Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval for edema, effusion History: sob and leg swelling. Cardiomegaly with small pleural effusions and nonspecific lower lung zone opacities.

Output: Mild CHF with cardiomegaly and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Aortic dissection, evaluate lung fields. Unchanged appearance of the cardiomediastinal silhouette. Known aortic dissection not visible by plain film technique.Mild hazy opacity now consistent with mild edema and atelectasis. Small pleural effusions.

Output: Mild hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: evaluate for pneumonia History: productive cough since 8 weeks Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.POD 1 LVAD. ETT tip 4.5 cm above the level of the carina. I jugular Swan-Ganz catheter tip at the level of the main pulmonary artery. Other hardware and devices unchanged. No pneumothorax. Improving pleural fluid and atelectasis, with minimal remaining on the right.

Output: Improving pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: MaleReason for Study: Reason: ? cp History: cp Left-sided ICD unchanged.Stable mild cardiac enlargement.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Aortic valve disorder Swan-Ganz remains in the pulmonary outflow tract. ETT terminates 6 cm above the carina. NG tube also similar with side port seen at the GE junctionChest tubes are unchanged overlying the mediastinum and right lung baseMild cardiomegaly with decreased lung volumes similar to prior study. Minimal edema cannot be excluded it difficult to discern given motion

Output: Swan-Ganz and ETT are unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: evaluate for decreased effusions/edema History: failed SBT last 2 days due to increased oxygenation requirement Moderate cardiomegaly, unchanged.Low lung volumes. Improved aeration of the left lung base with mild, persistent retrocardiac opacities. No large pleural effusion or pneumothorax.Median sternotomy wires are intact. Mediastinal drains in place.Right jugular Swan-Ganz catheter incompletely visualized due to motion.

Output: Improved aeration of the left lung base with mild, persistent retrocardiac opacities. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: eval for chest pain History: L sided chest pain, history of HTN The cardiac and mediastinal silhouette is normal.No specific evidence of infection, edema, or effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary abnormalityRight jugular to lead ICD with lead tips in the expected locations

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Cough and weight loss evaluate for pneumonia or mass. Nodular pleural thickening in the right hemithorax with probable pleural fluid and associated compressive atelectasis at the lung base. Airspace opacity and interstitial thickening in the right upper lobe. The right hilum is not well visualized. The left lung is clear.Tortuous thoracic aorta. Bilateral paratracheal stripe thickening may reflect lymphadenopathy.

Output: Nodular pleural thickening and fluid in the right hemithorax compatible with malignancy. Recommend thoracic CT for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: r/i infection History: r/u infection Surgical changes redemonstrated in the right shoulder.Cardiomediastinal silhouette unremarkable.Bilateral basilar and retrocardiac opacities consistent with subsegmental atelectasis or retained secretions.

Output: Bilateral basilar and retrocardiac opacities consistent with subsegmental atelectasis or retained secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: IABP placement and Swan ganz placement History: As above Moderate cardiomegaly with unchanged lower lung zone edema with pleural effusions.Right jugular Swan-Ganz catheter, tip in proximal right main pulmonary artery.Left subclavian ICD, leads unchanged in position.An IABP marker is not clearly visible.

Output: No change in support devices, or pulmonary edema with pleural effusions. IABP marker not identifiable.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with cough. Mild cardiomegaly.No consolidation, large pleural effusion, or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male; 72 years old. Reason: ptx History: LVRS Interval post surgical changes of left lung volume reduction surgery with two left-sided chest tubes in place. Mild subcutaneous emphysema in the left neck. No definite pneumothorax. Bilateral opacities are most compatible with scarring and subsegmental atelectasis, which appears similar in the right lung. Right upper lung surgical clips.

Output: Status post left lung volume reduction surgery. No definite pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: IABP History: IABP Left subclavian ICD in place. IABP marker projects 3.5 cm below the top of the aortic arch. Lungs are slightly better inflated with improving atelectasis. No specific signs of pulmonary edema or pneumonia. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: IABP marker projects 3.5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: intubated History: intubated Low lung volumes. Mild enlargement of the cardiac silhouette again noted.No abnormal focal lung opacities. No pleural effusion or pneumothorax in this single AP projection.The ET tube overlies the distal trachea, retraction is recommended.Enteric tube courses below the diaphragm and off the field-of-view.

Output: Low-lying ET tube, recommend retraction approximately 2 cm.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: pneumonia History: fever chills Low normal lung volumes.No pleural or parenchymal abnormality.

Output: No evidence of pneumonia; no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p OLT History: s/p OLT Stable position of support devices.Right greater than left diffuse pulmonary opacities with small pleural effusions. Cardio mediastinal silhouette remains stable. No interval pneumothorax.

Output: Right greater than left pulmonary opacities have become more diffuse. Persistent small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Line placement, initial check. Postop transplant. Right jugular catheter tip is obscured by the pre-existing dual-lumen central line, but can be followed to the level of the SVC. The dual-lumen central line present previously terminates in the right atrium.Bilateral subcutaneous emphysema, but no visible pneumothorax.No focal pulmonary opacities.

Output: New right jugular catheter can be followed to the SVC level but the tip is obscured. No pneumothorax. Subcutaneous emphysema bilaterally.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with bladder cancer and lumber returns CHEST:LUNGS AND PLEURA: Linear atelectasis in the right middle lobe. Linear atelectasis in the left lower lobe.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. Multiple low attenuation foci in the liver are unchanged from previous study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense lesion in the upper pole of the left kidney is unchanged. Previously described perinephric fluid and hyperdense material in the left ureter has resolved. Right kidney is unremarkable. Both ureters are normal in size.RETROPERITONEUM, LYMPH NODES: Non-enlarged left turgid lymph node on image number 114, series number 4, measuring 8 x 7 mm.BOWEL, MESENTERY: Multiple diverticuli throughout the colon. A short segment of the transverse colon demonstrates mild wall thickening and pericolic fat stranding, consistent with acute diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy. Neobladder is unremarkable.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: New destructive bone metastasis involving the right sacrum on image number 146, series number 4. This lesion abuts the proximal right common iliac vessels.OTHER: No significant abnormality noted.

Output: Resolving of the changes involving the left kidney.New sacral metastatic lesion.Focal diverticulitis involving the transverse colon.Dr. Hahn was notified and acknowledged about these findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 85-year-old female presents with left chest discomfort. Evaluate for cardiopulmonary disease. Multiple dense subcentimeter curvilinear foci project over the left upper quadrant of the abdomen; favor surgical etiology.Bilateral, left greater than right, pleural effusions. No pneumothorax. Bilateral discoid atelectasis. Atherosclerotic calcifications of the aorta noted.

Output: Bilateral, left greater than right, pleural effusions. Bilateral discoid atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval lung fields History: s/p CABG, TVR Chest and mediastinal drains with no pneumothorax.Right jugular Swan-Ganz catheter removed.Status post sternotomy, heart size upper normal.Mild basilar subsegmental atelectasis gradually improving.

Output: No significant pneumothorax. Gradually improving basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Status post aortic dissection. Interval removal of right jugular introducer without significant pneumothorax. Mediastinal drain unchanged in position. Cardiomegaly and appearance of the mediastinum unchanged, with slight mediastinal widening. Layering pleural fluid on the left with associated compressive atelectasis. Moderate pulmonary edema and dependent atelectasis.

Output: Stable mediastinal widening. No pneumothorax. Increased volume of nonspecific pleural fluid on the left, with associated retrocardiac opacity; although this may reflect pleural fluid and atelectasis it is a nonspecific finding by plain film and the possibility of blood products cannot be entirely excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: S/P TECAB History: s/p TECAB Interval removal of endotracheal tube, right central venous catheter, and mediastinal drains. Bibasilar atelectasis, not significantly changed. Unchanged cardiomegaly.

