Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: ETT eval History: intubated Support tubes and lines unchanged.Slightly decreased left pleural effusion and slightly increased to stable right pleural effusion. Basilar interstitial opacities persist.The cardiomediastinal contours are within normal limits for size.The imaged upper abdomen and skeleton are unremarkable.

Output: Shifting bilateral pleural effusions with stable associated basilar interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: 25 year-old female with pleuritic chest pain on the right side. Evaluate for PE. PULMONARY ARTERIES: Technically adequate exam. No evidence of pulmonary emboli.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of pulmonary emboli. No specific radiographic findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Non-Hodgkin's lymphoma. Reevaluate and compare previous. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. Minimal bibasilar atelectasis or scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Subcentimeter subcarinal lymph node Heart size normal without pericardial effusion. Coronary artery calcifications as noted previously.CHEST WALL: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating left renal cyst. Nonobstructing bilateral renal stones.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta and iliac arteries. Numerous small retroperitoneal lymph nodes appearing similar to prior study. Reference aortocaval lymph node (series 3; image 142) measures 0.8 x 1 cm (stable). Subtle infiltration of the fat along the origins of the celiac and superior mesenteric arteries as noted previously.BOWEL, MESENTERY: Sigmoid diverticulosis. Unchanged reference mesenteric lymph node with punctate calcifications (series 3; image 117) measures 1.5 x 1.9 cm.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Sigmoid diverticulosis.BONES, SOFT TISSUES: Lumbar spine fusion.

Output: Stable exam with reference measurements given above.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: chest pain, hgbs/thal History: chest pain A single lumen of the right port is currently accessed. The catheter remains in stable position.The patient is slightly rotated to the right. Cardiomediastinal contour is unchanged. Septal thickening may represent atelectasis or scar. Blunting of the costophrenic angles chronic. No interval edema or evidence of infection.

Output: Acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Status post pacemaker rule out pneumothorax. Left subclavian ICD with new pulse generator and new coronary sinus branch lead. Cardiomegaly with interval increase in right atrial dilatation since prior study as well as signs of hypervolemia and mild edema. No visible pneumothorax.

Output: No pneumothorax. Interval dilatation of the right atrium with signs of pulmonary venous hypertension and mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: eval hardware, cause of hypoxemia History: s/p OHT Support devices are unchanged.Cardiomegaly. Persistent mid to lower zone opacities of subsegmental atelectasis. No pneumothorax.

Output: No change in mid to lower zone subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Post intubation check tube. Endotracheal tube is not visualized.Moderate pleural fluid collections bilaterally with significant basal atelectasis and possible superimposed aspiration on the left, new from previous.Globular cardiomegaly unchanged.

Output: No endotracheal tube is identified. Moderate pleural effusions with basal opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Shortness of breath. History of right-sided breast cancer. Unremarkable cardiomediastinal silhouette.Bronchial wall thickening. Focal nodular right upper lobe opacities are again seen, suspicious for infection.Multiple right chest wall surgical clips.

Output: Nodular right upper lobe opacities suspicious for infection. If these do not resolve on follow-up imaging, evaluation with CT is recommended to exclude neoplasm


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Trip to IR with frequent patient turns. Endotracheal tube has been advanced with tip now 2-cm above the level of the carina. Left subclavian catheter and nasogastric tube unchanged in position. Right subclavian/brachiocephalic venous stent.Right lung with dependent atelectasis but otherwise clear. Moderate left pleural fluid collection appears decreased in volume with residual atelectasis in the lower lobe.

Output: Low endotracheal tube. Left pleural effusion decreased with improved aeration of the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Altered mental status. Low lung volumes with subsegmental atelectasis bilaterally. No conclusive focal airspace opacities. No pneumothorax. Clip or marker projects over the GE junction region.

Output: Patchy areas of subsegmental atelectasis, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for pneumonia History: SOB Large lung volumes suggestive of COPD.Mild bronchial wall thickening, but a faint nodularity seen on prior studies including a CT is no longer present.No specific evidence of infection.Unremarkable mediastinal contours and cardiac silhouette.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Central line placement. Hypotension. Left jugular catheter tip at the SVC level. Tracheostomy tube unchanged in position. Diffuse pulmonary opacities suggestive of ARDS with right hemithorax volume loss. No pneumothorax.

Output: Left jugular catheter tip at the SVC level, no pneumothorax. No acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: Eval prior ro TECAB History: Routine for TECAB on MOnday The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: assess for mediastinal mass, right neck fullness History: neck tightness, SOB Stable cardiomediastinal silhouette with borderline cardiac enlargement.No pleural effusions.

Output: Stable mild cardiac enlargement without acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with history of oral effusion s/p thoracentesis, evaluate for pneumothorax. Right pleural effusion decreased in size from prior exam post thoracentesis. Redemonstration of bilateral pulmonary nodules, hiatal hernia, and basilar scarring without interval change. Cardiomediastinal silhouette stable. No evidence of pneumothorax.

Output: No evidence of pneumothorax post procedure.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: r.o pna History: sob, cp, myalgias 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, 84 years old. History of partial nephrectomy. Assess for pulmonary metastases. Stable cardiomediastinal silhouette. Mild left basilar linear scarring/atelectasis. Apical pleural thickening bilaterally, unchanged from 2/2014. No suspicious pulmonary nodule. No pleural effusion.Right hemiabdomen surgical clips, unchanged.

Output: No radiographic evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of lung cancer presenting with right chest wall abscess with purulent drainage. Leukocytosis. Pleural effusion. CHEST:LUNGS AND PLEURA: Loculated right pleural fluid collection and overlying atelectasis and consolidation. Scarring and atelectasis also noted along the surgical suture lines in the right lower lobe with associated peribronchial thickening. Scattered micronodules (including 4-mm right upper lobe micronodule), unchanged.Paramediastinal and posterior pleural thickening on the right, also unchanged.2-mm nodule along the left major fissure is compatible with an intrapulmonary lymph node, unchanged.Mild linear scarring in the lingula.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 9 mm in short axis (unchanged). Heart size normal without pericardial effusion. Coronary and aortic calcifications.CHEST WALL: Fluid collection in the right chest wall is not completely within the field of view of this exam but has increased in size since prior study from 8/1/2001, measuring 12.4 cm in greatest AP dimension; previously measuring approximately 6 cm in greatest AP dimension. There is no associated rib destruction.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Marked interval increase in size of known right chest wall fluid collection since study from 8/1/2011.2. Loculated right pleural fluid collection and overlying atelectasis and consolidation as seen previously. A direct communication between the pleural fluid collection and the right body wall collection is suspected but cannot be confirmed via CT scan.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT, IABP, Swan placements History: as above ET tube tip approximately 4 cm above the carina.Balloon catheter tip projected 5.5 cm below the top of the aortic arch.Swan-Ganz catheter tip in the main pulmonary artery.Mild nonspecific basilar opacities compatible with atelectasis and small effusions.

Output: ET tube and aortic balloon catheter in appropriate position with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: please assess for improvement in suspected fungal/bacterial pneumonia History: dyspnea Tunneled right IJ catheter tip in the central SVC.Bilateral pulmonary opacities have improved significantly.No pleural effusion or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: Persistent but significantly improved bilateral pulmonary opacities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Balloon pump in place. Cardiomyopathy. IABP marker projects 3.8 cm below the top of the aortic arch. Left internal jugular Swan-Ganz catheter tip at the right main pulmonary artery. Presternal ICD in place.No convincing evidence of pulmonary edema. Basal atelectasis and scarring similar to prior.Cardiothoracic ratio unchanged.

