Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: device placement History: device placement Left subclavian dual-chamber ICD with leads projecting or the expected location of the right atrial appendage and right ventricle. Cardiac silhouette is again enlarged.Interval improvement in perihilar vascular congestion. Minimal left basilar bandlike atelectasis/scarring. No pneumothorax.

Output: Left subclavian dual-chamber ICD with leads projecting in satisfactory location. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Prekidney transplant, rule out cardiomegaly, rule out infiltrates Heart size is normal.Low lung volumes without evidence of infection, edema, or effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: febrile neutropenia, eval pna History: mild cough No sign of pneumonia or other acute change.Bilateral venous catheters extending to the SVC.Bilateral healed rib fractures.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: History CF History: Cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No radiographic evidence of cystic fibrosis.


Instruction: Generate impression based on medical findings.

Input: 37 year old female with severe thrombocytopenia and acute back pain and anemia. Also with hypoxia. Rule out retroperitoneal hematoma and further evaluate right lower lobe abnormality on CXR. CHEST:LUNGS AND PLEURA: Large right pleural effusion. Basilar atelectasis or consolidation. No visible lung nodules. The left lobe is normal and there is only a small left pleural effusion.MEDIASTINUM AND HILA: Small mediastinal and axillary nodes not pathologic by size criteria.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: Postsurgical changes consistent with liver transplant. Distortion of the contour of the liver along the dome and lateral aspect of the right lobe is redemonstrated due to mass effect by surrounding perihepatic or possibly subcapsular fluid. The extent of the fluid and mass effect is increased compared to the prior scan.SPLEEN: Massive splenomegaly to 27.2 cm cephalocaudad is seen on coronal image 53/99, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of retroperitoneal hematoma. Fat stranding consistent with a generalized anasarca. Small nodes. Largest node aortocaval distally Series IV image 120 measuring 1.1 x 0.8 cm, unchanged.BOWEL, MESENTERY: Moderate amount of generalized ascites markedly increased compared to prior scans. As described above some of the fluid around the liver is loculated and causing mass effect on the liver. This suggests that some of the fluid may be sub-capsular rather than purely free intraperitoneal.Incisional midline ventral hernia containing large bowel small bowel and omentum but nonobstructive.BONES, SOFT TISSUES: Extensive subcutaneous edema particularly in the anterior abdominal wall and laterally.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The previously seen left adnexal cyst cannot be discerned possibly due to the ascites.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of generalized ascites.BONES, SOFT TISSUES: Mild anasarca.OTHER: Small kidneys consistent with chronic medical renal disease, unchanged. Normal size renal allograft seen in the right iliac fossa, unchanged.

Output: New large right pleural effusion and small left pleural effusion. Increased ascites. Increased mass effect on the dome of the liver from loculated fluid. Unchanged massive splenomegaly and nonobstructive ventral hernia. Chronic medical renal kidneys. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: ETT placement. ETT tip 4.8 cm above carina. Left subclavian single lead pacemaker projects over the cranial aspect of the right ventricle, not overlying the apex.Right jugular catheter unchanged in position.Interval placement of an enteric tube which projects over the stomach.Slight worsening of interstitial and airspace opacities.

Output: ETT tip 4.8 cm above the carina. Worsening pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: placement of central IJ line History: as above Interval placement of a right IJ central catheter with the tip visualized to the floor of the right atrium. A cholecystostomy tube is visualized in the right upper abdominal quadrant.The patient is rotated to the right. There is prominence of the right hilum which may be due to overlapping vasculature. Recommend straight AP or PA radiograph of the patient can tolerate. No evidence of pneumothorax.

Output: No pneumothorax following central line placement which terminates deep in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Postop, evaluate endotracheal tube status post CABG and MVR There has been interval coronary artery revascularization. The patient is intubated with the endotracheal tube approximately 3 cm superior to the carina. An intra-aortic balloon pump is present with the tip, in the proximal descending thoracic aorta, immediately superior to the left mainstem bronchus. Mediastinal hardware are well aligned. A right IJ Swan-Ganz catheter terminates in the mid right pulmonary artery. Left basilar chest tube and tube mediastinal drains are present. Interval left lower lobe atelectasis and consolidation with small left pleural effusion. No significant pneumothorax. Heart size is magnified.

Output: Interval coronary artery revascularization with postoperative left lower lobe atelectasis and consolidation. Intra-aortic balloon pump is slightly low, in appropriate position on subsequent radiograph.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: History pancreatic cancer status post Whipple. CHEST:LUNGS AND PLEURA: Clustered micronodules in the right upper lobe are stable.MEDIASTINUM AND HILA: Enlarged thyroid gland particularly the left lobe, stable. Right-sided chest port with catheter tip in SVC. No lymphadenopathy. Heart size normal.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval resolution of enhancing hypodense lesion in the anterior right lobe of the liver indicating a post surgical etiology. No biliary ductal dilatation. No focal lesions.SPLEEN: No significant abnormality noted.PANCREAS: Patient status post Whipple. No residual mass is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scarring and cysts involving the right kidney are stable.RETROPERITONEUM, LYMPH NODES: Stable, mildly enlarged mesenteric lymph nodesBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval resolution of previously noted soft tissue nodules. Interval resolution of midline tissue defect along the abdominal incision.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval resolution of previously noted postsurgical changes adjacent to the liver and soft tissue nodules in the anterior abdominal wall.2.No evidence metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: PICC was pulled back slightly by mistake -- please assess position History: as above Left-sided PICC line with its tip in the left innominate.Stable cardiomediastinal silhouette.Left apical mass and associated airspace opacity similar to the most recent exam .

Output: Left PICC line with its tip now in the left innominate/left subclavian vein junction.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Unspecified bone disorder History: Unspecified bone disorder There is slight scoliosis of the thoracic spine.The cardiomediastinal silhouette is normal.Mild reticular interstitial opacities are seen bilaterally. There are no focal pulmonary opacities or pleural effusions.

Output: Reticular interstitial opacities favored to represent chronic interstitial changes (e.g. from smoking). Otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Intubated. Papillary thyroid carcinoma. Interval extubation. Unchanged biapical chest tubes. New left retrocardiac opacity, atelectasis versus aspiration. Unchanged subcutaneous emphysema and pneumomediastinum. Surgical drain at the thoracic inlet.

Output: Interval extubation. New left retrocardiac opacity, atelectasis versus aspiration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: PICC line placement History: new PICC line placement Interval placement of left PICC that terminates in the right atrium without pneumothorax. Right central venous catheter terminates in the right atrium, unchanged.Low lung volumes with small bilateral pleural effusions, not significant change.

Output: Interval placement of left PICC terminating in the right atrium without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Evaluate ETT placement. ETT tip 2.7 cm above the level of the carina. NGT tip off the caudal margin of the radiograph. Worsening retrocardiac cardiac opacification consistent with pleural fluid and now complete consolidation of the left lower lobe. Airspace opacity and atelectasis on the right about the same.

Output: ETT tip 2.7 cm above the level of the carina interval worsening of opacity on the left consistent with complete consolidation of the lower lobe, atelectasis in the lingula and development of pleural fluid. Opacities in the right lung suspicious for pneumonia, possibly the result of aspiration, are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Chronic cough for 7 months evaluate for acute pathology. Normal heart size. No pleural fluid or pneumothorax. No visible pulmonary nodules or masses.

