Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: 44 y/o woman with metastatic breast cancer and malignant pleural effusion. Evaluate for recurrent effusion. History: Worsening SOB. Moderate sized right pleural effusion and underlying atelectasis or similar to the prior exam allowing for differences in patient positioning and technique.Stable cardiomediastinal silhouette.The left lung is clear.No new pulmonary opacities identified.

Output: Moderate-sized right pleural effusion with underlying atelectasis similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old. Swan-Ganz catheter tip in the right main pulmonary artery. Left lower lobe nonspecific consolidation, unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Ventriculoperitoneal shunt and seizure today.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 01/17/16 Ventriculostomy tube tip is adjacent to midline in the middle cranial fossa. A right occipital burr hole is present. The Strata valve is set at a performance level of 1.0. The distal shunt tubing courses along the right neck and chest. It enters the peritoneal space in the right upper quadrant. The tip of the tube is in the left lateral abdomen. Bowel loops are not displaced from the distal tip. No shunt discontinuity is seen.No focal lung opacity is present. Mildly dilated bowel loops are seen.Lumbosacral spinal dysraphism is noted. Due to pelvic obliquity the hip joints are difficult to evaluate.

Output: No evidence of extraventricular shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Shortness of breath status post lobectomy. Left-sided chest tubes terminate at the apex, unchanged in position. Trace, 1-2 mm, pneumothorax on the left. Suture material and volume loss on the left consistent with left upper lobectomy. Mild basal atelectasis bilaterally. Otherwise, the lungs are clear. Gaseous distention of the stomach.

Output: Mild basal atelectasis. Trace left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: confirm ETT placement after adjustment Endotracheal tube tip approximately 2 cm above the carina. Right internal jugular catheter is kinked with tip in supraclavicular area. Enteric tube tip is in the gastric antrum or duodenal bulb. Cholecystectomy clips in the right upper quadrant. Left lower lobe atelectasis and elevation of the left hemidiaphragm is not significantly changed compared to the prior exam. Cardiomediastinal silhouette is unchanged and normal. No pneumothorax.

Output: 1.Endotracheal tube in adequate position.2.Left lower lobe atelectasis and elevation of the left hemidiaphragm is not significantly changed compared to the prior exam.3.Right internal jugular catheter is kinked with tip in supraclavicular area.Findings discussed with clinical service.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with metastatic melanoma CHEST:LUNGS AND PLEURA: Right major fissure. Reference lesion measures 3.6 by 3.7 cm, image number 56, series number 5. Right lower lobe reference lesion measures 7.1 x 5.6 cm image number 64, series number 5, not significantly changed. Left upper lobe lesion on the coronal plane measures 5.8 x 4.6 cm image number 50 of series number 8, 0384.MEDIASTINUM AND HILA: Subcarinal lymph node measures 4.1 x 3 .5 cm, slightly enlarged compared to previous CT.CHEST WALL: Right greater than left. Thyroid lobe nodules appear similar.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter focus in the right lobe is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small fat containing umbilical hernia is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Left groin lymph node measures 8.5 x 6.9 cm image number 106 on series number 4, slightly enlarged. The additional, smaller nodes in the left groin also, slightly enlarged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval enlargement in the subcarinal and left groin lymph nodes. Otherwise, no significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Cough, shortness breath, and fever. Personal history for cancer. Right-sided chest port tip in the right atrium. There are diffuse bilateral patchy airspace opacities and nodules with a right sided pleural effusion with overlying atelectasis/consolidation.

Output: Diffuse patchy airspace opacities and nodules are compatible with metastatic disease. However, cannot exclude a superimposed infectious process. Recommend CT for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: f/u pneumonia. On BiPAP now. History: above. Small bilateral pleural effusions, unchanged as compared with prior study. Stable multifocal airspace opacities, suspicious for pneumonia. The feeding tube is stable in position. There is no evidence of pneumothorax.

Output: Small bilateral pleural effusions, unchanged. Stable multifocal airspace opacities, suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: s/p CABG x3 History: asx Right IJ Swan-Ganz with its tip in the pulmonary artery.Chest/mediastinal tubes unchanged.IABP marker not identified.No evidence of pneumothorax.Stable cardiac enlargement.Bilateral perihilar and basilar opacities compatible with edema/atelectasis.Left retrocardiac consolidation/atelectasis and small effusion similar to the prior exam.

Output: IABP marker not identified. Remaining support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, basilar atelectasis, and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: POD #1 s/p robotic hysterectomy, now with low O2 sats History: low O2 sats, requiring 2 L NC No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: worsening cough, evaluate for new infiltrates History: cough, congestion Small lung volumes with moderate pulmonary fibrosis. Heart size normal.

Output: Small lung volumes with unchanged dominant fibrosis. No new findings to suggest superimposed edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old. Right PICC line is in place with its tip in the SVC.There are decreased lung volumes a stable cardiomediastinal silhouette.Left pleural thickening/effusion similar to the prior exam.Minimal left basilar scarring/discoid atelectasis.Prominence of the right hilum compatible with known right suprahilar mass.No new pulmonary opacities identified.

Output: Interval placement of a right PICC line. Stable cardiopulmonary appearance with right suprahilar mass and left pleural thickening and scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval lung fields History: fever Stable borderline cardiac enlargement. Interval development of patchy, probably right lung opacities. Findings may represent atypical pneumonia. No pneumothorax. No pleural effusions.

Output: Interval development of patchy right lung opacities. Consider atypical pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: needs chest x ray for fellowship History: none Cardiomediastinal silhouette is normal.No focal airspace opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary findings.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, 71 years old.Reason: tachypnea and hypoxia with trach History: tachypnea, hypoxia Left pleural effusion and smaller right, and the suggestion of basilar edema, unchanged.Tracheostomy tube tip approximately 6 above the carina.

Output: Tracheostomy tube tip approximately 6 above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Chest pain, S.O.B. recently diagnosed fungal infection. History of lung cancer. Rule out expanding fungal infection or pneumonia. No significant change in right upper lobe cavitary mass, irregular pleural thickening and architectural distortion of the right hilum. Normal heart size. Mild rightward mediastinal shift is unchanged.

Output: No visible change in right upper lobe cavitary mass compared to the previous examination.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Status post valvular replacement. Stable status post mitral and aortic valve replacement. Intact sternotomy hardware.Persistent signs of alveolar pulmonary edema, slightly improved from prior.No pneumothorax.Enteric tube coursing below the diaphragm.Mediastinal drains again noted.

Output: Slight improved alveolar pulmonary edema.Stable position of support apparatus.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: PTX History: Assess PTX Right-sided hydropneumothorax, not substantially different compared to previous study. Right inferior pleural pigtail drain again noted. Bibasilar subsegmental atelectasis or scarring again noted. Unchanged heart size.

Output: No substantial difference in right-sided hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: pre op clearance History: brain tumor Well marginated 3.8 x 4.9 cm right lower lobe mass.Elsewhere, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.Right jugular catheter, tip in SVC.Left neck surgical clips.

Output: Right lower lobe mass, CT recommended as this may represent primary lung cancer.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with history of colon cancer, status post right hemicolectomy CHEST:LUNGS AND PLEURA: Scattered subcentimeter nodules are unchanged. Dependent atelectasis.MEDIASTINUM AND HILA: Cardiomegaly. Index paratracheal lymph node is unchanged measuring 1.4 by 1.1-cm image number 27, series number 3. Other mediastinal lymph nodes are also unchanged.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: Nodular thickening of the left adrenal gland is unchanged.KIDNEYS, URETERS: Bilateral nonobstructive stones areRETROPERITONEUM, 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: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Increasing oxygen requirement History: as above Enteric tube terminates in the body of the stomach. Another tube overlies the trachea, which may be outside the patient. Lower lung volumes. Increased bibasilar opacities. Unchanged heart size. No pneumothorax.

Output: Lower lung volumes. Increased bibasilar atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Intraaortic baloon pump History: IABP Unchanged position of the IABP marker in the mid descending thoracic aorta approximately 9 cm from the aortic arch.Dobbhoff tube tip overlies the gastric body.Mild pulmonary edema and cardiomegaly are unchanged.

