulmonary edema.

Output: Heart size unchanged. Mild CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: 94F acute hypoxia, dyspnea History: hypoxia, SOB Dense opacity in the right upper lobe compatible with pulmonary consolidation or mass, unchanged since the previous day but new since 10/3/2014.Heart size about upper normal with a heavily calcified aorta compatible with age.Calcified right infrahilar lymph nodes compatible with previous infection.

Output: Dense right upper lobe opacity, compatible with pneumonia, infarct or mass. The differential diagnosis includes pulmonary embolism. Continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Lung resection in January, 2016 (adenocarcinoma). Right hemithorax volume loss with elevation of the right hemidiaphragm. The right lower lobe is better expanded compared to the prior radiograph with some remaining linear atelectasis. Nonspecific mild fullness along the right perihilar suture line, most likely postoperative.

Output: Improved right lung expansion and no specific signs of localized recurrence. Please refer to subsequent CT.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pain Mixed interstitial airspace opacities throughout all 4 quadrants with a grossly unremarkable cardiac and mediastinal contour. The distinct moderate to large effusions although small fluid collections cannot be excludedMidline sternotomy. Tracheostomy tube terminates 7 cm above the carina. Right jugular single port extends into the mid SVC

Output: Nonspecific multiple patchy opacities throughout all 4 quadrants suggesting multifocal infection over edema in the absence of additional findings of failure


Instruction: Generate impression based on medical findings.

Input: 84 year old with right upper lobe nodule. Assess for interval change. LUNGS AND PLEURA: 8 by 8mm right upper lobe nodule, unchanged from earlier scans dating back to at least 4/17/2008, very probably benign.Additional micronodules, unchanged.Mild chronic interstitial abnormalities at the lung bases.MEDIASTINUM AND HILA: No significant lymphadenopathy.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Right renal cyst and small adrenal nodules, probably benign.

Output: Stable right upper lobe nodule, almost certainly benign.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Cough The cardiac and mediastinal contours are within normal limits.The right cardiac contour is partially obscured secondary to asymmetric pectus excavatumThe lungs and pleural spaces are within normal limits.No displaced fractures are noted. Pectus excavatum, as an anatomic variant is noted.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: ? PNA History: SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: cough History: cough The cardiac mediastinal silhouette is unremarkable.The lungs are clear.Old right rib fracture deformities unchanged.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with an abnormal chest x-ray LUNGS AND PLEURA: Extensive branching serpiginous opacities extending from the right perihilar region compatible with a large bronchocele. An endobronchial mass is identified within the right mainstem bronchus . This is a low density suggesting this may represent mucous plugging however neoplasm cannot be excluded. Diffuse tree in bud opacities are noted within the right upper lobe.Multiple scattered calcified granulomas.Focal area of pleural and parenchymal scarring in the left lower lobe.Right upper lobe pulmonary cyst.MEDIASTINUM AND HILA: Mildly prominent paratracheal lymph nodes without definite evidence of lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Right upper lobe bronchocele with an obstructing lesion within the right mainstem bronchus possibly representing mucus plugging. The differential diagnosis would include allergic bronchopulmonary aspergillosis as well as an endobronchial mass.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: et tube position History: et tube Lines and tubes are unchanged. No new focal lung opacities. Unchanged heart size. No pneumothorax.

Output: No substantial difference.


Instruction: Generate impression based on medical findings.

Input: Static breast cancer CHEST:LUNGS AND PLEURA: Minimal left up apical scarring. Tiny nodule in the right upper lobe is stable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic hemangiomas are unchanged. The reference segment 8 lesion in the liver is unchanged. However the lesion in segment 6 (image number 106, series number 3) larger and better well seen measuring 4 x 2.4 cm. Same lesion was measuring 3.6 x 1.7 cm on previous study image number 103, series number 4.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 evidence of enlarged retroperitoneal lymph nodes. Again noted multiple nonenlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Enema shows stripe is dilated. Further evaluation with pelvic ultrasound is recommended.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple blastic lesions noted in the vertebral bodies, pelvic bones are unchanged. Mild compression deformity of T5 vertebral body.OTHER: No significant abnormality noted.

Output: Extensive vertebral body and other bone metastases are unchanged.Slight interval increase in the hepatic metastases. Chest findings are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Cough and fever question infiltrate Elevation of the right hemidiaphragm. Architectural distortion, nodules and calcified hilar lymphadenopathy in a pattern consistent with known sarcoidosis. No new opacities are appreciated to suggest infection. Degenerative changes of the spine. Normal heart size.