Output: No acute cardiopulmonary abnormality. No findings to account for the patient's source of cough.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of endometrial cancer status post chemotherapy CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Calcification in the right thyroid gland with small nodules is unchanged. Small mediastinal nodes are unchanged. Index AP window node measures 8 x 5 mm in image number 33, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Intra-extrahepatic biliary dilatation with common bile duct measuring up to 1.2 cm throughout its course is unchanged from previous study. Nonspecific, subtle hypodense lesion on image number 17, series number 3 is unchanged and too small to accurately characterize. No new liver lesions. M.R.C.P. may be helpful for further evaluation of the biliary dilatation.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: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified fibroid within the uterus is unchanged. Uterus cannot be well identified and differentiate it from the surrounding bowel loops. Right ovarian cyst measuring 2.8 x 2 cm is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: Index left obturator node is unchanged and now measures 1.7 by 1.2 cm on image number 159, series number 3. Previously it was measuring 1.6 x 1.2 cm on image number 165, series number 3. However other pelvic lymph nodes have minimally increased in size. For example on the right side a right obturator node now measures 1.7 x 1.1 cm on image number 164, series number 3. Previously, it was measuring 1.7 x 1.1 cm image number 164, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Scattered lung nodules unchanged.Significant intra-and extra hepatic biliary dilatation is unchanged. M.R.C.P. may be helpful for further evaluation. Ill-defined uterus which cannot be differentiated from the surrounding bowel loops in the pelvis.Minimal interval increase in some of the pelvic lymph nodes as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.IABP. Hypoxemia. Nonrheumatic mitral valve prolapse. IABP marker probably similar in position, not well visualized due to motion. Other tubes and lines unchanged.Moderate right pleural fluid extending over the apex unchanged.Bilateral extensive airspace opacities, most pronounced in the right upper lobe, also without significant change.

Output: No acute change in pulmonary opacities. IABP marker is not clearly visualized due to motion but it is probably in the proximal descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: AML, CLL, pleural effusion. Pleural fluid bilaterally, slightly increased. Associated atelectasis at the lung bases and dependent lung fields, left greater than right. No pneumothorax. Left lower lobe opacity has been present since the prior radiograph, correlate for signs of infection as an underlying pneumonia cannot be excluded.

Output: Moderate pleural effusions and atelectasis worsened in the interim; unable to exclude left lower lobe infection.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.SOB, evaluate for CHF, COPD. Normal heart size. Tortuous thoracic aorta. No signs of pulmonary edema. No pleural fluid. IVC filter partially visualized.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: ETT History: ETT ET tube, left IJ venous catheter, and NG tube unchanged.Decreased lung volumes with stable cardiac mediastinal silhouette.Perihilar opacities and pleural effusions similar in appearance to prior exam.No new pulmonary opacities identified.

Output: ET tube tip 4 cm above the carina. Stable cardiopulmonary appearance


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: 59 y/o interval change of pneumo post intubation History: none ET tube tip approximately 3 cm above the carina.Left venous catheter tip in the SVC.Right chest tube projects over the right midlung.Enteric tube tip in the stomach.Stable cardiomediastinal silhouette.Extensive subcutaneous emphysema over the entire chest wall and visualized lower neck is grossly similar to prior.No significant pneumothorax is evident.Streaky bibasilar opacities likely due to atelectasis.

Output: Subcutaneous emphysema but no evidence of pneumothorax


Instruction: Generate impression based on medical findings.

Input: 58-year-old male. Pathology at outside hospital done during laparoscopic cholecystectomy showed high-grade neuroendocrine carcinoma versus primary pancreas carcinoma. CHEST:LUNGS AND PLEURA: 8 x 7 mm left lower lobe nodule (series 10; image 69).MEDIASTINUM AND HILA: Borderline enlarged anterior diaphragmatic lymph node.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates an enlarged left lobe and slightly nodular contour. Innumerable hypodense lesions are identified throughout the right and left lobes of the liver. A reference lesion in segment 4A measures approximately 1.7 x 1.9 cm (series 11; image 76). A reference lesion in segment 6 measures approximately 2.9 x 2.3 cm (series 11; image 129). No arterial enhancement is identified. Patent paraumbilical vein is seen.Cholelithiasis is identified. Gallbladder wall thickening is present. SPLEEN: Small splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Prominent gastrohepatic and portacaval lymph nodes are seen. The largest measures 4.9 x 2.4 cm (series 11; image 110) in the portacaval region.BOWEL, MESENTERY: Haziness of the perihepatic omentum is identified (series 11; image 148).BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Conglomerate left iliac lymph node measures 4.8 x 3.4 cm (series 11; image 205)BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild ascites.

Output: Numerous hepatic lesions without hypervascularity, compatible with metastases. Metastatic adenopathy in the abdomen and left inguinal regions. Indeterminant subcentimeter pulmonary nodule. No pancreatic mass is seen.Likely cirrhosis with signs of portal hypertension (patent paraumbilical vein, mild ascites).Haziness of the omentum can be due to vascular congestion, though carcinomatosis cannot be excluded.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pathology 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, 56 years old.Hypoxia and tachypnea. Very low volumes with persistent atelectasis of the lower lobes bilaterally and moderate effusions.

Output: Progressive decrease in lung volumes and worsening of atelectasis/pleural fluid suspicious for enlarging volume of ascites.


Instruction: Generate impression based on medical findings.

Input: 75 year-old female with history bladder cancer with lung metastasis. Follow-up for disease progression. Fatigue. CHEST:LUNGS AND PLEURA: Index left upper lobe nodule has increased, series 5 image 36/90, measuring 12.9 x 11.6 mm. Previously 4.5 mm.Index right lower lobe nodule has increased, series 5 image 61/90, 20 by 15.5 mm. Previously 17.3 x 14.2 mm.No new nodules. Other nodules stable to slightly increased as well. No effusions.MEDIASTINUM AND HILA: Small mediastinal nodes stable. Not pathologic by size criteria.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: A few small nonspecific hyperattenuating foci.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously seen left-sided hydronephrosis is resolved. Some cortical thinning left kidney.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: Atrophic or surgically absent.BLADDER: Status post cystectomy and neobladder. 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: Increased size lung lesions. Resolution of left-sided hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 67 years old Male. Reason: IABP, Swan placement History: IABP, swam placement. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. The tip of the Swan-Ganz catheter projects over the right pulmonary artery. The tip of the intra-aortic balloon pump catheter project over the aortic arch. A metallic density projects over the upper abdomen left L1 transverse process.

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


Instruction: Generate impression based on medical findings.

Input: Reason: opacification seen on chest Xray from 9/22 at Palos Hospital. Also has greenish trachestomy secretions History: as above Small lung volumes with focal dense airspace opacity in the posterior basal segment of the left lower lobe, compatible with aspiration and infection.Tracheostomy tube in place.

Output: Left lower lobe airspace opacity, suggestive of aspiration and infection.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: pna History: persistent cough, chills The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval pulm edema, pna History: sob There is moderate cardiomegaly. Perihilar and basilar predominant interstitial and airspace opacities, compatible with mild pulmonary edema. There are small bilateral pleural effusions.

Output: Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with metastatic renal cancer CHEST:LUNGS AND PLEURA: Index lesion in the left lung base measures 11 x 11 mm number 63, series number 6. Other lung nodules are unchanged bilaterally. No new lung lesions.MEDIASTINUM AND HILA: Right hilar mass measures 4.2 x 2.5 cm on image number 62, series number 4. There is a pharyngeal mass measures 3 x 1.7 cm image number 18, series number 4. Again its orientation has changed but size is at the unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Scattered cysts in the liver are unchanged. Some of these lesions are too small to accurate characterize.SPLEEN: No significant abnormality notedPANCREAS: Hypervascular mass in the tail of pancreas measures 2.4 x 3 cm image number 108, series number 4.ADRENAL GLANDS: Thickening of the left adrenal gland is unchanged. Right adrenal gland is removed.KIDNEYS, URETERS: No evidence of recurrence in the right nephrectomy bed. Left 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: 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 in lung and pancreas metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: altered loc, History: altered loc, stroke eval Cardiomediastinal silhouette is unremarkable. Bibasilar opacities, left greater than right, suspicious for aspiration/infection. Linear opacity in the left mid to lower lung may represent atelectasis or pleural thickening.

