Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.With a history of right-sided lung mass presenting with shortness of breath and difficulty swallowing. Right pleural effusion with adjacent atelectasis. Possible right cavitary lesion with mediastinal lymphadenopathy or mass. There are new patchy bilateral airspace opacities.

Output: Right pleural effusion. Possible right cavitary lesion with mediastinal lymphadenopathy or mass and new patchy bilateral airspace opacities. Please see same day CT scan for further details.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Persistent oxygen requirement, pneumonia status post abdominal closure. Low lung volumes with basal atelectasis or scarring unchanged. Trace pleural fluid. Abdominal clips and a drain are incompletely visualized. Postoperative pneumoperitoneum. Chest wall surgical clips near the axilla.Multilevel thoracic spine vertebral body compression deformities.

Output: Multifocal subsegmental atelectasis at the lung bases. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: s/p line placement History: s/p line placement No significant cardiopulmonary abnormality.Left subclavian catheter, tip at cavoatrial junction.

Output: Left subclavian catheter, tip at cavoatrial junction level.


Instruction: Generate impression based on medical findings.

Input: 72 year old male with history of lung cancer status post chemoradiation. CHEST:LUNGS AND PLEURA: Right upper lobe nodular opacity (series 5 image 24) measures 12 x 8 mm (previously 15 x 8 mm). Previously identified 4-mm spiculated micronodule the same level in the right upper lobe is now faint hazy opacity, suggesting inflammatory etiology. Fluid in the right fissures with subpleural nodular opacities (series 5 image 29, 31, 36, 53), similar to prior. Additional small parenchymal nodular opacities are similar to prior. No new lesions identified.Right-sided volume loss with elevation of the right hemidiaphragm, unchanged. Small loculated anterior and posterior pleural fluid collections with relative high density fluid and enhancing rims, similar to prior. Persistent right basilar consolidated opacities with bronchiectasis, likely scarring/atelectasis, similar to prior.Left subpleural nodule (series 5 image 81) and additional micronodules unchanged.MEDIASTINUM AND HILA: Reference right hilar lymph node (series 3 image 37) measures 14 x 8 mm, unchanged. Reference right subcarinal lymph node (series 3 image 44) measures 19 x 25 mm (previously 15 x 19 mm). Right pericardiophrenic lymph node (series 3 image 51) similar to prior. Additional mediastinal and hilar lymph nodes appear stable.Extensive coronary artery calcifications. No pericardial effusion.CHEST WALL: Multiple small sclerotic lesions throughout the axial skeleton, not significantly changed from 12/8/10 or 10/27/10.ABDOMEN:LIVER, BILIARY TRACT: Few subcentimeter hypodense hepatic lesions are too small to characterize, but likely represent benign hepatic cysts, similar on prior.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Prominence of the left adrenal gland without focal nodule, similar on multiple priors.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Confluence lymphadenopathy surrounding the celiac trunk is similar on multiple priors dating back to at least 2008.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple small sclerotic lesions throughout the axial skeleton, not significantly changed from 12/8/10 or 10/27/10.Severe degenerative changes of the lumbar spine, similar to prior.OTHER: Moderate to severe vascular plaque of the abdominal aorta and its branches.

Output: 1) Overall, stable metastatic disease. Subtle decrease in right upper lobe lesions. Slight increase in a subcarinal lymph node size compared to prior, however, this lymph node measured larger on multiple priors in 2010 and 2009. Additional lymph nodes and osseous metastasis are unchanged. No new lesions. 2) Loculated right pleural fluid collections with enhancing rims, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: post PA catheter line adjustment History: as above Swan-Ganz catheter has been repositioned into the left pulmonary artery; the portion of the Swan-Ganz catheter within the right atrium is mildly redundant. Other lines and tubes, not substantially different increased bibasilar opacities. Unchanged cardiomegaly.

Output: Swan-Ganz catheter has been repositioned into the left pulmonary artery; the portion of the Swan-Ganz catheter within the right atrium is mildly redundant.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Swan Gantz catheter position. Swan-Ganz catheter tip terminates at the level of the main pulmonary artery. Left jugular introducer in place, unchanged in position. Sternotomy wires and plates in place. Left subclavian vascular stent. Cardiomegaly, unchanged. No new focal opacity, pleural effusion or pneumothorax.

Output: Swan-Ganz catheter tip terminates at the level of the main pulmonary artery.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: 65-year-old male with recent diagnosis of stage IV CRC/ileal cancer. Staging CT. CHEST:LUNGS AND PLEURA: Numerous well-circumscribed, predominantly peripheral pulmonary nodules. A reference pulmonary nodule in the left upper lobe measures 1.1 cm (series 7, image 65). Another reference pulmonary nodule in the left lower lobe measures 1.4 cm (series 7, image 83).MEDIASTINUM AND HILA: A left high paratracheal lymph node measures 1.2 cm (series 5, image 15). There is an enlarged cardiophrenic lymph node (series 5, image 80).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There are numerous liver masses which distort the vasculature, but there is no thrombosis or biliary ductal dilatation. A reference liver lesion in the left lobe measures 3.0 x 3.0 cm (series 5, image 118). A reference liver lesion in the right lobe measures 2.2 x 2.9 cm (series 5, image 113). There is perihepatic ascites.SPLEEN: Perisplenic ascites.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There is a conglomerate of enlarged retroperitoneal lymph nodes. A reference measurement is 2.3 x 2.0 cm (series 5, image 125)BOWEL, MESENTERY: Increased ascites compared to previous examination. Unmeasurable necrotic mass in right lower abdomen (series 5, image 150).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: A femoral lymph node measures 2.3 x 2.1 cm (series 5, image 186). Near the right iliac bone there is a mass which may be a peritoneal implant or an enlarged lymph node (series 5, image 164).BOWEL, MESENTERY: Carcinomatosis of the pelvis (series 5, image 187).BONES, SOFT TISSUES: No significant abnormality notedOTHER: Right hydrocele.

Output: 1. Multiple pulmonary nodules, compatible with pulmonary metastases.2. Multiple liver lesions, compatible with liver metastases.3. Carcinomatosis in the pelvis.4. Increased ascites.5. Retroperitoneal and pelvic lymphadenopathy.6. Right lower quadrant abdominal mass, compatible with primary malignancy of small bowel versus colon.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with chromophobe status post nephrectomy. Please evaluate 5-mm lesion in lingula from April scan and for other evidence of recurrence. CHEST:LUNGS AND PLEURA: Interval increase in size of previously seen subcentimeter lingular nodule with 2 other large new pulmonary nodules as well. The largest nodule is new and located in the left lower lobe (series 4, image 71), measuring 2.6 x 2.9 cm.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy without evidence of recurrence in the surgical bed.RETROPERITONEUM, LYMPH NODES: Pathologically enlarged left para-aortic node (series 3, image 117) is new since prior study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Superior endplate changes at T11 and T12 vertebral bodies are likely degenerative in etiology, unchanged from prior study.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Interval increase in size and number of pulmonary nodules, compatible with metastatic disease, with largest nodule now in the left lower lobe. 2. New pathologically enlarged left para-aortic node near the nephrectomy bed as measured above.


Instruction: Generate impression based on medical findings.

Input: Female 83 years old Reason: pre op History: Heart size at the upper limits of normal with tortuous aorta. No focal airspace opacity or pleural effusion. Marked degenerative changes of thoracic spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Pneumonia. Any change to pleural effusion after diuresis. Tubes and lines unchanged in position. Large layering pleural effusions about the same, with significant associated atelectasis. Consolidation/collapse of the left lower lobe. Branching interstitial-appearing opacities are slightly worse.

Output: No visible change in pleural fluid volume. The left lower lobe remains collapsed/consolidated, correlate for mucous plug. Development of either mild dependent edema or bronchiolitis from aspiration in the posterior lung fields.