Output: Interval removal of support devices.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with history of rectal/anal cancer. Status post chemotherapy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: A hypodense nodule in the left lobe of the thyroid measuring 16mm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate hypodense lesion in the right lobe of the liver, image number 90, series number 3. Other punctate lesions in the left lobe, also too small to accurate characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Subcentimeter left para-aortic lymph nodes and minimal soft tissue density extending along the left iliac arteries, uncertain etiology.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Soft tissue changes in the left inguinal region, which may be postoperative. Abdominal adenopathy, largest measuring 15 x 14 mm.OTHER: No significant abnormality noted

Output: Left inguinal adenopathy and left inguinal soft tissue changes, which may be postsurgical or postprocedural. Although less likely, neoplasm cannot be entirely excluded. Correlation with history is recommended. Small retroperitoneal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: eval for pathology History: chest pain Right port is currently accessed. There are multiple embolization coils and tubular opacification in the right low paratracheal location as before.Upper lobe predominant bronchial wall thickening, mucoid impaction and reticulation in the setting of cystic fibrosis. Basilar scarring. Definite evidence of pneumonia. Heart size remains normal.

Output: Findings reflective of a cystic fibrosis with prior embolization. No specific evidence of superimposed infection.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: eval lung fields, IABP History: s/p CABG IABP distal marker low, at least 7 cm below the top of the aortic arch.Median sternotomy with left lower lobe consolidation.Small left pleural effusion.Chest tubes are present with no pneumothorax. Right jugular Swan-Ganz catheter tip in main pulmonary artery.Status post extubation.

Output: No significant pneumothorax. The IABP catheter marker may be low.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Nonrheumatic aortic valve insufficiency. Follow-up. ETT tip 6.8 cm above the level of the carina. Enteric tube tip projects over the proximal stomach but the sidehole is above the GE junction, suggest advancement. Other tubes, lines and devices unchanged.Hazy basilar opacity consistent with edema, atelectasis and pleural fluid, slightly more pronounced due to diminished lung volumes but otherwise unchanged.

Output: Mild basal edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old. Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. Unremarkable cardiac and mediastinal silhouette. No significant pulmonary or pleural disease. Catheter tip in the SVC.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with gastric cancer status post resection and adjuvant chemotherapy CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. 6-mm right upper lobe nodule (series 4; image 39), unchanged. A nodular opacity adjacent to the right minor fissure is also unchanged and may represent a lymph node.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: The right-sided port terminates in the SVCABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hypodensities in the liver adjacent to the gallbladder fossa (series 3; image 123) and in segment 6 (series 3; image 122) are unchangedSPLEEN: No significant abnormality notedPANCREAS: The pancreas is atrophic without focal lesionADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post gastrectomy and partial esophagectomy with esophagojejunostomy.Scattered sutures are seen throughout the small bowel. No evidence of obstruction is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged and indents the base of the urinary bladderBLADDER: 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: Mild intrathoracic herniation of a small bowel loop just distal to the esophageal-jejunal anastomosis, without evidence of obstruction. Otherwise, stable examination.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: eval hypoxia. COPD exaccerbation History: as above Tracheostomy tube and right Port-A-Cath unchanged.Stable cardiac mediastinal silhouette.Mild interval improvement in the left midlung airspace opacity.No new pulmonary opacities identified.

Output: Interval improvement in the lingular pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p surgery, r/o PTX History: s/p surgery, r/o PTX Sternal wound skin closure.Mediastinal drains with no pneumothorax.Unchanged interstitial edema.New ECMO cannulae. Left jugular Swan-Ganz catheter tip in right ventricular outflow tract.Left subclavian IABP, the proximal marker 8 cm below the top of the aortic arch, and the introducer extending at least 5 cm into the aorta.LVAD and ICD unchanged.Tracheostomy tube tip approximately 6 above the carina.

Output: Skin closure. No significant pneumothorax. New ECMO cannula and Swan-Ganz catheter. Low IABP.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Chest pain with radiation to back, extensive GI history, including fundoplication, esophagectomy. Soft tissues and bony structures appear normal. Heart size is normal. Superior and mid mediastinum are normal. Increased density in the right cardiophrenic angle is seen which corresponds to dilated distal esophagus seen on CT examination 7/22/14. Lung parenchyma shows no focal airspace disease or mass lesions with normal pulmonary vascular structures.. No pleural disease.

Output: No acute cardiopulmonary disease and no etiology for patient's symptomatology seen.


Instruction: Generate impression based on medical findings.

Input: Hemiplegia. Heart failure No acute cardiopulmonary abnormality given technique

Output: Normal for technique


Instruction: Generate impression based on medical findings.

Input: Female 76 years old Reason: eval pna History: ams Streaky basilar opacities suggest mild atelectasis, perhaps related to aspiration. No pleural effusion or pneumothorax is evident. The cardiomediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: Mild bibasilar atelectasis, perhaps related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Fever evaluate for pneumonia. Low lung volumes with basal atelectasis and small volume of pleural fluid bilaterally. Right jugular chest port tip at the SVC/artery junction.

Output: No visible signs of pneumonia. Pleural fluid and basal atelectasis obscure the costophrenic angle regions however.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for pna History: sob Cardiomediastinal silhouette is normal.No pneumothorax. Left basilar consolidation with pleural effusion consistent with atelectasis and aspirated secretions. Well circumscribed nodules bilaterally, some may be end on vessels.

Output: Left basilar consolidation with pleural effusion, consistent with atelectasis and aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: PNA rule out History: as above Right basilar airspace opacity suggestive of pneumonia.Heart size normal.Upper lobe emphysema or scarring.

Output: Right middle or lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: s/p olt kidney trp History: s/p olt kidney trp Increasing left basilar consolidation.Pneumoperitoneum no longer evident.Small pleural effusions are seen.Mild cardiomegaly.ET tube tip 8 cm above the carina.An NG tube terminates in the stomach.Left subclavian catheter, tip in SVC.Left jugular catheter with tip in left innominate vein.Right jugular introducer, the tip in the jugular.Second right jugular catheter tip at right atrial level.

Output: Increasing left lower lobe consolidation. High ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: 72yo F w/ fevers, eval for pulm source History: as above Large lung volumes compatible with emphysema. No significant change in the left greater than right diffuse reticular opacities and bilateral infrahilar subsegmental atelectasis. Small bilateral pleural effusions are present. The heart size remains normal. Atherosclerotic disease affects the thoracic aorta.

Output: No significant change in the left greater than right diffuse reticular opacities suggestive of infection a background of emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: pt with right pleural effusion s/p right thoracentesis. r/o pneumothorax History: none Small right pleural effusion. No significant pneumothorax. Right basilar scarring and atelectasis. Heart size normal. Probable small left pleural effusion. Right chest port tip in SVC.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Chest pain evaluate for infiltrate or edema. Linear scarring at the left base. No focal airspace opacity, pleural fluid or pneumothorax. Normal heart size. No signs of pulmonary edema.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: sepsis Markedly underinflated lungs secondary to abdominal distention with multiple air filled loops of bowel in particular elevation of the right hemidiaphragm.Basilar subsegmental atelectasis, greater on the right.Port catheter with its tip in the SVC.

Output: Markedly underinflated lungs secondary to abdominal distention with resulting basilar atelectasis, but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: NSIP, DM , flare since 2007. CHEST:LUNGS AND PLEURA: Lower lung zone predominant ground glass opacities have increased recurred since the prior examination, but not to the extent present 2/28/2006. No specific evidence of fibrosis such as reticulation. Minimal airtrapping is present. No honeycombing identifiable. MEDIASTINUM AND HILA: Heterogeneous thyroid enlargement has not changed, consistent with goiter formation. Incidental note is made of a prominent anterior and superior pericardial recess. There is only a small pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Unchanged hepatic hypodensity probably a hemangioma, segment VII.

Output: 1. Recurrent groundglass opacities consistent with connective tissue disease or the patient's known dermatomyositis.2. Heterogeneous thyroid enlargement, probably a goiter.3. Small pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: new fever, eval for pneumonia History: fevers Right-sided pulmonary opacities unchanged.Mild retrocardiac atelectasis slightly increased.Left jugular catheter, tip in SVC.An NG tube terminates in the stomach.