Output: No visible signs of pneumonia. Sensitivity for detection of pulmonary infection is limited by underlying sarcoidosis. CT would be more sensitive.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Chest pain. Central venous catheter tip is in the right atrium. Stable cardiomegaly. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: Cardiomegaly without acute cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: s/p right chest tube removal r/o ptx History: s/p right chest tube removal Bilateral pleural effusions with mild basilar edema and left lower lobe consolidation, unchanged.No pneumothorax following right chest tube removal.Right jugular catheter traverses a stent terminating at the cavoatrial junction.

Output: No pneumothorax following right chest tube removal with stable pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: R/o pneumonia History: COPD exacerbation Right middle lobe opacity consistent with pneumonia.Heart size normal.Large lung volumes are consistent with COPD.

Output: Right middle lobe opacity consistent with pneumonia versus atelectasis from mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Dyspnea evaluate pleural effusion. Right pleural catheter tip near the apex. Right chest tube tip at the SVC level. Moderate right pleural fluid collections significantly improved in volume, no measurable pneumothorax. Allowing for patient rotation and mediastinal shift, the right upper lobe opacity inseparable from the hilum is unchanged. There is a spiculated nodule in the peripheral left lung which is also unchanged.

Output: Moderate right pleural effusion. Right upper lobe/hilar mass and left lung mass are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Heart failure. Evaluate line positions. IABP is unchanged in position, with the radiopaque marker located approximately 8 cm below the aortic arch. Stable position of left chest wall ICD and leads and Swan Ganz catheter. Unchanged mild cardiomediastinal enlargement. Left basilar heterogeneous opacities are unchanged, probable small effusion and adjacent subsegmental atelectasis.

Output: 1. IABP is unchanged in position, with the radiopaque marker located approximately 8 cm below the aortic arch.2.Probable small left pleural effusion and adjacent subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Sepsis Interval increasing diffuse patchy mixed interstitial and airspace opacities greater both bases and on the right.Left jugular catheters, NG and tracheostomy tube are otherwise unchanged

Output: Continued progression of diffuse bilateral opacities greater perihilar and right distribution. Suspected edema, however infection cannot be excluded


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: chest pain Unremarkable cardiomediastinal silhouette. Low lung volumes. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: Low lung volumes without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Shortness of breath History: coughing black The heart size is normal. The lungs are clear. No pleural effusion or pneumothorax. Stent in the left coronary artery.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male status post left thoracotomy with evacuation of hemothorax and removal of one chest tube. Endotracheal tube tip is approximately 6 cm above the carina.Enteric tube tip extends beyond the lower margin of the submitted radiograph.Interval removal of one left-sided chest tube without significant pneumothorax.Remaining support devices are unchanged.Cardiomediastinal silhouette is unchanged.Persistent left pleural effusion, right basilar subsegmental atelectasis and mild edema.Subcutaneous emphysema of the neck is again noted.

Output: Interval removal of one of the left-sided chest tubes without evidence of a significant pneumothorax. Persistent left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Metastatic renal CAD with brain METs status post ureteral stent placement last month hydronephrosis. Please evaluate stent placement and possible masses or and mediastinum and (lump ?). CHEST:Lack of IV contrast makes evaluation of the mediastinal nodes for measurement difficult.LUNGS AND PLEURA: There are moderate-sized bilateral pleural effusions which are new. There are a few scattered basilar lung nodules some with cavitation. These are not new. For example left base series 4 image 61. Right base series 4 image 52. Interstitial changes seen elsewhere particularly of focally in the right upper lobe. Minimal emphysematous changes.There is decrease of the previously seen pericardial effusion.MEDIASTINUM AND HILA: Grossly mediastinal nodes are stable but difficult to accurately measure. Index right paratracheal node with some calcification seen in series image 38 measures 1.2 x 1.2 cm. Right hilar node previously measured cannot be accurately differentiated from surrounding vessels for measurement purposes.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN: Exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal mass series 3 image 100 measures 4.1 x 3.7 cm.KIDNEYS, URETERS: Left nephroureterostomy stent in place.There is new right sided mild to moderate hydronephrosis without hydroureter. Few punctate calcifications right kidney consistent with nephrolithiasis lower pole.RETROPERITONEUM, LYMPH NODES: New caval filter. Scattered retroperitoneal nodes grossly stable. Index node in the left periaortic area cannot be accurately measured due to the anasarca and lack of IV contrast. The distal left periaortic node just above the pelvic inlet series 2 image 144 measures 1.5 x 1.2 cm.BOWEL, MESENTERY: Postsurgical changes. No evidence of obstruction. Small amount of generalized ascites which is new.BONES, SOFT TISSUES: Generalized anasarca no.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Seminal vesicle calcification.BLADDER: Nephroureterostomy catheter in place. Thick bladder wall.LYMPH NODES: Scattered lymphadenopathy grossly stable. The index left external iliac node is estimated on series 3 image 179 to measure 1.7 x 1.6 in.BOWEL, MESENTERY: Postsurgical changes. Ostomy right lower quadrant.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted

Output: New pleural effusions, ascites, anasarca. New right-sided hydronephrosis with no hydroureter. Left nephroureterostomy stent in place. No caval filter. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: State patient self extubated and then re-intubated Minimal repositioning and advancement of the ETT, currently tip projects 2 cm above the carina. Remaining chest tubes, support cardiac catheters are all otherwise unchanged.Cardiomegaly with underlying compression of the left lower lobe and small effusions similar

Output: ETT replaced and in proper position


Instruction: Generate impression based on medical findings.