Instruction: Generate impression based on medical findings.

Input: Female 97 years old Reason: truamatic injury from cpr, pna, acute pthology History: syncope s/p bystander cpr There is no focal consolidation, pleural effusion or pneumothorax.The cardiomediastinal contours are within normal limits for size. Tortuosity of the aorta is commensurate with age.Gaseous distention of the stomach likely reflects bag mask ventilation. The imaged skeleton is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: post op, eval ETT, lung fields History: s/p tecab Left chest tube with a minimal left apical pneumothorax versus artifact.Basilar atelectasis may be from aspirated secretions.Right jugular venous access sheath.

Output: Basilar atelectasis postop, and equivocally a pneumothorax on the left.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia, eval for atelectasis History: sob Complete opacification of the left hemithorax with proximal air bronchograms, suggestive of atelectasis and pleural effusion.Clustered nodular opacities in the right upper lung , of uncertain etiology but suggestive of infection.

Output: 1. Complete opacification of the left hemithorax without substantial volume loss, suggestive of atelectasis and pleural effusion.2. Nonspecific nodular opacities in the right upper lung, possibly due to infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: assess swan History: as above Unchanged right upper lobe opacity, a prior biopsy site.Otherwise, the lungs are unremarkable.Heart size upper normal.Left jugular Swan-Ganz catheter tip in right pulmonary artery, unchanged.

Output: Left jugular Swan-Ganz catheter tip in right pulmonary artery, unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: ventilator dependence History: respiatory failure Support devices unchanged. There are decreased lung volumes with stable cardiomediastinal silhouette.Pleural effusions, left greater than right , and basilar opacities similar to the prior exam.Persistent pneumoperitoneum.

Output: Support devices unchanged. Pleural effusions and basilar atelectasis similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant New right jugular catheter with Swan-Ganz in right ventricular outflow tract. New small right apex pneumothorax.New left subclavian venous catheter with tip in left subclavian vein. There is a very small left sided pneumothorax. ET tube tip 4 cm above carina.Right jugular tunneled catheter unchanged. Lungs hypoinflated with increasing basilar opacities likely edema and atelectasis with small effusions.

Output: New small bilateral pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Reason: increased SOB, orthopnea, chest pain. hx HF and COPD History: as above Limited examination due to obesity and underinflation.No gross cardiopulmonary abnormalities.

Output: No gross abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: MaleReason for Study: Reason: ARDS s/p trach, eval trach position and bialteral opacities History: as above Tracheostomy tube with its tip now 3 cm above the carina.Stable cardiac enlargement.Diffuse pulmonary opacities unchanged.

Output: Tracheostomy tube with its tip 3 cm above the carina. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.History of malignant neoplasm of the bladder. The heart is normal in size. Moderate tortuosity of the thoracic aorta.Lung volumes are normal. No abnormal focal lung parenchymal opacities.No pleural effusion or pneumothorax.No osseous lesions are present.

Output: Chest radiograph within normal limits, considering the limited value of conventional radiographs for detection of small noncalcified pulmonary nodules. If there is suspicion for pulmonary metastatic disease, further assessment with chest CT is recommended.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of prostate cancer. Evaluation of disease. CHEST:LUNGS AND PLEURA: Scattered micronodules. Reference right lower lobe pulmonary nodule (series 5, image 58) measures 8 x 8 mm (stable). MEDIASTINUM AND HILA: Several unenlarged mediastinal lymph nodes are again seen. Reference pretracheal lymph node measures 1.3 x 0.9 cm (series 3, image 37); previously 1.4 x 1.1 cm. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Osseous metastases as seen previously, including at the left clavicle and left second rib. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Fatty replaced.ADRENAL GLANDS: Stable left adrenal nodule.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered osseous metastases to the spine are stable.PELVIS:PROSTATE, SEMINAL VESICLES: Mild residual asymmetric thickening of the left seminal vesicle appearing similar to prior study.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered osseous metastases as seen previously.

Output: Stable metastatic disease


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: MaleReason for Study: Reason: new fever History: see above Tracheostomy tube and Dobbhoff tube unchanged.Stable cardiomediastinal silhouette. Mild basilar scarring/discoid atelectasis.No new pulmonary opacities identified.

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


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: pulm edema, pna History: sob, resp distress New focal opacity at the right lung base. Moderate cardiomegaly again noted. No large pleural effusion or pneumothorax.

Output: New focal opacity at the right lung base consistent with atelectasis, scar, or consolidation.


Instruction: Generate impression based on medical findings.

Input: 72 year old female with poor p.o. intake and a 50-pound weight loss over the last 3 months. Please note lack of IV contrast limits evaluation of solid organ pathology.CHEST:LUNGS AND PLEURA: Moderate sized bilateral pleural effusions with overlying atelectasis. Nonspecific left upper lobe and right upper lung groundglass opacities.MEDIASTINUM AND HILA: Coronary artery calcifications. Tortuous thoracic aorta, with mild dilation.CHEST WALL: Degenerative disease affects the spine.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Marked splenic vascular calcifications without appreciable aneurysm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Thickening of the left adrenal gland, nonspecific, not clearly visualized without IV contrast.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Several diverticula are noted. No obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Intra-abdominal free fluid, and extraperitoneal soft tissue edema. IVC filter.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No obstruction.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted.

Output: Moderate sized bilateral pleural effusions with overlying atelectasis and several groundglass opacities. Ascites and anasarca. No specific findings to explain the patient's acute weight loss.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: oht with sob History: oht with sob Pleural effusions and basilar opacities, the latter improving in the right mid to lower lung zone.Tracheostomy tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.A Dobbhoff tube extends below the lower margin of the image.Left subclavian catheter, tip in SVC.

Output: Improving right mid to lower lung zone, otherwise stable pulmonary opacities and pleural effusions. Tracheostomy tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Stage for lung cancer, hemoptysis, intubated for area protection. ETT tip approximately 3 cm above the carina. Right jugular ports tip in SVC, unchanged.Large right pleural effusion partially obscuring the infrahilar mass with extensive subcarinal lymphadenopathy, unchanged. Stable right hemithorax volume loss.No new findings.

Output: Large right pleural effusion without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 88 yearsGender: MaleReason for Study: Reason: intubated History: intubated ET tube is in place with its tip within the proximal right mainstem bronchus.NG tube with its tip in the stomach.Left-sided ICD unchanged.Cardiac enlargement with pleural effusions, edema, and basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Interval placement of an ET tube with its tip in the right mainstem bronchus.Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: please eval pneumonia History: fever, O2 93%, lymphoma on chemo Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: hx of sarcoidosis of meds x 2 weeks. now with diffuse body pain, cp History: chest pain, LE pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with history of basal cell cancer metastatic to the lungs are CHEST:LUNGS AND PLEURA: Left hemithorax wall there loss with associated mediastinal shift and parenchymal scarring likely secondary to radiation is unchanged. Multiple calcified granulomas are unchanged.MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes are unchanged. Infrahilar mass which is continuous with the ill-defined scarring is stable measuring 2 x 1.3 cm on image number 52, series number 3.CHEST WALL: Stable left axillary lymph node measuring 11 by 9-mm image number 20, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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: Stable exam.


Instruction: Generate impression based on medical findings.

Input: History of neuroblastoma status post resection as well as chemotherapy, radiation, stem cell transplant. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Previously seen low-attenuation hepatic lesion appears slightly larger with different enhancement characteristics on comparison to prior study. While this may represent a hemangioma at a different phase of contrast enhancement, sonographic imaging may aid further evaluation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Surgical clips are seen in the right adrenal bed. The right adrenal gland is not visualized, presumably secondary to surgical removal. No evidence of recurrence is noted in this location.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Surgical clips are again seen in the retroperitoneum and right adrenal bed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously noted, multiple poorly-defined lytic lesions are again seen in the vertebral column and remain stable in comparison to prior study. Regional area of decreased bone density is noted at T9-L2 vertebral bodies and may represent post-radiation changes.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable poorly-defined lytic lesions within the vertebral column as mentioned above.

