Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Please verify PICC placement. Left-sided PICC line projects over the left axilla and does not extend centrally. Repositioning should be considered. Heart size is at the upper limits of normal. No pleural or pulmonary abnormalities. No pneumothorax.

Output: Left-sided PICC line does not terminate centrally and projects over the left axilla. Repositioning should be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: swan placement History: swan placement Moderate cardiomegaly status post sternotomy.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter tip still in the right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.IABP catheter distal tip 2 cm below the top of the aortic arch.

Output: Cardiomegaly without pulmonary edema. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: s/p chest tube History: s/p chest tube Left chest tube unchanged in position with no pneumothorax and stable mild chest wall soft tissue emphysema.Left lower lobe consolidation and a left pleural effusionAre unchanged. Right basilar opacity is improved.Left PICC, tip in the SVC.

Output: Unchanged left chest tube with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 49 year-old with abdominal abscess. Evaluate fluid collection. ABDOMEN:LUNG BASES: Left basilar atelectasis has resolved.LIVER, BILIARY TRACT: No evidence of intrahepatic biliary ductal dilatation. No focal liver lesions. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes of the stomach and proximal small bowel with two anterior abdominal drains as noted previously. Right lower quadrant ostomy.BONES, SOFT TISSUES: Lumbar spine degenerative changes, unchanged.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Previously noted pelvic fluid collection has nearly completely resolved after catheter placement. OTHER: No significant abnormality noted

Output: Pelvic fluid collection described previously has nearly completely resolved after catheter placement.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: eval lung fields History: AMS Increased volumes with stable cardiomediastinal silhouette.Minimal scarring/discoid atelectasis at the lung bases.No focal consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: assess for pna History: leukocytosis Enteric tube terminates out of the field-of-view. Small bilateral residual pleural effusions with adjacent atelectasis. Iatrogenic device within the soft tissues of the left hemithorax. No new focal pulmonary opacity. The cardiomediastinal silhouette is within normal limits.

Output: Small bilateral pleural effusions with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: Dobhoff positioning History: s/p dobhoff advancement by 4 cm No significant change in position of the nasogastric tube and Dobbhoff tube, both in the distal stomach. The stylette from the Dobbhoff has been removed. Other findings stable.

Output: No significant change in position of the nasogastric tube and Dobbhoff tube, both in the distal stomach.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: evidence of infection History: sob Rightward shift of the superior aspect of the trachea again noted, consistent with thyroid mass/nodule. No new focal pulmonary opacity. Biapical pleural parenchymal scarring again noted. Heart size at the upper limit of normal. No pleural effusion or pneumothorax. Aortic atherosclerosis.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.SOB question infection/edema. History of metastatic RCC. Left peripherally placed catheter terminates in the ipsilateral axillary vein. Right subclavian stent. Right hemithorax volume loss with elevation of the hemidiaphragm and a large loculated apical extrapleural/chest wall collection which appears larger in this projection with absence of the medial and the right clavicle at the location of a large chest wall mass. Patchy opacities bilaterally consistent with nodules/masses and consolidation as seen on a subsequent CT scan.

Output: No signs of pulmonary edema. Please refer to separately reported chest CT regarding pulmonary lesions and right chest wall/extrapleural space occupying process.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: rule out infection History: leukocytosis Unchanged left lower lobe consolidation with small pleural effusions and subsegmental atelectasis right lower lobe.Heart size normal.Left renal staghorn calculus.

Output: Unchanged left lower lobe consolidation with pleural effusions, either atelectasis from mucous plugging or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Oxygen requirement. Evaluate for aspiration pneumonia. Interval increase in bilateral multifocal pulmonary opacities, especially in the left lung, which are may represent continued aspiration. Stable small left pleural effusionRight IJ line terminating in the left brachiocephalic vein. Tracheostomy tube noted. Surgical clips in the left neck and axilla.

Output: Interval worsening of bilateral multifocal pulmonary opacities, consistent with worsening pneumonia due to continued aspiration. Right IJ line terminating in the left brachiocephalic vein, consider repositioning.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: Adenocarcinoma No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Intubation Motion degrade sensitivity.ETT remains 4 cm above the carina. NG well advanced and beyond the inferior edge of the imageMarked nonspecific cardiomegaly with persistent scattered opacities representing suspected atelectasis however detail is obscured and limited. Effusions cannot be excluded

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old. Reason: intubated, eval ET tube History: Resp failure Exam is limited by motion artifact.Left central venous catheter with tip in the SVC. Interval removal of right central venous catheter.ET tube tip 6 cm above the carina.Enteric tube is difficult to visualize however the tip appears to be in the distal esophagus. Recommend advancing.Right upper and lower lung opacities with right pleural effusion are not significantly changed.

Output: 1. Persistent right lung opacities. 2. ET tube tip 6 cm above the carina.3. Enteric tube tip appears to be in the distal esophagus. Recommend advancing.


Instruction: Generate impression based on medical findings.

Input: Intubation Swan-Ganz again projects into the right pulmonary outflow tract. IVP is 5 cm below the aortic arch. Bilateral chest tubes and mediastinal chest tubes are unchanged along with numerous cannula projected over the mediastinum with 2 radiopaque markers from suspected packing.ETT terminates 2 cm above the carinaPersistent small lung volumes with moderate cardiomegaly. Prosthetic aortic valve. No overt new projected airspace gross abnormality.

Output: Mediastinal and chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Preop LV lead. Cardiomyopathy. Left subclavian ICD with leads in the right atrium, the right atrial appendage, 2 leads in the RV and a coronary sinus branch lead. Pulse generator appears portion of the left upper lobe which cannot be assessed.Bilateral pleural effusions. Consolidation in the left lung base and extensive interstitial and airspace opacities elsewhere consistent with severe acute pulmonary edema. Follow-up radiographs to assess for clearance of opacities in the left base recommended to exclude superimposed infection.

Output: Severe acute edema pattern. Recommend serial radiographic follow-up to superimposed infection in the left lung base.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: evaluate for pneumothorax History: chest pain x2 days Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax. No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Evalute for pneumonia History: Persistent cough and shortness of breath, recent ICU admission for asthma, history of pulmonary embolism, asthma Anterior chest wall is not included on the lateral radiograph, limiting evaluation. Postsurgical changes right chest wall. 4 cm faint spherical opacity overlying the right lower chest may be external to the lung parenchyma, possibly related to the nipple. The heart size is normal. No pleural effusion or pneumothorax. IVC filter projects over the upper abdomen.

Output: 4 cm faint opacity overlying the right lower chest may be external to the bony thorax, please correlate with physical examination. Follow-up imaging can be obtained using nipple or skin markers for confirmation if required. No additional pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: h/o worsening dyspnea, eval for worsening hf History: see above Swan-Ganz catheter terminates within the right pulmonary artery. Other iatrogenic devices, unchanged. Mild pulmonary edema. Mild patchy bibasilar opacities noted. No large pleural effusion or pneumothorax. Unchanged moderate cardiomegaly.

Output: New mild pulmonary edema and increased patchy bibasilar atelectasis and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: Swan History: swan Left-sided ICD, left PICC line, and right IJ Swan-Ganz catheter is unchanged.Stable cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Support devices unchanged. Stable cardiac enlargement without acute abnormality otherwise.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: Interval change in pulm opacities, location of RVAD cannulae History: s/p RVAD placement Cardiomegaly status post sternotomy with chest tubes but no pneumothorax.Unchanged mild basilar edema with pleural effusions.A Dobbhoff tube terminates in the stomach.Unchanged ECMO cannulae.Left jugular Swan-Ganz catheter tip in main pulmonary artery.ICD and LVAD unchanged in position.

Output: No change in support devices, or in pulmonary edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: ChylothoraxVIEW: Chest AP Mediastinal surgical clips, epicardial pacer leads and pacemaker device again noted. Left pulmonary artery stent unchanged. Multiple mediastinal surgical clips and right chest tube again noted. No focal lung opacity. There is a small right-sided pleural effusion. No evidence of pneumothorax.

