Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Evaluate improvement of PCP pneumonia. Stable positioning of lines/tubes. The cardiomediastinal silhouette is within normal limits. Diffuse reticular opacities throughout both lung fields is unchanged.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o CXR abnormalitiy and SOB 3/2015 History: dyspnea Normal heart size with a vascular stent in the distribution of the left coronary artery.No significant pulmonary abnormalities.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: 61M sp OHT with decreased breath sounds. History: sob Small right pleural effusion.Resolution of basilar atelectasis.Intact median sternotomy fixation devices.

Output: Small right pleural effusion and no other significant findings.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval for edema History: sob/tachycardia Marked cardiomegaly, as before. No new focal lung consolidation. No evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax.

Output: Marked cardiomegaly, as before.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Evaluate for pneumonia History: Bronchiectasis with increased cough, sputum production and fevers Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Incidental note made of bilateral diaphragmatic eventrations, as before.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: S/p CABG History: s/p CABG IABP catheter tip low, 7 cm below the top of the aortic arch.Status post median sternotomy with chest tubes but no pneumothorax.Increased left basilar consolidation and small pleural effusions present.ET tube tip approximately 1 cm above the carina.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.

Output: Low ET tube and IABP catheter. Increased left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: s/p OHT History: asx Cardiomegaly, status post sternotomy.Small lung volumes, without specific evidence of edema although there still a right pleural effusion.Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery.

Output: Cardiomegaly and and small right pleural effusion but no significant edema.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent bilateral basilar mixed interstitial and airspace changes mildly greater on the right with small effusions also greater on the right. Unchanged mild nonspecific artery mainly

Output: Suspected mild edema superimposed upon chronic scarring and nodular opacities previously described. Overall no significant change


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Cough and pain evaluate for any worsening. CT chest on 3/27/2015 with right upper lobe consolidation treated with antibiotics. Subtle right upper lobe groundglass opacity persists, only visible in retrospect when compared CT and not visible on the lateral film.

Output: Persistent right upper lobe groundglass opacity. The lack of resolution and configuration on prior CT make it moderately suspicious for a primary pulmonary malignancy such as an adenocarcinoma. A voicemail was left for Kimberly Gottlieb regarding recommendation for further evaluation and for/10/2015 a 9:24 a.m.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: Hypoxia History: Hypoxia, tachypnea Enteric tube extends in fairly off the field-of-view. Mild pulmonary edema with patchy bibasilar opacities and small pleural effusions. Moderate cardiomegaly again noted. No pneumothorax. Large patient body habitus.

Output: Mild pulmonary edema with patchy bibasilar opacities and small pleural effusions; moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: sob History: evaluation of pulm edema There is now complete opacification left hemithorax. This can represent pleural effusion with atelectasis. In addition patchy opacity right lung base may represent pulmonary edema versus atelectasis. What necessary.

Output: Interval complete opacification of the left hemithorax


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: lung nodule History: s/p lung resection Right chest port tip in the SVC. Surgical clips in the soft tissues of the left neck. Small left pleural effusion with small air component, and left basilar atelectasis. No specific evidence of infection or edema.

Output: Interval decrease in left hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Neurofibromatosis.VIEWS: Chest AP/lateral (two views) 04/12/16 Mediastinal surgical clips are present. Soft tissue mass in the left neck and chest is larger in size. Mediastinal soft tissue mass is unchanged with tracheal displacement to the right. Cervical spine abnormalities are again seen with expansion of the spinal canal.Cardiothymic silhouette is normal. No focal lung opacity is present.

Output: Increase in size of left neck and chest plexiform neurofibroma.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: o2 req s/p surgery History: o2 req s/p surgery Cardiomegaly with mild interstitial opacities suggestive of edema. No large pleural effusions.Median sternotomy.

Output: Cardiomegaly and nonspecific interstitial opacities suggestive of mild edema.


Instruction: Generate impression based on medical findings.

Input: Assess for pneumonia Evaluation of the mediastinal structures and upper abdomen is limited by lack of intravascular contrast administration. This limits sensitivity for detection of soft tissue masses and lymph nodes.LUNGS AND PLEURA:There is an irregular left hilar mass with an area of central central cavitation causing mass effect and obstruction of the left upper lobe and lower lobe bronchi with postobstructive consolidation and volume loss. Given lack of intravascular contrast administration, it is difficult to delineate the exact dimensions of the mass and separate it from the postobstructive pneumonia/volume loss, however findings have markedly progressed since CT study of 6/28/09.Thin walled cyst in left upper lobe may be either postinfectious/postinflammatory, given that it wasn't present on prior study, or reflect additional areas of cavitation.There are multiple scattered lung nodules with a larger additional area consolidative groundglass in the left lower lobe on image 51 of series 3 measuring up to 1.5 cm in maximum dimension, suspicious for metastatic deposits or pneumonia. There is thickening of the interstitial septum on the left, raising the possibility of lymphangitic spread of carcinoma.There is a stable 6-mm nodule in the right lower lobe on image 43 of series 5 as well as scarring in the right upper lobe.MEDIASTINUM AND HILA: There are multiple hilar lymph nodes which are difficult to delineate from the normal mediastinal structure and the aforementioned left upper lobe mass secondary to lack of intravenous contrast.CHEST WALL: There are multiple lytic destructive lesions including permeative destructive lesion of the posterior right fourth rib with adjacent soft tissue, destructive lesion of the posterior lateral eighth right rib with adjacent soft tissue, lytic destructive lesion of the right scapula on coronal image 17 of series 80272, probable metastatic deposit to the left scapula on image 7 of series 3, lytic metastatic deposit to C7, T5, T7, T9 and T10 with vertebral bodies compression fractures and partial vertebral body height loss at T9 and T10 but no CT evidence of retropulsion into the spinal canal.There is a small left pleural effusion.UPPER ABDOMEN: There is extensive pneumobilia, likely post iatrogenic in etiology. Furthermore, there are multiple low-attenuation masses in the liver compatible with metastatic disease the liver, also demonstrated on recent MRI of 1/18/10. There is dilatation of the main pancreatic duct, also noted on prior study.

Output: 1.Increase in size of left hilar mass with associated post obstructive volume loss and consolidation/pneumonia as described above. Thickening of the interstitial septum on the left raises the possibility of lymphangitic spread of cancer. Multiple additional nodules in the left lung may reflect additional areas of infection or metastatic deposits.2.Extensive osseous metastatic disease to the spine, ribs, scapula with additional metastases to the liver as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: eval line/ETT placement History: post-AVR Interval extubation.Swan-Ganz catheter looped in the right main pulmonary artery, unchanged.Small lung volumes with basilar opacity compatible with atelectasis and effusions.No pneumothorax or other acute change.

