Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Evaluate pulmonary infiltration History: sob w/hemoptysis(?), LUL nodule found on CT There is a new large retrosternal airspace opacity seen on the lateral view in the anterior segment of the left upper lobe which could represent hemorrhage or infection. New subsegmental atelectasis in the left mid lung zone. No pleural effusion or pneumothorax. The heart size is at the upper limit of normal.

Output: New left upper lobe airspace opacity is nonspecific but could represent hemorrhage or infection. CT scan would be appropriate for further evaluation if this finding does not resolve.


Instruction: Generate impression based on medical findings.

Input: Cough and chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Intubation ETT remains 2 cm above the carina, minimally advanced. NG extends into the distal stomach.No new or additional underlying cardiopulmonary abnormality

Output: ETT minimally repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Defibrillator leads, sternotomy sutures, and mediastinal surgical clips are stable.The cardiomediastinal silhouette is unremarkable.Pleural calcifications are again noted. There is evidence of emphysema, but no focal pulmonary opacity or mass. No pleural effusions.

Output: No evidence of pulmonary metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: patient with increased O2 need, h/o necrotizing pneumonia want to evaluate for effusion or worsening of her pneumonia History: cough, SOB, new o2 requirement Worsening right mid lung opacity consistent with infection.Large lung volumes are consistent with COPD.Heart size normal.Right PICC, tip in axillary region.

Output: Worsening right midlung opacity consistent with infection.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: picc placement History: confirm picc placement Right PICC, tip in axillary region.Small lung volumes.

Output: Right PICC, tip in axillary region.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with a 1 cm nodule in the right base on chest x-ray. LUNGS AND PLEURA: Mild centrilobular emphysema. A few scattered micronodules, some of which are calcified, likely reflect prior infection/inflammation. A left lower lobe micronodule measures approximately 5 mm on axial image 54/119. Six to 12 month follow-up should be considered. No suspicious nodule identified within the right lower lobe. No focal consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: Cardiac size is normal with no pericardial effusion. No significant hilar or mediastinal lymphadenopathy. Extensive atherosclerotic calcifications noted.CHEST WALL: Degenerative changes affect the spine.UPPER ABDOMEN: Abdominal aortic stent graft in place. The left kidney is incompletely evaluated but appears atrophic. A calcified gallstone is noted within the gallbladder. Calcific density within the omentum likely represents a calcified lymph node (axial image 106/123).

Output: Left lower lobe nodule noted. Six to 12 month follow up is recommended.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with chest pain with radiation to the jaw for 1 week. Evaluate for infiltrate or widened mediastinum. No focal airspace opacities. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Mildly continued increasing diffuse 4 quadrant pulmonary edema, layered effusions and mild cardiomegaly. Overall appearance again suggests moderate CHF. ICD unchanged

Output: Increasing CHF


Instruction: Generate impression based on medical findings.

Input: 66 year old male, Dobhoff placed, evaluate Dobhoff. Enteric tube tip terminates in the distribution of the antral/pyloric region. Cardiac device and leads unchanged.Bibasilar opacities and pleural effusions. Please refer to recent chest radiograph for additional details. Pelvis exclude from field-of-view.

Output: Enteric tube tip terminates in the distribution of the antral/pyloric region.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with history of malignant neoplasm of pancreatic cancer CHEST:LUNGS AND PLEURA: Moderate-sized left pleural effusion atelectasis in the left lower lobe anteriorly. Linear atelectasis in the right lower lobe.Calcified right middle lobe nodule.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Segment 7 hemangioma is unchanged. Two punctate lesions near the dome of the liver base image number 75, series number 21 are unchanged. Another punctate hypodense lesion in the segment 4, best seen on image number 115, series number 21 is unchanged. No new focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: Changes secondary to Whipple surgery. Pancreatic body and tail are unremarkable. 14-mm round cystic lesion adjacent to the pancreaticojejunostomy was, could represent a small fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple surgical drains are in place. Small amount of ascites persists. Previously described loculated collections have nearly completely resolved. There is a new collection on the right side of the abdomen measuring 10.3 x 4.5 cm medial to the descending colon. No drain is noted within this collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Pelvic mass extending into the right adnexa is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval resolution of the previously described abscesses. There is a new fluid collection in the right abdomen as described above.Moderate to large left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: please evaluate for pneumothorax after right sided BIV implantation History: right sided BIV implantation Cardiomegaly with mild interstitial abnormality suggestive of edema although there may be underlying chronic lung disease.Status post right subclavian biventricular ICD placement, leads in appropriate position with no pneumothorax.

Output: Uncomplicated right subclavian biventricular ICD placement.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male with history of Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Confluent mediastinal hilar adenopathy is again noted. Index measurement of the anterior mediastinal adenopathy is 4.6 x 2.2 cm image number 48, series number 3, slightly compared to previous study. Other mediastinal and hilar adenopathy is also slightly smaller however it is difficult to measure due to its confluent nature.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval decrease in the size of the confluent mediastinal and hilar adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: confirm swan placement History: heart failure Right jugular catheter retracted back to the main pulmonary artery or RV outflow tract.Right pleural effusion and basilar atelectasis unchanged.Left lung unremarkable.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: Right jugular Swan-Ganz catheter pulled back to the pulmonary outflow tract from a right interlobar pulmonary artery branch.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: post thora History: post thora Interval decrease in size of the right pleural effusion after recent thoracentesis. No postprocedural pneumothorax.Signs of emphysema and multilobar subsegmental atelectasis, mainly in the right lower lobe and right middle lobe.Focal areas of subpleural scarring in both upper lobes again noted.The cardiac contours are partially obscured. Tortuosity and atherosclerotic calcification of the thoracic aorta.Dual lead pacemaker in place, unchanged in position.

Output: No evidence of postprocedural pneumothorax after recent right thoracentesis. The right pleural effusion has decreased in size, now small.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Intubated. ETT tip 3.5 cm above the level of the carina. Enteric tube tip beyond the caudal margin of the film.Loculated appearing pleural fluid collections about the same. Slight improvement in basal aeration on the right, otherwise the diffuse pulmonary opacities are unchanged.Unchanged mediastinal appearance, consistent with right-sided lymphadenopathy.

Output: Decreased right basal consolidation. No significant change elsewhere.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Postop day 1 right VATS, chest tube in place. Right chest tube unchanged in position with small anteromedial ipsilateral pneumothorax difficult to quantify but similar to yesterday's examination. Reticulonodular opacities in the left lung base may indicate a small amount of aspirated secretions. Subcutaneous emphysema at the chest tube insertion site on the right. Postsurgical changes right lung.

Output: Stable small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: r/o pna History: cough New cardiac leads terminate in expected location of the right atrial appendage and right ventricular apex. Calcified granulomas again noted within the right lung. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Mid lower thoracic vertebral body compression deformity again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old, with metastatic osteosarcoma. Please evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Two peripheral micronodules in the left lower lobe have not definitely changed in the interval. The larger of the two measures 10 x 10 mm on axial image 186, series 5.A questionable left upper lobe micronodule has also not changed on axial image 71, series 5. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Left chest wall port, tip at the RA/SVC junction.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant interval change in left-sided pulmonary micronodules.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for acute lung pathology/PNA History: SOB, desatting Small lung volumes with bilateral basilar nonspecific airspace opacity and probable small to moderate pleural effusions.Surgical staples are present in the abdomen suggesting recent surgery and the basal abnormalities may be secondary to intra-abdominal disease. The differential diagnosis includes aspiration however.

Output: Basilar airspace opacities and probable pleural effusions which may be related to intra-abdominal disease or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval swan placement and for effusions/infiltrates History: eval swan placement Swan-Ganz catheter terminates in the interlobar pulmonary artery. Mitraclip and Amplatz occluder devices again noted. Basilar reticulation again noted. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: Swan-Ganz catheter terminates in the interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Status post heart transplantation, presenting for annual evaluation. Sternotomy hardware is again visualized with wires intact along with right upper quadrant surgical clips. Calcified left lung nodules are unchanged and consistent with chronic granulomas. No pneumothorax or pleural effusion. The cardiomediastinal silhouette is stable.