Output: Bibasilar opacities, most pronounced in the left base, suspicious for aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with hypoxia. Intubated. Evaluate for improvement in pleural effusion. Evaluation is limited secondary to patient positioning and marked rotation to the right.Endotracheal tube tip 5 cm above the carina. Enteric tube is set on the stomach. Left IJ venous catheter tip in the cavoatrial junction.There may be a decrease in size of right-sided pleural effusion with improved aeration of the lung however evaluation is limited as above. Left-sided interstitial opacities and pleural effusion without significant change.

Output: Limited study with decrease in size of right-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Marked interval enlargement of the now large right pleural effusion with near-complete underlying compression. Patchy nodular opacities in the mid left lung are also unchanged.No gross cardiac or mediastinal contour change at Limited evaluationRight jugular dual port stable in position

Output: Enlarging large right pleural effusion


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Pneumonia. Low lung volumes exaggerate cardiothoracic ratio. Basal opacities suggestive of atelectasis; if feasible, correlation with erect PA and lateral chest radiographs may be obtained if there is a high level of clinical suspicion for viral pneumonia as it could potentially have this appearance. Surgical anchor in the left humeral head.

Output: Low lung volumes produce artifact of underinflation. No conclusive airspace opacities to suggest pneumonia however viral pneumonia could not be excluded without PA and lateral technique films.


Instruction: Generate impression based on medical findings.

Input: Reason: first neutropenic fever, r/o pneumonia History: neutropenic fever Unremarkable cardiac and mediastinal silhouette. Port catheter with its tip in the SVC.Nodular opacity in the left upper lobe measuring approximately 2 cm in diameter, more prominent and probably increased compared to the previous chest radiograph. Differential diagnosis includes neoplasm and infection. A CT scan is recommended for further evaluation.A text message was sent to Dr.Kordas at the time of reporting.

Output: Left upper lobe nodular opacity, increased from previous, compatible with neoplasm or infection. A CT scan is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP placement History: IABP placement Balloon catheter extending to the level of the aortic arch.ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Small lung volumes with nonspecific basilar consolidation and atelectasis.

Output: Balloon catheter in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: r/o aspiration, status post colonoscopy with sedation yesterday History: sob Unchanged left first and probably second rib lesions consistent with known fibrous dysplasia.Adjacent pleural thickening is stable.No specific evidence of infection or edema.Heart size normal, with a coronary stent in place.Spinal stabilization hardware is seen in the cervical and upper thoracic region, and there has been a lumbar thoracoplasty.

Output: No significant abnormality. Known skeletal deformities consistent with polyostotic fibrous dysplasia.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: post attempted CVC, unable to pass wire History: none Stable cardiomegaly and peribronchial opacities suggesting mild edema which is unchanged from the prior study. No new lung opacities. No pneumothorax. No pleural effusion.

Output: Stable cardiomegaly and peribronchial opacities suggesting mild edema, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: evaluate IABP placement History: pulled back 1-2cm IABP marker position unchanged, with the proximal tip located within the right innominate artery and the distal marker at the level of T12-L1.Right upper extremity PICC tip terminates in the right axillary vein.Left subclavian AICD lead position unchanged.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Deformity of the left fourth and fifth ribs posteriorly suggestive of a previous thoracotomy.Nephrostomy tube on the right partially visualized.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: chest pain, sob, eval for fluid overload History: chest pain, sob, eval for fluid overload Moderate cardiomegaly, with lower lung zone opacities suggestive of edema.No specific evidence of infection.Bullet fragment projected over the right upper lobe, unchanged.

Output: CHF with cardiomegaly and pulmonary edema. Little change.


Instruction: Generate impression based on medical findings.

Input: 64 years, Female. Reason: evaluate for improvement in SBO History: abdominal distention, n/v improved with NG tube placement. History of surgery in July and radiation completed in October. There are multiple dilated loops of proximal small bowel measuring up to 5 cm in diameter with differential air fluid levels. No ileal or colonic air is seen. Findings are compatible with high grade mechanical obstruction, mildly improved since the prior radiograph. Feeding tube tip in gastric antrum. Surgical clips project over the pelvis.

Output: Mild interval improvement in high grade small bowel obstruction as described above. No free air.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: CP with c/f NSTEMI History: c/f pulm edema Sternotomy wires and clips and coronary stent redemonstrated. Abdominal surgical clips noted.Cardiomegaly unchanged.Retrocardiac and basilar opacities. Possible small left pleural effusion.

Output: There is retrocardiac and basilar opacity suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: SOB, recent intubation History: SOB Enteric tube tip overlies the gastric body.Multiple surgical clips in partial visualized IVC filter in the abdomen.Unchanged cardia mediastinal silhouette.Scarring at the left lung base appears similar to prior.No focal consolidation, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female status post cardiac arrest. The upper trachea is deviated to the left, likely secondary to patient's known multinodular goiter. Bilateral pleural effusions.Bilateral lower lobe consolidation, likely related to aspiration.Azygos vein is enlarged. Heart size is mildly enlarged.

Output: Bilateral pleural effusions and bilateral lower lobe consolidation, likely related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.History of COPD, hypertension diabetes recent Aspergillus pneumonia presenting with chest pain and SOB abdominal pain for one day. Question pneumonia, cardiomegaly or effusion. Interval removal of right jugular catheter without pneumothorax. Pleural thickening/retraction, volume loss and architectural distortion in the right upper lobe/perihilar region with bronchiectasis and scarring in the lower lobes, chronic and unchanged. Blunting of the costophrenic angles which may be due to pleural fluid is also unchanged. Right upper lobe mycetoma.Paucity of bowel gas in the upper abdomen, recommend correlation with abdominal radiographs if the patient remains symptomatic.

Output: No acute pulmonary abnormality, chronic findings appear unchanged including a right upper lobe mycetoma. Possibility of bowel gas in the upper abdomen may indicate pathology and can be further evaluated with abdominal radiographs if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Head and neck cancer, check for pneumonia Mild emphysematous changes without superimposed acute focal airspace abnormality. Tracheostomy tube is observed terminating 6 cm above the carina. Right PICC line extends into the mid SVC

Output: Well-positioned PICC line


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: PNA? History: cough, fever Thoracolumbar scoliosis. Cardiomediastinal silhouette within normal limits. Lungs clear of airspace or interstitial opacities. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: fevers and fatigue; metastatic pancreatic cancer; eval for focal opacity, pleural effusion, pulm edema, new lung mets History: see above Nodular opacity projected over the right chest wall infusion port could actually be intrapulmonary although not confirmed on the lateral view.Otherwise, no significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: Possible nodule projected behind the right chest wall port, a thoracic CT recommended to exclude metastases. Otherwise, no evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female; 32 years old. Reason: infiltrate, status of pleural effusion History: worsening shortness of breath with desaturations No significant interval change in moderate bibasilar opacities compatible with effusions with underlying atelectasis/consolidation and probable edema. No new pulmonary opacities. Stable thoracic spine fusion hardware.

Output: No significant interval change in moderate basilar opacities.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with left lower lobe lesion and cough. LUNGS AND PLEURA: Right lower lobe pleural based opacity with internal air is unchanged in size and appearance. Micronodule in the right major fissure is unchanged, and likely represents an intrapulmonary lymph node. No pleural effusions. No new suspicious pulmonary nodules. Minimal pleural thickening in the left may be postinflammatory.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Pleural-based opacity in the right lower lobe is unchanged in size and appearance. Follow-up in one year is recommended to confirm stability.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history of metastatic renal cell cancer. Restaging scans status post 6 cycles of oral mTOR inhibitor. CHEST:LUNGS AND PLEURA: Right > left pleural effusions, increased from prior study.MEDIASTINUM AND HILA: Cardiomegaly with stable moderate pericardial effusion. Atherosclerotic calcifications of the coronary arteries. Small mediastinal lymph nodes.CHEST WALL: Expansile and sclerotic right rib lesion, unchanged from prior study but increased in size since CT study from 2005. It was also seen on the nuclear bone scan from 2006.ABDOMEN: LIVER, BILIARY TRACT: Innumerable metastatic lesions, appearing similar to prior study. Reference lesion in the lateral segment of the left lobe (series 3, image 102) measures 6.3 x 4.1 cm (stable). Right hepatic lobe reference lesion (series 3, image 113) measures 8.2 x 6.5 cm, which is also stable accounting for differences in technique.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Small left adrenal nodule, unchanged.KIDNEYS, URETERS: Status post right nephrectomy without evidence of recurrence in the surgical bed.RETROPERITONEUM, LYMPH NODES: Left retroperitoneal soft tissue mass (series 3, image 144) appears similar prior study, measuring 2.5 x 1.9 cm (stable).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild anasarca in the lower abdomen.OTHER: Small amount of perihepatic ascites.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lower lumbar spine.

