Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: s/p cardiac surgery, mediastinal tube History: above Small lung volumes with persistent left lower lobe consolidation small pleural effusions.Multiple chest tubes are in place, no pneumothorax.Right jugular Swan-Ganz catheter tip in the right main pulmonary artery.

Output: Small lung volumes with persistent left lower lobe consolidation small pleural effusions.Multiple chest tubes are in place, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history head and neck cancer. Evaluate progression. LUNGS AND PLEURA: Innumerable right lung nodules that have increased in both size and quantity. The largest nodule located in the right perihilar region now measures 14.7 mm (section 74/111), which has increased from 11.1 mm on the previous film.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in both size and quantity of the right lung nodules. Although uni-lateral metastatic lung disease is highly unusual, the appearance of the nodules is consistent with metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: eval for sarcoidosis or TB History: chronic anterior uveitis Decreased lung volumes.Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiac arrest History: cardiac arrest ET tube tip approximately 1 cm above the carina.Moderate cardiomegaly, unchanged.A more recent radiograph has been interpreted.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old. Status post intubation. ETT tip is at the carina/right mainstem bronchus. NG tube courses through the stomach, tip distal to the caudal margin of film.Heart size is top normal to mildly enlarged.No evidence of infection or edema.

Output: Low-lying ETT.


Instruction: Generate impression based on medical findings.

Input: Status post ICD placement rule out pneumothorax. Left subclavian ICD terminates in the position of the right ventricle. No pneumothorax. Mild basal opacity on the right most consistent with atelectasis.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Status post intubation. The endotracheal tube tip is approximately 3 to 4 cm above the carina. Additional supportive hardware is not significantly changed.Minimal basilar subsegmental atelectasis. No pneumothorax or significant pleural effusions.Stable cardiomediastinal silhouette.

Output: The endotracheal tube tip is approximately 3 to 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: evaluate for infiltrate or effusion History: abnormal ekg Chronic elevation or eventration right hemidiaphragm.Minimal scarlike opacity left lung base.No specific evidence of infection or edema.Status post sternotomy.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old. New left jugular catheter with its tip in the area of the SVC, directed laterally. Right jugular catheter and ICD leads unchanged.Severe cardiomegaly with basilar opacity compatible with atelectasis and small effusions.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 82 years old Male. Reason: worsening pleural effusions? History: continued need for O2. Mild cardiomegaly, bilateral pleural effusions and interstitial changes in the left mid and lower lung fields, unchanged as compared with prior examination. There is no evidence of pneumothorax. Surgical clips are seen in the upper abdomen. Patient is status post sternotomy.

Output: Cardiomegaly, bilateral pleural effusion and interstitial changes in the left lung, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: r/o infiltrate History: shortness of breath Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: eval infection, edema, effusion History: L sided chest pain worse w/ palpation, failure to thrive Left chest pacer leads unchanged in position.Stable cardiomegaly.Small pleural effusions and mild basilar interstitial opacity raises the question of mild edema.No focal airspace opacity. No pneumothorax.

Output: Small effusions and mild basilar interstitial opacities raise the question of mild edema. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Age: 35 yearsGender: FemaleReason for Study: Reason: chest pain History: worsening chest pain over the past 2 days, history of infected tooth with swelling 2 weeks. 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, 83 years old.Reason: ACS History: CP Low normal lung volumes with minimal basal atelectasis. No focal airspace opacities. Normal cardiothoracic ratio. Atherosclerotic calcifications of the thoracic aorta at the level of the arch. Degenerative changes of the spine with thoracolumbar scoliosis.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: sp RUL History: ptx Right chest tubes in place with a small pneumothorax, unchanged from previous.Right paramediastinal opacity with surgical sutures, compatible contusion and atelectasis.Mild opacity at the left base compatible with atelectasis and aspirated secretions.

Output: Postoperative findings with a persistent small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Chest pain for one week. Evaluate for pneumonia. The cardiomediastinal silhouette is normal.There is no pleural effusion, pneumothorax, or focal opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: pneumo? History: O2 sat high 80's low 90's sp ct removal Pleural effusions and left lower lobe atelectasis unchanged, with no pneumothorax following chest tube removal.

Output: No pneumothorax following chest tube removal. Unchanged opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: PICC placement. Right chest port tip overlies the superior vena cava. Left internal jugular venous catheter tip also overlies the superior vena cava. Right IJ port catheter is unchanged. Feeding tube is coiled in the stomach with tip overlaying the gastric antrum. Surgical clips project over the right upper quadrant of abdomen. No new PICC is identified.The cardiomediastinal silhouette is unremarkable. Left basilar streaky opacity likely atelectasis. No focal pulmonary opacity suggestive of pneumonia. No large pleural effusion. No pneumothorax.

Output: No new PICC identified in the provided FOV.Discussed findings with Dr. Zhang at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: preop eval to r/o pulmonary History: SOB No significant cardiopulmonary abnormality.No specific evidence of infection or edema.Right subclavian dual chamber pacemaker, leads in appropriate position.Vascular stent projects over the thoracic inlet.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: ETT advanced History: advanced ett to 30 at lips Atelectasis medially in the right lower lung zone is unchanged.Elsewhere, the lungs are unremarkable.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: pulmonary edema? History: hypoxia Stable cardiac mediastinal silhouette.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. Specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Chest pain. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: eval IABP placement History: femoral IABP IABP marker in the proximal descending aorta.IVC Swan-Ganz with its tip in the pulmonary artery.Stable cardiac enlargement.Right pleural effusion with basilar atelectasis/edema similar to the prior exam.No new pulmonary opacities identified.

Output: Interval placement of an IVP and Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with history of chest pain and CHF, evaluate for pulmonary edema Biventricular pacemaker leads unchanged position from prior exam. Stable cardiomegaly and tortuous aorta. Right coronary artery calcifications noted.Bilateral upper lobe airspace opacities not present on prior exam. Retrospective correlation with CT PE (7/29/15) consistent with pulmonary infarcts.

Output: Bilateral upper lobe opacities concerning for pulmonary infarcts, please refer to CT PE report (7/29/15) for further characterization.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: s/p esophgaectomy History: see above Right sided chest tube with its tip at the apex.Enteric tube with its side-port in the mid neoesophagus.Subcutaneous emphysema noted along the right lateral chest wall without evidence of a significant pneumothorax.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Acute right rib fractures related to recent thoracotomy.Partially visualized IVC filter.

Output: Postoperative chest without complications.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.CHF. Swan placement. Cardiomegaly with mild diffuse interstitial and small to medium bilateral pleural effusions suggesting CHF are stable. No pneumothorax. Right jugular Swan-Ganz catheter tip over the right descending pulmonary artery. Right PICC line tip over the SVC/RA junction. These are unchanged.

Output: Mild to moderate CHF pattern, stable. Swan-Ganz catheter unchanged over the right descending pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: swan History: swan placement Swan-Ganz catheter has been advanced into the interlobar pulmonary artery. Iatrogenic devices are unchanged otherwise. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: r/o pulmonary edema History: sob Stable cardiomegaly and small effusions. Vascular congestion is stable. No airspace opacities. No pneumothorax.

Output: Stable findings of cardiomegaly and small effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: rule out pneumonia History: respiratory distress, hypercarbia Right midlung bandlike opacities representing discoid atelectasis is unchanged from recent study.No new abnormal focal lung opacities are noted.Low-lying ET tube localized approximately 2 cm above the carina, stable in position. Consider slight retraction.Enteric tube courses below the diaphragm.The pleural spaces are within normal limits in this single AP projection.

Output: ET tube localized approximately 2 cm above the carina. Consider retraction 2 cm.Right midlung discoid atelectasis is unchanged from recent comparison.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Cough, chest pain and S.O.B. Normal cardiomediastinal silhouette. The lungs are well inflated and clear. No focal air space opacities, pleural fluid or pneumothorax.

Output: Normal chest. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly. Diffuse idiopathic skeletal hyperostosis. Large patient body habitus.