Output: Unchanged patchy right-sided opacity, with increased retrocardiac opacity likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Status post right IJ triple lumen catheter placement Cardiomegaly with underlying atelectasis/consolidation, which with the prior study. Interval placement of a right jugular catheter with the tip terminating in the right atrium. No significant pneumothorax is evident. No large pleural effusion.

Output: Right jugular catheter tip terminates in the right atrium. No significant pneumothorax is evident.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: pna vs cardiopulm process, likely asthma History: sob asthma Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: ? pna History: AMS Improvement in pulmonary edema noted on previous study. No new focal lung consolidation. No overt left-sided heart failure. No large pleural effusion or pneumothorax. Moderate cardiomegaly again noted. Tortuous thoracic aorta, as before. Hilar prominence again noted bilaterally.

Output: Query pulmonary hypertension. Moderate cardiomegaly again noted. Tortuous thoracic aorta.No new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: R/O Pleural Effusion History: SOB/Cough Decreased lung volumes with stable cardiac enlargement.Bilateral pleural effusions and basilar atelectasis slightly increased from the prior exam.No focal airspace consolidation.Median sternotomy is intact.

Output: Interval increase in small bilateral pleural effusions .


Instruction: Generate impression based on medical findings.

Input: 70 year-old female status post hysterectomy and cystectomy. CHEST:LUNGS AND PLEURA: Left basilar subcentimeter pleural opacity has resolved. Subcentimeter nodule on image number 46, series number 6 is new from previous study, however, is nonspecific.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly. Possible 9-mm hypodense lesion in image number 75, series number 4. This lesion is slightly hypodense compared to the liver. MRI of the liver may be obtained, if further evaluation of liver for focal lesions is clinically indicated.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference right para iliac lymph node now measures 8 by 8-mm image number 127, series number 4, stable from previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy.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 right retroperitoneal, orenlarged lymph nodes.New subcentimeter punctate nodule in the left lower lobe. Follow-up imaging is recommended.Subtle small hypodense lesion in the right lobe liver. MRI of the liver may be obtained for further evaluation if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 46 year of male with bilateral parotid enlargement and equivocal mediastinal lymphadenopathy and LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Enlarged mediastinal, and hilar lymph nodes. Reference precarinal lymph node (image 38, series 3), measures 20 mm x 14 mm.Reference right hilar lymph node (image 44, series 3), measures 15 mm x 25 mm..Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Degenerative changes within the thoracic spine with evidence of probable old trauma at the L1-L2 level.UPPER ABDOMEN: No significant abnormality noted.

Output: Nonspecific mediastinal and hilar lymphadenopathy which may be inflammatory or neoplastic in origin. No pulmonary, pleural, or abdominal abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male; 68 years old. Reason: eval acute process History: SOB Unremarkable mediastinal and cardiac silhouettes. No abnormal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p PICC line History: s/p PICC line PICC catheter tip in the right axilla.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: PICC catheter tip in the right axilla.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: r/o infiltrate History: dyspnea Tracheostomy tube in place. Right internal jugular catheter tip in the SVC. Left upper extremity PICC tip in the azygos vein. Enteric tube in the stomach, extending beyond the field-of-view.Normal cardiomediastinal silhouette. Increased size of moderate bilateral layering pleural effusions with underlying bibasilar consolidation/atelectasis. Increased interstitial peripheral opacities, consistent with interstitial pulmonary edema. No pneumothorax.

Output: Interval increase in bilateral pleural effusions and interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: assess for acute process - hypoxia History: assess for acute process - hypoxia Cardiomediastinal silhouette is within normal limits. Diffusely increased lung markings are mild and nonspecific, but can be seen in bronchiolitis or perhaps mild diffuse atelectasis. No pleural effusions or pneumothorax.

Output: No specific signs of pneumonia, however nonspecific, mild diffusely increased lung markings can be seen in bronchiolitis or perhaps mild diffuse atelectasis. Given patient history of UC and risk for opportunistic infection or other pulmonary manifestation of disease, conservative serial follow-up with plain films is recommended until resolution.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: ETT, r/o PNA/ atalectasis/effusions History: ETT Support devices unchanged.Stable cardiomediastinal silhouette.Decreased lung volumes with left retrocardiac atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with left retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Reason: r/o acute process History: shortness of breath, cough for one week Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild to moderate cardiomegaly again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Evaluate L PICC, r/o pneumothorax History: L PICC Interval placement of left PICC, terminating in the SVC. Interval removal of right PICC. Decreased bilateral pleural effusions, with residual small right pleural effusion. Improving bilateral lower lung zone predominant opacities. Mild cardiomegaly, unchanged.

Output: 1. Interval removal of right PICC. Interval placement of left PICC terminating in the SVC.2. Interval improvement in bilateral pleural effusions, with residual right effusion. Improving pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: SOB History: SOB Support devices are unchanged in position with the left ventricular assist device inflow cannula directed cranially. Multiple metallic structures in the right upper abdomen favor embolization coils.Increasing bilateral opacities of moderate edema with small pleural effusions. Cardiomegaly is unchanged.

Output: Cardiomegaly with increasing edema. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old with new fever. Evaluate lung fields. Left upper extremity PICC tip is at the cavoatrial junction. Unchanged appearance of left upper quadrant surgical clips, partially visualized lumbar stabilization hardware and T12 kyphoplasty.Stable cardiomediastinal silhouette.Lung volumes with bibasilar subsegmental atelectasis. Focal retrocardiac airspace opacity. Probable small bilateral pleural effusions.

Output: Increasing retrocardiac airspace opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute process History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old Reason: evaluate left lung expansion History: s/p laparoscopic hiatal hernia repair Left pneumothorax not significantly changed from prior exam.Cardiomediastinal silhouette stable.Bibasilar opacities are similar in appearance to prior exam and likely represent pleural effusions and/or atelectasis.

Output: Stable left pneumothorax and bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: cough Multiple bilateral pulmonary nodules and masses compatible with metastases, markedly increased since the previous radiograph.Increased destructive lesion in the area of the acromion process of the left scapula.No specific evidence of pneumonia.Port catheter with its tip in the SVC.

Output: Progression of metastatic disease but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Cough for 4 months. Rule out pneumonia or development of ILD. History of rheumatoid arthritis. Lung volumes slightly decreased in the interim. Bilateral apical scarring appears stable.Right lower lobe peripheral and subpleural subsolid opacity with groundglass opacity extending cranially along the airways. There may be some intermixed subcentimeter nodules. Questionable faint similar opacities on the left. Right costophrenic angle scarring present previously.Normal heart size. No visible lymphadenopathy. Central pulmonary vasculature appears upper normal. Mild degenerative changes of the spine.

Output: Right lower lobe predominantly subpleural opacity with associated groundglass opacities and possible scattered nodules. Although some types of atypical infection may have an indolent course, the appearance is more concerning for follicular bronchiolitis or possibly pulmonary drug toxicity related to the patient's RA. ILD protocol thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with fall, pain and sob Mildly displaced left 6th rib fracture and possibly the left 5th rib as well. Small left pleural effusion with adjacent compressive atelectasis. No pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: Left 6th rib fracture and possible fracture of the left 5th rib as well. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.History of polycystic kidney disease with pleural effusion, status post Pleurx catheter placement. Left chest tube has been removed.The Pleurx catheter is unchanged in position in the left lower pleural space.The cardiomediastinal silhouette is unchanged.Bilateral pleural effusions are stable and left basilar opacity has improved. Previously seen pneumothorax has resolved.

Output: Interval removal of left chest tube with stable bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: status post bronchothermoplasty History: cough wheeze Small lung volumes with bronchial thickening and very mild linear opacities suggestive of scarring or subsegmental atelectasis at the right base. There is also an external artifact projected over the right costophrenic angle.

Output: Mild bronchial thickening and subsegmental atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: eval for PNA History: fevers Small lung volumes with left lower lobe consolidation unchanged.Heart size normal.Tracheostomy tube tip approximately 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right subclavian catheter, tip at cavoatrial junction level.Left subclavian catheter, tip in SVC.