Output: Swan-Ganz catheter looped in the right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and sepsis ETT has been repositioned, tip projects 3 cm above the carina. NG remains under advanced with side port seen at the GE junction. The 2 right jugular catheters and left subclavian ICD are all similar.Mild cardiomegaly with otherwise unchanged cardiopulmonary appearance.

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: 39 years, Male. Reason: Questional OG output concerning for feculent maternal vs bile+old blood History: Intubated + Sedated, ?OG Output Extremely limited both due to underpenetration secondary to body habitus, and portion of the right abdomen could also the field-of-view and the patient is approximately 45 degree right posterior oblique.Given that limitation I see no obvious dilated loops of bowel however there is a paucity of bowel gas. The patient's orogastric tube is not visible. I note that follow-up chest x-ray was done and not view of OG tube is incompletely visualized along the course in the proximal esophagus however its distal portion is not seen with certainty. Recommend a repeat view.

Output: Repeat view recommended. Findings communicated to Dr.Ninanbu, pager 4241.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: hypoxia in known rhf History: as above Cardiomegaly with small lung volumes and the suggestion of basilar edema.Left jugular catheter, tip in SVC.Stable pericardial drain.

Output: No change in cardiomegaly, small lung volumes with edema, or catheter positions.


Instruction: Generate impression based on medical findings.

Input: Male, 95 years old.Reason: r/o infection, edema, effusion History: weakness Clear lungs. Mild bilateral pleural thickening again noted. No pneumothorax. No acute bony abnormality. Normal heart size. Stigmata of previous granulomatous disease again noted. Cardiac leads, unchanged terminating expected location of the right atrial appendage and right ventricle.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: please evaluate lung fields in post transplant History: shortness of breath Interval chest tube removal with a trace left-sided pneumothorax. Left lung is better inflated.Right basilar fibrosis.

Output: Interval chest tube removal with a trace left-sided pneumothorax. Left lung is better inflated.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: sob History: sob ET tube, tip approximately 5 cm above the carina.Left IJ central venous catheter, tip in the SVC. Nasogastric tube extends below the lower margin of the image.Decreased lung volumes. Linear interstitial opacities, compatible atelectasis. No large pleural effusions.

Output: Low lung volumes and atelectasis. No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: s/p esophageal stent and IR drain History: hydropneumothorax Left-sided pigtail drain again noted. Other lines and tubes, also unchanged. The degree of gas within the loculated left hydropneumothorax has decreased from previous study. Unchanged left basilar opacity. No new focal opacity in the right lung. Unchanged heart size.

Output: Decreased size of pneumothorax component of left hydropneumothorax.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: MaleReason for Study: Reason: S/p CABG, AVR- eval chest History: as above ET tube is been removed.Chest/mediastinal tubes and Swan-Ganz catheter unchanged.Decreased lung volumes with stable cardiac enlargement.No new pulmonary opacities identified.Gaseous distention of the stomach is noted.

Output: Interval extubation. Stable cardiopulmonary appearance. Gaseous distention of the stomach .


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: increased sputum production and desaturations, concern for aspirating History: as above Interval extubation and removal of nasogastric tube.Lungs are hypoinflated. Patchy multifocal opacities are unchanged from prior may represent mild edema, aspiration or infection.

Output: Patchy multifocal opacities are unchanged from prior may represent mild edema, aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of ocular lymphoma CHEST:LUNGS AND PLEURA: Bilateral dependent atelectasis.MEDIASTINUM AND HILA: Patient's known present aortic region adenopathy is stable. No new adenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter benign hypodensity.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign bilateral simple cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Reference mesentery lymph node measures 17 x 12 mm on image number 129, series number 3, slightly enlarged compared to previous study. Another reference mesenteric lymph node measures 2.1 x 1.7 cm image no 150, series number 3, enlarged from previous study.. A third reference mesentery lymph node measures 5.2 x 3 .1-cm image number 142, series number 3, enlarged from previous study.Borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Please see discussion above.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: Interval increase in the size of the mesenteric lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Respiratory distress Cardiomediastinal silhouette is within normal limits. Moderate emphysema. Large lung volumes compatible with COPD. Dense retrocardiac opacity and lung base reticulonodular opacities, which appear progressed from CT chest 4 days ago.

Output: Dense retrocardiac opacity and lung base reticulonodular opacities suggestive of aspiration or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: eval for pathology History: chest pain 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: Right pleural effusion Enlarging right pleural fluid collection with probable loculation. Underlying patchy nonspecific airspace opacities greater on the right with extension into the right upper lobe. The appearance is not specific and although possibly partially atelectasis, an additional process such as infection must also be considered

Output: Enlarging right pleural effusion with increasing patchy nonspecific right hemithorax opacities


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval lung fields History: s/p AVR, MVR Leftward patient rotation. Lines and tubes are unchanged. Low lung volumes with bibasilar opacities again noted. No large pneumothorax.

Output: No substantial change.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: 85F with SOB, ?volume overload, ?pneumonia History: 85F with SOB, ?volume overload, ?pneumonia Right pleural effusion. The tip of the left PICC line projects over the SVC. No evidence of pneumothorax.

Output: Right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: PRE Lung or Heart-Lung Transplant Evaluation History: PRE Lung or Heart-Lung Transplant Severe upper lobe fibrosis consistent with known sarcoidosis.Heart size normal.No acute abnormality.

Output: Severe upper lobe predominant fibrosis consistent with known sarcoidosis and end stage lung disease.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Infection History: fever Left upper lobe focal opacity, and reticulonodular opacities elsewhere.Heart size normal.Left subclavian catheter tip at right atrial level.

Output: Reticulonodular opacities and focal consolidation left upper lobe suggestive of atypical pneumonia. A more recent CT has been performed.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: eval ETT placement History: AMS Endotracheal tube terminates 9 cm from the carina. Right IJ line terminates in the SVC. Lifevest device overlies the patient. Large right pneumothorax with leftward mediastinal shift and right inferior displacement of the hemidiaphragm highly worrisome for tension pneumothorax.

Output: Findings highly worrisome for right-sided tension pneumothorax. A chest tube has been placed in the interim.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: eval R pneumo History: as above Significant interval improvement in the right pneumothorax. Chest tube stable in position. No change in extensive bilateral pulmonary opacities with underlying effusions. Line position otherwise stable.