Output: Mild cardiomegaly. Clear lungs.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: s/p pleurex History: SOB Left hemithorax opacification is now complete with air bronchograms and pleural fluid despite a Pleurx catheter.Right hemithorax unremarkable.

Output: Increased opacification left hemithorax, now complete.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.ET tube. Evaluate for effusions. Rotation limits examination. Large lung volumes. No large pleural effusions or pneumothorax. ET tube tip terminates at the level of the thoracic inlet. Right central venous catheter tip terminates in the SVC. No significant interval change in size of the cardiomediastinal silhouette.

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


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Infiltrates History: Fever Increased left basilar opacity and pleural effusion with a left Pleurx catheter.Unchanged right pleural effusion and right basilar consolidation.

Output: Increasing left basilar opacity, infection possible, with bilateral pleural effusions and consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Left upper chest and axillary pain evaluate for infection or mass. Upper normal heart size. Unchanged appearance of the mediastinal silhouette. No pleural fluid or pneumothorax. Subtle old midthoracic vertebral body height loss, incompletely assessed as the patient is slightly angulated on the lateral radiograph.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval for pulmonary edema, consolidation History: high O2 requirement, crackles on exam, hepatic and renal failure Interstitial and airspace opacities suggestive of acute edema or atypical infection.Heart size normal.No large pleural effusions.Right jugular catheter, tip in SVC.

Output: Interstitial and airspace opacities suggestive of acute edema or atypical infection.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o pna History: sob, fever Multiple right upper lobe cavities unchanged but there may be more debris than before indicating enlarging mycetoma.COPD. No embolization coils projected over the right paratracheal region.

Output: Stable cavities but now more debris or enlarging mycetoma. Status post embolization.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old with history of fever, right gaze preference, altered mental status, evaluate for shunt function and position. SHUNT DEVICE: An intracranial shunt catheter exits through a right posterior parietal burr hole and courses down the soft tissues of the scalp, neck, anterior chest, and enters the peritoneal cavity where it loops and terminates in the mid-abdomen. No evidence of kinking or fracture along the radiopaque portions of the shunt catheter. The pressure valve notch now points anteriorly. SKULL: Two views of the skull demonstrate stable postoperative changes in the posterior parietal/occipital calvarium.CERVICAL SPINE: Two views of the cervical spine demonstrate mild multilevel degenerative changes at C5-6 and C6-7.CHEST: Stable cardiomediastinal silhouette without focal pulmonary opacity.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Unchanged shunt catheter without evidence of kinking or fracture along the radiopaque portions.


Instruction: Generate impression based on medical findings.

Input: Reason: neutropenic fever History: neutropenic fever 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: Age: 64 yearsGender: FemaleReason for Study: Reason: evaluate for infection History: sob Stable cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Cardiomegaly unchanged. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 55 years old Male. Reason: fluid overload vs infection History: SOB, o2 req. Apparent curvilinear lucency underneath the right hemidiaphragm and left hemidiaphragm is most consistent with pneumoperitoneum. This can be confirmed with upright and left lateral decubitus abdominal radiographs if warranted. Bibasilar atelectasis. No significant pleural effusions. No pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: Pneumoperitoneum.Findings were discussed with Dr. Chandni Patel by phone on 11/26/2015 at 2:45 AM. Bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval for effusion, pneumonia History: SOB Severe cardiomegaly compatible with 4 chamber dilatation. Abnormal contour of the superior left ventricle on the PA radiograph may represent either markedly dilated left ventricular chamber or aneurysm. Trace bilateral pleural effusions with lingular and left lower lobe subsegmental atelectasis. No active edema. Correlation to outside imaging is recommended. In the absence of such imaging, recommend echocardiography in the next step for further workup.

Output: Severe cardiomegaly with suggestion of 4 chamber dilatation. Correlation to outside imaging is recommended. In the absence of such imaging, echocardiography is recommended. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: post op History: acute changes ET tube tip approximately 6 cm above the carina.Right jugular catheter, pacemaker leads and left chest tube unchanged.Moderate cardiomegaly with basilar opacity compatible with atelectasis and aspirated secretions.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: 60 years, Male. Reason: Dobbhoff placement History: Dobbhoff Dobbhoff with tip in the distribution of the gastric antrum. Gaseous distention of the large and small bowel may represent a generalized ileus. The inferior pelvis is excluded from the field-of-view.Interval improvement in the bibasilar interstitial and airspace opacities compared to the recent chest radiograph. Small residual right pleural effusion.

Output: Dobbhoff with tip in the distribution of the gastric antrum.


Instruction: Generate impression based on medical findings.

Input: 32 year-old female with history of productive cough. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.The imaged osseous structures are unremarkable.

Output: Normal exam with no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Evaluate line position History: hypotension Median sternotomy with moderate cardiomegaly.Unchanged left lower lobe consolidation and left pleural effusion.New right jugular catheter, tip low in the right atrium.

Output: Low right jugular catheter. Persistent cardiomegaly, left lower lobe consolidation and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female 41 years old Reason: CP with back pain History: as above Cardiomediastinal silhouette not significantly changed from prior exam.Minimal bibasilar streaky opacities.No significant pleural effusions or pneumothorax.

Output: Mild basilar atelectasis without specific evidence of infection. No interval change from prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old evaluation for infiltration, CHF, hypoxia and SOB. Stable cardiomediastinal silhouette. Mild pulmonary vascular cephalization. No focal consolidation. No pleural effusion or pneumothorax.

Output: Findings suggest mild volume overload. No gross pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated patient, ARDS, aspergillus PNA History: Resp failure New left jugular catheter with its tip projected over the left side of the mediastinum, possibly in a persistent left SVC or left innominate vein.ET tube and right jugular catheter unchanged.NG tube tip projected over the T12 vertebra, compatible with location in a gastric interposition.Diffuse nonspecific airspace and interstitial opacity compatible with infection.

Output: ET tube in acceptable position. New left jugular catheter with slightly atypical location.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Eval for effusion and atelectasis History: S/P MVR Bilateral chest tubes but no pneumothorax after mediastinal drain removal.Improved basilar opacities.Swan-Ganz catheter removed.

Output: Improved basilar opacities and no pneumothorax after mediastinal drain removal.


Instruction: Generate impression based on medical findings.

Input: Reason: CP, SOB History: CP, SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old. New Swan-Ganz catheter with its tip in the main pulmonary artery.Right jugular catheter tip in the area of the right brachiocephalic vein and ET tube about 5 cm above the carina.Very large left pleural effusion with underlying compressive atelectasis. Smaller right effusion.A more recent radiograph has been interpreted.

Output: Large left effusion, possibly hemothorax. A more recent radiograph has been interpreted.


Instruction: Generate impression based on medical findings.

Input: Female 39 years old Reason: r/o edema/infection History: SOB. Left internal jugular central venous catheter tip is at the cavoatrial junction.Venous stent noted in the left axilla. Cardiac size upper limits of normal.Bibasilar opacities compatible with aspiration/edema/infection.

Output: Bibasilar opacities compatible with aspiration/edema/infection. In the appropriate clinical setting, this may represent multi-focal pneumonia.


Instruction: Generate impression based on medical findings.

Input: Confirm NJ tube placement NJ tube visualized with tip now seen in more advanced location when compared to prior imaging, located beyond ligament of Treitz. Small bowel loops clustered in central abdomen nonspecific but suggests underlying ascites. Relative paucity of large bowel gas.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Patient status post esophagectomy with anastomotic leak and revision right thoracotomy. Enteric tube tip beyond the field of view. Esophageal stent, chest tubes, and surgical staples unchanged.Cardiomediastinal silhouette stable.Small bilateral pleural effusions with adjacent atelectasis unchanged.

Output: Stable support devices, bilateral pleural effusions, and atelectasis.


Instruction: Generate impression based on medical findings.