Output: IABP marker about 3.8 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: pna? History: hypotension Moderate to severe cardiomegaly and a tortuous aorta unchanged.Small lung volumes.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiac History: palpitations Small lung volumes with basilar opacity, greater on the left, compatible with pleural effusions and atelectasis, not significantly changed.Interval removal of a right subclavian catheter. Left jugular catheter with its tip at the SVC/RA junction.

Output: Pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Line exchange cordis to TLC right IJ. Swan-Ganz catheter has been removed. Right jugular catheter tip in the cranial aspect of the right atrium. Right chest port and left subclavian ICD unchanged in position; and atrial pacemaking lead is directed inferiorly and could be displaced.Large right pleural fluid collection, slightly improved. Unchanged cardiomegaly. Airspace opacity and atelectasis in the right upper lobe about the same. Left retrocardiac opacity most likely reflecting atelectasis, unchanged. Left pleural fluid has nearly resolved.Possible 3 mm right apical pneumothorax.

Output: Right jugular catheter tip in the cranial aspect of the right atrium. There may be a tiny, 3 mm right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Worsening pleural effusion. Pericardial drain has been removed. Cardiothoracic ratio remains enlarged and the configuration is consistent with residual pericardial fluid. Moderate right and moderate to large left pleural fluid collections with associated atelectasis about the same. Significant retrocardiac atelectasis on the left.

Output: Increase in pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: NG placement ETT remains 5 cm above the carina. NG remains unchanged in position and appears mildly redundant and tortuous esophagus, tip projected above the GE junction.Underlying cardiopulmonary appearance otherwise unchanged

Output: NG unchanged in position


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Boerhaave's syndrome and esophageal perforation History: 5 months s/p L open and decortication, distal esophageal repair, and R VATS decortication Left basilar scarring.The lungs are otherwise unremarkable.Mediastinum unremarkable except for a esophageal clip.

Output: Left basilar scarring, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: port placement History: port placement Increasing right upper lobe consolidation consistent with infection or aspiration, with stable airspace opacities elsewhere.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: Increased right upper lobe consolidation consistent with progression of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval lung fields History: respiratory insufficiency No significant change in bilateral lung opacities with right upper lobe atelectatic changes. No change in pleural effusions. Line position stable.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: as above New tracheostomy tube with its tip about 4 cm above the carinaCatheter tip in the SVC.Mild basilar atelectasis.

Output: New tracheostomy tube with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.History: End-stage renal disease, preoperative kidney transplant evaluation. Unremarkable cardiomediastinal silhouette. Cardiomegaly and mild vascular redistribution seen on prior radiograph has resolved.Scattered calcified nodules, likely representing prior granulomatous disease, unchanged in appearance.No new pulmonary opacity.No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 96 years old.Reason: eval for aspiration or infection History: sob, leukocytosis Small lung volumes with left basilar scarring and prior granulomatous disease.Heart size normal.No specific evidence of infection or edema.Vascular calcifications noted in the neck.Numerous splenic granulomata are likely from prior histoplasmosis.

Output: No specific evidence of infection or edema. Small lung volumes with left basilar scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: concern for pneumonia History: SOB No significant cardiopulmonary abnormality.Healed granulomatous disease but no evidence of active infection.Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pneumothorax History: SCLC Cardiomegaly with pleural effusions and underlying atelectasis. Extremely minimal residual pneumothorax at the margin of the lung about 2 mm in the chest wall at the right upper lobe.Port catheter tip in the area of the SVC and esophageal stent in place.Embolization coil projected over the right hilar area.No new findings.

Output: Large pleural effusions and underlying atelectasis, with minimal residual right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT and DHT placement History: s/p subclavian IABP placement ET tube tip approximately 2 cm above the carina. Dobbhoff tube tip in the area of the gastric antrum.Other devices and asymmetric pulmonary opacity, unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Non-Hodgkin's lymphoma. Status post autologous stem cell transplant on 4/7/08. Restaging. CHEST:LUNGS AND PLEURA: Calcified granuloma in the left lower lobe is unchangedMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter ill-defined lesion within segment 7 of the liver is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 97 years old.Reason: SOB, Afib with RVR History: as above No change in bilateral pleural effusions and basilar consolidation left greater than right.Moderate cardiomegaly.

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


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ett repositioning History: as above Interstitial opacities suggestive of edema with pleural effusions, unchanged.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: eval effusions, pneumothorax History: increased O2 Lower lung zone opacities with pleural effusions are unchanged.ET tube tip at the level of the thoracic inlet.An NG tube terminates in the stomach, the side port above the hemidiaphragm level.Right jugular catheter, tip in SVC.

Output: No significant pneumothorax. Stable pleural effusions and pulmonary opacities, and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: iabp History: iabp Moderate cardiomegaly, with lower lung zone edema and pleural effusions consistent with CHF.Right subclavian catheter tip in right brachiocephalic vein.Left jugular catheter tip in left brachiocephalic vein to the left of midline.IABP catheter proximal marker projects over the aortic arch, unchanged.

Output: Cardiomegaly with pulmonary edema and pleural effusions consistent with CHF. Unchanged IABP catheter and other support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.COPD on home O2 with productive cough and mild respiratory distress. Large lung volumes with flattening of the diaphragm consistent with provided history of COPD. No focal airspace opacities. Mild bronchial wall thickening on the right. No pleural fluid. Normal heart size.

Output: COPD with bronchial wall thickening, but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Normal pressure hydrocephalus SHUNT DEVICE: An intracranial shunt exits the skull through a right frontal burr hole and courses down the right anterior scalp, neck, and anterior chest before entering the abdomen and terminating in the right lower quadrant. A portion of the shunt overlying the skull is relatively radiolucent and hence difficult to evaluate however we see no complications of the remaining shunt. The notch of the pressure valve points posteriorly.SKULL: Additional burr holes are noted within the calvarium.CERVICAL SPINE: There is degenerative disc disease and facet joint osteoarthritis of the cervical spine. Carotid calcifications are noted in the soft tissues of the neck.CHEST: There is hypoinflation of the lungs with elevation of the right hemidiaphragm. Streaky opacities within the base of the lungs may reflect scarring or atelectasis. There is orthopedic fixation of the T10 and T11 vertebral bodies and there is mild multilevel degenerative disc disease of the remaining thoracic spine.ABDOMEN: The bowel gas pattern is nonobstructive. There is degenerative disc disease of the L1-L2 and L5-S1 levels.

Output: Shunt device as described above with no evidence of complication.


Instruction: Generate impression based on medical findings.

Input: 70 year old male with metastatic bladder cancer. Status post 4 cycles of chemotherapy. 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: 13 x 13 mm enhancing mass in the uncinate process of the pancreas is unchanged.ADRENAL GLANDS: Stable subcentimeter left adrenal nodule.KIDNEYS, URETERS: Left kidney is absent. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy with neobladder.BLADDER: Status post cystectomy. LYMPH NODES: Right external iliac lymph node is unchanged measuring 15 x 7 mm image number 141.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic lesion with sclerotic margin and break in cortex in the right ischium is unchangedOTHER: Left-sided pelvic soft tissue mass containing calcifications is smaller measuring 2 x 2 cm image number 192.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Age: 36 yearsGender: FemaleReason for Study: Reason: eval for infiltrate History: productive cough x1.5 mths, active smoker The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: vomiting, abd pain. PNA? History: vomiting Mild elevation of left hemidiaphragm again noted. Bibasilar reticulation, as before. Heart size again appears upper limit of normal.Small pleural effusions. No pneumothorax. Loop recorder device again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: hx of kidney cancer s/p right open partial nephrectomy, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval ETT History: eval ETT ET tube tip approximately 5 cm above the carina.An endoscope extends below the lower margin of the image.Chronic appearing left hemidiaphragm elevation noted.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for infiltrates, edema History: S/p cardiac arrest, hypoxia ET tube tip approximately 6 cm above the carina.Catheter tip in the SVC.Severe cardiomegaly with blunting of the right costophrenic angle compatible with scarring and possibly a small effusion.No specific evidence of pulmonary edema or pneumonia.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: pneumonia History: cough Cardiomediastinal silhouette is within normal limits.Bibasilar subsegmental atelectasis/scarring is not significantly changed.Questionable opacity in the left lower lung zone most likely represents scarring as identified on prior CT, or alternatively may represent overlying soft tissues. No focal opacity identified on the lateral radiograph to suggest pneumonia.No pleural effusions or pneumothorax.