Output: 1. Innumerable hepatic metastases appearing similar to prior study. No new sites of disease.2. Pleural effusions, increased from prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: desat History: desat Focal opacity medially in the right lung base suggestive of infection or atelectasis from aspirated secretions.Bilateral jugular catheters terminate in the SVC.

Output: Right basilar opacity suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Tachycardia and diaphoresis evaluate for pneumonia. Basilar opacities nonspecific and may reflect atelectasis and/or aspirate. Normal heart size. No pneumothorax or visible pleural fluid.

Output: Nonspecific basilar opacities favored to represent atelectasis and/or aspirate. If patient remains symptomatic, follow-up plain films would be suggested to exclude development of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with history of aspiration pneumonia. Stable cardiomediastinal silhouette. Redemonstrated are bilateral midlung air space opacities appearing similar to the prior study. No pleural effusions or pneumothorax.

Output: Stable appearing bilateral air space opacities compatible with infection and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: dyspnea History: dyspnea Multiple bilateral pleural-based masses are present with associated rib destruction compatible with myeloma or metastatic disease.Moderately large right pleural effusion, with underlying opacity compatible with atelectasis.

Output: Multiple pleural or extrapleural masses with associated rib destruction compatible with multiple myeloma or metastatic disease. CT scan is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: TECAB Improved aeration with improved lung volumes and persistent mild interstitial changes in both bases, likely largely chronic and baseline. No specific new superimposed focal airspace process.Cardiac silhouette remains mildly enlarged. Mediastinal contours are within limits

Output: Improved aeration without new acute pulmonary findings


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Pneumonia and acute kidney failure. Motion artifact degrades image quality.Right jugular introducer unchanged in position.Interval placement of a Dobbhoff tube with tip off the caudal margin of the film.Right diaphragm is elevated with adjacent atelectasis.Faint pulmonary opacities unchanged.

Output: Faint pulmonary opacities suggestive of edema, about the same allowing for motion artifact.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: evaluate metastatic disease History: recently diagnosed rectal cancer Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Prominent epicardial fat pads.

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


Instruction: Generate impression based on medical findings.

Input: Male 60 years old; Reason: chest wound, possible abscess History: wound drainage The subcutaneous tissues of the anterior chest there is a heterogeneous fluid-filled pocket measuring 2.6 x 0.7 cm with a tract that extends to the skin. There are small foci of gas within the tract which appears well granulated.The anterior mediastinum is obscured due to overlying bone.

Output: 1.Findings suspicious for a small pocket of fluid (possibly infected) with a tract to the skin.2.Findings discussed with Dr. LIO, JONATHAN


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: assess for infiltrates History: cough Interval near-complete resolution of left pleural effusion. Interval decreased density of the retrocardiac left lower lobe consolidation. Cardiac silhouette is normal. No evidence of pneumothorax.

Output: Interval improvement of the left lower lobe pneumonia and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 49 year male with exposure to TB and abnormal chest x-ray, evaluate for lymphadenopathy and parenchymal disease LUNGS AND PLEURA: Demonstration of a well marginated 11 mm x 13 mm nodule within the left lower lobe (image 70 series 4). No internal calcification can be identified.No other pulmonary nodules can be identified.No pleural effusion.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Moderate coronary artery calcification.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Diffuse degenerative changes throughout the thoracic spine which may represent DISH (diffuse idiopathic skeletal hyperostosis)UPPER ABDOMEN: No significant abnormality noted.

Output: Solitary left lower lobe pulmonary nodule. Retrieval of any previous outside exams would be of value. If not obtained, a follow-up exam is recommended in 3 months. No evidence of active TB.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history of prostate cancer. Extent of tumor spread and retroperitoneum. Presenting with abdominal pain CHEST:LUNGS AND PLEURA: Bilateral small pleural effusions and dependent atelectasis. Left upper lobe, right middle lobe patchy ground glass opacities, nonspecific. There are pneumonia cannot be excluded. No lung nodules suspicious for metastatic disease. Calcified granulomas.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple ill-defined hypodense lesions in the liver, suspicious for metastatic disease. An index lesion near the dome measures 2.5 by 2 cm on image number 82, series number 4.SPLEEN: No significant abnormality notedPANCREAS: Pancreas is displaced by the extensive adenopathy. 3.4 x 2.2 cm cystic appearing lesion in the neck of the pancreas, incompletely evaluated. This may represent a pseudocyst or a branch type intrapancreatic mucinous neoplasm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left-sided mild hydronephrosis. Nephrogram is delayed on the left side. Nephrostomy tube is in place. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Extensive Conlin aerated retroperitoneal adenopathy. At the level of the left renal artery measures 14.7 x 6.2 cm on image number 122, series number 4. This adenopathy encases the retroperitoneal vessels and extends to the pelvis, to both peri-iliac regions, more prominent on the left side. On the left side the adenopathy invades the left renal hilum.There is also bilateral retrocrural adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: Left obturator adenopathy measuring 5.9 x 3.5-cm image number 185, series number 4.. there is also bilateral peri-iliac adenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Heterogeneous lytic lesions in L4 lumber vertebral body suspicious for metastatic disease.OTHER: No significant abnormality noted

Output: Extensive retroperitoneal and predominately left-sided pelvic adenopathy.Mild less hydronephrosis despite the nephrostomy tube.Hepatic metastases.Possible metastatic disease in L4 vertebral body


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Intubated/Sedated History: Intubated/Sedated Endotracheal tube terminates 3 cm above the carina. The remaining support devices are unchanged in position.Right-sided rib deformities compatible with prior fractures. Pulmonary nodule at the left lower zone is partially obscured by overlying metallic electrode. This is better characterized on previous CT thorax. Additional right-sided nodules are obscured by right hilar subsegmental atelectasis. No interval edema or pneumothorax.

Output: Lower zone nodular opacities partially secured by overlying hardware and subsegmental atelectasis. Continued follow-up is recommended as these may represent septic emboli or multifocal infection.


Instruction: Generate impression based on medical findings.

Input: Back pain Mildly decreased lung volumes although this may be largely due to semiupright portable positioning. No discrete superimposed new air space abnormalities within this limitation and appearance is similar to prior exam. Extensive sclerotic osseous metastatic lesions unchanged

Output: No new acute cardiopulmonary findings


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with history of cough and fever. Evaluate for pneumonia. Cardiomediastinal silhouette is unremarkable. There are right greater than left subtle airspace opacities which may be secondary to aspiration or atypical infection.

Output: Findings suggestive of aspiration or atypical infection, worse on the right.


Instruction: Generate impression based on medical findings.

Input: Reason: lvad, tachycardia and malaise History: above Cardiopulmonary monitoring and support devices, unchanged.No significant pulmonary abnormalities.A more recent radiograph has been interpreted.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: pancreatitis, eval for pleural effusion History: see abovr Previous enteric tube is no longer present.Low lung volumes. Heart size is unchanged, upper limits of normal. No consolidation, significant pleural effusion or pneumothorax.

Output: No significant pleural effusion. Low lung volumes.


Instruction: Generate impression based on medical findings.