Output: Unchanged left lower lobe consolidation, possible infection.


Instruction: Generate impression based on medical findings.

Input: Follicular non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Previously measured pretracheal lymph node now measures 3-mm in size.CHEST WALL: Previously measured left axillary lymph node has completely resolved.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pectoral calcifications and mildly prominent pancreatic duct consistent with chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate right renal stone. Hydronephrosis has resolved.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Infrarenal abdominal aortic aneurysm measuring 2-cm in its greatest dimension.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of enlarged lymph nodes in the chest abdomen or pelvis. Right renal stone without evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Evaluate for pneumonia History: sob, abd pain, vomiting There are mild basilar interstitial opacities with focal scarring which are most likely chronic. The heart size is normal. No pleural effusions or pneumothorax. No radiographic evidence of pneumonia.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 17 years old.Reason: s/p cardiac arrest, intubated, on ECMO and IABP History: s/p cardiac arrest, intubated, on ECMO and IABP ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.Balloon catheter tip at the level of the aortic arch with the balloon in the descending aorta.NG tube tip in the stomach.Progression of bilateral airspace opacity compatible with edema, improved, with layered out bilateral pleural effusions.

Output: Unfavorable progression of bilateral airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: assess for pna History: previous xr in dec 2016 Low lung volumes makes detailed cardiopulmonary assessment difficult. Improvement in right basilar pleural-parenchymal opacity. No new focal pleural parenchymal opacity. Paramediastinal scarring again noted consistent with radiation changes. Unchanged heart size. No large pleural effusion or pneumothorax. Surgical clips again noted within the upper neck and abdomen. Lumbar spinal hardware, incompletely visualized.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female who presents with shortness of breath. Evaluate for consolidation or edema. Postoperative changes of median sternotomy and LVAD, which is stable in position. Right PICC with tip unchanged in position. Cardiomediastinal silhouette is unchanged. No focal pulmonary opacities, pleural effusions, or pneumothorax.

Output: No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: pulm edema, pulm contusions, hemothorax, pneumothorax, traumatic injury. History: MVC 3 days ago, worsening chest pain and sob since then Small lung volumes.Normal cardiac and mediastinal contours.No pleural or parenchymal abnormalities.No pneumothorax.No displaced rib fracture.

Output: Small lung volumes with no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: S/P LVAD. eval for VAD position History: Post-op eval Increased bibasilar opacities and pleural effusions. Moderate cardiomegaly again noted. Iatrogenic devices are unchanged. No pneumothorax

Output: Increase in bibasilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: cp, sob Mild cardiomegaly, slightly decreased.No sign of CHF or active pulmonary disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Impella device positioning History: pt on ECMO ET tube tip approximately 3 cm above the carina. Impella device with its tip projected in the area of the apex of the left ventricle.Swan-Ganz catheter tip in the right descending pulmonary artery with a redundant loop in the right atrium.ICD leads unchanged.ECMO catheter from the IVC extending to the SVC.Small lung volumes with mild basilar opacity compatible with pleural effusions and atelectasis.

Output: Impella device with its tip projected in the area of the apex of the left ventricle.Swan-Ganz catheter looped in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: pna? History: tachypnea Enteric tube extends below the diaphragm outside the field-of-view.Stable enlarged cardiac silhouette.Bibasal atelectasis. Questionable nodular opacity overlying the left lung base.

Output: Questionable nodular opacity overlying the left lung base, which may represent developing pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: 57 y/o F w/ H\T\N SCC, h/o acute on chronic pancreatitis now with fever History: as above Moderate bilateral pleural effusions with basilar atelectasis, not significantly changed.Catheter tip in the SVC.No new findings.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Increasing white count Interval development of a moderate to large right effusion and small left fluid collection. Underlying perihilar edema-like changes are also observedLeft jugular Hickman unchanged

Output: New effusions and moderate edema, probable CHF


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: assess ETT position, changes in pulm opacities History: s/p intubation, resp failure ET tube is in a high position with its tip at the thoracic inlet.Enteric tube with its dependent margin of the image.Decreased lung volumes with stable cardiac enlargement.Diffuse pulmonary opacities, right greater than left, and left retrocardiac consolidation/atelectasis similar in appearance to the prior exam.

Output: Support devices unchanged with ET tube in high position. Stable cardiopulmonary appearance with extensive pulmonary opacities and cardiac enlargement.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: New pleural nodularities in both lungs posteriorly. There referenced pleural nodule in the right side measures 5 x 3 mm image number 51, series number 4. Linear atelectasis in the right middle lobe is unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Previously measured left chest wall mass has significantly increased in size and now measures 2.9 x 1.6 cm image number 23, series number 3. The mass also infiltrates the left pectoralis muscle. The mass also extends inferiorly in the left anterior chest wall.New right axillary adenopathy measuring 23 x 15 mm on image number 21, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Presumed hemangioma in the right lobe of the liver near the dome is unchanged. No other focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral caliectasis, unchanged.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: Enlarged heterogeneous uterus likely due to multiple fibroids, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously described lytic lesion in the midline sacrum is unchanged.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the left chest wall mass and new right axillary adenopathy. New pleural nodularity in both lungs. Other findings are stable.


Instruction: Generate impression based on medical findings.

Input: 65 year-old male with mesothelioma, CT for observation. LUNGS AND PLEURA: Bilateral pleural plaques, compatible with prior asbestos exposure, unchanged. Right middle lobe scarring, unchanged. No new pulmonary nodules or masses. No pleural fluid. Mesothelioma reference measurements as follows:Image 24/97 (level of the brachiocephalic confluence): 18 mm inclusive of pleura and contiguous structures at the two o'clock position, unchanged; 0 mm at the 6 o'clock position.Image 26/97 (level of the aortic arch): 9 mm at the 2:30 position, unchanged; 0 mm at the 6 o'clock position.Image 36/97 (level of the main pulmonary artery): 0 mm at the 6 o'clock position; 0 mm at the 9 o'clock position.MEDIASTINUM AND HILA: Right thyroid cystic lesion, unchanged. Stable aneurysmal dilatation of the ascending aorta measuring 5.0 cm on axial image 38/97. The cardiac size is mildly enlarged. Prosthetic aortic valve. Coronary artery calcifications. No pericardial fluid.No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Pleural-based soft tissue mass extending inferiorly along the margin of the liver measures 2.5 x 4.7 cm on axial image 83/97, increased in size compared to the prior exam where it measured 1.5 x 3.8 cm. The entire superior to inferior extent of the mass is not included in the plane of the scan but the visualized portion measures 6.2 cm on coronal image 59/108 which has increased from approximately 5.8 cm on the prior. Chest wall invasion is likely.Confluent osteophytes over several lower thoracic vertebral levels compatible with diffuse idiopathic skeletal hyperostosis. UPPER ABDOMEN: Mass-effect on the liver from the above-mentioned chest wall mass.

Output: 1.Stable mesothelioma reference measurements in the chest.2.Interval increase in the size of a perihepatic chest wall mass.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: eval infiltrates History: CP, cough - h/o PE Stable cardiomediastinal silhouette with tortuosity of aorta.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 36 years old Female. Reason: assess for infectious process History: as above. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: lesions? History: heavy smoker, cough? Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: cough for 4 weeks History: cough, post-tussive emesis The heart size is normal. The lungs are clear. Small calcified granuloma in the right middle lung zone. No focal pulmonary opacities.

