Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: s/p tracheostomy, History: s/p tracheostomy Enteric tube extends inferiorly off the view. Other lines and tubes are unchanged. Unchanged pulmonary edema, bibasilar opacities and pleural effusions. No pneumothorax. Unchanged heart size.

Output: Unchanged pulmonary edema, bibasilar opacities, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: post swan placement History: post swan placement Swan-Ganz catheter tip in the right descending pulmonary artery.Cardiomegaly with vascular redistribution, small pleural effusions and basilar atelectasis.ICD leads unchanged.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: ro pna History: lll crackles The heart is normal in size.Increased lung volumes and signs of upper lobe predominant emphysema with right upper lobe bullous disease.Bilateral lower lobe predominant coarse reticular opacities and septal lines are noted.Possible trace left pleural effusion.Decrease a pleural line in the right apex also visualized in the lateral view. Asymmetric right upper lobe bullous disease limits the differentiation with a pneumothorax.

Output: 1. Asymmetric right upper lobe bullous disease limits the assessment for pneumothorax. There is a right apical pleural line visualized in both views which may represent a parenchymal bulla or a small pneumothorax. No comparison images are available. Further assessment with noncontrast chest CT should be considered according to patient's clinical presentation.2. Bilateral lower lobe predominant fine reticular opacities and septal lines are suggestive of interstitial pulmonary edema or atypical (possibly viral) pneumonia. Correlate with history.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: post thora History: above Cardiomegaly with mild basilar edema and small pleural effusions, not significantly changed since earlier today. No specific evidence of infection.

Output: CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: + quantiferon gold; no cough History: xiphoid process tenderness 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: Female, 60 years old.Reason: SOB History: SOB No significant cardiopulmonary abnormality.No specific evidence of infection or failure.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: line placement History: none No change in pulmonary opacities and pleural effusion suggestive of edema.Left jugular catheter, tip in SVC.Other tubes and devices are unchanged.

Output: Left jugular catheter, tip in SVC. Otherwise stable.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Chest pain. No focal airspace opacity, pleural effusions or pneumothorax. The cardiomediastinal silhouette is normal.

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


Instruction: Generate impression based on medical findings.

Input: Reason: rule out thyroid metastases History: none There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. Increased radiotracer activity in the neck has resolved. Multiple foci of increased radiotracer activity and the lungs have decreased in size and number compared to prior exams. New faint focus in the region of the right shoulder a represent artifact or tumor.Probe uptake of the neck is 0.124%.

Output: 1.No residual functioning thyroid tissue in the neck.2.Interval decrease in pulmonary metastases.3.New faint focus in the region of the right shoulder a represent artifact or tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: AMS, assess for infectious etiology History: Non-productive cough Persistent moderate cardiomegaly. Prominence of the perihilar regions consistent with known adenopathy.Persistent streaky basilar densities with more focal opacity at the right lung base suggestive of aspiration. Likely small bilateral pleural effusions.

Output: Patchy opacities at the right lung base possibly related to aspiration. New or increasing small bilateral pleural effusionsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: post-op (s/p L main bronchus dilation, laser ablation) History: post-op (s/p L main bronchus dilation, laser ablation) Slightly decreased volume in the left lung withMild interstitial opacity, not significantly changed. Left main bronchus stent in place.Status post clamshell sternotomy.

Output: Findings consistent with previous bilateral lung transplant with left bronchial stent in place.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Fever question infection. Limited exam.Right jugular catheter projects over the cranial aspect of the right atrium.Limited evaluation of the lungs with hazy opacities throughout the right lung and faint patchy opacities and mild atelectasis on the left. Lung volumes remain low.

Output: Worsening hazy opacities suspicious for infection.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: pre-op for femur fx History: pre-op The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Surgical clips identified in the right upper abdomen.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval lung fields History: SOB Cardiomegaly. Small bilateral pleural effusions. Unchanged diffuse reticulonodular pulmonary opacities. Unchanged support devices.

Output: No significant change from prior examination.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: POD 1 left lower lobectomy History: POD 1 left lower lobectomy Two left chest tubes, tip in apex, with no large pneumothorax. Left hemithorax postsurgical volume loss.Right lung unremarkable.

Output: Left lower lobectomy without complication.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: eval lung fields History: fever, tachy Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: eval infxn, edema, effusion History: cough w/ blood tinged sputum, sob, intermittent fever 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: Male, 68 years old.Reason: r/o pneumothorax History: Chest tube removal Status post median sternotomy and valvular replacement. Stable cardiomegaly.Trace residual bilateral apical pneumothorax status after recent removal of the mediastinal drains and left basilar chest tube.No signs of pulmonary edema. Left basilar nodular opacity likely represents a nipple shadow.Trace bilateral pleural effusions.

Output: Trace bilateral apical pneumothoraces after recent removal of mediastinal drains and chest tube. Attention on follow-up chest radiographs.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: please assess positioning of line History: as above Interval removal of PICC line and placement of right internal jugular vein central venous catheter with tip in projection of superior vena cava. There is no pneumothorax.Low lung volumes. Basilar subsegmental atelectasis but no specific evidence of infection or edema.

Output: Line in good position with no pneumothorax. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: MaleReason for Study: Reason: PNA History: Seizure The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Patient status post left lung transplant, postoperative day 1 Interval removal of ET tube and right Swan-Ganz catheter. Left-sided chest tube with tip in apex redemonstrated and unchanged. Postsurgical changes related to left lung transplant redemonstrated. Unchanged left-sided pleural effusion and no findings to suggest a pneumothorax.Decreased lung volumes and basilar fibrosis in the native right lung redemonstrated.No new cardiac or mediastinal contour change.

Output: Interval removal of ET tube and Swan-Ganz catheter without additional change.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: Evaluate aspiration pneumonia, other causes of hypoxia History: Hypoxia, ?aspiration in pt with hx of esophageal ca and stricture Right Port-A-Cath and esophageal stent unchanged.Stable cardiomediastinal silhouette.Extensive bilateral pulmonary opacities and pleural effusions similar in appearance to the prior exam.Barium identified in loops of bowel in the left upper abdomen.Multiple surgical clips in the region of the GE junction.

Output: No significant interval change in the diffuse pulmonary opacities and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumonia History: fever, sickle cell anemia Mild cardiomegaly and chronic basilar interstitial opacity compatible with scarring.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o sternal disunion, c/o pain, please eval for pathology History: c/o reproducible pain at chest Unremarkable cardiac and mediastinal silhouette with intact sternal fixation wires.No significant pulmonary abnormalities.

Output: No significant cardiopulmonary abnormalities. However possible sternotomy nonunion cannot be adequately evaluated, and a CT scan would be superior for this purpose.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Pulled back ET tube History: pulled back ET tube Mild retrocardiac opacities suggestive of aspirated secretions.Elsewhere, the lungs are unremarkable although the periphery of the right lung base was not included on the image. ET tube tip approximately 6 cm above the carina, repositioned.

Output: ET tube repositioned, the tip now 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: assess ET tube Endotracheal tube terms approximately 4 to have centimeters from the carina. Enteric tube terminates within the body of the stomach. Low lung volumes makes detailed cardiopulmonary assessment difficult. Patchy basilar opacities. Heart size likely at upper limit of normal. No large pleural effusion or pneumothorax. Patient status post cholecystectomy.

Output: Patchy basilar opacities which may represent atelectasis, aspiration, edema, and/or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: ET in place? History: ET in place ET tube tip 4 cm above carina. Other support hardware is stable.Small lung volumes with bilateral airspace opacity, greater on the right, suggestive of infection and/or aspiration, stable.