Input: Female 3 days old Reason: Eval lung fields History: s/p chest tube placement, acute desatVIEW: Chest and abdomen AP (two views) 4/3/15 at 849 hours ET tube, NG tube, umbilical lines and right-sided chest tubes unchanged. Interval worsening in right tension pneumothorax with mediastinal shift towards the left. Persistent lung haziness and pattern of PIE.No change in complete paucity of abdominal gas.

Output: Worsening in right-sided tension pneumothorax.Findings were communicated to acknowledged by WOO, JOYCE on 4/3/15 at 9:48 a.m.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: infiltrate History: hypoxia Worsening of bilateral perihilar opacification consistent with edema. Heart size is normal.Bilateral pleural effusions with adjacent atelectasis.No pneumothorax.

Output: Interval worsening of bilateral effusions and edema


Instruction: Generate impression based on medical findings.

Input: 87-year-old female with history of strokes, hypertension and shortness of breath and chest pain. Positive d-dimer. Evaluate for PE. PULMONARY ARTERIES: Technically adequate study. Enlarged pulmonary artery suggestive of pulmonary artery hypertension. Multiple granulomas.LUNGS AND PLEURA: Previously described region of focal ground glass opacity in the right middle lobe (image 59, series 7), is unchanged; however, may still be monitored for stability as indolent neoplasm such as bronchoalveolar carcinoma cannot be excluded. Left upper lobe peripheral area of focal nodularity with areas of calcification likely represents postinflammatory changes.MEDIASTINUM AND HILA: Heart is within normal limits without evidence of pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Liver and splenic calcifications secondary to prior granulomatous disease.

Output: 1. No evidence of pulmonary embolus as clinically questioned. 2. Enlarged pulmonary artery suggestive of pulmonary arterial hypertension.3. Right middle lobe ground glass opacity has been stable since 2006 study; however, a longer period of surveillance may be considered due to the indolent nature of certain neoplasms such as bronchoalveolar carcinoma.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Cough, aphasia. No focal airspace opacities, pleural fluid or pneumothorax. Heart size appears normal.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: assess for blossoming of pneumonia vs. hypervolemia after getting fluid resuscitation History: as above, previously reported history of multiple myeloma Left port is accessed. The terminal portion likely terminates within the azygos vein. Persistent mild dilatation of the mediastinum with loss of the aortopulmonary window raises a question of lymphadenopathy. No specific evidence of infection or edema. No pneumothorax. Multilevel degenerative changes of the thoracolumbar spine.

Output: No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 64 year old female metastatic CRC on IV chemo. Evaluate and compare to previous scans. CHEST:LUNGS AND PLEURA: Redemonstrated changes consistent with a paraseptal emphysema. Previously seen lung nodules are no longer present. No effusions.MEDIASTINUM AND HILA: The small pretracheal nodes, unchanged.CHEST WALL: Port-A-Cath right chest wall. Small axillary nodes bilaterally unchanged.ABDOMEN:LIVER, BILIARY TRACT: Large confluent and multifocal masses redemonstrated all decreased in size with no new lesions seen. Dominant mass re-measured on series 3 image 85, 12.6 x 9.5 cm. Some mild biliary prominence in the lateral segment of the left lobe and posterior segment of the right lobe. No evidence of venous thrombus although the hepatic venous vasculature is encased and compressed in the region of the mass.SPLEEN: Nonspecific focal lesion in spleen series 2 image 81 measures 0.9 x 0.7 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Septated cysts lateral aspect left kidney unchanged.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal nodes unchanged.BOWEL, MESENTERY: Diminished thickening right colonic wall of uncertain significance. No evidence of ascites. No evidence of carcinomatosis.Portacaval node decreased in size measured on series 3 image 102 is 1.9 x 1.1 cm.BONES, SOFT TISSUES: No lytic or blastic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Exophytic uterine masses consistent with leiomyomata, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: All measured disease decreased in size. No new sites of disease. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: r/o metastatic dz from rcc History: as above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

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


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with history of asthma presenting with 2 days of wheezing. Evaluate for infection. Cardiomediastinal silhouette is unremarkable.No focal airspace opacity, pleural effusion, or pneumothorax.Metallic density overlies the left chest wall which are probable bullet fragments and are unchanged.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Shortness of breath Left-sided single lead ICD in place.Unremarkable cardiomediastinal silhouette.Low lung volumes.No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: cp History: chest pain Line position stable. No pneumothorax.Lungs clear.Heart size normal.No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: IABP Balloon catheter in the proximal descending aorta and ICD leads unchanged from previous.No significant pulmonary abnormalities.

Output: Balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonitits vs pneumonia, progression of lung mets History: met breast cancer to lung, sob, cough Marked interval increase in the size of multiple bilateral pulmonary nodules compatible with metastases.A right perihilar mass has also markedly increased.No evidence of pneumonia or pleural effusion.

Output: Marked interval progression of pulmonary metastasis.


Instruction: Generate impression based on medical findings.

Input: Reason: assess swan positioning History: swan ganz catheter placement Swan-Ganz catheter tip in the right descending pulmonary artery.ICD lead unchanged.Moderate cardiomegaly with vascular redistribution but no sign of pulmonary edema.

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


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: respiratory distress History: respiratory distress NG tube has been pulled back slightly with side port now just above the gastroesophageal junction. Endotracheal tube terminates approximately 4 cm from the carina. Low lung volumes. No new focal lung consolidation. Unchanged cardiomegaly. No pleural effusion or pneumothorax.

Output: NG tube has been pulled back slightly with side port now just above the gastroesophageal junction.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: eval acute process History: CP Right humeral prosthesis partially visualized. Mild cardiomegaly with evidence of prior coronary arterial stenting. The lungs and pleural spaces are clear. No pneumothorax

Output: No evidence of edema or infection. Mild cardiomegaly unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: compare if improvement in pleural effusion History: SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear. No pleural effusions.

Output: Interval clearing of the pleural effusions previously identified. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.History of renal transplant with fever. Evaluate for pneumonia. Cardiomegaly has resolved, the cardiomediastinal silhouette is unremarkable.Coarse basilar predominant reticulonodular interstitial and ground glass opacities appear similar to the prior CT and could represent small airways disease. No focal consolidation, pleural effusion or pneumothorax.

Output: Basilar predominant reticulonodular interstitial and groundglass opacities appear similar to the prior CT and may represent small airways and/or small vessel disease. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of amyloidosis with pulm involvement, with new whitening of hemithorax ?collapse vs edema History: cough, increase o2 req Almost complete opacification of the left hemithorax with depression of the left hemidiaphragm consistent with a large pleural effusion with underlying atelectasis.Moderate right pleural effusion.Extensive mediastinal and supraclavicular calcified masses, consistent with amyloidosis, as previously described.

Output: Almost complete opacification of the left hemithorax consistent with a large pleural effusion with underlying atelectasis, as confirmed on a CT scan of the previous day.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with aortic valve disease. Preoperative aortic valve replacement chest radiograph. Cardiac silhouette is within normal limits.No focal airspace opacity.Blunting of the right costophrenic angle is due to scarring.Multiple air-fluid levels seen in the bowel.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.History of heart failure for evaluation of edema Cardiomediastinal silhouette is borderline enlarged.No pleural effusion or pneumothorax.Left lower lung scarring/atelectasis.Anterior opacity only appreciated on the lateral projection may be due to technique.

Output: No specific evidence of edema. Anterior opacity only appreciated on the lateral view may be due to technique. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: rule out pneumothorax after block History: cough No pneumothorax identified.Lobulated left pleural thickening or loculated pleural fluid left lower lung zone unchanged.Unremarkable mediastinal contours and cardiac silhouette.Healed left rib fractures.Right jugular catheter tip at cavoatrial junction.

Output: No significant pneumothorax. Unchanged pleural thickening or loculated pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: 63 yo female with 2 days of left lateral chest pain with cough, assess for PNA History: cough and chest pain Linear scarring or atelectasis on the right.Dual lead pacemaker with one lead tip in the RA, the other coursing superiorly near the right ventricular outflow tract.