Output: IABP marker unchanged in position; other findings are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Assess for metastatic RCC. Right diaphragmatic pleural calcification noted.Low normal lung volumes.Unchanged appearance superior mediastinal lymphadenopathy. Normal heart size.Multilevel vertebral body height loss spine which is chronic.

Output: No acute pulmonary abnormality. No visible pulmonary metastases. Unchanged mediastinal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: evaluating for pna. History: acute onset fever-x 24h, Tm 102.5, w/ malaise, myalgias, cough-productive. Has personal h/o PNA x2 (on cxr, per pt, left sided) in 2015. Mild tachycardia, febrile in office. Oxygen sat 99%, Left upper \T\ mid lung field w/ audible bronchial plugging on ex Right perihilar opacity extending into the right upper lobe also seen on the lateral view suggestive of infection.Mild bronchial wall thickening noted.Heart size normal.

Output: Right perihilar/upper lobe patchy opacities suggestive of infection. Radiographic follow-up to resolution recommended, with a repeat study in the next 4-6 weeks.


Instruction: Generate impression based on medical findings.

Input: Female; 67 years old. Reason: r/o Pneumothorax ; shortness of breath. No significant pneumothorax. Right upper and lower lung zone opacities seen on prior radiograph have resolved. However, there now appears to be new ill-defined airspace opacity in the left lower lobe. No pleural effusions.

Output: 1.No significant pneumothorax.2.Interval resolution of right lung opacities with new poorly defined left lower lobe opacity which may represent developing infection versus aspirate or edema related to recent bronchoscopy.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: eval for infiltrate History: chest pain and shortness of breath Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Fatigue and shortness of breath Diffuse moderate interstitial changes scattered in all 4 quadrants and likely chronic. Overall appearance is not dissimilar to the prior chest CT given differences in technique. No specific superimposed focal airspace abnormality in this limited view, however serial imaging should be considered if suspicion remains high given this limitation.Moderate nonspecific cardiomegaly. Atherosclerotic changes and tortuosity of the aortaMild wedge deformity of mid thoracic vertebrae. Moderate degenerative changes of both shoulders incompletely visualized

Output: Cardiomegaly and underlying chronic pulmonary interstitial changes without superimposed acute focal air space abnormality, however consider repeat imaging specifically the lateral with improved raised arms ?


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Central line placement Right jugular catheter tip at the SVC. Lung volumes remain low. No focal pulmonary opacities. No pneumothorax.

Output: Appropriate position of right jugular catheter with tip at the level of the SVC. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Presenting with hypoxia. Please evaluate for progression of ARDS. Persistent diffuse interstitial and airspace opacities that appears consistent with previous exam. Endotracheal tube is about 4 cm above the carina and enteric tube tip is out of the field of view. Right central venous catheter tip is at the atriocaval junction.

Output: Persistent diffuse pulmonary opacities that appear unchanged from prior exam and are consistent with ARDS. ET tube tip is approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: active Tb; h/o inactive Tb s/p treatment, needs annual CXR for job interview History: none Slightly large lung volumes may indicate COPD.Otherwise, the lungs are unremarkable.Heart size normal.No active TB.

Output: No active TB. Mild COPD.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: Post-obstructive pneumonia History: As above Complete opacification right hemithorax redemonstrated.Increased interstitial opacities in the left lung compatible with edema.Probable small left pleural effusion.Lingular mass not as well visualized as on the prior exam.

Output: No interval change with complete opacification of the right hemithorax, lingular mass, and interstitial opacities in the left lung suggestive of edema


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: assess ET positioning History: intubated Cardiomegaly with mild to moderate edema, patchy consolidation and pleural effusions consistent with CHF.ET tube tip approximately 4 cm above the carina.NG tube removed.

Output: ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Status post thoracentesis -evaluate for pneumothorax and ett placement ETT tip 6 cm above the carina.Enteric tube tip in the stomach.Stable cardiomediastinal silhouette. Improved interval aeration of the right middle and lower lung zones. Unchanged pulmonary opacities, still consistent with a right-sided pneumonia or dense lymphangitic spread of tumor. Small bilateral pleural effusions. No pneumothorax.

Output: Improved aeration of the right middle and lower lung zones. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval et tube placement History: coughing on tube. eval for displaced ET tube tip approximately 5 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery.Cardiomegaly with bilateral opacity, greater on the right, consistent with edema and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval total femur replacement History: Chondrosarcoma There is mineralization of the soft tissue around the prosthesis and surgical clips. Unclear if this is heterotopic bone formation or residual tumor.Bone resorption is noted. Bulk of the soft tissue mass has been surgically removed as compared to the x-ray from 7/15/2015.

Output: Interval removal of bulk of the soft tissue mass. There is remaining soft tissue mineralization, unclear if this represents heterotopic bone formation or residual tumor. Follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: Female 6 years old Reason: s/p right chest tube removal, please eval for PTX, pleural effusion History: PNA c/b empyema s/p chest tube, just removed in EDVIEWS: Chest AP/lateral (two views) 5/20/2015 at 16:39 There has been interval removal of the right chest tube and left upper extremity PICC. The cardiomediastinal silhouette is normal. No pneumothorax is seen. The small right pleural effusion is unchanged as are patchy right lung opacities. The left lung appears normal.

Output: No pneumothorax. Stable small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT? History: see above ET tube tip approximately 3 cm above the carina.Dense consolidation and atelectasis in the left hemithorax, slightly increased compared to previous, with residual aeration at the left apex.Right perihilar airspace and interstitial opacity, suggestive of edema, slightly increased.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT History: intubated ET tube tip approximately 1 cm above the carina.Catheter tip in the SVC.Small lung volumes with bilateral perihilar and basilar opacity, improved compared to previous, consistent with atelectasis and pleural effusions.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Reason: sepsis, fluid resuscitaiton check pulmonary status History: sepsis, fluid resuscitaiton cehck pulmonary status Unremarkable cardiac and mediastinal silhouette.Catheter tip in the SVC.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old, with shortness of breath. Evaluate progression of pleural effusions and the liver (increasing LFTs). History of large B-cell lymphoma obtained on prior radiology requisition. CHEST:LUNGS AND PLEURA: A left-sided pleural effusion has improved significantly. A small right-sided pleural effusion is unchanged. Adjacent compressive atelectasis noted.Innumerable ground glass centrilobular nodules, worse on the right. This finding is nonspecific but may reflect aspiration bronchiolitis, infection (atypical, mycobacterial, fungal or viral) or hypersensitivity reaction.Dense consolidation at the left base, more so than expected from the degree of pleural effusion, may represent aspiration. Lingular scarring or atelectasis.MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. The cardiac size is normal. The pericardial fluid.CHEST WALL: Right chest wall port catheter, tip in the SVC. Sclerosis of a mid thoracic vertebral body is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Scattered small liver hypodensities are reidentified and may represent metastatic disease. A reference lesion adjacent to the gallbladder fossa measures 1.0 x 0.8 cm on image 119, series 3, decreased from 1.6 x 1.3 cm.Small amount of perihepatic ascites.SPLEEN: Scattered hypodense lesions in the spleen likely represent metastatic disease. A reference lesion measures 2.1 x 3.0 cm on image 95, series 3, decreased from 3.5 x 3.9 cm, although this difference may in part reflect the phase of contrast enhancement.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small right renal cystic lesion unchanged and probably benign.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy has improved. The reference lymph node on axial image 138, series 3, measures 1.7 x 1 .0 cm, decreased from 2.1 x 1.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See above.OTHER: No significant abnormality noted

Output: 1.Improvement in left pleural effusion.2.Diffuse centrilobular nodules may represent aspiration, infection or hypersensitivity reaction.3.Lymphoma reference lesions in the abdomen are improved.


Instruction: Generate impression based on medical findings.

Input: 54 year-old female history of shortness of breath and chest pain. Evaluate for edema or infection. The cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.