Input: History of heart failure, hypoxia, crackles in bilateral bases on exam diminished breath sounds. Evaluate for pulmonary edema. Moderate to severe cardiomegaly. Left subclavian ICD leads are similar in position. Vascular unsharpness suggests mild edema. Dense right infrahilar consolidation new from prior. There is a radiopaque metallic foreign body projecting over the lower aspect of the right thorax which may be internal or external to the patient; a foreign body cannot be excluded. A follow-up radiograph is recommended.

Output: 1. Radiopaque foreign body projecting over the right lower lobe, recommend follow-up portable plain film as well as physical examination to confirm location. Dr. Scheade (4216) verbally notified at 10:00 a.m. on 12/29/2016.2. Dense right infrahilar consolidation, new from 2015. In the absence of clinical signs of infection, infarction or a mass cannot be excluded. This should be followed to complete reservoir radiographic resolution. CT may be considered if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: chest pain; cough History: chest pain, cough No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: assess for whether pneumothorax is increasing History: pneumothorax Small to moderate-sized left-sided pneumothorax again noted, not substantially different. Moderate amount of pneumomediastinum again noted. No substantial change in diffuse pulmonary opacities given differences in inspiration. Unchanged cardiomegaly.

Output: Small to moderate-sized left-sided pneumothorax again noted, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Reason: interval exam, hx of urothelial Ca History: interval survey exam Moderate cardiomegaly.Extensive coronary artery calcification.No significant pulmonary abnormalities.

Output: Mild cardiomegaly and coronary atherosclerosis with no acute disease.


Instruction: Generate impression based on medical findings.

Input: Reason: cp History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval effusions History: hypoxia, hypercapnia Bibasilar edema and pleural effusions, greater on the left. Increasing left lower lobe consolidation and atelectasis. No pneumothorax.

Output: Increasing left lower lobe consolidation and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: eval for infiltrate, PNA; hx of tongue CA History: productive cough Severe COPD.Slight increase in patchy right mid to lower lung zone opacities could represent aspirated secretions or either early infection.No sign of metastases.Bullet fragments remain over the right chest wall.Right jugular catheter tip in SVC.

Output: Severe COPD, and possible evolving infection or aspiration right mid to lower lung zone.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Left IJ dialysis catheter placement. Cardiomegaly with a mild edema pattern is stable. Right jugular Swan-Ganz catheter tip overlies the right main pulmonary artery. Interval placement of left IJ catheter tip overlies the left brachiocephalic. No pneumothorax.

Output: No pneumothorax status post placement of left IJ catheter with tip over the left brachiocephalic vessels. Mild edema pattern is stable.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Chest pain and SOB assess for pulmonary edema Left subclavian ICD unchanged in position. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.Unchanged multichamber cardiomegaly.Mild pulmonary vascular redistribution and septal thickening consistent with mild hypervolemia/edema. Mild pleural thickening on the left is unchanged. Poorly defined basal pulmonary nodule seen on the lateral radiograph. Does not appear to correlate with any of the previously seen lesions on CT of 1/16/2015 the larger of the other numerous subsolid nodules seen previously are only faintly visible by plain film and cannot be accurately assessed by this technique.

Output: 1. Cardiomegaly and signs of mild hypervolemia/edema.2. Multiple pulmonary nodules are very poorly visualized however there appears to be at least one new lesion. Differential considerations again include metastases, synchronous primary neoplasms or sarcoidosis/granulomatous disease.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Heart failure. Central ECMO cannulation, left femoral ECMO decannulation. Indication for RFO study: One large needle missing. No unexpected RFO.Cardiomegaly. Mediastinal widening may be the result of increased circulating blood volume and/or hematoma. Surgical drains, esophageal probe and ECMO cannulae in project over the mediastinum. Left subclavian ICD unchanged. Severe diffuse edema and dependent atelectasis. Layering pleural fluid on the left. ETT terminates about 2.5 cm above the level of the carina.

Output: Severe CHF. No unexpected RFO. Findings discussed with Dr. Song via telephone by the Radiology Resident on Call on 5/23/2016 at 10:30 PM.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: mild ARDS from H1N1 influenza, eval progression of bilateral opacities History: as above Exam is limited by respiratory motion.Stable cardiomediastinal silhouette.Low lung volumes with stable interstitial and airspace opacities suggestive of edema and layering effusions.

Output: Stable pulmonary opacities and layering effusions compatible with viral pneumonia and ARDS


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old. Shortness of breath. Evaluate for pulmonary edema. Severe stable cardiomegaly and postsurgical findings of CABG.Mild nonspecific interstitial opacities suggestive of edema, new from prior.No evidence of infection.

Output: Cardiomegaly with probable mild CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: F/U right lung consolidation History: Cough and hypoxia Small lung volumes with diffuse coarse interstitial opacity, greater on the right, not significantly changed over the past 2 days.The differential diagnosis includes bronchiolitis obliterans and infection.Surgical artifacts in the mediastinum consistent with a history of bilateral lung transplant.

Output: Severe diffuse interstitial opacity, new since 12/14/2015, for which a CT scan is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: air in drain History: same Left loculated hydropneumothorax larger than on the prior study with atelectasis of the left perihilar region.Enlarging right pleural effusion.Left pleural drain remains in place slightly withdrawn.

Output: Interval enlargement of left hydropneumothorax, and right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: Evaluate for CHF, verify ETT location History: CHF, fluid overload ET tube tip approximately 5 cm above the carina. Enteric tube tip is coiled within the stomach.Stable cardiomegaly. Bilateral perihilar airspace opacities compatible with edema have increased slightly since the prior exam. Bibasilar opacities due to combination of effusions, atelectasis and possibly aspiration are also more prominent than on the previous study.

Output: Moderate CHF with increasing basilar opacities due to a combination of effusions, atelectasis and possibly aspiration. Stable ET tube position.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Moderate nonspecific cardiomegaly superimposed upon mildly decreased lung volumes with a mixed chronic appearing interstitial opacity. No discrete superimposed new focal findings, however serial imaging will be important. Probable small left effusion

Output: Persistent small left effusion and cardiomegaly


Instruction: Generate impression based on medical findings.

Input: 50 year-old female. Mesothelioma. CHEST:LUNGS AND PLEURA: There are metastatic pleural implants are now seen in the right hemithorax, predominantly posteriorly. The largest measures 13 mm in thickness (series 3; image 65).Large right pleural effusion, increased.MEDIASTINUM AND HILA: Calcified left hilar and mediastinal lymph nodes remain.Reference cardiophrenic lymph node measures 24 x 12 mm, previously 20 x 8 mm (series 3; image 61). Internal mammary lymph nodes on the right have increased in size.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: A large cystic lesion with circumferential mural nodularity which impresses upon the dome of the liver has developed. This lesion may represent a cystic peritoneal mass versus loculated fluid with peritoneal metastases involving the peritoneal layers (series 80216; image 67).SPLEEN: Multiple granulomata. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 14 x 14 mm left adrenal nodule (series 3; image 101), unchanged.KIDNEYS, URETERS: Punctate nonobstructive left nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are seen.BOWEL, MESENTERY: Reference right upper quadrant soft tissue nodule measures 23 x 16 mm (series 3; image 91), previously 27 x 16 mm. Other scattered soft tissue deposits in the peritoneum, omentum and mesentery (for example, adjacent to the caudate lobe) are unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of ascites, stablePELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The peritoneum remains thickened in the lower pelvis. Rectosigmoid sutures.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Marked progression of pleural and peritoneal disease.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.History: left lung atelectasis Endotracheal tube terminates 4 to 5 cm from the carina. Unchanged port catheter. Marked improved left lung aeration. Diffuse left lung opacities likely represent edema. Left-sided pleural effusion and/or thickening is also present. No substantial change in right basilar pleural parenchymal opacity. Unchanged heart size. Enlarged loops of bowel again noted within the upper abdomen.