Output: Linear scarring or atelectasis on the right.Dual lead pacemaker with one lead tip in the RA, the other coursing superiorly near the right ventricular outflow tract.


Instruction: Generate impression based on medical findings.

Input: Patient with laryngeal, renal cell and prostate cancer. Evaluate for response to treatment. CHEST:LUNGS AND PLEURA: Reference right middle lobe nodule is unchanged measuring 8 by 8mm image number 41, series number 4. Other scattered micronodules are also unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence.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 radical prostatectomy. Nodular left seminal vesicle is unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted. Focal area of sclerosis in the right iliac bone adjacent to the right SI joint is unchanged.OTHER: No significant abnormality noted

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: s/p LVAD c/b respiratory failure History: as above Support devices unchanged.Stable cardiomediastinal silhouette.Perihilar and basilar opacities compatible with edema and atelectasis.Small pleural effusions and left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: s/p VATS pleural biopsy History: see above Left chest wall pacemaker device, lead position unchanged. Prosthetic aortic valve in place. Sternotomy hardware intact. Surgical clips project over the right axilla. Improved subcutaneous emphysema along the right chest wall. Bibasilar atelectasis improved compared to the prior examination. Small bilateral pleural effusions, slightly improved on the left and stable in the right. Stable small right apical pneumothorax. The cardiac and mediastinal contours are unchanged in size.

Output: 1.Persistent small right apical pneumothorax.2.Basilar atelectasis and small effusion slightly improved from the prior examination.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.History: End-stage renal disease. Preoperative evaluation for kidney transplant. Unremarkable cardiomediastinal silhouette.No pulmonary or pleural abnormalities.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: eval for acute cardiopulm process History: asthma exacerbation, SOB, wheezing Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: r/o acute process - scd pain with cough History: r/o acute process - scd pain with cough Cardiomegaly with nonspecific basilar opacities suggestive of scarring.No reliable evidence of acute infection or infarction.

Output: Chronic sickle cell related findings, but no reliable evidence of acute infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.CHF and IABP. Left subclavian ICD unchanged in position. IABP marker projects 3-cm below the top of the aortic arch level.Unchanged cardiomegaly. Low normal lung volumes. Mild hazy perihilar opacity may reflect mild acute edema, though no septal lines are appreciated.

Output: Questionable mild pulmonary edema. IABP marker 3-cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female with history of gastric cancer status post resection and chemotherapy. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Hepatic hypodensity in segments 8 of the liver are unchanged from prior examination and may represent a hemangioma. Additional hepatic hypodensity in segment 4A is unchanged from prior examination. Large hemangioma in segment 7 is stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Suture line is noted in the stomach status post resection of tumor.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Multiple left ovarian cysts below 2cm in diameter and are most likely physiologic. On the previous exam there were more ovarian cysts noted bilaterally.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Cardiac surgery Postsurgical changes including bilateral chest tubes and small pneumothoraces, greater on the right are observed. ETT with a selected dual lumen, the longer lumen extending into the left mainstem bronchus.Right jugular sheath extends into the upper SVCNo immediate focal cardiopulmonary abdomen however exam limited with cut off of the left chest wall

Output: Bilateral chest tubes. See subsequent reports


Instruction: Generate impression based on medical findings.

Input: Female 72 years old Reason: pna History: cough Low lung volumes with no new focal airspace opacity.Nonspecific apical nodular opacity on the right.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is normal.

Output: No specific evidence of infection or significant interval change. Nonspecific apical nodular opacity on the right could represent scarring, but is incompletely characterized with this technique. If the referring clinical service can obtain and submit remote prior films for comparison to prove stability, an addendum may be provided.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, 73 years old.Reason: pneumothorax History: sob Persistent right hydropneumothorax with basilar opacities and a left pleural effusion.Right chest tube unchanged in position.

Output: Persistent right hydropneumothorax with basilar opacities and left pleural effusion. No significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: r/o acute process History: s/p lung transplant with recent pneumonia Patchy opacities at the left lung base have resolved. Underlying upper lung preponderant interstitial opacities with associated volume loss is not substantially different. Left mainstem bronchial stent again noted. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Resolution of left lower lobe pneumonia.Probable restrictive allograft syndrome.


Instruction: Generate impression based on medical findings.

Input: Sickle cell patient with history of acute chest syndrome, now with cough and hypoxia.VIEWS: Chest AP/lateral (two views) 1/22/2015 No focal airspace opacity seen to suggest acute chest syndrome. The cardiothymic silhouette is upper limits normal in size, and mild vascular engorgement is evident. Suture material is seen in the left upper quadrant.

Output: No evidence of acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: 20-year-old female presents with right upper back pain. Evaluate for pneumonia. The cardiomediastinal silhouette is normal. The right T5 spinous process appears sclerotic. No pleural effusion or pneumothorax.

Output: Sclerotic. Transverse spinous process of T5 on the right as described above is nonspecific; recommend dedicated T-spine radiographs to exclude nonbenign process given history of pain in the area.Discussed findings with Dr. Palma (emergency department physician) at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Adenocarcinoma. 6 week follow-up Mildly asymmetric lung volumes unchanged compatible with postsurgical changes including the small loculated pleural effusion along the medial margin. No suspicious abnormalities. Residual small right effusion has resolvedNo cardiac or mediastinal contour additional abnormality

Output: Resolved right pleural free effusion with suspected small loculated component medially with suspected scarring


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Please perform standing PA/lateral at bedside History: hypoxemia, tachypnea, hx of COPD, please rule out pulmonary edema Basilar opacities with pleural effusions unchanged.Status post extubation.

Output: No change in basilar opacities and pleural effusions following extubation. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: heart failure, swan ganz in place History: heart failure, swan ganz in place Cardiomegaly.No specific evidence of infection or edema.External defibrillator leads are unchanged.Right jugular Swan-Ganz catheter, tip in right descending pulmonary artery.

Output: Swan-Ganz catheter unchanged in position, tip in the right descending pulmonary artery. Cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: Reason: AMS History: AS above Tracheostomy tube in place and the catheter tip in the SVC.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Right upper lobectomy Interval removal of a right pleural catheter (one remains). 2cm right apical pneumothorax. Right hemithorax volume loss. Left basilar scarring/atelectasis. Cardiac silhouette is normal.

Output: Interval removal of a pleural catheter. 2cm right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Solitary pulmonary nodule. Right VATS surgery Interval continued improvement with improved aeration of the remaining right lung with postsurgical changes and mild to moderate volume loss. Persistent moderate layered effusion. No specific new superimposed focal acute airspace abnormality and lungs are significant for mild basilar changes suggesting atelectasis.Suspected right hilar calcified lymph nodes without additional cardiac or mediastinal contour abnormalityGrossly unchanged lower cervical spine fixation

Output: Resolving and decreasing yet persistent moderate right pleural effusion and postsurgical changes


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: chest pain History: chest pain The lungs and pleural spaces are clear. The heart size remains normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with lung cancer status post chemotherapy in RT. Follow-up. CHEST:LUNGS AND PLEURA: Paramediastinal atelectasis and associated traction bronchiectasis are again consistent with sequelae of radiation therapy, most prominent at the right apex. Scattered micronodules bilaterally, unchanged. No new suspicious nodules, mass, or pleural effusion.Emphysema.Surgical suture line in the right lung as seen previously.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal with a small amount of pericardial fluid. Coronary calcifications.CHEST WALL: Minimal degenerative changes of the spine. ABDOMEN: LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts bilaterally, many of which are too small to characterize, but all are unchanged since prior study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Minimal degenerative changes of the spine.

Output: No evidence of disease recurrence or metastases.


Instruction: Generate impression based on medical findings.

Input: Cough Mild COPD changes without superimposed additional acute cardiopulmonary abnormality

Output: Mild COPD


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: ETT placement confirm History: resp failure with vent requirement Lines and tubes are unchanged. Patchy opacities in the mid aspect of the lungs, likely atelectasis or scarring, again noted. Probable mild pulmonary edema, as before. Small pleural effusions, unchanged. Unchanged heart size. No pneumothorax.