Output: Minimal right pleural effusion not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: assess effusions, assess for evidence of rib pathology History: volume overload, rib pain Bilateral pleural effusions, left greater than right, slightly increased. No evidence of rib fracture given limits of technique.

Output: Bilateral pleural effusions, left greater than right, slightly increased. No evidence of rib fracture given limits of technique.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Cough and fever Pronounced confluent mixed interstitial and airspace opacity in the left upper lobe compatible with suspected pneumonia. Remaining lungs are clear. No significant effusions. Cardiac and mediastinal contours are within limitsPager 4480 paged

Output: Left upper lobe pneumonia


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: ett, pulm status History: ett Right IJ central venous catheter tip in the SVC. Interval removal of ET tube.Cardiomegaly unchanged.No large pleural effusions. No pneumothorax. Interval improvement of pulmonary edema. Bilateral lung base streaky opacities, likely subsegmental atelectasis.

Output: Interval improvement of pulmonary edema. Bilateral lung base streaky opacities, likely subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: fever, compare to previous CXR and chest CT History: fever No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: MaleReason for Study: Reason: Pt with newly dx'd AML prior to treatment regimen History: Evaluation of disease status prior to treatment regimen 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, 87 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Subtle nodularity in the lungs, increased from 10/2014. No pleural effusion or pneumothorax normal heart size. Stable left hilar fullness compared to previous study from 4/2015. Aortic calcification again noted.

Output: Question of slight increase in subtle nodularity since 2014. Consider correlation with chest CT.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with bladder cancer CHEST:LUNGS AND PLEURA: Subcentimeter nodules in the lungs unchanged.MEDIASTINUM AND HILA: AP window adenopathy is stable measuring 17 x 8 mm in image number 38, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left kidney is absent. No evidence of recurrence on the right side.RETROPERITONEUM, LYMPH NODES: Paracaval lymph node is stable measuring 11 by 8mm image number 143, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy with neobladder.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic ill-defined lesion involving the right ischium is unchanged. Etiology is unknown. Metastatic disease cannot be excluded.OTHER: No significant abnormality noted

Output: Stable CT exam without any significant change from pre-splint.On scan is recommended for further evaluation of the right ischial lesion which may represent metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: R/o PTX s/p thora History: T1RF Unchanged right pleural effusion, possibly improved in the left effusion.Decreased right basilar atelectasis.No significant pneumothorax.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.Unchanged skeletal metastases.

Output: Improvement in right basilar atelectasis and left pleural effusion. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old. Right IJ Swan-Ganz with its tip in the right pulmonary artery.Decreased lung volumes with stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.

Output: Right IJ Swan-Ganz are unchanged with tip in the right pulmonary artery. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Pt with respiratory failure, SOB, desaturation History: Desaturation on trach collar, secretions, SOB Support devices are unchanged in position.Partial clearing of previous opacities at the right mid zone. The remaining diffuse airspace and interstitial opacities favoring ARDS are otherwise unchanged. Small bilateral pleural effusions. No interval pneumothorax. Heart size is upper limits normal.

Output: Partial resolution of previous right mid zone opacities superimposed on likely ARDS.


Instruction: Generate impression based on medical findings.

Input: Reason: intubation/ aspiration pneumonia follow up History: as above ET tube tip approximately 5 cm above the carina.Venous catheters unchanged.Extensive atelectasis and consolidation in the right lower and middle lobes, compatible with aspiration, unchanged.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: EKG change Mild cardiomegaly with additional vascular redistribution and patchy nonspecific mixed interstitial and airspace changes greater on the right and in the right lung base. Mildly elevated hemidiaphragm may represent old scarring difficult to confirm without prior exams, however a more acute process such as infarcts, aspiration or even infection must also be considered superimposed upon mild edema

Output: Nonspecific mixed changes greater on the right and within the lung base. See details provided


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of IABP placement and shortness of breath. Interval placement of IABP with marker projecting in the proximal descending aorta. Interval placement of Swan-Ganz catheter with tip projected deep into a right interlobar pulmonary artery which can lead to infarction. Postsurgical changes from median sternotomy.Loculated right pleural effusion, questionably improved. Stable cardiomediastinal silhouette.

Output: Interval placement of IABP with marker projecting in the proximal descending aorta. Interval placement of Swan-Ganz catheter with tip projected deep into a right interlobar pulmonary artery which can lead to infarction. Loculated right pleural effusion, questionably improved.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: desat, CP History: desat New left upper lobe airspace opacities and bilateral pleural effusions with retrocardiac consolidation noted.Heart size upper normal.Right jugular catheter, tip in SVC.Status post kyphoplasty midthoracic region.

Output: New airspace opacities suggestive of infection as well as bilateral pleural effusions and left lower lobe consolidation, suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: Chest tube check Mediastinal left chest tube again remain unchanged in position with associated diminished lung volumes greater on the left with a large left effusion. Persistent small left apical pneumothorax, mildly improved Compression atelectasis versus partial consolidation remains of concern and difficult to distinguish.Right jugular dialysis catheter similar in position

Output: Chest tubes unchanged with a diminishing small left apical pneumothorax


Instruction: Generate impression based on medical findings.

Input: Age: 89 yearsGender: FemaleReason for Study: Reason: fluid overload History: fluid overload Increasing opacification of the left hemithorax compatible with enlarging pleural effusion.Small right pleural effusion and interstitial opacities in the right lung similar to the prior exam.

Output: Increasing opacification of the left hemithorax compatible with enlarging left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: R/o CHF History: SOBOE fatigue The heart size is normal. Unremarkable cardiomediastinal silhouette. Streaky left basilar opacities, likely atelectasis. Eventration of the right hemidiaphragm noted incidentally. No focal pulmonary opacities, pleural effusion, or pneumothorax. The bones and soft tissues appear unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: ? volume History: h/o pre-syncope Moderate cardiomegaly without acute edema or pneumonia.No significant change.

Output: Cardiomegaly, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 36 year old female with Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right anterior mediastinal mass is not significantly changed, measuring 5.8 x 1.9 cm (series 3; image 59), previously 5.9 x 2.0 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Small enhancing lesion in the posterior segment of the right lobe is less well visualized due to phase differences but is grossly unchanged in size.SPLEEN: Nodular appearance of the spleen is compatible with posttreatment changes.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Conglomerate paraaortic adenopathy measures 6.6 x 1.8 cm (series 3; image 118), previously 7.3 x 2.2 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Small fibroid at the uterine fundus.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patchy lytic foci in the iliac bones remain, status post treatmentOTHER: Trace free fluid in the pelvis.

Output: Mild decrease in size of the conglomerate periaortic/interaortocaval adenopathy with stable anterior mediastinal soft tissue.


Instruction: Generate impression based on medical findings.

Input: Cough and fever Interval removal of left jugular catheter. Midline sternotomyMild perihilar and basilar changes suggesting minimal edema with no distinct effusions yet vascular redistribution is observed.

Output: Minimal possible pulmonary edema with a questionable early nonspecific focal opacity in the lingula. Given patient history, serial imaging is needed to exclude infection


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Evaluate IABP placement History: IABP IABP marker in proximal descending thoracic aorta/T7 level.ICD unchanged. Swan-Ganz catheter tip in right pulmonary artery.Stable cardiomegaly. Right base may be slightly better aerated. No new opacity.

Output: IABP marker in proximal descending thoracic aorta/T7 level.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: INTUBATED History: AS ABOVE Endotracheal tube terminates 4 cm above the carina. Enteric tube terminates inferior to the caudal margin of the image.Left perihilar and right infrahilar opacities suspicious for aspiration with atelectasis. Left greater than right small pleural effusions not significantly changed when accounting for patient position and difference in technique. No interval pneumothorax. The heart size remains normal.