Output: Endotracheal tube terminates 4 to 5 cm from the carina. Marked improved left lung aeration with probable reexpansion edema.Enlarged loops of bowel again noted within the upper abdomen. Correlation with dedicated abdominal imaging is suggested when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: please eval for pulmonary edema History: shortness of breath LVAD and ICD leads are unchanged. Sternotomy hardware intact. Unchanged findings compatible with vascular redistribution. No pleural effusion or pneumothorax. Marked cardiomegaly, unchanged.

Output: Right cardiomegaly with improved lung volumes.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: change in mental status, assess for PNA History: altered mental status Low lung volumes without focal lung opacity, large pleural effusion, or pneumothorax. The heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: shortness of breath History: shortness of breath Mild cardiomegaly with pulmonary vascular redistribution.No specific evidence of infection or edema.No pleural effusions.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for acute cardiopulm abnormality History: cp Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: infectious w/u History: infectious w/u Streaky opacity affecting the right lower lung zone could be aspiration or infection.Ulcer the lungs are unremarkable.Heart size normal.Cervical spine stabilization hardware.

Output: Nonspecific right basilar opacity, suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusion History: sob Moderate right pleural effusion with underlying opacity compatible with atelectasis and consolidation.Mild subsegmental atelectasis in the left lower lobe.No pneumothorax or other acute change.

Output: Persistent right pleural effusion with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above The cardiomediastinal silhouette is normal in size.There are no pulmonary nodules or masses. No pleural effusion or pneumothorax.Degenerative changes affect the thoracic spine.

Output: No evidence of pulmonary metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.75-year-old female with hypoxia. Evaluate for pulmonary edema. Interval improvement in pulmonary opacities since the prior study, now nearly resolved. No specific evidence of edema.Cardiac silhouette normal in size.

Output: Interval improvement since the prior study. No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: pna History: code sepsis No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: h/o copd, cad, pm for complete heart block, stent placement 10/26 p/w chest pain History: chest pain, sob x 3 days No significant cardiopulmonary abnormality.Median sternotomy for CABG.Left subclavian pacemaker, leads unchanged in position.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Pain and swelling, rule out pneumonia. Chest pain Knee: Near severe osteoarthritic changes largely tricompartmental but greater in the medial compartment again observed and grossly unchanged. Moderate knee effusion with a minimally inferiorly displaced patella and questionable small new fragment along the superior aspect, within compared to the limited prior exam (4/3/13).Chest: Mildly decreased lung volumes although this may be partially due to portable technique. Minimal atelectasis without discrete superimposed focal air space abnormality. Borderline cardiomegaly also likely partially exaggerated however serial imaging is indicated if suspicion is high for a cardiovascular process

Output: 1. No gross chest acute abnormality within limitations provided. Consider serial imaging.2. Questionable patellar acute fracture again limited in evaluation, consider serial imaging to confirm following correlation with physical exam and suspicion


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Asthma and intubated, outside hospital transfer. ETT 3 cm above carina. Right peripherally inserted catheter tip projects over the right brachiocephalic vein. Nasogastric tube tip off the caudal margin of the film.No focal pulmonary opacities. No pneumothorax.

Output: No acute pulmonary abnormality. Appropriate position of endotracheal tube. Right PICC is cranial to the level of the SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: pneumonia, cardiomegaly, effusion History: productive cough and congestion x 1.5 weeks Low lung volumes.Lungs clear.Heart size normal.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: FemaleReason for Study: Reason: cat p History: productive cough Cardiac size is normal.Marked tortuosity aorta.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Cough for a month with yellow expectoration,Short of breath History: Cough with Yellow expectoration for a month ,Short of Breath Blunting of the left costophrenic angle suspicious for subsegmental atelectasis. No other evidence specific for infection. Cardiac mediastinal silhouette is unremarkable.

Output: Blunting of the left costophrenic angle suspicious for subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Chest pain evaluate for cardiomegaly. Normal heart size.Sternotomy wires.Bronchial wall thickening, most pronounced in the lower lung zones.Small clustered dense nodular opacities in the anterior right upper lobe nonspecific, but could reflect impacted distal airways. Probable granuloma on the left.No specific signs of CHF.Diffuse osseous sclerosis consistent with history of myelofibrosis.

Output: Normal heart size. Nonspecific bronchial wall thickening with probable debris in the airways. This could be due to an acute process such as bronchitis or aspiration or a chronic low-grade infection such as MAI.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Altered mental status over 2 days, seizure. CLL, SCT with graft-versus-host disease. Right jugular chest port with tip overlying the right atrium.Lung volumes remain low. Hazy opacity in the left lung may reflect debris within the airways. Atelectasis or scarring in the right middle lobe.

Output: Hazy branching opacities suspicious for aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p CABG Small lung volumes with basilar atelectasis and consolidation, unchanged.Swan-Ganz catheter tip in the right main pulmonary artery.Aortic balloon catheter with its tip in the descending aorta at the level of T7.

Output: Basilar atelectasis and consolidation with no acute change.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with history of sickle cell disease and leukocytosis. Evaluate for pneumonia. Cardiomegaly for age. No focal pulmonary opacity, pleural effusion or pneumothorax. Scattered subsegmental atelectasis/scarring, unchanged. Osseous changes of sickle cell disease are again noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: Pt w/ worsening SOB. History: Worsening dyspnea. Hx of lung cancer. Known right upper lobe nodule and right hilar lymphadenopathy.No specific evidence of infection or edema.

Output: Known right-sided lung cancer, but no acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 79 years, Male. Reason: r/o obs History: abd pain Chest:No focal air space opacity, pleural effusion, or pneumothorax. Large lung volumes suggestive of COPD. Cardiomediastinal silhouette is within normal limits.Abdomen:Dilated loops of small bowel in the left hemiabdomen, measuring up to 4.3 cm in diameter. No evidence of free intraperitoneal air, pneumatosis intestinalis or portal venous gas. Surgical suture projects over the right hemiabdomen. Equivocal cortical irregularity of the right femoral head/neck junction.

Output: 1. Focally dilated loop of small bowel in the left hemiabdomen is nonspecific, but can be seen in early partial small bowel obstruction versus focal adynamic ileus.2. Equivocal cortical irregularity of the right femoral head/neck junction. Clinical correlation is recommended. Further evaluation with a right hip radiographs could be considered if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Sepsis evaluate for pneumonia. Patchy airspace opacities most pronounced in the right upper lobe, suspicious for pneumonia.

Output: Multifocal opacities suspicious for pneumonia.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: Reason: R VATS exploration; hx of large right hilar tumor and left apical tumor History: oxygen requirement Extensive bilateral opacities compatible with tumor with a right pleural effusion and pleural thickening, not significantly changed.Interstitial opacity at the left base suggestive of edema and atelectasis.Subcutaneous emphysema on the right.

Output: Extensive pulmonary and pleural abnormalities with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: Post-op study. Eval for effusion, infection, edema History: Post-op aortic aneurym repair Moderate cardiomegaly with an ectatic aorta.Moderate bilateral pleural effusions with basilar atelectasis.A small sharply defined nodular opacity projected over the right lung base probably corresponds to a cutaneous or external nodular opacity seen on the lateral view.

Output: Cardiomegaly with pleural effusions suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with history of dermatomyositis, abdominal and chest pain. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate wall thickening involving the proximal SMA for a long segment causing more than 50% stenosis. IMA and celiac trunk are patent.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: Significant stenosis of the origin of the SMA.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.AML undergoing treatment. History of CHF evaluate for infection or effusion. Chronic elevation of the left hemidiaphragm. Low lung volumes. Right chest port unchanged in position. No focal airspace opacities, pleural fluid or pneumothorax. Degenerative changes of the spine.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: s/p retropleural exposure for spine surgery History: none No new focal lung consolidation. No pleural effusion or pneumothorax. No acute bony abnormality. Post surgical changes again noted in the upper abdomen. Increased dilation of bowel loops within the upper abdomen.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: re-evaluate pulmonary edema and pleural effusion History: hypoxia, new O2 requirement Port catheter tip in the SVC.The cardiac silhouette is enlarged but stable. Aortic arch calcifications noted.There is a moderate left pleural effusion with adjacent consolidation, stable from the prior exam when accounting for technique. Prominent perihilar vasculature is noted and stable.