Output: Questionable left lower lung zone opacity, which most likely represents scarring is identified on previous CT. If clinical symptoms persist, follow-up radiograph could be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: r/o free air History: s/p colonoscopy No specific evidence of free intraperitoneal air as clinically queried. However, please note that sensitivity on single view portable examinations for free air is limited.Basilar reticular opacities are unchanged from prior examination. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged. Unchanged metallic densities over the left upper chest wall and neck. Skin fold on the right.

Output: No specific evidence of free air as clinically queried.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: check central line placement Port catheter terminates deep within the RA. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Port catheter terminates deep within the RA. No substantial change in bibasilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Multiple sclerosis. Postop neurosurgery, febrile. Faint branching opacities in the right lung are suspicious for aspiration. No pleural fluid or pneumothorax. Mild retrocardiac atelectasis at the left lung base.

Output: Faint opacities suspicious for aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: sob History: sob Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval for resolving effusions History: chf, recurrent pleural effusions Left ICD device unchanged. No change in the right jugular catheter and right PICC.There is interval improvement in left lower lobe basilar opacification and pleural effusions.Cardiomediastinal silhouette is unchanged.

Output: Interval improvement in basilar opacities and effusions. Devices are stable as above.


Instruction: Generate impression based on medical findings.

Input: IABP check Interval mild advancement of the IABP, tip currently projects 3 cm from the aortic arch. Underlying ICD otherwise similar.Moderate nonspecific cardiomegaly without new pulmonary abnormalities. Right axillary surgical clips

Output: IABP repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Pt is a 51 yo male; potential stem cell donor Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Diffuse large cell lymphoma. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Right hilar lymph node is stable and normal in size.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Again noted partially calcified adenopathy in the aortocaval space, measuring 3 x 1.5 cm image number 117, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with pancreatic cancer CHEST: Port-a-Cath.LUNGS AND PLEURA: No significant abnormality.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are identified, unchanged and not pathologically enlarged by CT criteria. A borderline enlarged right hilar lymph node is also unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a Whipple procedure. Small hypodensities in the inferior tip of the liver are stable, likely cysts.SPLEEN: No significant abnormality notedPANCREAS: Postsurgical changes of a Whipple procedure with atrophy of the remaining pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Incidental note is made of a circumaortic left renal vein. RETROPERITONEUM, LYMPH NODES: Numerous mesenteric lymph nodes are again identified. A reference lymph node measuring 16 x 8 mm is unchangedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Fat and fluid containing right inguinal hernia, stable. Diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval lung fields History: s/p AVR, CABG Patient has been extubated. Other lines and tubes, unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: concern for aspiration during procedure, hypoxia History: coughing, hypoxia New streaky left basilar opacity consistent with aspiration. Low lung volumes. The cardiac and mediastinal contours are within normal limits for size.

Output: New streaky left basilar opacity consistent with aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: consolidation? spiked fever History: as above Stable cardiomediastinal silhouette.Mild chronic appearing interstitial opacities as well as right upper lobe nodule unchanged.No new airspace opacities.No pleural effusions.Median sternotomy is intact.

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


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval cardiac and lung fields post op day 2 History: post op day 2 Improved aeration in the right upper lobe. New opacity at the left base, likely atelectasis. Support hardware stable.

Output: Improved aeration in the right upper lobe. New opacity at the left base, likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 35 yearsGender: MaleReason for Study: Reason: rule out dissection History: nausea and vomiting, back pain, DMT1 Left central venous catheter with its tip in the RA.Left axillary and subclavian stents identified.Minimal basilar scarring.No focal areas of consolidation.Stable cardiomediastinal silhouette.Partial collapse of a mid thoracic vertebrae new from the prior exam.

Output: No acute cardiopulmonary abnormalities are identified. Partial collapse of the T8 vertebrae was not present on the prior exam. Magnetic resonance of the thoracic spine may be of value in determining the chronicity of this. The service was notified by phone at 9:00 AM on 4/19/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.COPD and CHF. Shortness of breath. Unremarkable cardiomediastinal silhouette.Diffuse basilar predominant interstitial opacities compatible with edema.Small bilateral pleural effusions.

Output: CHF with moderate edema.


Instruction: Generate impression based on medical findings.

Input: Pain after dropping bench press No cardiopulmonary acute abnormalities. Apical scarring and minimal bulla unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: eval for e/o aspiration, infiltrate History: confusion, weakness Cardiomegaly. Tortuosity of thoracic aorta again noted.No abnormal focal lung parenchymal opacities to suggest aspiration pneumonitis or aspiration pneumonia.The pleural spaces are within normal limits.

Output: No abnormal findings to suggest aspiration pneumonitis or aspiration pneumonia, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Tachycardia and tachypnea. New left lower lobe consolidation in the cardiophrenic angle region.There is at least moderate pulmonary edema, poorly assessed due to the extensive motion artifact.Chronic elevation of the right hemidiaphragm with atelectasis at the lung base.There are at least moderate pleural fluid collections bilaterally.

Output: Left lower lobe consolidation suspicious for pneumonia, though the rapid development could alternatively indicate that this is localized significant aspiration or other cause. Moderate CHF. Suggest short-term plain film follow-up.Dr. Khattak verbally notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: assess for ptx or other complication after thora History: as above Loculated right pleural effusion with no pneumothorax following thoracentesis.Moderate cardiomegaly.Right jugular catheter, tip in SVC.

Output: No pneumothorax following thoracentesis. Loculated right pleural effusion involving the fissure.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: line placement History: shock Right IJ venous catheter in place with its tip in the SVC.No evidence of pneumothorax.ET tube with its tip 5 cm above the carina.Decreased lung volumes with stable cardiomediastinal silhouette.Perihilar/basilar opacities and small effusions similar to the prior exam.

Output: Interval placement of a right IJ venous catheter without complication. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute process History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: evaluate for etiology of SOB - 88 yo M with HFrEF (EF 22%) History: intermittent SOB Interval increase in cardiomegaly, pulmonary edema and pleural effusions, findings representing worsening of congestive heart failure. No obvious pneumothorax.

Output: Worsening congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: 27-year-old male with central line placement and ET tube placement. Endotracheal tube 3 cm above the carina. Left IJ venous catheter tip in the right atrium. Partially imaged VP shunt catheter. Enteric tube tip in the stomach.Small lung volumes with increasing atelectasis in the left lower lobe. Possible small pleural effusions. Moderate cardiomegaly.