Output: 1.Previously seen liver lesion appears slightly larger with different enhancement characteristics. Sonographic evaluation may aid further characterization. 2.No evidence of disease recurrence.3.Stable bone lesions in the vertebral column as described above.


Instruction: Generate impression based on medical findings.

Input: Chest tubes old complains of SOB especially with peritoneal dialysis. Evaluate lung fields. Cardiomegaly with prominence of the central pulmonary vasculature and superior mediastinal widening above the level of the aorta unchanged. No specific signs of pulmonary edema. Trace pleural fluid or thickening at the left costophrenic angle. Mild retrocardiac atelectasis.

Output: Minimal pleural fluid and atelectasis on the left. Superior mediastinal contour abnormality present previously, nonspecific but statistically most likely due to ectatic, tortuous vasculature. This may be conservatively followed on subsequent portable plain films.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: assess for complication after procedure History: as above Stable position biventricular ICD electrodes.Stable heart size. No interval pneumothorax, edema or pneumonia.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: R/O mass or PNA History: chronic cough x 30 days The cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax. No focal masses visualized.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: RIJ central line placement History: above Right IJ sheath is in place. No pneumothorax. Chronic pulmonary opacities, unchanged. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Right IJ sheath, as above. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with hepatocellular carcinoma. Evaluate for lung metastases LUNGS AND PLEURA: There is demonstration of a small 4 mm subpleural nodule in the left apex. No other pulmonary nodules or masses can be identified. Minimal linear fibrotic changes are noted at both lung bases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: There is hepatosplenomegaly. Heterogeneous density is noted throughout the liver, which may represent this patient's hepatocellular carcinoma as well underlying cirrhosis. Serpiginous densities in the region of the splenic hilum, most likely represent varices

Output: Uniform. No matter, subpleural nodule is identified in the left apical region. This most likely represents a noncalcified granuloma although an early solitary metastasis cannot be definitely excluded. A follow-up examination in 3 months is recommended.


Instruction: Generate impression based on medical findings.

Input: SOB with wheezing, history of CHF rule out infiltrate or edema. Cardiomegaly with mild interstitial edema. Trace pleural fluid. No focal airspace opacities. Prominent central pulmonary vasculature unchanged.

Output: Mild CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre kidney transplant evaluation. r/o infiltrate, r/o cardiomegaly History: pre kidney trasplant Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: ? CHF History: SOB Cardiomegaly.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: evidence of dissection, infection, effusions History: chest pain Ill-defined right midlung nodular opacity in the artifact.Elsewhere the lungs are unremarkable.Heart size upper normal, mediastinal contours otherwise unremarkable status post sternotomy.Left subclavian pacemaker, leads unchanged in position.

Output: Cardiomegaly.Small nodular opacity right upper lung zone could be artifact but CT is recommended to exclude lung cancer.


Instruction: Generate impression based on medical findings.

Input: Intubation Interval removal of the ETT and NG tube. No additional distinct cardiopulmonary acute abnormality. Improved overall lung volumes, however lungs remain mildly decreased. Cardiomegaly and unchanged prosthetic valve

Output: ETT and NGT removed


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: eval pna History: sepsis screen Diffuse opacities in the right lung with a right-sided pleural effusion, unchanged. Left basilar pleuroparenchymal opacity, not substantially changed. Unchanged cardiomegaly. Unchanged vascular stents. No pneumothorax.

Output: Diffuse opacities in the right lung with a right-sided pleural effusion, unchanged. Left basilar pleuroparenchymal opacity, not substantially changed.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: s/p DHT placement History: s/p DHT placement Chronic elevation left hemidiaphragm. Cardiomediastinal silhouette within normal limits.Lung nodules identified on CT are not easily identified on plain film radiography. CT follow-up on the lesions will be necessary.Tracheostomy tube in projection of trachea above the carina.No pneumothorax.Dobbhoff tube with tip in projection of gastric pylorus.

Output: No acute interval change. Dobbhoff tube placement.See CT report for evaluation of small pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: r/o infection History: cough with blood tinged mucous Cardiac lead, unchanged terminating in the expected location the RV. Low lung volumes makes detailed cardiopulmonary assessment difficult. Patchy bibasilar subsegmental atelectasis or scarring. No new focal pleural parenchymal opacity. Mild to moderate elevation the right hemidiaphragm again noted. Unchanged cardiomegaly. Prominent loops of bowel noted within the upper abdomen, increased from last study.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with lung cancer. Follow-up of pulmonary nodules. Patient with cough and shortness of breath on exertion. CHEST:LUNGS AND PLEURA: Postoperative volume loss in the left upper lobe as seen previously.Reference right middle lobe nodule (series 5, image 59) measures 8 x 9 mm (stable).Spherical groundglass nodule in the left lower lobe (series 5, image 52) measures 10 x 9 mm (stable).Superior left lower lobe ground glass nodule (series 5, image 46) measures 6 x 6 mm (stable).Previously seen, ill-defined ground glass opacities in the left lower lobe have a varied appearance on multiple previous examinations. Currently, these appear more nodular (series 5, images 60 and 64). For reference, the larger of the two ground glass opacities measures 11 x 9 mm.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 17 x 13 mm, which is slightly decreased on comparison to prior study when it measured 17 x 17 mm. Heart size normal without pericardial effusion. Coronary calcifications.Hypodense right thyroid nodule as seen previously. Hiatal hernia.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Small right diaphragmatic hernia with poorly defined low-attenuation region in the dome of the liver which is unchanged on comparison to prior study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS: Nonobstructing left renal stone unchanged.RETROPERITONEUM, LYMPH NODES: Significant atherosclerotic disease of the aorta and iliac arteries.

Output: 1. Unchanged spherical groundglass nodule in the left lower lobe remains suspicious for an indolent neoplastic process.2. Previously ill-defined left lower lobe ground glass opacities are currently more nodular as described above. These are of unclear clinical significance however indolent multi-focal neoplasm cannot be completely ruled out.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: chest tube in place History: asymptomatic A right chest tube has been removed, another still in place, with a loculated apical air collection, stable.Patchy right-sided opacities unchanged.Small left pleural effusion the left lung otherwise unremarkable.

Output: One right chest tube removed with a stable apical air collection and right-sided opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: Eval retrocardiac opacity seen on portable cx History: fever The cardiomediastinal silhouette is normal.There is subsegmental atelectasis at the left lung base, but no focal opacity suspicious for pneumonia or mass.

Output: Subsegmental atelectasis without additional acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.History of shortness of breath. Left PICC has been adjusted, now with tip in the left brachiocephalic vein.The cardiac silhouette is enlarged but stable.No focal pulmonary opacity or large pleural effusion. Fine, granular interstitial/airspace opacity is unchanged.

Output: No acute cardiopulmonary abnormality. Diffuse groundglass opacity appears chronic, previously characterized on CT from 3/2013.Left PICC adjusted, now with tip in the brachiocephalic vein.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: venagram yesterday now having chills and tachycardic History: chills, tachycardia, coughx1week Mild left basilar opacity, likely atelectasis or scar. No pleural effusion or pneumothorax. No acute bony abnormality. Improvement in heart size, now the upper limit of normal.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with history of cough Increased lung volumes.Retrocardiac focal consolidation.No pleural effusions or pneumothorax.Cardiomediastinal silhouette normal.

