Instruction: Generate impression based on medical findings.

Input: Reason: assess for pulmonary edema History: pulm edema ET tube tip approximately 2 cm above the carina.Bilateral opacity, compatible with effusions and atelectasis.Right jugular catheter tip in the SVC.

Output: Pleural effusions and atelectasis, but no specific evidence of pulmonary edema or infection.


Instruction: Generate impression based on medical findings.

Input: Reason: ICU, assess lung fields History: post-op resp failure s/p AVR/MVR, endocarditis ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.Extensive bilateral patchy airspace opacities suggestive of pneumonia, possibly due to aspiration, without significant change.Chest tubes in place with no significant pneumothorax.No new findings.

Output: Extensive airspace opacities suggestive of pneumonia with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: FemaleReason for Study: Reason: r/o edema History: SOB Stable cardiac enlargement.The lungs are clear.Minimal left basilar scarring/discoid atelectasis.No focal airspace consolidation.No large 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: Male, 73 years old.Reason: rule out aspiration pneumonia History: head and neck cancer, coughing at times when swallowing, white count elevated New patchy right upper lobe opacity and retrocardiac opacities, suggestive of infection or aspiration.Extensive lymphadenopathy in the hilar and subcarinal regions is seen on the lateral view.Left subclavian catheter, tip in SVC.

Output: Patchy pulmonary opacities suggestive of infection or aspiration. Extensive hilar and mediastinal lymphadenopathy seen best on the lateral view.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: PNA? History: cough, lung cancer, testicular cancer Low lung volumes. Multifocal pulmonary nodules and masses are again identified. Increased small right pleural effusion. Bibasilar subsegmental atelectasis.Unchanged cardiomediastinal silhouette.

Output: No appreciable change in multifocal pulmonary nodules and masses. Increased small right pleural effusion. No specific evidence of superimposed infection.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: pna, cardiomegaly History: chest tightness Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: cough History: see above Heart size normal although there is calcification over the cardiac apex presumably in a LV aneurysm from prior infarct.No specific evidence of infection or edema.

Output: No specific evidence of infection or edema. Calcified left ventricular apex aneurysm.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with history of metastatic melanoma. Evaluate for disease progression. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Tiny subcentimeter hypodense lesions in the liver are again seen and too small to characterize. These are unchanged from the prior exam and their stability over time suggest that they are benign.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 other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: No evidence of disease recurrence in the chest, abdomen, and pelvis.Exams were reviewed with Dr. J. Lorenz.


Instruction: Generate impression based on medical findings.

Input: 78 year old male presents for follow-up of left lower lobe mass. CHEST: LUNGS AND PLEURA: Opacity in the left lower lobe with associated air bronchograms, a few punctate calcifications and volume loss, more suggestive of cancer than of cryptogenic organizing pneumonia with increase in size since 5/2008. The opacity measures 3.1 x 5.4cm (series 4, image 53) previously 2.5 x 4.8.Right upper lobe 6mm nodule, unchanged since 10/2008. No new nodules identified.MEDIASTINUM AND HILA: No significant lymphadenopathy. Severe coronary arterial calcifications and stents. Aortic calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small kidneys with arterial calcifications and several cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aorto-iliac stent graft, incompletely imaged but not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Opacity in the left lower lobe more suggestive of cancer than of cryptogenic organizing pneumonia with increase in size since 5/2008. An IR consult could be obtained for biopsy feasibility.2. Other findings as described above, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: 27 y/o female with T cell NHL s/p allogeneic stem cell transplant approx 18 months ago with 1 week history of fever and cough. Evaluate for pneumonia. History: Cough, fever New left lower lobe opacity and left pleural effusion consistent with infection.Elsewhere, the lungs are unremarkable.Right subclavian catheter, tip in SVC.

Output: New left lower lobe pneumonia with a small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: MaleReason for Study: Reason: eval trauma, fractures History: MVC. The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No obvious rib fractures.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pna, volume - dka History: assess for pna, volume - dka Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Infiltrates History: fever No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Fluid overload recent transfusion, acute chest. SOB. Right chest port unchanged in position. Interval worsening of interstitial and airspace opacities. No visible pleural fluid.

Output: Extensive interstitial and airspace opacities suspicious for pneumonia/acute chest and acute edema.


Instruction: Generate impression based on medical findings.

Input: 47 year old female with sciatica secondary to spinal mass. Scanning for metastases, history of breast cancer with lung mets, recent spinal mass. CHEST:LUNGS AND PLEURA: Focal scarring and bronchiectasis at the left apex is likely secondary to post radiation changes. Multiple bilateral pulmonary nodules are nonspecific, however suspicious for metastatic disease in the setting of known malignancy. Additionally, there is a spiculated soft tissue mass in the right lower lobe, measuring 1.1 cm x 1.2 cm (image 66, series 6).Focal left lower lobe tree in bud pattern with adjacent consolidation is most consistent with aspiration pneumonitis or an infectious process. Volume loss on the left status post lobectomy is noted. MEDIASTINUM AND HILA: Status post left sided lobectomy with associated mediastinal shift to the left. Heart size is normal without pericardial effusion. Right-sided chest port tip is in the SVC.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: A single hypodense round lesion in the right hepatic lobe measures 0.9 cm x 1.1 cm. It may represent a hemangioma however its characteristics are nonspecific with only one phase of imaging. 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: The proximal colon is distended with stool. 1 cm x 1 cm soft tissue density polypoid lesion in the descending colon is consistent with a polyp, however malignancy cannot be excluded. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A lytic lesion in the L2 vertebral body is suspicious for metastatic disease.OTHER: No other significant abnormality noted.

Output: 1. Lytic lesion in the L2 vertebral body suspicious for metastatic disease. Please correlate this finding with impression from the MRI of the lumbar spine dated 11/1/20102. Spiculated soft tissue mass in the right lower lobe suspicious for primary lung cancer versus metastatic disease.3. Scattered nonspecific pulmonary nodules may represent metastases. 4. Focal left lower lobe tree in bud pattern is most consistent with aspiration pneumonitis versus an infectious process.5. Polypoid lesion in the descending colon. Malignancy cannot be excluded. 6. Hypodense lesion in the liver is nonspecific and may represent a hemangioma. Dedicated imaging is recommended if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Hypoxia. MRSA bacteremia with multiple DVTs status post cervical laminectomy. Bibasilar interstitial and airspace opacities with small right and medium left pleural effusion have all progressed from previous. Cardiomegaly again noted. These findings may reflect projection of edema or infection. Left subclavian central line tip over the right atrium.

Output: Progression of bibasilar parenchymal and pleural opacities which may reflect progression of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath. No cardiopulmonary acute abnormalities. Mild tortuosity of the aorta unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old with history of sickle cell disease.Reason: Fever History: Fever Persistently low lung volumes make detailed assessment of the lung fields difficult. Bibasilar Atelectasis. Unchanged elevation of the right hemidiaphragm. No pleural effusion or pneumothorax. No focal pulmonary opacity. Cardiomegaly.

Output: Cardiomegaly without focal pulmonary abnormality. No specific evidence of acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: eval ETT placement History: s/p ETT advancement Unchanged lower lung zone opacities and pleural effusions left worse than right.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Cardiomegaly, pneumonia, effusion, edema and mediastinitis. Apparent cardiomegaly. Calcified right hilar and mediastinal lymph nodes suggestive of old, healed granulomatous infection. Although there is no septal thickening in the left lung, the right lung is poorly assessed due to both overlying soft tissue artifact beneath the level of the clavicle and an overlying pad external to the patient. No visible pleural fluid.