Output: Significant improvement in the right pneumothorax. No change in bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: Check lines/tubes/devices History: Chest lines/tubes/devices Interval removal of Swan-Ganz catheter and mediastinal drains.Persistent cardiomegaly with bilateral pulmonary opacity compatible with edema and small effusions.PICC line tip in the left axilla and chest tube at the right base.Subcutaneous emphysema on the left, unchanged or decreased.

Output: Interval removal of Swan-Ganz catheter and mediastinal drains with no other acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate lungs for infiltrate, edema History: post-op Small air collection adjacent to the left cardiac margin extending to the mediastinum, most likely pneumomediastinum.Minimal right pneumothorax with the apex of the lung a few millimeters from the chest wall.Small lung volumes with bilateral pleural effusions, greater on the right and underlying atelectasis.Relatively distended air-filled stomach.

Output: Pneumomediastinum and minimal right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: intubated History: intubated Adequate position of ET tube.The left IJ venous catheter overlies the descending aorta, unchanged in position and possibly within a persistent left SVC. Correlate with function.Cardiomegaly.No signs of pulmonary edema.Possible trace right pleural effusion. No pneumothorax.

Output: Adequate position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Signs of acute heart failure? History: PAH Low lung volumes makes detailed cardiopulmonary assessment difficult. Central venous catheter terminates within the superior aspect of the right atrium. Mild cardiomegaly again noted. Enlarged central pulmonary arteries again noted. Focal opacity in the upper left hemithorax again noted demonstrating incomplete borders suggestive of an extrapulmonary location.

Output: No new focal pleural parenchymal opacity. Massive pulmonary arterial enlargement consistent with pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p CABG History: S/P CABG Moderate cardiomegaly with an ICD lead in place, unchanged from previous.Moderate bilateral pleural effusions, greater on the left, with partial atelectasis and consolidation in the left lower lobe.Resolution of pneumopericardium.

Output: Pleural effusions and atelectasis, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Fever, history of HIV/AIDS. Evaluate for pneumonia. Cardiomediastinal silhouette is unchanged. Right lower lobe subsolid mass measuring up to 4.9 cm. No additional pulmonary opacities. No pleural effusions or pneumothorax.

Output: Right lower lobe subsolid mass is nonspecific. Further evaluation with CT may be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: ETT placement; assess interval change in lung fields History: ETT placement Improving left lower lobe airspace opacities, stable opacities elsewhere.Heart size normal.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Right upper quadrant pigtail drain.Right jugular catheter, tip in SVC.

Output: Improving left lower lobe opacity, with no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval line placement History: eval line placement ETT 4 cm above the carina. Enteric tube in the stomach, extending beyond the field-of-view. Interval placement of a right internal jugular central venous catheter, with its tip at the atriocaval junction.Stable cardiomediastinal silhouette.Continued interval increase in left upper lobe perihilar perihilar and bibasilar airspace opacities, consistent with edema or pneumonia.Interstitial septal thickening, consistent with interstitial pulmonary edema.No change in size of small bilateral pleural effusions with a loculated component on the right.No pneumothorax.

Output: Continued interval increase in bibasilar and left upper lobe airspace opacities, consistent with worsening pulmonary edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: aspiration pna History: PNA ET tube tip approximately 5 cm above the carina.Catheter tip in the SVC.Bilateral extensive air space opacity compatible with clinical diagnosis of aspiration pneumonia, not significantly changed from the previous radiograph.Small right pleural effusion.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: interval eval for swan placement` History: as above Cardiomegaly with moderate pulmonary opacities worse in the bases and new in the right upper lung zone.Presternal ICD unchanged.Right jugular Swan-Ganz catheter placed, the tip difficult to visualize but probably in the proximal right main pulmonary artery.

Output: Worsening pulmonary opacities, with a newly placed Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: pna? History: altered mental status Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable hiatus hernia, better appreciated on previous radiograph again noted. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Aortic atherosclerosis again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old. Nasogastric tube within gastric body.. Repeat chest x-ray is recommended if a central venous catheter was placed.

Output: NG tube within the stomach. Repeat chest x-ray for view of central venous line placement.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with lung cancer status post chemoradiation. CHEST:LUNGS AND PLEURA: Right paramediastinal and right upper lobe volume loss/atelectasis with architectural distortion, similar to prior, compatible with radiation fibrosis. Mild emphysema, unchanged. Scattered nonspecific micronodules, unchanged, likely represent intrapulmonary lymph nodes.Central airways debris now in the left mainstem bronchus.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Moderate coronary artery calcifications and small pericardial effusion/thickening, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Round hyperattenuating lesion in the left hepatic lobe, similar on priors, likely represents hemangioma. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative disk disease thoracic spine.OTHER: Moderate vascular calcifications of the abdominal aorta.

Output: Stable post-radiation findings with no measurable disease.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: hx of CHF, b/l LE edema, CHF exacerbation? History: see above Moderate cardiomegaly. Unchanged pulmonary opacities suggestive of edema.Left subclavian ICD, leads unchanged in position.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary opacities suggestive of edema, aspiration also in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: 65-year-old with metastatic rectal cancer on chemotherapy. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules are evident which are new and/or larger when compared to the prior examination. A left lower lobe reference lesion measures 1.8 x 1.4 cm on axial image 105/122 compared to 6 x 6 mm on the prior examination.Severe diffuse emphysematous changes. No pleural fluid.MEDIASTINUM AND HILA: Mildly prominent precarinal lymph nodes are noted. No evidence of hilar lymphadenopathy.CHEST WALL: A focus of pleural soft tissue density with adjacent bony destruction of the rib on axial image 36/122 may represent metastatic disease. Right chest wall port catheter in place.ABDOMEN:LIVER, BILIARY TRACT: Innumerable metastatic foci are evident in both lobes. A segment 6 reference lesion measures 1.5 x 1.1 cm on axial image 124/224.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No evidence of mesenteric or retroperitoneal lymphadenopathy. Atherosclerotic disease affects the aorta.BOWEL, MESENTERY: No evidence of ascites.BONES, SOFT TISSUES: See below.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: A right perirectal soft tissue mass measures 2.8 x 3.3 cm on axial image 197/224. This lesion is not clearly identifiable on the prior examination.BOWEL, MESENTERY: A large mass is evident within the cul-de-sac which is inseparable from the rectal wall with loss of the normal fat plane between the prostatic bed compatible with the patient's stated history of rectal cancer.BONES, SOFT TISSUES: A sclerotic focus evident in the right sacral wing on axial image 172/224 may represent metastatic disease.OTHER: No significant abnormality noted

Output: Large rectal mass with evidence of local invasion and distant metastases to the lungs, liver and possibly the bone.


