Instruction: Generate impression based on medical findings.

Input: 70 year-old female, evaluate for aortic dissection, mesentery ischemia. Presenting with abdominal pain and septic shock Study is limited due to lack of IV contrastCHEST: Endotracheal tube is in place. I axil pleural effusions, small. Bilateral dependent atelectasis.Esophagus is dilated throughout its course.Limited evaluation of type B dissection starting distal to the left subclavian artery. Lack of IV contrast limits optimal evaluation.Mild cardiomegaly and small amount of pericardial effusion.ABDOMEN:Streak artifacts from barium and lack of IV contrast severely limits optimal evaluation of the abdomen.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Lack of IV contrast limits although evaluation of the liver. Lateral segment of the left lobe of the liver is diffusely hypodense compared to the rest of the liver. Etiology is unknown.Percutaneous cholecystostomy tube is in place.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic dissection extends into the abdominal aorta. It cannot be optimally evaluated due to lack of IV contrast.BOWEL, MESENTERY: Retained barium in the distal small bowel loops significantly limits evaluation of the bowel. Proximal small bowel loops are dilated measuring up to 4.9 cm. Distal small bowel loops in the pelvis are decompressed. These findings are compatible with distal small bowel obstruction.There is right inguinal hernia containing nonobstructed small bowel loops. No evidence of perforation.BONES, SOFT TISSUES: Streak artifacts from metallic orthopedic hardware.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: She see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: Left femoral line.

Output: Limited study due to lack of IV contrast, streak artifacts from barium and orthopedic hardware. CT finding suggestive of small bowel obstruction.Type B aortic dissection, incompletely evaluated.Right-sided inguinal hernia containing nonobstructive bowel loops.Bilateral pleural effusions, the pattern atelectasis, small pericardial effusion.Diffuse hypodensity of the lateral segment of the left lobe of the liver is of unknown etiology.Percutaneous cholecystostomy tube is in place.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: S/P LVAD. post-op eval for VAD position History: post-op Chest/mediastinal tubes have been removed.No evidence of any pneumothorax or pneumomediastinum.Stable cardiac enlargement.Right-sided ICD and LVAD are unchanged.Bilateral basilar subsegmental atelectasis.No large pleural effusions.

Output: Chest/mediastinal tubes have been removed without complication. Left-sided ICD and LVAD unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: Evaluate ETT tube placement History: Endotracheally intubated Mild interstitial edema with small pleural effusions, unchanged.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Unchanged edema and small pleural effusions, and stable support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: acute chest syndrome in patient with SCD History: chest pain, cough with yellow sputum, SOB The lungs and pleural spaces are clear. No evidence of infection.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Status post LVAD Support devices are unchanged.Cardiomegaly left lower lobe dense consolidation/atelectasis. Increased right perihilar/middle lobe airspace opacity.Perihilar bronchial wall thickening may be the result of edema or aspirate.No pneumothorax. Probable small pleural effusions.

Output: Patchy right perihilar/middle lobe airspace opacity may reflect edema and/or aspiration. Unchanged cardiomegaly and dense left consolidation/atelectasis. Support devices unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.SOB question pneumonia. Right lower lobe airspace opacity compatible with pneumonia.Moderate cardiomegaly with tortuosity of the thoracic aorta unchanged. Left subclavian ICD.

Output: Right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: concern for peri-AICD placement complications History: orthopnea, dyspnea on exertion, elevated lactate Severe cardiomegaly and/or pericardial effusion.Mild retrocardiac subsegmental atelectasis, but only minimal edema is present at all.Left subclavian ICD, leads unchanged in position.

Output: Left subclavian ICD, leads unchanged in position. No evidence of pneumothorax. Minimal basilar atelectasis. Severe cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: s/p PICC History: s/p PICC Left upper extremity PICC tip is in the right atrium. NG tube projects over the gastric body.Cardiomediastinal silhouette is unchanged.Left pleural effusion and retrocardiac opacity may reflect atelectasis consolidation.No pneumothorax. Mild basilar edema.

Output: Left upper extremity PICC tip is in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate PICC line History: post PICC placement Interval placement of left PICC which is coiled in the left internal jugular vein. Interval removal of endotracheal tube. Additional cardiopulmonary support devices are unchanged. Mediastinal drains.Low lung volumes with bibasilar atelectasis and large pleural effusions, increased compared to prior.

Output: Left PICC is coiled in the left internal jugular vein. Increasing bibasilar atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: confirm NG tube placement History: n/a NG tube tip in the body of the stomach.Port catheter with tip at the SVC/RA junction.No significant cardiopulmonary abnormalities.

Output: NG tube tip in the stomach.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: volume status History: heart transplant Left-sided PICC appears to terminate in the brachiocephalic vein. Augmented cardiac leads again noted in the superior mediastinum. No new focal lung consolidation. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No substantial change.


Instruction: Generate impression based on medical findings.

Input: Persistent WBC and cough. Right chest port unchanged in position.Innumerable pulmonary nodules suspicious for metastatic disease.Moderate right and large left pleural fluid collections with associated atelectasis about the same. Left lower lobe consolidation and dependent airspace opacity bilaterally could indicate superimposed infection.Bilateral lymphadenopathy, about the same.

Output: Airspace opacities and consolidation suspicious for infection. Stable moderate to large pleural fluid collections. This is superimposed upon innumerable pulmonary nodules suspicious for metastatic disease. Suggest thoracic CT when feasible.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: FemaleReason for Study: Reason: Persistent cough History: persistent cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with metastatic prostate cancer. Please restage. This examination is limited by the absence of IV contrast. CHEST:LUNGS AND PLEURA: Stable right lung base calcified granuloma and mild centrilobular emphysema. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size isnormal without pericardial effusion. Coronary artery calcifications. CHEST WALL: Sclerotic lesion in right posterior eighth rib likely represents a metastatic lesion. Bilateral gynecomastia. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Normal gallbladder. No intra-or extrahepatic biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Perinephric soft tissue infiltration is stable bilaterally as seen previously. Bilateral ureteral stents are again seen.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are stable.Reference left periaortic node (series 3, image 119) measures 1.5 x 1 cm (stable).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic vertebral metastases are re-identified. T12 vertebral body has vestigal ribs and contains a metastatic lesion which further disrupts the cortex. Multiple new foci of increased sclerosis corresponding to increased radiotracer activity are seen in multiple ribs bilaterally, several thoracic and lumbar vertebral bodies, and in the left femur. Additionally, previously identified lesions in the left femur, multiple ribs bilaterally, pelvis, and left sacroiliac region are larger compared to the previous examination.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Thickened bladder wall is stable.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse sclerotic osseous metastases are larger, compared with the prior exam.

Output: 1. Multiple osseous metastatic lesions. Progression of metastatic disease with multiple new lesions, as well as increased size of several previously described lesions.2. Stable, enlarged retroperitoneal lymph nodes.3. Stable thickening of the bladder wall.


Instruction: Generate impression based on medical findings.

Input: Reason: copd, upcoming surgery History: dyspnea Large lung volumes consistent with COPD.Small calcified nodule in the right lower lobe with calcified right hilar lymph nodes compatible with previous infection.Normal heart size and mediastinum.

Output: COPD with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: r/o aortic dissection History: new cp, back pain Stable cardiomegaly and vascular congestion. No new lung opacities.Interval placement of dual lumen power port, tip projects in the superior vena cava. No pneumothorax.