Output: No conclusive signs of pulmonary edema. Cardiomegaly. Assessment of the right lung is limited. If a subsequent examination is performed, request removal of overlying pad.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: eval for PNA, effusions, atelectasis History: fever Iatrogenic devices are unchanged. Bilateral small pleural effusions versus thickening. Newly apparent focal rounded opacity in the right lateral costophrenic angle. No pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: New rounded opacity in the right lateral costophrenic angle may be artifactual given that it was not present on multiple previous studies. Repeat PA study is suggested.


Instruction: Generate impression based on medical findings.

Input: Pleural effusion. Check for pneumothorax Minimal residual left effusion without associated postprocedural complications. Other than minimal atelectasis. Cardiac and mediastinal contours are within limits

Output: Minimal left effusion without postprocedural complication


Instruction: Generate impression based on medical findings.

Input: Reason: interval assessment ICU patient History: diastolic heart failure Interval repositioning of a left jugular catheter with its tip now in the SVC.Cardiomegaly with diffuse bilateral opacity compatible with edema, atelectasis and pleural effusions, greater on the right.

Output: Interval repositioning of left jugular catheter and no other significant change allowing for inflation in position.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Procedure- generator change Cardiac leads, unchanged. Mild spinal curvature. Mild atelectasis or scarring at the lung bases. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Cardiac leads, unchanged. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Cervical spine stabilization hardware placed since the prior study.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Concern for HCAP, COPD post extubation new oxygen requirement. Pseudomonal culture from tracheal aspirate. Artery right pleural fluid collection with associated atelectasis about the same. Coarse pulmonary opacities bilaterally unchanged. Improved lung inflation on the left with probable resolution of pleural fluid. Unchanged scarlike opacity at the left apex.

Output: Persistent right pleural effusion and nonspecific diffuse opacities which are nonspecific in appearance and could reflect atelectasis on a background of diffuse emphysema but should be followed by plain films. No new airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: ET tube placement 5/1 History: ET tube placment 5/1 Small lung volumes with retrocardiac opacity unchanged.ET tube approximately 3 cm above carina.An NG tube terminates in the stomach.

Output: ET tube in good position. No other interval change.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with shortness of breath. Likely COPD exacerbation, evaluate for pneumonia, tension pneumothorax, pulmonary edema. Emphysema with bibasilar scarring/atelectasis. No focal airspace opacity. No significant pleural effusions. No pneumothorax. Normal cardiomediastinal silhouette.

Output: Emphysema with no superimposed acute process.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: chest pain, short of breath History: chest pain, short of breath No focal airspace opacities. No pleural effusion or pneumothorax. Cardiac mediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: abnormality? History: chest pain, wheeze bilaterally There is no focal consolidation, pleural effusion or pneumothorax. There is apical paraseptal emphysema. The lungs appear somewhat hyperinflated. The cardiac and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: Apical paraseptal emphysema with suggestion of pulmonary hyperinflation, but without evidence of superimposed pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: s/p R IJ CVL History: R IJ CVL Mild basilar subsegmental atelectasis, with small lung volumes.NG tube side port at the hemidiaphragm level or above.Right jugular catheter, tip in SVC.

Output: Basilar subsegmental atelectasis. High NG tube.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: eval for pneumonia History: Fever, Cardiomegaly.No specific evidence of infection or edema.Cholecystectomy clips.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 21 years old Female. Reason: eval for intrilate/ptx History: chest pain. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax.Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.XR ABDOMEN COMPLETE W UPRIGHT CHEST MIN 3V, 7/7/2015 2:34 PM Chest: Interval removal of the spinal catheter. No focal consolidation is observed.Abdomen: Surgical clips in the right upper quadrant likely represent previous cholecystectomy, midline pelvic surgical staple is visualized. Calcified pelvic vessels are visualized. There is average stool burden.

Output: Average stool burden.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate integrity of ICD leads, possible fracture, shock lead impedance rise to > 200 ohms History: increase in shock impedance since late Nov early Dec Massive cardiomegaly with vascular redistribution.ICD leads in place, unchanged from previous.No sign of pulmonary edema or pleural effusions.

Output: Intact ICD leads and no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: dyspnea, wheezing Unremarkable cardiac and mediastinal silhouette. Mild basilar scarring or atelectasis but no sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: short of breath History: short of breath Cardiomegaly with diffuse interstitial opacity suggestive of pulmonary edema. No significant pleural effusions. Prominent hilar structures are presumably distended vasculature rather than mediastinal lymphadenopathy, though this can be followed on future studies when the patient is euvolemic.

Output: Findings suggestive of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: 62 y/o female with follicular lymphoma and 2 week history of cough (dry). History: Cough Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Stigmata of previous granulomatous disease again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: eval infiltrates History: hyperglycemia The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: 65M intubated in MICU, hypoxic respiratory failure, ?ETT placement History: 65M intubated in MICU, hypoxic respiratory failure, ?ETT placement Right hilar mass with a right bronchial stent unchanged.Stable right-sided airspace opacity but improvement in right basilar interstitial disease and right pleural effusion.Stable interstitial opacities left lower lobe.ET tube tip approximately 6 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Mild improvement in right basilar edema, otherwise unchanged opacities, tubes and devices.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with chest pain. Cardiac cath in 8/11/08 was negative. Patient has positive d-dimer. Evaluate for PE. PULMONARY ARTERY: In this technically adequate study, no pulmonary emboli identified.LUNGS AND PLEURA: Minimal paraseptal emphysema in the apices. No suspicious pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: Stable left thyroid hypodensity likely a cyst. Mild cardiomegaly. Coronary stent in the distribution of the LAD. Coronary artery calcifications. No pericardial effusions. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant axillary lymphadenopathy. Bulky osteophytes are seen to bridge several vertebral bodies in the mid and upper thoracic spine.UPPER ABDOMEN: Nonspecific hypodense lesion in the superior pole of the spleen (image 258/265).LOWER EXTREMITY: No DVT. Fat stranding identified in the right groin likely from recent cardiac cath.

Output: 1. No PE or DVT.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Cordis placed in LIJ, eval for proper position History: S/p LIJ cordis placement Improvement in lung volumes. Left IJ sheath termination is difficult to visualize but likely terminates within the left brachiocephalic vein.Persistent patchy left basilar opacity. Focal opacity in the mid aspect the right lung, unchanged. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Persistent patchy left basilar opacity. Focal opacity in the mid aspect the right lung, unchanged. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: cough, sob, tachycardic Focal patchy airspace opacity in the left lower lobe, highly compatible with pneumonia.Small right pneumothorax but the margin of the upper lobe about 10 mm from the chest wall.Large lung volumes with perihilar bronchial thickening suggestive of asthma or chronic bronchitis.

Output: 1. Small right pneumothorax and left lower lobe pneumonia.2. Large lung volumes and bronchial thickening suggestive of asthma or chronic bronchitis.The findings were discussed with Dr.Cosban in the ED at the time of reporting


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Chest are unremarkable. Status post recent removal of the mediastinal drains. The cardiac and mediastinal contours are stable and within normal limits. Intact median sternotomy hardware. No evidence of pneumomediastinum or pneumothorax in this single AP projection.Worsening right basilar subsegmental atelectasis. No signs of pulmonary edema.

Output: Status post removal of the mediastinal drains. No signs of pneumothorax or normal mediastinum in this single AP projection.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: ETT placement, interval changes? History: intubated ET tube tip approximately 4 cm from the carina. Right-sided chest wall port tip is in the SVC. Enteric tube tip below the diaphragm and extends below the field of view.Cardiac size is within normal limits. Interval improvement of bilateral upper lung aeration. Right mid lung dense patchy opacity concerning for infection. Bilateral pleural effusions.