Output: ET tube tip 4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male status post liver transplant with cholangiocarcinoma and HCC. Please evaluate for recurrence of disease CHEST:LUNGS AND PLEURA: Left upper lobe calcified nodule with calcified left hilar lymph node are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Small amount of fluid around the caudate lobe of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index portacaval node is unchanged measuring 10 by 9-mm in image number 100, series number 12. Other retroperitoneal lymph nodes are also unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: s/p OHT, evaluate lung fields History: O2 requirement Changes of a prior median sternotomy are noted. Right internal jugular venous catheter has its tip overlying the superior cavoatrial junction. Surgical clips project over the mediastinum.Persistent elevation of the left hemidiaphragm. The cardiac mediastinal silhouette is unremarkable. No focal pulmonary opacity suggestive of pneumonia. No large pleural effusion. No pneumothorax. Streaky bibasilar opacities consistent with atelectasis and/or scarring.

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


Instruction: Generate impression based on medical findings.

Input: Reason: assess for new pulmonary changes vs prior CXR today History: worsening hypoxia, h/o PNA and pleural effusion Small lung volumes with patchy bilateral airspace and interstitial opacity, not significantly changed.Probable small right pleural effusion.Catheter tip in the SVC.Moderately distended air-filled stomach and bowel.

Output: Extensive nonspecific pulmonary opacity with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Eval for pneumonia pulmonary edema and effusion History: Desaturation and increased O2 requirements Worsening right lower lobe atelectasis. Patchy left basilar opacities, unchanged. Unchanged cardiomegaly. No pneumothorax. Small right pleural effusion.

Output: Worsening right lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: shock and cardiac arrest, et tube History: shock and cardiac arrest, et tube Lines and tubes are unchanged. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged heart size. No pneumothorax.

Output: No substantial change in bibasilar pleural-parenchymal opacities. Unchanged heart size.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.PE?. Dyspnea. Extensive coarse interstitial abnormality progressed from 2013. Normal heart size. Central pulmonary vasculature mildly enlarged, unchanged. No pleural fluid.

Output: Interval progression in interstitial lung disease since exam of 2013. This can be further characterized by an ILD protocol high-resolution thoracic CT if desired. Signs of pulmonary hypertension. No visible infarcts by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.SOB status post MVR and mediastinal washout. Hardware and devices similar in position.Lung volumes remain low, no significant pneumothorax.Basal opacity compatible with pleural fluid and atelectasis, left greater than right, about the same.Unchanged mild mediastinal widening.

Output: Small pleural effusions with associated atelectasis, left greater than right, unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for pleural effusion History: Tachypnea Small lung volumes with basilar subsegmental atelectasis and small pleural effusions.Chronic fracture deformity of the left clavicle. Port catheter with its tip in the SVC.

Output: Small pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Syncope. Low normal lung volumes. Basal scarring/atelectasis, chronic in appearance. No acute pulmonary abnormalities. No specific signs of pneumonia.Chronic degenerative changes of the thoracic spine including loss of intervertebral disc space height, mild compression deformities and osteophyte formation.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: r/o pneumonia History: cough, generalized malaise, body aches Cardiomediastinal silhouette is stable. Lungs are clear of airspace opacities. No evidence of infection or edema. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Status post thoracotomy, bronch to assess for secretions. Right and left ventricular assist devices noted. ETT tip about 6 cm above the level of the carina. Left subclavian ICD projects over the RV. Left subclavian central line terminates in the SVC. Nasogastric tube terminates in the stomach but the sidehole is at the GE junction.Two left-sided chest tubes terminate in the upper thorax and the third terminates in the projection of the posterior left costophrenic angle. Small pneumothorax on the left.Sternotomy hardware and staples similar in alignment. Mitral ring.Left lower lobe is probably collapsed and the left lower lobe airway is not visualized. Dense loculated left pleural fluid collection consistent with known hemothorax. Enlarged cardiothoracic ratio with density projecting over the RV; patient has a known hemopericardium.Allowing for motion artifact, there appears to be atelectasis as well as probable mild edema in the right lung.Subcutaneous emphysema in the neck.

Output: Left upper lobe remains expanded however the left lower lobe bronchus is not clearly visualized and may remain occluded. No significant change in known left hemopneumothorax or in the cardiomediastinal appearance. Questionable mild edema on the right.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer Unchanged mild elevation of right hemidiaphragm without additional cardiopulmonary abnormality

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: as above Balloon catheter marker at the level of the aortic arch with the balloon in the descending aorta.ICD leads unchanged.PICC line tip in the right subclavian vein.No significant pulmonary abnormalities.

Output: Balloon catheter in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p CABG Interval extubation.Right jugular catheter unchanged.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: Interval extubation with decreased lung volumes and no other significant change.


Instruction: Generate impression based on medical findings.

Input: 59 year-old man with Hodgkin's disease. Motion artifact limits evaluation of the pelvis.CHEST:LUNGS AND PLEURA: Stable subcentimeter scars and nodular fociMEDIASTINUM AND HILA: No change in mediastinal nodes. Although the reference mediastinal node is blurred and measures approximately 10 by 5 mm previously 11 x 4 mm (image 45; series 3). Coronary artery calcifications. Small anterior pericardial effusion is stable. CHEST WALL: Right chest port.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Stable. Spleen within the upper limits of normal for size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node at the level of the SMA (image 111; series 3) measures 5 mm previously 6 mm in diameter, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T11 presumed Schmorl's node, unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference right femoral lymph node cannot be actually measured due to motion artifact.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Motion artifact limits evaluation of the pelvis.Stable disease.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Thoracentesis. Assess for pneumothorax. Increased size of small to moderate size left pleural effusion. Left basilar subsegmental atelectasis or scar again noted. Superimposed consolidation cannot be completely excluded. Mild right basilar subsegmental atelectasis or scar again noted. Small hiatus hernia, as before. Stable heart size.

Output: Increased size of small to moderate sized left pleural effusion compared to 7/2015. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: r/o pneumonia History: chills 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: Female, 21 years old.Reason: evaluate size of lung mass History: Wegener's Residual right basilar opacity improved.No new findings. Heart size normal.

Output: The resolution of right basilar opacity with no evidence of new vasculitis involvement. CT would be more sensitive if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: neutropenic fever, assess lung pathology History: as above No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: post code History: ams Cardiomegaly with an edema pattern suggestive of CHF/hypervolemia.ET tube tip approximately 6 cm above the carina.Esophageal probe noted.

Output: Pulmonary edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: r/o infection/edema/effusion History: chest pain, hx MI, copd Severe emphysema.Nonspecific left base opacity appears chronic and there is no evidence of acute edema or pneumonia.Heart size normal.

Output: Severe emphysema. Patchy left base opacity most likely chronic and unchanged, without reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Preoperative heart transplant Persistent mild cardiomegaly without additional cardiopulmonary abnormality. ICD appears similar, however the right jugular Swan-Ganz has been advanced with the tip extending into the right lower lobe artery

Output: Swan-Ganz repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Reason: eval for pna History: hypotensive No new focal lung consolidation. No large pleural effusion or pneumothorax. Unchanged heart size. Prominent bowel loops within the abdomen again noted.

Output: No acute cardiopulmonary process on radiography. Prominent bowel loops again noted within the abdomen; clinical correlation suggested.


Instruction: Generate impression based on medical findings.

Input: Reason: left pleural effusion s/p VATS, eval for opacities or effusions History: s/p VATS. Interval removal of a left chest tube with no sign of pneumothorax or other acute change.Other devices unchanged.Cardiomegaly with basilar nonspecific opacity compatible with atelectasis, consolidation and probably small effusions.

Output: Interval left chest tube removal and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Chest pain Mild basilar streaky densities suggesting atelectasis and less likely aspiration. No superimposed additional new acute cardiopulmonary findings. Exaggerated borderline cardiomegaly is thought to represent artifact from semiupright portable technique

Output: Suspected atelectasis and less likely aspiration


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Acute chest pain. Study limited by lordotic positioning on the frontal radiograph. No focal lung consolidation or evidence of overt left-sided heart failure. Normal heart size. No acute bony abnormality. Query esophageal dilation.