Output: Retrocardiac focal consolidations suggestive of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 78 year old female status post right upper lobe resection for adenocarcinoma. CHEST:LUNGS AND PLEURA: Volume loss of the right lung with postoperative changes of a right upper lobe resection, similar to prior. Few pulmonary micronodules are stable from multiple priors. No lesions suspicious for metastases.MEDIASTINUM AND HILA: Right paraesophageal lymph node (series 4 image 14) measures 10 x 9 mm on current exam is unchanged from prior. On 11/1/08, this lesion measured 7 x 6 mm, with time course favoring reactive changes over malignancy.Additional mediastinal lymph nodes are similar to prior. Reference AP window lymph node (series 4 image 29) measures 10 x 8 mm, unchanged.Mild diffuse esophageal wall thickening, similar to prior.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Few hepatic granulomata. No focal lesions.SPLEEN: Multiple splenic granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypodense left renal lesion, too small to characterize, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postoperative changes of ventral hernia repair.OTHER: Atherosclerotic calcification of the abdominal aorta and its branches.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: interval exam, pt remains intubated History: intubated Small lung volumes with small right pleural effusion.No specific evidence of infection or edema.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: rt flank pain Unremarkable cardiac and mediastinal silhouette.Status post median sternotomy.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: fall, thoracic back pain over ribs History: above Chronic rib deformities in the right hemithorax possibly postoperative.No visible displaced rib fractures, though a chest radiograph is not sensitive for rib fracture detection.Approximately normal heart size with a tortuous aorta.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: chest pain Normal cardiomediastinal silhouette. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with history of pancreatic cancer CHEST:LUNGS AND PLEURA: Few scattered subcentimeter pleural nodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. No focal lesions in the liver. Pneumobilia secondary to Whipple surgery.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes in the pancreas. No evidence of recurrent mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. In reference portacaval lymph node measures 15 x 7 mm image number 88, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study. Fatty infiltration of the liver.Scattered micronodules are unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: annual testing History: annual check Stable cardiomediastinal silhouette with hyperlucency in the right lung and left hemithoracic volume loss.Left lung opacities unchanged.No new pulmonary opacities identified.Left fifth anterior rib sclerosis redemonstrated.Blunting left costophrenic angle may represent small effusion and/or pleural thickening.

Output: Stable exam without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: worsening opacities; clarification of possible pneumothorax History: monitoring for change Skin fold at the right apex but no pneumothorax.Bilateral mainly lower zone nonspecific opacity compatible with effusions, atelectasis and possibly aspirated secretions.Tracheostomy tube and venous catheter unchanged.

Output: 1. Pleural effusions and atelectasis with possible aspirated secretions, not significantly changed.2. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Shortness of breath Persistent bilateral basilar bandlike opacities representing multilobar discoid atelectasis. No new abnormal lung parenchymal opacities are noted.The pleural spaces are within normal limits.The heart is normal in size.

Output: Persistent multilobar discoid atelectasis. No new abnormal lung parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.SOB and wheezing evaluate for pneumonia. No pleural fluid or pneumothorax. Small irregular nodular opacity in the left upper lobe, please refer to recent CT report. No new opacities to suggest pneumonia. Normal heart size. Left proximal glenohumeral prosthesis. Multilevel spina bifida occulta involving the upper thoracic spine.

Output: No signs of pneumonia. Left upper lobe nodular opacity was described on a recent CT.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evolving pneumonia? History: cough, shortness of breath. Increased right pleural effusion. New small left pleural effusion. Fibrotic changes in native right lung. Transplanted left lung without focal opacity.

Output: Increased right pleural effusion. New small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 59 year old male with ETT advanced 3 cm ET tube approximately 3 cm above the carina. Other support devices unchanged. Bilateral pleural effusions unchanged.Stable cardiopulmonary silhouette.

Output: ET tube 3 cm above the carina. No interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 51-year-old man with diffuse large B cell lymphoma. Status post chop/R. chemo with IT MTX on 7/27/06. Compare 3/3/08 CHEST:LUNGS AND PLEURA: No evidence of metastatic disease lung nodules or effusion.MEDIASTINUM AND HILA: No pathologic size nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate nonspecific hyperdensity right lobe, unchanged. Otherwise normal.SPLEEN: No evidence of splenomegaly or focal lesions.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple cyst left kidney. Some scarring posterior aspect right kidney unchanged.RETROPERITONEUM, LYMPH NODES: No pathologic size lymph nodes. Shotty nodes, unchanged. Atherosclerotic calcifications no aneurysm.BOWEL, MESENTERY: No pathologic size nodes. Previously measured small noted in the left mesentery is unchanged seen on series 3 image 119 measuring 8.6 x 4.2 mm. No evidence of ascites. Bowel normal.BONES, SOFT TISSUES: Sclerotic focus left aspect along the upper thoracic vertebral bodies, unchanged. Likely benign.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis. No adenopathy.BONES, SOFT TISSUES: Soft tissue density consistent with urachal remnant redemonstrated.

Output: No interval change. No pathologic size lymph nodes. Several other findings as above, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: ETT History: ETT New bilateral chest tubes, the left directed towards the apex, the right towards the mid lung with its side port well outside the pleural space.A pneumomediastinum is present extending into the neck and supraclavicular regions.Bilateral chest wall soft tissue emphysema noted.No large pneumothorax.An NG tube extends below the lower margin of the image.ET tube tip approximately 4 cm above the carina.

Output: Pneumomediastinum with no pneumothorax. Bilateral chest tubes noted above.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: worsening pulmonary effusions History: desaturating/hypoxia ET tube is been advanced with its tip now 2 cm above the carina.NG tube with tip in the margin image.Right IJ venous catheter with its tip in the SVC.Stable cardiac mediastinal silhouette.Diffuse interstitial opacities and pleural effusions similar in appearance to the prior exam.

Output: ET tube advanced with its tip 2 cm above the carina. Stable cardiopulmonary appearance with diffuse interstitial opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: patient with recent permacath placement and acute 3 gram hgb drop, assess for hemothorax History: as above Severe cardiomegaly.Gradually worsening interstitial and airspace opacities with basilar consolidation and pleural effusions.Right jugular catheter, tip at cavoatrial junction.

Output: Gradually worsening pulmonary opacities suggestive of edema with severe cardiomegaly and pleural effusions. No evidence of intrathoracic hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Reason: Concern for recurrent hydrothorax given new onset tachypnea, O2 requirement, tachycardia History: Ascites and hydrothorax s/p thora and para, now with SOB, on 2L O2, and HR 110s Large right pleural effusion with almost complete opacification of the right hemithorax and mediastinal shift to the left.Small amount of aeration in the right upper lobe.Mild interstitial opacity on the left suggestive of edema.

Output: Small amount of aeration in the right upper lobe and no other significant change in a large pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: FemaleReason for Study: Reason: h/o COPD and lung nodule, evaluate for PNA or pulmonary edema History: hypoxia Increased lung lines compatible COPD.Stable cardiomediastinal silhouette.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 38 years old Female. Reason: IABP placement History: poor augmentation. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Stable mild cardiomegaly. The right chest wall ICD electrode is stable in position. A metallic density is noted in the upper abdomen overlying the L3 vertebral body.

Output: Stable mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Chest pain There is a right apical opacity without definite evidence of volume loss on the right. Streaky bibasilar opacities, left greater than right, likely represents atelectasis/scarring. No large pleural effusion or pneumothorax. The heart size is normal. Unchanged leftward deviation of the trachea.

Output: Right apical opacity may represent a pleural/extrapleural mass or loculated fluid; malignancy is not excluded. CT of the chest with contrast is suggested for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: chronic cough productive of daily white/yellow sputum, eval for e/o infection or obstructive lung disease History: see above Mild cardiomegaly and a tortuous aorta.No specific evidence of infection or edema.Small to moderate size hiatal hernia.

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


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: Status post removal of R tunneled IJ HD line History: as above Interval removal of right central venous catheter. Interval placement of left catheter, the tip in projection of the aortic knob. No pneumothorax.Stable cardiomediastinal silhouette.Lungs clear.