Output: Interval improvement of bilateral upper lung aeration. Right mid lung dense opacity concerning for infection. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: fever, eval for consolidation History: fever No acute abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Pneumonia, pleural effusion, pneumothorax? History: chest pain The heart size is normal. The lungs are clear. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: NG tube placement History: NG tube Cardiomediastinal silhouette is unremarkable.Right chest port tip in the right atrium. NG tube tip in the gastric fundus. Endotracheal tube tip 3 cm from the carina.No significant pulmonary abnormalities.

Output: NG tube tip in the gastric fundus.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p ICD placement History: s/p ICD placement Chronic appearing right hemidiaphragm elevation with subtle overlying atelectasis, unchanged.No specific evidence of infection or edema.Mild cardiomegaly status post sternotomy for CABG.New left subclavian single lead ICD, tip in the expected location of the RV apex. No complication such as pneumothorax.

Output: Uncomplicated ICD placement. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: r/o PNA History: Cough with sputum Right basilar opacity likely posteriorly in the right lower lobe.Elsewhere, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Right basilar pneumonia. This was communicated to the ED by stat consult.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Chest pain and weight loss. No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval IABP History: IABP in place Right subclavian IABP, the proximal marker projected over the aortic arch.Moderate to severe cardiomegaly and subtle basilar edema noted.Left subclavian ICD, leads unchanged in position.

Output: Unchanged support devices including the IABP.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: Cough with green sputum, SOB Moderate cardiomegaly with no evidence of pulmonary edema or pleural effusions.Perihilar bronchial thickening and focal streaky opacity in the left mid lung, compatible with bronchitis and focal scarring respectively.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: MaleReason for Study: Reason: s/p bilateral pneumo History: - Bilateral chest tubes unchanged.Severe upper lobe predominant cystic disease redemonstrated.Persistent left apical pneumothorax.Stable cardiomediastinal silhouette.

Output: Stable cardiopulmonary appearance with persistent left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: cardiopulmonary process History: chest pain Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p chest tube removal, assess improvement of pneumo History: routine Moderate cardiomegaly with bilateral basilar opacity compatible with atelectasis and pleural effusions.Minimal residual right apical pneumothorax with the margin of the lung a few millimeters from the chest wall.

Output: Minimal residual right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with metastatic prostate cancer CHEST:LUNGS AND PLEURA: Bilateral mild emphysematous changes. Subcentimeter nodule image number 26 procedures number 6. Linear atelectasis and scarring in the left lung periphery, nonspecific.MEDIASTINUM AND HILA: Right retrocrural soft tissue density. This cannot be optimally evaluated due to lack of IV contrast, however, suspicious for adenopathy. It measures 2.7 x 1.9 cm in image number 84, series number 4.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: Ill-defined hypodensity in the upper pole of the left kidney measuring fluid density. Lack of IV contrast limits of the evaluation of this lesion. There are other similar density lesions in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Periumbilical hernia containing fat.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: Right retrocrural soft tissue density. This cannot be ultimately evaluated due to lack of IV contrast. However it is suspicious for retrocrural adenopathy.Ultrasound may helpful for further evaluation of the left renal hypodense lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Right-sided rib pain after fall evaluate for fractures or underlying lung injury. No pneumothorax. Normal heart size. Calcified right mediastinal and hilar region lymph nodes. No focal air space opacities, pleural fluid or pneumothorax. Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. No visible displaced rib fractures are appreciated. Cholecystectomy clips.

Output: No acute pulmonary abnormality. If there is continued clinical concern, dedicated rib series may be performed to exclude rib fracture. Nondisplaced fracture cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: ET placement History: Intubated Lines and tubes are unchanged. Mild left basilar atelectasis. No new focal pleural parenchymal opacity. Small pleural effusions. No pneumothorax. Unchanged heart size.

Output: Lines and tubes are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: pna History: Persistent cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: line repositioned in R IJ History: line repositioned in RIJ Right jugular catheter with its tip projecting in the area the right atrium. Left jugular catheter unchanged.Left chest tubes in place with no significant pneumothorax. Bilateral nonspecific pulmonary and pleural opacities, unchanged.Pericardial calcification.

Output: Right jugular catheter tip in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: eval for infection vs edema History: unable to wean off bipap Worsening interstitial and airspace opacities consistent with edema and superimposed pneumonia.Heart size normal.Minimal pleural effusions.Right jugular catheter, tip in SVC.NG tube removed.

Output: Worsening pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: leukocytosis History: see above NG tube projects over the gastric body. Interval extubation.Cardiomediastinal silhouette is normal. Low lung volumes.Nonspecific left basilar opacity may represent pleural effusion with adjacent atelectasis and/or consolidation.No pneumothorax.

Output: Nonspecific left basilar opacity may represent pleural effusion with adjacent atelectasis, possibly due to aspiration. Infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 21 year old female with chest pain, rule out infectious etiology. No focal airspace opacities. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable though the right PA and interlobar artery are borderline in size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: pneumonia History: concern for DKA, elevated WBC ct 13.2 Cardiomediastinal silhouette is within normal limits. No pulmonary opacity, pleural effusions or pneumothorax.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz repositioning Interval repositioning of the Swan-Ganz with the tip currently projecting in the right pulmonary outflow tract having been retracted from the right middle lobe. Underlying cardiopulmonary appearance is otherwise grossly unchanged with incomplete visualization of the left lateral and inferior aspects. ICD is grossly similar

Output: Swan-Ganz repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: TACO, TRALI History: fever s/p transfusion PRBC Clear lungs. No pleural effusion or pneumothorax. Normal heart size. Diffuse bony sclerosis with some areas of extrapleural thickening for example along the right lateral hemithorax and thickening of the paraspinal lines bilaterally consistent with metastatic prostate cancer.

Output: No acute cardiopulmonary process on radiography. Metastatic prostate cancer to bone and paraspinal/extrapleural regions.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: SOB, CHF History: SOB Cardiomegaly with basilar interstitial abnormality fissural thickening and septal lines consistent with edema. No significant pleural effusion.

Output: Pulmonary edema. No significant pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: eval for infection. pt Dr. Cart in infusion therapy. History: syncope Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: dyspnea on exertion, h/o pneumonia History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: One day old 24 week gestational age patient with pneumothorax and placement of chest tubes.VIEWS: Chest AP/lateral (two views) 01/11/15, 0821 and 0825 Three right chest tubes are present. One has its tip anteriorly into have their tips posteriorly. Endotracheal tube tip is at thoracic inlet. Umbilical venous line tip is in right atrium. Umbilical arterial line tip is at T6.Right pneumothorax is much smaller. Anterior and subpulmonic components are present. Left mediastinal shift to the left is seen. Hazy opacities are present in both lungs. Cardiac silhouette size is normal.

Output: Decrease in size of pneumothorax after additional chest tubes.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: assess for signs of infection History: SOB for 1 week, recently finished z pack today Stable cardiomediastinal silhouette.Decreased lung volumes with minimal basilar subsegmental atelectasis.No focal areas of consolidation.No pleural effusions.

Output: Decreased lung volumes of minimal basilar atelectasis. No acute cardiopulmonary abnormalities identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: pneumonia, cardiomegaly, effusion History: cough, sore throat, runny nose x 3 weeks Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly.

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


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: preop eval to r/o pulmonary disease prior to re-do MVR History: SOB Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Status post sternotomy. Mitral annuloplasty ring is noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA History: PNA Small lung volumes with bilateral basilar airspace opacities and atelectasis, unchanged or slightly improved compared to previous.Tracheostomy tube in place.No new findings.

Output: Basilar airspace opacities and atelectasis compatible with aspiration and infection, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Reason: 71M hx R PNx for RCC. Surveillance for metastasis. History: as above Small bilateral calcified nodules and calcified mediastinal and hilar lymph nodes compatible with previous infection.No sign of metastases or other significant change.