Instruction: Generate impression based on medical findings.

Input: 37-year-old left male with chest pain radiating to back. Low lung volumes. Cardiomediastinal silhouette within normal limits.No acute focal airspace opacity.No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: IABP placement History: n/a Cardiomegaly, with left basilar subsegmental atelectasis, unchanged.Left subclavian ICD, leads unchanged in position. IABP catheter proximal marker 7 cm below the top of the aortic arch, significantly lower than before.

Output: IABP catheter reposition, the proximal marker now only 7 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Respiratory distress Stable cardiomediastinal silhouette with tortuous aorta.Mild atelectasis of the left lower lung zone.No pleural fluid collections or pneumothorax.Areas of skeletal sclerosis again noted, nonspecific finding which may be related to known leukemia.

Output: Mild left lower lung zone atelectasis.


Instruction: Generate impression based on medical findings.

Input: Dyspnea on exertion Interval clearance of previously observed patchy opacities greater both bases. Lungs are currently clear.Cardiac and mediastinal contours are within limits

Output: Interval resolution of previously observed nonspecific opacities, suspected resolution of prior suspected infection


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old. Reason: eval shunt placement and check for kinks, disconnects, and valve History: hydrocephalus SHUNT DEVICE: There is an intracranial shunt that exits the skull via a right-sided burr hole and courses down the right scalp, neck, and chest wall, presumably entering the peritoneal cavity with its tip overlying the right iliac wing. Portions of the shunt device within the head are not well seen due to overlying skull, but we see no specific radiographic evidence of shunt complication.SKULL: There are skin staples in the scalp with mesh material overlying the occiput.CERVICAL SPINE: Single view of the cervical spine is unremarkable.CHEST: The lungs are underinflated.ABDOMEN: There is gaseous distention of the stomach and multiple loops of bowel, perhaps reflecting ileus.

Output: Limited study showing a VP shunt as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: ETT advanced 3 cm. Please re-eval position History: ETT advanced Heart size upper normal.Unchanged right pleural effusion. Stable retrocardiac opacity suggestive of infection or aspiration.Both jugular catheters terminate at the cavoatrial junction region.ET tube tip approximately 3 cm above the carina.Gastrostomy tube noted.

Output: ET tube advanced, the tip 3 cm above the carina. Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: evaluate ET tube placement History: ET tube advanced The endotracheal tube tip terminates at 5 cm above the carina. Right chest wall port in the superior vena cava. Enteric tube tip in the stomach.Lower lung zone edema-like opacities and moderate pleural effusions are unchanged.

Output: Adjustment of endotracheal tube. Pulmonary edema with persistent pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: r/o cardiopulmonary abnormality History: chest pain Low lung volumes. Mild basilar atelectasis. Mild-to-moderate cardiomegaly given low lung volumes. Prominent azygos vein. No large pleural effusion or pneumothorax.

Output: No focal lung consolidation with mild to moderate cardiomegaly. Prominent azygos vein suggesting elevated right-sided cardiac pressure.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with chest pain and cough. Evaluate for infection, edema, pleural effusion. Heart size upper limit of normal without mediastinal widening. Mild bibasilar interstitial opacities may represent mild edema. Blunting of the left costophrenic angle which may represent small pleural effusion/scarring. No pneumothorax. Right upper quadrant tube clips noted.

Output: Bibasilar interstitial opacities may represent mild edema.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Presence of PNA or atelectasis History: POD#3 febrile and desats overnight Mild basilar scarring or subsegmental atelectasis.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: Nonspecific basilar scarring or subsegmental atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Presenting with persistent shortness of breath with congestive heart failure status post diuresis, evaluate. Mild cardiomegaly appears improved as compared to prior exam. Calcified perihilar lymph nodes appear unchanged. There is interval resolution of bilateral pleural effusions with interval improvement in pulmonary edema. No focal airspace opacities are identified. No pneumothorax is present.

Output: Interval resolution of bilateral pleural effusions and improvement in pulmonary edema and cardiac size.


Instruction: Generate impression based on medical findings.

Input: 61 years old Male. Reason: rule out pneumonia History: shortness of breath and cough. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Linear atelectasis is noted in the bilateral lower lungs. There is no evidence of pneumothorax or pleural effusion.

Output: Cardiomegaly and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: eval ETT, lung fields History: s/p LVAD exchange Was status post redo sternotomy, with a surgical wound open.Surgical drains overlie the region, as well as multiple surgical sponges in the field and surrounding the heart.LVAD replace, now with a Heartware version.Increasing edema like opacities.Presternal ICD now displaced leftward with the open sternotomy wound.Right jugular Swan-Ganz catheter, tip directed towards the right interlobar pulmonary artery.ET tube tip approximately 4 cm above the carina.

Output: ET tube tip approximately 4 cm above the carina. Open sternotomy with surgical drains and sponges. Increased edema following LVAD replacement.


Instruction: Generate impression based on medical findings.

Input: 75 year-old female with esophageal cancer status post partial chemotherapy and radiation treatment. Patient is not a surgical candidate secondary to poor nutrition and performance status. Evaluate status of cancer. CHEST:LUNGS AND PLEURA: Interval resolution of nodular opacity previously seen in the right middle lobe. Small left pleural effusion. Interstitial thickening with a reticular pattern in the basilar aspect of the left lower lobe with traction bronchiectasis consistent with radiation related changes.MEDIASTINUM AND HILA: Diffuse esophageal wall thickening which measures 1.6 cm as seen on image 75/146. The thickening extends to the proximal stomach past the GE junction and involves the wall of the stomach in the lesser curvature as seen on image 84/146. The reference pretracheal lymph node is stable in size and measures 1.5 x 1 cm in size as seen on image 43/146 (previously 1.6 x 1 cm). Multiple hypoattenuating lesions within the thyroid are stable. CHEST WALL: Sclerotic changes in the spine are suspicious for diffuse metastases. Correlation with bone scan is recommended.ABDOMEN:LIVER, BILIARY TRACT: Interval development of ascites. Multiple subcentimeter hypodense lesions are reidentified and are stable in appearance. Cholelithiasis without evidence of cholecystitis. No evidence of intrahepatic or extrahepatic ductal dilatation.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS: Left renal artery calcifications are noted.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged para-aortic lymph node which measures 2.4 x 1.1 cm as seen on image 101/146.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Hyperdense nodule and air foci in the lower abdomen as seen on image 141/146 which is most likely secondary from subcutaneous injection.