Output: Stable cardiomediastinal silhouette.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: 59 y/o m w h/o RUL lung abscess, eval for evoultion with antibiotics. History: see above Increased lung volumes compatible with COPD.Bilateral apical bullae redemonstrated.Interval improvement in associated right upper lobe opacity.Right apical pleural thickening.No new pulmonary opacities identified.

Output: Right apical pleural thickening and residual scarring from previously infected right apical bulla and right upper lobe infection.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with metastatic breast cancer CHEST:LUNGS AND PLEURA: Stable noncalcified nodules, more prominent in the left upper lobe are unchanged. Stable right apical scarring.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney with left upper poor renal cyst is unchanged. Bilateral mild caliectasis is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Omental nodular thickening and reticular infiltration consistent with peritoneal carcinomatosis is unchanged.Antral wall thickening is unchanged.BONES, SOFT TISSUES: Stable diffuse bone metastases 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: Stable diffuse bone metastases are unchanged.OTHER: No significant abnormality noted.

Output: No significant change in the extensive bone metastases and peritoneal carcinomatosis.Bilateral mild caliectasis is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Chest pain History: Chest pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: acute cardiopulmonary process? History: shortness of breath The heart size is normal. Unremarkable cardiomediastinal silhouette. No focal pulmonary opacities, large pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: eval for change, edema History: SOB No change in basilar opacities and pleural effusions.Heart size upper normal status post valve repair.Left subclavian pacemaker, leads unchanged in position.IVC filter noted.

Output: Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: eval fracture History: MVA, L-side rib pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No evidence of a displaced rib fracture or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: pulmonary edema History: pulmonary edema Marked cardiomegaly with moderate pleural effusions suggestive of CHF.Extensive nonspecific pulmonary opacity compatible with chronic scarring and bronchiectasis, as shown on a recent CT scan, possibly with superimposed pulmonary edema.No new findings.

Output: Findings consistent with CHF with underlying scarring and bronchiectasis.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female status post CRT for head and neck cancer. Compare to previous measurements please. CHEST:LUNGS AND PLEURA: Biapical scarring as seen previously. New scarring and atelectasis is also seen in the right lower lobe and may represent sequela of aspiration. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Right chest Port-A-Cath with catheter tip in distal SVC. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETER: Ptotic right pelvic kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastric tube with tip in the gastric lumen.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Right lower lobe scarring and atelectasis likely represents sequela of aspiration. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Check chest tubes Mediastinal left basilar chest tubes unchanged. Diminished lung volumes with retrocardiac patchy opacities, likely atelectasis with small effusionRight jugular sheath well-positioned with interval removal of the Swan-Ganz

Output: Swan-Ganz removal


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: rule out pneumonia History: chest pain The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.Old rib fracture deformity in the left hemithorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: s/p septic shock check pulmonary status History: s/p septic shock check pulmonary status Gradually enlarging pleural effusions.Unchanged left lower lobe consolidation.Mild to moderate cardiomegaly.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Gradually enlarging pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Status post lung transplant Small bilateral pleural effusions with underlying atelectasis/consolidation. Bibasilar opacities, right greater than left. No evidence of significant pneumothorax.Chest tubes, Swan-Ganz catheter, mediastinal clips, sternotomy wires and plates in place, unchanged. ET tube tip terminates approximately 2 cm above the level of the carina. Persistent subcutaneous emphysema along the left lateral hemithorax.

Output: Small bilateral pleural effusions and bibasilar opacities which may represent mild pulmonary edema/atelectasis.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, 64 years old.Reason: eval ETT History: ETT moved ET tube tip 8.5 cm above the carina, partially withdrawn.No change in pulmonary opacities and other support devices/surgical artifact.

Output: ET tube high, tip 8.5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with history of multiple left-sided rib fractures presents with left-sided chest pain x1 week. Multiple rib deformities affecting ribs 3, 4, and 5 are consistent with provided history of chronic healed rib fractures. Additionally, the left mid clavicle is foreshortened with fusion of the fragments consistent with prior healed fracture. Finally, deformity of the scapula also appears to be a malformed prior healed fracture. No evidence of acute displaced fracture given the limitations of a chest radiograph.The cardiomediastinal silhouette is normal. No focal pulmonary opacity. No pneumothorax or pleural effusion.

Output: 1.Healed fractures of ribs 3, 4, and 5 on the left, sequela of prior trauma. No pneumothorax.2.Deformities of the left mid clavicle and left scapula consistent with prior healed fractures.3.No evidence of acute displaced fractures.


Instruction: Generate impression based on medical findings.

Input: 60 years old Male. Reason: CP SOB w/o 5 cardiac stents History: CP, SOB. The right subclavian ICD is stable in position. There is no evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: interval change; new lung infiltrate History: SOB; COPD exacerbation Multiple right upper lobe cavitary lesions with mycetoma are not significantly changed in appearance given differences in technique and positioning. No new areas of consolidation. Large lung volumes consistent with COPD. Embolization coils are projected over the right upper mediastinum.

Output: Right upper lobe cavitary lesions with mycetoma not significant change from prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.New trialysis line placement in right IJ. 3 films were obtained portably: 12:04, 12:07 and 12:11 hours.The right jugular catheter projects 5-6 cm below the level of the azygos arch on the 12:07 film. No pneumothorax.Tracheostomy tube and left subclavian catheter unchanged in position. Cardiomegaly and mediastinal widening unchanged. Extensive bilateral pulmonary opacities without significant change.

Output: Limited evaluation due to projection, image quality and habitus. No pneumothorax is appreciated, though follow-up is recommended given the limitation. The new right jugular catheter appears to be situated near the superior cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old has a nodule in the left lung. Stable left upper lobe nodule, which was characterized as a hamartoma on the prior CT.No additional suspicious pulmonary nodules or masses. No focal consolidation. No large pleural effusion or pneumothorax. Stable cardiomediastinal silhouette.

Output: Stable left upper lobe nodule, presumably a hamartoma based on prior CT.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Bladder cancer status post radical cystectomy evaluate for metastatic disease. Normal cardiomediastinal silhouette. The lungs are clear. No pleural fluid. Mild degenerative changes of the spine.

Output: No signs of pulmonary metastases or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Infiltrates History: fever Small pleural effusions best seen on the lateral view.No specific evidence of infection or edema.Heart size normal.Deviation of the trachea at the thoracic inlet level to the right is likely from a large goiter.Right jugular catheter, tip in SVC.Gastrostomy tube noted.

Output: Pleural effusions but no evidence of underlying infection.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.ETT placement. ETT less than 1 cm above the level of the carina. Nasogastric tube projects over the stomach.Low lung volumes with significant basal atelectasis and layering pleural effusions. The possibility of underlying aspiration or infection cannot be excluded.A vascular stent projects over the region of left axilla.

Output: Low endotracheal tube, suggest repositioning. Basal opacities consistent with pleural fluid, atelectasis and possibly a superimposed process such as aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: eval intubated micu pt History: as above Interval extubation.Some improvement in patchy bilateral opacities.Cardiomediastinal silhouette unchanged.No pneumothorax. Lines otherwise in stable position.

Output: Interval extubation. Some improvement in bilateral patchy opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: r/o acute process History: chest congestion The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion in segment IVb of the liver remains stable (series 3, image 82). No new lesions are identified. No evidence of intra-or extrahepatic biliary ductal dilatation. Normal appearing gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left nephrolithiasis unchanged; left renal cyst also unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.Atherosclerotic calcification of the descending aorta and bilateral iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: CT tube placement, asses for new intra pulmonary process History: MICU Unchanged basilar opacities and small pleural effusions.ET tube tip approximately 6 cm above the carina.An NG tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: 78-year-old male with right lower lobe opacity, assess for interval change. Right lower lobe airspace opacity compatible with known pulmonary mass on CT is not significantly changed compared to prior radiographs. Bibasilar atelectasis or scarring.Cardiomediastinal silhouette is unremarkable.