Output: No sign of metastases.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with non-Hodgkin's lymphoma in remission. Evaluate disease status. Lack of IV contrast limits evaluation of the visceral organs.CHEST:LUNGS AND PLEURA: Unchanged minimal right upper and lower lobe scarring.MEDIASTINUM AND HILA: The thyroid gland remains enlarged with substernal extension.Soft tissue in the anterior mediastinum appears to contain a small amount of calcification and is grossly unchanged. No hilar adenopathy is present.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: Mildly atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small, stable external iliac and bilateral inguinal lymph nodes.BOWEL, MESENTERY: Minimal diverticulosis.BONES, SOFT TISSUES: Surgical clips in both inguinal regions.OTHER: No significant abnormality noted

Output: Stable soft tissue density in the anterior mediastinum. No significant lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Check for fluid overload. Syncope Mild COPD changes without additional superimposed acute cardiopulmonary abnormality. The 3-lead left subclavian ICD is unchanged

Output: Mild COPD


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Evaluate pneumothorax, post thoracic surgery. Right neck central venous catheter and right chest tube unchanged in position. Small right apical pneumothorax unchanged. There is a small amount of air in the subcutaneous soft tissues of the lateral right hemithorax. Nasogastric tube remains positioned with the distal tip at the GE junction, and the well-positioned a the GE junction. Mild cardiomegaly. Mild to moderate pulmonary vascular congestion. Bandlike opacity in the region of the right middle lobe is unchanged and likely represents discoid atelectasis. Left basal opacity may represent infection and/or pleural effusion. Curvilinear lucency at right base concerning for free air.

Output: No pneumothorax. Interval worsening of left basilar airspace disease and/or small pleural effusion. Subdiaphragmatic versus subpulmonic free air noted on the right.


Instruction: Generate impression based on medical findings.

Input: Reason: eval fluid status, missed HD History: Missed HD x1 week, intermittent SOB No significant cardiopulmonary abnormalities. Moderate renal osteodystrophy.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with cirrhosis, NASH, and with HCC on most recent MRI. Please evaluate for metastases. CHEST:LUNGS AND PLEURA: Calcified granuloma in right lower lobe (series 6, image 41). No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Cirrhotic liver morphology. Cholecystectomy clips.

Output: No evidence of pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Evaluate for acute cardiopulmonary process History: fall Stable cardiomediastinal silhouette allowing for differences in inspiratory effort.Redemonstration of enlargement of the pulmonary arteries.Mild lung hyperinflation with prominence of interstitial markings likely chronic in nature. No focal consolidation, sizable effusion or pneumothorax.

Output: 1.No radiographic evidence of acute cardiopulmonary process.2.Enlargement of the central pulmonary arteries suggesting pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: hx chf, sob History: above Moderate cardiomegaly status post sternotomy.Scattered septal lines at the right lung base are suggestive of edema without sizable pleural effusions. No specific evidence of infection.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: Moderate cardiomegaly with mild edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: 57 years old Female. Reason: r/o pneumonia History: cough and fever. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardia silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: EVALUATE FOR ACTIVE TB History: No significant cardiopulmonary abnormality.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval for infiltrate History: fever No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Seizure Moderate rotatory scoliosis exaggerates the mediastinal contours, however no distinct definite focal abnormalities observed of then mild decreased lung volumes. Airspace spaces are otherwise well expanded and without effusions.

Output: Decreased lung volumes without definite superimposed additional acute abnormality


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Interval improving aeration and largely resolving axial opacities representing previously described suspected edema. Resolving effusions. Persistent mild cardiomegaly.Midline sternotomy.

Output: Partially resolving edema and suspected CHF


Instruction: Generate impression based on medical findings.

Input: ETT placement. Cardiac arrest. ETT tip 5 cm above the level of the carina. Other tubes and lines unchanged. Patchy atelectasis and airspace opacities consistent with aspiration. Small left pleural fluid collection.

Output: ETT tip 5 cm above the carina. Worsening basal opacities and atelectasis consistent with aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lobectomy Chest tube extending to the right apex with a small residual pneumothorax.Bilateral nonspecific pulmonary opacities with septal lines, suggestive of edema, in addition to nonspecific airspace opacity, atelectasis and right pleural effusion.Interval removal of one right chest tube and no other significant change.

Output: Small residual right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: rule out pneumonia History: COPD patient w/ shortness of breath Increased lung volumes compatible with known emphysema.Cardiac size is normal.No focal airspace opacities.Blunting left costophrenic angle compatible with scarring.Significant amount of debris is identified within a dilated esophagus compatible with known achalasia.Surgical clips identified in the region of the distal esophagus.

Output: No acute cardiopulmonary abnormalities identified without interval change. No specific evidence of infection. Marked amount of debris within the dilated esophagus compatible known achalasia.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.History of respiratory failure following mitral valve replacement. Atrial and ventricular defibrillator leads, enteric tube, ventricular assist device, and median sternotomy hardware unchanged.The cardiac silhouette is enlarged but stable.Basilar predominant interstitial and airspace opacities are unchanged.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p SC-ICD implantation --> r/o pneumothorax and evaluate lead position History: as above Single lead ICD device with its tip projected in the area of the apex of the right ventricle.Moderate cardiomegaly and mild basilar opacity compatible with atelectasis and possibly small effusions.

Output: New ICD device with no complications.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with a history of a non-Hodgkin's lymphoma status post liver transplant and chemotherapy. CHEST:LUNGS AND PLEURA: Bibasilar dependent atelectasis. No other significant abnormality.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Several old healed left posterior rib fractures. Gynecomastia.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Soft tissue infiltration around the common hepatic artery appears unchanged (image 98; series 3).SPLEEN: Small parasplenic fluid collection which appears unchanged when compared to the previous study. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes the anterior abdominal wall. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Minimally distended bladder with persistent mild circumferential bladder wall thickening.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small right-sided fat containing inguinal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Stable examination. No evidence of significant interval change since the previous examination.2. Persistent stable mild circumferential bladder wall thickening.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: eval acute process History: CP. Unremarkable cardiomediastinal silhouette.No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: evaluate lung fields. History: s/p right thoracotomy, right middle and lower lobectomy. Interval placement of 2 right chest tubes with tips overlying the apex, multiple surgical clips in the right perihilar region and multiple skin staples overlying the right axilla.Deviation of trachea and cardiomediastinal silhouette to the right with expected right lung volume loss status post right upper lobe lobectomy.No acute focal airspace opacity. Probable small layering right pleural effusion. Left parenchymal and pleural spaces are clear. No large pneumothorax.

Output: Expected right lung volume loss status post right upper lobe lobectomy with probable small layering right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: ETT placement History: intubated Mild to moderate cardiomegaly with small lung volumes.No specific evidence of infection or edema.ET tube tip approximately 2 cm above the carina.A Dobbhoff tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Mild to moderate cardiomegaly without other acute findings.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: ? infiltrate History: URI with constant coughing Stable cardiac mediastinal silhouette.Mild scarring at the left base unchanged.No focal areas of consolidation.No pleural effusions.Degenerative changes in thoracic spine.

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


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.History: Dyspnea. Query: Pneumonia Chronic interstitial abnormalities. No focal pulmonary consolidation. Right Port-A-Cath unchanged with tip in the SVC. Stable cardiomediastinal silhouette.

Output: Chronic interstitial abnormalities with no superimposed acute disease.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Evaluate for edema History: crackles on exam Small bilateral pleural effusions or scarring. Moderate cardiomegaly. No pneumothorax. Degenerative changes affect the thoracic spine.

Output: Bibasilar small pleural effusions with scarring less likely.


Instruction: Generate impression based on medical findings.