Output: 1. Thickened distal esophagus with extension into the proximal GE junction with involvement of the stomach wall in the lesser curvature suspicious for extension of tumor into the stomach.2. Sclerotic changes in the spine which may represent metastases. Correlation with bone scan or PET is recommended.3. Interval enlargement of para-aortic lymph node in the upper abdomen and development of ascites.


Instruction: Generate impression based on medical findings.

Input: 73 year-old female with resected lung cancer. Restage. CHEST:LUNGS AND PLEURA: Mild to moderate centrilobular emphysema. Areas of interstitial prominence and some groundglass appearance but with no mass or nodules. The nodule seen in the right major fissure on the prior exam is no longer present. No effusions. Expected decreased volume left lung.MEDIASTINUM AND HILA: Cardiomegaly. Atherosclerotic calcifications aorta. Small middle mediastinal nodes. Pretracheal node seen on image 30/201 measures 10 x 10.7 mm, unchanged.CHEST WALL: A fractures left ribs consistent with prior thoracotomy.ABDOMEN: Not sensitive for detecting lesions in solid organs due to lack of intravenous contrast.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: Right upper pole renal cyst unchanged. Left upper pole renal cyst unchanged.RETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic calcification. No aneurysm. No pathologic size nodes.BOWEL, MESENTERY: Scattered colonic diverticulosis. Otherwise normal.BONES, SOFT TISSUES: Scoliosis and degenerative changes. No lytic or blastic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive colonic diverticulosis. No evidence of ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No definite evidence of metastatic disease. Numerous findings as above.


Instruction: Generate impression based on medical findings.

Input: Reason: edema History: sob, chf Moderate cardiomegaly and bilateral small-to-moderate pleural effusions, greater on the right.Underlying interstitial opacity suggestive of edema, new from previous.Focal airspace opacity in the right middle lobe and right lower lobe and to a lesser extent in the left lower lobe, increased since the previous radiograph and better characterized on CT scan.This airspace process is not typical of edema and the differential diagnosis includes recurrent aspiration and mucinous adenocarcinoma.

Output: 1. Findings suggestive of CHF.2. Underlying airspace opacities that have progressed over the past 6 months suggestive of a separate process such as recurrent aspiration or mucinous adenocarcinoma. Further follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Dyspnea. Question infection or aspiration. Dobbhoff tube tip off the caudal margin of the film. Large layering pleural fluid collections with associated atelectasis, new from prior study.

Output: Interval development of large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Left first rib resection check for pneumohemothorax. Postop pain. Small left pleural fluid collection which appears partially loculated near the left first rib resection site which could reflect a small superimposed pleural or extrapleural hematoma. Surgical drain and subcutaneous emphysema thoracic inlet.Improved lung volumes with diffuse faint opacity suggestive of edema. Left basal consolidation disproportionate to volume or fluid, correlate for signs of infection.

Output: No pneumothorax. Persistent left pleural fluid collection nonspecific with area of loculation near the resection site. Left basal consolidation; correlate for signs of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: dyspnea, h/o sarcoid History: dyspnea Gradual increase in basilar interstitial opacities without significant sized pleural effusions and a normal sized heart.Mild mediastinal and hilar lymphadenopathy noted.

Output: Increasing basilar predominant interstitial opacities more likely chronic than edema as the heart size is normal and there are no significant pleural effusions. While mediastinal and hilar lymphadenopathies is consistent with sarcoidosis, another form of interstitial lung disease is possible and could be best evaluated by ILD CT.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Elevated WBC. Evaluate for pneumonia. Patient with history of penile cancer. New left lower lobe and lingular consolidation. No pleural effusions or pneumothorax. There is small left pleural effusion which possibly tracks into the left major fissure. There is a nodular opacity with superimposing ECG lead in the left upper lobe.Mediastinal silhouette is normal. Cardiac silhouette is obscured by the lingular opacity. Tortuous aorta again noted. Postoperative changes of median sternotomy

Output: New left lower lobe, left upper lobe, and lingular opacity. In view of clinical history, differential considerations include metastatic disease versus infection. Further evaluation with CT scan is recommended if no resolution after treatment on follow-up radiograph.


Instruction: Generate impression based on medical findings.

Input: 37 -year-old female with history of rectal cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes involving the pelvis and sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable postsurgical changes without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Give mild differences in technique and mildly decreased lung volumes, no cardiopulmonary abnormalityCholecystectomy clips

Output: Mildly decreased lung volumes without additional cardiopulmonary definite abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval for PNA History: SOB, O2 desat Left pacemaker and leads, unchanged.Heart size is normal. Tortuous and calcified aorta, unchanged.COPD with no acute pulmonary findings.

Output: COPD with no acute cardiopulmonary abnormality. Previously seen right upper lobe streaky density is not identified.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: ? infiltrate History: SOB and basilar rales. A left chest pacemaker has its tips unchanged in position. Evaluation of the lung parenchyma limited by overlying pulse generator.Peribronchial cuffing, interstitial and airspace opacities, septal thickening, and small bilateral pleural effusions are suggestive of pulmonary edema. Bilateral basilar opacities may represent atelectatic edematous lung, however infection is not excluded.

Output: CHF with nonspecific basal opacities.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with prostate carcinoma CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: Reference right hilar lymph node is unchanged, measuring 11 by 8mm image number 45, series number 21. Other small mediastinal lymph nodes are also unchanged.CHEST WALL: No change in scapular sclerotic metastatic focus. On the left side.ABDOMEN: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: Reference aortocaval lymph node measures 9 x 5 builder image number 190 groceries number 21. No significant change.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic foci involving multiple vertebral bodies, suspicious for metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cholecystectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable multifocal pelvic also is metastatic foci.OTHER: No significant abnormality noted

Output: Stable study with extensive metastatic bone lesions. Reference mediastinal and retroperitoneal lymph nodes are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.With end-stage renal disease on hemodialysis with Rales on exam. Please rule out edema versus effusion. No pleural effusion or pneumothorax. Mild cardiomegaly. Stable scarring or discoid atelectasis. No specific evidence of pulmonary edema.

Output: No pleural effusion or specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with metastatic renal cancer CHEST:LUNGS AND PLEURA: Referenced nodule in the right upper lobe measures 5 Billiter image number 25, series number 5, not significantly changed from previous study.Nonspecific patchy groundglass opacities in lung basesMEDIASTINUM AND HILA: Mylar small mediastinal lymph nodes are stable.CHEST WALL: Lytic lesions in bilateral ribs with associated pathologic fracture are stable.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes involving the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcutaneous nodule in the left lower quadrant is unchanged, measuring 12 x 10 mm image number 159, series number 3.Small lytic lesion of the spinous process of L3 is unchanged. Spinal fusion hardware and bone graft defect in the right iliac bone are unchanged.OTHER: 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: Please see discussion above.OTHER: No significant abnormality noted

Output: Stable study.