Output: No significant interval change in right lower lobe opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: eval PNA History: cough Right central venous catheter with its tip in the RA.Decreased lung volume with stable cardiac enlargement.Basilar opacities compatible with atelectasis, edema, and pleural effusions unchanged allowing for differences in patient positioning.Extensive calcification of the abdominal aorta.

Output: No interval change in the basilar opacities compatible with atelectasis, edema, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Status post robotic CABG. Shortness of breath Persistent large loculated left pleural effusion with underlying mild compression and decreased lung volumes bilaterally. Smaller right pleural effusion with basilar atelectasis again observed without superimposed new cardiopulmonary abnormality.Mild cardiomegaly. The mediastinal contours although exaggerated appeared grossly unchanged given semiupright positioning

Output: Persistent extensive atelectatic changes in both bases with loculated effusions and questionable mild edema


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia, CHF History: cough x 3 months, wheezing Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Sepsis. Rule out pneumonia. No focal pulmonary opacities to suggest infection. Asymmetrical opacification of the right lung field is likely due to overlying right breast malignancy and known bilateral pulmonary nodules. No evidence of pleural effusion or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No focal pulmonary opacities to suggest infection.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: Central line placement. The right-sided internal jugular central line terminates at the right brachiocephalic vein. The left subclavian pacemaker and leads are unchanged in position.

Output: Right-sided internal jugular central line terminates at the right brachiocephalic vein.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extra cardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality in the extra cardiovascular portions of the exam.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: sob History: 48581 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: Reason: ? PNA History: chest pain and HIV Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed metastatic melanoma CHEST:LUNGS AND PLEURA: Multiple punctate micronodules in both lungs are unchanged. Subcentimeter pleural based nodules on the left suspicious for metastatic disease.MEDIASTINUM AND HILA: New numerous mediastinal adenopathy. Numerous mediastinal lymph nodes are seen in the bilateral paratracheal space, prevascular space, adjacent to SVC, superior mediastinum adjacent to esophagus and on the pericardium and adjacent to descending thoracic aorta. A reference node is measured anterior to the SVC on image number 42/229. The lymph node measures 2 x 1.2 cm.CHEST WALL: Multiple, numerous subcutaneous and skin nodules have developed throughout the chest wall , supraclavicular regions, shoulders bilaterally. A reference nodule in the right axilla measures 17 x 13 mm on image number 50/229.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts are unchanged. Numerous perihepatic, omental, mesenteric, retroperitoneal, abdominal wall, subcutaneous metastatic nodules have developed within the interval.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney.RETROPERITONEUM, LYMPH NODES: Numerous metastatic nodules as described.BOWEL, MESENTERY: Numerous metastatic mesenteric nodulesBONES, SOFT TISSUES: Numerous abdominal wall and subcutaneous metastatic nodulesOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Numerous extra peritoneal, intraperitoneal, soft tissue and skin nodules consistent with metastatic disease. Multiple metastatic lesions are also present in the proximal thigh, and on the left hip joint.

Output: Interval development of numerous mediastinal, axillary, supraclavicular, skin, subcutaneous, chest and abdominal wall, splenic, pericardial, extraperitoneal metastatic lesions as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.IABP, Swan catheter positioning. IABP marker projects over the descending thoracic aorta 4.5 cm below the top of the aortic arch level. Left jugular Swan-Ganz catheter tip projects over the right main pulmonary artery.Low lung volumes. Elevation of the left hemidiaphragm. Coarse interstitial predominant opacities bilaterally with mild basal and dependent atelectasis, not significantly changed. Right basal opacity appears less dense.

Output: IABP marker 4.5 cm below the top of the aortic arch level. SGC tip projects over the right main PA.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Rule out pneumo, eval pulm edema History: Refractory hypoxemia, pulm edema Large lung volumes with normal-sized heart.Interstitial opacities are suggestive of edema.COPD/emphysema.ET tube tip at least 9 cm above the carina.An NG tube in place but the side-port is above the GE junction.

Output: Interstitial opacities suggestive of edema with marked emphysema but no pneumothorax. High NG and ET tubes.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: pneumonia History: sob, rhonchi heard on ascultation Basilar interstitial opacities confluent in the right middle lobe with minimal pleural effusions. Heart size upper normal, right side predominant which could be a fat pad or pericardial cyst projected over the right heart border.

Output: Right middle lobe opacities suggestive of infection. Superimposed edema or chronic fibrosis is present as well.


Instruction: Generate impression based on medical findings.

Input: Reason: SGC is now at 40 rather than 50. please confirm placement History: SGC is now at 40 rather than 50. please confirm placement Swan-Ganz catheter tip in the proximal right upper lobe pulmonary artery.Small lung volumes with mild basilar atelectasis.A more recent radiograph has been interpreted.

Output: Swan-Ganz catheter tip in the proximal right upper lobe pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of B-cell non-Hodgkin's lymphoma status post auto transplant CHEST:LUNGS AND PLEURA: 13 x 9 mm right middle lobe nodule (series 4; image 62), unchanged when remeasured (previously 13 x 10 when remeasured). The two other adjacent nodules are also stable.MEDIASTINUM AND HILA: Coronary calcifications. Low-density of the liver is unchanged, suggestive of fatty infiltration. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Spleen is small in size, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Intermediate density left upper pole renal mass measures 2.7 x 2 .1 cm, previously 2.8 x 2.3 cm (series 3; image 91). Other bilateral renal lesions, some definitively cysts, are also unchanged in size.RETROPERITONEUM, LYMPH NODES: Overall, the vast majority of the mesenteric and retroperitoneal lymph nodes have not changed in size.16 x 15 mm paraaortic lymph node (series 3; image 115), previously 17 x 16 mm.Reference mesenteric node measures 13 x 11 mm (series 3; image 123), previously 15 x 11 mm. The other reference mesenteric lymph node measures 16 x 8 mm (series 3; image 135), previously 16 x 12 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic disease.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Though the reference lesions have mildly decreased in size, overall, there has been no significant change in the abdominal adenopathy.Stable bilateral renal lesions, only some of which are definitively cysts.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: 69-year-old with new metastatic adenocarcinoma with desaturations and mental status changes Right chest port catheter tip at the atriocaval junction.Suboptimal evaluation of the cardiomediastinal silhouette due to patient rotation. Small right pleural effusion and left basilar subsegmental atelectasis. Multifocal ill-defined patchy airspace opacities throughout the right lung. No pneumothorax.

Output: Multifocal patchy airspace opacities throughout the right lung, consistent with multifocal pneumonia or aspiration. Superimposed diffuse metastatic disease cannot be excluded. Follow-up CT scan is suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: 49 year old female s/p endobronchial valve placement (left) evaluate for pneumothorax History: post bronch sob Endobronchial valves placed in the left lower lung. Cardiomediastinal silhouette is normal. No pneumothorax. Mild left basilar atelectasis.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: 79 yo M with prior TB, lobectomy who had massive hemoptysis, now resolved. establish new baseline History: as above Extensive right lung volume loss with pleural thickening, bronchiectasis, and a cavitary lesion with an air-fluid level in the right perihilar region.Patchy left basilar opacities may represent aspiration.Stable cardiomediastinal silhouette.Embolization coils identified overlying the mid thoracic spine compatible with recent bronchial artery embolization.ET tube has been removed.

Output: Interval extubation. Extensive right lung abnormalities including cavitary lesion with an air-fluid level in the right perihilar region.


Instruction: Generate impression based on medical findings.