Output: 1. Endotracheal tube and central line placement as above.2. Increasing atelectasis in the left lower lobe and possible small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: cp History: cp Moderate cardiomegaly without acute edema or pneumonia.Minimal pleural effusions seen on the lateral view.Left subclavian pacemaker, leads unchanged in position.Cardiac loop recorder noted.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure. Shortness of breath and chest pain Motion degrade sensitivity.Essentially unchanged cardiopulmonary appearance with largely interstitial opacities observed in all 4 quadrants with marked nonspecific cardiomegaly. No definite effusions with mildly persistent decreased lung volumes.Sternotomy, vascular stent, prosthetic heart valve, LVAD and single lead ICD are all unchanged. Right jugular PICC line extends into the mid SVC. Small residual resuscitation wire again observed projected over right lower neck, unchanged

Output: Stable hardware and underlying cardiopulmonary appearance with nonspecific pulmonary changes most suggestive of mild edema


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of metastatic breast carcinoma. Please evaluate disease extent. CHEST:LUNGS AND PLEURA: Slight interval increase in loculated pleural fluid/pleural based metastases extending into the fissures.Stable centrilobular emphysema. MEDIASTINUM AND HILA: Precarinal lymph node measures 2.3 cm x 1.2 cm on series 3, image 42/214 and is stable versus equivocally larger.CHEST WALL: Patient status post left mastectomy. ABDOMEN:LIVER, BILIARY TRACT: Previously seen hypervascular lesions appear unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole cyst remains unchanged.RETROPERITONEUM, LYMPH NODES: Retrocaval lymph node measures 2 .1 cm x 1.2 cm (stable) on series 3, image 106/214.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: IVC filter in place.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: Sigmoid diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Slight interval increase in right pleural effusion with overall stable extent of disease on comparison to previous exam as described above.


Instruction: Generate impression based on medical findings.

Input: Male 84 years old Reason: r/o PNA vs edema History: volume overload Mild cardiomegaly with tortuous aorta, unchanged.No focal airspace opacity to indicate infection. No pleural effusion.

Output: No acute cardiopulmonary abnormality. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: s/p intubation and og placement History: ET placement Endotracheal tube terminates approximately 2.5 cm from the carina. Enteric tube terminates inferiorly off the field-of-view. Right IJ line terminates in the superior aspect of the RA. Intra-aortic balloon pump again noted terminating approximately 5.4 cm from the top of the aortic arch. Temporary pacemaker lead noted overlying the left aspect of the heart. Low lung volumes. Question mild pulmonary edema. Unchanged cardiomegaly. No pneumothorax.

Output: Lines and tubes, as above. Low lung volumes with mild pulmonary edema again noted.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for acute changes History: chest pain Mild cardiomegaly with a tortuous aorta.Extensive coronary artery and mitral annulus calcification.No sign of pulmonary edema or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: pleural bx History: asymptomatic Right-sided nodular pleural thickening consistent with mesothelioma.No complication of pleural biopsy.Left hemithorax unremarkable.

Output: No complication of pleural biopsy.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Lightheadedness and diaphoresis. Unremarkable cardiomediastinal silhouette. No focal consolidation, pleural effusions or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: eval for bony abnormalities History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. Follow-up CT performed.


Instruction: Generate impression based on medical findings.

Input: Left lung pneumonia, evaluate empyema. LUNGS AND PLEURA: Large left-sided pleural effusion with almost complete left lung collapse. Minimal pleural enhancement. Right lower lobe nodule (image 36/64, series 4. Diffuse ground-glass haziness of the right lung.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Reidentification of a thoracic levoscoliosis.UPPER ABDOMEN: No significant abnormality noted.

Output: Large left lung empyema. Ultrasound is recommended for evaluation of possible loculations.Right lower lobe focal nodule consistent with a typical, viral or fungal infection. Diffuse ground-glass haziness of the right lung.


Instruction: Generate impression based on medical findings.

Input: Reason: ro pna History: ams Small lung volumes with diffuse chronic interstitial disease compatible with fibrosis, unchanged from previous.No specific evidence of pneumonia or other acute change.

Output: Severe chronic interstitial fibrosis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for PNA History: Deep cough Normal heart size with obscuration of the right heart border secondary to a large pericardial fat pad, as shown on a previous CT scan.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: new hypoxia, pulm edema vs. PNA History: hypoxia Small lung volumes.No specific evidence of infection or edema.Left jugular catheter, tip in SVC.

Output: Small lung volumes, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of pancreatic carcinoma status post Whipple procedure on adjuvant chemotherapy. Please evaluate response. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Previously noted segment two hypodense lesion remains too small to characterize and stable on comparison of previous exam.Soft tissue density contiguous with SMA also appears stable.SPLEEN: No significant abnormality noted.PANCREAS: Proximal pancreatic body and tail appear unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Previous noted lymph nodes remain stable on comparison to previous exam. Reference pancreatic lymph node remains stable (series 3, axial image 104/217), measuring 1.2 cm x 0.7 cm.BOWEL, MESENTERY: Status post Whipple procedure.BONES, SOFT TISSUES: Degenerative changes noted in the lower lumbar spine.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: Stable left common femoral lymph node measures 2.7 cm x 1.2 cm (series 3, axial image 181/217).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.Stable soft tissue density surrounding the SMA.2.Previously referenced lymph nodes remain stable as detailed above.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old. PICC line from a left arm with its tip directed slightly cephalad at the area of the junction of the subclavian and left jugular veins.Moderate left pleural effusion with associated atelectasis and possibly a small right effusion.

Output: Catheter tip directed cephalad in the area of the left jugular vein.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: dizziness History: dizziness Heart size upper normal.No significant pulmonary or pleural abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Interval mild decrease in focal nodule projects in the mid right upper lung. The nodular density overlies the right seventh rib and currently measures approximately 9 mm and previously 14 mm. Appearance is grossly similar to a 2008 CT, and likely scarring. No superimposed discrete additional airspace abnormality. No effusionsThe cardiac and mediastinal contours are within limits

Output: Presumed old scarring in the right upper lung, see details provided


Instruction: Generate impression based on medical findings.

Input: Reason: routine s/p R thoracentesis. r/o R PTX History: none Decreased right pleural effusion and no pneumothorax following thoracocentesis.Right perihilar mass and other findings compatible with metastatic disease.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: pna? History: fall, pt unsure if he vomited Small lung volumes.No acute abnormality.No displaced rib fracture or pneumothorax.Coronary stents are visible.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with nodular lymphoma CHEST:LUNGS AND PLEURA: Stable biapical scarring. Stable emphysema.MEDIASTINUM AND HILA: Reference subcarinal lymph node best seen on image number 50, series number 4 has significantly increased in size and now measures 2.4 x 1.9 cm. Other mediastinal adenopathy has also increased in size.Bilateral retrocrural adenopathy is also increased in size.CHEST WALL: Several increase in the size and number of axillary adenopathy. A reference left axillary lymph node measures 15 x 10 mm image number 26, series number 4.ABDOMEN:LIVER, BILIARY TRACT: Stable right lobe subcentimeter benign lesion.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: Reference portacaval lymph node is significantly increased in size now measures 4.2 x 1.5 cm image number 94, series number 4. Other retroperitoneal adenopathy is also significantly increased in size and extends throughout the aorta into the pelvis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Stable leiomyomatous uterus. 5 x 3 cm right ovarian cystic mass is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: Increase in the size of the pelvic adenopathy. Reference left external iliac lymph node measures 3 x 1.5 cm image number 172, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval progression of disease as described above.


Instruction: Generate impression based on medical findings.

Input: 74 years old Male. Reason: Upright, eval NGT History: NGT. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The tip of the NG tube projects over the stomach.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: 57 yo female with history of AML; post-allo SCT research evaluation History: evaluate Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Patient again status post cholecystectomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: pulmonary edema History: bibasilar crackles Mild left basilar subsegmental scarring or atelectasis. No focal lung consolidation. Normal heart size. Mild aortic atherosclerosis. Surgical clips and staples noted in the left upper quadrant of the abdomen. Cervical spinal fusion hardware, incompletely visualized. Diffuse osteopenia and mild-to-moderate disc degeneration. Widening of the right AC joint, possibly posttraumatic in etiology.