Output: Stable cardiomegaly without evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with metastatic rectal cancer and liver metastases CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Borderline enlarged. Mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: 15 x 15 mm defined hypodense lesion in segment 7 of the liver appears more conspicuous on today's study. Further evaluation with liver MR may be helpful.SPLEEN: ThePANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: New left-sided hydronephrosis and hydroureter. Left ureter is dilated up to a point in the pelvis where it cannot be differentiated. Ill-defined soft tissue density on image number 173, series number 4. This is suspicious for invasion of the left ureter by primary or metastatic neoplasm.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: Enlarged prostate gland.BLADDER: Bladder wall is diffuse a thickened.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Rectal wall is diffusely thickened, which measures secondary neoplasm./changes secondary to radiation. Ill-defined soft tissue around the sigmoid colon suspicious for recurrent tumor.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New left-sided hydro-nephrosis and hydroureter secondary to invasion of the left ureter by a presumed recurrent tumor. Ill-defined soft tissue in the sigmoid colon suspicious for recurrent tumor.MRI is recommended for further evaluation of the segment 7 hypodense lesion.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with non-small cell lung cancer status post chemo/RT. CHEST:LUNGS AND PLEURA: Paramediastinal fibrosis and perihilar right lower lobe fibrosis with bronchiectasis and consolidation likely reflects radiation reaction and is unchanged. Apical centrilobular emphysema is unchanged. A new left lower lobe ill-defined air space opacity (axial image 60/105) is nonspecific and may reflect early or evolving infection or inflammation. Scattered micronodules, some of which are calcified, are unchanged.MEDIASTINUM AND HILA: Pretracheal soft tissue density measures 1.5 cm on axial image 33/145 and is unchanged. No other significant hilar or mediastinal lymphadenopathy. The cardiac size is normal with no pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule measures 1.4 x 1.7 cm on axial image 84/145 and is not significantly changed.KIDNEYS, URETERS: Multiple small cortical hypodensities in the right kidney are unchanged and likely represent cysts.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.No definite evidence of recurrent or metastatic disease in the chest or abdomen.2.Nonspecific new left lower lobe opacity as above.3.Stable right adrenal nodule.


Instruction: Generate impression based on medical findings.

Input: Reason: cough, fever; hx pneumonia 1 year ago History: cough, fever Normal cardiac and mediastinal contours.Large lung volumes suggestive of COPD.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Non-small cell lung cancer Improving overall lung volumes with improved aeration in both lung bases. Residual mild atelectasis yet resolving effusions.No new superimposed air space abnormality. The large left pleural based mass is otherwise grossly similar, correlating with relatively recent CT exam. Left chest tube removed.Scoliosis with vertebroplasty unchanged. The cardiac and mediastinal contours other than exaggeration appears otherwise similar and without new discrete abnormality. Left subclavian port unchanged.

Output: Improving overall aeration and decreasing atelectasis and effusions. Left lung mass otherwise grossly unchanged and without a superimposed associated new acute abnormality


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: FemaleReason for Study: Reason: s/p implant of a Medtronic single chamber ICD --> r/o pneumothorax and evaluate lead position History: as above Left-sided ICD is in place with its lead wire in the right ventricle.Cardiac size is normal with tortuosity of the aorta.Lungs are clear.No pleural effusions.Median sternotomy is intact.No evidence of pneumothorax.

Output: Interval placement of a left-sided ICD without complication. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female"pneumonitis due to inhalation of food and vomit [J69.0]" ET tube tip has been retracted now approximately 5 cm from the carina. Right jugular CVC tip in SVC.NG tube tip projected over the lower mediastinum consistent with location in the gastric interposition.Extensive bilateral airspace opacity compatible with aspiration and infection, not significant changed since prior study..

Output: ET tube tip 5 cm above carina. Right jugular CVC tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: r/o acute chest or other cardiopulmonary process History: worsening cough, left sided sternal chest pain No change in cardiomegaly. Vascular congestion and basilar opacities may represent combination of edema and atelectasis.No specific evidence of infection.

Output: Cardiomegaly with vascular congestion and basilar opacities suggesting edema.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with chest pain. Cardiomediastinal silhouette is unremarkable.No focal opacity or pleural effusion.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: 24 yo M w spina bifida, trachs History: vent wean Markedly underinflated lungs.Nonspecific opacities consistent with pleural effusions and adjacent atelectasis, slightly improved.Tracheostomy tube and left jugular catheter, unchanged.

Output: Nonspecific opacities consistent with pleural effusions and adjacent atelectasis, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: intubated History: intubated Endotracheal tube terminates 4 cm above the carina. When accounting for change in patient position, the support devices are in stable position.Persistent lower zone opacities, slightly increased on the left. This is suspicious for aspiration with a component of basilar edema. Small bilateral pleural effusions. No pneumothorax.

Output: Basilar opacities suggestive of edema with subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: 55 y/o CHF, CAD, interval pulmonary edema History: sOB Stable cardiac enlargement.Mild perihilar opacities compatible with edema slightly improved from the prior exam.No new pulmonary opacities identified.No pleural effusions.

Output: Cardiomegaly with mild edema improved from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Metastatic ACC with wall metastases reporting new dyspnea on exertion. Pulmonary masses appear slightly larger. Small pleural fluid collections, right greater than left, increased. Signs of pulmonary edema in the right lower lobe.Compression wedge deformity in the midthoracic spine.Cardiomegaly left chest port unchanged.

Output: Enlarging pulmonary metastases and slight increase in pleural fluid volume. Signs of pulmonary edema on the right.


Instruction: Generate impression based on medical findings.

Input: 74 year old male history of esophageal cancer. CHEST:LUNGS AND PLEURA: Severe upper lobe predominant centrilobular and paraseptal emphysema, similar to prior.Multiple new micronodules within the right interlobar fissures likely represent intrapulmonary lymph nodes. Few additional calcified and noncalcified micronodules are nonspecific. Postoperative changes of the left upper lobe medially, unchanged. Slight right basilar scarring/atelectasis with trace bilateral effusions.MEDIASTINUM AND HILA: Postoperative appearance of gastric pull-up, similar to prior with stable to slightly decreased neo-esophageal wall thickening. New 6mm paraesophageal lymph node (series 3 image 92) is nonspecific. No supraclavicular, mediastinal, or hilar lymphadenopathy.Post-operative coronary bypass appearance, unchanged. Cardiomegaly with severe coronary artery and aortic valve calcifications with minimal pericardial effusion, similar to prior.CHEST WALL: Sternotomy wires and postsurgical changes of the right lateral chest wall, unchanged. ABDOMEN:LIVER, BILIARY TRACT: Mild asymmetric thickening of the anterior wall of gallbladder, similar to priors.SPLEEN: Patchy splenic artery calcifications.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged.PANCREAS: 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: Moderate to severe vascular calcifications of the abdominal aorta and its branches. No aneurysmal dilatation.

Output: No specific evidence of recurrence of metastasis. Additional findings without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Fever and shortness of breath. The cardiac and mediastinal contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities.No pleural effusion or pneumothorax.Partially visualized metallic fragments in the soft tissues of the neck.

Output: No radiographic findings to suggest pneumonia, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Tachycardia, status post OLT, increased secretions. Tubes and lines unchanged in position. Lung volumes remain low. Right pleural fluid collection, slightly improved. Right basal opacity may be a combination of compressive atelectasis related to pleural fluid and aspirate, unchanged.

Output: No specific signs of pneumonia. Atelectasis on the right is unchanged in appearance. Right pleural fluid collection may be slightly smaller.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: IABP History: IABP Left-sided ICD unchanged.IVP marker in the distal aortic arch.The cardiomediastinal silhouette is unremarkable.The lungs are clear.

Output: IVP marker in the distal aortic arch. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: eval for pneumonia, pneumothorax History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 75 years old Female. Reason: Aspiration event this morning - please evaluate lung pathology History: Aspiration of cream of wheat this am with decrease in O2 sat improved with duonebs / increased FIO2. Interval new bilateral diffuse interstitial changes and left lower lobe patchy opacities. A new nodular density is seen in the left lower lung. The tracheostomy tube is stable in position. Cardiac silhouette is normal. There is no evidence of pneumothorax.

Output: New diffuse bilateral interstitial changes and patchy opacities and nodular density in the left lower lung, which are consistent with aspiration. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: assess for PNA History: hx of COPD, failure to thrive Large lung volumes consistent with COPD. Heart size upper normal.No specific evidence of infection or edema.