Input: Sepsis.VIEW: Abdomen AP (one view) 02/03/15, 0326 Gastrostomy tube remains in place. Opacities in the lung bases are similar to those described on the chest radiograph obtained at the same time.No dilated bowel loops are seen. Bowel gas pattern is slightly disorganized. Trace feces is present in the colon.

Output: No evidence of obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: r/o pneumo, infiltrate, atelectasis History: post-op oxygen requirement Cardiomediastinal silhouette is unremarkable. Surgical clips are noted overlying the sternum.Streaky left basilar opacity suggestive of atelectasis. No large effusion or pneumothorax.

Output: Streaky left basilar opacity suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: Infiltrates History: fever Moderate cardiomegaly.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality. Follow up radiographs revealed developing pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Shortness of breath, cough, rule out pneumonia Cardiac silhouette is unremarkable.No specific evidence of infection, edema, or effusions.Scarring and hyperinflation most notable at the lung bases suspicious for air trapping or emphysema and is highly atypical for the patient's age.Possible bronchiectasis.

Output: Scarring and hyperinflation appears chronic and is suspicious for air trapping or emphysema. No acute abnormality. Consider CT if these chronic findings have not been previously worked up. Correlate for history of severe neonatal or childhood pulmonary insult versus alpha-1 antitrypsin deficiency.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o cardiopulm process History: shortness of breath Unremarkable cardiac and mediastinal silhouette.Small calcified granuloma in the right upper lobe compatible with previous infection.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Improvement in interstitial edema. Stable right midlung nodular opacity.Left subclavian ICD, leads unchanged in position.No pneumothorax following recent ICD revision.

Output: Improvement in pulmonary edema. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Bilateral lung transplant with persistent effusion. SOB. Moderate bilateral pleural effusions which appear partially loculated. Asymmetric lung density, right greater than left, please refer to prior CT for details. Unchanged cardiomegaly and fullness in the AP window region.

Output: Asymmetric density of the right lung, but no new airspace opacities. Unchanged mediastinal lymphadenopathy and bilateral partially loculated moderate pleural fluid collections.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: R/o pneumonia- chronic cough. History: Cough Stable cardiomediastinal silhouette. Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval for pneumonia History: wheezing, chest pain No pleural effusion or pneumothorax. No focal opacities are visualized. The heart size is upper limits of normal with a mildly tortuous aorta. Aoritc and coronary atherosclerosis.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Persistent coughing LUNGS AND PLEURA: An 8mm well-defined nodule seen in the lingula (image 50 series 5). Minimal dependent changes otherwise noted bilaterally with increased largely minimal interstitial changes seen in the left lower lung. Scattered calcified granuloma compatible with old healed granulomatous exposure. Mild bronchial wall thickening and no effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: A solitary well-defined nodule which is either high or low risk patient population requires a 3 month follow from point of discovery unless prior imaging is available to confirm stability from an outside source for comparison. Minimal additional left lower lobe changes to suggest possible aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: right pleural effusion History: SOB Persistent right pneumothorax, improved, with stable chest tubes.Basilar opacities consistent of atelectasis and pleural fluid are stable.Right jugular introducer unchanged.

Output: Improving right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history pleural effusions. Now with fever and eosinophilia, patient has a history of CML LUNGS AND PLEURA: Interval increase in the bilateral pleural effusions, left greater than right. Previously noted calcified nodule at the left base is obscured by the fluid on the current examMEDIASTINUM AND HILA: Stable paratracheal lymph node on the left measures 13.7 mm x 10.7 mm (image 23, series 3) previously measuring 11 x 13 mm. Redemonstration of coronary calcifications and a stent in the LAD. Hypoattenuation in the blood pool is consistent with anemia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Interval increase in the bilateral pleural effusions, left greater than right.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: f/u hydropneumothorax History: dyspnea Right central venous catheter with its tip in the SVC.Moderate to large size left-sided hydropneumothorax with mild shift of the mediastinum from left to right.Right basilar consolidation/atelectasis and right pleural effusion new from the prior exam.Diffuse interstitial opacities throughout the right lung compatible with lymphedema.Nodular density peripherally in the right midlung

Output: Large left-sided hydropneumothorax with new right pleural effusion right basilar consolidation/atelectasis. Right peripheral lung nodule and diffuse interstitial opacities in the right lung compatible with lymphedema.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Evaluate for volume overload History: Dyspnea The lungs and pleural spaces are clear. Extensive osteophyte formation of the thoracic spine. The heart size is normal. Calcifications in the right upper abdominal quadrant compatible with cholelithiasis.

Output: No evidence of edema. Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Chest pain Unchanged mildly decreased lung volumes without additional superimposed acute definite cardiopulmonary abnormality. A faint ill-defined groundglass opacity mid right lung cannot entirely be excluded and may require follow-up imaging, suspected right upper lobe. Specifically the previously described right basilar nodular density is currently not appreciatedMinimal scoliosis and the cardiac and mediastinal contours are otherwise within limits

Output: No definite superimposed acute abnormality, however a faint opacity in the mid right lung cannot be excluded


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Abdominal pain. Evaluate for free air. Lungs are clear. Heart size within normal limits. No pneumothorax. No displaced fractures. The visualized upper abdomen unremarkable with no evidence of free intraperitoneal air although this is somewhat limited by only semierect technique.

Output: No significant cardiopulmonary abnormality. No evidence of free intraperitoneal air.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: Patient with bilateral pleural effusions s/p thoracentesis and diuresis, please evaluate interval progression History: As above Other than technique, no interval change in appearance of the bilateral lung opacities with bilateral effusions, right greater than left.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Malignant neoplasm of esophagus, unspecified location History: Malignant neoplasm of esophagus, unspecified location Stable cardiomediastinal silhouette.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.

Output: No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Device placement Unchanged leadless ICD projected over the cardiac contours, unchanged in position. Cardiopulmonary appearance is also similar. No new immediate postprocedural complicationsScattered vertebral changes including a compressed lower thoracic vertebral body

Output: Unchanged leadless ICD


Instruction: Generate impression based on medical findings.

Input: Endobronchial valve placement Multiple endobronchial valve placement overlying the left hilar region. Other than mild asymmetry in lung volumes, now decreased on the left with extensive bulla and emphysematous changes in both bases greater on the right, appearance is otherwise free of focal airspace abnormalitiesCardiac and mediastinal contours are within limits

Output: Left bronchial valves placed


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: r/o pulm edema, aspiration PNA History: hypoxia, crackles Iatrogenic devices are unchanged. Slight increase in mid and left basilar opacities, likely atelectasis. Small left pleural effusion again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Slight increase in mid and left basilar opacities, likely atelectasis. Small left pleural effusion again noted.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: infection, aspiration History: speech difficulty The cardiac mediastinal silhouette is unremarkable.Minimal basilar atelectasis may be related to aspiration.No focal airspace consolidation.Blunting the right costophrenic angle most likely represents pleural thickening.

Output: Mild basilar scarring/atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Prekidney transplant evaluation, end-stage renal disease. Rule out cardiomegaly or infiltrates. Mild cardiomegaly unchanged. Enlargement central pulmonary vasculature consistent with pulmonary hypertension. Small right pleural fluid collection. Vascular redistribution but no specific evidence of pulmonary edema. No focal airspace opacities.

Output: Stable mild cardiomegaly. Chronic small right pleural fluid collection and signs of pulmonary redistribution but no signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure Mildly increasing redistribution and patchy opacities suggesting increasing early diffuse edema with moderate nonspecific cardiomegaly. Hardware unchanged

Output: Increasing mild CHF


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: 70yo w/h/o head/neck CA, now with L-neck abscess + aspiration PNA. Previous CXR with increased opacities/effusions. Still desating when supine after diuresis. Please re-eval for pulm edema/effusion, increased mucus plugging, new infection? History: on 3L NC, desat overnight requiring 6L to keep sats >90% Right chest wall Port-A-Cath tip terminates at the cavoatrial junction.Low lung volumes. Streaky bibasilar opacities consistent with aspiration/atelectasis, slightly decreased. There is no pneumothorax or pleural effusion. The cardiac and mediastinal contours are within normal limits for size.