Input: 49 years, Male. Reason: r/o ileus or obstruction Diffuse gaseous distention of loops of small and large bowel compatible with ileus. No evidence of free air on supine views. Please refer to same-day chest radiograph report for thoracic findings.

Output: Diffusely distended loops of small and large bowel compatible with ileus. Please refer to subsequent CT abdomen/pelvis for additional details.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: evaluate for pneumonia History: cough x 4 weeks, international travel last month Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: r/o acute chest History: L sided chest pain, h/o sickle cell Basilar scarring consistent with known sickle cell disease.Heart size normal.No evidence of infection or infarction.Azygos pseudo-lobe, normal variant.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: 59 y/o F with mid-sternal chest pain History: mid-sternal chest pain No change in cardiomegaly and tortuous aorta. Known small high density pericardial effusion was better evaluated on recent CT. Small left pleural effusion stable. Left basilar atelectasis.

Output: No change in cardiomegaly and tortuous aorta. Known small high density pericardial effusion was better evaluated on recent CT. Small left pleural effusion stable. Left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Respiratory distress on bipap, no known past medical history, eval for infection/edema Low lung volumes. Elevation of the right hemidiaphragm with bibasilar atelectasis. Diffuse bronchial wall thickening. The cardiomediastinal silhouette is unremarkable. No pleural effusion or pneumothorax.

Output: Diffuse bronchial wall thickening, consistent with asthma.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA, hx COPD History: CP Unremarkable cardiac and mediastinal silhouette. Large lung volumes consistent with COPD.Mild scarring at the left base but no sign of pneumonia.

Output: COPD with no acute disease.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: pneumonia? History: cough Upper lung preponderant reticulonodular opacities again noted, difficult compared to CT. No new focal lung consolidation. Normal heart size. No large pleural effusion or pneumothorax.

Output: Upper lung preponderant reticulonodular opacities consistent with sarcoidosis. It is difficult to compare to previous CT scan.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: hx of metastatic renal cell carcinoma, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Cough, fever, abnormal lung sounds in the right lower lung. The cardiomediastinal silhouette is within normal limits. No focal airspace opacity, significant pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: status post intubation History: status post intubation ET tube tip near thoracic inlet. This is been advanced on subsequent study.NG tube tip in stomach. Patchy multifocal pulmonary opacities are unchanged.

Output: ET tube tip near thoracic inlet. This is been advanced on subsequent study.


Instruction: Generate impression based on medical findings.

Input: Reason: eval effusion, ptx History: dyspnea Moderately large right pleural effusion with underlying opacity compatible with atelectasis.No pneumothorax.Ventriculopleural shunt in place.

Output: Moderately large residual right pleural effusion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Tachycardia Mildly diminished lung volumes, however this may be secondary to portable technique. No cardiopulmonary abnormality observed

Output: Normal for technique


Instruction: Generate impression based on medical findings.

Input: Reason: NGT in place? History: NGT replaced NG tube extending to the stomach with its tip doubled back in the area of the gastric antrum.ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Right aortic arch and nonspecific airspace opacity without significant interval change.

Output: NG tube tip doubled back in the gastric antrum.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Study is limited by large patient body habitus. Lines and tubes are unchanged. Unchanged bibasilar opacities and pleural effusions. Unchanged heart size. No pneumothorax. Focal nodular opacity again noted in the mid aspect of the right lung.

Output: No substantial change.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.DKA rule out pneumonia. Normal heart size. No focal airspace opacities, visible pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Wheezing. Left cardiac contour abnormality is new from previous. This is lower than expected for the left atrial appendage and is nonspecific but could indicate partial absence of the pericardium.No pleural fluid or pneumothorax. Very subtle reticulonodular appearance of the lung parenchyma may be the result of smoking related lung disease, such as respiratory bronchiolitis, but is beyond resolution for accurate characterization by plain film technique. Mild bronchial wall thickening consistent with bronchitis. Probable chronic endobronchial debris in the right upper lobe

Output: Mild chronic bronchial wall thickening and a subtle chronic interstitial abnormality are most likely the result of smoking related lung disease. No evidence of pneumonia. Interval development of a subtle left cardiac contour abnormality of indeterminate etiology but suggestive of partial absence of the pericardium; this may be further assessed with enhanced CT if required.