Output: Mild left basilar subsegmental atelectasis or scar.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: eval lung fields History: cp, sob Normal heart size.Lungs clear.No pleural effusion. No pneumothorax.

Output: No cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: FemaleReason for Study: Reason: post op, eval ETT, lung fields History: s/p LVAD ET tube is in place with its tip approximately centimeter above the carina.Right IJ Swan-Ganz with its tip in the right descending pulmonary artery. Aleft-sided ICD unchanged.New LVAD in place.IVP marker in the mid descending aorta.Median sternotomy placed with chest/mediastinal tubes.Moderate cardiac enlargement.Ill-defined right upper lobe airspace opacity suggestive of aspiration.

Output: Postop chest. ET tube in somewhat low position. Right upper lobe airspace opacities suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: LUNGS AND PLEURA: Stable calcified micronodules, likely granulomas. No new nodules, masses, or pleural effusion. Stable apical scarring.MEDIASTINUM: Small right paratracheal node (image 29/158) measures 9 x 6 mm, stable. No hilar lymphadenopathy. Normal heart size. Stable minimal pericardial fluid. Left chest port tip in in the proximal right atrium.CHEST WALL: Surgical clips low right neck. Interval resolution of right low neck fluid collection.UPPER ABDOMEN

Output: 1. Right paratracheal node not pathologically enlarged by CT criteria.2. No intrathoracic metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: eval for pathology History: decreased mental status Interval removal of nasogastric tube. Interval extubation.Cardiomediastinal silhouette is unchanged.Low lung volumes. No focal air space abnormality. No large pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: FemaleReason for Study: Reason: infiltrate History: cp, SOB On the exam is somewhat limited due to overlying artifact. Left central venous catheter with its tip in the SVC.Cardiomediastinal silhouette is unremarkable.No focal airspace consolidationNo pleural effusions.

Output: Exam is somewhat limited due to overlying artifact. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: fever History: fever Basilar opacities and pleural effusion suggestive of edema and/or aspiration.Heart size normal.

Output: Basilar opacities right greater than left suggestive of edema or aspiration, pneumonia less likely in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Further characterize pleural effusion rule out infiltrate on lateral chest x-ray. Cough. Loculated pleural fluid or pleural thickening in the posterior lateral aspect of the left thorax not significantly changed. Airspace opacity in the adjacent lung is again noted. Lung volumes remain low. Small focal opacity right lung base is new. Mild interstitial thickening nonspecific, slightly improved on the right. Cervical spine stabilization hardware incompletely visualized.

Output: Left lower lobe airspace opacities with adjacent small volume of loculated pleural fluid or thickening. Absent additional clinical information this may reflect infection or be post procedural as a history of recent left-sided chest tube was provided on the prior requisition. Follow-up to resolution suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: eval for cause of acute cp/sob History: chest pain, neck pain, jaw pain. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Patient status post sternotomy and CABG.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: pneumonia History: fever, chills Low lung lungs without focal pulmonary opacity. No evidence of edema or effusions. Cardiac silhouette is within normal limits.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: new hypoxia, fresh trach, ?infiltrate, ?effusion History: new hypoxia, fresh trach, ?infiltrate, ?effusion Bilateral pleural effusions and basilar opacities suggestive of atelectasis, comparable to the recent CT.Heart size normal. Tracheostomy tube, the tip at the level of the thoracic inlet.A Dobbhoff tube extends below the lower margin of the image.Right PICC, tip in the SVC.

Output: Basilar opacities suggestive of edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval for pna v atelectasis, post op, co cough, fever History: same Patchy airspace opacities right side predominant, consistent with multifocal pneumonia or aspiration.Heart size upper normal.No large pleural effusions.

Output: Multifocal pneumonia or aspiration. This should be followed to resolution to exclude underlying tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: AM CXR History: AM CXR shortness of breath Increased right basilar opacities likely due to aspirate or atelectasis. Other findings stable.

Output: Increased right basilar opacities likely due to aspirate or atelectasis. Other findings stable.


Instruction: Generate impression based on medical findings.

Input: Reason: 88 y/o with R sided effusion History: sob Moderately large bilateral pleural effusions, slightly increased on the right, with a right pleural drain in place.Underlying pulmonary opacity compatible with atelectasis and possibly edema.Skin folds overlying the upper lungs but no pneumothorax.NG tube tip in the stomach.

Output: Bilateral pleural effusions, slightly increased on the right.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: eval for acute process History: cough/wheezing, h/o asthma The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Cough Moderate diffuse changes consistent with CHF including mild cardiomegaly, edema and small effusions however a retrocardiac focal opacity is also observed concerning for possible superimposed consolidation. Serial imaging is needed to confirm clearance and absence of possible infection/pneumonia

Output: Mild CHF with underlying questionable left lower lobe retrocardiac pneumonia


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: pneumothorax s/p lung biopsy History: pneumothorax s/p lung biopsy No change in small right pneumothorax. Other findings also stable in short interval.

Output: No change in small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with metastatic colorectal cancer. CHEST:LUNGS AND PLEURA: Innumerable pulmonary metastases are again seen some of which appear to have slightly increased in size. For example, a right upper lobe nodule, now measures 1.6 x 1.2 cm (image 41, series 5) compared to 1.1 x 1.1 cm previously. The reference right posterior costophrenic angle nodule measures 1.3 x 0.7 cm (image 76, series 5). MEDIASTINUM AND HILA: Left supraclavicular lymph nodes appear similar to slightly increased in size. The reference supraclavicular node measured previously is difficult to measure on this exam. A more superior supraclavicular node measures 1.1 x 1.2 cm (image 5, series 3) compared to 0.9 x 1.2 cm previously. Small AP window, subcarinal and prevascular lymph nodes appear similar to the prior exam.CHEST WALL: No evidence of axillary lymphadenopathy. Right chest porta catheter with its tip at the junction of the SVC and right atrium.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are evident.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scattered renal lesions most likely represent cysts. The one in the right upper pole measures slightly higher than water density and is not completely characterized on this exam.RETROPERITONEUM, LYMPH NODES: Subjectively, there appears to be slight interval increase in size in the left periaortic lymph nodes (image 116, series 3).BOWEL, MESENTERY: Note is made of a duodenal diverticulum.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: Scattered colonic diverticula and surgical anastomosis of the sigmoid colon, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal change in metastatic disease, reference measurements as above. No new sites of disease are identified.


Instruction: Generate impression based on medical findings.

Input: 59 years old Female. Reason: evaluate change in pleural effusions, pulmonary edema History: peripheral edema, crackles. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. Small amount of bilateral pleural effusions are noted. Bibasilar atelectasis.

Output: The above findings are consistent with CHF, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p sternotomy with rib disarticulation History: sternal clicking Unremarkable cardiac and mediastinal silhouette. Status post median sternotomy with interval partial or complete withdrawal of several screws from the sternal plates.No significant pulmonary abnormalities.

Output: Intact sternal screw and plate devices, but with interval withdrawal of several screws from the sternal plates.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: evaluate LLL atelectasis History: cough Stable cardiomediastinal silhouette. Interval improvement in left retrocardiac atelectasis with residual left pleural thickening and/or small effusion noted.The right lung is clear.No new pulmonary opacities identified.Median sternotomy is intact with repaired saccular aneurysm of the aortic arch stable.