Output: Streaky basilar opacities consistent with aspiration/atelectasis slightly improved from the prior.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with newly diagnosed scalp melanoma. Evaluate for extent of tumor, evaluate for metastases. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Small scattered mediastinal lymph nodes. Reference lymph node measures 0.9 cm x 0.6 cm (image 28, series 3). Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver appeared Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypodense lesion in the lower pole of the left kidney is too small to characterize, however favor benign pathology.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.No definite evidence of metastatic disease to the chest, abdomen, or pelvis.2.Small nonspecific mediastinal lymph nodes. Reference lesion as described above.3.Fatty infiltration of the liver.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: Eval for Pneumothorax History: S/P CT removal after AVR Interval removal of multiple chest tubes and right central catheter. No large pneumothorax. Right basilar consolidation and bilateral pleural effusions, right greater than left. Cardiomediastinal silhouette is mildly enlarged. Median sternotomy hardware intact. Aortic valve replacement.

Output: Persistent right basilar consolidation and bilateral pleural effusions, right greater left. No large pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: pna? History: weakness Mild cardiomegaly.Small lung volumes.No specific evidence of infection or edema.

Output: Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old, with history of chest pain. Evaluate for PE. PULMONARY ARTERIES: Technically adequate exam. No pulmonary embolus.LUNGS AND PLEURA: Ground glass opacity in the right lower lobe with subtle adjacent nodularity (image 84, series 7) may represent aspiration or infection. Short-term CT follow up is recommended to document resolution.Scattered additional micronodules, some calcified, likely represent prior granulomatous disease. No pleural fluid.MEDIASTINUM AND HILA: The cardiac size is enlarged. Aortic and coronary artery calcifications. No pericardial effusion.Prominent precarinal and right hilar lymphoid tissue is unchanged to slightly smaller. Small hiatal hernia.CHEST WALL: Left chest wall pacemaker generator, leads in the right ventricle and coronary sinus.UPPER ABDOMEN: Splenic and hepatic calcifications likely represent prior granulomatous disease. Cholelithiasis versus calcification of the gallbladder wall. Low-attenuation left adrenal nodule, unchanged and likely benign.Bilateral renal cystic lesions are unchanged.

Output: 1.No PE.2.Right lower lobe opacity may represent aspiration or infection. Short-term CT follow-up (one month) is recommended to document resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old. Catheter tip in the SVC.No pneumothorax or other complications.No other significant cardiopulmonary abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: pneumothorax eval History: none--post transbronchial bx Unchanged cardiomediastinal silhouette.New focal airspace opacities at the right lung base may be postprocedural. No pleural effusions or pneumothorax is identified.

Output: Right basilar opacity which may be postprocedural. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old. Catheter tip in the SVC.Mild blunting of both costophrenic angles suggestive of small pleural effusionsNo other significant findings.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Pt is a 65 yo male; potential stem cell donor History: eval Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: DKA, eval for infectious process History: as above The heart is normal in size. Single lead pacer in place with leads overlying the right atrium.Lung volumes are normal. No abnormal focal lung opacities.The pleural spaces and visualized bones are within normal limits.

Output: Stable position of single lead pacer. No radiographic findings suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Eval for pulmonary disorder. History: Wheezing. Minimal streaky basilar opacity may be due to atelectasis. Otherwise no acute cardiopulmonary abnormality.

Output: Minimal streaky basilar opacity may be due to atelectasis. Otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: weight loss r/o pulmonary disease 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, 33 years old.Cystic fibrosis with fever spike and persistent productive cough. Bronchiectasis and associated opacities consistent with cystic fibrosis. No visible change in appearance. Normal heart size. Right chest port unchanged in position.

Output: No convincing evidence of new opacities to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with nephrolithiasis, elevated vitamin D, history of lymphadenopathy. Evaluate for granulomatous disease. LUNGS AND PLEURA: Multiple scattered calcified and noncalcified pulmonary micronodules, compatible with granulomas. Nonspecific small nodule in right upper lobe (series 7 image 42) measures 6mm.Multiple small foci of groundglass opacities in the dependent lung zones bilaterally, likely postinflammatory. MEDIASTINUM AND HILA: Multiple prominent mediastinal and hilar lymph nodes. Right paratracheal lymph node (series 5 image 35) measures 17 mm in short axis. Right subcarinal lymph node (series 5 image 50) measures 36 x 29 mm. Punctate calcification in a left hilar lymph node is suggestive of prior granulomatous disease. Additional mediastinal and hilar lymph nodes are noncalcified and nonspecific, may be reactive vs malignant.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Cholelithiasis. Diffuse steatosis of the liver limits detection of focal lesions. Well-rounded hypodense lesion in the spleen posteriorly (series 5 image 104) measuring 3 cm is nonspecific, likely benign cyst. Indeterminate left renal cystic lesion with relative high density is incompletely evaluated on current exam.

Output: 1) Mediastinal and hilar lymphadenopathy of uncertain etiology. 2) 6mm right pulmonary nodule. Recommend follow-up imaging if high clinical risk of malignancy. 3) Indeterminate left renal cystic lesion. Recommend contrast enhanced abdominal CT with dedicated renal protocol for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Asthma with recent hospitalization for exacerbation. S.O.B. and rhonchi. Linear subsegmental atelectasis near the left costophrenic angle, new from the previous study. Bronchial wall thickening consistent with provided history of asthma. No pneumothorax or pneumomediastinum. IVC filter noted.

Output: Bronchial wall thickening with a small focus of subsegmental atelectasis in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: re-evaluate RUL pneumothorax History: pneumo s/p lung bx Interval removal of right pleural pigtail catheter.Small residual right pneumothorax, decreased in size when compared to prior. Bilateral pulmonary nodules, the larger of the 2 is unchanged in the right upper lobe. Left lung is fully inflated. Heart size is normal. Right rib deformity unchanged.

Output: Decreased size of the small right pneumothorax following removal of pleural pigtail catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: hypoxemia, has trach- pls determine if worsening pulm edema vs other etiology History: hypoxemia Tracheostomy tube and left PICC remain in stable position.Increasing right pleural effusion that tracks to the apex. Stable multifocal patchy airspace opacities. No interval pneumothorax. Heart size remains enlarged.

Output: Bilateral patchy airspace opacities are unchanged. Increasing right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of mantle cell lymphoma CHEST:LUNGS AND PLEURA: Bibasilar dependent atelectasis.MEDIASTINUM AND HILA: The tip of the port catheter is at the junction of the SVC and right atrium.Index right paratracheal node measures 7 by 8mm image number 12, series number 3, smaller compared to previous study. Right hilar nodal conglomerate is unchanged measuring 7 x 8 mm on image number 47, series number 3. Stable ectasia of the ascending thoracic aorta.CHEST WALL: Enlarged right axillary lymph node is unchanged measuring 18 by 11-mm image number 20, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the liver is unchanged. No new lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index left external iliac node measures 19 by 9-mm image number 189, series number 3. Stable from previous study. Reference right inguinal lymph node measures 19 by 5-mm image number 208, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with colon cancer. Restaging after chemotherapy. CHEST:LUNGS AND PLEURA: Scattered micronodules bilaterally, several appearing minimally increased in size since prior study (for example, series 6, image 50). Upper lobe paraseptal emphysema.MEDIASTINUM AND HILA: Stable mediastinal lymphadenopathy. Reference para-aortic lymph node (series 4, image 21) measures 1.6 x 2.7 cm (stable).Paraesophageal soft tissue mass (series 4, image 70) has decreased in size, measuring 2.8 x 2.2 cm; previously measuring 3.3 x 2.6 cm.Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: Multiple, large bilobar hypoattenuating lesions are again consistent with metastases. Reference right hepatic lobe lesion (series 4, image 79) measures 6.8 x 4.9 cm; previously measuring 7.5 x 6.1 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular thickening of the left adrenal gland as seen previously.KIDNEYS, URETERS: Multiple bilateral hypoattenuating foci remain too small to characterize. Stable probable right renal cyst.RETROPERITONEUM, LYMPH NODES: Interval decrease in size of retroperitoneal adenopathy. Reference para-aortic lymph node (series 4, image 120) measures 2 x 1.8 cm; please measuring 2 x 2 cm.BOWEL, MESENTERY: Postsurgical changes from partial gastrectomy with gastrojejunostomy. No evidence of bowel traction.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple common iliac chain lymph nodes appear smaller than on prior study.Reference left periaortic lymph node at the bifurcation (series 4, image 146) measures 1.2 x 1.3 cm; previously measuring 1.5 x 1.8 cm.BOWEL, MESENTERY: Circumferential thickening and narrowing of the sigmoid colon (se and reference hepatic and ries 4, image 186) is reidentified.BONES, SOFT TISSUES: Ill-defined lytic lesion in L4 vertebral body, unchanged.