Instruction: Generate impression based on medical findings.

Input: 84 years old Male. Reason: Hypoxemia s/p arrest and fluid resuscitation History: Hypoxia, arrest. Right predominantly interstitial and airspace opacity suggest edema with fibrosis and superimposed infection or aspiration, unchanged. The tip of the NG tube projects over the distal portion of esophagus. The tip of the ET tube is about 4 cm above the carina. The tip of the left jugular catheter project over the left brachiocephalic vein. There is no evidence of pneumothorax.

Output: Tip of the NG tube in the distal portion of the esophagus.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of chronic lymphocytic lymphoma CHEST:LUNGS AND PLEURA: Index left lower lobe nodule is unchanged measuring 8 mm on image 62, series number 4. Left lower lobe subsegmental atelectasis.MEDIASTINUM AND HILA: Interval decrease in the size of the mediastinal lymph nodes. Index pretracheal lymph node measures 1.8 x 0.8 cm on image number 38, series number 3.Second index node in the anterior mediastinum measures 8 mm on image number 29, series number 3.CHEST WALL: Interval decrease in the size of the axillary lymph nodes. Index node in the left superior axilla measures 11 by 7 mm on image number 19, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Unremarkable.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Interval decrease in the size of the retroperitoneal lymph nodes. Index lymph node in the hepato- duodenal 3.4 x 1.2 cm in image number 102, series number 3. ligament measuresBOWEL, 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: Pelvic lymph nodes have decreased in size. Index left external iliac node measures 1.7 x 1 .1 cm lymph node on image number 179, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the CT CHEST ABDOMEN PELVIS W, 5/13/2011 9:55 AM CLINICAL INFORMATION:Clinical informationTECHNIQUE: TechniqueCOMPARISON: ComparisonFINDINGS:CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small hypodense lesions are unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out aspiration History: leukocytosis Large bilateral pleural effusions, increased compared to previous.Underlying opacity compatible with atelectasis. Some of the findings could be related to aspiration but are nonspecific.Catheter from the left arm with its tip in the area of the left axillary vein.Moderately dilated loops of bowel with air-fluid levels in the abdomen.

Output: Large pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Eval for worsening effusions History: Hypoxia Left upper extremity PICC terminates in the left subclavian vein. Right IJ catheter position is unchanged.Moderate left pleural effusion with basilar opacities unchanged. Right lower lung interstitial opacities are unchanged. No pneumothorax. Left upper lung suture material noted. The heart size is stable. Left axillary surgical clips.

Output: Unchanged pleural effusion and pulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Diffuse scattered subcentimeter nonspecific nodules in the right lower lobe adjacent to the fissure likely representing intrapulmonary lymph nodes.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 12-mm hypodense lesion in the left kidney, too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions involving thoracic and lumber vertebral body suspicious for metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right external iliac lymph node measuring 2.3 x 0.9 cm on image number 181, series number 3. There a few other borderline enlarged pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic bone metastases involving the left pubic and ischium as well as right iliac bone and sacrum..OTHER: No significant abnormality noted

Output: Small minimally complex hypodense lesion involving the left kidney. Follow-up imaging in one year is recommended.Punctate stone involving the right upper pole renal collecting system.Bone metastases as described above.Borderline enlarged pelvic lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: FemaleReason for Study: Reason: 41 yo F recurrent pneumothorax s/p CT placement History: 41 yo F recurrent pneumothorax s/p CT placement Right-sided chest tube unchanged.Dense of subcutaneous emphysema along the right lateral chest wall and right supraclavicular region again noted.No significant pneumothorax identified.Stable cardiomediastinal silhouette.Scattered areas of scarring/discoid atelectasis similar to the prior exam.

Output: Persistent subcutaneous emphysema along right lateral chest wall. No pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: desaturation, recent abdominal surgery The heart size is within normal limits. Unremarkable cardiomediastinal silhouette. Low lung volumes with superimposed bibasilar airspace opacities, suggestive of atelectasis or aspiration. No large pleural effusion or pneumothorax.Enteric tube tip likely above the gastroesophageal junction with its side-port in the distal third of the esophagus. Multiple surgical clips are present in the upper abdomen and left and right axilla.

Output: 1. Streaky bibasilar opacities, suggestive of subsegmental atelectasis or aspiration.2. Enteric tube tip above the gastroesophageal junction.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Intubation assess ETT placement. No endotracheal tube is identified. There is partial collapse of the left upper lobe with dependent atelectasis/consolidation. Atelectasis in the lingula is also worse. Moderate left and small right pleural fluid collections. IVC filter partially visualized.

Output: No endotracheal tube is identified. Worsening volume loss on the left.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Intubated. Malaise and fatigue. ETT 6 cm above the level of the carina. Nasogastric tube tip off the caudal margin of the film.Cardiomegaly and mediastinal widening unchanged. Enlargement central pulmonary vasculature. Coarse opacities in the left lung and right upper lobe suggestive of edema, slightly improved in the right lung base.

Output: Slightly improved pulmonary opacities. Cardiomegaly and mediastinal widening about the same


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Postop transplant, line placement, initial check. Left jugular catheter tip at the superior cavoatrial junction. No pneumothorax. Subsegmental atelectasis at the left base. Lung volumes remain low.

Output: Left jugular catheter tip at the superior cavoatrial junction, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: S/P AVR CABG Chest tubes out History: Cough Support devices are stable.The cardiomediastinal silhouette is enlarged but stable.There is mild basilar interstitial opacity, subsegmental bibasilar atelectasis and bilateral pleural effusions, right greater than left.

Output: No change in CHF pattern.


Instruction: Generate impression based on medical findings.

Input: 24 years old Male. Reason: eval for pneumonia. History: cough. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: r/o pulm infection History: leukocytosis The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Left chest tube inserted Left chest tube again projects to the level of the aortic arch and towards the midline. No appreciable associated pneumothorax. ICD, LVAD and left jugular catheter/Swan-Ganz are all otherwise unchanged.The cardiopulmonary appearance is also similar including nonspecific retrocardiac opacity, cardiomegaly and low lung volumes. Underlying partial consolidation left lower lobe again cannot be excluded

Output: Left chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: pulm edema? History: crackles on exam Interval removal of right IJ central venous catheter. Stably enlarged cardiac silhouette. Extensive calcifications of the thoracic aorta and arch vessels. Coronary artery calcifications again seen.There is minimal prominence of interstitial markings which may relate to an element of edema or most likely underpenetration due to patient's body habitus. No focal consolidation, sizable effusion or pneumothorax.No acute osseous abnormalities.