Output: No radiographic evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female restaging urothelial cancer. CHEST:LUNGS AND PLEURA: Too numerous to count lung nodules are seen diffusely throughout both lungs -- largest of these measures 5 mm (series 7, image 31). In light of history these most likely represent diffuse metastases.No effusion seen. MEDIASTINUM AND HILA: No adenopathy seen. Atherosclerotic calcifications seen in the aorta and coronary arteries.CHEST WALL: No significant abnormality noted.ABDOMEN: Lack of IV contrast limits ability to evaluate solid parenchymal organs and vascular structures -- within these limitations the following observations can be made:LIVER, BILIARY TRACT: Extensive hypoattenuating lesions are seen diffusely throughout both lobes of the liver almost certainly representing metastatic disease. These are new since 10/11/12. Largest of these measures 4.3 x 3.9 cm (series 6, image 86) could reference lesions for subsequent follow-up would include posterior right lobe lesion (series 6, image 96) measuring 1.7 x 1.6 cm.Status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation is seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Resection of right kidney since 10/11/12. Postoperative changes are seen about the duodenum and the retroperitoneum. Increased soft tissue density is seen effacing the posterior aspect of the duodenum extending to the psoas muscle (series 6 count image 124) measuring approximately 3.7 x 3.2 cm. This is nonspecific in appearance and some of this represents postoperative change but the large extent of soft tissue mass with continuation of this more inferiorly along the psoas muscle in the iliac -- psoas space, this most likely represents recurrent tumor. RETROPERITONEUM, LYMPH NODES: Aortobiiliac graft unchanged in appearance.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: 1. Resection of right kidney with probable extensive soft tissue recurrence in the retroperitoneum abutting duodenum and psoas muscle. 2. Innumerable parenchymal lung nodules most likely diffuse metastases. 3. Extensive metastases to liver.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Evaluate for pulmonary edema History: Increasing SOB and LE edema x2-3 weeks. Severe HF, on home milrinone Severe cardiomegaly.No specific evidence of infection or edema.Left jugular catheter tip in SVC region.Left subclavian ICD, leads unchanged in position.

Output: Severe cardiomegaly, without edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with history of paravesicular endothelial carcinoma CHEST:LUNGS AND PLEURA: Increasing right pleural effusion. Decreasing left pleural effusion. Micronodules unchanged.MEDIASTINUM AND HILA: Index on the right the lymph nodes at the level of the great vessels measures 2.1 x 1.6cm (image 11; series 4), equivocally decreased in size. Other extensive cardiophrenic and posterior paramediastinal lymph nodes roughly stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic metastases. For reference purposes, there is a 3.4 x 2.9 cm index lesion in the right lobe (image 78; series 4).SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic or peripancreatic lesion measures 5.4 x 4 .1 cm, slightly enlarged (image 91; series 4).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephrostomy catheters catheters. Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: Index hepatogastric lymph nodes has increased in size and measures 2.6 x 2.0 cm (image 82; series 4). Reference left para-aortic lymph nodes measures 5.2 x 4.4 cm (image 132; series 4), slightly enlarged..BOWEL, MESENTERY: Significant interval worsening of the peritoneal carcinomatosis and increasing ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Increasing ascites as noted above.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.BLADDER: Bladder compressed by tumor.LYMPH NODES: Index right internal iliac node cannot be well differentiated from the surrounding soft tissues but it has increased in size and measures 8.5 x 5.3 cm (image 173; series 4).BOWEL, MESENTERY: Interval worsening of the peritoneal carcinomatosis. Previously measured mesenteric mass has increased in size and now measures 11.4 x 5.4 cm (image 163; series 4).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anasarca

Output: Overall worsening of disease with measurements given above.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: r/o ptx History: chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 71 years old Female. Reason: CHF History: CHF. Multiple patchy opacities are seen in the right upper lobe and in lower lungs. The cardiac silhouette is prominent. There is no evidence of pleural effusion.

Output: Multiple and new patchy opacities in both lungs, suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: assess for volume, tachypneic History: as above Cardiomegaly with mild to moderate lower lung zone edema with small pleural effusions.No specific evidence of infection.Right subclavian ICD unchanged.

Output: CHF with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia, s/p thora History: hypoxia, s/p thora Unremarkable cardiac and mediastinal silhouette. Diffuse interstitial opacity suggestive of edema with moderately large bilateral pleural effusions and underlying atelectasis.No pneumothorax or other acute change.

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


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: assess ETT position History: s/p intubation, severe COPD exacerbation Interval intubation. Endotracheal tube 6 cm above the carina.Lungs clear.No pneumothorax.Heart size normal.

Output: Interval intubation with endotracheal tube at 6 cm above the carina. No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 66 years old Male. Reason: Eval lines/tubes/devices History: ADHF. ET tube tip is at thoracic inlet. Additional supporting devices are unchanged. Pulmonary edema and pleural effusions have improved compared with prior radiograph a but appears similar to examination from 4/15/2016. Mild cardiomegaly is again noted.

Output: Mild] cardiomegaly and pulmonary edema as well as a pleural effusion, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: 56M with esophageal cancer causing aspiration and leukocytosis. Rule out PNA. History: aspiration, rule out PNA Mild focal narrowing of the superior aspect of the trachea again noted. Small pleural effusions with bibasilar opacities. No pneumothorax. Normal heart size. Percutaneous gastrostomy tube in place.

Output: Small pleural effusions with bibasilar atelectasis and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: assess lung fields History: assess lung field, SOB Social edema with pleural effusions and retrocardiac atelectasis, unchanged.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Unchanged pulmonary edema and pleural effusions with retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Peripheral, nodular density in the right middle lobe is unchanged measuring 8 x 7 mm on image number 50 Focalin series number 5. Extensive calcified pleural plaque formation in both lungs is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Presumed hemangioma in the left lobe is unchanged. Other small hypodensities in the liver are also unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal stone and benign-appearing renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive osteoblastic diffuse metastatic disease is stable. Entire skeleton is involved.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Soft tissue density between the rectum and bladder in the expected location of prostate is stable.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Please see discussion above.OTHER: Previously described asymmetric ovoid density in the region of the right spermatid cord is normal in the visualized. Present postsurgical changes in the pelvis most prominent on the right side.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Resolution of pleural effusion, pneumothorax. History: completed thoracentesis Moderate to large left-sided pleural effusion is not significantly changed in size with underlying atelectasis/consolidation. Moderate volume of pleural fluid on the right with slight worsening of pulmonary opacities, probably a combination of aspirated secretions and atelectasis. Left-sided PICC line is in stable position terminating within the SVC. No pneumothorax. Surgical clips in the right upper quadrant, unchanged.

Output: No pneumothorax. Moderate to large left-sided pleural effusion is not significantly changed in size.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: pneumonia History: neutropenic fever; shortness of breath, cough Right Port-A-Cath its tip in the SVC. Right pleural effusion and right basilar consolidation/atelectasis may represent acute infectious process.The a left lung is clear.The current mediastinal silhouette is unremarkable.

Output: Right pleural effusion and underlying right basilar consolidation/atelectasis may be a source of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: post op, eval lung fields History: s/p MVR, TVR Right IJ venous catheter unchanged. ET tube and NG tube have been removed.Stable cardiac enlargement.Bilateral pleural effusions and basilar atelectasis similar to the prior exam.No new pulmonary opacities noted.

Output: Interval extubation. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: recurrent left pneumothorax History: none Stable retrocardiac consolidation and a loculated left pleural effusion.No significant pneumothorax.Right hemithorax unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Unchanged loculated left effusion and retrocardiac consolidation. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: rule out pneumonia History: AMS on chemo Right chest port catheter terminates at the superior atriocaval junction.Low lung volumes specific evidence of infection or edema. Left retrocardiac opacity may reflect aspiration and/or atelectasis. Nodular opacity within the right midlung correlates to a pulmonary nodule seen on recent CT.