Output: CHF pattern with left pleural effusion and adjacent atelectasis, stable from the prior exam accounting for technique.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: r/o acute process History: s/p Right lung transplant 2009 Stable cardiomediastinal silhouette. Calcified aortic arch.Low lung volumes with redemonstration of left lung architectural distortion, pleural thickening and scarring, unchanged.No acute osseous abnormality.

Output: Stable appearance of the chest with chronic left lung architectural distortion, pleural thickening and scarring.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with cough. Evaluate for fever. Moderate right pleural effusion increased from prior study with adjacent atelectasis/consolidation. Left lung is clear. No pneumothorax. Borderline cardiomegaly.

Output: Increasing right pleural effusion with adjacent atelectasis/consolidation, infection or excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old. Reason: eval lung fields History: post-op cardiac surgery Right IJ sheath unchanged in position.Stable cardiomegaly.Persistent low lung volumes with nonspecific basilar opacities compatible with atelectasis and effusions, similar to prior. No pneumothorax.

Output: Unchanged basilar opacities compatible with atelectasis and effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Increasing SOB, DOE, productive cough. Normal heart size. Large lung volumes suggestive of COPD/emphysema. Mild to moderate bronchial wall thickening, most pronounced in the left lower lobe. Focal pleural calcifications right upper lobe

Output: Signs of COPD/emphysema and bronchitis.


Instruction: Generate impression based on medical findings.

Input: Reason: assess pulm edema History: resp failure ET tube tip approximately 3 cm above the carina. Diffuse bilateral mainly interstitial opacity compatible with edema/ARDS with probable underlying emphysema.No new findings.

Output: Unchanged diffuse opacity compatible with edema/ARDS but not specific, with underlying emphysema.


Instruction: Generate impression based on medical findings.

Input: Chest tube removed Right chest tube removed without evidence of associated new complication. Small lung volumes persist with additional unchanged diffuse largely reticular abnormalities and small effusions greater on the right

Output: Right chest tube removed


Instruction: Generate impression based on medical findings.

Input: Left lower lobe wedge resection for adenocarcinoma Postsurgical changes in volume loss with basilar scarring without evidence of superimposed new abnormality. Specifically no plain film findings to support evidence of recurrence. Biapical scarring again observed.Cardiac and mediastinal contours within limits with and moderate atherosclerotic changes of the aorta

Output: Stable unchanged postsurgical changes from a left lower lobectomy


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: line palcement History: ecmo Right IJ venous catheter, impella device, and ECMO catheter unchanged.Cardiac enlargement with increasing perihilar edema.Left retrocardiac atelectasis redemonstrated.No large pleural effusions.

Output: Cardiomegaly with increasing pulmonary edema. Support devices unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Uveitis. Evaluate for signs of sarcoidosis. No focal bony opacities, pleural effusions, or pneumothorax.Cardiomediastinal silhouette is within normal limits. Tortuous aorta.

Output: No evidence of pulmonary sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: lung eval History: lung eval Hemithorax opacification unchanged.Interstitial and airspace opacities throughout the right lung are stable suggestive of edema.Left jugular catheter, tip in SVC.

Output: No change in complete left hemithorax opacification and right-sided edema.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: febrile, immunosuppressed History: febrile Port catheter, unchanged. Bibasilar atelectasis or scarring again noted. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Colon cancer now with abdominal pain, nausea, constipation. Rule out obstruction. CHEST:LUNGS AND PLEURA: Interval increase in the size of the left upper lobe nodule to 5-mm on image number 24/87. Retrospectively this nodule can be seen on the previous CT but only measuring 2-mm. Subsegmental small atelectasis in the left lower lobe is unchanged.ill-defined groundglass opacity adjacent to the pleura in the right lower lobe is nonspecific and may represent small atelectasis.MEDIASTINUM AND HILA: Bilateral filling defects in the lower lobe pulmonary arteries consistent with emboli.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Metastatic lesions have significantly increased in size. Representative index lesion within segment 6 of the liver now measures 4.7 x 3.4 cm. The peripheral lesion in the segment 6 now measures 5.9 x 2.2 cm. multiple new mostly perihepatic metastatic lesions are present peritoneal carcinomatosis. Been increase in size and number. Previously measured metastatic nodule anterior to the left lobe now measures 14 x 13 mm.SPLEEN: No significant abnormality noted.PANCREAS: The low attenuation focus adjacent to the pancreatic tail has increased in size now measuring 25 x 27 mm.. This likely represents peritoneal carcinomatosis or less likely a pancreatic metastases.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal carcinomatosis has significantly progressed and developed with interval increase in the size and number peritoneal nodules and increase in the thickening of the omentum. Right lower quadrant omental mass on image number 125 now measures 43 x 54-mm. This same mass was measuring 3 x 3.6-cm on image number 136/214 on 12/1/2007. This mass also invades the anterior abdominal wall. Mildly dilated focal segments of small bowel loops are seen in left lower quadrant measuring up 3.2-cm. There are no carcinomatosis encases the bowel loops in the pelvis. Stool is present in the colon. Oral contrast passes to the level of the distal ileum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: Bladder is displaced inferiorly by a small loculated fluid collect in the midline pelvis measuring 6.4 x 2.9 cm. Extensive peritoneal thickening is associated with this loculation of peritoneal fluid. Small amount of ascites is also present around the liver.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel loops, sigmoid and rectum in the pelvis are encased by extensive peritoneal carcinomatosis. No evidence of free air to suggest perforation.BONES, SOFT TISSUES: In the midline pelvis there is an omental mass invading the anterior abdominal wall which is increased in size compared to previous CT. Multiple other metastatic soft tissue nodules are seen in the anterior abdominal wall.OTHER:

Output: Bilateral pulmonary embolus as described above.Interval progression of disease with increase in the size of the left upper lobe lung nodule, peritoneal carcinomatosis, liver and abdominal wall metastases.Focal dilatation of the left lower quadrant small bowel loops likely secondary to extensive peritoneal carcinomatosis.Dr. Chu was notified about these findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 51 year -old male with metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Index right middle lobe pulmonary nodule measures 8 by 6-mm image number 106 on series number 4.Left lower lobe index nodule measures 12 x 11 mm image number 242, series number 4. They have not changed in size and number significantly.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Unremarkable.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific, small hypodense lesion in the liver on image number 89, series number 3 is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Soft tissue nodules in the nephrectomy bed are stable. Larger one measures 21 x 11 mm image number 114, series number 3.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion in the L3 vertebral body is unchangedOTHER: 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: Female 74 years old Reason: h/o right nephrectomy, needs screening cxr for placement to rehab STAT History: Evaluate for intrathoracic process, evaluate for tb Right chest port tip in the SVC.The cardiac mediastinal silhouette is unremarkable. Mild opacity at the left lung base compatible with either atelectasis or small effusion. No abnormal pulmonary opacity to suggest infection.No pneumothorax.

Output: No evidence of bacterial pneumonia or tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Concern for aspiration pneumonia. The cardiac and mediastinal contours are within normal limits.No abnormal lung parenchymal opacities to suggest aspiration pneumonitis or aspiration pneumonia.The pleural spaces are normal.The visualized portion of the VP shunt catheter overlying the left anterior chest wall is intact, without evidence of discontinuity or kinking.Thoracolumbar scoliosis again noted.

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


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: malignant pleural effusion History: none Right pleural drain unchanged.Interval decrease in right pleural effusion.Nodular opacities in the left midlung are new.Stable cardiomediastinal silhouette.