Output: COPD. No acute abnormality such as edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 57 year-old female T3 N1 urethral cancer status post anterior exenteration with questionable soft tissue mass near clips. Palpable right groin LN. Restage. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: Sub-centimeter lesion in the left lobe unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered small lymph nodes in the groin. Right groin node previously measured are slightly larger pseudocyst image 178 measures 2 x 1.6 cm.BOWEL, MESENTERY: Rounded fluid density collection in the right iliac fossa underneath the rectus muscles redemonstrated now measuring 4.5 x 4 cm on series 2 image 157. This is slightly smaller than on the prior scan.Postsurgical changes redemonstrated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Decrease in size of probable a seroma in the right iliac fossa. Right groin lymph node minimally larger.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: 34yo F with CHF and IABP, assess placement. History: CHF, IABP Cardiomegaly without edema.IABP catheter proximal marker 2 cm below the top of the aortic arch.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly without edema. Unchanged tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: assess for pneumonia History: chest pain cough Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: s/p Redo AVR History: SOB Right hemithorax volume loss with a right pleural effusion or pleural scarring, unchanged.Left lung unremarkable.Status post median sternotomy with moderate cardiomegaly.

Output: Moderate cardiomegaly status post sternotomy. Unchanged right pleural effusion or pleural scarring with right hemithorax volume loss.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: MaleReason for Study: Reason: s/p MVR History: s/p MVR Right IJ venous catheter has been removed.When the right-sided chest tubes has been removed.Left PICC line with its tip in the axilla.Decreased lung volumes with basilar opacities compatible with atelectasis.Small pleural effusions unchanged.

Output: Interval removal of one of the right-sided chest tubes. No evidence of a pneumothorax. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for re-accumulation of pleural effusion, pneumothorax History: SOB, h/o PNA and pleural effusion Persistent left lower lobe consolidation and left pleural effusion. No evidence of pneumothorax.

Output: Persistent left lower lobe consolidation and left pleural effusion. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: check pulmonary status History: check pulmonary status Tracheostomy tube and catheters unchanged.Cardiomegaly with bilateral opacity compatible with edema, atelectasis and pleural effusions, not significantly changed.

Output: Findings suggestive of CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: r/o ptx/pneumomediastinum History: chest pain anterior chest The lungs and pleural spaces are clear. The heart size appears enlarged when compared to 2011. Recommend a dedicated PA and lateral radiograph for further evaluation. No evidence of pneumothorax

Output: Heart size appears enlarged when compared to 2011. A dedicated PA and lateral radiograph is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: hypoxia/atelectasis ?effusion History: as above Nonspecific basilar opacities suggestive of atelectasis, without significant sized pleural effusions.Heart size normal.Previously questioned nodule not confirmed.

Output: Nonspecific basilar atelectasis could be from aspirated secretions or mucous plugging, but pulmonary embolism is also in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Chest pain. Evaluate for pneumonia or effusion. No focal pulmonary opacities, pleural effusions, or pneumothorax.Unchanged cardiomegaly and suggestion of main PA enlargement. Retained catheter cuff on right.

Output: Cardiomegaly but no significant edema.


Instruction: Generate impression based on medical findings.

Input: Male, 6 years old. Reason: evaluate for line placement History: manipulation of lineVIEW: Chest AP (one view) 3/27/2015, 1948 ET tube tip below the thoracic inlet and above the carina. Enteric tube terminates in the stomach. Bilateral chest tubes are unchanged in position. Left arm PICC, tip at the brachiocephalic vein/SVC confluence.The cardiothymic silhouette is normal.Bilateral lower lobe airspace opacities, mildly improved from the prior exam. No new focal opacities, pleural effusion, or pneumothorax.

Output: Mildly improved bilateral lower lobe opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: PNA History: decreased PaO2, leukocytosis Worsening perihilar opacities suggestive of edema or aspiration.Heart size upper normal.Tracheostomy tube tip approximately 4 cm above the carina.Right jugular catheter tip at cavoatrial junction.

Output: Worsening perihilar opacities suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Advanced progressive endometrial cancer with vaginal bleeding. CHEST:LUNGS AND PLEURA: Several tiny nodules are seen in both lungs, several of which are calcified. They are unchanged in appearance. No new nodules identified.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes. Stable heterogeneous appearance of the thyroid gland.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple gallstones are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephroureterostomy catheters terminate within the urinary bladder. RETROPERITONEUM, LYMPH NODES: The reference retroperitoneal lymph node just caudal to left renal vein has increased slightly in size it currently measures 1.7 x 1.2 cm (image 114; series 3). The retroaortic left renal vein and vena caval filter are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Bladder cannot be well evaluated due to lack of IV contrast. In particular, the bladder mass previously described cannot be adequately measured. Few pockets of air are again noted within the bladder.LYMPH NODES: Right external iliac lymph node has enlarged and currently measures 2.5 x 2.0 cm (image 168; series 3). Inguinal lymph nodes again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited exam due to lack of IV contrast. Increased size of reference retroperitoneal and pelvic reference lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: ETT too deep s/p tube advancement today, now s/p tube pulled 1cm, re-eval tube placement History: see above Basilar atelectasis unchanged.ET tube repositioned, the tip 3 cm above the carina.NG and Dobbhoff tubes extend below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: ET tube repositioned, the tip now 3 cm above the carina. Stable basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: SOB History: SOB Stable cardiac enlargement.Right pleural effusion/thickening and smaller left pleural effusion as well similar to the prior exam.Basilar opacities compatible with atelectasis/edema.No focal areas of consolidation.Median sternotomy is intact.

Output: Cardiomegaly with pleural effusions and basilar opacities similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: CT placement and Central Line placement History: s/p Cardiac Surgery , AVR and CABG Swan-Ganz catheter has been removed. Other lines and tubes, unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Shortness of breath. Left subclavian ICD unchanged. Elevation of the left hemidiaphragm again seen. No focal airspace opacities, though portion of the left upper lobe is obscured by the pulse generator. Linear scarring in the left lung. No pleural fluid or signs of pulmonary edema. No pneumothorax. Atherosclerotic calcification in the expected distribution of the right carotid vasculature. Sternotomy hardware and mediastinal clips suggestive of prior CABG. Upper normal heart size.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Lung Transplant patient with Pleural Effusion History: s/p Pigtail drains for effusions requiring bipap Bilateral pleural effusions with pleural drains, and no pneumothorax.Worsening interstitial edema like opacities with persistent basilar consolidation.

Output: New pleural drains with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: chest pain History: chest pain No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: further eval for RML pneumonia History: decreased PO intake in patent with dementia Very small pleural effusions are seen on the lateral view, new since last year.Otherwise, no pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.No specific evidence of infection.

Output: Small pleural effusion seen only on the lateral view, otherwise unremarkable. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: pt intubated w/ hx of aspiration pna History: new a-a gradient Venous catheter tip at RA/SVC junction, NG tube tip in stomach, ET tube tip 4 - 5 cm above carina.Lungs hypoinflated. No new opacity to suggest pneumonia.

Output: Lungs hypoinflated. No new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: cardiomegaly, PNA History: acute onset shortness of breath, pleuritic chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male 22 days status post haplo cord (haplo-identical cord blood blood transplantation) for mds (myelodysplastic syndrome) with new dyspnea. CHEST:LUNGS AND PLEURA: Right basilar pleural and parenchymal scarring as was seen previously. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Calcifications along left brachiocephalic vein as well as subtle adjacent stranding may represent chronic thrombosis.CHEST WALL: Right jugular central venous catheter with tip near SVC/RA junction. Spinal stabilization hardware.UPPER ABDOMEN: Cholecystectomy clips. IVC filter.