Output: Interval removal of right central venous line. Interval placement of left vascular line, tip in projection of the aortic knob. Clinically assess position of the newly placed line. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: cardiopulm process History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: AMS, last chemo yesterday History: AMS, history of ovarian cancer Stable cardiomegaly and bilateral pleural effusions, left greater than right. Tortuous aorta. Right chest port catheter tip projects over the SVC. Left basilar atelectasis. No pneumothorax. No new focal consolidation.

Output: Stable bilateral pleural effusions and left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Operative History: SOB Moderate cardiomegaly with an aortic valve prosthesis in place.No sign of CHF or active pulmonary disease.

Output: Moderate cardiomegaly and aortic valve prosthesis with no acute findings.


Instruction: Generate impression based on medical findings.

Input: 68 years old Male. Reason: line placement, iabp History: n/a. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is a mild interstitial changes. ICD and right jugular Swan-Ganz catheter and Impella device unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: pre MRI, pacemaker patient. History: stroke, slurred speech- pre MRI Stable position left pacemaker. There is evidence of prior coronary arterial revascularization.Chronic blunting and elevation of the right hemidiaphragm. No interval edema, pneumothorax or evidence of infection. Heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: eval balloon pump placement History: balloon pump Bilateral pleural effusions unchanged.IABP catheter tip 5 cm below the top of the aortic arch. Other tubes and devices stable.

Output: IABP catheter tip 5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Reason: Severe CAD, Pre Op History: SOB Left ventricular predominant cardiomegaly.No consolidation, pleural effusion, or pneumothorax.

Output: Left ventricular predominant cardiomegaly. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with metastatic colon cancer CHEST:LUNGS AND PLEURA: Reference right lobe cavitary lesion now measures 3.1 by 1.7-cm on image number 74, series number 4. The cavitation raises same, however, is additional soft tissue posterior to this lesion which led to the increase in its size.Index left upper lobe cavitary lesion measures 5.2 by 3.8-cm image number 31, series number 4, slightly increased in size compared to previous study. Soft tissue component of this lesion has also increased in size.Index Linda Lancaster he mass measures 3.1 by 3.2-cm image number 42, series number 4. The size of the lesion stable, however, the amount of soft tissue is increased.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole simple renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal interval increase in the size of the solid the bilateral extensive lung lesions. Overall the amount of cavitation is decreased and the amount of soft tissue has increased within the lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: S/P TECAB, Lt SC emphysema History: None Minimal left apical pneumothorax and extensive left chest wall soft tissue emphysema.Left mid and lower lung zone atelectasis, increased.

Output: Small left pneumothorax with extensive left chest wall soft tissue emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Evaluate for pneumonia or bony abnormality. Midsternal chest pain and SOB. 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. The sternum is not visualized on this frontal image.Interval placement of low cervical and upper to mid thoracic spine fixation rods. These obscure the underlying mediastinal and skeletal structures which cannot be assessed.Cardiothoracic ratio appears mildly increased from the prior study.No visible pneumothorax or focal airspace opacity. Subsegmental atelectasis or scarring in the region of the lingula.

Output: Mild subsegmental atelectasis or scarring on the left, but no other acute pulmonary abnormality. Unable to exclude skeletal abnormality, suggest correlation with dedicated bone-technique sternal radiographs and PA and lateral chest films if required.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: Edema? History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval swan History: None Swan-Ganz catheter tip in the proximal right descending pulmonary artery.Marked cardiomegaly with moderate bronchial thickening but no specific evidence of pulmonary edema.Bullous emphysema at the right apex.

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


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: Daily CXR Iatrogenic devices are unchanged. Improvement in pulmonary edema. Confluent basilar opacities and pleural effusions unchanged. Unchanged cardiomegaly.

Output: Improvement in pulmonary edema. Confluent basilar opacities and pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: shortness of breath , on 5 litre of oxygen History: shortness of breath Left Port-A-Cath with its tip in the SVC.Decreased lung volumes with moderate cardiac enlargement.Increasing perihilar/basilar interstitial opacities compatible with edema.Right pleural effusion with right middle and lower lobe consolidation/atelectasis as well as underlying mass, and increased from the prior exam.

Output: Increasing right pleural effusion and right middle and lower lobe consolidation, atelectasis, underlying mass better appreciated on same-day CT.


Instruction: Generate impression based on medical findings.

Input: Female, 103 years old.Reason: worsening lower extremity edema in context of CHF History: lower extremity edema Increase in diffuse pulmonary opacities. Stable small pleural effusions, left greater than right. Unchanged cardiomegaly. No pneumothorax.

Output: Congestive heart failure, increased from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: ett History: ett Small lung volumes with basilar atelectasis and a small left pleural effusion.Mild cardiomegaly.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Unchanged basilar atelectasis which may be the result of aspirated secretions or mucous plugging. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: PACU, post op CXR History: PACU, post op CXR A second left chest tube inserted, the left pneumothorax now resolved.Left pleural effusion and post operative changes.

Output: Second left chest tube placed, alleviating a prior left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: sp heart txp History: - Two mediastinal drains have been removed. Swan-Ganz catheter has also been removed. Small right pleural effusion with question of small right-sided pneumothorax again noted. No new focal pleural parenchymal opacity. Unchanged cardiomegaly.

Output: Small right pleural effusion with question of small right-sided pneumothorax again noted. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: History of testicular cancer. R/o mets History: none Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: interval film for pleural effusion and BiVAD History: above Right internal jugular central venous catheter tip is in the right atrium. Enteric tube courses below the field-of-view. Interval removal of Swan-Ganz catheter. Additional support devices are unchanged.Large bilateral pleural effusions are not significantly changed. No pneumothorax.Bibasilar atelectasis.

Output: Unchanged bilateral pleural effusions with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: as above ET tube tip at the level of the carina. This is been corrected on subsequent radiographs.Increased aeration of the right lung.Other findings, unchanged.A more recent radiograph has been interpreted.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Lung transplant annual testing. Fibrotic appearing native right lung similar in appearance. No pleural fluid or pneumothorax. Transplanted left lung similar in volume and without acute abnormality. Normal heart size. Tortuous thoracic aorta.

Output: No acute pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Confirm central line placement History: s/p central line placement Pulmonary artery catheter tip in left lower pulmonary artery. Left central venous catheter tip at RA/SVC junction. ET tube and NG tube unchanged.Stable nonspecific basilar opacities likely due to edema or atelectasis.

Output: New left central venous catheter tip at RA/SVC junction.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Slight increase in basilar subsegmental atelectasis, otherwise unremarkable.Left subclavian ICD, leads unchanged in position.No significant pneumothorax.

Output: No pneumothorax following recent ICD placement.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: Evaluate for source of infection History: fever Heart size normal.Interval removal of left central venous catheter and placement of a right central venous catheter with tip in projection of superior vena cava. There is no pneumothorax.Low lung volumes with basilar atelectasis/scarring.No pulmonary opacities.

Output: Good position of central venous catheter. No pneumothorax.Basilar atelectasis/scarring unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: ICU survey; evaluate lines and lung fields History: s/p AVR Right IJ sheath has been removed.Decreased lung volumes with stable cardiomediastinal silhouette.Perihilar/basilar opacities unchanged.No new pulmonary opacities identified.Left chest tube and mediastinal drains removed. Right basilar chest tube unchanged.

Output: Interval removal of left-sided chest tubes and mediastinal drains without evidence of a pneumothorax or pneumomediastinum. Stable cardiopulmonary appearance with cardiomegaly and perihilar/basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.History of esophageal perforation status post stent placement. Bilateral chest tubes, enteric tube, and esophageal stent are unchanged.The cardiomediastinal silhouette is stable.The small right apical pneumothorax appears to have resolved. Small bilateral pleural effusions with patchy left lung opacities unchanged.