Output: Patchy opacities in the mid aspect of the lungs, likely atelectasis or scarring, again noted. Probable mild pulmonary edema, as before. Small pleural effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Cough/fever. Evaluate for infection. Persistent consolidation in the lateral aspect of the left mid lung when compared to prior CTs. A pulmonary nodule within the right upper lobe is again noted. No large pleural effusion or pneumothorax. The heart size is normal.Right chest port catheter terminates in the SVC.

Output: Persistent consolidation in the lateral aspect of left midlung may represent radiation pneumonitis or pneumonia. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: cough, chest pain History: cough, chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of ascending colon mass CHEST:LUNGS AND PLEURA: Focal area of airspace opacity adjacent to the fissure in the left upper lobe, likely represents focal subsegmental atelectasis. Follow-up imaging is recommended to exclude a mass. Left lower lobe subsegmental atelectasis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. This study is limited for evaluation of focal liver lesions due to lack of IV contrast.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 2.9 x 2.4 cm left ovarian cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited study due to lack of IV contrast.No definite evidence of metastatic disease. Follow-up imaging is recommended for the air space opacity in the left upper lobe and left ovarian cystic lesion.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Concern for ingested foreign body. Unremarkable cardiomediastinal silhouette.No pulmonary or pleural abnormalities.No unexpected radiopaque foreign object identified within the thorax.

Output: No unexpected radiopaque foreign object within the thorax. Please see accompanying abdominal radiograph.


Instruction: Generate impression based on medical findings.

Input: Age: 23 yearsGender: MaleReason for Study: Reason: Compare to 4/10 CXR for worsening or resolution of nodular density projecting from the right mediastinum History: Neutropenic Right Port-A-Cath and left central venous catheter unchanged.Stable cardiomediastinal silhouette.Nodular density and noted on the prior exam is not well defined on the current exam and may have represented outside the patient.The lungs are clear.No pleural effusions.

Output: No acute abnormalities identified. No specific evidence of infection. Nodular density in the projection of the right upper lobe on the prior exam is not identified on the current exam and this may have been external to the patient.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: confirm stable IABP placement History: advanced heart failure ith IABP Balloon catheter in the proximal descending aorta and ICD leads unchanged from previous.No significant pulmonary abnormalities.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: 10-year-old male with Takayasu's arteritis with weakness. Evaluate for progression of stenoses/aneurysms. Motion artifact limits evaluation on multiple sequences. Within this limitation, the following observations are made.No significant steno-occlusive disease of the brachiocephalic artery, left common and internal carotid arteries, and the bilateral subclavian arteries. Persistent occlusion of the right common carotid artery. The vertebral artery origins appear normal. Mild narrowing of the aortic arch appears unchanged. Aortic and branch vessel wall thickening in the chest is difficult to evaluate due to motion artifact.

Output: 1. No significant interval change with persistent occlusion of the right common carotid artery. The remainder of the aortic arch branch vessels are patent. Aortic and branch vessel wall thickening in the chest is difficult to evaluate due to motion artifact.2. MRA of the neck is reported separately.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: MaleReason for Study: Reason: sp intubation patient with sob History: sob ET tube and NG tube have been removedLeft PICC line with its tip in the RA..Pleural effusions, left greater than right, and basilar consolidation/atelectasis similar to the prior exam.Stable cardia mediastinal silhouette with mediastinal widening.

Output: Interval extubation. Stable cardiopulmonary appearance with pleural effusions and basilar consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: PNA? COPD, HIV with worsening SOB History: above No acute abnormality.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: s/p cardiac surgery, respiratory insufficiency History: above Tracheostomy tube and pacemaker, unchanged.Basilar opacities consistent with edema/atelectasis and pleural effusions, not significantly changed.

Output: Pleural effusions and edema/atelectasis without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.S.O.B. question of pulmonary edema. Left VAD tip unchanged in position near the SVC. Basal atelectasis and effusions, left greater than right, about the same. Coarse interstitial abnormality consistent with atelectasis and edema, about the same.

Output: No significant change from recent previous.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: s/p lung transplant History: sob / trach Tubes and lines are unchanged.Stable cardiomediastinal silhouette.Bilateral diffuse pulmonary opacities, more pronounced on the left are similar in appearance to the prior exam.Pleural effusions, left greater than right, are stable.Small left apical air collections not as well appreciated on this examination.

Output: Stable cardiopulmonary appearance with extensive pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Diabetes mellitus with low-grade fever The cardiac silhouette is unremarkable. Low lung volumes and basilar atelectasis without specific evidence of infection, edema, or effusions.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Stage III metastatic melanoma CHEST:LUNGS AND PLEURA: Bilateral apical pleural scarring. If you micronodules in both lungs, unchanged. Reference left lower lobe nodule measures 5 mm on image number 8, series number 5, not significantly changed.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes are unchanged. Reference right hilar lymph node with fatty hilum is unchanged measuring 11 by 11-mm image number 44, series number 4.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Left lobe hepatic cyst is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm measuring 2.5-cm in greatest AP dimension is unchanged.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: Male, 48 years old.Left VATS wedge. Solitary pulmonary nodule. Left chest tube is slightly retracted. Right jugular chest port unchanged in position. Unchanged elevation of the right hemidiaphragm. Severe left sided subcutaneous emphysema.Very small left apical pneumothorax. Paramediastinal atelectasis or scarring in the left lower lobe. Azygos pseudolobe, normal variant anatomy. Cardiomegaly unchanged.

Output: Very small left apical pneumothorax. Extensive left chest wall subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Renal mass rule out metastases. No pleural fluid or pneumothorax. Scattered pulmonary nodules, most likely granulomas, though nonspecific as they are not conclusively calcified. Pulmonary hila appear slightly prominent, though no discrete lymphadenopathy is appreciated. Normal heart size. Right upper quadrant surgical clips.

Output: Nonspecific pulmonary nodules/micronodules for which a baseline thoracic CT is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: Reason: swan location History: swan Swan-Ganz catheter tip in the main pulmonary artery.Questionably decreased cardiac size and no other significant change.

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


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: Eval for cardiopulmonary disease. History: Dizziness. Moderate cardiomegaly.Mild basilar interstitial opacities suggestive of edema versus fibrosis.No significant sized pleural effusions identified.Large lung volumes consistent with COPD.No specific evidence of infection.

Output: Cardiomegaly, with basilar edema versus fibrosis, without acute pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: Evidence of pneumonia? History: Fever, SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pulmonary edema History: evaluate for pulmonary edema No significant cardiopulmonary abnormalities.PICC line tip in the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: shortness of breath, evaluate for pneumonia History: shortness of breath Unchanged cardiomegaly with prominence of the central pulmonary vasculature. Persistent bibasilar subsegmental atelectasis. No specific evidence of infection. Sternotomy hardware unchanged and wires intact.

Output: Mild pulmonary venous hypertension. No pulmonary edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: eval for pulm edema, effusions History: SOB, CHF, COPD Basilar interstitial opacities are suggestive of edema or aspirated secretions. Mild cardiomegaly status post sternotomy, unchanged.Left subclavian biventricular dual-chamber pacemaker unchanged.

Output: Recurrent basilar opacities suggestive of edema or aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: HELLP (preeclampsia), desaturation to 88% on magnesium History: HELLP, desaturation to 88% on magnesium No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old. Reason: sp NGT, ETT adjustment History: none ET tube with tip approximately 4 cm above the carina. NG tube curled within the stomach. Right IJ central venous catheter, tip near the cavoatrial junction.Surgical clips overlying the left chest and upper abdomen. Drain overlying the right lung base, unchanged in position.Mild cardiomegaly.Nonspecific basilar opacities, compatible with effusions and atelectasis, similar in appearance to prior.