Output: No significant interval change from prior study. No findings to account for patient's dyspnea.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: r/o PNA History: chest pain, cough Port catheter again terminates in the RA. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size., Large hiatus hernia again noted. Serial clips again noted in the right axilla.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: 70M with cough and fatigue x5 days, ?pneumonia, ?volume overload History: 70M with cough and fatigue x5 days, ?pneumonia, ?volume overload Cardiomediastinal silhouette is unchanged. Deviation of trachea is due to goiter, unchanged from prior CT dated 1/9/15.No pleural effusion or pneumothorax. No focal pulmonary opacity.Surgical clips in the right paratracheal region.Anterior wedging of a midthoracic vertebral body, unchanged.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old. Status post left wedge resection. Chest tube. Left chest tube, tip in the apex, unchanged. No significant pneumothorax.Post-surgical changes of left lung wedge resection. 1cm linear radiopaque object at left lung base, unchanged.Possible small pleural effusions.Basilar atelectasis, greater on the left, unchanged.

Output: Stable left chest tube without a significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p bil lung tx History: s/p bil lung tx Bilateral chest tubes in place with small pneumothoraces, greater on the right, not significantly changed.Left subclavian catheter tip in the area of the left brachiocephalic vein.No new findings.

Output: Small apical pneumothoraces, greater on the right, without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: HX of CAD with new persistent cough History: cough Left subclavian AICD.No focal pulmonary opacity, pleural effusion, or pneumothorax.Moderate cardiomegaly and extremely tortuous thoracic aorta, as seen on recent CT.

Output: No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: s/p LVAD, Chest tubes History: SOB, post op eval Interval removal of Swan-Ganz catheter. Interval placement of left upper extremity PICC in the left subclavian vein. Otherwise, cardiopulmonary monitoring and support devices are unchanged. No pneumothorax.Severe cardiomegaly with retrocardiac compressive atelectasis and pleural effusion.No significant interval change.

Output: Severe cardiomegaly with retrocardiac compressive atelectasis and pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: central line placement History: above Right jugular catheter tip in SVC. No evidence of pneumothorax. Other findings stable.

Output: Right jugular catheter tip in SVC. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: eval pneumonia History: difficult ventilation in OR, tachy, febrile Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar atelectasis or scarring. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old, history of non-small cell lung cancer, needs restaging. Status post chemotherapy. CHEST:LUNGS AND PLEURA: A right upper lobe pleural-based mass measures 3.3 x 2.2 cm on axial image 22/101, decreased from 3.5 x 2.7 centimeters. Cavitation has progressed within this lesion. Erosion of the adjacent rib is unchanged.A left upper lobe reference mass measures 4.0 x 4.0 cm on axial image 31/101, increased from 3.4 x 3.7 cm.Right lower lobe mass measures 5.3 x 5.1 cm on axial image 68/101, increased from 4.9 x 4.2 cm.Additional scattered nodules and masses have also increased in size.Severe centrilobular emphysema. Right apical scarring and adjacent nodular soft tissue are grossly unchanged.MEDIASTINUM AND HILA: Cystic lesions in the right thyroid are unchanged.Reference subcarinal lymph node measures 2.7 cm on axial image 40/131, increased from 2.5 cm.The cardiac size is normal. No pericardial fluid.CHEST WALL: Sclerosis and deformity of a right lateral rib (axial image 76/131) is unchanged. T9 compression deformity unchanged. Endplate sclerosis at T12 and L1, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter hypodense liver lesions are re-identified. A lesion in segment 3 measures 5 mm on axial image 98/131, equivocally larger when compared to the prior exam where it measured approximately 3 mm.SPLEEN: No significant abnormality notedADRENAL GLANDS: Left adrenal thickening unchanged.KIDNEYS, URETERS: Hypodense right renal lesion measures 1.8 x 2.0 cm on axial image 107/31, slightly increased from the prior exam where it measured 1.7 x 1.8 cm. Left renal cyst is unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Mixed response but overall progression of disease with increasing reference lung lesions, mediastinal lymphadenopathy and abdominal reference lesions.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: ETT adjusted History: ARDS ET tube with its tip now 3 cm above the carina.Right IJ venous catheter and NG tube unchanged..Stable cardiomediastinal silhouette.Upper lobe predominant interstitial nodular opacities are similar in to prior exams.No new pulmonary opacities identified.

Output: ET tube repositioned with its tip now 3 cm above the carina. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Dobbhoff tube placement History: tube placement Feeding tube again in place with tip overlying the gastric antrum or first portion of the duodenum. Right sided Mediport and IVC filter again seen. Embolization coils again project over the right upper quadrant.Stable cardiac silhouette.Interval increase in interstitial prominence.No change in right hilar mass with adjacent radiation fibrosis and right lung volume loss. Mild left retrocardiac atelectasis. No pneumothorax.

Output: Feeding tube tip has been advanced and now overlies the gastric antrum or first portion of the duodenum. Interval increase in interstitial prominence suggesting edema. Correlate with fluid status. No other significant changes.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection, edema, effusion History: confusion, altered mental status Normal heart size and mediastinum with evidence of previous median sternotomy.Benign pleural thickening laterally on the right, unchanged.No sign of infection, edema or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: ETT History: as above ET tube unchanged with its tip 2 cm above the carina.NG tube with its tip beyond the margin the image.Decreased lung volumes with stable cardiomediastinal silhouette.Mild basilar scarring/discoid atelectasis.No new pulmonary opacities identified.

Output: ET tube with its tip 2 cm above the carina. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: s/p cordis placement, swan placement History: s/p cordis placement, swan placement Patchy opacity left mid and lower lung zone slightly improved, suggestive of aspiration.COPD.Moderate cardiomegaly. Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.

Output: Slowly improving left mid to lower lung zone opacity, with underlying COPD.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: iabp position History: iabp ] Right PICC line and left-sided ICD unchanged.Right Swan-Ganz placed with its tip in the right pulmonary artery.IABP marker in the proximal descending aorta.Stable cardiac enlargement with left pleural effusion and left basilar atelectasis similar to the prior exam.

Output: Placement of a Swan-Ganz catheter with its tip in the right pulmonary artery. IABP marker in the proximal descending aorta. Stable cardiopulmonary appearance with left pleural effusion and underlying consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: cardiac History: CP The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old. Interval placement of right central venous catheter, tip in projection the superior vena cava. There is no pneumothorax.Borderline cardiomegaly with normal vasculature. No airspace opacities.

Output: Interval placement of right central venous catheter with no pneumothorax. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: aspiration History: shortenss of breath Heart size normal. Lungs clear.No effusion. No pneumothorax.

Output: No specific evidence of infection or edema, or interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: eval for pneumonia History: bacteremia Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Previous edema like opacities have resolved.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Anterior mediastinal mass resection Right chest tube projects towards the right hilar region with the side port seen beyond the pleural interface. No associated significant pneumothorax. Mild to minimal chest wall emphysema. Underlying lungs are significant for mild patchy opacities in both lung bases possibly minimal atelectasis with mild cardiomegaly. Moderate atherosclerotic changes and tortuosity of the aorta

Output: Right chest tube placed


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: PNA, aspiration History: acute desat to 70's. Now in 90's on 5L. H/O PE. tachycardic Interval placement of right hemodialysis catheter with tip at junction of right atrium and superior vena cava. No pneumothorax.Bilateral lung opacities with bilateral pleural effusions and basilar atelectasis.Interval removal of the left-sided central venous catheter.

Output: Interval development of bilateral pulmonary opacities and pleural effusions. Heart size appears to be at upper limits normal.Interval placement of hemodialysis catheter.


Instruction: Generate impression based on medical findings.