Output: Normal exam with no specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male history sarcoma. Please evaluate EOD and provide reference measurements. CHEST:LUNGS AND PLEURA: Extensive area of consolidation airspace disease is seen in the superior segment of the right lower lobe. This is consistent with an inflammatory process - rule out pneumonia. No lung nodules or effusions however.MEDIASTINUM AND HILA: Right paratracheal node cyst image 38 measures 1.4 x 1 cm. No evidence of axillary hilar diaphragmatic or retrocrural nodes.CHEST WALL: Port-A-Cath left chest wall.ABDOMEN:LIVER, BILIARY TRACT: A focal hypoattenuating lesion in segment 7 suspicious for metastasis in. The appearance suggests that there may of been two lesions growing together. Largest dimensions are obtained on series 2 image 93 where it measures 2.8 x 3 cm. no other hypodense lesions are seen in the liver. There is an ill-defined hyperattenuating focus seen in the lateral segment of left lobe series 3 image 106. This is not likely to be metastasis could represent a hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small nodes are seen peripancreatic. Nonpathologic by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse mixed sclerotic lytic pattern throughout all bones consistent diffuse osseous metastases. Surgical appliance seen L4-L5 level. Small soft tissue nodule in the subcutaneous tissues on the left postero-lateral wall seen on series 2 image 131. It measures 1.2 x 1.1 cm. No other subcutaneous nodules are seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse osseous sclerosis with some lytic areas consistent with diffuse metastases. Surgical clips along the inguinal canals noted. There is minimal asymmetry in the perineum with suggestion of a small nodular density near the base of the penis seen on series 3 image 226. This is of uncertain significance.

Output: Diffuse osseous metastases. Focal liver lesion. Postsurgical changes lumbar spine. Airspace disease right lung likely inflammatory or postinflammatory correlate for acute inflammatory process.


Instruction: Generate impression based on medical findings.

Input: SOB question infiltrate Moderate right pleural fluid collection with probable air loculated within the right minor fissure and a moderate right pleural fluid collection. The right lower lobe is collapsed. Hazy opacities in the right upper lobe unchanged and within the left lower lobe has progressed, with new left basilar airspace opacities. The scratch thatThere appears to be a fluid level in the right mainstem bronchus. New Dobbhoff tube with tip beyond the caudal margin of the radiograph.

Output: Moderate right pleural fluid collection with probable air in the minor fissure, suspicious for hydropneumothorax. Fluid in the right mainstem bronchus. Airspace opacities bilaterally could reflect aspiration or infection. Clinical service (Dustin Harris, 2135) notified via Web exchange text page at 1:34 PM on 11/15/2016. Serial follow-up and monitoring for possibility of empyema recommended, especially if there was a difficult enteric tube placement.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate vs edema History: hypoxia Interval extubation.Small lung volumes with extensive bilateral airspace opacity and large pleural effusions, not significantly changed allowing for projection and inflation.Catheter tip in the SVC.

Output: Bilateral nonspecific airspace opacity compatible with edema or aspiration with large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: persistent cough and sputum > 3 weeks - pls eval. R/O pneumonia History: as above 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: Female, 32 years old.Chest pain and orthopnea. Normal heart size. No pleural fluid or pneumothorax. No specific signs of pulmonary edema. No focal airspace opacities.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: r/o acute process History: sob CP, worsening activity tolerance Left port catheter and inferior sternal hardware unchanged in appearance.There are persistent, right greater than left, pleural effusions. Right perihilar postsurgical changes and streaky basilar opacities of scarring and subsegmental atelectasis. Opacity at the left apex from pleural fluid or thickening. No new consolidation or edema. Heart size is normal.

Output: Persistent small bilateral pleural effusions, left greater than right. Basilar scarring and subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: intubated History: intubated Mild cardiomegaly with retrocardiac atelectasis, possibly from aspirated secretions.ET tube tip 3 cm above the carina.NG tube coiled in stomach.

Output: Cardiomegaly with retrocardiac atelectasis possibly from aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: intubation History: placement of tube Interval intubation with the endotracheal tube terminating 4 cm above the carina. New right IJ central catheter terminates in the midsuperior vena cava. The remaining support devices are unchanged in position.Incidental azygos lobe again noted. Small bilateral pleural effusions with reduction of basilar opacities favoring atelectasis. No pneumothorax. Heart size remains stable, enlarged.

Output: Improved aeration of the lung bases following intubation. No pneumothorax following central catheter placement.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.ET tube placement ETT tip 2 cm above the level of the carina. Enteric tube looped in the stomach. Probable cardiomegaly. Mild pulmonary edema-like abnormality.

Output: ETT 2 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: pna History: pna Lower lung zone opacities left greater than right, suggestive of aspiration or infection with edema.Left pleural effusion.Right jugular catheter, tip in SVC.

Output: Left basilar predominant opacity with left effusion consistent with pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: swan placement History: swan placement Swan-Ganz catheter has been pulled back slightly. Unchanged defibrillator lead. Low lung volumes. Patchy left basilar opacity is again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Swan-Ganz catheter has been pulled back slightly.


Instruction: Generate impression based on medical findings.

Input: 7 x 14 mm nodular opacity in the left lower lobe. History of smoking. LUNGS AND PLEURA: An 8 x 5 mm scarlike, pleural-based opacity is noted within the left lower lobe (axial image 67/104). Three to 6 month follow-up is recommended for a high-risk patient.A few scattered calcified micronodules likely reflect prior granulomatous disease. No pleural effusion.MEDIASTINUM AND HILA: The descending aorta appears ectatic. The cardiac size is large with no evidence of pericardial effusion. No significant hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: A punctate calcification within the pancreas is noted.

Output: Left lower lobe scarlike nodule. Follow-up is recommended in 3 to 6 months.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old. Cough, dyspnea on exertion. Heart size top normal, unchanged.No evidence of infection or edema.

Output: No evidence of infection or significant acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p thoracentesis History: s/p thoracentesis Large left pleural effusion, not visibly changed, with no sign of pneumothorax following thoracocentesis.Underlying opacity compatible with compressive atelectasis as shown on the recent CT scan.

Output: Persistent large left effusion with no significant change.


Instruction: Generate impression based on medical findings.

Input: Rule out cardiomegaly. End-stage renal disease Mildly decreased lung volumes, however this may be due to inspirational cycle. Lungs are otherwise clear. Borderline cardiomegaly without additional cardiac or mediastinal contour change

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: 69M intubated in MICU with sepsis and hypoxia History: 69M intubated in MICU with sepsis and hypoxia ET tube with its tip 5 cm above the carina.NG tube with its tip in the margin of the image.Right central venous catheter with its tip in the SVC.There are decreased lung volumes with stable cardiomediastinal silhouette.Technically limited exam decreases sensitivity of pulmonary abnormalities.

Output: ET tube with its tip 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 50 year old female with metastatic lung cancer status post chemotherapy. Evaluate for response. CHEST:LUNGS AND PLEURA:. Spiculated mass in the left lung base (series 5, image 32) with interval decrease in size, now measuring 7 x 9 mm (previously 1.2 x 1.1 cm).MEDIASTINUM AND HILA: Stable to decreased mediastinal lymphadenopathy. Reference right paratracheal lymph node (series 3, image 24) now measures 1.1 x 0.9 cm (previously 1.4 x 1.2 cm)CHEST WALL: Nonspecific subcentimeter nodule in the left breast, unchanged in size. Persistent prominent bilateral axillary lymph nodes, largest node in the right axilla measures 1.2 x 1.4 cm (series 3, image 30), similar to prior. ABDOMEN:LIVER, BILIARY TRACT: Homogenous hypoattenuation of liver consistent with fatty deposition. No focal lesions. No evidence of biliary ductal dilatation. Expected post cholecystectomy findings, unchanged. SPLEEN: Splenule in the splenic hilum, unchangedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No interval change in mesenteric and retroperitoneal lymph nodes. Referenced caval lymph node (series 3 image 105) measures 9 x 7 mm (previously 9 x 12 mm).BOWEL, MESENTERY: Small fat-containing periumbilical hernia, unchanged.BONES, SOFT TISSUES: Subcentimeter soft tissue nodule anterior abdominal wall, (series 3, image 133) unchanged from prior.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal dermoid tumor measures 7 cm in diameter (previously 7.5 cm). BLADDER: No significant abnormality noted.LYMPH NODES: Stable prominence of the inguinal and obturator lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine, greatest at L5 -S1.OTHER: No significant abnormality noted.