Output: Study is limited by lordotic view.No acute cardiopulmonary process on radiography.If symptoms continue and no reason for chest pain is identified, further evaluation with chest CT is suggested.Query esophageal dysmotility.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: patient s/p R thoracotomy and R lung nodule resection, assess for PTX or other acute process History: patient s/p R thoracotomy Right chest tube with no pneumothorax following wedge resection.Unchanged left perihilar opacity.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Intubated with ARDS versus ADHF ET tube tip is 3 cm above the carina. Enteric tube tip projects over the proximal gastric body.Cardiomediastinal silhouette is enlarged and unchanged.Perihilar airspace and basilar opacities compatible with pleural effusions and atelectasis/consolidation, not significantly changed since prior exam. No pneumothorax.

Output: Stable cardiopulmonary appearance, with persistent areas of consolidation and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: r/o PNA History: AMS Mild cardiomegaly.No specific evidence of infection or edema.Degenerative abnormalities affect the shoulders.

Output: No acute abnormality. Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: intubated History: intubated NG tube tip in stomach. ET tube tip 4-5 cm above carina.Interval increase in interstitial abnormality likely due to edema. New retrocardiac opacity may be due to aspiration given rapid development.

Output: Interval increase in interstitial abnormality likely due to edema. New retrocardiac opacity may be due to aspiration given rapid development.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant No focal lung consolidation. Focal area of subsegmental scarring in the lateral aspect of the left lung. Patient is status post cholecystectomy. Moderate cardiomegaly. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pre-op, tachy History: above Diffuse osseous abnormalities of the ribs of uncertain etiology. No apparent thoracic vertebral body compression fracture. Possible sclerosis of T10. Nodular opacity at the left cardiophrenic angle. Heart size is within limits of normal. No associated pneumothorax. A dedicated PA and lateral radiograph is recommended with energy subtraction for further evaluation

Output: Bilateral rib abnormalities for which PA and lateral radiograph is recommended. Nodular opacity left cardiophrenic angle can be better evaluated on subsequent imaging.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Hypoxemia. Presents with dizziness. History of diabetes and hypertension. Evaluate for etiology. Right basilar subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax. Cardiac mediastinal silhouette within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: r/o infiltrate History: cough; fever; Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Status post cardiac surgery.VIEW: Chest AP (one view) 2/23/2016 at 1951 hours. Dextrocardia is again noted. ET tube tip is below thoracic inlet. NG tube terminates at the stomach Right IJ venous access tip is at the SVC. Atrial line, multiple surgical clips, bilateral chest tubes, mediastinal drain and epicardial pacer leads are again noted.Cardiac silhouette size is normal. No focal lung opacities, effusions or pneumothorax.

Output: Status post cardiac surgery with no evidence of complete medications related to the procedure.


Instruction: Generate impression based on medical findings.

Input: 26 day old male with no pneumothorax. Status post new chest tube placement.VIEW: Chest AP (one view) 1/12/2015, 11:22 Endotracheal tube tip below the thoracic inlet above the carina. Interval repositioning/replacement of one of the chest tubes, with the tip now terminating more inferiorly. The second chest tube position is unchanged. Left upper cavity PICC line tip terminates in the superior vena cava. Feeding tube tip is in the fundus of the stomach.Persistent soft tissue edema and changes related to metabolic bone disease of prematurity.Significant interval increase in size of the right pneumothorax. Right-sided interstitial emphysema and pneumatoceles again seen. The right lung volume is increased, extending across the midline. Complete left lung collapse with associated mediastinal shift to the left is unchanged.

Output: Repositioning/replacement of one of the two chest tubes and significant interval increase in size of the pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: intubated, eval for tube position, new infiltrates History: as above ET tube tip now 6 cm above the carina, repositioned.No significant pulmonary or pleural abnormality.An NG tube terminates in the stomach.

Output: ET tube tip approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: 66M s/p VATS decortication/pleurodesis History: s/p VATS decortication/pleurodesis Median sternotomy with several fractured wire sutures, unchanged.Heart size near upper normal.Pulmonary and pleural scarring is present, but the lungs are better inflated and clear than on the prior study.No pneumothorax following left chest tube removal.

Output: Improvement in pulmonary opacities with no new findings. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Hemoptysis evaluate for worsening of LLL opacification. Interval placement of an embolization coil at the level of the left hilum. Coarse peribronchial opacities in both the left upper and right middle lobes related to known tumor unchanged. Increased volume of pleural fluid on the left. The left lower lobe remains collapsed and consolidated due to central obstruction. No pneumothorax.

Output: Increased left pleural fluid collection. Coarse opacities in the region of known tumor may reflect acute pulmonary hemorrhage and/or radiation pneumonitis in the appropriate clinical context.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: Decreased PO2 eval for pulmonary etiology History: Poor ventilation Lines and tubes are unchanged. Focal opacity in the left lung base again noted. Unchanged heart size. No pneumothorax.

Output: No substantial change compared to previous study in focal left basilar opacity consistent with focal aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: hemoptysis History: hemoptysis Volume loss in the left lung with lower zone atelectasis and a moderate pleural effusion.Tracheostomy tube and venous catheter probably unchanged though venous catheter is poorly visualized due to motion artifact.No new findings.

Output: Persistent atelectasis and left pleural effusion with no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval for new infiltrates, pneumonia History: fever, previously reported history of T-cell lymphoma/leukemia Persistent scarring at the left posterior and lateral cardiophrenic angle which correlates to recent CT imaging. Ill-defined opacities projecting over the posterior right eighth rib may be interval foci of atelectasis or aspirated secretions. No significant pleural effusion, pneumothorax or new edema. The cardiomediastinal silhouette is unremarkable.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: pnemonia History: hypoxia , shortness of breath Unremarkable cardiac and mediastinal silhouette. Large lung volumes with flattening of the diaphragm consistent with COPD.Mild volume loss in the right upper lobe, compatible with scarring, unchanged.

Output: COPD with no acute findings.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with metastatic breast cancer CHEST:LUNGS AND PLEURA: Stable left apical scarring. Index left lower lobe nodule measures 8 by 6-mm image number 65 of series number 5, stable from previous study.Ill-defined left lower lobe subpleural groundglass opacity measures 7 x 4 mm image number 56 on series number 5, newfrom previous study.Cystic small groundglass opacity in the right lower lobe on image number 59, series number 5.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Index left axillary lymph node measures 15 x 12 mm on image number 7, series number 3, not significantly changed.Stable diffuse sclerotic metastatic bone lesions.ABDOMEN:LIVER, BILIARY TRACT: Again noted multiple metastatic lesions in the liver. Index lesion measures 12 x 9 mm image number 72, series number 3 in the right lobe of the liver, not significantly changed. Other smaller metastatic lesions have also not significantly changed.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse sclerotic bone lesions are unchanged.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: Diffuse bone lesions, unchanged.OTHER: No significant abnormality noted.

Output: Extensive bone metastases are stable. Liver metastases are stable.Index left lower lobe lung nodule is stable. New, nonspecific ground glass opacities in right and left lobe as described above. Their etiology is not certain. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: lumbar peritoneal shunt, with headaches , shunt tap done today and shunt set to 11, please do x-ray to left lateral chest wall for setting determination, make sure valve is visible . Call Darlene rn , at 4-7104 or page at 6603 for quick review of setting. History: headache, shunt tap today Lateral view only showing a lumbar arterial shunt partially visualized.Measurements will be left to the referring service.

Output: Lateral view for shunt visualization.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: eval for infiltrate History: wheezing/sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: r/o acute cardiopulm process History: cp, sob, h/o lung CA Right Port-A-Cath unchanged.There are decreased lung volumes with stable cardiomediastinal silhouette.Prominence of central pulmonary vasculature compatible with pulmonary arterial hypertension.Right hilar/perihilar nodule more prominent than the prior exam.No new pulmonary opacities identified.

Output: Probable increasing right perihilar nodule. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Follow CT of 3/9/2010 which showed left lower lobe abnormality, possible cancer. Smoking history. CHEST:LUNGS AND PLEURA: Poorly marginated opacity deep in the left costophrenic angle, subpleural in location, has not as far back as 9/8/2009. This lack of change increases the likelihood of malignancy.Scattered less than 3-mm micronodules have not changed.MEDIASTINUM AND HILA: Vascular calcifications including the aortic annulus.No significantly enlarged mediastinal or hilar lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Small hiatal hernia.