Input: 47-year-old man history of non-Hodgkin's lymphoma 2004. Evaluate for relapse. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Borderline splenomegaly. Maximal cephalocaudad dimension 13.7-cm coronal 57/157PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered small shotty nodes. Portacaval node Series IV image 113, 2.6 x 1 cm. No definite pathologic by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No definite evidence of recurrence. Borderline splenomegaly. Shotty retroperitoneal lymph nodes. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Has the proximal PE resolved? Recurrent DVT and pulmonary emboli. CHEST:PULMONARY VASCULATURE: Improved chronic embolus burden within the left descending pulmonary artery and its branches, partially recanalized but still present. Emboli in the right descending coronary artery branches have improved to a greater extent abuts filling defects are still seen within lobar and segmental branches (image 174).LUNGS AND PLEURA: Chronic scarring at the lung bases. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: Partial resolution of chronic bilateral lobar and segmental level pulmonary emboli.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: SOB Perihilar opacities as well as basilar opacities with septal thickening and small pleural effusions suggestive of congestive heart failure. Moderate cardiomegaly. Tortuous thoracic aorta. No pneumothorax.

Output: Probable congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o fluid overload, LVAD pt History: diminished lung sounds Normal heart size with an LVAD in place, unchanged from previous.Coronary stent, mitral valve prosthesis and retained epicardial pacer wire, also unchanged.Large lung volumes suggestive of COPD.Scarring of the right costophrenic angle, but no sign of pneumonia no or pulmonary edema.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old. Cough. Evaluate for pneumonia. Unremarkable cardiac and mediastinal silhouette.No significant pleural or parenchymal abnormality.Right upper quadrant surgical clips.

Output: No evidence of infection or significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: Aspiration History: Increase WOB Lung behind stable cardiomediastinal silhouette.Bilateral basilar subsegmental atelectasis redemonstrated.No focal areas of consolidation.No new pulmonary opacities identified.No large pleural effusions.

Output: Mild basilar atelectasis without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: chest pain, mid sternal, orthopnea History: chest pain Cardiomediastinal silhouette is unremarkable. No focal pulmonary opacity or pleural effusion

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: neutropenic fever History: fever Moderate superior mediastinal widening consistent with lymphadenopathy, decreased compared to previous.Catheter tip in the SVC.No sign of pneumonia or other significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Altered mental status. Evaluate intubation. ET tube tip projecting about 1 cm above the carina. Enteric tube tip terminates inferior to this image.Mild basilar atelectasis and/or scarring. Scattered lung granulomata. No additional focal lung opacity, pleural effusion or pneumothorax is evident.Mildly enlarged cardiac silhouette size, unchanged.

Output: 1.ET tube tip about 1 cm above carina.2.Mild cardiomegaly, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Chest pain rule out cardiopulmonary abnormality. Low lung volumes with basal compressive atelectasis. No convincing evidence of pulmonary edema or pneumonia. Mild basal scarring on the right. Right upper quadrant cholecystectomy clips.

Output: Low lung volumes with basal atelectasis but no visible signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.CABG and DOE. Cardiomediastinal silhouette unchanged in appearance. No focal pulmonary opacities or pleural fluid. Left upper quadrant surgical clips. Degenerative changes of the spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Hypertensive emergency and HA. Probable mild cardiomegaly with increase in cardiothoracic ratio since the prior study. Unfolding of the thoracic aorta which appears ectatic; aneurysm cannot be excluded.No pleural fluid or visible mediastinal hematoma. No focal pulmonary opacity or pneumothorax.

Output: Slight interval increase in cardiothoracic ratio and size of tortuous, ectatic thoracic aorta. Thoracic aortic aneurysm or other aortic pathology cannot be excluded. No evidence of mediastinal hematoma by plain film.CT angiogram may be performed if required and was discussed with Rachel Gilmore at 8:30 a.m. on 3/18/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: hx COPD, OSA, ?CHF, off of Lasix, increased sob History: sob No new focal lung opacity. No evidence of overt left-sided heart failure. Interval removal of endotracheal tube and enteric tube. Moderate cardiomegaly again noted. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female 47 years old Reason: Focal consolidation? History: Newly febrile Right internal jugular central venous catheter terminates in the SVC.There are persistent bibasilar interstitial opacities and probable small pleural effusion on the left, which appear slightly increased compared to the prior examination, although this is likely accentuated by technique. There is no pneumothorax. Increased retrocardiac opacity suggests atelectasis/consolidation.Moderate cardiomegaly is unchanged from the prior.The imaged skeleton upper abdomen are unremarkable.

Output: Pulmonary edema and small left pleural effusion, appearing slightly increased from the prior examination, although this is likely accentuated by technique. Increased retrocardiac opacity suggests atelectasis/consolidation, perhaps reflecting infection in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Acute respiratory failure with hypoxia. ETT tip 3.4 cm above the level of the carina.Basal atelectasis and pleural fluid about the same on the left and slightly improving on the right. Right apex is obscured by overlying bone and soft tissues.Bronchial wall thickening unchanged.

Output: Pleural fluid, bronchial wall thickening and atelectasis with slight improvement in the right. Findings are suspicious for previous aspiration.


Instruction: Generate impression based on medical findings.

Input: 32 years old Female. Reason: ETT History: ETT. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Minimal streaky basilar opacities. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: rule out infection History: fever Bullet fragments overlying the chest are unchanged in position. Chronic scarring, especially the left lower lobe. Normal heart size.

Output: No evidence of infection. Bullet fragments again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: ET tube placement 4/30 History: ET tube placement 4/30 Small lung volumes with retrocardiac opacity unchanged.ET tube low, within 1 cm of the carina.An NG tube terminates in the stomach.

Output: Low ET tube, a follow-up radiograph already requested. Mild opacity left lower lung zone may be related to low ET tube placement.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p TAVR History: s/p TAVR Small lung volumes with bilateral skin folds but no pneumothorax.Probable small effusions in the posterior costophrenic angles.Status post TAVR.Catheter tip in the SVC.

Output: Small pleural effusions and no other acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: r/o pneumonia History: fever tachycardia AMS No significant cardiopulmonary abnormality.Cholecystectomy clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p ETT placement History: accessory m. use, tachypnea ET tube tip approximately 1 cm above the carina.NG tube doubled back in the stomach.Mild basilar opacity, greater on the right, improved compared to previous consistent with atelectasis and aspirated secretions.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old with chest pain. Evaluate for pneumonia. Surgical clips project over the left axilla and left upper trachea. There is mild leftward displacement of the trachea due to a goiter, unchanged.The cardiomediastinal silhouette is unremarkable.No abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: No pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: Pneumonia, progression ILD History: Cough in setting of Jo-1 ILD on immunosuppression. Stable cardiomediastinal silhouette.Interval development of right lower lobe predominant airspace consolidation. No sizable pleural effusion or pneumothorax.

Output: Interval development of right lower lobe consolidation concerning for pneumonia/aspiration in the proper clinical setting.


Instruction: Generate impression based on medical findings.

Input: Reason: 65F with ischemic cardiomyopathy and IABP. History: IABP Cardiomegaly with pulmonary edema, not significantly changed.ET tube tip approximately 3 cm above the carina.Balloon catheter with its tip in the proximal descending aorta and Swan-Ganz catheter tip in the left descending pulmonary artery.

Output: CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Tachypnea, known pneumonia Interval minimal questionable progression of the right upper lobe focal opacity with mixed interstitial and airspace opacities again seen in both bases. Moderate pleural effusions are again observed with decreased lung volumes. Overall appearance is similar to questionably progressed multifocal pneumonia. Superimposed edema again also cannot be entirely excluded.Cardiac and mediastinal contours are otherwise grossly unchanged

Output: Suspected multifocal pneumonia with questionable minimal progression and superimposed edema


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: please eval for malignancy History: long time smoker, incidentally noted involuntary weight loss Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old. ET tube and Swan-Ganz catheter unchanged.Balloon catheter in the descending aorta with its tip projected about 6 cm below the top of the aortic arch.Cardiomegaly and lower zone nonspecific opacity compatible with edema atelectasis and small effusions, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cardiac surgery History: s/p cardiac surgery Cardiopulmonary monitoring and support devices, unchanged.Diffuse pulmonary opacity compatible with edema with probable moderate effusions and left lower lobe atelectasis, not significantly changed.