Output: Resolution of small right apical pneumothorax, otherwise stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Fever. Wheezing. New right upper lobe airspace opacity. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal in size.

Output: New right upper lobe pneumonia. Recommend follow-up to resolution.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with abnormal CT chest in 4/2010 with subpleuritic nodules and hepatic lesion. CHEST:LUNGS AND PLEURA: Multiple subcentimeter subpleural nodules are seen in the lungs bilaterally, unchanged from prior. No new lesions identified.MEDIASTINUM AND HILA: Hardware and metallic wires of intracardiac device are again noted, similar in position. The aorta is moderately calcified. Few mildly enlarged calcified right hilar nodes are unchanged and suggestive of prior granulomatous disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity is right hepatic lobe superiorly and likely represents benign cyst. Previously mentioned lesion in right hepatic lobe (series 13, image 82) shows discontinuous enhancement on arterial phase, and central filling in on portal venous and delayed images, compatible with cavernous hemangioma. Liver is otherwise, normal in appearance.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cyst in the left inferior pole, compatible with benign simple cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate vascular calcifications are noted.

Output: 1) Nonspecific subcentimeter subpleural lung nodules, unchanged. No new lesions2) Liver hemangioma.3) Simple renal and hepatic cysts.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Shortness of breath, evaluate for pneumonia Cardiomediastinal silhouette is unremarkable.No large pleural effusion or pneumothorax.Large lung volumes with chronic appearing changes in the bases without superimposed acute abnormalities.

Output: No acute abnormalities without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: ? CHEST PAIN History: ? PTX Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild atelectasis or scarring at the right lung base. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No pneumothorax. Mild atelectasis or scarring at the right lung base.


Instruction: Generate impression based on medical findings.

Input: Male, 91 years old.Bradycardia. Hypotension. Stable cardiomediastinal silhouette, with tortuous aorta.Large lung volumes compatible with COPD.Bibasilar streaky opacities compatible with bibasilar atelectasis/scarring.No specific evidence of infection or interstitial edema.New small pleural effusions.

Output: New small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old Reason: evaluate cardiac changes History: chest pain Right central venous catheter tip in the SVC, unchanged.The cardiomediastinal silhouette is normal.Persistent opacity and volume loss in the right lung base is compatible with atelectasis. No new pulmonary opacities to suggest infection.No pleural effusions.

Output: Persistent atelectasis with no new abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath. Bilateral pleural effusions, right greater than left, not substantially changed since prior examination when accounting for differences in technique and position.Again noted is near-complete collapse of the right. Basilar opacities in the left lung are unchanged.No pneumothorax.

Output: Bilateral pleural effusions with no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: post-op TECAB History: downtrending MAPs, concern for bleeding ET tube tip approximately 5 cm above the carina.Right IJ catheter tip in the right brachiocephalic vein.Bilateral chest tubes in place with small pleural effusions but no pneumothorax.Mild basilar atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Cough for a week with hemoptysis Large lung volumes. Right lower lobe nodular consolidation. Cardiomediastinal silhouette is normal.

Output: Right lower lobe nodular consolidation which may represent aspiration, pneumonia, hemorrhage, or tumor. Consider further evaluation with Chest CT.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: cough and rales at left base; eval for pneumonia History: cough/ rales Basilar atelectasis left greater than right, most likely aspirated secretions or mucous plugging.Unremarkable mediastinal contours and cardiac silhouette.

Output: Specific left base predominant subsegmental atelectasis. The differential diagnosis includes mucous plugging or aspirated secretions, infection or even pulmonary embolus.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: eval edema or effusion History: tachycardia Metallic valve occupies the mitral position. Sternotomy hardware remains well aligned.Infrahilar opacities compatible with subsegmental atelectasis. Left ventricular enlargement. No interval edema or pneumothorax.

Output: Persistent left ventricular enlargement with infrahilar opacities of atelectasis.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with anaplastic thyroid cancer new onset abdominal pain. Evaluate for abscess or appendicitis. CHEST:LUNGS AND PLEURA: Nodule right middle lobe series 7 image 40 slightly larger. Pleural-based nodules in the right base the largest of which is increased in size now measures 1.3 x 1.1 cm and 37 image 71. Elsewhere granulomatous disease left lower lobe. No effusions.MEDIASTINUM AND HILA: Granulomatous disease. Prominent mediastinal fat.CHEST WALL: Port-A-Cath left chest wall.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast.LIVER, BILIARY TRACT: No definite focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal mass with soft tissue fat and calcific components consistent with a myelo lipoma.There is a 2 x 1.2 cm right adrenal nodule which is near what a density likely represents an adenoma..KIDNEYS, URETERS: There is a left lower pole renal mass somewhat exophytic off the posterior aspect of the kidney measuring 5.9 x 4.6 cm is seen on series 5 image 132. It is about 22 Hounsfield units in density. Diagnosis of exclusion is renal cell carcinoma. There is no evidence of hydronephrosis.The right kidney has a small nonspecific hyperdensity along the lateral aspect of the mid kidney likely a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Oral contrast has progressed into the colon. On follow-up views there is better filling of some loops of small bowel in the right lower quadrant. There are tubular fluid density collections in the distribution of the distal ileum concerning for extraluminal contrast extraluminal collections with extensive fat stranding around them. These are be consistent with abscesses. Collection in the right lower quadrant seen on series 5 image 166 measures 11.5 x 6.4 cm. Other collection centered around image 161 and to the left of midline image 165 collection measures 5.9 x 4.8 cm. Given the lack of history of inflammatory bowel disease perforated appendicitis is a distinct possibility. It seems distinct and separate from the colon.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: As above. No free or loculated intraperitoneal fluid however.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: The extensive fat stranding and several loculated fluid collections in the distribution of the distal ileum with nonvisualization of the appendix in the right lower quadrant fluid collection abutting the cecum. These could represent abscesses secondary to perforated appendicitis.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.New PICC, assess line placement. A left upper extremity PICC terminates in the left brachiocephalic vein.No acute cardiopulmonary abnormality.

Output: Left PICC terminates in the left brachiocephalic vein.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lines/tubes/devices History: eval lines/tubes/devices Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly and lower zone opacities consistent with atelectasis and possibly edema or infection, unchanged from previous.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: Assess for pna History: persistent SOB Left pleural drain with a persistent left hydropneumothorax, pleural air diminished.Small lung volumes.Right jugular catheter, tip in SVC.

Output: Persistent left hydropneumothorax. No reliable evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female 52 years old Reason: r/o infiltrate or pulmonary edema History: Shortness of breath, dietary indescretion, ESRD Right central venous catheter tip in the right atrium. Nonspecific bibasilar opacities, likely representing effusions, atelectasis, and/or edema. Cardiac silhouette size is difficult to evaluate due to opacities.

Output: Bibasilar opacities likely due to effusions, atelectasis and edema.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: pna, pleural effusions, widedn mediastinum History: convulsions Lungs hypoinflated with basilar interstitial opacities and atelectasis and probable small pleural effusions. Stable mild cardiomegaly

Output: Lungs hypoinflated with basilar interstitial opacities and atelectasis and probable small pleural effusions. Stable mild cardiomegaly


Instruction: Generate impression based on medical findings.

Input: 55 year old female with colon cancer after sigmoidectomy CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst in the left lobe measuring 17 x 18 mm on image number 8, series number 3 is unchanged. Other smaller hypodense lesions in both lobes of the liver are also unchanged. No new lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node is unchanged measuring 9 x 6 km. Image number 107, series number 3. New left retroperitoneal lymph node measuring 12 x 7 mm image number 123, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral ovaries are unremarkable. Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval development of small left retroperitoneal lymph node. Other findings are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pretransplant evaluation. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Left axillary vascular stent.