Output: Left lung base abnormality not significantly changed over 10 months, the likelihood of primary lung cancer high. PET is recommended or tissue diagnosis.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Altered mental status Cardiomediastinal silhouette is unremarkable. No large pleural effusions or pneumothorax. No focal pulmonary opacity.

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


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: Infiltrates History: neutropenic fever No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.Cholecystectomy clips.

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


Instruction: Generate impression based on medical findings.

Input: Reason: r/o worsening effusion History: tachypnea Small lung volumes with a layered out right pleural effusion and left perihilar opacity suggestive ofAtelectasis and aspirated secretions, unchanged. Tracheostomy tube partially obscured by overlying hardware and catheter tip in the SVC.

Output: Layered right pleural effusion, without appreciable change in allowing for position and lung inflation.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: TLC History: TLC Cardiomegaly without acute edema.Right jugular temporary pacemaker, lead tip directed towards the pulmonary outflow tract.Left jugular catheter tip at right atrial level.

Output: Left jugular catheter, tip at right atrial level. Unchanged temporary pacemaker lead.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: 56 yo cirrhosis post intubation for EGD History: AMS GI bleed ET tube with its tip 5 cm above the carina.NG tube with its tip in the stomach.Persistent elevation of the left hemidiaphragm.Stable cardiomediastinal silhouette.Minimal basilar atelectasis.No new pulmonary opacities identified.

Output: Interval intubation and placement of an NG tube. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 37 year old female with severe thrombocytopenia and acute back pain and anemia. Also with hypoxia. Rule out retroperitoneal hematoma and further evaluate right lower lobe abnormality on CXR. CHEST:LUNGS AND PLEURA: Large right pleural effusion. Basilar atelectasis or consolidation. No visible lung nodules. The left lobe is normal and there is only a small left pleural effusion.MEDIASTINUM AND HILA: Small mediastinal and axillary nodes not pathologic by size criteria.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: Postsurgical changes consistent with liver transplant. Distortion of the contour of the liver along the dome and lateral aspect of the right lobe is redemonstrated due to mass effect by surrounding perihepatic or possibly subcapsular fluid. The extent of the fluid and mass effect is increased compared to the prior scan.SPLEEN: Massive splenomegaly to 27.2 cm cephalocaudad is seen on coronal image 53/99, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of retroperitoneal hematoma. Fat stranding consistent with a generalized anasarca. Small nodes. Largest node aortocaval distally Series IV image 120 measuring 1.1 x 0.8 cm, unchanged.BOWEL, MESENTERY: Moderate amount of generalized ascites markedly increased compared to prior scans. As described above some of the fluid around the liver is loculated and causing mass effect on the liver. This suggests that some of the fluid may be sub-capsular rather than purely free intraperitoneal.Incisional midline ventral hernia containing large bowel small bowel and omentum but nonobstructive.BONES, SOFT TISSUES: Extensive subcutaneous edema particularly in the anterior abdominal wall and laterally.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The previously seen left adnexal cyst cannot be discerned possibly due to the ascites.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of generalized ascites.BONES, SOFT TISSUES: Mild anasarca.OTHER: Small kidneys consistent with chronic medical renal disease, unchanged. Normal size renal allograft seen in the right iliac fossa, unchanged.

Output: New large right pleural effusion and small left pleural effusion. Increased ascites. Increased mass effect on the dome of the liver from loculated fluid. Unchanged massive splenomegaly and nonobstructive ventral hernia. Chronic medical renal kidneys. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of upper tract urothelial cancer CHEST:LUNGS AND PLEURA: new right lower lobe nodule measuring 9-mm in diameter image number 15, series number 3 suspicious for metastatic disease or primary bronchogenic carcinoma.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy.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: Interval cystectomy. Neobladder is unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New right lower lobe nodule suspicious for metastatic disease or primary bronchogenic carcinomaInterval cystoprostatectomy with neobladder formation.


Instruction: Generate impression based on medical findings.

Input: 47 year-old male with right-sided chest pain, history of recent left lower extremity DVT. Evaluate for PE. PULMONARY ARTERIES: Large filling defect in the right lower lobe pulmonary artery branch (axial image 148/252) extending into several segmental branches compatible with pulmonary embolus.LUNGS AND PLEURA: Bibasilar consolidation, particularly on the right, may represent atelectasis or infarction. Subtle ground glass opacity, particularly at the right base, is suggestive of hemorrhage. MEDIASTINUM AND HILA: Mildly enlarged cardiac size. No evidence of right heart strain. No pericardial effusion.Small superior mediastinal lymph nodes are seen. No pathologically enlarged mediastinal or hilar nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Small hiatal hernia.

Output: Large right lower lobe pulmonary embolus.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old. Reason: r/o mets History: Testicular cancer. Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No significant cardiopulmonary abnormality or evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: chest tube placement History: s/p LLL lobectomy Left-sided chest tube in place with its tip at the apex.Hyperlucency in the left apex may be related to patient's emphysema.No definite pneumothorax.Subcutaneous emphysema noted along left lateral chest wall.Right apical pleural thickening and parenchymal scarring unchanged.Increasing perihilar and basilar opacities in left lung compatible with edema and atelectasis.

Output: Placement of left-sided chest tube with its tip at the apex. No significant pneumothorax noted. Increasing left perihilar and basilar opacities compatible with atelectasis and edema.


Instruction: Generate impression based on medical findings.

Input: Male, 93 years old.Reason: eval infection, edema, effusion History: cardiac arrest Mild cardiomegaly with nonspecific pulmonary opacities and a right pleural effusion.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: Pulmonary opacities, right pleural effusion and cardiomegaly suggestive of CHF although underlying infection is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with history of intubation. Endotracheal tube tip 2 cm above the carina. NG tube tip projecting over the gastric body. Stable cardiomediastinal silhouette. Low lung volumes. Left lower lobe air space opacities appear similar to prior.

Output: Stable left lower lobe air space opacities which may represent atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for VAD position History: repeat CXR to eval for VAD position LVAD and ICD leads unchanged.Mild blunting of the costophrenic angles compatible with small effusions or scarring, not significantly changed.No new findings.

Output: LVAD and ICD leads unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: 8/10/15 s/p right VATS bullectomy, and pleurodesis History: none Interval removal of chest tube. No evidence of significant pneumothorax. Subcutaneous emphysema has resolved.

Output: No evidence of significant pneumothorax. Subcutaneous emphysema has resolved.


Instruction: Generate impression based on medical findings.

Input: Reason: please evaluate lungs in setting of possibly new murmur History: dizziness, SOB Heart size but upper normal or moderately enlarged withPacemaker leads extending to the area of the right atrial appendage and right ventricular apex. Tracheostomy tube in place and surgical staples and a drain in the neck. Small pleural effusions and basilar pulmonary opacity, greater on the left, consistent with atelectasis and aspirated secretions.No specific evidence of pulmonary edema.

Output: Small effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: neutropenic fever History: neutropenic fever Left PICC with tip at the confluence of the brachiocephalic veins.Cardiomediastinal silhouette is unchanged. New right lower lobe opacity and small pleural effusion as well as new left lower lobe interstitial opacity.

Output: The new bibasilar opacities and right pleural effusion likely be secondary to infection and/or aspiration with a component of edema.


Instruction: Generate impression based on medical findings.

Input: Reason: 69M with persistent bacteremia, unclear source with previous infected ICD leads, now removed, r/o ICD pocket infection collection History: bacteremia, infected ICD Sonographic attention to area of previous ICD in the right chest wall does not demonstrate any fluid collection within the superficial soft tissues.

Output: No evidence of fluid collection in the right chest wall.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Desaturation. Large new left pneumothorax with near complete collapse of the left lung.Right thoracoplasty and stable basilar opacities. NG tube tip overlies the gastric body. ETT above the carina.