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


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: eval for pna History: ams No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: ET tube advanced History: as above Endotracheal tube 4 cm above the carina. Lines otherwise stable.No pneumothorax.No change in left basilar opacity and effusions.

Output: ET tube 4 cm above carina. No change in left basilar opacity and effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Shortness of breath. History of lung cancer. Mild cardiomegaly.Low lung volumes are again noted.Persistent opacity in the mid aspect of the left lung.Mild interval progression of diffuse pulmonary opacities with small pleural effusions.No evidence of significant pneumothorax.

Output: Persistent opacity in the mid aspect of the left lung. Mild interval progression of diffuse pulmonary opacities with small pleural effusions, consistent with pulmonary edema or multifocal aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 79 years old Female. Reason: eval for PNA History: elevated WBC. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Linear densities are seen in the left lung base, which are nonspecific.

Output: The above findings are suggestive of mild congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old. New left jugular catheter with its tip in the area of the left brachiocephalic vein.PICC line tip in the SVC.NG tube tip in the stomach. Small lung volumes with bilateral nonspecific airspace and interstitial opacity, slightly increased.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.IABP placement. Aortic balloon catheter marker projects immediately inferior to the aortic arch, similar in location compared to prior examination. ICD leads are unchanged. Cardiomediastinal silhouette is unchanged. No focal airspace opacity.

Output: Aortic balloon catheter marker projects immediately inferior to the aortic arch, similar in location compared to prior examination.


Instruction: Generate impression based on medical findings.

Input: Reason: ro pna History: ro pna No sign of pneumonia. Mild blunting of the posterior costophrenic angles which may be due to small effusions or atelectasis. Venous catheter tip in the right atrium.

Output: Mild basilar opacities but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: assess hardware, compare to prior History: intubated Left-sided ICD unchanged.Right IJ Swan-Ganz with its tip in the pulmonary artery.IABP marker and the proximal descending aorta.Decreased lung volumes is stable cardiac enlargement.Interval improvement in the basilar opacities

Output: Support devices unchanged. Interval improvement in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Persistent cough. Large lung volumes. No focal pulmonary opacities to suggest infection. No pleural effusion or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube placement History: s/p radical pleurectomy decortication Bilateral chest tubes in place with no significant pneumothorax. Small lung volumes with basilar opacity compatible with atelectasis and nonspecific consolidation. A more recent radiograph has been interpreted.

Output: Basilar atelectasis and focal consolidation with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p L wedge resection, chest tube Chest tube at the left apex with no pneumothorax. Small lung volumes with basilar opacities consistent with atelectasis, unchanged.

Output: Postoperative findings with no significant change.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Left subclavian Swan-Ganz again projects at the bifurcation of the pulmonary artery. IABP unchanged, tip projects 4 cm below the aortic archICD and underlying cardiopulmonary appearance is significant for mildly decreasing interstitial changes suggesting resolving mild edema. Persistent marked nonspecific cardiomegaly

Output: IABP and Swan-Ganz are both unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: Effusion or enlarged heart History: chest pain The heart size is normal. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Shortness of breath Stable cardiomediastinal silhouette.Moderate right and small left pleural effusions with mild basilar edema and subsegmental atelectasis.Sternotomy wires and mediastinal clips noted. Enteric tube tip in the gastric body. Right chest port with tip in the SVC.

Output: Bilateral pleural effusions with bibasilar edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: pleural effusion History: cough; pleural effusion Stable cardiomediastinal silhouette.Bilateral pleural effusions similar in appearance to the prior exam.No new pulmonary opacities identified.Pectus excavatum deformity redemonstrated.

Output: No interval change in the bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: ? PNA History: AMS Cardiomediastinal silhouette is within normal limits.Lungs clear.No pneumothorax. No pleural effusion.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Evaluate for right parotid lymph node. Right facial paralysis. Images through skull base and sinuses are unremarkable.Examination demonstrates multiple small normal-appearing, nonenhancing lymph nodes bilaterally in the parotid, carotid, submandibular, submental and posterior cervical spaces. No evidence of a mass or pathologic lymphadenopathy is identified. The airway and vasculature are patent. The thyroid glands appear normal. A lucency is seen in the C3 vertebral body, likely representing degenerative change.Limited view of the chest is unremarkable.

Output: No evidence of mass or pathologic lymphadenopathy in the soft tissues of the neck.


Instruction: Generate impression based on medical findings.

Input: Check pneumothorax Left chest tube removed with interval marked decrease in the underlying subpulmonic pneumothorax previously described. No significant pneumothorax currently observed. Minimal chest wall emphysemaLungs are otherwise clear. Cardiac and mediastinal contours are within limits

Output: Left chest tube removed and interval resolution of the underlying pneumothorax upon chest tube removal


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: eval for edema or infection History: sob No change in hyperinflated lung fields and flattening of the diaphragm. No evidence of infection or edema. Mild cardiomegaly is unchanged.

Output: No acute evidence of infection or edema. No other interval changes.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxic respiratory failure and pulmonary edema intubated History: shortness of breath Interval extubation.Bilateral lower lobe subsegmental atelectasis, slightly improved.No new findings.

Output: Interval extubation with residual basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 78-year-old female with metastatic colon cancer. Evaluate for disease progression. CHEST:LUNGS AND PLEURA: Stable right middle lobe micronodule.MEDIASTINUM AND HILA: Previously measured left supraclavicular lymph node appears larger compared to the prior study and measures 2.6 x 2.1 cm (series 3, image 5).CHEST WALL: Central venous catheter tip is seen in the superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Two stable hypodense foci are noted and are stable. The larger hypodensity measures 0.9 x 0.8 cm, unchanged compared to prior study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left middle pole renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Reference retrocaval lymph node measures 7 x 5 mm, stable compared to the prior exams (series 3, image 94).BOWEL, MESENTERY: Status post right hemicolectomy. Ventral hernia containing mesenteric fat and nonobstructing small bowel is unchanged.BONES, SOFT TISSUES: Degenerative changes affect the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus and adnexa are not well visualized and may be surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Status post right hemicolectomy.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine and bilateral hips.OTHER: No significant abnormality noted.

Output: 1.Left supraclavicular lymph node is larger compared to the prior study.2.No evidence of local recurrence or metastatic lesions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusions History: ams ET tube tip approximately 3 cm above the carina.Enteric tube traversing the esophagus. Mild hazy lower zone opacity compatible with atelectasis and probably small effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: seizures, new oxygen requirement, evaluate for aspiration pna History: above Cardiomediastinal silhouette is normal. No pleural effusion. No specific evidence of edema. Faint opacity in the right lung base is poorly seen on this portable view.

Output: No definite acute cardiopulmonary abnormality. Follow-up PA and lateral chest radiographs may be obtained if symptoms worsen.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.SOB and chest discomfort. Upper normal heart size. Highly tortuous thoracic aorta with prominence of the ascending aortic segment. Low normal lung volumes with underinflation artifact. Minimal atelectasis or scarring at the bases. No signs of CHF or pneumonia. No pleural fluid or pneumothorax.

Output: Prominence of the ascending segment of the thoracic aorta nonspecific by plain film technique; t ectasia or aneurysmal dilatation cannot be excluded. This may be seen in the setting of aortic valve stenosis. Consider thoracic further evaluation with gated cross-sectional imaging or echocardiogram when feasible. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: chest discomfort, radiating to back. assess lungs and mediastinum (connective tissue disease) History: chest discomfort Enteric tube courses below the field-of-view.Heart size is normal. Mediastinum at the level of the aortic arch is prominent for age, which may be pathologic or related to body habitus. No pleural effusion or pneumothorax. No focal pulmonary opacities.