Output: Stable cardiac pulmonary appearance. ET tube and NG tube adjusted as above.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female status post TACE times RFA x 3 and history of Nash cirrhosis and hepatocellular carcinoma LUNGS AND PLEURA: Multiple, subcm nodules in the right lower lobe are stable compared to previous CT. An index nodule measures 8 mm on image number 59, series # 10 in the right lower lobe. MEDIASTINUM AND HILA: Cardiomegaly, unchangedCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Stable right subcm nodules


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Backache, question pneumomediastinum. A right sided lower rib pain status post vomiting. EtOH, hematemesis. Normal heart size. Unsharpness of the left cardiac border at the level of the atrial appendage with bronchial wall thickening seen on the lateral radiograph. No mediastinal widening. No pneumothorax or visible pneumomediastinum. No focal air space opacities or pleural fluid. A metallic bullet remnant projects over the left lower lateral mid thorax, a second bullet fragment projects over the left shoulder, and multiple smaller metallic fragments project over the left shoulder region.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended.

Output: No pneumothorax or visible pneumomediastinum; please note that small amounts of mediastinal air may not appreciable by plain film. Bronchial wall thickening and atelectasis suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: 69yo M with CHF and IABP, assess placement History: CHF, IABP Mild cardiomegaly without edema.Right jugular catheter, tip in SVC.IABP catheter proximal marker projects over the aortic arch.Left subclavian ICD, leads unchanged in position.

Output: Unchanged tubes and devices. Cardiomegaly, without edema.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Postop transplant. Line placement, initial check. Right jugular catheter tip low in the right atrium and may be retracted by about 5 cm. The right hemidiaphragm is mildly elevated. Unchanged cardiomegaly. Increased dependent atelectasis in the left hemithorax. No pneumothorax. Right upper quadrant calcification consistent with a chronic staghorn calculus.

Output: Low position of right jugular catheter; due to elevation of the right hemidiaphragm the catheter may enter the suprahepatic IVC upon inspiration. Suggest catheter retraction by about 5 cm. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: pt with pulm edema and requiring bipap, has pulm edema worsened? History: SOB Feeding tube again terminates within the body of the stomach. Low lung volumes with diffuse pulmonary opacity unchanged. Unchanged cardiomegaly. No pneumothorax.

Output: No substantial difference compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Seven year old female with history of cough and shortness of breath. Right chest port with tip in the SVC. Multiple surgical clips project over the left supraclavicular region.Stable cardiomediastinal silhouette. Severe elevation of the left hemidiaphragm is unchanged. No focal opacities or pleural effusions.

Output: Severe elevation of the left hemidiaphragm, but otherwise no acute cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Infiltrates History: fever Defect in left hemidiaphragm representing Bochdalek hernia stable.Low lung volumes with chronic-appearing basilar interstitial opacities, unchanged. Cardiomediastinal silhouette is unremarkable.No pneumothorax.

Output: No specific evidence of infection or interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: worsening respiratory status, fluid overload? History: worsening respiratory status Normal heart size with a tortuous calcified aorta.Large lung volumes with severe upper zone bullous emphysema and mild interstitial opacity in the lower lungs which has slightly increased since 10/24/2015 and may represent interstitial edema.Opacity in the posterior costophrenic angles is suggestive of small effusions.

Output: Severe COPD with probable interstitial edema and possible small effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: eval lung fields, cardiomegaly History: acute chest pain and SOB Mild to moderate cardiomegaly.Small lung volumes.No significant pulmonary or pleural abnormality.Right subclavian pacemaker leads unchanged.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: evaluate for volume overload History: shortness of breath No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: pulmonary edema History: pulmonary edema Cardiomegaly with lower lung zone opacities suggestive of edema with a right pleural effusion, slightly improved.Tracheostomy tube tip approximately 3 cm above the carina.Right jugular catheters unchanged.

Output: Slight improvement in basilar opacities with no new findings.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p PICC line pull back History: same Small lung volumes with elevation of the left hemidiaphragm.Catheter tip in the SVC, adjusted since the previous radiograph.Mild basilar atelectasis.

Output: Interval adjustment of PICC.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female status post right upper lobectomy for stage IA adenocarcinoma. Three year status post multiple wedge resections in the left lung for BAC. Follow-up CT CHEST:LUNGS AND PLEURA: Postsurgical changes from right upper lobectomy and partial left upper and lower wedge resections are unchanged.Semisolid nodule in the superior segment of the right lower lobe (series 5, image 16) measures 8 x 11 mm (unchanged from prior study but minimally larger on comparison to study from 12/16/2009).Additional right lower lobe groundglass nodule (series 5, image 26) is unchanged from study from 12/16/2009.Ill-defined ground glass opacity in the right upper lobe (series 5, image 23) is not significantly changed since 12/16/2009.Subpleural nodule in the left upper lobe (series 5, image 102) has increased in size since prior study, measuring 5 mm.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Aortic and coronary calcifications.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts bilaterally, unchanged from most recent prior study and grossly similar to prior contrast enhanced study from 12/16/2009.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: 1. Semisolid nodule in the superior segment of the right lower lobe remains suspicious for adenocarcinoma. It is questionably accessible via percutaneous biopsy. Consultation with interventional radiology may be of use. Additional right lung ground glass nodules are unchanged since December 2009.2. Interval increase in size of a subpleural left upper lobe nodule, which remains nonspecific. Continued surveillance is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: Chest pain History: Chest discomfort The heart size upper normal or mildly enlarged with a moderately tortuous aorta.Multiple calcifications consistent with previous granulomatous infection.Large lung volumes suggestive of COPD with no acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 37-year-old female with bicuspid aortic valve with a ascending aortic aneurysm into arch and to left subclavian artery CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Please note that cardiac motion artifact at the aortic root limits its evaluation. Aneurysmal dilatation of the ascending aorta measures 5.1 x 4.6 cm at the level of the main pulmonary artery in the axial plane. It involves the aortic root and ascending aorta to the left subclavian artery. The aorta is normal in caliber distally with the descending thoracic aorta measuring 2.6 x 2.4 cm in the axial plane.The aortic root measures at least 4.1 cm at the sinus of Valsalva.No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.CTA RUNOFF:The SFA and popliteal artery are patent with normal trifurcation vessels bilaterally. There is normal triple vessel runoff to the level of the ankles bilaterally as well.

Output: Ascending aortic aneurysm as described above


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Cough History: Cough The cardiomediastinal silhouette is normal.There are no focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: assess for PNA History: cough Lungs hypoinflated with minimal nonspecific basilar opacity likely edema or atelectasis. No evidence of pneumonia.

Output: Lungs hypoinflated with minimal nonspecific basilar opacity likely edema or atelectasis. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: lung eval History: sob The previously noted changes involving the aortic knob are no longer evident though continued follow-up is recommended.Stable pulmonary edema with pleural effusions. Support hardware unchanged.

Output: The previously noted changes involving the aortic knob are no longer evident though continued follow-up is recommended.Stable pulmonary edema with pleural effusions. Support hardware unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Tachycardia with concern for pneumothorax. Interval extubation and removal of enteric tube. Midline surgical staples project over the upper abdomen.Interval development of large right and moderate left pleural fluid collections with associated atelectasis and near complete collapse of the left lower lobe.No visible pneumothorax.

Output: No pneumothorax is visible on this semierect portable film. Significant worsening of pleural fluid and atelectasis since the prior study.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Numerous pulmonary findings correlating with the recent chest CT. This includes multiple large nodular and pleural-based masses in the right lung with mildly superimposed edema-like changes in both bases with enlarging moderate effusions. Changes correlate with known underlying mesothelioma.Cardiac and mediastinal contours are grossly unchanged

Output: Overall appearance similar to recent chest CT, however clinical concern for pneumonitis versus infection is difficult to discern and differentiate or exclude by plain film. Please correlate with recent prior CT and/or consider follow-up serial CT imaging