Output: Left perihilar and right infrahilar opacities suspicious for aspiration with atelectasis. Small pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of breast cancer, metastatic to the spine, now with ascites. CHEST:LUNGS AND PLEURA: Right pleural effusion is new. Multiple new, bilateral pulmonary nodules compatible with metastatic disease, the largest of which measures 8 x 6 mm on axial image 41/91.MEDIASTINUM AND HILA: Interval increase in the size of a pretracheal lymph node which now measures 1.7 by 1.5 cm on axial image 29/200. This lesion measured approximately 0.7 x 1.1 cm on the prior exam. Pathologically enlarged subcarinal lymphoid tissue is new. Although lack of IV contrast limits the evaluation, prominent hilar soft tissue bilaterally likely also reflects metastatic disease.CHEST WALL: Diffuse sclerotic bony metastatic disease is unchanged with no impending pathologic fractures.ABDOMEN: Within the limitations of a noncontrast enhanced examination, the following observations are made.LIVER, BILIARY TRACT: Interval increase in perihepatic and abdominal ascites. Although precise evaluation of the liver parenchyma is not possible given lack of IV contrast, mottled attenuation throughout it suggestive of diffuse metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal masses are re-identified. The right adrenal measures 3.9 x 2.8 centimeters on axial image 84/200 which is increased from 3.1 x 2.0 cm on the prior exam. The left adrenal measures 4.2 x 3.7 cm on axial image 90/200 and is also increased from 3.5 x 3.1 cm on the prior exam.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Confluent retrocrural and retroperitoneal soft tissue density encases the celiac and SMA origins and is more prominent on the current exam likely representing progressive metastatic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse metastatic disease as above.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Partially calcified pelvic mass likely representing a degenerated fibroid is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ascites has increased as above.BONES, SOFT TISSUES: Diffuse metastatic disease as above.OTHER: No significant abnormality noted.

Output: Progression of disease in the chest and abdomen as described above. Diffuse bony metastatic disease is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: pt intubated w/ pneumo and chest tube History: intubated Endotracheal tube terminates 4 cm above the carina. Remaining support devices are unchanged in position.Persistent low lung volumes with basilar subsegmental atelectasis. No pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: assess position of L IJ trialysis catheter History: ESRD, cardiogenic shock Interval placement of a left IJ central catheter that terminates in the central left brachiocephalic vein. Endotracheal tube terminates 4 cm above the carina. The tip of the intra-aortic balloon pump is not well visualized but the balloon is inflated to at least the left mainstem bronchial level. The remaining support devices are unchanged in position.Decreased pulmonary edema with residual infrahilar opacities suspicious for a degree of aspiration. Retrocardiac atelectasis and consolidation has increased. Small left pleural effusion. The right costophrenic angle is excluded from field-of-view. No pneumothorax.

Output: No pneumothorax following left IJ central catheter placement.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: bilateral opacities c/f PNA vs ARDS w/ b/l effusion. Pt s/p cardiac arrest (x2). History: Intubated and Sedated The endotracheal tube terminates approximately 6 cm above the level of the carina. Right jugular catheter terminates in the cavoatrial junction. Enteric tube remains coiled within the large hiatal hernia.Cardiomegaly is unchanged. Interval increase in right pleural effusion. Bilateral interstitial opacities suggestive of edema are not significantly changed.

Output: Interval increase in right pleural effusion, with stable bilateral interstitial opacities suggestive of edema and cardiomegaly, compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: 65-year-old woman with history of recurrent metastatic stage II A. endometrial CVA. 1979 Hodgkin's disease surgery RT and splenectomy. 9/2005 TAHBSO. 1/2006 MRI thin subdural hematoma with craniotomy an IVC filter. 7/2007 right subcutaneous L. N. right lung mass by CT he currently status post 6 cycles dextrocardia. Assess right subcutaneous L. and, right upper lobe lung mass, retroperitoneal mesenteric lymph nodes and the other sites of disease. CHEST:LUNGS AND PLEURA: Soft tissue density and fibrotic changes in the right paramediastinal area possibly related to radiation. Soft tissue density measurable on the soft tissue windows in the right paratracheal azygos region seen on image 22/210 measuring 2.6 x 1.5 cm. This could represent fibrotic residual of previously treated tumor. There are clusters of small subcarinal and AP window nodes. The largest individual node measures 1.6 x 1.3 cm in the AP window on image 29/211.No discrete lung nodules.MEDIASTINUM AND HILA: Calcification seen in the aortic root and coronary arteries. Left ventricle slightly prominent in size. No pathologic-sized hilar nodes.CHEST WALL: Sternotomy wires. Port-A-Cath in the right chest wall. Small axillary nodes not pathologic by size criteria.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Surgically absent.KIDNEYS, URETERS: Thinning and atrophy in the medial aspect of the upper pole and medial lower pole of the left kidney probably on a vascular basis.Wedge-shaped fatty lesion posterior cortex of the right kidney probably representing a focal angiomyolipoma.ADRENAL GLANDS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Caval filter in place. Surgical clips. Atherosclerotic calcification aorta no evidence of aneurysm.BOWEL, MESENTERY: Midline incisional hernia containing small bowel but nonobstructive. See image 133/211. No bowel wall thickening or dilatation. No ascites. No evidence of carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Varices in the anterior pelvic wall. Some skin thickening.OTHER: No significant abnormality noted.

Output: The soft tissue density in right paratracheal and paramediastinal areas measured above. Probable postradiation changes. Small mediastinal nodes. Nonobstructive incisional hernia. Miscellaneous postsurgical changes as above. Multifocal areas of atrophy left kidney. Angiomyolipoma right kidney.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath ETT advanced, tip projects 1 to 1.5 cm above the carina. NG and underlying cardiopulmonary appearance is also similar given differences in technique. Please see subsequent report

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Leukocytosis. Minimal retrocardiac atelectasis. No focal airspace opacity, pleural effusions or pneumothorax.The cardiac mediastinal silhouette is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 63 year old female with shortness of breath. Evaluate for PE. Review of prior records indicates history of asthma as well as multiple prior nondiagnostic PE studies. PULMONARY VASCULATURE: Technically nondiagnostic study, due to poor arterial opacification. LUNGS AND PLEURA: Dependent atelectasis and scarring at the bases. No suspicious nodules or masses.MEDIASTINUM AND HILA: Stable mediastinal lymphadenopathy. Normal heart size with lipomatous hypertrophy of the interatrial septum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Nondiagnostic examination of the pulmonary arteries. If there is high clinical suspicion for pulmonary embolus consider a V/Q scan. The findings were discussed with the clinical servive at the time of interpretation.2. Stable mediastinal adenopathy but no suspicious pulmonary masses or nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Follicular lymphoma treated with RCHOP and Urelumab , evaluate disease. Normal heart size. Left hilum enlarged. Surgical clips in the projection of the right axilla. Mild blunting of the costophrenic angles. No pneumothorax.

Output: Left hilar lymphadenopathy, present on prior CT. No acute pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Abdominal pain History: As above Intact sternotomy hardware. Unchanged retained ICD coil in SVC.Normal heart size.Calcified lymph nodes in the left hilum compatible with previous granulomatous infection.No significant pulmonary abnormalities or interval change.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Exercise-induced bronchospasm. Check for URI No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with history of recent thoracic aortic aneurysm surgery Endotracheal tube, NG tube, and aortic graft are unchanged in position. Median sternotomy hardware noted.No focal lung opacities or pneumothorax.

Output: No interval changes from prior exam.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of sarcoma CHEST:LUNGS AND PLEURA: Stable biapical scarring.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Previously mentioned hypodense lesions in the liver are grossly stable. They measure less than 1 cm in diameter and remain indeterminate. Subcentimeter polyp involving the gallbladder is also unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

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


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Fever and leukocytosis. Moderate cardiomegaly. Large lung volumes suggestive of COPD. Retrocardiac atelectasis. No specific signs of pneumonia.

Output: Subsegmental left lower lobe atelectasis. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: r/o PNA, ?CHF History: fever No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: patient s/p cystogastrostomy tube placement; r/o perforation History: chest pain Pleural effusions enlarging on the left compared to the prior CT, and now involving the fissures on the right.Compression atelectasis left lower lung zone is new.Heart size normal.Upper abdominal internal stent identified.