Instruction: Generate impression based on medical findings.

Input: 70 old male with history of bladder cancer with liver lesions. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Subcentimeter pretracheal lymph node on image number 23, series number 4.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: This study is severely limited for evaluation of the liver lesions do to lack of IV contrast. However, there are multiple large liver lesions that are slightly hypodense compared tourists of the liver. One of them measures 8.5 x 8.0-cm on image number 76, series number 4. This lesion cannot optimally measure to characterize and lack of IV contrast. Other smaller liver lesions are enlarged and there are other multiple the liver lesions. Further evaluation of the liver with MRI is recommended.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right hydronephrosis and dilated right ureter throughout its course is unchanged.RETROPERITONEUM, LYMPH NODES: Reference peripancreatic lymph node measures 18 x 11 mm in image number 86, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Pelvis images are limited due to metal artifacts from the right hip prosthesis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy. Neobladder with ileal conduit.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left inguinal hernia containing unobstructed sigmoid colon. Small perincisonal hernia containing nonobstructing small bowel segments. Right lower quadrant ileostomy.BONES, SOFT TISSUES: Fat stranding posterior to the sacrum which may be secondary to decubitus ulcers. Clinical correlation is recommended.OTHER: Small amount of free fluid in the pelvis.

Output: A significant interval increase in the size and number of the liver lesions suspicious for metastatic disease. These lesions cannot be optimally evaluated on this noncontrast CT. right-sided moderate hydronephrosis and right hydroureter unchanged.Midline perincisonal and left inguinal hernia sacs containing unobstructed bowel segments.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reevaluate left lower lobe pneumonia. Possible pneumonia seen on CT status post antibiotic course. Interval near complete clearing of left retrocardiac opacity, with bilateral basal scarring. Hardware and devices unchanged. Persistent subpleural atelectasis in the posterior aspect of the left upper lobe abutting the fissure.

Output: Interval improvement in left lower lobe consolidation, though it has not completely resolved. Additional follow-up recommended in 6 weeks with PA and lateral technique chest radiographs.


Instruction: Generate impression based on medical findings.

Input: Epigastric pain Nonobstructive bowel gas pattern. Average stool burden. Lumbosacral spinal degenerative disease.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Patient has increased shortness of breath with possible increased right sided pleural effusion. History: Patient has pleural mesothelioma. Stable cardiomediastinal silhouette.Grossly stable extensive right-sided pleural and fissural nodular thickening in keeping with patient's history of mesothelioma.Slight increase of septal thickening involving the left lung base and retrosternal region. Left lung is otherwise grossly unchanged.No acute osseous abnormalities.

Output: 1.Grossly stable pronounced right-sided nodular pleural thickening with no evidence of significant pleural effusion.2.Mild increase in interstitial prominence at the left lung base and correlate with concern for mild interstitial edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: New hypoxia- determine etiology History: hypoxia Increased bilateral diffuse opacity suggestive of edema with moderate pleural effusions.Calcified nodule in the right lower lung consistent with a healed granuloma.Unremarkable cardiac and mediastinal silhouette.

Output: Findings suggestive of pulmonary edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: post thoracentesis, r/o PTX History: post thoracentesis Port catheter terminates just below the cavoatrial junction. Increase in small to moderate size right pleural effusion with right basilar atelectasis. Left lung remains clear. Unchanged heart size. No pneumothorax.

Output: Increase in small to moderate size right pleural effusion with right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for pneumonia. Pt is immunosuppressed History: Subjective fevers Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.SOB and pain with deep inspiration. Assault. Evaluate for rib fracture or pneumothorax. A piercing projects over the mandible to the right of midline, presumably in the soft tissues.Normal heart size. No pneumothorax or focal pulmonary opacities. Minimal basal atelectasis on the right.No grossly displaced rib fractures are appreciated, however please refer to separately reported rib series if the limitations of technique for assessment of skeletal pathology.

Output: No acute pulmonary abnormality. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of colon cancer CHEST:LUNGS AND PLEURA: Diffuse bilateral pleural thickening, stable. These findings are suggestive of previous asbestosis exposure. No lung nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic right kidney, unchanged.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm is stable measuring 3.6 cm on image number 133, series number 3. Index left para-aortic lymph node is stable measuring 1.2 x 0.8 cm on image number 116, series number 3.BOWEL, MESENTERY: Status post right hemicolectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for pneumothorax History: S/P CHest tube removal Interval removal of chest tubes with no significant pneumothorax.Postoperative mediastinal widening, unchanged.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: Small pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Preop TECAB, coronary artery disease, latent TB infection The lungs are clear. The heart size is normal. No pleural effusions or pneumothorax.

Output: No cardiopulmonary disease.