Input: Pneumonitis, check trach tube Persistent well-positioned tracheostomy tube, tip projects 5 cm above the carina. NG tube projects beyond the inferior edge of the image.The underlying cardiopulmonary appearance is also grossly similar appearance, however mild improvement representing resolving edema cannot entirely be excluded. This change may be partially due to diminished motion.

Output: Suspected improvement in diminishing superimposed mild edema


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Exertional dyspnea rule out interstitial disease. Shortness of breath. Lung volumes have decreased since the prior examination and are low, with chronic elevation of the right hemidiaphragm again noted. Normal heart size. Hazy opacity in the periphery of the left lung new from previous, with a 17 mm subpleural nodular opacity seen only on the frontal radiograph, new from previous. No pleural fluid or pneumothorax.

Output: 1. 17 mm nodular opacity projecting over the subpleural left lower lung is not identified on the lateral radiograph and could reflect a pulmonary nodule or artifact. Suggest follow-up erect (standing) PA and lateral chest radiographs at full inspiratory effort. If this nodular opacity persists on the subsequent radiographs, then a CT will be recommended for further evaluation.2. Progressive decrease in lung volumes could be a sign of ILD, though no specific findings of ILD are appreciated by plain film technique. This is more likely to be the result of diaphragmatic compression if the patient's weight has increased since the 2013 study.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: pre-procedural History: ICD site No significant cardiopulmonary abnormality.Left subclavian ICD, leads unchanged in position.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: MVA injury History: back pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.VBAC, febrile, recent stroke question pneumonia. Malaise and fatigue. Low normal lung volumes. Retrocardiac compressive atelectasis, but no focal airspace opacities or specific signs of pneumonia. Thoracolumbar scoliosis.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval for change History: eval for change Moderate right pleural effusion, not significantly changed since yesterday afternoon but definitely improved since earlier yesterday.Right base compression atelectasis is stable.The heart remains mild moderately enlarged.Minimal left pleural effusion.No evidence of edema or pneumonia.

Output: Right pleural effusion unchanged since yesterday afternoon but improved compared to earlier yesterday. Findings remain consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: location of LIJ HD catheter al line replacement Left IJ line terminates near the junction of the left brachiocephalic vein and SVC. Other lines and tubes, not substantially different. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Left IJ line terminates near the junction of the left brachiocephalic vein and SVC. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for placement of swan History: see above Persistent and slightly worsened and alveolar pulmonary edema.The position of the IABP is unchanged with radiopaque marker overlying the aortic arch.Bilaterally and pleural effusions again noted. No pneumothorax.The right IJ Swan-Ganz catheter overlies the distal right pulmonary artery. The enteric tube courses below the diaphragm.

Output: Slightly worsened pulmonary edema.Stable adequate position of support apparatus.


Instruction: Generate impression based on medical findings.

Input: Intubation IABP marker has been placed and projects 4 cm below the arch. Swan-Ganz extends into the right pulmonary outflow tract essentially unchanged. Bilateral basilar and mediastinal chest tubes are also similar. NG tube coiled in the proximal stomach.Marked cardiomegaly and underlying cardiopulmonary appearance remains similar suggesting moderate pulmonary edema

Output: IABP placement


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: pna vs chf exacerbation History: cough, mild sob New small pleural effusions. No focal lung consolidation or evidence of overt left-sided heart failure. Heart size at the upper limit of normal. No pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Iatrogenic devices are unchanged. Increase in lung volumes. Mild interstitial pulmonary edema and small pleural effusions. Unchanged cardiomegaly. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 70 years old Male. Reason: Swan in place, please eval for placement History: swan in place. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiomegaly. The tip of Swan-Ganz catheter projects over the right main pulmonary artery.

Output: Swan-Ganz catheter as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Edema? PNA? History: SOB New basilar opacities are suggestive of edema with small pleural effusions.Heart size at least upper normal.Left lower lobe pneumonia is in the differential diagnosis.

Output: Pulmonary edema with possible left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: new tracheostomy; +Klebsiella pneumonia. History: poor oxygenation; requires pressure support for adequate ventilation Left greater than right with a left pleural effusions and associated atelectasis.Tracheostomy tube, the tip 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter tip at cavoatrial junction.Right PICC, tip in right atrium.Cardiac valve prosthesis in place.Unchanged LVAD. Mediastinal and pleural drains unchanged. Very small right apical pneumothorax.

Output: Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Short of breath with epigastric pain. Low normal lung volumes normal heart size. No pleural fluid or pneumothorax. No focal airspace opacities. Bronchial wall thickening and atelectasis inferior to the left hilum, mild. No free intraperitoneal air.

Output: No pneumothorax or free intraperitoneal air. Bronchial wall thickening and mild atelectasis on the left, nonspecific, correlate for signs of bronchitis or recent history of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: dobhoff placement position, unable to advance past 35 History: none Feeding tube terminates within the mid aspect of the esophagus. Other iatrogenic devices, unchanged. Low lung volumes with bibasilar opacities and pleural effusions again noted. Unchanged heart size.

Output: Feeding tube terminates within the esophagus. Unchanged bibasilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Productive cough. Evaluate for infection. No focal air space opacity, pleural effusions or pneumothorax. The cardiomediastinal silhouette is normal. Bronchial wall thickening.

Output: Bronchial wall thickening, suggestive of asthma or bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval for effusions History: known effusions, s/p R pigtail Low lung volumes.Pigtail catheter projects over the right costophrenic angle; marker projects external to the bony thorax, consider repositioning or removal.Small right pleural effusion, not substantially changed.Scattered subsegmental atelectasis.Multiple surgical clips and midline skin staples in the upper abdomen.

Output: Stable small right pleural effusion. Pigtail catheter projects over the right costophrenic angle; marker projects external to the bony thorax, consider repositioning or removal.Findings communicated via telephone to Dr. Warnecke.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Acute chest syndrome. Chest pain. Very mild scarring diffusely. Normal heart size. No acute appearing airspace opacities. No pleural fluid.

Output: No specific evidence of acute chest syndrome. Mild diffuse chronic parenchymal changes bilaterally related to sickle cell disease.


Instruction: Generate impression based on medical findings.

Input: Metastatic prostate cancer CHEST:LUNGS AND PLEURA: Reference right posterior costophrenic angle nodule is enlarged measuring 17 x 14 mm on image number 76, series number 3. Other spiculated small nodules are unchanged. MEDIASTINUM AND HILA: Prevascular node is stable measuring 10 by 8mm image number 42, series number 3. Other small mediastinal lymph nodes are also stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is unchanged. Splenomegaly is unchanged. No focal lesions are seen in the liver within the limitations of a noncontrast study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Radiation pellets within the prostate.BLADDER: No significant abnormality notedLYMPH NODES: Previously mentioned right external iliac reference lymph nodes unchanged measuring 20 x 9 mm image number 170, series number 3. Multiple perirectal lymph nodes are again noted. Right perirectal lymph node measures 9 x 8 mm on image number 178, series number 3. It was measuring 8 by 8mm on on the seventh 5, series number 3 on the previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the right lower lobe nodule. Other smaller nodules are stable. Mediastinal adenopathy is stable. Pelvic adenopathy is stable.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval ETT, lung fields History: s/p AVR, MVR Redo sternotomy with an opened wound, a radiopaque surgical sponge marker projects over the right heart border, with overlying drainage catheters. No pneumothorax with bilateral pleural drains.Patchy left upper lobe opacity post procedure suggestive of aspiration or localized edema.ET tube tip approximately 1 cm above the carina.Right jugular Swan-Ganz catheter tip in main pulmonary artery.Aortic valve replaced.Left subclavian pacemaker, leads unchanged in position.