Output: 1) Spiculated lung mass left lower lobe with interval decrease in size.2) Slight interval improvement of mediastinal lymphadenopathy.3) Stable prominence of pelvic and axillary lymph nodes. Retroperitoneal lymph nodes unchanged. 4) No new lesions.5) Left adnexal teratoma, similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: Eval for Pneumo or effusion History: S/P CT removal Interval removal of mediastinal drains. No pneumothorax. Improvement in basilar opacities.

Output: Interval removal of mediastinal drains with improvement in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with history of stage IIB colorectal cancer, for follow up. Evaluate disease status. CHEST:LUNGS AND PLEURA: The mild right apical scarring is unchanged. Calcified granuloma, unchanged, noted in the lingular segment.MEDIASTINUM AND HILA: No significant abnormality noted . Thymic remnant in anterior mediastinum. CHEST WALL: Interval removal of Right sided venous access device. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality noted. Splenule at the hilum. Calcified granuloma noted within the splenic parenchyma, unchangedPANCREAS: Pancreatic duct measures up to 2 mm, appropriate for patient age. No focal lesions within the pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Several low attenuation lesions in both kidneys most likely nonspecific, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sutures along the lesser and greater curvature of the stomach appear intact. No evidence of bowel obstruction. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No measurable disease. Stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Cough and hemoptysis. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No findings to account for the patient's hemoptysis. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with relapsing-remitting multiple sclerosis. Month 24 scan for clinical trial to rule-out active infection prior to immunosuppressive therapy. 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: Superior endplate compression of T3 vertebral body. UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: R/o PNA- febrile patient History: fever Dense right upper lobe subpleural masslike opacity with associated lytic destruction of the right fourth rib posterolaterally and a lytic lesion in the right scapula. Volume loss in the right upper lobe and probable hilar and right paratracheal lymphadenopathy.A text page was sent to Dr. Bhatia at the time of reporting.

Output: Findings suspicious for a primary carcinoma in the right upper lobe with chest wall invasion. A CT scan is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 75 years old Male. Reason: Evaluate for acute process History: cough, shortness of breath. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. Linear densities are seen in the lung bases, which are consistent with atelectasis.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: eval iabp History: as above Small lung volumes with mild basilar edema or subsegmental atelectasis on the left.IABP catheter proximal marker 6 cm below the top of the aortic arch.

Output: Subtle basilar opacities and IABP catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p RIJ TLC catheter History: as above Cardiomediastinal select is unchanged.Bibasilar opacities compatible with pleural effusions and adjacent atelectasis/consolidation. Patchy diffuse airspace opacities.No pneumothorax.Tracheostomy tube is unchanged. Interval placement of a right internal jugular central venous catheter with tip in the right atrium. Left upper extremity PICC tip is in the SVC. Unchanged IVC filter, median sternotomy wires, vertebroplasties, Dobbhoff tube and right pigtail catheter.

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


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Other specified conditions influencing how status. Swan. Interval removal of Swan-Ganz catheter without visible pneumothorax. Cardiomegaly. No focal pulmonary opacities. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed. Left subclavian ICD unchanged in position. Cholecystectomy clips.

Output: Interval removal of Swan-Ganz catheter without visible pneumothorax however left thoracic inlet visualization is limited due to lordotic patient positioning and superimposition of a subclavian ICD coil in the area.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.History of CHF assess for volume overload. Enteric tube projects are the stomach.Low lung volumes with basal atelectasis. Tortuous thoracic aorta.No specific signs of CHF.

Output: No evidence of CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: r/o pulm edema History: shortness of breath Moderate cardiomegaly and severe pulmonary arterial hypertension.Enlarged pulmonary arteries are calcified.No specific evidence of infection or edema.Mild chronic appearing basilar interstitial opacities noted.

Output: Severe pulmonary arterial hypertension without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old. Status post LVAD. Severe cardiomegaly with LVAD and ICD, unchanged. Two right jugular catheters, unchanged.IABP marker in the proximal descending thoracic aorta.Left lower lobe consolidation and lower zone edema, unchanged.

Output: IABP marker in the proximal descending thoracic aorta. Left lower lobe consolidation and lower zone edema, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval for pathology, AMS History: febrile Small lung volumes with mild basilar subsegmental atelectasis possibly aspirated secretions or mucous plugging.Heart size upper normal.Shunt tubing overlies the left side of the chest.

Output: Basilar subsegmental atelectasis, possibly from aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Cough and fever No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: FemaleReason for Study: Reason: reason for acute desat and labored breathing History: labored breathing Left sided pacemaker with one lead in the right ventricle.Right PICC line with its tip in the right axilla.The cardiomediastinal silhouette is unremarkable with heavy calcification of the mitral valve.Chronic appearing interstitial opacities in both lungs without focal areas of consolidation.Pleural effusions.Median sternotomy is intact with evidence of prior CABG.

Output: No acute cardia pulmonary abnormality identified. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with Swan placement. Monitor hardware. IABP proximal marker projects over the level of the aortic arch, unchanged.Right jugular Swan-Ganz catheter tip projects over the right main pulmonary artery, unchanged.Left ICD in place. Air pocket and surgical clips project over the right upper hemithorax.Moderate cardiomegaly, unchanged.Persistent lower lobe airspace opacities may represent aspiration, edema and atelectasis.Small bilateral pleural effusions.

Output: Persistent lower lobe airspace opacities may represent aspiration, edema and/or atelectasis.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male diagnosis metastatic melanoma to brain currently on therapy. Please evaluate for response to therapy evaluate disease status. CHEST:LUNGS AND PLEURA: Right granuloma right upper lobe there is no lung nodules. Some scarring in the right lung base unchanged. No pleural effusions.MEDIASTINUM AND HILA: Massive enlargement nodularity of the thyroid gland with extension of the right lobe dorsal to the esophagus causing marked mass effect on the esophagus and trachea. This is unchanged.No pathologic size nodes.CHEST WALL: Postsurgical changes consistent with sternotomy and coronary artery surgery.ABDOMEN:LIVER, BILIARY TRACT: Multiple soft tissue densities seen in the gallbladder some with ring like appearance but without calcification. Given the absence of metastatic disease elsewhere in the abdomen and stability of these findings to the baseline CT of February 8, 2007, these likely represent gallstones rather than metastases.SPLEEN: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts some somewhat large on the right next effect, unchanged. Few punctate calcifications seen in the left kidney, unchanged.ADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Nonpathologic sized nodes. Atherosclerotic disease no evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Postsurgical changes prostatic bed.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No interval change. Soft tissue densities in the gallbladder likely noncalcified stones rather than metastases. No definite evidence of metastatic disease in the abdomen or pelvis. Thyroid masses, granulomatous disease chest, renal cysts, nephrolithiasis, postsurgical changes chest and prostatic bed, all unchanged.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with anal cancer CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged from previous study.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described fluid soundings cannot be optimally evaluated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: Bilateral pulmonary metastases and increase in size. Referenced nodule anteriorly. The right upper lobe, now measures 13 x 13 mm, image number 34, series number 5. A right lower lobe referenced nodule measures 13 x 11 mm image number 49, series number 5.New bilateral moderate pleural effusions.MEDIASTINUM AND HILA: Reference superior mediastinal lymph nodes has increased in size and now coalesced together with the surrounding other mediastinal lymph nodes and difficult to measure. Within this limitation, the lymph node measures 24 by 17-mm image number 21, series number 3. Other additional enlarged lymph node with central necrosis in the mediastinum and hila have also increased in size compared to previous study.CHEST WALL: Lytic and sclerotic lesions in the sternum are stable. New, small lytic lesion in the anterior aspect of the T1 vertebral body is suspicious for metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Cyst in the left lobe of the liver is unchanged. A new subcentimeter hypodensity in segment 8 measures 8 by 6-mm image number 16, series number 3 and is suspicious for metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left ovarian dermoid cyst is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval progression of disease with interval increase in the size of the nodules, mediastinal, lymph nodes. New bilateral pleural effusions and subcentimeter hepatic lesion suspicious for metastatic disease.Lytic and sclerotic changes in the sternum are stable and may represent metastatic disease versus radiation necrosis.New, small lytic lesion in the anterior T1 vertebral body is suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: r/o cardiopulm abnormality History: cough Nonspecific opacity the periphery of the right lung base could be chronic or new infection, and there may be a very small right pleural effusion.Elsewhere, the lungs are unremarkable. Unremarkable mediastinal contours and cardiac silhouette.