Output: Enteric tube courses below the field of view. PA and lateral radiograph is recommended for more accurate assessment of the mediastinum; pathology cannot be accurately ruled out by plain film . If suspicion for vascular pathology persists, a CTA is recommended.Findings discussed with Dr. Lyon at 1753 on 3/16/15.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: MaleReason for Study: Reason: cp History: cp The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Noted is an IVC filter.Median sternotomy is intact with evidence of a prior CABG, AVR, and RCA coronary stent.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Bilateral pneumothorax. Shortness of breath Persistent small to moderate bilateral pneumothoraces measuring under 1 cm apically bilaterally. Bilateral neck and left chest wall emphysema with a left chest tube projected into the apex. Chest tube position unchangedCardiac silhouette and mediastinal contours remain within limits other than additional outline of the mediastinal structures suggest pneumomediastinum

Output: Unchanged left chest tube and small bilateral pneumothoraces


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent decreased lung volumes with small to moderate bilateral pleural effusions and basilar streaky densities suggesting atelectasis and less likely aspiration. Retrocardiac consolidation remains similar and a superimposed process cannot entirely be excluded. Midline sternotomy. The cardiac and mediastinal contours are otherwise unchanged

Output: Persistent moderate pleural effusions with retrocardiac nonspecific consolidation


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with cough. Evaluate for pneumonia. Cardiomediastinal silhouette is unremarkable.No focal opacity or pleural effusion.Bilateral breast implants.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: complicated PNA last year with continued pleuritic pain - evalaute for interval changes History: pleuritic pain Unremarkable cardiomediastinal silhouette.Unchanged blunting of the right costophrenic angle which may reflect scarring or very small effusion.No new focal opacities, pneumothorax, or pleural effusion.

Output: No specific evidence of pneumonia or acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with history of respiratory distress. Right upper extremity PICC with tip in SVC. Stable cardia mediastinal silhouette. Diffuse bilateral reticular opacities are nonspecific. Possible small bilateral pleural effusions.

Output: Diffuse bilateral reticular opacities are nonspecific but may represent hemorrhage, drug reaction, and/or fibrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: assess for infection, overload, acute process History: assess for infection, overload, acute process Motion artifact. Cardiomediastinal silhouette is within normal limits. Mild bibasilar subsegmental atelectasis/scarring. No pneumonia. No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: SOB; fevers; productive cough; eval for PNA History: see above Streaky right base subsegmental atelectasis, which can be seen in aspirated secretions or early pneumonia. Pulmonary embolism is in the differential diagnosis as well.Elsewhere, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Right basilar opacity suggestive of atelectasis although early infection or treatment pulmonary embolism are in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: 61 years old Male. Reason: assess placement ETT and possible improvement pulmonary edema History: impaired oxygenation. ET tube and right jugular catheter are stable in position.Cardiomegaly with basilar opacity compatible with atelectasis, consolidation and pleural effusions. Probable Interval improvement of the right pleural effusion.Stent graft in the aorta.No pneumothorax or other acute change.

Output: Probable interval movement of the right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: s/p bilat lung transplant, eval CT position, r/o pneumo History: as above Lower lung volumes. The 2 bilateral apical chest tube side ports are at the margin of the chest walls, as before. Right basilar chest tube may have been pulled back slightly. Tracheostomy tube remains in place. Enteric tube extends inferiorly off the view. Central venous lines, again noted. Diffuse pulmonary opacities with pleural effusions, right greater than left, unchanged. Small hydropneumothoraces again noted.

Output: No substantial change in small hydropneumothoraces. Chest tube side ports are again at the margins of the chest wall, as before. Diffuse pulmonary opacities with pleural effusions, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: s/p left robotic wedge resections of LUL and LLL History: left chest tube Left-sided chest tube unchanged.No significant pneumothorax.Stable cardiomediastinal silhouette.Airspace opacity in left upper lobe decreased from the prior exam.

Output: Interval decrease in left upper lobe airspace opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: interval change History: interval change History of acute respiratory failure with hypoxia Support hardware unchanged. Stable cardiomegaly with pulmonary edema.

Output: Stable cardiomegaly with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: +quant gold History: cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with metastatic colorectal cancer. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules are again identified, all increased in size. The reference left upper lobe nodule measures 18 x 17 mm (series 4; image 42), previously 16 x 14 mm. Mild bronchial wall thickening is identified.MEDIASTINUM AND HILA: Calcified mediastinal and left hilar lymph nodes. A 16 x 10 mm anterior diaphragmatic lymph node has increased in size (series 3; image 73) (previously 10 x 9 mm).Coronary artery calcificationsCHEST WALL: The right-sided port terminates in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes affect the the liver with a residual 4.3 x 1.2-cm fluid collection, decreasing in size.6-mm hypodensity in segment two of the liver (series 3; image 95) is not significantly changed.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral nephrolithiasis without evidence of obstruction, not significantly changedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ileocolic anastomosis in the right upper quadrant.The small bowel loops are clustered in the right abdomen, likely due to postsurgical herniation, unchanged.Very small ventral, fat-containing herniasA small right-sided Spigelian hernia containing nonobstructed loops of small bowel is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Subcentimeter lymph node in the right obturator region, mildly increased in size.BOWEL, MESENTERY: Small fat-containing inguinal hernias.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderately severe infrarenal atherosclerotic disease.A graft originates from the right common femoral artery and is occluded proximally. The remainder of its extent is not visualized. Adjacent fat stranding may be postprocedural.

Output: Increase in size of the numerous pulmonary nodules. Enlarged anterior diaphragmatic lymph node.Indeterminate 6-mm hypodensity in the liver, not significantly changed.Subcentimeter right obturator lymph node, mildly increased in size.Partially visualized, occluded graft extending from the right common femoral artery.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: SOB c PH History: ? Fluid Small lung volumes.The lungs are otherwise unremarkable.Mild cardiomegaly.

Output: Mild cardiomegaly, but no sign of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Metastatic colorectal cancer. Evaluate chemotherapy response. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Left Port-A-Cath in place with distal tip in the SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple bilobar hypoattenuating lesions representing metastatic disease unchanged. A reference lesion in caudate lobe is unchanged measuring 9 x 8 mm on image number 99. Cholelithiasis unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing right renal calculus is 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: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status post proctocolectomy with left lower quadrant colostomy unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the pelvis

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: ETT History: ETT Small lung volumes, but no acute pulmonary abnormality.Median sternotomy, the heart not significantly enlarged.ET tube tip approximately 8 cm above the carina, while above the thoracic inlet.An NG tube extends below the lower margin of the image.Partial extraction of ICD leads and removal of the chest wall generator.

Output: High ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: r/o aspiration or edema History: hypoxia New basilar subsegmental atelectasis, possibly mucous plugging or aspiration.Heart size upper normal.An NG tube extends below the lower margin of the image.

Output: New basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: pt with new leukocytosis, ILD History: SOB Improvement in lung volumes. Decrease in interstitial pulmonary edema. Small pleural effusions and bibasilar opacities again noted. Iatrogenic devices, unchanged. Unchanged cardiomegaly. No pneumothorax.

Output: Improvement in interstitial pulmonary edema. No new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna History: concern for sepsis, reported cough pta Right jugular catheter tip in the SVC with no pneumothorax or other complications.NG tube traversing the esophagus with its tip below the inferior margin of the radiograph.Small lung volumes with diffuse interstitial and airspace opacity, increased over the past few days.

Output: Nonspecific diffuse airspace and interstitial opacity, increased over the past few days, compatible with pneumonia in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Diminished breath sounds, status post BKA. Assess for pulmonary edema. Interval increase in bibasilar atelectasis and bilateral pleural effusions.Right upper extremity PICC with tip in the right subclavian vein. Left IJ central catheter with tip in the right atrium. ETT tip approximately 4 cm above the carina.Cardiomegaly unchanged.