Output: Surgical sponge marker present postop, with an open sternotomy wound. This is known to the service. New left upper lobe opacity possibly aspiration, localized edema or even infection.


Instruction: Generate impression based on medical findings.

Input: 52 year-old female status post mitral valve replacement with right-sided chest pain and pneumococcal bacteremia. Evaluate for pneumonia. Given the limitations of nonenhanced study, the following observations are made.CHEST:LUNGS AND PLEURA: Focal area of postsurgical scarring in the inferior aspect of the right upper lobe adjacent to the surgically fractured rib. Pulmonary nodule in the right lower lobe is reidentified and stable in size, measuring 4 mm as seen on image 45/96. Calcified nodule in the right middle lobe likely represents prior granulomatous infection. Nodule adjacent to the descending thoracic aorta that measures 10 x 12 mm as seen on image 63/96. No focal consolidations to suggest pneumonic process.MEDIASTINUM AND HILA: Stable cardiomegaly. Small mediastinal lymph nodes are identified. Enlarged pulmonary artery which raises the question of pulmonary hypertension.CHEST WALL: Interval decrease in size of axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Very small nonobstructive nephrolith in the left kidney.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted

Output: 1.No pulmonary nodule adjacent to the descending thoracic aorta. Recommend radiological follow up with nonenhanced CT of the chest in 4 months.2.Enlarged pulmonary artery which raises the question of pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Eval for appropriate placement of iABP, Swan-Ganz catheter History: Cardiogenic shock Increasing edema-like opacities with pleural effusions and left lower lobe consolidation.Unchanged right pleural drain with no pneumothorax.Tracheostomy tube tip approximately 6 above the carina.A Dobbhoff tube terminates in the stomach. Right subclavian IABP, proximal marker projects over the aortic arch.Right jugular Swan-Ganz catheter, tip in right pulmonary artery. Left jugular catheter tip in left brachiocephalic vein to the left of midline.

Output: Worsening pulmonary opacities and pleural effusions suggestive of CHF. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with metastatic renal cancer CHEST:LUNGS AND PLEURA: Moderate-sized, partially loculated right pleural effusion and is identified. Scattered amounts of air, greatest anteriorly are identified within the effusion, likely chronic. Numerous pleural based metastatic lesions are seen throughout the right hemithorax. For reference, one of them in the right upper lung measures 4.8 x 2.7 cm (series 4; image 32). The largest in the right lower lung measures 9.7 x 5.2 cm (series 4; image 108).Hypodensities within the right pleural space compatible with prior pleurodesis.A few pulmonary nodules are seen in the right lung base. A few pulmonary nodules are seen in the left lung, largest measuring 10 x 7 mm in the left upper lobe. A calcified granuloma is also noted in the left upper lobe adjacent to the oblique fissure.MEDIASTINUM AND HILA: 3.9 x 2.6 cm hypodense left thyroid nodule. The right lobe of the thyroid gland is not visualized.Calcified mediastinal and left hilar lymph nodes.Visualization of the cardiac chambers suggests anemia. The heart size is enlarged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The right kidney is not visualized.KIDNEYS, URETERS: The right kidney is absent.Numerous cysts are seen in the left kidney. 2.0 x 1.9 cm exophytic lesion off the lower pole of the left kidney demonstrates increased density (35HU).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Numerous pleural-based lesions within the right lung, compatible with metastases. A few parenchymal nodules are seen in both lungs, greatest in number in the right lung base.Right hydropneumothorax (small amount of air), with resultant volume loss and evidence of prior pleurodesis. Given the presence of air, an empyema cannot be excluded-please correlate clinically.Hyperdense exophytic left renal lesion. A dedicated renal CT/MRI with contrast is suggested for further evaluationEvidence of prior granulomatous infection.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of metastatic renal cell cancer This study is limited due to lack of IV contrastCHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. Patchy groundglass opacities in upper lobes are stable. Linear subsegmental atelectasis in the lower lobes are stable.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 17 x 13 mm image number 52, series number 3, stable. Other small mediastinal lymph nodes are also stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Previous described ill-defined hypodense lesion in the liver is not well seen on today's study. Lack of IV contrast severely limits optimal evaluation. MRI of the liver may be obtained for better evaluation of the liver, if clinically indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Small hypodense lesion in the lower pole left kidney is stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions through the lower spine and pelvis are stable.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: Lytic lesions through the lumber spine and pelvis are stable.OTHER: No significant abnormality noted

Output: Previously described lesion in the liver is not seen on today's study. Lack of IV contrast severely limits opal evaluation of the liver. MRI of the liver may obtained for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old, with history of non-small cell lung cancer status post resection presenting with increased work of breathing. PULMONARY ARTERIES: Technically adequate exam. No evidence of pulmonary embolus.LUNGS AND PLEURA: Postoperative change status post left lower lobectomy. The previously noted left basilar mass has been resected. No new suspicious nodules or masses. A nodule within the right major fissure (axial image 70/140) probably represents an intrapulmonary lymph node.Moderate centrilobular emphysema. Mild peripheral and predominantly basilar reticular pattern is unchanged. Small left pleural effusion.Subtle paramediastinal scarring may reflect prior radiation therapy.MEDIASTINUM AND HILA: Cardiomegaly. No pericardial effusion. Extensive aortic and coronary artery calcifications are noted. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Deformity of multiple left sided ribs is probably postsurgical.UPPER ABDOMEN: Bilateral renal cystic lesions unchanged and probably benign. The spleen is not visualized and may have been surgically excised.Reflux of contrast into the hepatic veins can be seen in right heart failure.

Output: 1.No PE.2.Mild basilar interstitial abnormality is grossly unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: chest pain History: chest pain No significant cardiopulmonary abnormality.Metallic fragment left mid abdomen could be a bullet remnant.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Check Swan-Ganz Swan-Ganz again has been minimally retracted, tip is in the right main pulmonary outflow tract at the level of the takeoff of the upper lobe pulmonary artery. The ICD and other catheters are all otherwise unchanged.Cardiopulmonary appearance is also similar including diffuse mixed interstitial and airspace nonspecific opacities, likely representing edema. Please see subsequent report

Output: Swan-Ganz repositioned


Instruction: Generate impression based on medical findings.

Input: Reason: lvad History: same Cardiopulmonary monitoring and support devices, unchanged.Bilateral opacity compatible with edema, atelectasis and pleural effusions.No significant interval change.

Output: Nonspecific opacity compatible with edema and atelectasis without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: device placement History: impella, swan Cardiomegaly, status post sternotomy.Small lung volumes with left lower lobe and right perihilar consolidation, and a small left pleural effusion.ET tube tip approximately 4 cm above the carina.Left subclavian dual chamber pacemaker, leads in appropriate position.An NG tube extends below the lower margin of the image.Right jugular Swan-Ganz catheter tip directed towards the right main pulmonary artery.An Impella cardiac assist device inserted from below, tip near but possibly just short of the LV apex region.A right subclavian catheter loops upon itself into the jugular.

Output: 1. Multiple devices including a cardiac assist catheter.2. Right subclavian catheter doubled back upon itself in the jugular.3. Cardiomegaly and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: Failed video swallow study, assess for pathology, also with tracheostomy and s/p transfer from OSH, assess for proper placement History: as above Tracheostomy tube terminates 6 cm above the carina.There is deformity of the right humeral head which is partially visualized. Evidence of prior right rib fractures. Streaky mid to lower zone opacities may represent aspirated secretions. No focal consolidation. Heart size is normal.

Output: Streaky basilar opacities suggestive of subsegmental atelectasis and aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: r/o acute process History: chest pain Cardiothymic silhouette is unremarkable. Aortic arch calcification is noted. No pleural effusions or pneumothorax. Chronic appearing interstitial thickening.