Output: Right basilar peripheral opacity, consistent with early infection.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Chest pain. Low lung volumes. No focal pulmonary opacities or pleural fluid. Normal heart size. Cholecystectomy clips project over the right upper quadrant.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Cough, or cystic rhonchi at bases, evaluate for pneumonia Mild nonspecific basilar interstitial opacity without convincing evidence of infection, edema. Trace pleural effusions.The cardiac silhouette is unremarkable.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old. Catheter tip in the SVC.No significant cardiopulmonary abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: et tube History: et tube ET tube tip 2 cm above the carina. Other support hardware unchanged. Large lung lines consistent with COPD with minimal basilar interstitial opacity. No new lung opacity.

Output: ET tube tip 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: LVAD check Overall improving aeration with basilar streaky densities suggesting atelectasis with mild volume asymmetry with increased volume on the right. Mild COPD LVAD, ICD otherwise unchanged. No effusions.

Output: LVAD unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: cough and sob for days with fever; wheezing History: cough sob wheezing The heart size is normal. Nonspecific bibasilar interstitial opacities and large lung volumes, consistent with moderate COPD. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: COPD without specific radiographic evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Status post CABG. Stable bibasilar opacities and pleural effusions. Marked cardiomegaly again noted. Unchanged right internal jugular venous sheath. No acute bony abnormality.

Output: No substantial change compared to previous study in bibasilar atelectasis or consolidation and pleural effusions. Stable marked cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: asthma, SOB, looking for alternative diagnosis History: asthma sob Nonspecific elevation the right hemidiaphragm.No pleural effusion.No focal opacities.Probable mediastinal lipomatosis.

Output: Elevation of the right hemidiaphragm, but no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male; 59 years old. Reason: cough History: cough Mild right and moderate left basilar opacities, most compatible with effusions with underlying nonspecific atelectasis. Nodular opacity overlying the left mid lung and widening of the mediastinum; please refer to PET CT from 1/2/15.Evaluation of the heart size is limited due to obscuration by the left basilar opacity. Right proximal humerus plate and screw fixation device, partially visualized.

Output: Basilar opacities most compatible with effusions and underlying nonspecific atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: HD catheter placement History: bleeding from site Mild cardiomegaly.Small lung volumes.No specific evidence of infection or edema.Left jugular catheter, tip in SVC.

Output: Left jugular catheter, tip in SVC. Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: balloon pump History: balloon pump The cardiomediastinal silhouette is unchanged. Swan-Ganz catheter tip is in the right main pulmonary artery. IABP marker is roughly 6 cm below the top of the aortic arch. Subcutaneous ICD in place. Bibasilar subsegmental atelectasis and small left pleural effusion. No pneumothorax.

Output: Bibasilar subsegmental atelectasis and small left pleural effusion. IABP marker is roughly 6 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Chest pain, SOB History: chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: metastatic fallopian tube cancer, evaluate for recurrent pleural effusion History: shortness of breath Low lung volumes. Mild interval increase in size of the large right pleural effusion and no significant change in size of the large left pleural effusion, with underlying compressive atelectasis. The visible portions of the heart and mediastinal contours are unchanged. No pneumothorax is evident.

Output: Mild interval increase in size of the large right pleural effusion and stable large left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: assess ET tube placement History: assess ET tube placement Stable adequate position of support apparatus.Persistent signs of pneumomediastinum.Bilateral basilar and midlung consolidative opacities and traction bronchiectasis again noted.Stable small bilateral pleural effusions. Limited assessment for pneumothorax.

Output: Persistent signs of pneumomediastinum.Adequate position of support apparatus.


Instruction: Generate impression based on medical findings.

Input: Empyema chest tube placementVIEW: Chest AP Right-sided chest tube in place. There is minimal subcutaneous emphysema in the right lateral chest wall. The right pleural effusion has decreased. Patchy opacities in the right lower lobe has improved from prior study. Cardiothymic silhouette normal. No evidence of pneumothorax.

Output: Right pleural effusion and right lower lobe opacities have improved from prior study.


Instruction: Generate impression based on medical findings.

Input: Female 11 years old Reason: VP shunt with new HA, dizziness, nausea; assess shunt History: VP shunt with new HA, dizziness, nauseaVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 1/30/2016 Strata valve performance level is 1.5. Unchanged positioning of intracranial VP shunt catheter. Extracranial VP shunt tubing is following a non interrupted pathway towards the right soft tissues of the neck, anterior soft tissues of the chest and abdomen and terminates coiled inside the abdominal cavity at the right upper abdominal quadrant.Adenoid hypertrophy noted. Cardiac silhouette size is normal. No focal lung opacities, effusions or pneumothorax. Normal abdominal gas pattern. A orphan catheter is coiled in the pelvis.

Output: No evidence of VP shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: f/u R apical nodule, ?fluid overload History: SOB Normal heart size. Tortuous thoracic aorta.1.0 cm sharply defined nodular opacity in the right apex overlying the right first rib, unchanged.Mild bibasilar subsegmental atelectasis/scarring without focal consolidation, pleural effusion, or pneumothorax.Mild thoracic scoliosis.

Output: Unchanged well-circumscribed right apical nodule. No new superimposed acute pulmonary abnormality. Specifically, no signs of CHF.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with malignant neoplasm of the lower lobe of right lung status post lung resection x1 week (5/31/2016). Postoperative changes related to right lower lobectomy with compensatory overinflation of the right middle lobe. There is a loculated right pleural effusion tracking along the peripheral aspect of the minor fissure. The left lung is clear. No pneumothorax. Normal cardiomediastinal silhouette.

Output: Postoperative changes related to right lower lobectomy with small to moderate right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: daily icu film History: icu film Exam significantly limited by patient rotation and motion. Severe cardiomegaly and aortic aneurysm again noted. Basilar opacities are grossly stable. Right jugular line and other devices also unchanged. No demonstrable pneumothorax.

Output: Limited exam. Cardiomegaly, aortic aneurysm, and bilateral opacities without acute change.


Instruction: Generate impression based on medical findings.

Input: 80 year-old male with history of gastric cancer. Status post resection CHEST:LUNGS AND PLEURA: Interval increase in the interstitial densities in the left lower lobe with increase in the small left-sided pleural effusion. Interval increase in the air space opacities in the left lower lobe with associated bronchiectasis. These changes likely represent pneumonia, which may be secondary to aspiration. In the apical segment of the left lower lobe. There is new air space density which is also suspicious for pneumonia.Interval increase in the interstitial opacities in the right lower lobe and middle lobe, which may be early fibrosis.Scattered micronodulesMEDIASTINUM AND HILA: Small pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes involving the stomach. The wall of the residual stomach is slightly thickened.BONES, SOFT TISSUES: Previously described mass adjacent to the T11 vertebral body measures 4.1 x 3.1 cm image number 81, series number 3, not significantly changed.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.

Output: Interval increase in the interstitial and air space opacities in the left lower lobe likely representing pneumonia which may be aspiration.Soft tissue mass adjacent to T11 vertebral bodies, unchanged.Wall thickening of the gastric reminant. Further evaluation with endoscopy may be helpful, if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for aspiration History: s/p EGD w/ dilation, now with desaturation Bilateral perihilar opacity in the superior segments of the lower lobes, highly compatible with aspiration, new from previous.Linear subsegmental atelectasis or scarring in the right upper lobe.Status post median sternotomy.