Output: 1.Cardiomegaly with minimal prominence of interstitial markings which may relate to an element of edema or most likely underpenetration due to patient's body habitus.2.Coronary artery calcifications suggesting significant coronary artery disease.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Eval Pulmonary edema History: Wheezing Moderate cardiomegaly, unchanged.Low lung volumes without focal pulmonary consolidation, pleural effusion, or pneumothorax.Single lead presternal ICD.

Output: Cardiomegaly without acute superimposed abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: r/o mets History: testicular cancer Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 40-year-old female with dyspnea on exertion. Evaluate for pulmonary edema. Cardiomediastinal silhouette within normal limits.Left retrocardiac bandlike atelectasis. No other acute focal airspace opacity.No pneumothorax or pleural effusion.Surgical clips in the right upper quadrant.

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


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: fever, hx of lung cancer History: fever Diffuse reticular abnormality again noted within the lungs. Fullness of the right hilum again noted. Normal heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography. Diffuse reticular abnormality and right hilar fullness again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: hx of CAP requiring Bipap would like ro r/o ARDS History: hypoxia Progressive, asymmetric left-sided airspace and interstitial opacities, rapidly progressed from prior. Considerations include interval aspiration, pulmonary edema or hemorrhage. Increasing small left pleural effusion. The right lung is relatively spared with only minimal opacities at the right mid zone and right costophrenic angle. The mediastinum is prominent which raises a question of lymphadenopathy. Further evaluation with a CT thorax is recommended.

Output: Increasing left-sided, asymmetric airspace and interstitial opacities with associated pleural effusion. Prominent mediastinum raises question of lymphadenopathy. Further evaluation with a CT thorax is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: post op afib surgery History: SOB Marked elevation of the right hemidiaphragm, suggestive of phrenic nerve paralysis, with overlying subsegmental atelectasis. The heart size about upper normal with a few faint septal lines at the left base and no other evidence of CHF.

Output: Marked elevation of the right hemidiaphragm and no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB Hx lung CA History: SOB Extensive opacity in the left hemithorax consistent with atelectasis, consolidation and bronchiectasis as shown on the CT scan performed the next day.Port catheter with tip in the SVC.No significant interval change.

Output: Extensive chronic abnormalities in the left hemithorax, better characterized on the CT scan performed the next day.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: r/o fx/ptx History: left arm pain Mild left basilar pleural-parenchymal scarring again noted. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Mild aortic tortuosity again noted.

Output: No acute cardiopulmonary process on radiography. No acute displaced fractures.


Instruction: Generate impression based on medical findings.

Input: Reason: post op, eval lung fields History: s/p CABG Interval removal of a left chest tube and right jugular catheter.Persistent volume loss and opacity in the left hemithorax consistent with atelectasis, consolidation and effusion.Small right pleural effusion.

Output: Interval chest tube removal with no significant residual pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: follow up on lung infection History: as above Large lung volumes consistent with COPD.Linear scarring unchanged.No specific evidence of infection or edema.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: intubated History: intubated Endotracheal tube tip approximately 3 cm above the carina. Enteric tube projects at the inferior margin of the image. Right central venous catheter tip in the SVC.Tortuous aorta. The heart size is upper limits of normal.Persistent bilateral effusions with basilar opacities. Right upper lobe opacity may be marginally increased versus 9/13/15 but similar to 9/12/2015.

Output: Endotracheal tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: pna v infiltrate History: SOB Interval progression of bilateral pleural effusions and pulmonary edema. Cardiac megaly again noted.Central venous line unchanged.

Output: Progression of bilateral pleural effusions and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: edema History: sob Median sternotomy for CABG, the heart size upper normal.No specific evidence of infection or failure.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.SOB status post TAVR. Left subclavian dual-chamber pacemaker. TAVR in expected position. Endotracheal tube tip about 4.5 cm above level of the carina. Right jugular introducer. Enteric tube looped in the stomach.Moderate to severe pulmonary opacities consistent with edema, pleural fluid and atelectasis. Nonspecific retrocardiac atelectasis/consolidation.No visible pneumothorax.

Output: Diffuse pulmonary opacities consistent with layering pleural fluid, edema and atelectasis. Dense opacity in the left lower lobe nonspecific and may be due to atelectatic lung from prior aspiration. This may be followed by chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Right-sided chest pain, sickle cell No specific interval new findings to support infection or new acute cardiopulmonary abnormality, however reidentified are multiple scattered and largely interstitial changes greater on the right and a perihilar distribution with cardiomegaly. Specifically the more focal peripheral right midlung opacity isn't minimized since the prior study, suggesting partial resolution of previously suspected infection.

Output: Interval partial resolving suspected right upper lobe focal opacity, concerning for infection versus infarct


Instruction: Generate impression based on medical findings.

Input: Reason: post op History: post op Chest tube extending to the right apex with no significant pneumothorax on the current examination.Mild atelectasis at the left base.No other significant change.

Output: Unremarkable postoperative chest.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Prekidney evaluation, end-stage renal disease, rule out cardiomegaly and pneumonia The cardiomediastinal silhouette is within normal limits.No evidence of infection, edema, or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p lobectomy, requiring HFNC Moderately large left pneumothorax with underlying large pleural effusion and atelectasis.Chest tube projected over the left base with the sidehole in the chest wall.Focal opacity at the right base consistent with atelectasis and consolidation, not significantly changed.

Output: Large left hydropneumothorax with interval increase in left lung atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old. Crosstable lateral view demonstrates a left-sided chest tube in place with its tip at the apex.Small anteriorly located left-sided pneumothorax identified.No expected radiopaque foreign objects identified.

Output: Postoperative chest with left-sided chest tube in place. Small anterior pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old. SOB, cough. Evaluate for CHF. Right PICC tip in the SVC.Normal cardiomediastinal silhouette.Small left pleural effusion with overlying atelectasis, unchanged. No evidence of pulmonary edema.

Output: Small left pleural effusion with underlying atelectasis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: tachycardia- sinus History: no other symptoms at this time Linear scarring or atelectasis at left base.

Output: Linear scarring or atelectasis at left base.


Instruction: Generate impression based on medical findings.

Input: Ventriculoperitoneal shunt.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 04/07/16 Ventriculostomy tube tip is to the right of the midline in the middle cranial fossa. The distal tubing courses along the right head, neck, and chest. The tubing enters the peritoneum in the epigastrium and coils upon itself in the right upper quadrant. No discontinuity is identified. There is posterior plagiocephaly. Right thoracolumbar curve is noted. Lumbosacral spinal dysraphism is again seen. Surgical clips are noted in the right lower quadrant. Cerclage wires are present at the symphysis pubis. There appears to be an ascending colonic enema catheter. A moderate amount of feces is noted in the colon.