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


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: pleural mesothilioma History: hisotry of ongoing shortness of breath with a negative cardiac workup since October 2014 which progressively worsened The cardiomediastinal silhouette is unremarkable.Increased lung vines compatible COPD. Right pleural thickening with tenting of the the right hemidiaphragm noted.The lungs are clear.Degenerative changes in the thoracic spine.

Output: Right pleural thickening compatible with history of mesothelioma. Increased lung vines compatible COPD. No acute cardiopulmonary identified. See current CT of the chest.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Eval pulmonary edema History: crackles Left greater than right multifocal pulmonary opacities, not substantially different. Small pleural effusions. Normal heart size. Lines and tubes are unchanged..

Output: Left greater than right multifocal pulmonary opacities, not substantially different. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer Mildly decreased lung volumes without definite acute cardiopulmonary abnormality. Calcified right hilar and mediastinal lymph nodes suggest old granulomatous disease exposure.Moderate to large hiatal hernia

Output: Hiatal hernia with old granulomatous disease exposure.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: cough, post tussive emesis, nausea History: as above No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Leukocytosis evaluate for pneumonia LVAD incompletely visualized, please refer to subsequent separately reported CT. Left subclavian ICD unchanged in position; the atrial lead extends into the azygos arch and posteriorly distends into the azygos vein adjacent to the spine. This atypical position has been noted on multiple prior examinations and was present on the earliest chest radiograph of 12/9/2014.Cardiothoracic ratio appears enlarged compared to earlier exams this admission, compatible with a pericardial fluid collection. There is increasing retrocardiac atelectasis.Moderate to large volume of pleural fluid bilaterally, increased. No specific signs of pulmonary edema.

Output: No specific evidence of pulmonary edema or pneumonia. Enlarging pleural and pericardial fluid collections, please refer to separately reported chest CT.


Instruction: Generate impression based on medical findings.

Input: 47 year old female with pleuritic chest pain and history of PE. PULMONARY ARTERIES: No evidence of filling defect in the pulmonary arteries.LUNGS AND PLEURA: No pulmonary nodules or effusion. Mild emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Patient is status post cholecystectomy.

Output: No evidence of pulmonary embolus.


Instruction: Generate impression based on medical findings.

Input: Evaluate progression of pulmonary edema/pneumonia. Left superior mediastinal widening and contour abnormality consistent with history of aneurysm repair and known mediastinal hematoma, similar to recent previous studies. Tubes and lines unchanged in position. Mild bilateral paramediastinal lung atelectasis/consolidation is similar to prior. Nodular consolidation along the left major fissure may reflect loculated fluid/hematoma and adjacent atelectatic lung, unchanged. No evidence of pulmonary edema. Small pleural effusions.

Output: No acute change in cardiopulmonary appearance. Small pleural effusions, partially loculated in the major fissure on the left, and multifocal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: eval for edema History: chf with sob Improvement in patchy basilar opacities and small pleural effusions. Unchanged cardiomegaly. No pneumothorax. Unchanged cardiac lead.

Output: Improvement in patchy basilar opacities and small pleural effusions which may have represented pulmonary edema, aspiration, and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Shortness breath, please evaluate for pulmonary edema. Low lung volumes. Diffuse interstitial opacities. Unchanged partially calcified granulomata. Cardiomediastinal silhouette is unremarkable other than hilar lymph nodes. No focal pulmonary opacities.

Output: Low lung volumes with diffuse interstitial opacities. Unchanged hilar lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusion History: SOB Nodular pleural thickening in the right hemithorax with underlying effusion and atelectasis, consistent with mesothelioma.Interval removal of right chest tube with no pneumothorax.Findings are better demonstrated on the CT scan performed the same day.

Output: Findings consistent with right pleural mesothelioma with no acute interval change.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old Reason: r/o infiltrate History: c/o intermittent cough. Cardiomediastinal silhouette is within normal limits.15 mm faint nodular opacity in the right upper lobe. No pneumothorax or significant pleural effusion is identified.Prominent pulmonary vasculature is noted.

Output: Faint nodular opacity in the right upper lobe measuring 15mm. Recommend follow-up radiograph in 6 weeks to exclude infectious/inflammatory lesion. If persistent on follow-up imaging, CT is suggested.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old Reason: r/o acute process History: left sided chest pain with shortness of breath Cardiomediastinal silhouette is within normal limits.No focal opacity, pneumothorax, pleural effusion is identified.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Intubated, Hypoxia, Resp Failure History: Intubated, Hypoxia, Resp Failure Moderate cardiomegaly.Improving basilar opacities, although a right pleural effusion may be new.Left subclavian pacemaker, leads unchanged in position. Status post extubation.

Output: Improving basilar opacities. Status post extubation.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Eval swan placement History: None Femoral Swan-Ganz catheter tip in main pulmonary artery. IABP marker in proximal descending thoracic aorta. Other findings stable.

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


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Evaluate IABP. Swan-Ganz catheter and right chest wall ICD leads are unchanged in position. Balloon pump marker is unchanged in position in proximal descending aorta approximately 3 cm below the superior margin of the aortic arch. Significant cardiomegaly unchanged. Minimal edema unchanged.

Output: Balloon pump marker unchanged in the proximal descending aorta. No interval cardiopulmonary changes.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: pre-transplant evaluation Right aortic arch and descending aorta.Heart size normal.No significant pulmonary or pleural abnormality.An IVC catheter terminates at the right atrial level.

Output: Right aortic arch, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: eval for infiltrate History: tachycardia desats Cardiomegaly with pulmonary vascular redistribution.No reliable evidence of edema except for some thickening of the fissures seen on the lateral view.No specific evidence of infection.

Output: Cardiomegaly, and equivocal edema but no sign of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: s/p TECAB History: s/p TECAB Mild basilar subsegmental atelectasis and pleural effusions.Left chest wall soft tissue emphysema noted with no significant pneumothorax.

Output: Unchanged small pleural effusions. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: eval lung fields, cardiac silhouette History: high blood pressure Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval sob History: sob Cardiomediastinal silhouette is unremarkable. Aorta is tortuous. Low lung volumes. Mild left basilar streaky opacities suggestive of atelectasis. No pleural effusion or pneumothorax.

Output: Low lung volumes and mild left basilar atelectasis, otherwise no acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Assess ET tube position and any change in lung pathology History: Intubated with pneumonia Endotracheal tube terminates 8.5 cm from the carina and could be advanced if clinically indicated. Enteric tube has been pulled back slightly with side port in the upper aspect of the stomach. Scarlike volume loss within the right upper lobe again noted. Improvement in nodular opacity at the right lung base. Right lower lobe opacity, improved from previous study. Innumerable small calcified lesions noted throughout the lungs. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Endotracheal tube terminates 8.5 cm from the carina and could be advanced if clinically indicated. Improvement in right lower lobe opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: S/P LVAD. Repeat exam to Eval for aspiration History: Hypoxia Small lung volumes, with a slight increase in basilar atelectasis, possibly from aspirated secretions or mucous plugging.LVAD and left subclavian ICD unchanged.

Output: Slight increase in basilar opacities consistent with atelectasis from aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: evaluate for potential pneumonia History: hypoxia, URI symptoms Small lung volumes.No specific evidence of infection or edema.