Output: Bilateral airspace opacity in the superior segments of the lower lobes highly compatible with aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: Pulmonary edema? History: SOB Severe cardiomegaly with mild basilar edema and redistribution of the pulmonary blood flow.

Output: Cardiomegaly, with pulmonary edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: SOB question pleural effusion. Moderate loculated appearing right pleural fluid collection with associated significant right lower lobe consolidation. Patchy consolidation at the left base appears worse and there is some increasing opacity in the dependent right lung as well. Bronchial wall thickening noted.Left PICC tip at the SVC.

Output: Moderate right pleural fluid collection is probably loculated which is concerning for empyema. Multifocal pulmonary opacities with bilateral lower lobe consolidation appears worse, most compatible with pneumonia. Dustin Harris (2135) notified via Web exchange text page at 10:51 AM on 11/28/2016The above abnormalities should be followed to complete radiographic resolution by serial imaging to exclude alternate etiologies such as neoplasm or atypical infection.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with history of tonsil cancer status post chemo and radiotherapy. CHEST:LUNGS AND PLEURA: Stable post inflammatory granuloma. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: No evidence of metastatic disease


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: Eval location of PICC line termination History: as above Right PICC line with distal tip in the SVC.Cardiac mediastinal silhouette is unremarkable.The lungs are clear.Redemonstration of scoliosis of the thoracolumbar spine.

Output: Right PICC line with its tip in the SVC. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: 72 y/o with lymphoma, chemotherapy; eval for pleural effusion/edema History: dyspnea on exertion; orthopnea New small pleural effusions and basilar atelectasis.No specific evidence of infection.Mild cardiomegaly.Right jugular catheter, tip in SVC.

Output: Mild hypervolemia/CHF, but no sign of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Myeloma with fever, evaluate pneumonia. Right chest port tip at the superior cavoatrial junction. Upper normal heart size. Tortuous thoracic aorta, unchanged. Linear scarring in the lingula. No focal airspace opacities, pleural fluid or pneumothorax. Enlargement of the central pulmonary vasculature suggests pulmonary hypertension.

Output: No signs of pneumonia or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: cough 77M panc ca; hyperbilirubinemia History: persistent cough No significant cardiopulmonary abnormality.Right upper quadrant stent.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with metastatic lung cancer CHEST:LUNGS AND PLEURA: Continued improvement of the cavitary right upper lobe mass. Reference measurements measure 15 x 11 mm image number 84, series number 4. Mild peribronchial and perivascular thickening around the hilum and pleural surfaces essentially unchanged.Paramediastinal and left apical radiation changes are stable.MEDIASTINUM AND HILA: Reference precarinal node measures 6 x 7 mm image number 30 lung, series number 3, unchanged. Reference right hilar node measures 10 x 12 Blitzer image number 36, series number 3, slightly smaller.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion in the right lobe of the liver on image number 103, series number 3 is unchanged. Another punctate lesion on image number 104, series number 3 is new, but too small to accurate characterize.Subtle hyperdensity in the region of the distal common bile duct. No biliary dilatation. If there is any clinical concern for biliary obstruction and choledocho lithiasis. M.R.C.P. may be helpful.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule is stable, measuring 12 x 10 mm image number 87, series number 3. Right adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal interval decrease in the size of the right upper lobe cavitary mass and mediastinal lymph node.Stable left adrenal lesion.New, punctate hypodensities in the liver, too small to accurate characterize and of unknown etiology and clinical significance.Subtle hyperdensity in the region of the distal common bile duct. There is a clinical concern for a distal common bile duct stone M.R.C.P. may be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: History of relapsed Ewing's sarcoma. Off therapy evaluation. LUNGS AND PLEURA: Triangular-shaped pleural-based nodule in apical segment of right lower lobe (series 10207 image 22) measuring 5mm is new from prior. Subcentimeter nodular interstitial opacity in right mid lung (series 10207, image 29) similar to prior. Tree in bud and ground glass opacities in right mid lung posteriorly, similar to prior.Post surgical and radiation changes in left lung are similar to prior. MEDIASTINUM AND HILA: Normal.CHEST WALL: Left sided Port-A-Cath terminates with tip in the right atrium. No axillary lymphadenopathy.UPPER ABDOMEN: Normal

Output: 1) New 5mm pleural-based nodule in apical segment of right lower lobe.2) Post-surgical and post-radiation changes, similar to prior. 3) Nodular interstitial opacity in right mid lung, similar to prior.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: post op heart transplant History: post op heart transplant Chest tubes with no pneumothorax are unchanged.Lower lung zone opacities suggestive of edema, stable.Right jugular catheter, tip at cavoatrial junction.

Output: Mild basilar edema. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with pleuritic chest pain and history of PE. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the segmental level.LUNGS AND PLEURA: Mild central bronchial wall thickening, improved since prior study from January 2011. 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. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No PE. 2. Mild central bronchial wall thickening, which can be seen in reactive airway disease, improved since prior study from January 2011.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: 78y/o with AML, now with exertional dyspnea and fine mild bibasilar rales. Evaluate for infiltrates vs edema History: DOE Bilateral lower lobe lace like opacities are noted, concerning for infection/aspiration. No pleural effusions are present. Cardiomediastinal silhouette appears unremarkable.

Output: Bilateral lace like opacities in the lower lobes, this is concerning for infection/aspiration. Recommend CT chest for further characterization.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath The 2 basilar right chest tube has been partially retracted and again observed without associated complicationPersistent decreased lung volumes with basilar atelectasis, mild cardiomegaly and possibly small effusions persistTracheostomy tube replaces the ETT, tip projects 3 cm above the carina. Bilateral jugular catheters and Dobbhoff are otherwise similar

Output: Mild right basilar chest tube repositioning


Instruction: Generate impression based on medical findings.

Input: Age: 35 yearsGender: FemaleReason for Study: Reason: rule out pneumothorax History: SOB, decrese breath sounds on L Right central venous catheter and left-sided chest tube unchanged.Left apical pneumothorax similar appearance the prior exam.Stable cardiomediastinal silhouette.Diffuse pulmonary opacities compatible with fibrosis.No new pulmonary opacities noted.

Output: Left apical pneumothorax unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: eval lung fields History: decompensated CHF Iatrogenic devices are unchanged. Mild pulmonary edema and patchy bibasilar opacities and pleural effusions again noted. Unchanged cardiomegaly.

Output: Unchanged mild pulmonary edema, bibasilar opacities, and pleural effusions, left greater than right.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Right IJ line terminates at the cavoatrial junction. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Right IJ line terminates at the cavoatrial junction. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old. SOB. Fever. Stable cardiomediastinal silhouette. No evidence of infection or edema. Right upper quadrant surgical clips, unchanged.

Output: No evidence of infection or acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Patient w/ PNA/ ARDS, intubated, please eval for placement and interval change in pulmonary opacities History: As above Support devices in stable position.No interval change and pulmonary opacities.Slight increase in right pleural effusion.No obvious pneumothorax.

Output: Slight increase in right effusion otherwise stable pulmonary opacities.Line position stable.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Preop TECAB. History of angina Presternal ICD in place. Heart size appears at least upper normal. Atherosclerotic calcification of the thoracic aorta. Vascular stent projects over the left upper chest wall. No pneumothorax. Minimal pleural fluid. Mild thickening of the fissures and vascular unsharpness may indicate a very mild component of pulmonary edema. Linear scarring in the lingula.