Output: Interval decrease in right pleural effusion in the presence of a pleural drain. New nodular opacities in left lung are mildly improved compared to the recent CT dated 6/3/2015 and may be related to aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: pulled chest tube, looking for pneumo History: none Interval removal of left chest tube. Previously noted very small left apical pneumothorax has nearly completely resolved. Swan-Ganz catheter is been removed. Other findings stable.

Output: Interval removal of left chest tube. Previously noted very small left apical pneumothorax has nearly completely resolved.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. Right-sided chest tube is been placed with its tip directed at the apex.Significant improvement in the right sided pneumothorax with a very minimal amount of residual apical pneumothorax identified.Remaining support devices unchanged.Cardiac enlargement with interstitial edema similar to the prior exam.Right pleural effusion with loculation at the right apex.

Output: Double placement right-sided chest tube with significant reduction in the previously noted pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Acute leukemia PICC placement. Right impression the PICC tip at the SVC/RA junction. Lung volumes remain low. Small pleural effusions with associated compressive atelectasis; opacity in the left costophrenic angle slightly larger but remains nonspecific, differences could be related to patient inflation. Hazy opacities suggestive of edema and atelectasis elsewhere.

Output: Right PICC tip at the SVC/RA junction. Mild hypervolemia/edema. Subpleural consolidation in the lateral aspect of the lingula is most likely chronic, possibly organizing pneumonia, however given lack of remote prior examinations, serial radiographic follow up with plain films is suggested to exclude rapid change which may indicate a superimposed active process such as infection.


Instruction: Generate impression based on medical findings.

Input: 23-year-old male with shortness of breath and wheezing. Cardiac silhouette is within normal limits.Mild peribronchial thickening.No abnormal focal pulmonary opacity.No pneumothorax or pleural effusions.

Output: Mild peribronchial thickening compatible with asthma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Rule out infection Chronic right upper lobe volume loss with groundglass opacity surrounding a small nodule similar to previous.No pleural fluid or signs of pulmonary edema. No new focal airspace opacities

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pulm edema History: sob Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.History of testicular cancer. Evaluate for metastatic disease. No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: SOB, eval for PNA/fluid overload History: SOB, eval for PNA/fluid overload Marked cardiac enlargement is again identified.Increasing pulmonary vascular redistribution, pulmonary edema, and pleural effusions compatible with CHF.No focal areas of consolidation.

Output: CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with pancreatic islet cell cancer with metastases to liver. Please evaluate for interval change. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Coronary calcifications.CHEST WALL: Healing right ninth rib fracture, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic lesions are again identified, not significantly changed in size. No new lesions are seen. A reference lesion at the dome measures 3.1 x 2 .9 cm, previously 3.3 x 2.4 cm. Adjacent postsurgical changes are again identified.Cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Stable pancreatic atrophy and ductal dilatation. Pancreaticojejunostomy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left hilar cysts remainRETROPERITONEUM, LYMPH NODES: 15 x 10 mm lymph node in the mesentery which time its arterial enhancement, not significant changed (series 10; image 70), previously 16 x 11 mm.BOWEL, MESENTERY: Partial colectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Fever Persistent small bilateral pleural effusions with mild basilar changes suggesting atelectasis. Minimally improving aeration although this may be partially due to improved technique and two view fully upright imaging.Unchanged right jugular dialysis catheter

Output: Improved aeration with persistent small effusions and mild cardiomegaly. No discrete focal pulmonary finding to substantiate concern for pneumonia


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: post-biopsy chest radiograph History: post-biopsy chest radiograph Stable to marginal increase in size of mass within the upper aspect of the right lung measuring 5.2 cm in the side-to-side direction compared to 5 cm previous study. There is increased hazy opacity within the mid aspect of the right lung which could certainly represent biopsy changes. Left lung remains clear.

Output: Stable to marginal increase in size of right suprahilar mass, consistent with lung cancer.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Fevers, evaluate for pneumonia. Worsening bibasal atelectasis. No specific signs of pneumonia. No visible pleural fluid. There is an unusual curvilinear lucency projecting to the right of the inferior heart border which has been present on prior examinations and is suspicious for localized air trapping. Given the patient's age, this is most likely congenital such as a cystic adenomatoid malformation or congenital emphysema.

Output: Worsening basal atelectasis. Hyperlucency of a right basal pulmonary segment has been present on multiple prior films in retrospect and is most likely congenital.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#1 Increasing bilateral upper lobe predominant air space opacification.Lobulated pleural thickening bilaterally has increased on the left, and may indicate a hematoma or hemothorax.Bilateral chest tubes unchanged.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter tip in main pulmonary artery.ECMO cannula unchanged.

Output: Worsening pulmonary opacities and lobulated pleural thickening suggestive of hematoma or hemothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.With chest pain. No pneumothorax or pleural effusion. Cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year old female status post chest tube exchange. Evaluate for pneumothorax. Left sided chest tube now looped in the left apex.Enlarged lung volumes compatible with COPD. Left upper lobe nodular opacity correlates with that seen on CT. Left sided pneumothorax appears increased now approximately 5 cm from the chest wall. No right pneumothorax. No pleural effusion. Cardiomediastinal silhouette is unremarkable.

Output: Interval change in position of the chest tube with increasing left sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: daily am CXR History: n/a Two right chest tubes with no significant pneumothorax. Increased pulmonary opacities possibly edema.An NG tube traverses a gastric pull-up, unchanged.ET tube tip approximately 5 cm above the carina.Upper abdominal drain likely an enterostomy.

Output: Increased pulmonary opacities. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: where is central line? History: central line Unchanged pulmonary opacities and right pleural effusion.New left jugular catheter crosses the midline retrograde into the right brachiocephalic vein.Tracheostomy tube tip approximately 4 cm above the carina.

Output: Left jugular catheter, crosses the midline but extends retrograde into the right brachiocephalic vein and should be repositioned.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: SOB History: Hemothorax Right pleural effusion and/or thickening compressing the right lung unchanged.No pneumothorax.Mild subsegmental atelectasis left lower lobe.Stable cardiomediastinal silhouette

Output: No change in right pleural effusion with associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: s/p Redo AVR History: SOB Cardiomegaly.Right hemithorax volume loss with right pleural fluid or thickening, unchanged.Unremarkable left lung.

Output: Cardiomegaly with a right pleural effusion and right hemithorax volume loss.


Instruction: Generate impression based on medical findings.

Input: Osteomyelitis and past cardiomegaly No cardiopulmonary abnormalityCholecystectomy clips

Output: Normal exam, specifically no cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: evidence of infection History: febrile, searching for infection. Gets chemo every other week so immunosuppressed. Just vomited a few hours ago so could have pneumonitis. Patchy airspace opacity in both lower lung zones are consistent with infection or aspiration. Heart size normal.Large lung volumes are suggestive of COPD.Right jugular catheter, tip in SVC.Gastrostomy tube identified.

Output: Multifocal pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: follow up effusion History: none Large right pleural effusion slightly smaller than on prior radiographs.Persistent right mid to lower lung zone compression atelectasis, slightly improved.Left lung unremarkable.

Output: Improvement in right pleural effusion. No pneumothorax if a thoracentesis has been performed.


Instruction: Generate impression based on medical findings.

Input: Reason: multifocal PNA History: multifocal PNA Large right upper lobe and right lower lobe cavities, similar to recent previous radiographs, consistent with necrotizing pneumonia.Catheter tip in the SVC.NG tube tip in the gastric antrum. No new findings.

Output: Large right upper and right lower lobe cavities consistent with necrotizing infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pleural effusion History: pleural effusions Tracheostomy tube and catheters unchanged.Large pleural effusions with underlying atelectasis.No new findings.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: lung Ca, status of pleural effusion History: shortness of breath Large right pleural effusion occupying over one half of the right hemithorax volume, compressing the right middle and lower lobes.Left lung subsegmental atelectasis or scarring.Heart probably enlarged but partially obscured.

Output: Large right pleural effusion compressing right lung base.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: chest pain History: ro mass Left-sided shot fragments.Focal left lower lung zone nodule, possible lung cancer.No specific evidence of infection.Heart size upper normal.