Output: New large left pneumothorax with near complete collapse of the left lung.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: 63-year-old male with colorectal cancer CHEST:LUNGS AND PLEURA: Bilateral numerous parenchymal nodules consistent with metastatic disease. Left lower lobe. Reference lesion measures 20 x 19 mm image number 64, series number 3, increased in size from 2/3/2010.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Left lobe hemangioma is unchanged. Hypervascular lesion in the right lobe adjacent to gallbladder is also unchanged. Cholelithiasis, unchanged.Ill-defined, hypodense lesion in the right lobe of the liver, measuring 11 x 13 mm image number 85, series number 3, new from previous CT. this lesion is suspicious for metastatic disease. Ill-defined hypodensity in the right lobe anterior to the main portal vein on image number 86, series number 3 may represent focal fatty infiltration versus metastatic disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged retroperitoneal lymph nodes suspicious for metastatic disease. Reference left para-aortic lymph node measures 22 x 14 mm image number 117, series number 3. This lymph nodes are conflagration of multiple lymph nodes. This lymph node used to measure 16 x 11 mm on the previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Thickwalled bladder consistent with cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the extensive bilateral parenchymal metastases.Possible new metastatic disease in the liver. MR of the liver is recommended for further evaluation. Benign liver lesions are unchanged.Interval increase in the size of the retroperitoneal enlarged lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: pna vs pne History: Pleuritic chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly, as before. Coronary artery stent noted. Aortic atherosclerosis, as before.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: chest tube placement History: s/p esophagectomy 2 right-sided apically directed chest tubes are in place. There is a nasogastric tube with the sidehole positioned at the level of the mid right atrium.Trace right pneumothorax is present. Infrahilar streaky opacities favoring aspirated secretions. Right paramediastinal opacity favors appearance of gastric interposition. The left lung is fully inflated. Heart size is normal. Small amount of subcutaneous emphysema is noted at the right infralateral chest wall and supraclavicular location.

Output: Trace right apical pneumothorax in the setting of 2 chest tubes.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: Pneumonia History: Leukocytosis Port catheter again noted terminating in the superior aspect of the RA. Moderate cardiomegaly is noted. No new focal lung consolidation. Basilar atelectasis. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: evaluate left lung expansion History: s/p left chest tube removal after thoracotomy Interval removal of left-sided chest tube. No evidence of pneumothorax. Low lung volumes with basilar opacities are unchanged. Cardiomegaly stable.

Output: Interval removal of left-sided chest tube with no pneumothorax. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: PNA History: 65Fw AMS Decreased lung volumes with stable cardiac mediastinal silhouette.Mild nonspecific basilar opacities compatible with atelectasis.No focal areas of consolidation.No pleural effusions.

Output: Mild basilar atelectasis without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain, h/o COPD History: chest pain Marked cardiomegaly with ICD leads unchanged. Large pulmonary artery consistent with pulmonary hypertension.Interval clearing of interstitial edema and septal lines over the past few days with minimal residual and mild basilar atelectasis.

Output: Resolving pulmonary edema with no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: cp History: cp No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: LE swelling, eval for fluid overload History: LE swelling, eval for fluid overload Moderate cardiomegaly.Small lung volumes without reliable evidence of edema or pneumonia.

Output: Cardiomegaly, with small lung volumes but no acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old with cough. The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: evaluate icd History: icd, vf Cardiomegaly with mild-to-moderate pulmonary edema consistent with CHF.An Impella is identified, in appropriate location.IVC Swan-Ganz catheter, tip in right main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Mild to moderate CHF with pulmonary edema. IVC Swan-Ganz catheter, Impella and left subclavian ICD are in appropriate positions.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with shortness of breath, chest pain. Assess for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.0LUNGS AND PLEURA: Few isolated, thin-walled intrapulmonary cysts, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: No PE.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.History of esophageal perforation. Shortness of breath. Evaluate for atelectasis, pneumonia, pleural effusions. Unchanged cardiomediastinal silhouette.Persistent lower lung zone opacities and pleural effusions.Interval removal of left-sided chest tube without evidence of pneumothorax.Pericardial drain is stable in position.Skin staples are again noted.

Output: Persistent pleural effusions and pulmonary opacities. Interval removal of left-sided chest tube without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: pulmonary edema? History: SOB Decreased lung volumes with stable cardiac enlargement. Perihilar/basilar interstitial opacities similar to the prior exam.No new pulmonary opacities identified.Possible small left pleural effusion.

Output: No interval change in the cardiac enlargement and nonspecific perihilar/basilar opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: CHEST: Limited by field-of-view and extent of coverage.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Nodular hepatic contour compatible cirrhosis.

Output: Cirrhotic morphology of the liver.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old. History of respiratory failure, worsening. Increased bibasilar opacities consistent with edema, atelectasis, and effusions. No pneumothorax. ET tube approximately 4 cm above the carina. NG tube in the stomach. Right IJ central venous catheter tip unchanged in position.

Output: Increased bibasilar opacities consistent with edema, atelectasis, and effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: is there an infiltrate History: asthma and 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, 25 years old.Multiple sclerosis and SOB evaluate for infiltrate. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Mild scoliosis. Interval clearing of previously seen right lower lobe airspace opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Tracheostomy tube Interval removal of the Dobbhoff tube and right jugular catheter extending into the right atrium. Tracheostomy tube persists terminating 7 cm above the carinaUnderlying cardiopulmonary appearance significant for enlarging moderate pleural effusions greater on the right with underlying atelectasis, greater on the left. Although pulmonary appearance suggests edema and mild CHF, infection or aspiration cannot be excluded

Output: Dobbhoff and right jugular catheter removed


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.History of asthma and lung cancer status post resection, now with possible exacerbation or pneumonia. The cardiomediastinal silhouette is normal.There is elevation of the right hemidiaphragm and blunting of the right costophrenic angle, stable from prior exams.No focal pulmonary opacities or pleural effusions.

Output: Stable examination without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 3-day-old former 24 week gestational age patient with pneumothorax.VIEW: Chest AP (one view) 11/15/15, 0525 and 0527 Endotracheal tube tip is above carina. Right chest tube remains in place. Feeding tube tip is in gastric body. Umbilical venous line tip is in right atrium. Umbilical arterial line has its tip at T6.A very small subpulmonic pneumothorax is seen on the right. Granular and hazy opacities are present bilaterally. Small round lucencies are noted bilaterally right greater than left. Lung volumes are large with hemidiaphragms between ninth and 10th posterior ribs. Cardiac silhouette size is normal.

Output: Very small residual pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: R IJ line placement History: lactic acidosis Nonspecific basilar subsegmental atelectasis, unchanged, which could be from aspirated secretions or mucous plugging.Heart size normal.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC. Unchanged subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: r/o pna History: syncope Low lung volumes. Patchy bibasilar opacities. No pleural effusion or pneumothorax. Mild cardiomegaly. No acute bony abnormality.

Output: Low lung volumes. Patchy bibasilar atelectasis, less likely consolidation. Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with malignant ascites with unknown primary Lack of IV contrast limits evaluation of the visceral organs.CHEST:LUNGS AND PLEURA: Ill-defined micronodules line the minor and oblique fissures on the right. Small bilateral pleural effusions.MEDIASTINUM AND HILA: No mediastinal nodes are pathologically enlarged by CT criteria.Coronary artery calcifications are identified.The esophagus is mildly dilated and fluid-filledCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The gallbladder is contracted.SPLEEN: The spleen is small in size.PANCREAS: No significant abnormality.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A small simple cyst is seen in the midpole of the right kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nodularity of the omentum is seen in the left midabdomen (series 7, image 105).BONES, SOFT TISSUES: No significant abnormality notedOTHER: A large amount of loculated ascites is identified in the abdomen, which scallops the liver and causes mass effect on the bowel loops without obstruction. The retroperitoneal structures are compressed.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Thickening of the presacral space and perirectal fascia is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic ascites. Anasarca.