Output: 1. Sigmoid colon mass with interval decrease in size of reference hepatic lesion and lymphadenopathy.2. Minimal interval increase in the size of several pulmonary nodules as above.3. Stable ill-defined lytic lesion in L4 vertebral body.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: abnormality History: left lower rib pain post mvc No focal pulmonary opacity. The cardiomediastinal silhouette is normal. No evidence of infection or edema. No rib fracture is identified. No pneumothorax.

Output: No acute cardiopulmonary abnormality. No rib fracture is identified.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: please assess reason for sob History: sob Enlarging loculated right pleural effusion despite right chest tube, compressing the right mid to lower lung zone.Left lung unremarkable.Left jugular catheter, tip in SVC.

Output: Enlarging loculated right pleural effusion despite right chest tube, further compressing the right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: swan, iabp History: swan, iabp Cardiomegaly with a small right pleural effusion unchanged.IABP proximal marker 3 cm below the top of the aortic arch.Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: IABP exchanged for a subclavian insertion. Other support devices stable, and there is a small right pleural effusion which is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: r/o edema, pneumonia History: chest pain The cardiomediastinal silhouette is within normal limits. Multiple coronary stents noted. No focal consolidation, significant pleural effusion or pneumothorax. No specific evidence of edema.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath The cardiomediastinal silhouette is unchanged.Persistent right hilar architectural distortion, chronic bronchiectasis and volume loss in the right upper and lower lobes. Improved aeration of the right lower lobe. The previously described right lower lobe nodular opacity is poorly seen. Moderate right pleural effusion is slightly decreased from the prior exam. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: DOE History: DOE No consolidation, edema or pleural effusion. Heart size is normal. No pneumothorax.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: eval for infection History: sob, uri symptoms Overlapping vascular stents in the axilla are now present. Right central catheter terminates at the central superior vena cava.Mild cardiomegaly, unchanged. No associated edema, pleural effusion or pneumothorax.

Output: Mild cardiac enlargement without edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: eval for acute process History: flu like sx The cardiomediastinal silhouette is unremarkable. Mild increased reticulonodular interstitial opacities particular in the right lung with complaint bronchial wall thickening.No focal areas of consolidation.No pleural effusions.

Output: Bronchial wall thickening and mild increased reticulonodular interstitial opacities particularly in the right lung may represent bronchitis/endobronchial infection. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: 63yoM AMS r/o infx History: AMS Right IJ venous catheter with its tip in the SVC.Outlaw tube with its tip in the stomach. ET tube has been removed.There are decreased lung volumes.The cardiomediastinal silhouette is unremarkable.Perihilar interstitial opacities suggestive of edema.Mild basilar atelectasis.

Output: Mild interval increase in perihilar interstitial opacities suggestive of edema. Interval extubation.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: chest tube History: chest tube Right chest tube unchanged in position with no evidence of significant residual right-sided pneumothorax. Small left pneumothorax is unchanged. Left base consolidation unchanged.

Output: Right chest tube unchanged in position with no evidence of significant residual right-sided pneumothorax. Small left pneumothorax is unchanged. Left base consolidation unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Status post TEVAR, endoleak with SOB. Esophagectomy. Right jugular catheter, aortic stent graft and gastrostomy tube retention device similar in position.Moderate layering pleural fluid collections with associated atelectasis about the same. Fluid on the right remains partially loculated.Cardiomediastinal appearance similar to recent previous.The left paratracheal mass correlating to a presumed hematoma at site of esophagectomy causes slight narrowing of the mid thoracic trachea at the level of the aortic arch.

Output: There is slight narrowing of the mid thoracic trachea due to extrinsic compression from mediastinal hematoma. No acute change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: r/o mets History: none The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: ILD s/b ARDS now extubated History: HYPOXIA ET tube tip approximately 1 cm above the carina with the neck in a flexed position.Catheter tip in the SVC.NG tube tip in the area of the gastric antrum.Small lung volumes with diffuse nonspecific interstitial opacity, compatible with ARDS, unchanged or slightly improved.

Output: Findings compatible with ARDS with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male; 75 years old. Reason: assess for cause of SOB History: SOB and chest pain Normal cardiomediastinal silhouette. No focal airspace opacity or pleural effusion. Persistent mild elevation of the left hemidiaphragm and partially visualized gaseous distention of stomach and bowel loops.

Output: No acute cardiopulmonary abnormality without interval change.


Instruction: Generate impression based on medical findings.

Input: History of pneumothorax. Shortness of breath Small right apical pneumothorax is observed, please see subsequent reports

Output: Small right pneumothoraxI 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, 57 years old. SOB. Evaluate for pleural effusions. Right PICC tip is at the cavoatrial junction.Normal cardiomediastinal silhouette.Bilateral small pleural effusions with overlying atelectasis. No evidence of infection or edema.Dilated small bowel loops in the upper abdomen with multiple air fluid levels.

Output: Small bilateral pleural effusions with overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: f/u right pleural effusion History: pleural effusion Right pleural effusion with underlying atelectasis not substantially changed since the prior exam.Stable mild cardiac enlargement.No new pulmonary opacities identified.

Output: Persistent right pleural effusion and underlying atelectasis without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for PNA History: Cough, shortness of breath x2 days Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: wheezing, febrile History: as above Moderate cardiomegaly with a tortuous and ectatic aorta, not appreciably changed from previous.Small lung volumes with streaky basilar opacities compatible with atelectasis and scarring.No specific evidence of pneumonia or CHF.

Output: Dilated and ectatic aortic arch, unchanged from previous. Basilar atelectasis and scarring, also unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: palpitations History: as above Moderately severe cardiomegaly, unchanged.Interval removal of aortic balloon catheter and temporary pacemaker.No evidence of pulmonary edema or other acute change.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: septic shock History: septic shock Right basilar pigtail drain. Tracheostomy, enteric tube, and right central catheter are unchanged. Bilateral pleural effusions and diffuse pulmonary interstitial opacities are not significant changed compared to the prior exam. Cardiomediastinal silhouette is unchanged.

Output: Bilateral pleural effusions and diffuse pulmonary interstitial opacities consistent with edema are not significantly changed compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? MS flare? History: nausea Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: esoph cancer s/p chemorads and surg, ck response History: gastroparesis Unremarkable cardiac and mediastinal silhouette. Blunting of the right costophrenic angle, unchanged since previous radiographs, most likely due to pleural scarring more organized effusion.No new findings.