Output: No significant abnormality. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Right jugular Swan-Ganz again projects into the right pulmonary outflow tract. ICD and change.Mild nonspecific cardiac megaly with otherwise clear lungs however please note right however that the right chest wall is cut off which limits sensitivity

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with uterine cancer. CHEST:LUNGS AND PLEURA: New subcentimeter pleural nodules in the right lower lung posteriorly.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesion adjacent to the falciform ligament in the left lobe liver is unchanged and represents a perfusion difference rather than a true lesion. Subcentimeter nonspecific hypodensity near the dome of the liver is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left hydronephrosis likely secondary to compression of the left ureter by the enlarged uterus. Right ureter is also minimally dilated.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Significantly enlarged leiomyomatous uterus with dilated endometrial cavity containing irregularly enhancing mass is grossly unchanged. The uterus extends superiorly up to the level of the lower pole of the left kidney. Ovaries cannot be evaluated due to the large uterine mass.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large uterine mass containing numerous large fibroids. Endometrial cavity is dilated with enhancing irregular lesions consistent with patient's known history of uterine cancer.Bilateral mild calyectasis, more on the left than on the right.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Sepsis. Tubes and lines unchanged in position. Large layering pleural effusions with associated atelectasis bilaterally, especially at the lung bases. Hazy airspace opacity bilaterally nonspecific and may reflect edema or infection..

Output: Large pleural effusions with atelectasis.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with metastatic melanoma. Status post DTIC chemotherapy. Evaluate for response disease. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules are again seen. The reference right lower lobe lesion has increased in size and measures 1.7 cm x 2.3 cm (image 70/220, series 3), compared to 1.9 cm x 1.3 cm on the previous exam. The left upper lobe reference lesion is stable and measures 0.5 cm x 0.9 cm (image 41/220, series 3) compared to 0.5 cm x 1.1 cm on the previous exam.MEDIASTINUM AND HILA: Stable subcentimeter mediastinal and hilar lymphadenopathy. Mild cardiomegaly with a stable pericardial effusion. A moderate-sized hiatal hernia is again seenCHEST WALL: Postoperative changes from median sternotomy. ABDOMEN:LIVER, BILIARY TRACT: Multiple subcentimeter hypodense lesions are seen in the liver and appear stable when compared to the prior exam.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 other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Small prostatic calcifications are again seen.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Equivocal enlargement of the right lower lobe pulmonary nodule; Multiple other pulmonary nodules are too small to measure but appear to be unchanged in size, when compared to the prior exam.2. Mild cardiomegaly with stable, small pericardial effusion


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: interval change, eval chest tube History: interval change as above Left chest tube with no pneumothorax.Left hemithorax volume loss and postsurgical widening of the superior mediastinum, stable.Mild basilar edema and atelectasis.An NG tube traverses a gastric pull-up.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: new onset sob History: sob Mild cardiomegaly, pulmonary edema and pleural effusions, unchanged.Interval extubation.Catheter tip in the SVC.

Output: Interval extubation and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old. Interval removal of right PICC line.No pneumothorax.No change in the degree of cardiomegaly. Interval development of basilar opacities likely representing pulmonary edema.

Output: Cardiomegaly with very edema. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old Reason: evaluate for acute process like pneumonia History: increased SOB, increased cough and sputum production in CF patient already on IV antibiotics Right chest port catheter is coiled in the right internal jugular vein, unchanged.The cardiomediastinal silhouette is normal.Bilateral bronchiectasis and endobronchial debris compatible with the given history of cystic fibrosis appear similar to the prior exam.No pleural effusion or pneumothorax.Rib deformities on the right, unchanged.

Output: No significant interval change in bronchiectasis compatible with cystic fibrosis. No visible sign of a new pneumonia by plain film.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: tubes in right place/ History: ccu Linear opacities, with improvement in pleural effusions and basilar consolidation.Lucency in the left perihilar region most likely is related to fluid in the fissure rather than a cavity as none was seen on a CT performed yesterday afternoon.The lungs are better inflated.IABP catheter tip within 1 cm of the top of the aortic arch.IVC ECMO cannula extending into the left jugular unchanged.ET tube tip 9 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular Swan-Ganz catheter, tip peripherally in a right upper lobe pulmonary artery branch.

Output: High ET tube. Improved basilar opacities and inflation. Swan-Ganz catheter tip peripherally in the lung.


Instruction: Generate impression based on medical findings.

Input: 75 years, Male. Reason: patient with ileus, worsening exam History: abdominal distention Chest: A chest port is seen with tip in the right atrium. Lung volumes are low and there is bibasilar subsegmental atelectasis.Abdomen: Markedly dilated loops of small bowel are again seen organizing throughout the abdomen and measuring up to 53 mm in diameter. Additionally, gas dilated loops of colon are also seen. There is no evidence of free intraperitoneal air.

Output: Overall stable appearance of high-grade ileus without evidence of free intraperitoneal air.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.History of pulmonary hypertension and sarcoid presents with increased shortness of breath. Again seen is chronic elevation of the right hemidiaphragm. There is a right-sided pleural effusion and basilar consolidation versus atelectasis, which is slightly increased compared to prior. Perihilar, interstitial opacities, and volume loss are compatible with history of sarcoidosis.

Output: Right-sided pleural effusion and basilar consolidation versus atelectasis is increased compared to prior examination.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: RLL consolidation History: pls see above Unchanged basilar opacities and small left pleural effusion. ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Left subclavian catheter, tip in SVC.

Output: Unchanged pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: R/O PNA vs atelectasis History: increasing O2 requirement after prolonged hospitalizattion and bacteremia Right IJ line unchanged terminating near the caval atrial junction. Left-sided PICC terminates over the left axilla. Small right pleural effusion or thickening and right basilar opacity again noted. Left lung is clear. Resolution of left basilar opacity. Heart is again at the upper limit of normal. No pneumothorax. No acute bony abnormality.

Output: Left-sided PICC terminates over the left axilla. Improvement in left basilar opacity. Persistent right pleural effusion/thickening.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female past medical history DM, endometrial cancer, status post surgery for restaging. CHEST:LUNGS AND PLEURA: Paraseptal emphysema. No discrete lung nodules. No effusions.MEDIASTINUM AND HILA: Mediastinal granulomata. Small noncalcified nodes. Coronary artery and aortic calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal nodes pathologic in size consistent with metastatic disease. For baseline purposes any left para-aortic node is measured on series 4 image 126 is 2.2 x 1.7 cm.The node behind the left renal pedicle is measured on image 106 is too by 2-cm.Heavy calcification aorta and iliac arteries. No aneurysm.BOWEL, MESENTERY: Scattered lymph nodes with calcifications in the porta hepatis and peripancreatic area may be due to granulomata or treated metastatic disease. Scattered omental nodules particularly in the left abdomen for example see series 4 image 114. For baseline purposes, lesion on the lateral left abdominal wall, image 121 measures 2.4 x 1.4 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: Small bilateral common and external iliac nodes not pathologic by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Midline surgical scar.OTHER: No significant abnormality noted.

Output: Retroperitoneal adenopathy. Omental implants. Granulomatous disease. Atherosclerotic calcification. Emphysema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval device placement History: above Swan-Ganz catheter tip in the main pulmonary artery.Small lung volumes with blunting of the costophrenic angles consistent with small effusions and atelectasis.No new findings.

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


Instruction: Generate impression based on medical findings.

Input: 47 year old female with possible history of non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: No cystic punctate nodule along the right major fissure on image number 37, series number 5 may represent an intrapulmonary lymph node. Right apical scarring.MEDIASTINUM AND HILA: 13 x 7 mm right hilar lymph node on image number 39, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is enlarged. There is an ill-defined hypodense mass in the myometrium of the uterus. Further evaluation with pelvic ultrasound pelvic MR is recommended.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of significantly enlarged lymph nodes.Uterus is enlarged and ill-defined hypodense lesion. Further evaluation with pelvic ultrasound or MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Left jugular catheter placed Interval placement of a left jugular catheter, tip projects into the innominate just beyond the confluence with the jugular. No additional underlying cardiopulmonary changes, specifically no postprocedural complications

Output: Left jugular catheter placed