Output: Interval worsening of previous bibasilar atelectasis and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 40-year-old female with chest pain. Cardiomediastinal silhouette with prominent aortic knob, consistent with known aortic dissection as seen on CT angiography, unchanged. No focal pulmonary opacity, pleural effusion or pneumothorax.

Output: Prominent aortic knob. No acute cardiopulmonary abnormality, without interval change.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with history of cancer status post surgery and chemotherapy. Evaluate liver and periportal lymph nodes seen on November 07 CT scan. CHEST:LUNGS AND PLEURA: Mild emphysematous changes are unchanged.MEDIASTINUM AND HILA: Paratracheal adenopathy measuring 13 x 7 mm unchanged from previous CT. This lymph node was measuring 12 by 8mm on previous study.CHEST WALL: Borderline enlarged left axillary lymph nodes are unchanged measuring 9 x 10 mm.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly is unchanged. No focal liver lesions. Cholelithiasis without biliary dilatation.Previously measured periportal lymph node now measures 2.7 x 2.5 cm on image number 74, series number 3.SPLEEN: Mild splenomegaly, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Bilateral retroperitoneal adenopathy is unchanged. The reference aorta caval lymph node measures 14 by 8mm image number 100, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.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: Previous described subcutaneous nodules in the lower abdomen is decreased in size and number. Previously described subcentimeter nodule on image number 144 on previous study is not seen on the current study.

Output: Stable mediastinal and retroperitoneal lymph nodes. Slight interval increase in the periportal lymph node.Interval decrease in the size and number of subcutaneous nodules.Hepatosplenomegaly and cholelithiasis are unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 23 yearsGender: MaleReason for Study: Reason: 23M w ALL eval for effusion vs PNA History: dull lung bases Right central venous catheter with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Cough, fever, SOB. Moderate pleural fluid, interstitial edema and bronchial wall thickening.

Output: Moderate CHF-like abnormality. In the setting of fever, underlying viral infection may be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: serial assessment History: serial assessment Increasing right basilar opacity likely from atelectasis and a pleural effusion extending into the minor fissure.Unchanged retrocardiac consolidation.Small left pleural effusion.ET tube tip approximately 5 cm above the carina.Spinal stabilization hardware unchanged.

Output: ET tube tip approximately 5 cm above the carina. Increased right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: 71-year-old man with metastatic melanoma and lung cancer. Staging exam. CHEST:LUNGS AND PLEURA: Small pulmonary nodule in the posterior aspect of the right upper lobe as seen on image 47/120. Postoperative changes in the left hemithorax with a loculated effusion anteriorly and a moderate sized posterior effusion.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy of indeterminate etiology with reference node as seen on image 51/231 measuring 1.6 x 0.9 cm in size.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No parenchymal lesions in the liver. The gallbladder appears normal in appearance. No evidence of intrahepatic or extrahepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small nonobstructive calculus in the left kidney. No evidence of hydronephrosis.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: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple diverticula noted in the large bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Hilar and mediastinal lymphadenopathy of indeterminate etiology. Otherwise, no evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Impella, assess interval change History: see above Cardiopulmonary monitoring and support devices, unchanged.Moderate cardiomegaly with no sign of CHF or infection.

Output: Impella Swan-Ganz catheter unchanged.


Instruction: Generate impression based on medical findings.

Input: Lymphoma please evaluate and compare to previous CHEST:LUNGS AND PLEURA: Left pulmonary nodule measures 9 x 7 mm, unchanged from previous CT. (Image number 38/101)MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple cysts in the liver unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter mid left pole lesion is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Soft tissue patrician Ann small lymph nodes in the root of the mesentery which have been described previously are stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Less than 1 cm lucent lesion left iliac bone is stable.OTHER: Left inguinal hernia containing fat

Output: Stable exam. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Respiratory failure. Ventilator dependent. No significant change in cardiopulmonary appearance. Retrocardiac opacity on the left may be secondary to pleural fluid and atelectasis. No pneumothorax. Hardware and devices similar in position, with IABP marker projecting 10 cm below the top of the aortic arch at the level of approximately T8/T9 and the endotracheal tube terminating 4 cm above the level of the carina.

Output: No acute change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No acute cardiopulmonary abnormality other than previous observed mild cardiomegaly

Output: Mild cardiomegaly without additional new abnormality


Instruction: Generate impression based on medical findings.

Input: 37 years, Female. Reason: r/o obstruction History: vomiting and constipation Nonobstructive bowel gas pattern. No free air seen on upright film.Consolidation left lower lobe may represent a pneumonia.

Output: Nonobstructive bowel gas pattern. Consolidation left lower lobe may represent pneumonia.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male, evaluate for fluid collection or abscess. Persistent fevers. CHEST:LUNGS AND PLEURA: There is significant bilateral pleural demonstrating what relations towards the upper lobes. A left-sided pleural drainage catheter is in place. Endotracheal tube is in place. Bilateral consolidations in both lungs involving most of the lung parenchyma.MEDIASTINUM AND HILA: Externalization of oral contrast from the distal esophagus into bilateral pleural space.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: An atrophic right kidney with small hypodense lesion in its upper pole measuring 12 x 13 mm number 117. This lesion is complex and cannot be optimally evaluated. Left renal stones without evidence of hydronephrosis. Nonspecific hypodense lesion in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Five of the transverse colon herniates through a ventral. Seasonal hernia. No evidence of obstruction.BONES, SOFT TISSUES: Noncystic subcentimeter hypodensity in the subcutaneous fat.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: No significant abnormality notedOTHER: No significant abnormality noted

Output: Extravazation of oral contrast from distal esophagus into bilateral pleural space. Bilateral large, partially loculated pleural effusions with extensive air space consolidations.Atrophic right kidney. Left renal stones. Small indeterminate right renal lesionHerniated transverse colon segment without evidence of obstruction.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: chest pain, h/o stents History: above Normal cardiac and mediastinal contours.Borderline low lung volumes.Bibasilar subsegmental atelectasis.Calcified left hilar granulomas.

Output: Mild basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female restaging GIST status post gastric resection, 3 months CHEST:LUNGS AND PLEURA: Emphysematous changes again seen. Prior referenced left lower lobe nodule which may represent a lymph node in the major fissure is unchanged at 5 mm. MEDIASTINUM AND HILA: Thyromegaly again seen with an enlarged multinodular right lobe extending into the right paratracheal area unchanged. No lymphadenopathy.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: Bilateral benign appearing renal cysts are again seen. Inferior pole of the right kidney kidney one of these is higher than water attenuation measuring approximately 50 HU -- this is stable in appearance back to first CT here 8/6/2011 and most commonly these findings represent a high attenuation benign cyst, but without precontrast imaging to determine specific characteristics, this cannot be confirmed..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical changes from prior partial gastric resection seen unchanged. No evidence of tumor recurrence is seen. The small and large bowel contour appears normal without wall thickening or mesenteric masses or fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent or atrophic uterus. No change in appearance of the adnexa with no abnormal masses.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small and large bowel contour appears normal without wall thickening or mesenteric masses or fluid..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Postoperative expected appearance to stomach without evidence of recurrent tumor. 2. No change in small 5-mm nodule in lung which may represent interfissural lymph node. 3. No evidence of tumor recurrence elsewhere. 4. Enlarged right thyroid gland extending into mediastinum with multiple nodules. 5. Multiple benign cysts in kidney and one cyst of higher attenuation, most likely benign cyst but without precontrast CT, definitive characterization is not possible.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: MVC, eval for fx, PTX History: chest pain Subsegmental atelectasis or scarring again noted at the left lung base. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Healed right-sided rib fractures.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Intubation Minimal nonspecific opacities again compatible with probable atelectasis observed in both bases, however aspiration cannot entirely be excluded. No discrete new superimposed focal air space abnormalities.Mild cardiomegaly, largely left ventricular similar to prior exam. Paragraph ETT terminates 3 cm above the carina, unchanged. The left subclavian catheter extends into the mid SVC.G-tube projected over left upper quadrant

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.