Output: Chronic blunting of the right costophrenic angle compatible with scarring or chronic organized pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 82 years old Reason: chf History: shortness of breath Streaky basilar opacities suggest scarring or mild atelectasis. The cardiac silhouette is mildly enlarged. There is no large pleural effusion or pneumothorax. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with lung nodule. Follow-up. CHEST:LUNGS AND PLEURA: Scarlike opacity in the right upper lobe peripherally (series 4, image 18; series 8028, coronal image 33) with adjacent groundglass opacities and mild adjacent pleural thickening. It may be inflammatory in etiology, such as a resolving infarct; however, continued follow-up is recommended if no prior studies are available for comparison.3-mm nodule along the right major fissure is compatible with an intrapulmonary lymph node.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild coronary calcifications.CHEST WALL: Small sclerotic foci in the T4 and T7 vertebral bodies are likely benign bone islands; however, they can be followed on subsequent studies.UPPER ABDOMEN: No significant abnormality noted.

Output: Scarlike opacity in right upper lobe, possibly inflammatory etiology such as a resolving infarct. Continued follow-up to ensure stability or resolution is recommended if no prior studies are available for comparison.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval for fracture History: pain after fall The cardiac and mediastinal contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities.No pleural effusion or pneumothorax.Deformity in the left breast tissue is suggestive of prior left lumpectomy. Left axillary surgical clips are noted.Moderate degenerative changes of the thoracic spine. There are no focal osseous lesions or findings to explain patient's symptoms.

Output: Deformity in the left breast tissue is suggestive of prior left lumpectomy. Left axillary surgical clips are noted. No clinical information provided at the time of interpretation. Correlate with patient's surgical history.No abnormal radiographic findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval for consolidation History: shortness of breath, cold, bilateral crackles in bases Severe cardiomegaly and rate pericardial effusion unchanged.Stable pleural effusions and basilar opacities suggestive of atelectasis and edema.No specific evidence of infection.

Output: Findings suggestive of CHF, more likely than infection.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with lung cancer status post right upper lobectomy. Cardiomediastinal silhouette is unchanged. No focal opacity or pleural effusion. Asymmetric elevation of the right hemidiaphragm is unchanged.Surgical suture in the right upper lung.

Output: No significant interval change. No acute cardiopulmonary abnormality. No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Nonspecific basilar subsegmental atelectasis and pleural effusions are new.Heart size upper normal.Left subclavian dual chamber ICD, leads in appropriate positions with no pneumothorax.

Output: No significant pneumothorax. Increasing basilar atelectasis with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Status asthmaticus, OG placement, intubation. Nasogastric tube sidehole straddles the GE junction and may be advanced. Endotracheal tube tip 4.5-cm above the level of the carina. Moderate pleural effusions. Interval worsening of pulmonary opacities which are now extensive. Nodular opacities described previously, partially obscured.

Output: Interval development of extensive reticulonodular opacities which may reflect diffuse pulmonary edema or extensive aspiration bronchiolitis in the setting of known aspiration.


Instruction: Generate impression based on medical findings.

Input: Female 5 months old Reason: assess for tube placement, pt rotated in bed with increasing agitation History: increasing agitation, elevated BPVIEW: Chest AP and abdomen AP and crosstable lateral on 9/29/2016 at 1737 hours (3 views) Left upper extremity PICC terminates in the left subclavian vein. Right IJ venous access tip is at the SVC. ET tube tip is below thoracic inlet. Gastrostomy tube is present. Persistent massive soft tissue edema.Cardiac silhouette size is enlarged but stable. Persistent lung vascular engorgement and diffuse lung haziness with no focal opacities, effusions or pneumothorax.Paucity of abdominal gas.

Output: Persistent lung vascular engorgement.Paucity of abdominal gas.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: r/o lytic lesion History: mid sternal pain Mild cardiomegaly.No specific evidence of infection or edema. Multiple lytic lesions are present, including the left first rib, lateral aspect of the left fourth rib in the lateral aspect of the right seventh rib.A lytic lesion affects the lateral aspect of the right sixth rib, and other known lesions have been seen on other radiographs. Left jugular catheter, tip at cavoatrial junction.

Output: Multiple lytic lesions were identified. No specific evidence of infection or edema. No evidence of a sternal lesion although CT would be more sensitive for this.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: eval for worsening pulmonary infiltrates, aspiration History: vomiting, desats Enlarging left pleural effusion further compressing the left lung base.Patchy airspace opacities are unchanged.Tracheostomy tube tip approximately 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter, tip at cavoatrial junction level.Right upper quadrant drainage catheter.

Output: Enlarging left pleural effusion compressing the left lung base, with unchanged airspace opacities elsewhere.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: assess for pulm edema History: DOE, crackles, decreased BS; CHF Small right pleural effusion with basilar edema and right basilar atelectasis.Heart size upper normal.

Output: Findings suggestive of CHF with edema and a right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Discharged from outside hospital diagnosis of pneumonia today here with chest pain. Normal heart size. Low lung volumes. No focal airspace opacities, pleural fluid or pneumothorax.Degenerative changes of the mid thoracic spine.

Output: Low lung volumes, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Question of Swan-Ganz catheter position after being pulled back 2 cm after AM radiograph. Slight interval retraction of the Swan-Ganz catheter with tip located in the right interlobular pulmonary artery. A right IJ catheter terminates in the right atrium.No focal lung opacity, large pleural effusion, or pneumothorax. Cardiomegaly is unchanged.

Output: Slight retraction of a Swan-Ganz catheter with tip located within the right intralobular pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male 83 years old Reason: eval for effusion History: hx of CHF, SOB A left-sided pacemaker is noted with leads in the right atrial appendage and left ventricle. No focal opacity, pleural effusion or pneumothorax. Mild cardiomegaly.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 67 year old female with non-small cell lung cancer now presenting with worsening shortness of breath. CHEST:LUNGS AND PLEURA: The left paramediastinal/suprahilar mass is best delineated on coronal images given the lack of IV contrast to differentiate the mass from the adjacent pulmonary vasculature. This mass (series 80272, coronal image 39) measures 5.5 x 3 cm; previously measuring 5.3 x 3.1 cm in the coronal plane, which is stable accounting for differences in technique.Please note that the previous measurements were in the axial dimension and appear to include the left main pulmonary artery.Multiple pulmonary nodules and micronodules are unchanged, some of which are calcified. Reference right upper lobe nodule (series 5, image 24) again measures 5 x 5 mm. Previously reference subpleural right lower lobe nodule is not adequately measurable given adjacent pleural thickening/effusion, but it appears grossly unchanged. A different right lower lobe nodule (series 5, image 51) measures 5 x 4 mm (unchanged).Right septal thickening may represent asymmetric CHF; however lymphangitic spread of tumor can have a similar appearance.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is enlarged without pericardial effusion. Severe calcifications of the right artery, left circumflex, and LAD arteries.CHEST WALL: Left abdominal wall ICD. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Stable left paramediastinal/suprahilar mass.2. Probable new right-sided pulmonary edema compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Cardiac surgery and effusion. Interval removal of right jugular catheter without pneumothorax. Sternal hardware appears in alignment. Cardiomegaly. Layering right pleural effusion with associated atelectasis about the same. Retrocardiac opacity unchanged.

Output: No acute change in pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: dilated loops of bowel History: diarrhea Diffuse dilated loops of small and large bowel. Surgical clips in the right upper quadrant. Please see chest radiograph report for thoracic findings.

Output: Diffusely dilated loops of small and large bowel suggestive of ileus.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of carcinoid (T1 N0). Status post surgery 1/16/08. LUNGS AND PLEURA: Volume loss and postoperative change on the left status post left lower lobectomy. Scattered micronodules are unchanged. No suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged. The cardiac size is normal. No pericardial fluid. Aortic and coronary atherosclerotic calcifications are noted.CHEST WALL: Densely sclerotic lesion within the vertebral body of T8, unchanged.UPPER ABDOMEN: Status post cholecystectomy.

Output: Stable examination with no evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: sob History: sob Exam is limited secondary to technique.Enteric tube tip is between the thoracic inlet and the carina. Partially visualized NG tube extends out of the field of view.Low lung volumes, cardiomegaly.No focal consolidation, pleural effusion, or pneumothorax.