Output: Very mild hypervolemia/CHF.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Index precarinal lymph node measures 15 x 10 mm image number 40, series number 3, slightly smaller compared to previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Index hypodense lesion in the right lobe now measures 22 x 14 mm in image number 114, series number 3, not significantly changed from previous study. Other, smaller, ill-defined hypodense lesion adjacent to the cholecystectomy clips best seen in image number 105, series number 3 is also unchanged.Status post cholecystectomy. Metallic stent in the distal common bile duct. There is intra-and extrahepatic biliary dilatation. Round hyperdensity within the common bile duct superior to the superior border of the stent may represent stone versus a neoplasm. This is best seen on image number 108, series number 3.SPLEEN: No significant abnormality notedPANCREAS: Hypodense mass in the consummate process measures 17 x 15 mm image number 122, series number 3. Stone in the pancreatic head. Pancreas is atrophic with a significantly dilated pancreatic duct throughout its course.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left lower pole renal mass measures 29 by 34-mm image number 134, series number 3, grossly unchanged. Other small hypodense lesions in the left kidney are also unchanged.Right renal stones, large benign-appearing right renal cyst and smaller cyst in the inferior pole of the right kidney are also unchanged.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: Radiation seeds in the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Bladder in the right inguinal canal

Output: Mass or stone in the distal common bile duct above the metallic stent causing mMeasurements of other index lesions in described in the report. oderate intra-and extrahepatic biliary dilatation.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: s/p esophagectomy now with BL effusion, CT site leaking History: as above Pleural effusions and left base predominant consolidation are unchanged.Right jugular catheter, tip in SVC.

Output: Stable pleural effusions and left lower lobe consolidation. No significant pneumothorax. Central


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: intubated, pna, ARDS History: ett position ET tube tip approximately 6 cm from the carina. Enteric tube terminates in the field-of-view. Left subclavian pacemaker unchanged.Bilateral patchy pulmonary airspace opacities are not significantly changed, suggestive of infection, hemorrhage or ARDS.Stable cardiomediastinal silhouette.

Output: Endotracheal tube tip approximately 6 cm from the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: MaleReason for Study: Reason: pt with unexplained fever and dullness to percussion of right lower lobe and unclear abnormality to ausculatation of left upper lobe History: fever The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Incidentally noted is an azygos pseudolobe.

Output: No acute cardiopulmonary abnormality identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: r/o edema History: SOB Left-sided ICD and right central venous catheter unchanged.Stable cardiac enlargement.Decreased lung volumes with basilar opacities compatible with edema, atelectasis, pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, pleural effusions, and basilar edema/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old. Reason: evaluate lung fields History: s/p cardiac surgery Swan-Ganz catheter has been retracted. Mediastinal drain is unchanged in position. Median sternotomy hardware, mitral valve replacement.Stable cardiomediastinal silhouette.Previously seen small right apical pneumothorax is stable to slightly smaller compared to the prior study. Small pleural effusions, similar to prior.Streaky mid-lung and basilar opacities appear similar to prior.

Output: Unchanged basilar opacities. Persistent small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Persistent cough. The heart is normal in size. Tortuosity of the thoracic aorta.Lung volumes are normal. No abnormal focal lung parenchymal opacities to suggest pneumonia.The pleural spaces and visualized bones are within normal limits.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Chest pain. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary vasculature are also normal. No airspace opacity, pleural effusion, or pneumothorax. The osseous structures and visualized upper abdomen are unremarkable.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Cancer of the colon, fever and abdominal pain. Low lung volumes. Air space opacity in the left lower lobe may be slightly increased from the same day CT and may reflect superimposed infection. Patchy atelectasis, groundglass opacities and small nodular opacities otherwise similar to CT. Right chest port tip at the SVC/RA junction. Drainage catheter projects over the right upper quadrant. Nonspecific bowel gas pattern, but two recent CT.

Output: Left lower lobe air space opacities appear slightly worse in comparison to recent CT and may indicate superimposed pneumonia, either post obstructive or aspiration-related.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: please evaluate for pneumothorax History: left sided ICD New left chest ICD device lead position appropriate. Upper abdominal embolization coils and IVC filter unchanged.New patchy left perihilar and left basilar opacities suggests aspiration/atelectasis. There is no pneumothorax.Moderate cardiomegaly unchanged.

Output: New patchy left perihilar and basilar opacity suggests aspiration/atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent moderate to large right pleural effusion with underlying compression atelectasis. Less pronounced atelectasis in the left lung base otherwise observed.The cardiac and mediastinal contours are otherwise unchanged and within limits

Output: Persistent right pleural effusion


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: ett History: ett Mild basilar opacities suggestive of edema or aspiration, and mild cardiomegaly, unchanged. ET tube tip approximately 6 cm above the carina.An NG tube terminates in the stomach.

Output: Stable pulmonary opacities. ET tube tip approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: ?Evolution of effusion, PNA History: Vent dependent Cardiopulmonary monitoring and support devices, unchanged.Lower zone atelectasis and pleural effusions.No pneumothorax or other acute change.NG tube traversing the esophagus, extending below the inferior margin of the radiograph.

Output: Pleural effusions and atelectasis with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: new fever in AIDS patient History: fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Mild deformity of the right fifth and sixth ribs laterally compatible with healed fractures.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval for evolving pneumonia in hypoxic chronically vent dependent patient History: eval for pneumonia in hypoxic chronically vent dependent patient Stable cardiomediastinal silhouette.Extensive diffuse interstitial opacities are unchanged with stable bibasilar airspace opacities. Stable bilateral pleural effusions. There is no pneumothorax.Tracheostomy tube with tip located approximately 6 cm above the carina. Enteric tube with tip not included in the field-of-view.Partial visualization of dilated transverse colon again seen.

Output: Stable extensive diffuse interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: eval for effusions History: ams Interval extubation. Left basilar opacity unchanged. No pneumothorax.

Output: Interval extubation with no evidence of pneumothorax.No change in left basilar opacity


Instruction: Generate impression based on medical findings.

Input: Line placement Left jugular catheter again projects into the proximal SVC, mildly retracted. ETT terminates 4 cm above the carina.ICD unchanged in position and appearanceModerate nonspecific cardiomegaly with decreased lung volumes in mixed nonspecific minimal interstitial changes unchanged. Specifically no new superimposed focal airspace process

Output: ETT well-positioned


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: Fever, r/o PNA History: as above Moderate cardiomegaly with enlarged central pulmonary arteries again noted. New patchy right basilar opacity. No large pleural effusion or pneumothorax.

Output: New patchy right basilar atelectasis or consolidated lung. Enlarged central pulmonary arteries and moderate cardiomegaly, as before.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: assess pneumothorax History: left pneumothorax Enteric tube and endotracheal tube have been removed. Small left apical pneumothorax again noted, not substantially different. No new focal lung consolidation. Unchanged chronic. Right pleural process.

Output: Small left apical pneumothorax again noted, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? trach placement? History: leukocytosis at OSH Tracheostomy tube in place with its tip about 4 cm above the carina.Left jugular catheter with tip in the SVC.Extensive bilateral mainly lower zone airspace opacity, increased from previous, suggestive of aspiration pneumonia.

Output: Findings suggestive of aspiration pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: nausea History: nausea No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: s/p fall, with right facial trauma. r/o fracture History: pain to palpation along right maxillary bone Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60M with CHF and swan, recently advanced, check new position. History: swan position Patchy interstitial and air space opacities are stable.Right jugular Swan-Ganz catheter, tip peripherally in the right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Right jugular Swan-Ganz catheter tip now quite peripheral in the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Altered mental status Aortic arch calcifications. Otherwise unremarkable cardiomediastinal silhouette.No focal airspace opacities or pleural effusions evident.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: newly placed PICC History: assess tip placement Median sternotomy for LVAD placement.No specific evidence of infection or failure.Chronic left costophrenic angle blunting.Right PICC, tip in the right atrium directed towards the tricuspid valve.

Output: Right PICC, tip in the right atrium directed towards the tricuspid valve, low in location.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: CP, post cervical ACDF, dyspnea, dysphagia stridor c/f aspiration History: CP, post cervical ACDF, dyspnea, dysphagia stridor c/f aspiration Cervical immobilization hardware is partially visualized.Diffuse sclerosis of the thoracic osseous structures. Heart size remains stable. No interval pneumonia, edema or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: cough History: cough Cardiomegaly with redistribution of the pulmonary blood flow.Equivocal perihilar edema.No specific evidence of infection.