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


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: r/o PNA History: cough x1 wk, fevers, chills Faint patchy nonspecific airspace opacity in the right midlung and right base may represent atelectasis, aspiration, or infection. Heart size normal. No pleural effusion.

Output: Faint patchy nonspecific airspace opacity in the right midlung and right base may represent atelectasis, aspiration, or infection.Findings communicated to ED at the time of final report.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: status right pleural effusion History: ciugh,mild dyspnea;known metastatic breast cancer Moderate size right pleural effusion and underlying atelectasis identified.The cardiac mediastinal silhouette is unremarkable.The left lung is clear.Multiple surgical clips in the right axilla.

Output: Moderate sized right pleural effusion most likely malignant in origin.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of malignant melanoma CHEST:LUNGS AND PLEURA: 3-mm right middle lobe nodule image number 57, series number 5, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Postsurgical changes in the right axilla.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with metastatic bladder cancer CHEST:LUNGS AND PLEURA: Mild emphysema and scattered bilateral micronodules are unchanged.MEDIASTINUM AND HILA: Index reference precarinal lymph node is stable measuring 1.3 x 1 cm image number 45, series number 3.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: Stable right percutaneous nephroureterostomy catheter with mild but unchanged right hydronephrosis and hydroureter. Stable small subcentimeter renal lesions.RETROPERITONEUM, LYMPH NODES: Stable mildly enlarged retroperitoneal lymph nodes. Index aortocaval lymph node measures 1 cm in diameter on image number 112, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:*PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystoprostatectomy. Ileal conduit is noted in the right lower quadrant.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Well-defined low-density lesion in the left gluteal subcutaneous area is unchanged on image number 168, series number 3 and measures 7 by 2.9-cm.OTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: sp ivc filter placement History: none No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.IVC filter seen at the inferior margin of the image.

Output: Uncomplicated IVC filter placement.


Instruction: Generate impression based on medical findings.

Input: Reason: line check History: line moved possibly Right jugular catheter tip in the SVC, not significantly changed.Tracheostomy tube and ICD leads also unchanged.Increased pulmonary inflation with diffuse nonspecific interstitial and airspace opacity compatible with edema, with small pleural effusions.

Output: Improved pulmonary inflation and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Respiratory distress Interval removal of the Swan-Ganz catheter, however the right jugular sheath remains extending into the upper SVC. Mediastinal chest tubes unchanged yet ETT removedDobbhoff projects beyond the inferior to the image.Underlying mixed enlarged airspace opacities in all 4 quadrants but greater on the right in a perihilar distribution appears progressed with larger effusions. Concern for continued edema over infection is suggested.

Output: ETT and Swan-Ganz catheter removed


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: L lung transplant 3 weeks History: none Residual left pleural effusion but decreased left basilar opacity suggestive of edema.Dense fibrotic native right lung unchanged.

Output: Improving left-sided edema and left pleural effusion, and no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: pneumonia, cardiomegaly, effusion History: continued palpitations, reported taking molly last night No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: cardiomegaly, widened mediastinum History: syncopal episode while drinking, 62F hx of HTN Technique limits evaluation. Within these limitations is no acute cardiopulmonary abnormality identified. No evidence of mediastinal widening.

Output: While technique limits evaluation, no obvious central widening or evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Neutropenic stem cell transplant patient with first neutropenic fever. No focal pulmonary infiltrates, pleural effusion, or pneumothorax.Cardiac silhouette is unremarkable.Right chest wall port is visualized, with tip in the SVC. There are surgical clips in the left chest wall.

Output: No cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: ? fever w/u History: ? PNA Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: history of breast cancer, new COPD diagnosis, please evaluate for s/s infection or cancer History: history of breast cancer, new COPD diagnosis, please evaluate for s/s infection or cancer Heart size normal, the aorta tortuous but consistent with age.No significant pulmonary or pleural abnormality.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 63 year old female, history of breast cancer, with pulmonary nodules and COPD. Evaluate for change in pulmonary nodules. LUNGS AND PLEURA: Severe, diffuse centrilobular emphysema.Previously noted right upper lobe nodule is smaller on axial image 40/105. Previously noted left upper lobe nodule has also decreased in size on axial image 24/105. Left lower lobe micronodule seen on the prior exam is no longer evident. Scattered additional micronodules are unchanged. No new nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: Aortic and coronary artery calcifications. The cardiac size is normal. No pericardial fluid.CHEST WALL: Previously noted right chest wall nodule measures 6 x 4 mm axial image 26/105 and has not changed.Status post mastectomy on the right.UPPER ABDOMEN: Numerous surgical clips are evident at the GE junction. Surgical clips in the gallbladder fossa.

Output: Interval improvement and/or resolution of several previously noted pulmonary nodules. Continuation of standard post cancer treatment follow-up intervals is suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Endotracheal tube advanced. Endotracheal tube between 4 and 5 cm above the carina. Stable cardiomegaly, small left pleural effusion and adjacent atelectasis. Enteric tube tip in the gastric antrum. Sternotomy hardware.

Output: Endotracheal tube between 4 and 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: ro pneumonia History: sob, prod cough, fever, known asthmatic Stable cardiomediastinal silhouette.Decreased lung volumes with mild basilar subsegmental atelectasis.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.SOB and chest pain question enlarged cardiac silhouette. Normal cardiomediastinal silhouette. The lungs are clear. No focal airspace opacities, pleural fluid or pneumothorax.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: why increased oxygen requirement? History: above No real change in left basilar opacity which can represent atelectasis, aspiration and/or pneumonia.Lungs otherwise clear.Heart size normal.No pleural effusion. No pneumothorax.

Output: Stable appearance of small left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: ICU, assess lung fields History: s/p sternal dehis s/p wound vac Tracheostomy tube tip within about 1 cm above the carina. Venous catheter is extending to the SVC and mediastinal drainsIn the midline. Small lung volumes with basilar atelectasis, not significantly changed.

Output: Basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: POD#2 s/p pleurectomy/decortication History: chest tubes Right chest tubes in place with a small persistent right apical pneumothorax.Basilar opacity consistent with atelectasis and effusions.

Output: Small right apical pneumothorax, unchanged or slightly decreased.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No cardiopulmonary banality given technique and semiupright portable positioning

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: fever, concern for infection Unremarkable cardiac and mediastinal silhouette.Catheter tip in the SVC.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Chest pain Moderate COPD changes without additional superimposed acute cardiopulmonary abnormality

Output: COPD without acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: hypoxia History: assess for pulmonary edema No change in patchy left-sided opacities and right lung subsegmental atelectasis. Heart size normal. No new findings.

Output: Stable pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval for interval change History: shortness of breath, choking sensation Unchanged cardiomegaly with an enlarging right pleural effusion and basilar atelectasis.Unchanged pacemaker leads.

Output: Cardiomegaly with increasing basilar opacities and an enlarging right pleural effusion. Findings, overall, suggestive of CHF/edema.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: IABP History: IABP No acute abnormality.Heart size upper normal.IABP catheter proximal marker projects over the aortic arch.Right subclavian ICD and left PICC unchanged.

Output: No change in support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval pneumonia History: HIV+, cough Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Chronic pain, contusion to chest wall No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 71-year-old female preprocedure ICD. Borderline cardiomegaly.Blunting of the right costophrenic angle may represent a small right pleural effusion or basilar scarring. Prominent pulmonary arteries are again observed, which raises the question of pulmonary hypertension. No pneumothorax. Moderate scoliosis.

Output: Small right pleural effusion or basilar scarring. Prominent pulmonary arteries raise the question of pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: assess hypoxia History: as above Cardiac silhouette is again nearly completely obscured.Multiple pulmonary nodules and masses again seen. Stable to slight increase in large left pleural effusion with associated atelectasis. Question trace right pleural effusion. No pneumothorax.