Output: Interval improvement in the left basilar atelectasis with residual left pleural thickening/small effusion. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with history of squamous cell lung cancer status post right lower lobectomy in 2009. Review of medical records also indicates history of sickle cell disease. CHEST:LUNGS AND PLEURA: Postsurgical changes from right lower lobectomy are unchanged in configuration and morphology. Focal fibrosis in the left upper lobe, also unchanged.Few scattered micronodules, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No pathologically enlarged lymph nodes. However, two prevascular lymph nodes (series 80250, image 32) are minimally larger on comparison to prior studies. They can be followed on subsequent exams.Heart size normal without pericardial effusion. Coronary and aortic calcifications.Heterogeneous enhancement of the thyroid with dominant nodule in left lobe.CHEST WALL: Degenerative changes of the spine with patchy sclerosis throughout the thoracic spine and visualized pelvis, unchanged.Sclerotic foci in the humeral heads is compatible with prior avascular necrosis given patient's history of sickle cell disease.ABDOMEN: LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with multiple hypodensities which are likely cysts bilaterally, unchanged.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the spine with grade 1 anterolisthesis of L4 on L5, unchanged. Patchy sclerotic areas in the pelvis presumably secondary to patient's sickle cell disease.

Output: Postsurgical changes without evidence of tumor recurrence or metastases. Osseous changes presumably reflecting patient's history of sickle cell disease.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.CNS vasculitis, altered mental status. Subtle hazy basilar opacities bilaterally. It is unclear if these are new or chronic as the patient had edema and atelectasis in these regions previously. On the current study, the lungs are better inflated and without evidence of edema. Probable mild emphysema. Persistent nodular opacity in the paramediastinal left upper lobe on the energy subtraction image with overlap of the left clavicle and medial fourth rib/transverse process, possibly bony summation artifact. Normal heart size. No pleural fluid.

Output: Hazy basilar opacities, most likely aspirated secretions in the setting of altered mental status, but should be followed to complete radiographic resolution to exclude the possibility of interstitial lung disease. The questionable left upper lobe nodular opacity can also be followed at that time. PA and lateral chest radiographs recommended in 6 weeks.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.History of chest pain and shortness of breath. The cardiomediastinal silhouette is normal.No focal pulmonary opacity or large pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Chest pain Single lead ICD, sternotomy wires, and surgical clips appear similar to prior.Cardiomegaly, with a stable cardiomediastinal silhouette.Vascular redistribution, without specific evidence of infection or edema.

Output: Vascular redistribution, without specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: intubated History: intubated The endotracheal tube is high, 6 cm above the carina. The cuff is likely at the cords. Interval removal of bilateral chest tubes. The remaining support devices are unchanged in position.Persistent basilar opacities of atelectasis and edema with right greater than left pleural effusions. No interval pneumothorax. Heart size remains stable.

Output: Endotracheal tube is high with the cuff likely near the cords. Repositioning is recommended.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: s/p pneumonectomy History: post op Right-sided chest tube with the tip directed towards the right lung apex. NG tube tip projects out of the field of view inferiorly. The cardiac and mediastinal contours are within normal limits for size.The left lung is well aerated.Air in the pneumonectomy cavity with a small to moderate right pleural effusion, an expected post-operative finding.Moderate subcutaneous emphysema along the right chest wall.

Output: Postoperative findings related to pneumonectomy, with fluid and air in the pneumonectomy cavity.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Postoperative day 1. Status post LVAD Tubes and lines unchanged in position no significant sized pneumothorax. Retrocardiac and basal atelectasis, about the same. LVAD unchanged in position. Unable to exclude a left pleural fluid collection.

Output: No acute change in cardiopulmonary appearance. Unable to exclude a left pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath, eval for pleural effusion History: shortness of breath. Large right pleural effusion, increased compared to previous.Status post right mastectomy with multiple surgical clips in the right axilla and sclerosis in the right scapula and first rib suggestive of radiation necrosis.

Output: Markedly increased right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Febrile, evaluate for infection. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Right PICC tip at the level of the right subclavian vein.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 28 years old Female. Reason: balloon pump placement History: balloon pump placement. Cardiomegaly. There is interval improvement of the interstitial changes in the left upper lung field. The Swan-Ganz catheter, and cardiac pacemaker electrodes are stable in position. The intra-aortic balloon pump catheter tip is noted in the aortic arch.

Output: Intra-aortic balloon pump catheter tip at aortic arch.


Instruction: Generate impression based on medical findings.

Input: Reason: 44 y/o s/p CVA intubated History: AMS ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC. NG tube tip in the stomach.Diffuse mainly interstitial opacity, improved compared to the previous study, compatible with edema.No sign of pneumothorax.

Output: Interval improvement in pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: pneumonia History: productive cough since thanksgiving. Cardiomediastinal silhouette is within normal limits. Low lung volumes. No evidence of pulmonary opacities.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: PNA, effusion, Cardiomegaly History: productive cough for several weeks. Multiple surgical clips project over the right axilla and right chest wall.The cardiomediastinal silhouette is unchanged.Left lower lobe airspace opacity has increased since the prior exam.No pleural effusion or pneumothorax.

Output: Left lower lobe opacity which may represent pneumonia or aspirate. Given the patient's age this should be followed to resolution to exclude an underlying neoplasm.


Instruction: Generate impression based on medical findings.

Input: Thoracentesis Unchanged aortic stent and marked interval decrease in the previously described large left pleural effusion secondary to the thoracentesis. No immediate postprocedural complications, specifically no evidence of a pneumothorax

Output: Markedly decreased left pleural effusion without postprocedural complications


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: s/p PICC line History: none No significant cardiopulmonary abnormality.Left PICC, tip in the SVC.Prior right subclavian catheter still crosses the midline retrograde into the left brachiocephalic vein.

Output: Left PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: History of immature teratoma CHEST:LUNGS AND PLEURA: Small area of pleural based thickening and scarring in the right upper lobe is unchanged. Tiny nodule at the right lung base is stable and has been present as far back as an exam of 5/7/05 (image 69; series 4). This could be an intrapulmonary lymph node.MEDIASTINUM AND HILA: Borderline enlarged 11 x 13 mm right hilar lymph node (image 45; series 3) is roughly stable compared to previous.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged retroperitoneal lymph nodes have increased in number compared to previous CT.BOWEL, MESENTERY: Numerous borderline enlarged mesenteric lymph nodes have increased in number and size compared to previous CT. The reference node is stable and measures 11 x 9 mm on image number 139/227. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Right ovarian cyst decreased in size measuring 2.1 x 3.0 cm. The previously described cystic lesion on the right superolateral aspect of the bladder has a different configuration on today's examination possibly secondary to differences in bladder distention. It measures approximately 2.2 x 5.6 cm on coronal images (image 50/112; series 80232).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: Decrease in size of right ovarian cystic lesion. Cystic lesion versus fluid collection on the superior aspect of the bladder roughly stable given differences in bladder distention. Other findings are stable with measurements given above.


Instruction: Generate impression based on medical findings.

Input: Patient fell, pain, lower back Pelvis, sacrum and coccyx: Moderate hip osteoarthritis without distinct acute superimposed osseous abnormality. Significantly no fracture or malalignment however exam is mildly limited due to extreme demineralization. Please see subsequent CT pendingSevere degenerative changes incompletely visualized involving the lower lumbar spineChest: Borderline mild cardiomegaly with suspected large hiatal hernia. Cholecystectomy clips with decreased lung volumes in suspected minimal basilar pulmonary scarring. Atherosclerotic changes. Degenerative changes both shoulders incompletely visualized. Cholecystectomy clips

Output: Borderline cardiomegaly without discrete superimposed acute pulmonary or rib acute abnormalities. Moderate hip and pelvis degenerative changes with more severe osteoarthritic findings of the lower lumbar spine incompletely visualized. Consider dedicated lumbar spine imaging given patient history.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: pa cath position History: none Right jugular catheter tip at RA/SVC junction. Left jugular catheter tip in upper SVC. NG tube tip in stomach. Presternal ICD unchanged. Swan-Ganz catheter via femoral approach no longer visible.Stable cardiomegaly with basilar edema and atelectasis.