Output: Limited exam without acute cardiopulmonary abnormality. ET tube between the thoracic inlet and the carina.


Instruction: Generate impression based on medical findings.

Input: Inflammatory breast disease No cardiopulmonary abnormality. Mild eventration of the right hemidiaphragm

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: S/P OHT, routine screening. History: as above Sternotomy sutures and mediastinal surgical clips noted.The cardiomediastinal silhouette is normal.No focal pulmonary opacity or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: MaleReason for Study: Reason: ho PE now sharp chest pain to upper R side radiating to back like w his PE History: as above The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.No pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified. Significant interval decrease in cardiac size.


Instruction: Generate impression based on medical findings.

Input: Reason: fever History: fever Focal large mass like opacity in the lingula with poorly defined margins, better evaluated on a subsequent CT scan, performed the same day.Marked rotation and scoliosis, which limits evaluation of the mediastinum.Fixation device in the cervicothoracic spine.

Output: Large masslike opacity in the lingula which may represent infection, infarct or neoplasm. A CT scan has been performed.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: pulm edema History: cough No appreciable interval acute abnormality. Mild eventration of the right hemidiaphragm with otherwise clear lungs. Mild tortuosity of the aorta with otherwise unremarkable cardiac and mediastinal contours

Output: No acute diseaseI 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, 24 years old.Reason: eval lung fields History: eval lung fields Right chest tube with a stable right pneumothorax.Small left apical pneumothorax unchanged.Nonspecific pulmonary opacities are stable.Tracheostomy tube tip approximately 5 cm above the carina.Left jugular and left subclavian catheters terminate in the SVC.

Output: No change in pulmonary opacities and small pneumothoraces following lung transplant.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: Right IJ central line placed. We would like to make sure it is in the right position History: none Mild cardiomegaly.No specific evidence of infection or edema.Right jugular catheter tip at cavoatrial junction.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Chest pain and DOE evaluate for fluid overload. Normal heart size. No visible mediastinal lymphadenopathy. No pleural fluid or pneumothorax. No signs of interstitial edema. Cholecystectomy clips.

Output: No acute cardiopulmonary abnormality. Normal chest.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: pt s/p diaphragm stripping with occasional SOB History: SOB Right chest tube removed with no pneumothorax.Enlarging right pleural effusion.Left pleural effusion improved.Right jugular catheter, tip in SVC.

Output: Enlarging right pleural effusion following right chest tube removal. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Multiple myeloma, evaluation for autologous stem cell transplantation. The cardiac size is within normal limits. Previously seen pneumonia and pleural effusions are no longer visualized. No new focal lesions are appreciated.Numerous skeletal abnormalities related to multiple myeloma.

Output: No visible acute cardiopulmonary process. Please note that due to extensive chest wall and parenchymal abnormalities, early identification of infection may be difficult, and CT may be considered if diagnosis would alter management.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: s/p bilateral lung txp History: s/p bilateral lung txp Tracheostomy tube and left IJ venous catheter unchanged. There are decreased lung volumes with stable cardiac enlargement.Pleural effusions, and basilar edema/atelectasis similar to the prior exam.No new pulmonary opacities noted.

Output: Support device in change. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: COPD exacerbation History: sob Extensive lower lung zone bronchial wall thickening and bronchiectasis consistent with MAI.No evidence of superimposed infection or edema, nor pleural effusions.Unremarkable mediastinal contours and cardiac silhouette.

Output: Extensive lower lung zone bronchiectasis and bronchial wall thickening consistent with MAI or other form of chronic bronchiectasis and bronchiolectasis. Unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old. Reason: s/p AVR/mitral valve repair/ bilateral talc pleurodesis History: SOB/DOE Left chest wall ICD with mitral and aortic valve prostheses, the pulse generator obscures a portion of the left lung. Resolution of right apical pneumothorax component and subcutaneous emphysema.Heart size is unchanged.Near complete resolution of pulmonary edema with moderate loculated pleural effusions which are unchanged compared to prior study.Median sternotomy and right chest wall surgical clips unchanged. Interval removal of midline surgical staples.

Output: Moderate loculated pleural fluid bilaterally with resolution of pneumothorax component and subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.IABP and Swan placement. IABP marker projects over the proximal descending thoracic aorta approximately at the T6/T7 level. A Swan-Ganz catheter from an IVC approach terminates overlying the right main pulmonary artery near its orifice. No focal airspace opacities or pneumothorax.

Output: No acute pulmonary abnormality. Slight advancement of Swan-Ganz catheter. Stable position of IABP marker.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: lvad w/ AMS, eval for PNA History: AMS Moderate cardiomegaly status post ICD and LVAD placement.Stable mild basilar subsegmental atelectasis, but no reliable evidence of infection.

Output: No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: eval for pna History: cough, hyperglycemia Unremarkable cardiac and mediastinal silhouettes. No specific evidence of infection or failure.Calcified right hilar lymph nodes.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with pancreatic cancer status post chemo/RT CHEST:LUNGS AND PLEURA: No significant abnormality noted. 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. ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis possibly secondary to interval chemotherapy administration. Percutaneous transhepatic biliary catheter traverses the liver, appearing similar prior study.The portal and hepatic vasculature are patent with stable attenuation of the superior mesenteric vein and portal vein near the confluence suggestive of vascular invasion.SPLEEN: No significant abnormality noted.PANCREAS: Heterogeneity at the pancreatic head is again identified, measuring 3.0 x 2.5 cm (series 12, image 113); previously measuring 3 x 3.8 cm. Please note however that no definite mass is able to be delineated. Adjacent fluid filled structure with enhancing rim appears similar prior study and again likely represents a postinflammatory cyst.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable prominent portacaval and retroperitoneal lymph nodes.BOWEL, MESENTERY: Status post gastric bypass. Diffuse colonic wall thickening that is new on comparison to prior study from 9/17/2009 and consistent with colitis. No evidence of obstruction or free air.Multiple mesenteric nodes appear similar to prior study.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free pelvic fluid.

Output: 1. Heterogeneity of the pancreatic head appears similar to prior study; however please note that a discrete mass is not able to be delineated at this location. Stable pancreatic pseudocyst. Attenuation of the portal vein at its confluence with the SMV as seen previously and again suggestive of vascular invasion.2. Diffuse colonic wall thickening that is new since prior study from 9/17/2009 and consistent with colitis. Please correlate with patient symptoms.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old. Reason: chest tube placement History: s/p right lower lobectomy Two right-sided chest tubes unchanged in position.No significant pneumothorax.Normal heart size.Left lung is clear

Output: No significant pneumothorax status post right lower lobectomy.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, 82 years old.Reason: s/p AVR History: NA Small pleural effusions primarily on the right, with underlying COPD.The lungs are better inflated than on the prior study.Heart size normal, status post aortic valve replacement.

Output: Persistent right pleural effusion, improved. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: RIJ TLC pulled back 3.5cm History: see above Cardiomegaly with persistent left lower lobe consolidation.The right jugular catheter is been partially retracted but still lies in the right atrium.

Output: Right jugular catheter still low, entering the right atrial region.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: eval lung fields History: s/p myxoma removal ET tube has been removed.Right-sided chest tubes, left-sided ICD, and right IJ venous catheter is unchanged.No significant pneumothorax.Stable cardiomediastinal silhouette.Basilar subsegmental atelectasis similar to the prior exam.

Output: Interval extubation. Remaining support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o pna vs. edema History: chest pressure, recent clinical dx of pna Small lung volumes, but no specific evidence of edema or pneumonia.Heart size upper normal.

Output: Small lung volumes, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Cough status post LVAD. Overlying material obscures detail. Significant cardiomegaly again noted. LVAD in place. Retrocardiac opacity. The apex is stable. Left PICC appears slightly more proximal now over the brachiocephalic vessels. No pneumothorax.

Output: Stable retrocardiac opacity. PICC catheter slightly more proximal now over the brachiocephalic vessels.