Output: Equivocal edema, otherwise unremarkable. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: Rule out pneumonia. History: Persistent leukocytosis Markedly underinflated lungs secondary to abdominal distention.Elevation of the right hemidiaphragm with overlying subsegmental atelectasis.Right jugular catheter with its tip projected over the area of the right jugular vein.Multiple dilated loops of bowel in the abdomen with air-fluid levels compatible with obstruction.

Output: Markedly underinflated lungs secondary to abdominal distention with basilar atelectasis but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval pna History: chest pain Large right pleural effusion occupying two thirds of the right hemithorax volume, compressing the right lung.Left lung unremarkable.Right jugular catheter, tip in SVC.

Output: New large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old. Lymphoma. Hypoxia. Evaluate for effusion versus atelectasis. Right chest port tip in SVC.Unremarkable cardiac and mediastinal silhouette.No evidence of infection or edema. No large pleural effusion. No significant pneumothorax.

Output: Interval placement of right chest port, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Status post drainage of pleural fluid assess for pneumothorax. Moderate to large loculated right pleural fluid collection similar in volume. There may be a small right apical pneumothorax, poorly visualized. Right basal Pleurx catheter similar in position.Retrocardiac opacity on the left unchanged, likely atelectasis but correlate for signs of infection.

Output: Possible small pneumothorax on the right, no significant change in size of pleural fluid collection.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: IABP placement History: IABP Status post median sternotomy and CABG surgery.Grossly stable cardiomediastinal silhouette with right cardiophrenic angle opacity likely related to hiatal hernia as seen on MRI chest 3/28/2014.Limited evaluation due to hypoinflation with bibasilar atelectasis and likely trace pleural effusions.

Output: Line position stable. No change in basilar atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: eval for infiltrate History: tachypnea No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: pleural effusion History: cough Low lung volumes. Moderate pleural effusions with underlying atelectasis largely unchanged from previous study.Right port catheter and left PICC tips terminate in SVC. Surgical clips noted in upper abdomen.

Output: Persistent pleural effusions with underlying consolidation and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: SOB, pneumonia? History: SOB, pneumonia Median sternotomy, the heart size upper normal.Minimal scarring or subsegmental atelectasis left lung base periphery, the lungs otherwise unremarkable.No specific evidence of infection or edema.Left subclavian dual-chamber ICD leads in place.

Output: No acute abnormality. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent moderate nonspecific cardiomegaly with mildly decreased lung volumes. LVAD and ICD lead unchanged. No new superimposed acute pulmonary finding

Output: LVAD and ICD are unchanged. No new superimposed acute pulmonary disease


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old. Pre-kidney transplant evaluation. End-stage renal disease. Evaluate for cardiomegaly and infiltrates. Unremarkable cardiac and mediastinal silhouette.No significant pleural or parenchymal abnormality.Multilevel mild degenerative disk disease of the thoracic spine.

Output: No significant acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: assess for pneumonia History: as above Small lung volumes, otherwise unremarkable.Healed granulomatous disease.No specific evidence of infection or edema. Heart size normal.

Output: Small lung volumes, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: intubated; dyspnea; swan History: see above Heart size near upper normal.Interstitial opacities consistent with pulmonary edema and small pleural effusions are unchanged.Right jugular catheter, tip in SVC.Swan-Ganz catheter removed.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.

Output: Pulmonary edema and small pleural effusions. Swan-Ganz catheter removed.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: infection History: SOB Cardiomediastinal silhouette and vasculature normal. Lungs clear of airspace opacity. Mild basilar subsegmental atelectasis.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: 68 m p/w ams, risk of asp pna History: Hypoxia, tachycardia, intubated Endotracheal tube tip 3-3.5-cm above the level of the carina. Nasogastric tube projects over the stomach.Low lung volumes with a moderate to large left pleural effusion and atelectasis/ consolidation involving the left lower lobe. Atelectasis seen to a lesser extent at the right lung base.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: Stem cell transplant with known pneumonia. Right IJ line, unchanged. Diffuse opacities again noted. Small moderate size pleural effusions, as before. Heart size difficult to assess. No pneumothorax.

Output: Trend toward worsening diffuse pulmonary opacities. Given rapid development, pulmonary edema is a distinct possibility. Pneumonia whether in isolation or superimposed on edema cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Shortness of breath and fever. No focal airspace opacity, pleural effusions or pneumothorax. The cardiac mediastinal silhouette is unremarkable.

Output: 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: Male, 82 years old.Reason: SOB, inadequate ventilation History: SOB/inadequate ventilation Interval intubation with the endotracheal tube 2 cm superior to carina.Slight improved aeration with chronic interstitial opacities. Suspected superimposed aspiration in the upper lobes. Small pleural effusions. No significant pneumothorax.

Output: Interval intubation. Chronic interstitial disease with suspected superimposed aspiration in the upper lobes.


Instruction: Generate impression based on medical findings.

Input: Reason: Fever, known PTX; evaluate for infiltrate History: as above Resolution of a small right pneumothoraxlarge residual right pleural effusion with underlying atelectasis.New right jugular catheter with its tip in the SVC.

Output: Resolution of pneumothorax. Large right pleural effusion, possibly increased, with underlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 36 yearsGender: MaleReason for Study: Reason: pre-transplant evaluation. r/o cardiomegaly, r/o effusions History: pre-transplant eval The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: Pleural effusion History: pleural effusion Support devices are unchanged in position.No significant change in the right-sided pulmonary opacities, including atelectasis with elevation of the right hemidiaphragm and pleural effusion. Retrocardiac consolidation is unchanged. No interval pneumothorax.

Output: Right-sided pulmonary opacities of atelectasis, pleural effusion and consolidation not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: s/p chest tube History: chest tube, ?pneumo, ?NG tube placement Unchanged left lower lobe consolidation and small pleural effusions.Right chest tube stable in position with no pneumothorax.An NG tube terminates in the stomach.Right shoulder arthroplasty.

Output: No significant pneumothorax. Unchanged left lower lobe consolidation and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA History: fevers Heart size about upper normal or mildly enlarged.No evidence of CHF, pneumonia or other acute findings.

Output: Borderline heart size and no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: pulmonary edema, infection, pneumo History: SOB, CHF, COPD Right basilar scarring, otherwise unremarkable.No specific evidence of infection or edema.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with history of colon cancer off chemotherapy since October. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: A reference cardiophrenic lymph node measures 0.7 cm in diameter (series 3, image 64), previously measuring 0.8 cm.CHEST WALL: A right chest port is in place with its tip at the superior vena cava/RA junction.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous appearing liver with fissural prominence with reactive enlarged portacaval lymph nodes. A small hypoattenuating lesion in the left hepatic lobe is unchanged. Gallstones and biliary sludge layering in the gallbladder is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reactive portacaval lymph nodes. A reference portacaval lymph node measures 1.6 x 1.0 cm, previously measuring 1.4 x 0.8 cm.BOWEL, MESENTERY: Postoperative changes in right lower quadrant with small bowel anastomosis. There is no evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes of the spine. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted

Output: 1. No evidence of metastatic disease.2. Stable prominent porta caval lymph nodes, likely reactive.


Instruction: Generate impression based on medical findings.

Input: Angina. Preoperative TECAB Mild COPD changes without superimposed acute cardiopulmonary additional abnormality. Diffuse intrahepatic skeletal hyperostosis. Partially visualized right reverse total shoulder arthroplasty

Output: COPD without acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: rule out infiltrate, dyspnea, productive cough 4 days History: as above No acute cardiopulmonary abnormality.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: r/o infiltrates, cardiomegaly, pna History: chest pain, sob Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild widening of the superior mediastinum, not substantially different, which may be related to aortic tortuosity or ascending aortic dilation.

Output: No acute cardiopulmonary process on radiography. Mild widening of the superior mediastinum, not substantially different, which may be related to aortic tortuosity or ascending aortic dilation.