Output: Enlarging pleural effusions with new left lower lobe compression atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant No significant cardiopulmonary abnormality.Right jugular catheter, tip at cavoatrial junction.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old, with new shortness of breath and decreasing saturations status post right lower lobectomy. PULMONARY ARTERIES: The examination is limited by poor contrast opacification. Within this limitation, a filling defect within the right lower lobe pulmonary branch (series 9, image 140) may reflect a pulmonary embolus versus postsurgical change. The examination is nondiagnostic beyond the lobar level.LUNGS AND PLEURA: Volume loss and postsurgical change on the right status post right lower lobectomy. Two right chest tubes are in place. Small right hydropneumothorax is likely postoperative. Scattered patchy opacities with more dense consolidation at the left base may reflect atelectasis, aspiration or infection.MEDIASTINUM AND HILA: Small pneumomediastinum, likely postoperative.The cardiac size is mildly enlarged. No significant pericardial effusion.CHEST WALL: Subcutaneous emphysema on the right. Old healed fracture of the fifth rib on the right.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Filling defect in the right lower lobe pulmonary artery branch may represent an embolus or postsurgical change.2.Expected post surgical change and scattered opacities which may reflect atelectasis, aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: 61 year old male w/ multiple myeloma s/p 6 cycles of CyborD prior to ASCT (D0-05/05/14); progressed on PdC; screening for KPT-CFZ History: 61 year old male w/ multiple myeloma s/p 6 cycles of CyborD prior to ASCT (D0-05/05/14); progressed on PdC; screening for KPT-CFZ Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Left subclavian catheter, tip in SVC.Lumbar spine stabilization hardware.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 years old Male. Reason: confirm stable IABP placement History: advanced heart failure awaiting transplant. Balloon catheter marker at the level of the aortic arch, unchanged.ICD leads in place.No significant pulmonary abnormalities.

Output: Balloon catheter marker at the level of the aortic arch, unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Severe cardiomegaly unchanged.Worsening pleural effusions and basilar edema as well as left lower lobe consolidation.Status post extubation and NG tube withdrawal.

Output: Worsening pleural effusions and basilar edema with left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: xr obtained in error History: xr obtained in error ET tube and NG tube have been removed.The cardiomediastinal silhouette is unremarkable.Diffuse bronchial wall thickening and nodular opacities compatible with history of bronchiolitis.No focal areas of consolidation.No large pleural effusions.

Output: Interval removal of ET and NG tubes. Stable cardiopulmonary appearance with diffuse nodularity and bronchial wall thickening compatible with bronchiolitis.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval lung fields History: chronic SOB, DoE, obstructive asthma Tortuous thoracic aorta again noted. No new focal lung consolidation. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: FemaleReason for Study: Reason: sob, cough w/ productive sputum History: cough Opacification right hemithorax unchanged from the prior exam.The cardiac size cannot be adequately assessed.The right lung is clear.

Output: No interval change in the opacification of the right hemithorax secondary to a large right pleural effusion and underlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Shunt malfunction SHUNT DEVICE: An intracranial shunt device exits the skull via a right frontal burr hole, courses down the right scalp, neck, and anterior chest wall before entering and terminating within the abdomen. Portions of the shunt overlying the skull are radiolucent which limits its evaluation. Specifically, there is a radiolucent portion between the segments of tubing at the burr hole and we cannot determine if this represents a shunt discontinuity or a radiolucent connector although its appearance is similar to the prior exam.SKULL: No significant abnormality noted. Note is made of multiple impacted/unerupted molars.CERVICAL SPINE: No significant abnormality noted.CHEST: There is no focal pulmonary opacity. The cardiomediastinal silhouette is normal.ABDOMEN: The bowel gas pattern is nonobstructive. A T-shaped contraceptive device overlies the pelvis.

Output: Shunt device as described above appears similar to the prior exam. A radiolucency between the segments of tubing at the level of the right frontal burr hole may represent discontinuity or a radiolucent connector device but this appears similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Rule out pneumonia, congestion and rhinorrhea No cardiopulmonary abnormality. Unchanged right jugular single port, yet left jugular catheter removed without complication

Output: No acute disease is an interval removal of left jugular catheter


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: sob, trach placed Stable coarse opacities and extensive bronchiectasis related to cystic fibrosis.Tracheostomy tube, and central venous catheters are unchanged, including right chest port, with the catheter looped within the right internal jugular vein and tip pointing caudally.Coarse calcific density projects over the gastric fundus.

Output: Stable cardiopulmonary appearance with diffuse changes related to cystic fibrosis. Right chest port catheter remains looped in the right IJ as above.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: ET tube placement History: intubated No significant cardiopulmonary abnormality.ET tube tip approximately 5 cm above the carina.Right jugular catheter tip at right atrial level.Left subclavian ICD, leads unchanged in position.

Output: ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for PNA History: fever, cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: ETT in place History: see above Right Port-A-Cath in ET tube unchanged.Dobbhoff tube placed with its tip in the stomach.Interval increase and pulmonary opacities particularly in the left lung compatible with edema.Basilar atelectasis and pleural effusions also increased from the prior exam.

Output: Increasing pulmonary opacities compatible with edema as well as increasing pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old, history of base of tongue cancer status post chemo/RT. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules, most of which are unchanged. However, a new ground glass nodule is evident in the right lower lobe measuring 7 mm on high resolution axial image 220/294.MEDIASTINUM AND HILA: The cardiac size is normal. No pericardial effusion. A small focus of air is evident in the left brachiocephalic vein. Aortic and coronary artery calcifications are noted thereNo pathologically enlarged hilar or mediastinal lymph nodes.Small hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Few, punctate hypodensities are too small to characterize but probably benign. Cholelithiasis.SPLEEN: 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 noted

Output: New 7-mm right lower lobe nodule. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiac 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: 46 years old Male. Reason: Eval for effusion, edema, consolidation History: s/p AVR, MVrepair /CABG readmitted with bacteremia. Cardiomegaly unchanged as compared with prior study.There is no evidence of acute infiltrate, pleural effusion or pneumothorax. Poststernotomy changes are noted.

Output: Cardiomegaly unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: 50M intubated in CCU post-VA-ECMO decannulation and subclavian AIBP, ?placement History: 50M intubated in CCU post-VA-ECMO decannulation and subclavian AIBP, ?placement Aortic balloon catheter marker projected about 5 cm below the top of the aortic knob and the descending aorta.ET tube tip approximately 5 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.NG tube tip in the area of the GE junction.Small lung volumes with right upper lobe and left lower lobe opacities compatible with atelectasis, not significantly changed.

Output: Balloon catheter in the descending aorta, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: new infiltrate, pneumo? History: ccu pt w AMS, hypoxia Diminished lung volume, with a significant increase in interstitial and airspace opacities with pleural effusions.Tracheostomy tube tip approximately 5 cm above the carina.

Output: Significant worsening of pulmonary opacities consistent with edema or diffuse infection. Evolving ARDS is in the differential diagnosis. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Assess placement of enteric tube Enteric tube seen curled overlying gastric body. Thinner caliber line overlying medial aspect of partially imaged inferior right hemithorax may be external to patient but nonspecific, may be correlated with patient's history/physical exam. Relative paucity of small bowel gas. No specific evidence for bowel obstruction. Partially imaged bilateral hip hardware. Multilevel spinal degenerative disease.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Reason: monitor IABP History: s/p IABP Balloon catheter in the proximal descending aorta, unchanged.ICD lead also unchanged.Left ventricular cardiomegaly with retrocardiac compressive atelectasis.No new findings.