Output: 1. No specific evidence of infection.2. Right lung pulmonary nodule better characterized on prior CT.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: 74 yo F with central chest wound, ET tube, and pleural effusions, ? Change in effusions History: intubated Right chest tube, no pneumothorax.Unchanged pulmonary opacities including a right lower lung zone nodule.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: ET tube tip approximately 3 cm above the carina. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 78-year-old female with left upper lobe nodule and left lower lobe nodule. Shortness of breath. Please note that lack of IV contrast significantly limits evaluation of solid organs, including adenopathy.CHEST:LUNGS AND PLEURA: Marked centrilobular emphysema with cavitary lesions at both apices with adjacent scarring/atelectasis. Additionally, pleural-based, wedge-shaped region of atelectasis/consolidation with air bronchograms is noted in the superior segment of the left lower lobe posteriorly (series 5, image 31) with subjacent scarring more inferiorly as well.Calcified granuloma in the right middle lobe (series 5, image 54). Nonspecific, noncalcified nodule in the left upper lobe (series 5, image 35).MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Heavy vascular calcifications.CHEST WALL: Nonspecific breast calcifications. Correlation may be made with prior mammograms if available.UPPER ABDOMEN: Partially calcified left upper renal pole cyst (series 3, image 104; measuring 2 x 2.2 cm) is incompletely evaluated on this noncontrast examination. Further evaluation with a dedicated renal protocol CT may be considered if clinically needed to confirm benignity.

Output: Please note that no prior examinations are available for comparison.1. Marked emphysema throughout both lungs with apical cavitary lesions at the apices possibly from prior infection. Scattered atelectasis/scarring as above.2. Partially calcified left upper renal pole cyst is incompletely evaluated on this noncontrast examination. Further evaluation with a dedicated renal protocol CT with contrast may be considered if clinically needed to confirm benignity.3. Nonspecific breast calcifications bilaterally. Correlation may be made with prior mammograms if available.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Shortness of breath. Evaluate for aspiration, pneumonia versus pulmonary edema. Metallic bullet fragments overlie the right lower chest. No focal consolidation, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary process, without interval change.


Instruction: Generate impression based on medical findings.

Input: 29 years, Female. Reason: asses for obstruction/stool burden History: Obstipation, nausea, vomiting Cardiomediastinal silhouette is unremarkable. No significant pleural or pulmonary abnormality is noted.No evidence of free air. There is mildly distended stomach and proximal small bowel with differential air fluid level and paucity of bowel gas distally. Paucity of gas may be due to fluid filled small bowel loops are seen on recent CT, but early partial SBO is not excluded. Surgical clips are seen overlying the abdomen.

Output: Mildly distended stomach and proximal small bowel with differential air fluid level and paucity of bowel gas distally. Early partial SBO is not excluded.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with chronic sensation that gas is stuck in throat and chest. Assess for structural disease, motility disorder. Scout radiograph of the chest demonstrates no evidence of focal pulmonary consolidation, pleural effusion or pneumothorax.Double contrast evaluation of the esophagus revealed no mucosal or mural abnormalities. No hiatal hernia was identified. No spontaneous or provoked gastroesophageal reflux was identified. Limited examination of the visualized stomach demonstrated no abnormalities of the mucosal surfaces or mural contours. Fluoroscopic examination of esophageal motility revealed mild esophageal dysmotility. There was a normal primary peristaltic wave with mild to moderate proximal escape, best seen on series 15. There was consequent stasis within the distal esophagus with mildly delayed passage into the stomach. There was subsequent opacification of the stomach and proximal small bowel.Upon administration of a 13 mm barium pill, the pill passed freely and immediately into the stomach.

Output: Mild esophageal dysmotility.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p 2/19/15 Robotic thymectomy History: follow up Normal heart size and mediastinal contour apart from a marked dextroscoliosis.Retrocardiac hiatal hernia.No significant pulmonary abnormalities.Probable minimal residual pleural effusions.

Output: Interval resolution of basilar atelectasis with probable minimal residual effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Shortness or breath. Upper respiratory infection. Poststernotomy changes, left-sided dual lead AICD, and LVAD device are unchanged. Stable cardiomegaly. Right basilar opacity. No other air space opacity, large pleural effusion or pneumothorax.

Output: Right basilar opacity. Subsegmental atelectasis versus developing infection.


Instruction: Generate impression based on medical findings.

Input: Reason: PICC line placement History: none Catheter tip in the SVC and NG tube doubled back in the stomach. Pleural effusions, greater on the left, with underlying atelectasis.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Nonrheumatic aortic valve stenosis. Mediastinal drain. Aortic valve bioprosthesis in expected position. Sternotomy hardware appears in alignment. Left chest tubes with a small amount of air along the tube tracts but otherwise no significant sized pneumothorax.Layering pleural fluid and atelectasis bilaterally about the same.

Output: No acute change in pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Swan-Ganz remains in right pulmonary flow tract without interval change in the NG or ICD previously describedModerate nonspecific cardiomegaly with otherwise mildly decreased lung volumes. No discrete superimposed focal airspace or acute abnormality. CABG clips

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: 44 year-old female with hemoptysis and chest pain for one week. PULMONARY ARTERIES: Limited exam secondary to poor opacification of the pulmonary vessels and patient motion. Within that limitation, no large central pulmonary embolus is evident.LUNGS AND PLEURA: Moderate paraseptal and centrilobular emphysema predominantly affects the upper lobes. Airspace opacity within the lingula may represent atelectasis or infection. Patchy foci of subsegmental atelectasis also noted. No suspicious nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No suspicious hilar or mediastinal lymph nodes. Cardiac size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.LOWER EXTREMITIES: Nondiagnostic examination for DVT secondary to poor contrast opacification.

Output: 1.Limited examination as above. No large central PE. Nondiagnostic for DVT.2.Airspace opacity in the lingula may reflect atelectasis or infection.A preliminary interpretation of this exam was provided to the clinical service by the radiology resident on call. No significant discrepancy between preliminary and final reports.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with PMH of ulcerative colitis status post loop ileostomy takedown presents with fever and abdominal pain. Evaluate for intra-abdominal abscess or leak. CHEST:LUNG BASES: Bilateral right greater than left pleural effusions with associated compressive atelectasis are present.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholecystectomy clips are seen.SPLEEN: The spleen is enlarged, measuring 15.8cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: An orogastric tube is in the stomach. Majority of the contrast is retained in the body and antrum of the stomach. There has been a total colectomy with evidence of an ilial pouch anal anastomosis. Postsurgical changes from loop ileostomy takedown in the right lower quadrant is also seen. Multiple moderately dilated fluid-filled loops of small bowel are present with no evidence of obstruction. There is no extravasation of contrast suggest a leak. No abnormal intra-abdominal fluid collections are visualized.BONES, SOFT TISSUES: In the right lower quadrant of the anterior abdominal wall, there is a minimally peripheral enhancing fluid collection containing foci of gas measuring 1.0 cm x 3.3 cm (image #64, series 3). Adjacent fat stranding is also seen.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: An orogastric tube is in the stomach. Majority of the contrast is retained in the body and antrum of the stomach. There has been a total colectomy with evidence of an ilial pouch anal anastomosis. Postsurgical changes from loop ileostomy takedown in the right lower quadrant is also seen. Multiple moderately dilated fluid-filled loops of small bowel are present with no evidence of obstruction. There is no extravasation of contrast suggest a leak. No abnormal intra-abdominal fluid collections are visualized.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. 1.0cm x 3.3cm enhancing fluid collection in the right lower quadrant subcutaneous tissue likely represents an abscess.2. Post surgical changes as described above with no evidence of intra-abdominal abscess or anastomotic leak.3. Diffusely dilated loops of small bowel consistent with an ileus pattern.4. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: evaluate lung volumes and volume status, hardware History: s/p cardiac surgery (ECMO) Complete whiteout of the thorax in this patient. Patient has been extubated; enteric tube has been removed. New feeding tube has been placed terminating within the body of the stomach. Other lines and tubes, unchanged.

Output: Complete whiteout of the thorax suggestive of large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: 74 y/o man w/ hypoxia. History: 74 y/o man w/ hypoxia. No definite left-sided pneumothorax. No right-sided pneumothorax. Left-sided chest tube remains in place. Slight increase in right basilar pleural-parenchymal opacities. Diffuse left lung opacities unchanged. Unchanged heart size.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 71 years old Male. Reason: lung eval History: lung eval. Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.No significant pneumothorax. The right IJ catheter has been removed.

Output: Stable bibasilar opacities, consistent with the atelectasis, consolidation and effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: evaluate effusion, volume status with diuresis History: SOB Improvement in pleural effusions and basilar edema like opacities.Unchanged retrocardiac consolidation.Focal atelectasis is now present in the right upper lung zone.Embolization coils are projected over the midline.