Output: Limited study due to lack of IV contrast.Large amount of loculated abdominal ascites which causes mass effect with omental nodularity in the left mid abdomen, consistent with peritoneal carcinomatosis and malignant ascites.Pulmonary micronodules on the right, likely infectious/inflammatory in natureDilated esophagus.Thickening of the presacral space-please correlate with history of prior therapy of rectum/prostate.


Instruction: Generate impression based on medical findings.

Input: Reason: cystic fibrosis annual follow up History: baseline CF Unremarkable cardiac and mediastinal silhouette. Extensive bilateral bronchiectasis as previously described with focal airspace opacity in the lingula, not significantly changed.Findings are consistent with known cystic fibrosis with bronchial mucous plugging.

Output: Extensive bronchiectasis consistent with cystic fibrosis with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: edema History: eval for cp Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old. Left PICC line with its tip in the right atrium.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: Left PICC line with its tip in the RA. No acute cardiopulmonary abnormality noted.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with lupus, history of right lower lobe pneumonia, assess for progression of disease CHEST:LUNGS AND PLEURA: The previously identified focus of consolidation in the lateral basal segment right lower lobe has slightly increased since one week earlier. It now measures approximately 48 x 36 mm (62/97), as compared to 40 x 36 mm. Persistent peripheral air bronchograms are noted with this consolidation.There is a new cavitary lesion in the right upper lobe (35/97) measuring approximately 5 mm.Anterior to this, there is a secondary focus of consolidation adjacent to a bronchus which is no longer dilated. New foci of scarring noted in the posterior right major fissure. New faint, dependent ground glass opacity of both lower lobes is present. There are interval small pleural effusions, greater on the right.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral axillary adenopathy, largest node on the right, approximally 14 mm in short axis dimension (27/97).UPPER ABDOMEN: This study is not optimal for evaluation of the renal parenchyma given lack of contrast. However, the superior pole of left kidney does appear enlarged, possibly edematous.

Output: 1. Slightly enlarging rounded consolidation in the right lower lobe with adjacent, smaller focus of consolidation. New cavitary lesion right upper lobe. The findings are suspicious for possible fungal infection or refractory bacterial pneumonia. Etiologies such as Blastomycosis, Nocardia, Actoinomycosis may be considered.2. New, small bilateral pleural effusions.3. Persistent, bilateral axillary lymphadenopathy.4. Incompletely evaluated renal parenchyma. Possible edematous superior pole the left kidney.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: sob History: sob Mild pulmonary edema and patchy bibasilar opacities, unchanged. Persistent moderate cardiomegaly. No pneumothorax.

Output: Mild pulmonary edema and patchy bibasilar opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: evaluate lung field History: s/p R thoracotomy and decor Right apical chest tubes are noted. Small right-sided pneumothorax. Question of small amount of pneumoperitoneum is also noted. Patchy bibasilar opacities, likely atelectasis. Decreased size of right pleural effusion. Unchanged heart size.

Output: Right apical chest tubes are noted. Small right-sided pneumothorax. Question of small amount of pneumoperitoneum is also noted. Correlation with left lateral decubitus radiograph is suggested for further assessment. This suggestion was verbally discussed with Dr. Zachary Waxman at 12:17 PM on day of study.


Instruction: Generate impression based on medical findings.

Input: ETT. Motion artifact. Endotracheal tube tip 3 cm above the level of the carina.Moderate pleural effusions. Left lower lobe appears collapsed/consolidated. Significant dependent opacity in the posterior lung fields may be atelectasis and aspiration. There is superimposed hazy opacity consistent with layering pleural fluid and minimal edema.

Output: ETT tip 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 26-year-old female with a lumbar peritoneal shunt. Evaluate for status, connectivity and setting and valve. SHUNT DEVICE: Note is made of a lumboperitoneal shunt device with the intraspinal portion entering at the level of L3 extending superiorly to the level of the mid thoracic spine, approximately at the level of the T7 vertebral body. The shunt valve position is situated at the 3:00 position. There is interval retraction of the extraspinal portion of the shunt catheter with the shunt catheter traversing the soft tissues of the right lateral hemiabdomen and coiling within the soft tissues along the lateral aspect of the right flank.CHEST: The upper lung fields are not included in the field-of-view. No focal pulmonary opacity, pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits.ABDOMEN: Nonobstructive bowel gas pattern. Moderate amount of stool is noted throughout the colon.

Output: Interval retraction of the extraspinal shunt catheter which now appears coiled within the soft tissues of the right flank and appears to be external to the peritoneal cavity.


Instruction: Generate impression based on medical findings.

Input: 63 years old Female. Reason: eval for pneumonia, eval for cause of neutropenic fevers History: neutropenic fever. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Age: 37 yearsGender: FemaleReason for Study: Reason: eval acute process History: tachy Cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: post procedure History: n/a Central venous catheter, unchanged. Bibasilar reticular abnormality again noted. No large pleural effusion or pneumothorax. Marked cardiomegaly again noted.

Output: Central venous catheter again noted. No pneumothorax. Basilar reticular abnormality again noted consistent with pulmonary fibrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: interval change History: interval change Swan-Ganz catheter tip in the right main pulmonary artery.Balloon catheter in the descending aorta with its tip projected 5.5 cm below the top of the aortic arch.Small lung volumes with mild interstitial opacities suggestive of edema.No pneumothorax or other acute change.

Output: Mild interstitial edema with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Diffuse mainly interstitial opacity in the right upper and right lower lobe areas, new from previous, compatible with lavage fluid or hemorrhage if the patient is post bronchoscopy.No sign of pneumothorax.Unremarkable cardiac and mediastinal silhouette.

Output: New right lung opacities compatible with bronchoscopic lavage, aspiration or hemorrhage. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female 12 years old Reason: mets History: h/o thyroid cancer, with prior evidence of lung mets Iodine avid tissue in the midline neck is again seen appearing similar to the prior exam. Also again seen is well-defined iodine avid tissue in the left chest, compatible with metastatic disease . This also appears similar to the prior study. There is less discrete uptake on the right which may represent additional pulmonary metastases.There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. Probe uptake of the neck is 0.2 %.Region of interest or tumor uptake: 0.8 %

Output: Iodine avid metastases to the chest and iodine avid tissue in the midline neck without substantial change from the previous exam.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infection or edema History: SOB, hemoptysis, wheezing. Known COPD, CHF and RUL mass 43 x 34 mm right upper lobe mass, suspicious for primary carcinoma, better characterized on the CT scan performed the same day.Marked cardiomegaly and aneurysmally dilated aorta, also better shown on the CT scan.Mild basilar atelectasis or scarring.

Output: Right upper lobe mass and aortic aneurysm with no acute change since the previous radiograph.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: r/o ptx History: s/p left thoracentesis Right jugular central venous catheter in the superior vena cava. Median sternotomy and multiple mediastinal surgical clips are again noted. Aortic valve prosthesis is present.Cardiomediastinal silhouette is unchanged. Interval decrease in size of the left pleural effusion. Unchanged right pleural effusion. Interstitial opacities bilaterally suggestive of edema unchanged. Retrocardiac consolidation is unchanged. No evidence of pneumothorax.

Output: Interval decrease in left pleural effusion with no evidence of pneumothorax status post thoracentesis. Stable right pleural effusion and interstitial opacities bilaterally suggestive of edema. Persistent retrocardiac consolidation.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female presents for evaluation after a thoracentesis. Surgical clips project over the hemithoraces and axilla bilaterally. Round well-defined areas of increased attenuation project over the lower lungs and the chest wall bilaterally, consistent with prior breast augmentation. There is been interval removal of bilateral chest tubes.The cardiomediastinal silhouette is normal. No focal pulmonary opacity. No right-sided pneumothorax. Left-sided pneumothorax unchanged. Small left pleural effusion, decreased in size compared to prior examination.