Output: Aortic balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Altered mental status and shortness of breath Persistent moderate right pleural effusion with atelectasis as well as the associated retrocardiac opacity again also thought to represent atelectasis. Aspiration however cannot be excluded and CT may be required if further characterization is needed clinically.Marked scoliosis with posterior fixation. Two left jugular catheters and tracheostomy tube are all otherwise unchanged. Surgical or drainage catheters projected over left upper quadrant. Shunt tubing is projected and overlies the right neck and chest wall laterally, unchanged

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Reason: 33F p/w 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: Age: 85 yearsGender: FemaleReason for Study: Reason: COPD with increased SOB History: SOB Volume loss in left lung with left pleural effusion/thickening similar to the prior exam.Stable cardiac mediastinal silhouette with atherosclerotic changes of the aorta.Emphysematous changes in the right lung redemonstrated.No new pulmonary opacities identified.

Output: No interval change in the left pleural effusion/thickening and postsurgical volume loss of left lung. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: FemaleReason for Study: Reason: SOB History: above Stable mild cardiac enlargement.The lungs are clear.Pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia, ards History: as above Catheter tip in the SVC.Bilateral nonspecific airspace and interstitial opacity, unchanged or slightly improved compared to previous, compatible with edema and ARDS.Moderate bilateral pleural effusions and cardiomegaly.

Output: Diffuse nonspecific opacity and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old Reason: eval acute process History: CP Cardiomediastinal silhouette is unremarkable.No significant pulmonary or pleural abnormalities.No displaced rib fractures.

Output: No acute cardiopulmonary abnormality. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: post op, eval lung fields History: s/p LVAD Cardiomegaly, with mild basilar edema pattern and streaky atelectasis, unchanged.Chest tubes are present with no pneumothorax.Multiple support devices are stable in appearance and position.

Output: No change in cardiomegaly, edema-like opacities and multiple support devices.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: eval for pna History: eval for pna The cardiomediastinal silhouette is unremarkable.Mildly decreased lung volumes.Scattered scarring/discoid atelectasis.No focal areas consolidation.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: 26M, disseminated adeno, ARDS, with desaturations, eval opacities History: desaturations Increasing patchy basilar opacities consistent with edema and aspiration.Right jugular catheter, tip in SVC.An NG tube terminates in the stomach.

Output: Increasing basilar opacities consistent with edema and aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: MaleReason for Study: Reason: r/o pneumonia vs reactive airway History: SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: right sided pleural effusion, plan for pleurex cather placement tomorrow History: SOB Moderate sized loculated right sided pleural effusion with underlying atelectasis/edema similar to the prior exam allowing for differences in patient positioning.No new pulmonary opacities.Stable cardiomediastinal silhouette .

Output: Moderate sized loculated right-sided pleural effusion unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: assess for acute process - palpitations and sob History: assess for acute process - palpitations and sob. Cardiomediastinal silhouette within normal limits.No acute focal airspace opacity.No pneumothorax or large pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of prostate cancer. Evaluate for metastatic disease. CHEST:LUNGS AND PLEURA:Scattered micronodules not changed substantially compared to the prior examination. No dominant pulmonary nodules. Mild interstitial emphysema.MEDIASTINUM AND HILA: Calcified mediastinal lymph node, however no other significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic granuloma is unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral hydronephrosis and hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. Correlate with bone scan.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES:The prostate is enlarged. The right seminal vesicle is prominent. BLADDER:The bladder wall is diffusely thickened and moderately distended, likely secondary to bladder outlet obstruction. Bladder diverticula notedLYMPH NODES: Multiple small inguinal lymph nodes are stableBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES:Compression deformity of the L1 vertebral body with anterior osteophyte formation.OTHER: No significant abnormality identified.

Output: No definite evidence of metastatic disease. Increasing bladder distention with mild bilateral hydronephrosis and hydroureter, presumed secondary to bladder outlet obstruction.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: assess for pneumonia, aspiration History: fever Mild left base scarring or subsegmental atelectasis, otherwise unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: 63 years old Male. Reason: ET tube placement, assess for edema History: as above. Endotracheal tube tip is approximately 1 cm above the carina. Stable mild cardiomegaly and bilateral interstitial and airspace opacities as well as a bilateral pleural effusions. Distended bowel loop or stomach is noted in the upper mid abdomen.

Output: Suboptimal position of the ET tube. Stable diffuse bilateral airspace and interstitial opacity as well as the bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Shortness of breath and tightness in chest. Cardiomediastinal silhouette is normal. Large eventration of the anterior right hemidiaphragm. No focal pulmonary opacity, pleural effusion, or pneumothorax. Lower lobe nodule as specifically noted on the lateral projection is compatible with a granuloma when compared to the prior CT.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: Burn patient; trach on vent in ICU History: hypoxemia Support devices unchanged in position.Diffuse patchy airspace opacities not significant changed from prior exam.Cardiomediastinal silhouette stable.

Output: Diffuse patchy airspace opacities not significantly changed from prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: 53year old female, intubated History: intubated Worsening left-sided airspace opacity with volume loss.Right lung unremarkable.ET tube tip approximately 5 cm above the carina.Right jugular catheter tip at right atrial level.Cervicothoracic spine stabilization hardware noted.

Output: Worsening left-sided airspace opacity suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 86 yearsGender: MaleReason for Study: Reason: r/o pneumonia History: cough Cardiac enlargement with pulmonary vascular redistribution.Increased interstitial opacities with septal lines compatible with interstitial edema.Small bilateral pleural effusions.No focal areas of consolidation.

Output: CHF without evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old with chest pain. Cardiomegaly, unchanged. Minimal basilar subsegmental atelectasis/scarring.No pleural effusions. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pleural effusions History: as above Bilateral diffuse opacities suggestive of edema with moderate pleural effusions and basilar atelectasis, not definitely changed allowing for marked differences in projection.However the effusions may be slightly smaller.

Output: Pleural effusions, edema and atelectasis with questionable improvement.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with lymph node inferior to the left thyroid, night sweats, evaluate for lymphadenopathy. LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Minimally enlarged. Mediastinal lymph nodes with reference right paratracheal lymph node (image 14, series 4) measuring 7 mm x 15 mm and subcarinal lymph node (image 34, series 4) measuring 13 mm x 7 mm.Pacer wires are identified in right atrium , right ventricle and epicardium.Venous collaterals via internal mammary, hemiazygos, and azygos veins.CHEST WALL: Median sternotomy.UPPER ABDOMEN: Mild splenic enlargement

Output: Mild nonspecific enlargement of several mediastinal lymph nodes, which may be reactive in origin.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: pna History: temp No significant cardiopulmonary abnormality.No specific evidence of infection.An NG tube terminates in the stomach.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male status post liver transplant for cirrhosis, history of prostate cancer with unexplained weight loss and anemia. CHEST:LUNGS AND PLEURA: Subcentimeter, punctate ill-defined nodule in the right middle lobe image number 51, series number 5. Possible small filling defects in the right lower lobe pulmonary artery suspicious for pulmonary embolus. Other scattered small pulmonary emboli may also be present. The study is suboptimal for evaluation of pulmonary embolus.MEDIASTINUM AND HILA: Esophagus is diffusely dilated and its proximal and midportion. Mild wall thickening distally. Endoscopy may helpful for further evaluation if clinically indicated.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No evidence of biliary dilatation. Hepatic veins, portal vein and hepatic artery are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Some of the hypodense lesions in both kidneys are too small to accurately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Radiation seeds in the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Possible small subsegmental pulmonary emboli. The study is limited for evaluation of pulmonary embolus. Dr. Jung was notified and acknowledged about these findings at the time of dictation.Mild proximal dilatation of the esophagus with possible distal wall thickening. Endoscopy may helpful for further evaluation of clinically indicated.Bilateral renal cysts and small hypodense lesions which are too small to characterize.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.LVAD placement. LVAD is partially visualized. Postsurgical changes of a median sternotomy with mediastinal drain and bilateral basal chest tubes in place. Endotracheal tube tip projects 3.5 cm above the expected level of the carina. A left jugular Swan-Ganz catheter terminates over the right main pulmonary artery. New valve prosthesis.No significant pneumothorax. Small volume of pleural fluid with associated atelectasis at the lung bases.