Output: Improving pleural effusions and basilar edema.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia, altered History: above Underinflated lungs with a tortuous aorta, accentuated by patient rotation.Mild upper zone chronic interstitial opacities and motion artifact.Port catheter with its tip in the SVC.No sign of pulmonary edema or pneumonia.A CT scan has been performed subsequently and provides more detailed evaluation.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: sp jejunal interposition History: hypotension Tracheostomy tube has been removed. Left-sided chest tube again noted. Increase in pleural effusions, mild pulmonary edema, and basilar opacities. Increased heart size, likely due to lower lung volumes. Small left-sided pneumothorax.

Output: Small left-sided pneumothorax. Left-sided chest tube is in place.Increase in pleural effusions, mild pulmonary edema, and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with confusion, lightheadedness. Evaluate for pneumonia. No focal airspace opacities, pleural effusions or pneumothorax. Normal cardiac mediastinal silhouette.

Output: No acute cardiopulmonary abnormality. No evidence of infection as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: r/o evidence of pulmonary sarcoid History: abnormal cardiac MRI, VT, syncope Moderate cardiomegaly.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality. No specific evidence of sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with metastatic melanoma CHEST:LUNGS AND PLEURA: Right upper lobe nodule is stable measuring 9 by 8 mm on image number 31, series number 5. Other subcentimeter nodules are also stable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left pararenal mass is stable measuring 7 mm on image number 112, series number 3. Right pararenal mass is stable measuring 1.5 cm on image number 98, series number 3. Bilateral renal hypodense lesions are difficult to compare with the previous study due to different phase of scan, however, there grossly stable and suspicious for metastatic disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small omental and mesenteric nodular densities are stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable lung, renal, perirenal, omental lesions


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: hypoxemia s/p balloon blocker in right mainstem History: as above Right upper lobe consolidation and mycetoma as on previous. ET tube tip just above the orifice of right mainstem bronchus. NG tube extends beyond the field-of-view of study. Embolization coils on the right. No new opacity.

Output: ET tube tip just above the orifice of right mainstem bronchus.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: eval for pulm edema History: worsening b/l LE edema Small pleural effusions with bibasilar opacities. Moderate cardiomegaly. Aortic atherosclerosis. No pneumothorax. Mild disc degeneration and osteopenia.

Output: Small pleural effusions and bibasilar atelectasis or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: dyspnea History: dyspnea Stable severe biapical scarring and volume loss with multiple surgical staples at the left apex. There is mild rightward tracheal deviation, similar to 10/2014 and is suspected to be positional. Chronic basilar interstitial opacities of fibrosis and pleural thickening. Stable position right ICD electrode. Sternal wires remain well aligned.

Output: Chronic basilar opacities of fibrosis. Stable appearance of biapical scarring and volume loss.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: assess NG tube placement History: as above The cardiomediastinal silhouette is normal in size.There is elevation of the left hemidiaphragm with adjacent compressive atelectasis. No dense consolidation, large pleural effusion or pneumothorax.ET tube tip is 1 to 2 cm above the carina. Left chest wall port tip is in the right atrium. Enteric tube is below the diaphragm extending beyond the field of view.

Output: Enteric tube is below the diaphragm extending inferiorly beyond the field of view. ET tube tip is 1-2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT, OG, s/p cardiac arrest History: intubated, cardiac arrest ET tube and right jugular catheter are unchanged.Enteric tube extending below the inferior margin of the radiograph.Patchy bilateral mainly perihilar and lower zone opacities suggestive of aspiration.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Check for cardiomegaly. End-stage renal disease and prekidney transplant No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: infection History: ams Increasing right hemidiaphragm elevation with increased basilar subsegmental atelectasis right greater than left.No specific evidence of infection or edema.Heart size normal.

Output: Increasing right hemidiaphragm elevation, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Evaluate for pulmonary edema, effusions History: increased SOB, CHF The cardiomediastinal silhouette is moderately enlarged. Right dual-lead ICD is in place with wires in the right atrial appendage and right ventricle.Streaky left upper and lower lobe opacities likely reflect subsegmental atelectasis. There is no focal airspace opacity, pleural effusion or pneumothorax.

Output: Left upper and lower lobe subsegmental atelectasis and moderate cardiomegaly. No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Would like to assess for improvement in edema/effusions and opacities (s/p Tx for HCAP) History: Increase WBC Moderate cardiomegaly, slightly decreased. Interval partial clearing of pulmonary opacities compatible with edema with small pleural effusions.No new findings.

Output: Resolving CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for evidence of infection History: leukocytosis, lactic acidosis Unremarkable cardiac and mediastinal silhouette. No sign of pneumonia or other acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with history of non-Hodgkin lymphoma. Reevaluate and compare to previous The following observations are made given the limitations of an unenhanced study.CHEST:LUNGS AND PLEURA: UnremarkableMEDIASTINUM AND HILA: No significant abnormality noted. Small hiatal hernia.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: Bilateral nonobstructing punctate renal stones are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Subcentimeter common femoral lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: confirm triple lumen placement. History: none Right IJ line terminates within the right atrium approximately 5 cm from the cavoatrial junction. Left-sided PICC, unchanged terminating near the cavoatrial junction. Clear lungs. Improvement in interstitial pulmonary edema. No pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: Right IJ line terminates within the right atrium; no evidence of pneumothorax. Improvement in interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: Lightheadedness and syncope. Mild cardiomegaly.Enlargement of the pulmonary arteries.Displacement of the superior trachea anteriorly and to the right, presumably due to goiter.No focal opacity, pleural effusion or pneumothorax.

Output: 1.No acute cardiopulmonary process.2.Enlarged pulmonary arteries consistent with pulmonary hypertension.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: PA catheter location History: a fib rvr Endotracheal tube terminates 5 cm superior to carina. Advancement of the right Swan-Ganz catheter, now with in the mid to distal right inferior pulmonary artery. Nasogastric tube side hole at distal esophagus. Interval placement of external defibrillator pad. Diffuse airspace interstitial opacities, less confluent on the right, favoring edema. Increasing pleural effusions. Heart size normal.

Output: Advancement Swan-Ganz catheter now in mid to distal right inferior pulmonary artery. Advancement nasogastric tube recommended. Moderate severe pulmonary edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Right nephrectomy and status post cystectomy for bladder cancer No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Colorectal cancer status post chemotherapy CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule measures 5 mm number 18, series number 6. It's unchanged from previous CT. However, some of the other bilateral scattered nodules have minimally increased in size within the interval. In reference lingular nodule measures 8 x 9-mm image number 37, series number 6. Previously it was measuring 8 x 6 mm image number 41, series number 80284.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference lesion in segment 7 has increased in size now measures 21 x 25 mm image number 72, series number 4. Reference segments 6 lesion has also slightly increased in size measuring 23 x 17 mm numbers 86, series number 4. Again noted multiple metastatic lesions in the liver.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: There is fusion of hernia containing nonobstructing small bowel loops.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is significantly enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Wall thickening and irregularity involving the mid sigmoid colon. Small bowel loop in the pelvis is closely associated with the area demonstrating focal wall thickening. An ilio sigmoid fistula cannot be excluded.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the bilateral pulmonary nodules and liver metastases. Irregular wall thickening involving the mid sigmoid colon suspicious for neoplastic disease. An ilio sigmoid fistula cannot be entirely excluded based on CT findings.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Atrial septal defect with cough for one month. Upper normal heart size. Left lower lateral thoracic extrapleural lipoma with some adjacent linear scarring. Mild scarring in the lung bases.No signs of pulmonary edema and no suspicious pulmonary nodules or masses. Atherosclerotic calcifications of the abdominal aorta seen in a limited fashion on the lateral radiograph.

Output: No acute pulmonary abnormality. Left thoracic extrapleural lipoma.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Intermittent chest pain. Early satiety. Low lung volumes. No focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is at the upper limits of normal.