Output: Left lower lung zone ill-defined nodule, consistent with an early lung cancer. A thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.History: Shortness of breath and cough. Stable cardiomediastinal silhouette with tortuous aorta.Mild pulmonary vascular redistribution, bilateral lower zone interstitial opacities, and mild peribronchial cuffing, compatible with early CHF.No focal pulmonary opacity.

Output: Findings suggestive of CHF. Chest findings with ED physician at 3:00 PM.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with prostate cancer status post two cycles of chemotherapy. CHEST: LUNGS AND PLEURA: Stable mild right lower lobe bronchiectasis. Bilateral mild emphysema, more prominent in the upper lobes. MEDIASTINUM AND HILA: No significant lymphadenopathy.CHEST WALL: No significant abnormality noted ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted SPLEEN: No significant abnormality noted PANCREAS: No significant abnormality noted ADRENAL GLANDS: Small left adrenal nodule is unchanged. KIDNEYS, URETERS: Small left renal cysts are unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Stable right lower quadrant ileostomy with herniation of nonobstructed bowel loops through the ostomy. BONES, SOFT TISSUES: No significant abnormality noted PELVIS: PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: The urinary bladder is collapsed around a suprapubic catheter. Bladder wall is thickened.LYMPH NODES: No significant abnormality noted BOWEL, MESENTERY: No significant abnormality noted BONES, SOFT TISSUES: No significant abnormality noted

Output: Stable examination without evidence of recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath The lungs and overall volume remain mildly decreased without specific focal pulmonary or new mediastinal abnormality. The cardiac silhouette remains borderline to mildly nonspecifically enlarged. No definite effusions.Left PICC line again terminates in the mid subclavian

Output: PICC line unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: Pt is a 38 yo male w/ hx of myelofibrosis; pre-allo sct evaluation History: evaluate No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Somnolence Unchanged low lung volumes and large diaphragmatic hernia with adjacent atelectasis. No large pleural effusion or pneumothorax. Stable cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: OSH line placement History: OSH line placement No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Decreased lung volumes, with mild basilar atelectasis and possible edema in the left lower lung zone.Small right pleural effusion.Left jugular catheter, tip in left jugular/subclavian junction region.

Output: Left jugular placement described above. Postop basilar opacities and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Marked cardiomegaly with ICD leads in place, unchanged from previous. No pneumothorax or other complications. Mild basilar scarring.

Output: ICD leads in appropriate locations with no visible complication.


Instruction: Generate impression based on medical findings.

Input: Encephalopathy. Check for pneumonia No cardiopulmonary abnormality. Note is made of a stimulator projects over the left mid chest wall with extension towards the left lower neck, unchanged.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: post-op History: post op Right IJ sheath in place. PICC terminates in the RA. Endotracheal tube terminates 5 cm from the carina. Multiple ECMO catheters and bilateral chest tubes noted. Diffuse pulmonary opacities and small pleural effusions again noted. No definite pneumothorax. Moderate cardiomegaly, as before.

Output: Lines and tubes, as above. Persistent diffuse pulmonary opacities and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: AMS x1 day (unresponsive, now combative), poor historian, eval for signs of infection History: pls see above Small lung volumes with moderate cardiomegaly and basilar interstitial opacity compatible with subsegmental atelectasis and possibly mild edema.Superior mediastinal widening compatible with lymphadenopathy, unchanged.No evidence of pneumonia.

Output: Possible CHF but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: FemaleReason for Study: Reason: trapezius pain History: trapezius pain The cardiomediastinal silhouette is unremarkable.Mild pleural and parenchymal scarring at the right lung base unchanged.No new pulmonary opacities identified.No evidence of pleural effusions.

Output: No acute cardiopulmonary abnormalities identified. Interval improvement in the interstitial opacities and pulmonary vascular redistribution.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: 83yo F w/ SCLC, assess interval change in lung fields History: as above Bibasilar opacities and reticulation again noted. Small pleural effusions. Unchanged heart size. PICC line again noted overlying the lateral right hemithorax. No pneumothorax.

Output: Unchanged bibasilar opacities and reticulation with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 67 year old female with metastatic breast cancer 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: Multiple hemangiomas in the liver are unchanged from previous study. Punctate hypodense lesions in the liver are also unchanged compared but they are too small to accurately characterize. Cholelithiasis unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions involving the thoracic vertebral bodies representing metastatic disease, unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: desats -- please rule out aspiration pneumonia History: see above AICD, LVAD, right internal jugular venous catheter, and sternotomy sutures are unchanged.The cardiac silhouette is enlarged but stable.Bilateral basilar predominant air space opacities have increased compared to the prior examination and there is increased bibasilar consolidation with pleural effusion.

Output: Worsening CHF pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval for infiltrate/edema History: sob, known CHF Cardiomegaly but no evidence of significant pulmonary edema.

Output: Cardiomegaly but no evidence of significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: chest pain History: cough, sob Subtle right upper lobe opacity is not substantially changed compared to last study and has improved compared to more remote studies. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Subtle right upper lobe opacity is not substantially changed compared to last study and has improved compared to more remote studies. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Lung cancer, status post chemotherapy completed more than one year ago. Complains of abdominal discomfort from the front to the back. CHEST:LUNGS AND PLEURA: Right lung radiation fibrosis is unchanged. Scattered micronodules are also unchanged. No new nodules or masses. Interval development of right pleural scarring medially. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Right-sided Port-A-Cath in place with its distal tip in the SVC. Stable collaterals about the right subclavian vein with attenuation of the contrast column in the SVC raises the question of SVC occlusion or thrombus.Cardiac size is normal. No pericardial fluid.Right paratracheal lymph node is slightly smaller, measuring 0.9 x 1.1 cm (36/132), previously measuring 1.0 x 1.3 cm. Right perihilar lymph node is grossly unchanged measuring 1.3 x 0.9 cm (image 48/32), previously measuring 1.4 x 0.9 cm.CHEST WALL: New collapse of the T7 and T8 vertebral bodies.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small left renal hypodensities unchanged probably representing benign cysts.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic focus in the L1 vertebral body is unchanged. Sclerotic focus in the right ilium is partially visualized.

Output: 1.New thoracic compression fractures. 2.Otherwise stable CT.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: Evaluate for metastatic disease History: History of osteosarcoma The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormality identified without interval change. No evidence of metastatic disease .


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: central line placement History: as above Right jugular catheter tip in the area of the inferior vena cava. This is been adjusted on the subsequent radiograph.Cardiomegaly and chronic interstitial disease, unchanged.

Output: Catheter tip in the IVC.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with shortness of breath in this dialysis. Evaluate. Cardiomediastinal silhouette is normal. No focal pulmonary consolidation, pleural effusions, or pneumothorax. No opacities to suggest pulmonary edema.

Output: No evidence of infection or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: eval of gastropleural fistula leak/effusion History: R chest tube Right Port-A-Cath, right-sided chest tubes, and esophageal stent unchanged.Embolization coils again identified in the right hemithorax.Stable cardiomediastinal silhouette.Right pleural effusion and right basilar consolidation similar in appearance to the prior exam.Foci of pleural air noted at the right lung base.Postsurgical changes involving the right lateral chest wall.

Output: Support devices unchanged. Stable cardiopulmonary appearance with right pleural effusion/thickening and basilar consolidation/cavitation.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: FemaleReason for Study: Reason: sp extubation, prev concern for vap in rll, eval for interval change History: see above ET tube has been removed.NG tube with its tip in the stomach.Right IJ venous catheter with its tip in the SVC.Stable cardiac enlargement with decreased lung volumes.Right basilar subsegmental atelectasis unchanged.No new pulmonary opacities identified.

Output: Interval extubation. Right basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube History: chest tube Chest tube extending to the right apex with no significant pneumothorax.Small lung volumes with diffuse interstitial lung disease which has been previously characterized by CT scan.