Output: Low lung volumes with basal atelectasis and small pleural effusions but no signs of pulmonary edema or conclusive evidence of aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax History: Dyspnea Small lung volumes with a left chest tube in place and no significant pneumothorax.Basilar subsegmental atelectasis, not significantly changed.ET tube and venous catheters unchanged.

Output: Basilar atelectasis and no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: r/p pneumothorax post CT removal History: CT removal Interval chest tube removal with no sign of pneumothorax.Cardiomegaly with a mitral valve ring in place.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: Resolving basilar atelectasis and effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: ETT placement History: advanced ETT 3 cm Stable position of support devices.Stable mid to lower zone opacities of edema, atelectasis and pleural effusions. No pneumothorax.

Output: Endotracheal tube in good position, 2 cm above the carina. No significant interval change in basilar opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: AML patient status post allogenic stem cell transplant. VRE bacteremia. Rule out pulmonary septic emboli. LUNGS AND PLEURA: Minimal scarlike opacities within the lungs are unchanged. No nodule or mass. No focal consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: Right IJ central venous line in place. Hypoattenuating lesion within the left lobe of the thyroid is unchanged. Small, benign-appearing pretracheal lymph nodes are unchanged. No hilar lymphadenopathy.Minimal pericardial thickening/effusion appears more prominent. Cardiac size is normal. Coronary calcifications noted.CHEST WALL: Degenerative changes and flowing osteophytes along the right lateral thoracic spine compatible with DISH.UPPER ABDOMEN: Fatty atrophy of the pancreas. Evaluation of the abdomen is limited by the lack of IV and oral contrast. Within that limitation, no gross abnormality noted.

Output: 1.No evidence of pulmonary septic emboli.2.Pericardial thickening/effusion is slightly more prominent although still minimal.3.No gross abdominal abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: needed within 24hrs for VQ scan History: volume overload Mild cardiomegaly and moderate mediastinal widening unchanged.Moderately large right pleural effusion with underlying opacity compatible with atelectasis and consolidation.No new findings.

Output: Right pleural effusion with underlying consolidation and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: hemoptysis History: hemoptysis Mild interval decreased lung volumes. No evidence of interval infection or edema. Heart size is accentuated by under inflation which is upper limits of normal for size.

Output: Under inflation of the lungs accentuating the mediastinum and the perihilar vasculature. No evidence of pulmonary hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Murky chest tube output. Lines and hardware unchanged in position. Postsurgical changes right chest wall. Right lung airspace disease is grossly unchanged.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: evaluate lung fields post op History: s/p cardiac surgery New subcutaneous emphysema on the right, near the chest tube site. Support hardware is unchanged. One of the jugular sheath is unchanged at the venotomy.No evidence of significant pneumothorax. Persistent nonspecific right-sided pulmonary opacities.

Output: No evidence of significant pneumothorax. Persistent nonspecific right-sided pulmonary opacities. New subcutaneous emphysema on the right, near the chest tube site.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Wheezing, bacteremia evaluate for infection. New multifocal air space opacities in the left lung. Bronchial wall thickening. Pleural thickening and fluid bilaterally, increased on the left. Tip of the LVAD partially visualized. Valvular prosthesis. Left atrial appendage occlusion device.

Output: Multifocal pulmonary opacities with bronchial wall thickening consistent with pneumonia. Serial plain film monitoring recommended. Pleural fluid and thickening on the left has increased.


Instruction: Generate impression based on medical findings.

Input: 72 year old female with history of non-Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: Few subcentimeter nodules in the lungs bilaterally, unchanged.MEDIASTINUM AND HILA: Postoperative changes of median sternotomy again noted. Cardiac size is mildly enlarged, but stable. Few retroaortic lymph nodes are slightly more prominent, the largest (series 3 image 63) measures 1.6 x 1 cm.CHEST WALL: Bilateral shoulder prostheses are incompletely visualized.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Ill-defined left periaortic soft tissue mass (series 3, image 111) measures 3.2 x 1.5 cm, unchanged in size.BOWEL, MESENTERY: Index mesentery lymph node (series 3, image 109) now measures 7 x 6 mm (previously 8 x 9 mm)BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prosthetic enlargement, similar to prior.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left gluteus minimus lipoma, unchanged.OTHER: No significant abnormality noted

Output: Subtle increase in few retroaortic lymph nodes in the chest. Stable small para-aortic mass in abdomen. No new lesions identified.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Evaluate for acute process History: chest pain/back pain/sob Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Stable mild spinal curvature.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: New pneumothorax, check size for enlargement History: check pneumo size No evidence of pneumothorax.Low lung volumes.Bibasilar opacities similar to prior, likely reflecting aspiration or atelectasis.Cardiomediastinal silhouette is normal.There is moderate gaseous distention of the st

Output: No pneumothorax. No interval radiographic change.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Check central line History: s/p bilateral chest tube placement Bilateral chest tubes with no pneumothorax.Mild basilar subsegmental atelectasis noted.An NG tube traverses a gastric pull-up, the tip at the hemidiaphragm level.

Output: Mild basilar subsegmental atelectasis. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 41 years old Female. Reason: 41 y/o F who p/w w/ chest pain x3 weeks and SOB r/o cardiopulmonary process History: Chest pain/SOB. There is large infiltrate in the left mid lung, which can be due to pneumonia. The cardiac silhouette is normal. There is no evidence of pleural effusion or pneumothorax.

Output: Left lung infiltrate, which is suspicious for pneumonia. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: S/P LVAD. eval for pleural effusion History: SOB Interval placement of an LVAD device. Interval placement of right internal jugular central venous catheter with tip in the SVC. Unchanged ICD with leads.Severe cardiomegaly.Retrocardiac compression atelectasis. Right basilar airspace opacity is slightly increased from the prior exam.

Output: Interval placement of LVAD. Moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: as above Mild cardiomegaly, unchanged.Free intraperitoneal air, decreased compared to previous radiographsNo sign of pulmonary edema or pneumonia.

Output: Decreasing pneumoperitoneum and no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: desats, resp mucle weakness 2/2 polymyositis, eval PNA History: as above Interval extubation and removal of venous catheter.Small lung volumes with right basilar air space opacity which could represent aspirate or pneumonia.S/P cholecystectomy.

Output: Small lung volumes with right basilar air space opacity which could represent aspirate or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: Eval chest tube position, PTX History: 3 chest tubes 3 right-sided chest tubes are unchanged in position. Surgical skin staples overlie the right axilla. Otherwise, the appearance of the chest is stable. No new cardiopulmonary disease.

Output: Stable appearance of the chest without new acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with shortness of breath. Preop mitral surgery. Single sternotomy wire.Moderate cardiomegaly with perihilar interstitial opacities, septal lines and probable pleural effusions.Rotary scoliosis of the spine.

Output: Findings most compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Vomiting No pleural effusion or pneumothorax. No focal pulmonary opacities. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Peripartum cardiomyopathy. Intubated. Unchanged small left pleural effusion. Limited evaluation of the left lower lobe given prominent heart size and significant overlying hardware.Cardiomegaly, unchanged. Median sternotomy and skin staples unchanged. Status post LVADETT tip approximately 4 cm above the carina. Interval removal of lateral right and left chest tubes, with unchanged medial drains. Enteric tube seen coursing below the diaphragm, tip off the field of view. Left IJ Swan-Ganz with tip in the distal interlobar artery, unchanged. Esophageal temperature probe terminating above the clavicles. Unchanged left chest wall 3-lead ICD.

Output: Unchanged small left pleural effusion. Retraction of Swan-Ganz and advancement of esophageal temperature probe are recommended.Findings discussed with clinical service/Dr. Martin on 9/21/2016 at 11:30 AM.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Hypotension with concern for worsening sepsis. Low lung volumes. Development of patchy atelectasis in the lung bases, with perhaps minimal airspace opacity at the right base.Fine, diffuse pattern of calcification in the spleen. No discrete nodules.