Output: Low lung volumes, without evidence of an acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with abdominal pain and leukocytosis. Evaluate for abscess and diverticulitis. CHEST:LUNG BASES: There are bilateral pleural effusions with associated atelectasis, left greater than right. A calcified lesion in the left lower lung base, likely represents a granuloma. Status post left mastectomy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Multiple calcified lesions within the spleen, represent granulomas.PANCREAS: Dilatation of the pancreatic duct in the region of the pancreatic tail, which is normal for the patient's age.ADRENAL GLANDS: Left adrenal thickening of unknown significance.KIDNEYS, URETERS: Hypodense lesions located in the left kidney, likely represent cysts. The lesion in the upper pole of the right kidney is fat-containing on post contrast images and enhances on delayed images, suggestive of an angiomyolipoma. As this is not a dedicated renal protocol study, ultrasound might be helpful for confirmation RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are no distended loops of bowel or evidence of obstruction. There is no evidence of appendicitis. Small, midline, fat-containing ventral hernia is noted.BONES, SOFT TISSUES: Degenerative changes with vacuum disk phenomenon of the lower lumbar spine are noted. OTHER: Atherosclerosis affects the aorta and the iliac arteries. There is mural thrombosis of the abdominal aorta which is seen on images 40-64, series 5.PELVIS:UTERUS, ADNEXAE: The uterus is absent with adjacent surgical clips noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple phleboliths are located in the pelvis.

Output: 1.No acute intra-abdominal findings to suggest source of abdominal pain.2.The lesion in the upper pole of the right kidney is most consistent with an angiomyolipoma. However, ultrasound is recommended for further confirmation 3.Bilateral pleural effusions with associated atelectasis, left greater than right. 4.Atherosclerosis of the abdominal aorta and iliac arteries; mural thrombosis of the abdominal aorta


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: NG tube placed, assess for positioning History: as above No significant cardiopulmonary abnormality.An NG tube extends below the lower margin of the image.

Output: An NG tube extends below the lower margin of the image.


Instruction: Generate impression based on medical findings.

Input: IABP check IABP placed, 3 to 4 cm from the aortic arch. ETT is also retracted, currently terminating 4 cm from the carina. Swan-Ganz advanced into the right pulmonary outflow tract from an inferior approach.Cardiopulmonary appearance otherwise significant for increasing layered effusions and diffuse suspected CHF. See subsequent report

Output: IABP and Swan-Ganz placement. ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: evaluate for pneumonia, displaced ribs History: chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Diffuse large B-cell non-Hodgkin lymphoma. Status post chemotherapy. Restaging. CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. Punctate right upper lobe nodule is unchanged. Other punctate calcified granulomas are also unchanged. Subsegmental atelectasis in the right lung base.MEDIASTINUM AND HILA: No evidence of enlarged lymph nodes in the mediastinum. Previously measured pretracheal lymph node now measures 5-mm in diameter on image number 29/230. Descending aorta is ectatic measuring 4.3 x 4 cm.CHEST WALL: Previously measured left axillary lymph nodes likely represent tortuous veins or collateral vessels.ABDOMEN:LIVER, BILIARY TRACT: The previously described biliary dilatation have resolved. Previously seen large peripancreatic and retroperitoneal conglomerate adenopathy has almost completely resolved.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral stones and simple cysts without hydronephrosis or unchanged.RETROPERITONEUM, LYMPH NODES: Unremarkable.BOWEL, MESENTERY: Residual mesenteric adenopathy measuring 4.5 x 4.4 cm on image number 123/230. Inferior to this adenopathy hazy density surrounding the mesenteric vessels are is seen like the representing treated residual lymph nodesBONES, SOFT TISSUES: L2 vertebral body hemangioma and degenerative changes are unchanged.OTHER: No significant abnormality notedPELVIS:Pelvic images are significantly degraded by the artifacts from the bilateral hip prosthesis.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: Chest findings are stable. Significant interval decrease in the size of the retroperitoneal and peripancreatic adenopathy. Residual mesenteric adenopathy as described above.Bilateral nephrolithiasis unchanged.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female with shortness of breath, pulmonary arterial hypertension, and interstitial lung disease/sarcoidosis LUNGS AND PLEURA: Extensive, predominantly upper lobe subpleural nodules with cavitation are basically unchanged. New nodules are identified in the right lower lobe (images 52 and 53, series 5), and left lower lobe (image 52, series 5), as well as mild increase in size of the left lower lobe cavitating nodules.Diffuse bronchiolar wall thickening is again identified.No significant air trapping identified on the expiration images.MEDIASTINUM AND HILA: Stable marked mediastinal and hilar lymphadenopathy.Moderate size pericardial effusion is unchanged. Moderate enlargement of the pulmonary artery compatible with pulmonary arterial hypertension.Right-sided central venous catheter with its tip in the RACHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.1.

Output: 2.Progression of cavitating pulmonary nodules in the lower lobes. Stable disease in the upper lobes.3.Stable diffuse peribronchiolar interstitial disease compatible with sarcoidosis.4.Stable mediastinal lymphadenopathy and pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: CTICU History: Daily CXR Iatrogenic devices are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Decreased size of left pleural effusion. Increased aeration of the left lung compared to last study. Diffuse pulmonary opacities have increased in the right lung. Unchanged cardiomegaly.

Output: Decreased size of left pleural effusion with increased left lung aeration. Probable worsening pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: IABP placement History: IABP placement The intra-aortic balloon pump marker is no longer visualized the proximal descending thoracic aorta. There is an opacity that favors the tip, projecting at the left mainstem bronchus. This has been successfully repositioned on a subsequent radiograph. The remaining support devices are unchanged in position.Stable cardiomegaly. The right costophrenic angles excluded from the field-of-view. No evidence of edema or pneumothorax.

Output: Intra-aortic balloon marker suspected to terminate at the level of the left mainstem bronchus, successfully repositioned on subsequent radiograph.


Instruction: Generate impression based on medical findings.

Input: Reason: ett History: ett ET tube tip approximately 5 cm above the carina.Cardiomegaly with bilateral opacity compatible with edema, atelectasis and pleural effusions.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old. Right IJ venous catheter with its tip at the SVC/RA junction.Left IJ couldn't catheter placed with its tip extending retrograde into the distal right subclavian vein.Cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: Left IJ venous catheter extending retrograde into the right subclavian vein. Subsequent imaging demonstrates appropriate. positioning


Instruction: Generate impression based on medical findings.

Input: 74 years old Male. Reason: lung eval History: lung eval. Interval worsening of left pneumothorax. Swan-Ganz catheter with removed. The mediastinal drainage catheters are stable in position.Basilar opacity compatible with atelectasis and consolidation, unchanged.

Output: Interval worsening of the left thorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: 57yr old male with history of MM; pre-auto sct evaluation History: evaluate Mild left upper lobe scarring. No other significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Bodyaches chills and wheezes rule out pneumonia. Normal heart size. Asymmetric perivascular opacity near the right hilum in the right upper lobe and also adjacent to the right middle lobe bronchovascular structures centrally. Subsegmental atelectasis at the right lung base. The left lung is clear.

Output: Opacities in the right lung suspicious for pneumonia. In an adult patient, follow-up chest radiographs are suggested in 6 weeks to assess for clearance and exclude alternate pathology.


Instruction: Generate impression based on medical findings.

Input: Age: 85 yearsGender: FemaleReason for Study: Reason: eval for infection History: syncope The cardiomediastinal silhouette is unremarkable. The lungs are clear. No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: worsening pna History: ams Center venous catheter terminates in the RA. Diffuse opacities in the right lung with hazy opacities in the left lung again noted and not substantially different. Small right pleural effusion. Unchanged cardiomegaly. No pneumothorax.

Output: Probably pulmonary edema with superimposed consolidation in the right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: cp, sob History: cp, sob Median sternotomy presumably for CABG.Left hemithorax volume loss with mild left basilar scarring unchanged.No specific evidence of infection or edema.

Output: No acute abnormality.