Output: 1.Interval removal of chest tubes; Small residual left pleural effusion which is decreased in size.2.Stable left-sided apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: signs of silent aspiration History: admitted with infection Small lung volumes with no specific evidence of aspiration or other acute process.Tracheostomy tube in place.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with tachycardia, lower extremity edema. Evaluate for PE. Ocular melanoma. CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: Innumerable pulmonary nodules bilaterally of varying sizes as well as pleural nodularity predominantly on the right are compatible with metastases. For reference, a fissural metastasis (series 9, image 68) measures 12 x 11 mm.Right greater than left pleural effusions and overlying atelectasis.MEDIASTINUM AND HILA: Bulky subcarinal lymphadenopathy measures 22 mm in short axis. Enlarged lymph nodes are also seen in the right cardiophrenic space (series 7, image 177).Heart size normal with a moderately sized pericardial effusion. Nodular density along the pericardium (series 7, image 161) is suspicious for pericardial invasion in the face of pericardial effusion.CHEST WALL: Right chest port catheter with catheter tip in the right atrium. Superior and inferior endplate depression at T6 with an ill-defined lucency in the vertebral body (series 80531, sagittal image 52); additional ill-defined lucent lesions at T8 and T11 (series 80531, sagittal images 53 and 55); these findings are suspicious for metastases.Multiple subcutaneous nodules (for example, series 7, images 53, 136, 156) may also represent metastases.UPPER ABDOMEN: Enlarged liver with multiple metastases, including serosal deposits. Please refer to CT abdomen/pelvis performed on the same date for further details.

Output: 1. Numerous metastases to the lungs, mediastinum, and pleura with probable osseous and subcutaneous deposits.2. Hepatic metastases, partially visualized.3. No PE.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Patient w/ CHF s/p IABP, please eval placement History: As above IABP marker is approximately 5 cm below the top of the aortic arch. Right IJ Swan-Ganz catheter tip in the right main pulmonary artery. Single lead left subclavian ICD unchanged.Small lung volumes and mild cardiomegaly. Perihilar and basilar pulmonary opacities, not significantly changed.

Output: IABP and Swan-Ganz catheter as detailed above.


Instruction: Generate impression based on medical findings.

Input: 22 year-old female with lower abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Small amount of perihepatic and perisplenic fluid.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. No evidence of appendicitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Increased density fluid in the pelvis suggestive of hemorrhage.PELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of hemorrhagic fluid in the pelvis which obscures the ovaries.

Output: Moderate amount of intra-abdominal hemorrhage. Most likely diagnosis is hemorrhagic cyst rupture. Further evaluation of the ovaries with pelvic ultrasound may be helpful.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Pneumonia, seizure Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: No specific evidence of infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for pneumonia and cause of chest pain with inspiration History: chest pain with inspiration Low lung volumes makes detailed cardiopulmonary assessment difficult. Increased basilar opacities, likely atelectasis. No large pleural effusion or pneumothorax. Unchanged heart size. Unchanged surgical hardware.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Increased basilar opacities, likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: 65 year old female with neck and chest pain and periesophageal lesion seen at the level of the thyroid. LUNGS AND PLEURA: Severe emphysema. Unchanged right apical pleural thickening. Unchanged right upper lobe micronodule (image 33 of series 5).MEDIASTINUM AND HILA: Interval decrease in size of paraesophageal mass at the level of the thyroid measuring 1.0 by 1.0 cm (image 12 of series 3), previously 1.7 x 1.3 cm.Calcified right hilar lymph and mediastinal lymph nodes compatible with prior granulomatous disease. Mild coronary artery calcifications. The heart is normal in size. Small pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Multiple subcentimeter hypodense lesions in the liver are too small to characterize, however, likely benign. Moderately severe atherosclerotic disease of the abdominal aorta.

Output: Interval decrease in size of right paraesophageal mass which is very likely benign.


Instruction: Generate impression based on medical findings.

Input: 23 years, Male. Reason: r/o obstruction History: n/v post operative Proximal jejunal loops dilated to 5.2cm with no distal small bowel seen. Colon surgically absent. Pattern consistent with high grade mechanical obstruction.No intramural or free air. Surgical staples right lower quadrant.Chest normal.

Output: Mechanical small bowel obstruction pattern.Dr. Bailey Su, pager 2701 informed by page.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: is there an infiltrate or free air History: abdomen pain, Crohn's, vomiting, developed chest pain with vomiting Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No free air.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP placement History: as above Aortic balloon marker projected slightly above the aortic arch with a balloon in the proximal descending aorta. ICD leads and Swan-Ganz catheter unchanged.Moderate cardiomegaly with no evidence of CHF or infection.

Output: Balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.History of congestive heart failure. The tip of the IABP is localized approximately 5 cm below the top of the aortic arch, splenic vein stable in position.Cardiomegaly. ICD/pacemaker in place. Left IJ vascular sheath in place overlies the left IJ vein.No signs of pulmonary edema. Minimal left midlung discoid atelectasis.

Output: Stable position of IABP, localized approximately 5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Fever and crackles Interval progressing mixed interstitial airspace opacities greater both bases and on the left with moderate effusions. Increasing confluence with mild decrease in overall lung volumeLeft jugular catheter extends into the right atrium unchanged

Output: Coarse mixed nonspecific opacities in both bases concerning for infection given history


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: Swan in place History: None Swan-Ganz catheter tip in the proximal right main pulmonary artery. Cardiomegaly unchanged. No pleural effusions or pneumothorax. Right mid/lower zone opacity that appears without significant change from prior study.

Output: Pulmonary opacities and cardiomegaly unchanged from prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: r cp ?pna History: cp 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, 83 years old.Reason: Intubated, ARDS History: Intubated, ARDS Diffuse bilateral pulmonary opacities are unchanged. Support hardware stable.

Output: Diffuse bilateral pulmonary opacities are unchanged.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of neuroendocrine tumor. Follow-up scan. CHEST:LUNGS AND PLEURA: Stable mild pleural nodularity as well as small peripheral nodules in the right upper lobe. No new suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Multiple arterially enhancing lesions are reidentified in the liver, the reference lesion in the left hepatic lobe (series 9, image 34) measures 6 x 11.5 cm; previously measuring 6 x 12 cm (stable accounting for differences in technique). The majority of the arterially enhancing lesions appear similar to prior study with exception of two subcentimeter segment 6 lesions (series 9, image 73 and 86), which appear slightly more prominent on current study. However, this difference may be due to differences in phase of scanning.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left lower pole renal cyst.RETROPERITONEUM, LYMPH NODES: Borderline enlarged periceliac and para-aortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Absent.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lumbar vertebral body hemangiomas, unchanged.

Output: Overall the liver lesions are stable in size and number with slight increase in prominence of two small right hepatic lobe lesions as detailed above, which may be due to differences in phase of scanning.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: eval line placement History: as above Malpositioned left internal jugular central venous catheter with tip directed cranially within the right internal jugular vein, unchanged.Mild basilar predominant interstitial opacity with retrocardiac atelectasis/scarring. No large pleural effusion or pneumothorax. Cardiomegaly is unchanged.Abdominal embolization coils.

Output: 1. Continued malposition of the left internal jugular central venous catheter. 2. Mild edema. 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, 64 years old.Chest pain and palpitations. Lung volumes are high normal. Normal heart size. No pneumothorax or pleural fluid. Mild scarring. Minimal retrocardiac opacity most consistent with atelectasis. No specific signs of CHF

Output: Mild retrocardiac opacity most likely reflects atelectasis, but no other acute pulmonary abnormality and no signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Dobbhoff tube placement The Dobbhoff tube tip is not visualized. LVAD, right femoral approach ECMO cannula, and multiple support devices are in unchanged position. Pelvic temperature probe in place.Mild gaseous distention of the large and small bowel, consistent with a generalized ileus pattern.Please reference chest radiograph from the same date for thoracic findings and details regarding support devices.