Output: Bilateral basal atelectasis which could be the result of aspiration. Short-term follow-up recommended to exclude development of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Abnormal EKG Calcified right pleural plaques without additional superimposed acute cardiopulmonary abnormality. Specifically lungs are clear. Midline sternotomy

Output: Asbestos exposure without additional superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: worsening atelectasis? History: worsening dyspnea Patchy left lower lobe atelectasis may be from aspiration or mucous plugging, slightly worse.Heart size upper normal status post median sternotomy.

Output: Minimal worsening of left basilar atelectasis which may be the result of aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: pna? History: fever No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: s/p MAZE with LAA ligation History: S/P MAZE with LAA ligation Stable position of support devices.Small bilateral pleural effusions tracking into the major fissure and over the apex on the right. There is a small right apical hydropneumothorax. Heart size remains stable..

Output: Small right apical hydropneumothorax in the setting of a chest tube.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Rule out pna History: SOB Surgical clips are noted in the anterior superior mediastinum.Moderate cardiomegaly. Tortuous aorta. No pleural effusion or pneumothorax. Mild interstitial changes likely chronic in nature. No focal pulmonary opacities.

Output: Moderate cardiomegaly without specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: History of atrial fibrillation, evaluate for evidence of edema/infection The heart size is normal. The lungs are clear. Minimal right basilar atelectasis. Bronchial wall thickening and decreased pulmonary perfusion may be consistent with bronchitis. No pleural effusion or pneumothorax.Multilevel anterior wedge compression defects of the thoracic vertebrae.

Output: Bronchial wall thickening and decreased pulmonary perfusion suggestive of bronchitis and COPD.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: lung infiltrate History: cough, chills Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: Hx: breast cancer currently undergoing chemotherapy, now with increasing cough and sputum production History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Degenerative changes in the thoracic spine.Multiple surgical clips in the axillary regions bilaterally.

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


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Shortness of breath, chest pain, evaluate for pneumonia The cardiomediastinal silhouette is within normal limits. No significant pulmonary or pleural abnormality.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 95 years old.Reason: intubated eval ET tube History: see above Perihilar opacities persist, less densely consolidated than on the prior study, possibly aspiration or acute edema.Heart size normal.An NG tube terminates in the stomach.ET tube tip approximately 5 cm above the carina.

Output: Perihilar opacities less dense than before consistent with improving aspiration or acute edema.


Instruction: Generate impression based on medical findings.

Input: Male; 85 years old. Reason: eval for HCAP History: recent admit, now tachypneic and hypoxic Large bilateral pleural effusions with underlying atelectasis/consolidation, increased on the left with near-complete opacification of the left hemithorax.Cardiomegaly.

Output: Large bilateral pleural effusions, increased on the left.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: ETT changed and OG advanced History: as above Stable right upper lobe opacity, infection or aspiration.Elsewhere, the lungs are unremarkable.Left supraclavicular soft tissue emphysema is present and there may be a small pneumomediastinum.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach, although deeply into the hypopharynx.

Output: Possible pneumomediastinum, with persistent right upper lobe opacity.NG tube looped in the hypopharynx.


Instruction: Generate impression based on medical findings.

Input: Reason: hemoptysis History: hemoptysis Marked volume loss left hemithorax with opacity in the left apex suggestive of radiation reaction and fibrosis.Marked mediastinal shift to the left comparedno significant abnormalities in the right lung.

Output: Extensive abnormalities in left hemithorax with volume loss and scarring. There may be underlying bronchiectasis which could be a source of hemoptysis. A CT scan would allow more accurate evaluation in this respect.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pain.VIEWS: Chest PA/lateral (two views) 04/04/15 Cardiothymic silhouette and pulmonary vascularity are normal. The aortic arch, cardiac apex, and stomach are left-sided.Mild peribronchial thickening is present. No focal air space disease is identified.Thoracic kyphosis is decreased and AP diameter of chest is decreased.

Output: Bronchiolitis/reactive airways disease pattern. Probable straight back syndrome.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p CABG Interval extubation. Decreased lung volumes with increased basilar atelectasis. Left chest tube and right jugular catheter unchanged.

Output: Interval extubation and increased basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: above Unremarkable cardiac and mediastinal silhouette. Mild mainly perihilar interstitial opacities with bronchial thickening and some small streaky opacities at the periphery which may represent scarring or subsegmental atelectasis.Allowing for differences in technique there is been no significant interval change.No evidence of pneumonia or pulmonary edema.

Output: Interstitial opacities suggestive of bronchial thickening and possibly bronchial mucous plugging. This is compatible with a history of chronic bronchitis and MAI infection. If clinically indicated, a CT scan could be performed for more accurate evaluation.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT History: as above ET tube tip approximately 3 cm above the carina.Pacemaker leads unchanged.Cardiomegaly with moderately large pleural effusions and underlying atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: r/o cardiopulm abnormality History: chest pain Cardiomediastinal silhouette is normal. Lungs clear of airspace and interstitial opacities. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: metastatic urothelial cancer History: Acute upper respiratory symptoms, low grade fevers in the setting of diarrhea please evaluate Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No sign of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 90-year-old female with abdominal pain, abdominal aneurysm. Evaluate mediastinum. Retrocardiac opacity which appears similar to prior although a superimposed airspace opacity cannot be excluded. In the left apex there appears to be a linear demarcation extending inferiorly to the rib margin, although this may be artifactual related to a skinfold, there are no definite vascular markings seen peripheral to this line and in the appropriate clinical setting this could represent a pneumothorax. Cardiomegaly and tortuous aorta unchanged.

Output: 1. The findings in the left apex may be artifactual as described above, however in the appropriate clinical setting this could represent a pneumothorax. If clinically warranted, serial imaging with PA/Lateral chest radiographs may be considered to confirm absence of a pneumothorax.2. Retrocardiac opacity appears similar to prior study although a superimposed airspace opacity cannot be excluded. Findings were discussed with Dr. Seth Trueger by phone on 5/31/2015 at 10:55 AM.


Instruction: Generate impression based on medical findings.

Input: Hydrothorax Complete opacification of the right hemithorax is observed with no definitive distinct air bronchograms. Presumed collapsed right lung with minimal right to left mediastinal shift. Left lung is clear. Cardiac and mediastinal contours are incompletely visualized but grossly unremarkable

Output: Appearance consistent with large right pleural effusion and underlying collapse lung


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Status post wireless pacemaker placement, the device projected over the RV apex region and unchanged.No significant pneumothorax.

Output: Wireless pacemaker placement, without complication.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with new diagnosis of uterine cancer, vaginal bleeding CHEST:LUNGS AND PLEURA: 6 mm, nonspecific nodule, in the right middle lobe as seen on image number 34, series number 5. Right lower lobe small bulla.MEDIASTINUM AND HILA: Small, nonenlarged mediastinal lymph nodes. Index node measures 13 by 8mm on image number 25, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subtle hyperdensity in the gallbladder may represent cholelithiasis or sludge.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: Multiple, nonspecific, borderline enlarged retroperitoneal lymph nodes. An index preaortic lymph node at the level of the right renal vein measures 11 x 11 mm on image number 101, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous uterus with multiple fibroids BLADDER: No significant abnormality noted.LYMPH NODES: Index right peri-iliac lymph node measures 11 x 12 mm image number 144, series number 3. Multiple other borderline enlarged pelvic lymph nodes are also present .BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Borderline enlarged retroperitoneal and pelvic lymph nodes as described above. Metastatic disease cannot be excluded.Nonspecific small mediastinal lymph nodes and subcentimeter right middle lobe nodule.


Instruction: Generate impression based on medical findings.

Input: Left-sided chest pain assess for pneumothorax, effusion or pneumonia. Complete collapse of the right middle lobe. Small volume of pleural fluid bilaterally. Mild elevation of the left hemidiaphragm. Significant atelectasis in the left lower lobe and lingula and segmental atelectasis in the left upper lobe, compared to prior.Nonspecific chronic micronodules and probable emphysema.Left pacemaker unchanged in position. No visible pneumothorax.