Output: Right chest tube in place with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: pna? History: sirs Basilar predominant interstitial opacities are suggestive of edema or aspiration, with focal consolidation medially behind the heart both bases.Very small left pleural effusion likely.Large lung volumes suggest COPD.Right subclavian dual-chamber pacemaker leads are in adequate position.Cholecystectomy clips noted.

Output: Basilar opacities suggestive of edema or aspiration. There may be pneumonia in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Female; 59 years old. Reason: 45 year hx of smoking, cough, subjective chills, rule out PNA, malignancy. Normal cardiac silhouette. Questionable faint opacity in the left upper lobe may represent artifact vs early infection. No pleural effusion or pneumothorax. No displaced rib fractures.

Output: Questionable faint opacity in the left upper lobe may represent artifact vs early infection. Follow up PA/lateral chest radiographs suggested in 1-2 days to further evaluate.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Tracheostomy tube, Dobbhoff and left jugular sheath are all unchangedPersistent cardiopulmonary appearance of the diffuse nodular pulmonary opacities and pleural effusions mildly greater on the left. Concern for edema again remains high without definite new superimposed focal airspace process.

Output: Extensive pulmonary unchanged opacities again suggesting edema


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: Infiltrates History: fever Interval removal of right subclavian central venous catheter.Right PICC, tip in axilla.Moderate cardiomegaly, unchanged.Likely residual small bilateral pleural effusions.Left lower lobe airspace opacities, suggestive of infection.Diffuse degenerative changes of the visualized osseous structures.

Output: Unchanged cardiomegaly with new left lower lobe airspace opacities, suggestive of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: s/p LUL wedge VATS. Assess lung expansion History: s/p LUL wedge VATS. Assess lung expansion 15 mm left apical pneumothorax, left chest tube.No other significant abnormality.

Output: Small left apical pneumothorax, not visible on the prior study.


Instruction: Generate impression based on medical findings.

Input: Female 31 years old Reason: Dilator interval change in apical loculated collection History: Tachycardia, high CVP ET tube 2 cm above the carina. Bilateral chest tubes, Swan-Ganz catheter and chest port are unchanged in position. Median sternotomy hardware is again noted.Loculated right pleural effusion with associated atelectasis/consolidation, unchanged. Left basilar atelectasis, similar to prior exam. No new focal opacity.

Output: Unchanged support devices, and cardiopulmonary appearance including loculated right effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.History of acute leukemia. Prestem cell transplant evaluation. Right jugular catheter tip terminates in the SVC. No focal airspace opacity, pleural effusion or pneumothorax.The cardiomediastinal silhouette is within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: EKG abnormality Improved overall aeration without acute pulmonary abdomen. Underlying moderate emphysematous changes similar to baseline exam in mid 2015.No cardiac or mediastinal contour abnormality

Output: Improved aeration baseline appearance


Instruction: Generate impression based on medical findings.

Input: Check ETT ETT remains 4 cm above the carina. NG tube projects beyond inferior edge of the image. Right jugular catheter terminates in the upper SVCMild cardiomegaly with nonspecific patchy opacities in both lung bases with large effusions greater on the right with possible loculation

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: post-thoracic surgery day 1 History: post-op Support devices unchanged.Marked widening of the mediastinum compatible with postoperative changes related to aortic aneurysm repair.Pulmonary opacities, more marked on the left, similar to the prior exam.No new pulmonary opacities identified.

Output: No interval change in the support devices and cardiopulmonary postoperative appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: r/o pneumothorax, chest tube removal History: s/p chest tube removal No substantial change in moderate-sized right hydropneumothorax status post removal of right-sided chest tube. Calcified nodular lesion again noted at the left lung base. Right-sided subcutaneous emphysema again noted. Otherwise, no substantial difference.

Output: No substantial change in moderate-sized right hydropneumothorax status post removal of right-sided chest tube.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p right VATS with washout and pleural biopsy, pathology negative for malignancy History: none Moderate residual right pleural effusion that may be loculated or organized, slightly decreased from previous, with underlying atelectasis.Heart size about upper normal with ICD leads in place, unchanged. No new findings.

Output: Moderate residual right pleural effusion, decreased from previous.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: r/o pneumonia History: cough,fever Decrease lung volumes with extensive subpleural fibrosis as well as subpleural areas of consolidation/atelectasis similar in appearance the prior exam.Blunting of the right costophrenic angle compatible with small effusion and/or pleural thickening.No new pulmonary opacities identified.Stable cardiomediastinal silhouette.

Output: Stable diffuse changes of pulmonary fibrosis without an acute abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.History of shortness of breath, evaluate for pleural effusion. Gas-distended loops of small bowel and colon are seen.The cardiomediastinal silhouette is normal.Hazy groundglass opacities are noted throughout the upper lobes. A nodular opacity is seen in the right lower lung and there is an area of consolidation in the peripheral left midlung. No large pleural effusions.

Output: Hazy bilateral upper lobe pulmonary opacities along with more focal area of consolidation in the left lung and nodule in the right lung. Given patient's history, enhanced CT is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: serial exam after clamping chest tube, post-op History: serial exam Nasogastric tube has been removed. Other lines and tubes, unchanged. Small left apical pneumothorax, unchanged. Unchanged left-sided pleural parenchymal opacities. Unchanged heart size.

Output: Small left apical pneumothorax, unchanged. Unchanged left-sided pleural parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute process, pt POD #5 from lung transplant History: SOb, cough Small right apical pneumothorax, and small pleural effusions, not significantly changed.Mild residual basilar opacity compatible with edema and atelectasis.

Output: Resolving edema with small effusions and small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Cough productive of green sputum, history of COPD. Emphysema with flattening of the diaphragm. Normal heart size. No pleural fluid or pneumothorax. Left shoulder and humerus prosthesis.Patchy distribution, very faint hazy opacities bilaterally in the lung periphery nonspecific but have an appearance similar to the abnormalities seen on the last CT. This may be the result of bronchitis, possibly with very early bronchopneumonia.

Output: COPD with signs of bronchitis, possibly with very early bronchopneumonia, but beyond the resolution of plain film for definitive diagnosis. Plain film follow-up may be obtained in 7-10 days if required.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: PNA? History: cough, rhonchi Small lung volumes.Interstitial opacities in the left lower lung zone may be the result of underinflation artifact versus aspirated secretions.Heart size normal.Residual contrast material is seen in the colon, and there are cholecystectomy clips.

Output: Nonspecific left base interstitial opacities versus artifact, aspiration in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: r/o pna History: cough, mucous Stable cardiomediastinal silhouette.Interval improvement in left retrocardiac atelectasis.No new pulmonary opacities noted.Bullet fragments are again identified in the right hemithorax.Severe scoliosis redemonstrated.

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


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval lung fields History: s/p CABG Endotracheal tube tip is approximately 3 cm above the carina. Other iatrogenic devices are unchanged in position.Left retrocardiac opacity and left effusion are unchanged. No focal lung opacity on the right. No pneumothorax. The heart size is stable.Right upper quadrant surgical clips and distended loops of bowel within the abdomen.

Output: 1. Stable cardiopulmonary appearance and positions of iatrogenic devices.2. Distended loops of bowel.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with shortness of breath. Rule out pneumothorax. Cardiomediastinal silhouette is unremarkable.Cavitary lesion seen on CT is not clearly identified on the radiograph, however is likely still present. No consolidation, pneumothorax, or pleural effusion.

Output: Cavitary lesion seen on CT is not clearly identified on the radiograph, however is likely still present. No other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Chest pain. Evaluate for pneumonia and CHF. The cardiomediastinal silhouette is within normal limits. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: history of liver transplant History: asymptomatic Bilateral central venous catheters, enteric tube, and right-sided chest tube unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Nonspecific basilar and perihilar opacities compatible with edema, atelectasis, and small effusions.No new opacities identified.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: pna? edema? History: chest pain The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: No acute cardiopulmonary disease.