Output: 1. Dobbhoff tube not visualized.2. Bowel gas pattern consistent with mild generalized ileus.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: Pre surgical evaluation History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Unchanged right lower lobe mass and other scarlike opacities.No pneumothorax following bronchoscopy.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Cough and sickle cell. Question lung infiltrate/acute chest. Left chest port unchanged in position.Right greater than left parenchymal scarring similar in appearance. No new superimposed pulmonary opacities to suggest acute chest. Normal heart size. No pleural fluid.

Output: Chronic parenchymal abnormalities consistent with scarring. No new findings to suggest acute chest.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: eval for any changes, impella History: eval impella Left jugular Swan-Ganz catheter tip is in right main pulmonary artery.Impella device projected in the distribution of the left ventricle, unchanged.Stable cardiomegaly with an ICD.Retrocardiac atelectasis/consolidation, marginally improved.

Output: Stable positioning of the Impella device.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: swan placement History: swan placement Right IJ Swan-Ganz catheter with the tip in the right pulmonary artery. No evidence of pneumothorax.Cardiomegaly redemonstrated. Sternotomy wires are noted again. There is a small fracture in the inferior sternal wire with no evidence of diastases.Left basilar opacity representing atelectasis/possible effusion redemonstrated.Left calcified hilar node is noted.

Output: Swan-Ganz catheter with tip located in the right pulmonary artery, no significant interval change in the cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p bivad Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with bilateral mainly perihilar airspace and interstitial opacity compatible with pulmonary edema.No new findings.

Output: Pulmonary edema with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: screening as a candidate for kidney donation History: see above; no symptoms Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.Degenerative changes of the thoracic spine with mild anterior wedging of several lower thoracic vertebrae unchanged from the prior exam.Multiple surgical clips in the left axilla.

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


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Left chest tubes x2 status post left lower lobectomy. Slight retraction of left-sided chest tubes with small residual pneumothorax. Majority of the air collection medially is probably located within an air-filled hiatal hernia. Subcutaneous emphysema left chest wall and neck. Basilar atelectasis and small pleural fluid collections.

Output: Small left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Status post CABG and aortic valve repair. Drains and support devices unchanged. Widened postoperative mediastinum appears stable. Bilateral hazy opacities are stable.

Output: Stable appearance of support devices and hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer No distinct cardiopulmonary acute abnormality. A small focal density projects over left lower lung does not demonstrate correlating abnormality in the lateral projection and likely superimposed artifact.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: s/p esphageal dilation and DHT placement History: s/p espohageal dilation and DHT placement Pneumomediastinum with a moderately large right and smaller left pneumothorax.Large pneumoperitoneum.Tracheostomy tube and port catheter in place. Dobbhoff tube tip in the area of the gastric pylorus.

Output: Bilateral pneumothoraces, pneumomediastinum and large pneumoperitoneum. The findings were communicated to Dr. Paz by telephone at the time of reporting (2.20pm).


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.History of squamous cell esophageal cancer. Again seen are postsurgical changes from a right hemithorax with volume loss from a right upper lobectomy. Stable to slight interval decrease in size of pneumothorax component.Stable opacification of the right middle lobe and the cardiophrenic angle. Loculated apical right pleural effusion. Air is again noted in the proximal esophagus.

Output: Stable to slight interval decrease in persistent air in the right pleural space.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: evidence of RCC mets History: renal mass incidentally found on CT Cardia mediastinal silhouette.Minimal left basilar scarring/discoid atelectasis.No suspicious pulmonary nodules or masses.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: ARDS S/P Esophagectomy History: ARDS S/P Esophagectomy Tracheostomy tube and venous catheter unchanged.Small lung volumes with diffuse interstitial opacity compatible with ARDS.No new findings.

Output: ARDS with no acute change.


Instruction: Generate impression based on medical findings.

Input: Empyema.VIEW: Chest AP (one view) 4/28/15 at 554 hours. Central line and right-sided chest tube unchanged. Stable multifocal opacities of the right lung with interval improvement in right-sided hydropneumothorax.

Output: Interval improvement in right-sided hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and dyspnea. Pulmonary fibrosis Moderate to pronounced enlargement basilar and right upper lobe interstitial and mixed airspace opacities correlating with previously observed moderate fibrotic changes and patient's known underlying condition. Superimposed nonspecific airspace opacity representing either mild edema or less likely infection must be considered, requiring serial imaging to ensure clearance. No definite effusionsModerate nonspecific aortic tortuosity and borderline cardiac silhouette similar to the CAT scan.

Output: Moderate and predominantly basilar fibrotic changes with questionable superimposed nonspecific opacities concerning for edema versus infection. See detail provided


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: shortness of breath History: shortness of breath No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT terminates 6 cm above the carina. Dobbhoff extends into the mid gastric lumenModerate nonspecific cardiomegaly with underlying atelectasis and decreased volume. No specific new focal airspace process

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: infection History: sepsis sob The cardiac mediastinal silhouette is apparently magnified. Low lung volumes. Vascular indistinctness. Peribronchial cuffing. Small right-sided pleural effusion and probable left-sided pleural effusion. No pneumothorax.

Output: Pulmonary edema without substantial change given variations in technique.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: postop History: postop Chest tubes but no pneumothorax.Mild left basilar subsegmental atelectasis.ET tube tip approximately 5 cm above the carina.Right jugular Swan-Ganz catheter tip in main pulmonary artery.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? cough, SOB History: SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Fragments of a jacketed bullet in the right upper posterior abdominal wall.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval for pulm edema History: s/p heart transplant Lines and tubes are unchanged. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.PICC placement. Interval placement of right PICC with tip in the right brachiocephalic vein. Other support hardware appears unchanged. No pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: Interval placement of right PICC with tip in the right brachycephalic vein.


Instruction: Generate impression based on medical findings.

Input: History of alpha one antitrypsin deficiency and left lower lobe wedge resection for cancer. LUNGS AND PLEURA: Paraseptal emphysema is seen, most prominent in upper lobes, with large bullae in the right apex. Panlobular emphysema, more prominently seen in lower lung zones.Suture in the left lower lobe, likely from the prior wedge resection, without findings suggestive of recurrence.Irregular opacity in the right upper lobe measuring 24 x 12 mm (image 29, series 7) with an adjacent nodule measuring 7 mm (image 24, series 7) is noted. A few smaller irregular opacities in the right lung base. PET CT is recommended for these lesions.Scarring in the right lung base and left lingula.MEDIASTINUM AND HILA: No significant abnormality noted. No mediastinal or hilar lymphadenopathy. Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted in the visualized portion of liver, gallbladder, kidneys, adrenal glands, spleen, or pancreas..

Output: 1. Paraseptal emphysema predominantly in upper lobes and panlobular emphysema predominantly in lower lobes. 2. Irregular opacity in the right upper lobe and a few smaller irregular opacities in the right lung base. PET CT is recommended for these lesions.3. Postsurgical changes in left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement, perform on 1/25/16 History: above ET tube tip approximately 5 cm above the carina.Catheter tip in the SVC.Diffuse mainly interstitial pulmonary opacity, unchanged.ECMO catheter extending from the right jugular vein to the IVC.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: sp BIVAD History: - Small pleural effusions and retrocardiac subsegmental atelectasis are unchanged.LVAD and ICD stable in appearance.ECMO cannulae unchanged.Left jugular Swan-Ganz catheter tip in main pulmonary artery.A Dobbhoff tube extends below the lower margin of the image.

Output: Small pleural effusions and retrocardiac subsegmental atelectasis unchanged. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: evidence of infection? History: neutropenic fever Mild bronchial wall thickening noted, consistent with asthma or chronic bronchitis.No reliable evidence of infection.Small lung volumes.Unremarkable mediastinal contours and cardiac silhouette.Right PICC, tip in the SVC.Cholecystectomy clips.

Output: Nonspecific bronchial wall thickening, which could be a manifestation of viral infection, but there is no other evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p thora, r/o PTX History: as above Interval decrease in right pleural effusion following thoracocentesis. No pneumothorax or other complications.

Output: Decreased right pleural effusion and no pneumothorax.