Output: Interval development of multisegmental and subsegmental atelectasis in the left lung which could be due to acute aspiration or in the appropriate clinical setting, PE.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.New dyspnea. Right lower lobe airspace opacity suspicious for aspiration or infection.Diffuse bronchial wall thickening and reticular opacities could be sequela of bronchitis, aspiration or possibly atypical edema.Cardiothoracic ratio appears enlarged, though incompletely evaluated by portable technique.Left subclavian ICD with proximal coil in the projection of the SVC, distal coil in the region of the right ventricle and a third lead in a branch of the coronary sinus. Postoperative markers consistent with prior CABG. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed. No visible pneumothorax.Blunting of the right costophrenic angle consistent with a small volume of pleural fluid.

Output: Small right pleural effusion with diffuse peribronchial opacities and a more focal opacity in the right lower lobe. Findings are suspicious for mild hypervolemia/CHF with superimposed aspiration or infection. Suggest follow-up PA and lateral chest radiographs in 6 weeks to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: night sweats History: night sweats- Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male history of NHL status post allograft stem cell transplant presenting with hives, supraumbilical abdominal pain, and left lower flank pain/back pain. Evaluate for relapse. CHEST:LUNGS AND PLEURA: Left upper lobe fissural micronodular is unchanged dating back to 2008.MEDIASTINUM AND HILA: Central venous catheter is seen with its tip in the distal superior vena cava. No lymphadenopathy.CHEST WALL: Port-A-Cath is seen in the subcutaneous tissues overlying the right chest.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No evidence of lymphadenopathy.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 evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of disease recurrence. No new findings since the prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: s/p bilat lung tx, eval for pneumo / trach / CT position History: as above Significant interval increase in the right pneumothorax. Pulmonary findings are stable. Line position stable.

Output: Interval enlargement of right pneumothorax. Other pulmonary findings are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: r/o mets History: h/o RCC Chronic appearing right hemidiaphragm elevation.Otherwise, the lungs are unremarkable.No evidence of metastases.Heart size normal.

Output: Chronic right hemidiaphragm elevation, without evidence of metastases or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female status post transplant. Cough, rhinorrhea. CHEST:LUNGS AND PLEURA: Scattered tree-and-bud and confluent areas of ground glass opacities are seen bilaterally with more nodular areas of focal consolidation in the lingula and lung bases as well. Moderate bronchial wall thickening and mild bronchiectasis, especially in the lower lobes.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild pericardial thickening.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Subcentimeter hepatic hypodensities remain too small to characterize.

Output: Bronchiolitis pattern compatible with viral or bacterial infection.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: copd exacerbation, pna? History: SOB Very large lung volumes consistent with COPD.Heart size normal, the aorta tortuous but consistent with age.No specific evidence of infection or edema.Metallic fragments projected over the left upper quadrant are presumably from a prior bullet injury.

Output: Severe COPD, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Status post left subclavian central venous catheter insertion. Verify positioning. Bibasilar atelectasis with a small left pleural effusion.Cardiomediastinal silhouette is within normal limits, given low lung volumes.Interval placement of left subclavian central catheter with tip in SVC. Status post cervical laminoplasty, with overlying skin staples.

Output: Left subclavian catheter with tip in SVC. Bibasilar atelectasis with a small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: New consolidation History: Fever Small lung volumes with nonspecific basilar airspace opacity and atelectasis, not significantly changed.Probable small pleural effusions.

Output: Basilar opacities compatible with atelectasis and effusions, possibly with a component of aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: tachycardia Tracheostomy tube and venous catheter unchanged. Small lung volumes with basilar opacity compatible with atelectasis and aspirated secretions. No new findings.

Output: Nonspecific basilar opacities compatible with atelectasis and aspirated secretions unchanged. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: CHEST: Exam markedly limited by field of view and scan length.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality noted in the extracardiovascular portions of the examination, markedly limited study.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: r/o pneumonia History: cough, weakness Loculated right pleural effusion and right middle lobe opacity compatible with pneumonia and possibly empyema which is better characterized on the subsequent chest CT which has since become available. Normal cardiomediastinal silhouette. Cholecystectomy clips in the right upper quadrant.

Output: Loculated right pleural effusion and right middle lobe opacity compatible with pneumonia and possibly empyema.


Instruction: Generate impression based on medical findings.

Input: CT INFUSED UPPER ABDOMEN, CT INFUSED PELVIC[LOW ABDOMEN], CT INFUSED CHEST 2/23/2008 11:57 AM CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: All mediastinal nodes have decreased in size with involvement seen in the pretracheal paratracheal subcarinal right hilar and prevascular spaces. Index node in the pretracheal area is ill-defined and estimated at 1.9 x 1 cm seen on image 23/220.Sub-carinal node which previously measured possibly including the azygos vein. Current measurements are comparable to image 41/220, now measuring 2.7 x 1.8 cm.No new sites of disease.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Previously mentioned soft tissue nodule anterior to the right psoas muscle seen on image 139/220 and measures 1.3 x 1.1 cm. No other measurable nodesBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 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 noted

Output: The decrease in size of lymph nodes. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Male; 60 years. Reason: Follow up on lymphoma. CHEST:LUNGS AND PLEURA: Peripheral right lower lobe atelectasis/scarring, not significantly changed.MEDIASTINUM AND HILA: Coronary calcification versus stent. Small pericardial effusion.CHEST WALL: Right Port-A-Cath tip in the SVC. ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense hepatic lesions are unchanged from prior, consistent with hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple subcentimeter mesenteric lymph nodes, not significantly changed. Reference soft tissue/lymphatic measurement (series 3 image 143) of 1.1 x 1.2 cm, previously 1.2 x 1.2 cm. BOWEL, MESENTERY: Haziness of the mesenteric root with small mesenteric lymph nodes are overall similar to prior.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: Mesenteric soft tissue attenuation, stable. No new disease.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and history of COPD and CHF Persistent bilateral basilar atelectasis minimally increased with minimal scarring and scattered calcified granuloma. No definite effusions.Cardiac and mediastinal contours are again similar with borderline cardiomegaly and more moderate atherosclerotic disease. Left subclavian ICD unchanged

Output: No acute cardiopulmonary abnormality superimposed upon persistent shifting basilar atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 99 years old.Reason: leukocytosis History: leukocytosis Minimal pleural effusions and heart size normal with a tortuous aorta.No specific evidence of infection or edema.

Output: Minimal pleural effusions but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with abnormal breath sounds and abnormal chest x-ray. History of weight loss. LUNGS AND PLEURA: Predominantly upper lobe, dense consolidation in a bronchovascular distribution with scattered, more discrete foci of nodules likely of the same process and associated mild mediastinal lymphadenopathy. No pulmonary edema or pleural effusions.MEDIASTINUM AND HILA: Mildly enlarged pretracheal and AP window lymph nodes evident. Calcified hilar lymph nodes may reflect prior granulomatous disease.Cardiac size is upper normal with relatively lower attenuation in the ventricles suggesting anemia. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Findings as above most compatible with sarcoid. Bronchocentric granulomatosis or crytogenic organizing pneumonia can occasionally produced a similar appearance.Malignancy is considered unlikely.


Instruction: Generate impression based on medical findings.

Input: Reason: post op cabg History: post op cabg Small lung volumes with basilar opacity compatible with atelectasis and small effusions. Chest tube in the left apex with no pneumothorax.Catheter tip in the SVC.

Output: Postoperative atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: intubated History: as above Endotracheal tube terminates 7 cm from the carina. Enteric tube extends inferiorly off the field-of-view. Central venous catheters, unchanged. Diffuse pulmonary opacities with pleural effusions again noted. Unchanged heart size. No pneumothorax.

Output: Unchanged pulmonary edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Empyema, status post chest tube placement.VIEW: Chest AP (one view) 5/5/2015 at 1843 hours. Right-sided chest tube and subcutaneous emphysema is noted. Contrast material in bowel loops is present. Cardiac silhouette size is normal. Residual right-sided hydropneumothorax and right lung base opacity. Normal left lung.

Output: Status post chest tube placement with residual right-sided hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: r/o mets History: none Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.