Output: Swan-Ganz catheter via femoral approach no longer visible.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with history of gastric GIST, status post resection CHEST: Lungs are clear. No evidence of mediastinal adenopathy. Heart is unremarkable.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes involving the stomach. No evidence of recurrence.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Possible exophytic fibroid is unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Reason: worsening SOB, worsening of R pleural effusion? other etiology? History: dyspnea Small lung volumes with hazy opacity at the right base consistent with pleural effusion and atelectasis.Probable small left pleural effusion.

Output: Small lung volumes with probable increased pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with esophageal cancer CHEST:LUNGS AND PLEURA: Scattered micronodules in both lungs, nonspecific. Linear atelectasis at the lung bases.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Mild biliary prominence. Common bile duct is dilated up to its intrapancreatic portion.SPLEEN: No significant abnormality notedPANCREAS: Atrophic pancreas with a significantly dilated pancreatic duct and numerous calcifications throughout the pancreas and pancreatic duct consistent with chronic pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Soft tissue thickening at the esophagogastric junction which may be compatible with patient's known history of carcinoma. 8mm diameter lymph node adjacent to the diaphragmatic crus in the midline on image number 88, series number 3.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: Nonspecific, scattered bilateral micronodules.Wall thickening of the esophagogastric junction associated with nonenlarged lymph nodes around the lesion.Chronic pancreatitis.


Instruction: Generate impression based on medical findings.

Input: Reason: 90 y/o s/p chest tube History: CHEST TUBE Right chest tube in place with its tip directed medially and inferiorly.Interval decrease in the right pneumothorax with a small residual superolaterally.ET tube tip approximately 3 cm above the carina.Moderate bilateral pleural effusions with underlying atelectasis, not significantly changed.

Output: New right chest tube with decreased right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Shortness of breath status post AVR/CABG status post chest tube check for pneumothorax or effusion. Interval removal of chest tubes and mediastinal drain. Ventral staples and sternal wires similar in alignment. . Small pleural effusions. Basal atelectasis. Right posterior costophrenic angle remains lucent which could reflect a loculated pneumothorax given the presence of a chest tube in this location previously.

Output: Small pleural effusions. Nonspecific asymmetric right cardiophrenic angle lucency should be followed by serial plain films as it could reflect a loculated pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: Routine screening History: post OHT on immune suppression Median sternotomy for heart transplant.Small right pleural effusion versus pleural scarring, unchanged.No specific evidence of infection or edema.

Output: Unchanged right pleural scarring or small pleural effusion, but no sign of edema or pneumonia following heart transplant.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: r/o pneumonia. Low grade fever, left sided chest pain with cough History: as above No focal lung consolidation. No pulmonary edema. No pleural effusion or pneumothorax. No acute bony abnormality. Large patient body habitus.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: possible aspiration History: new cough Lower lung zone predominant patchy interstitial opacities with small pleural effusions suggestive of edema and/or aspiration, unchanged.Status post extubation and right jugular catheter removal.

Output: No change in pulmonary opacities following extubation with no new findings.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: evaluate for obstruction History: bilious vomiting Right vascular catheter terminates at the level of the cavoatrial junction.The lungs are clear. The cardiomediastinal silhouette is unremarkable. The aorta is calcific and tortuous.Enteric tube terminates in the region of the gastric body and projects over the left upper abdomen. IVC filter projects over the lower lumbar spine and cholecystostomy clips projects over the right upper abdomen.Amorphous calcific material projects over the right ilium and is possibly external to the patient.The bowel gas pattern is nonobstructive. Scattered phleboliths are noted within the pelvis.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer Right upper lobe peripheral and apical scarring are unchanged and without evidence of new superimposed acute pulmonary abnormality. Moderate COPD changes. The cardiac and midline mediastinal contours are within limits.

Output: Scarring and COPD without superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: swan, impella, check position History: Right IJ Swan-Ganz catheter has been retracted, now within the main pulmonary artery. The right pleural pigtail catheter has changed position, suspected to be related to tube positioning external to the patient. The remaining support devices are unchanged in position.Slight decrease in lung volumes. Stable pleural effusions and basilar atelectasis. No significant pneumothorax.

Output: Right IJ Swan-Ganz catheter now positioned in the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of metastatic melanoma status post two cycles of chemotherapy. Evaluate for response. CHEST:LUNGS AND PLEURA: Two right lung metastatic lesions have decreased in size since prior study. Reference right lower lobe mass (series 5, image 48) measures 3 x 3 cm in the axial plane; previously measuring 3.6 x 3.4 cm.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Reference segment 6 hepatic lesion (series 3, image 105) is stable in size, again measuring 2.8 x 2.1 cm. No new focal hepatic lesions identified. The portal and hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left-sided colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Left-sided colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Interval decrease in size of pulmonary metastases. Stable hepatic metastasis. No new lesions identified.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant Cardiac silhouette and pulmonary arteries are again enlarged.Low lung volumes with no focal consolidation sizable effusion or pneumothorax.

Output: 1.Cardiomegaly.2.Bilateral pulmonary arterial enlargement suggesting pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Altered mental status Unremarkable cardiomediastinal silhouette.Streaky bibasilar opacities likely represent subsegmental atelectasis/scarring.No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumothorax History: R clavicle fracture, dyspnea Right clavicular fracture deformity and right cervical rib.No significant cardiopulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: increased secretions, desatting History: as above Unremarkable cardiac and mediastinal silhouette. Underinflated lungs with basilar opacities consistent with subsegmental atelectasis and scarring, generally unchanged.Chronic right apical pleural thickening.No specific evidence of pneumonia.

Output: Basilar atelectasis and no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: eval for pneumothorax; post procedure 04/6 endobronchial valves placed History: post procedure Severe lower lung zone predominant emphysema suggestive of alpha-1 antitrypsin deficiency.Left lower lung zone endobronchial valves have resulted in left hemithorax volume loss with patchy left basilar consolidation.No obvious pneumothorax identified, and right basilar emphysema should not be mistaken for one.

Output: Severe basilar emphysema and gradually increasing left basilar consolidation likely secondary to endobronchial valve placement although infection is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: dyspnea History: dyspnea Mild cardiomegaly.No specific evidence of infection or edema.

Output: Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval ett History: ett Endotracheal tube is 4 cm above the carina. Lines otherwise unchanged.Extensive interstitial and airspace opacities bilaterally compatible with ARDS and infection about the same. Left lower lobe atelectasis and consolidation similar to prior, with a layering left pleural fluid collection. No pneumothorax.

Output: Repositioning of endotracheal tube. No change in pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Large lung volumes. Stable cardiomediastinal silhouette.Right lower lobe costocardiac opacity not present on prior radiograph.No significant pleural effusion.

Output: Right lower lobe costocardiac opacity not substantially different from prior CT (6/15/15) and likely represents focal atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: endocarditis History: as above Cardiomegaly with mild left basilar subsegmental atelectasis and small left pleural effusion.No specific evidence of infection or edema. Left subclavian dual-chamber ICD, leads in appropriate position.Right jugular catheter, tip in SVC.An NG tube terminates in the stomach.

Output: Cardiomegaly with a small left pleural effusion and left basilar scarring, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 96 years old.Reason: pna? History: decline in elderly pt Very large goiter.Chronic left hemidiaphragm elevation with overlying atelectasis, the lungs otherwise unremarkable and unchanged.Small lung volumes.