Output: Stable to slight increase in large left pleural effusion. No other significant interval changes.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Empyema History: Empyema Stable position of left apical pigtail pleural catheter. Persistent small left apical hydropneumothorax associated with pleural thickening, in keeping with history of empyema. The amount of fluid and air is stable from recent chest radiographs.Left upper lobe chronic volume loss again noted.The right lung is within normal limits.No right pleural effusion or right pneumothorax.Right upper extremity PICC terminates in the right subclavian vein.

Output: Stable size and appearance of left apical loculated complex hydropneumothorax (known empyema) with pigtail catheter in place.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT History: intubation ET tube tip approximately 3 cm above the carina.Bilateral pleural effusions, larger on the right, with underlying atelectasis. A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: s/p fall with left upper chest pain History: chest pain Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax. Moderate COPD. No displaced fractures.

Output: No acute cardiopulmonary abnormalities. Moderate COPD. No displaced rib fractures.


Instruction: Generate impression based on medical findings.

Input: ARF and systolic heart failure Tracheostomy tube, ICD and LVAD are all unchangedModerate nonspecific cardiomegaly with decreased lung volumes, moderate layered left effusion and suspected compression atelectasis of left lower lobe unchanged.

Output: Unchanged bilateral left over right suspected basilar atelectasis, with a moderate to large left effusion


Instruction: Generate impression based on medical findings.

Input: 20-day-old male status post PDA ligation. Evaluate lines and tubes.VIEW: Chest AP (one view) 3/12/15 ET tube tip is below the thoracic inlet. Right central line with tip at the right atrium. Nasogastric tube is present with tip and proximal sidehole in the gastric body. Interval placement of PDA ligation clip.Cardiac silhouette size is at the upper limits of normal. Bilateral diffuse airspace disease and pulmonary edema. There is a small amount of subcutaneous emphysema along the left chest. Hyperlucency in the left compared to the right and focal lucency in the left costophrenic angle probably represents a small pneumothorax.

Output: 1. Small left pneumothorax.2. Mild subcutaneous emphysema along the left chest wall.3. Airspace disease and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? acute pathology History: cough, uri, chest pain Unremarkable cardiac and mediastinal silhouette. Small lung volumes with some perihilar bronchial thickening but no specific evidence of pneumonia.Mild blunting of the left posterior costophrenic angle, most likely scarring but possibly a very small effusion.

Output: Mild blunting of the left posterior costophrenic angle but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.IABP dependent, check position. Moderate cardiomegaly. IABP marker projects 3.5 cm below the top of the aortic arch.Left subclavian single lead ICD. Right jugular Swan-Ganz catheter tip projects over the right main pulmonary artery.Faint nodular airspace opacity at the right lung base, approximately 3.5 cm in diameter.

Output: IABP marker projects 3.5 cm below the top of the aortic arch. Right basal airspace opacity suspicious for developing infection or blood products.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: Assess for new opacity History: cough, sob No significant cardiopulmonary abnormality.Bilateral ureterostomy stents.

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


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Status post CABG. Intermediate coronary syndrome. Cardiopulmonary monitoring and support devices similar in position. Mild elevation of the left hemidiaphragm with associated atelectasis. No pneumothorax.

Output: Mild left basal atelectasis and mild elevation of the left hemidiaphragm may be an early indicator of phrenic nerve impairment, follow up suggested.


Instruction: Generate impression based on medical findings.

Input: Evaluate for SBO versus colitis, altered mental status and abdominal guarding Partially imaged left-sided cardiac device with leads in right atrium, right ventricle and coronary sinus. Nonobstructive bowel gas pattern. Right-sided abdominal surgical clips. Spinal degenerative disease. Bilateral total hip arthroplasties. Small pleural effusions.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Increased oxygen demand and white count elevation No significant interval change in the previously observed diffuse nonspecific interstitial abnormality mildly greater both bases. Mild cardiomegaly with otherwise unremarkable mediastinal contours again observed. Specifically no new superimposed acute airspace process within these limitations.

Output: Unchanged nonspecific interstitial disease again of uncertain etiology without appreciable new superimposed focal acute process. Consider close cervical imaging to improve sensitivity, if suspicion remains high clinical


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: fever, eval for new infiltrates History: fever Enteric tube with its tip in the stomach.Decreased lung volumes with stable cardiomediastinal silhouette.Mild interstitial opacities similar to the prior exam.No new pulmonary opacities identified.No pleural effusions.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old. History of viral URI 4 months ago, weight loss, 30 pack year smoking history. Development of interstitial opacities suggesting fibrosis. Nodular density in the retrosternal clear space on the lateral view. No effusions.

Output: 1. Nodular density in the retrosternal clear space on the lateral view suspicious for mass. CT chest recommended. 2. Development of interstitial opacities suggesting chronic fibrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.History of type A aortic dissection. Status post dissection repair. Jugular catheters have been removed.Small to medium bilateral pleural effusions.Significant left lower lobe atelectasis unchanged.Wide mediastinum, compatible with history of aortic dissection repair.Normal cardiac silhouette size.

Output: Moderate effusions and significant left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Angina. TECAB Persistent mildly decreased volumes with small right effusion and basilar atelectasis. Questionable borderline cardiomegaly with scattered calcifications/granulomas previously observed.

Output: Questionable mild early failure, yet changes most likely represent small effusion and atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: cough greater 4 weeks History: Cough for 4 weeks Stigmata of previous granulomatous disease, as before. No focal lung consolidation or evidence of overt left-sided heart failure. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.Patient status post left shoulder replacement.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: Eval lung fields History: Desaturations Support devices unchanged.Stable cardiopulmonary appearance.Multifocal areas of consolidation and bilateral pleural effusions similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with extensive multifocal areas of consolidation and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: organ donation History: organ donation Increasing left basilar opacity suggestive of atelectasis.Lungs are unremarkable elsewhere and heart size normal for the AP view.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Increasing retrocardiac atelectasis which subsequently resolved.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: eval for CP, SOB History: hx of pericarditis, acute onset substernal chest pain, pain w inspiration, exertional dyspnea New ill-defined right upper lobe opacity could represent an early lung cancer and a thoracic CT is recommended for follow-up.Elsewhere, the lungs are unremarkable.Status post mitral valve repair.Cardiac silhouette unremarkable.

Output: New right upper lobe ill-defined opacity could represent an early lung cancer and a thoracic CT is recommended for follow-up.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: s/p R Hemothorax check pulmonary status History: s/p R Hemothorax check pulmonary status Tubes and lines are unchanged. Bilateral pleural effusions and perihilar edema redemonstrated with probable interval increase .Left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Increasing left pleural effusion and perihilar edema suggesting CHF/fluid overload.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: sob, pulm edema History: chf, cough Low lung volumes makes detailed cardiopulmonary assessment difficult. Unchanged cardiac lead. Increased basilar opacities, left greater than right. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Increased basilar opacities, left greater than right, likely atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: syncope x4, long QT hx History: passing out Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Cholecystectomy clips noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: congestion History: volume overload Small right pleural effusion and pleural thickening is unchanged. No pneumothorax. Upper lobe predominant emphysema is not significantly changed. Bibasilar subsegmental atelectasis. No focal pulmonary abnormalities. Cardiomediastinal silhouette is within normal limits.

Output: No significant change from prior examination with small right pleural effusion/pleural thickening.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out pneumonia History: desaturation Normal heart size with a moderately tortuous calcified aorta compatible with age.Elevated left hemidiaphragm with overlying opacity compatible with atelectasis and nonspecific consolidation,, unchanged.No specific evidence of pneumonia.NG tube with its tip in the gastric fundus.

Output: Small lung volumes with basilar atelectasis, unchanged. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.With chest pain. The cardiomediastinal silhouette is within normal limits. No pleural effusion. No pulmonary opacities. Lumbar levocurvature centered at the L2 vertebral body.

Output: No acute cardiopulmonary abnormality.