Output: Small lung volumes but no reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: s/p drain removal History: s/p drain removal Near resolution of a prior right effusion. No new findings.Shunt tubing overlies the right side of the chest.

Output: Near resolution of right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: pna? fluid? History: worsening hemoptysis Severe upper lobe volume loss with hilar retraction consistent with healed granulomatous disease.Mild apical cavitation is unchanged. No evidence of superimposed pneumonia.

Output: Severe fibrosis from prior granulomatous disease, without superimposed edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Post-thoracentesis History: post-thoracentesis Right thoracentesis with no pneumothorax.Persistent right pleural effusion with overlying consolidation/atelectasis.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 76 years old Reason: staged Dobbhoff tube placement History: above Interval placement of Dobbhoff tube with the tip terminating in the gastric body, just distal to the GE junction. Remaining medical support hardware unchanged. Layering right pleural effusion with associated atelectasis appears similar to the prior examination. Unchanged retrocardiac opacity suggesting atelectasis/consolidation. Moderate cardiomegaly.

Output: Dobbhoff tube tip terminating in the gastric body, just beyond the GE junction. Layering right pleural effusion and bibasilar atelectasis/consolidation similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.End stage renal disease with chest pain. New right upper lobe airspace opacity may reflect aspiration or infection. Pleural fluid and atelectasis in the lung bases, about the same.

Output: New right upper lobe airspace opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.ESRD, CHF, diminished breath sounds assess for effusions or edema. Cardiac silhouette is largely obscured however globular configuration is consistent with known pericardial fluid.Low lung volumes, decreased in the interim.Significant multisegmental compressive atelectasis at the lung bases and moderate pleural effusions.No specific signs of pulmonary edema.Left jugular catheter, vascular stents and upper abdominal surgical clips unchanged.Skeletal sclerosis suggestive of chronic renal disease.

Output: Low lung volumes with moderate pleural effusions and interval worsening of basal atelectasis. Globular cardiomegaly consistent with pericardial effusion with adjacent compressive atelectasis.


Instruction: Generate impression based on medical findings.

Input: Head and neck cancer with unknown primary CHEST:LUNGS AND PLEURA: New patchy ground-glass opacity within the right lower lobe. Small granuloma in the left lower lobe. Few nonspecific micronodules unchanged. No suspicious pulmonary opacities. MEDIASTINUM AND HILA: No lymphadenopathy. Residual thymic tissue unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hypodensity within the caudate lobe and adjacent to the gallbladder. Lesion adjacent to the gallbladder like represents a hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal hypodensity likely cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Focus of ground glass opacity within the right lower lobe likely secondary to mild aspiration. 2. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Check pneumothorax Interval development of a right pneumothorax with a discrete subpulmonic component. Apical measurement is approximately 3 cm. Subsequent images and interpreted.

Output: Right moderate pneumothorax correlating with the recent CT.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p RFA liver lesions History: r/o ptx Cardiomediastinal silhouette is unremarkable. Low lung volumes. No pneumothorax. Small right pleural effusion. Bilateral basilar streaky opacities compatible with subsegmental atelectasis.

Output: No evidence of pneumothorax. Bibasilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with pulmonary nodule seen on cardiac CT. Patient asymptomatic. Six-month follow-up study. CHEST: LUNGS AND PLEURA: The nodule in the right posterior costophrenic angle has decreased in size and measures 8 mm. This nodule most likely is post inflammatory in etiology. Nodules this size are typically followed to two years to confirm stability. No new masses or nodules. No pleural effusion.MEDIASTINUM AND HILA: No significant lymphadenopathy. Residual thymic tissue. Heart size normal without pericardial effusion. Coronary artery calcification.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: Right posterior costophrenic angle has decreased in size and now measures 8 mm. This is most likely post inflammatory, however, nodules of this size are typically followed to 2 years to confirm stability.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with history of tachypnea. Tracheostomy tube and support devices unchanged. Stable cardiomegaly. Small left pleural effusion/pleural thickening. No specific evidence of aspiration.Partially imaged IVC filter. G-tube in the stomach.

Output: Tracheostomy tube with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: recent pneumonia, immunosuppresed History: fever, cough Left midlung opacity similar to the prior exam and compatible with pneumonia.No new pulmonary opacities identified.Stable cardiomediastinal silhouette.No pleural effusions.

Output: Left mid lung opacity unchanged and compatible with atypical infection. CT of the chest may be of value.


Instruction: Generate impression based on medical findings.

Input: Reason: extubated, evaluate pleural effusion, volume overload History: respiratory distress Partial clearing of bilateral airspace opacities over the past two days with residual lower zone airspace opacity compatible with resolving edema and atelectasis.NG tube coiled in the stomach.No new findings.

Output: Residual basilar consolidation and atelectasis with interval clearing of diffuse pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: MaleReason for Study: Reason: r/o cardiopulm abnormality History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna History: neutropenic fever Unremarkable cardiac and mediastinal silhouette. Catheter tip at SVC/RA junction and stabilization hardware in the thoracolumbar spine.No sign of pneumonia or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.CLL. ETT. ETT tip 5 seen above the level of the carina.Low lung volumes with patchy basal atelectasis new from previous.Hardware external to the patient obscures the mid lung fields bilaterally.No visible pneumothorax.

Output: ETT tip 5 seen above carina. Patchy atelectasis most likely the result of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Check for obstruction. Generalized edema and neoplasm of nasal cavities No new or interval cardiopulmonary abnormality. Lung volumes remain mildly decreased without evidence of new airspace findings

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pneumonia History: sob Volume loss and opacity in the right lower lung consistent with atelectasis and, unchanged or decreased from previous allowing for marked patient rotation.Catheter from the right arm with its tip directed cephalad.

Output: 1.Partial right lung atelectasis, unchanged or decreased.2.Abnormal location of venous catheter.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate placement of ETT History: intubated Tracheostomy tube with its tip about 5 cm above the carina.Bilateral catheters extending to the SVC.Cardiomegaly with bilateral symmetrical airspace and interstitial opacities suggestive of edema, unchanged or slightly improved.

Output: Tracheostomy tube unchanged with CHF and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old. Interval intubation with tip of endotracheal tube approximately 5 cm above carina. Line position otherwise stable.No interval change in bilateral lung opacities.

Output: Interval intubation. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess edema History: comparison Low lung volumes with persistent bibasilar opacities and pleural effusions.

Output: Stable bibasilar opacities, pulmonary edema, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with Ewing sarcoma of the mandible, status post resection/chemo, evaluate and compare LUNGS AND PLEURA: Small micronodules knee and two segment of the right upper lobe is stable. No other pulmonary nodules or masses can be identified. No pleural effusion is noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Schmorl's nodes with mild degenerative changes in the midthoracic spineUPPER ABDOMEN: No significant abnormality noted.

Output: Stable micronodule in the right upper lobe. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: dyspnea on exertion progressive over 6 months, evaluating for pulmonary abnormalities History: DOE, progressive over 6 months There is borderline cardiac enlargement with marked tortuosity of aorta.The lungs are clear.No pleural effusions.Moderate degenerative changes in thoracic spine with mild anterior wedging of several midthoracic vertebrae of indeterminate age.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: eval mets, preop plan History: colon ca, brain mets Multiple bilateral pulmonary nodules and masses consistent with metastases, markedly increased since the previous radiograph.Port catheter extending to the SVC.No sign of infection or other acute process.

Output: Marked progression of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: elderly pt with intermittent sharp chest pain History: chest pain, shoulder pain, neck pain Heart size normal.Lungs clear.No specific evidence of infection or edema.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.