Output: Unchanged configuration of the peritoneal component of the ventriculoperitoneal shunt catheter is suggestive of shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Multiple neoplasms, most recently Hodgkin's lymphoma on chemotherapy with acute onset of chest pain and elevated d-dimer. History of lung cancer. PULMONARY ARTERIES: There are no filling defects in the pulmonary vascular to suggest pulmonary embolism.LUNGS AND PLEURA: Tree in bud opacities in the anterior right upper lobe are more prominent than on recent PET study of 4/16/10, even given difference in technique, and a most suggestive of infectious etiology/bronchopneumonia. Previously described ground glass opacity in the right upper lobe on image 99 and series 5 is stable in size measuring approximately 2.6 x 1.5 cm. Additional areas of groundglass in the right and left lungs are also grossly stable in appearance.Sutures in the right middle lobe and right lower lobe are compatible with prior wedge resection.2.2 x 1.4 cm lingular nodule is similar to prior study but does demonstrate hypermetabolism on recent PET study.There are small bilateral pleural effusions which are new.MEDIASTINUM AND HILA: 1.6 -cm nonspecific right thyroid nodule is unchanged. There are no enlarged mediastinal or axillary lymph nodes, though please refer to PET study of 4/16/10 for further evaluation as there are multiple hypermetabolic lymph nodes in the mediastinum. CHEST WALL: Chemotherapy port is present on the right. Lipoma in the left subscapularis muscle is unchanged. No vertebral body compression fractures evident.UPPER ABDOMEN: The spleen is enlarged.

Output: 1.No evidence of pulmonary embolism.2.Tree in bud opacities in the anterior right upper lobe are most suggestive of infectious etiology such as bronchopneumonia with atypical mycobacterial infection also possible.3.Multiple other areas of groundglass nodules are stable. Please refer to recent PET examination for further characterization of their metabolic activity.4.Splenomegaly, likely related to the patient's known lymphoma.5.Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated History: Daily CXR Interval removal of a Swan-Ganz catheter with the catheter sheath in the right jugular vein.ET tube tip approximately 5 cm above the carina.ICD leads and LVAD unchanged.Cardiomegaly with left lower lobe atelectasis/consolidation and small effusions, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: sp LVAD History: - Slight increase in retrocardiac opacity and pleural effusions. Mild cardiomegaly status post sternotomy.LVAD and ICD are unchanged.A Dobbhoff tube extends below the lower margin of the image.Tracheostomy tube tip approximately 6 above the carina.Right jugular catheter, tip at right atrial level.

Output: Slight increase in effusions and basilar opacities. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Recent intubation. Adequate position of ET tube overlying the mid trachea.The cardiac contours are partially obscured.Low lung volumes. Persistent mild elevation of the right hemidiaphragm and right basilar passive subsegmental atelectasis. No signs of pulmonary edema.No pneumothorax.

Output: Persistent low lung volumes and right basilar subsegmental atelectasis.Adequate position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Recent thoracotomy Persistent resolution of the right pneumothorax and an unchanged right chest tube with tip projected against the midline inferiorly. Persistent small suspected effusions with decreased lung volumes and basilar atelectasisMild cardiomegaly again cannot be excluded. Tortuous aorta and extensive atherosclerotic changes are observed. The mediastinal contours are difficult to discern given patient's extensive rotation

Output: Right chest tube unchanged with resolving underlying pneumothorax


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Right internal jugular triple lumen placement Interval placement of right internal jugular central venous catheter with the tip at the superior vena cava.ET tube tip is 3 cm above the carina. The seminal drain is unchanged.Cardiomediastinal silhouette is unchanged. Persistent airspace opacities. Left pleural effusion and retrocardiac atelectasis/consolidation. No pneumothorax.

Output: Right IJ catheter tip is at the superior vena cava.


Instruction: Generate impression based on medical findings.

Input: Right VATS procedure 2 right chest tubes again project towards the apex with mild change in position including the more medial catheter minimally retracted 5 cm.The cardiopulmonary appearance is otherwise essentially unchanged with moderate elevation of the right hemidiaphragm and decreased volumes. Basilar atelectasisOverlying right chest wall emphysema essentially unchanged

Output: Minimal repositioning of one of the 2 right chest tubes, as described


Instruction: Generate impression based on medical findings.

Input: 81-year-old female status post Whipple with bilious vomiting. Evaluate for SBO. CHEST:LUNG BASES: Bibasilar atelectasis/scarring with patchy areas of consolidation which may represent aspiration. ABDOMEN:LIVER, BILIARY TRACT: Heterogeneously enhancing liver with abnormal lesions. Pneumobilia is unchanged from prior study.SPLEEN: Hypoattenuating area in the spleen (series 4, image 34) is compatible with a splenic infarct.PANCREAS: Postoperative changes status post Whipple.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Interval occlusion of the SMA (series 4, image 53).Atherosclerotic disease of the aorta.BOWEL, MESENTERY: Nonobstructing incisional hernia (series 4, image 89) containing transverse colon. Foci of air in the mesentery appear to be intravascular in location. However, no abnormal bowel loops are identified. No evidence of obstruction or wall thickening.G-tube in expected location.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Bladder is decompressed around a Foley catheter.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Occlusion of the right femoral artery is also identified (series 4, image 120).

Output: 1. Bibasilar atelectasis/consolidation; consider aspiration.2. Interval occlusion of the SMA as above, likely secondary to embolus. No abnormal bowel loops identified.3. Right femoral artery occlusion as above.4. Incisional hernia in the midabdomen.5. Splenic infarctFindings were communicated to the ordering service by the overnight radiology resident on call via telephone and stat consult.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: eval lung fields History: ETT, inhalational injury Endotracheal tube terminates 4 cm above carina. Bilateral enteric tubes terminate inferior to the caudal margin of the image.Right greater than left infrahilar opacities of aspirated secretions. No interval consolidation, pleural effusion or pneumothorax. The cardia mediastinal silhouette is unremarkable.

Output: Right infrahilar opacities slightly increased, suggestive of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: ETT position History: as above ET tube with its tip 2 cm above the carina.Left central venous catheter and enteric tube unchanged.Stable cardiac mediastinal silhouette.Basilar opacities compatible with atelectasis and pleural effusions.

Output: Interval retraction of the ET tube with its tip now 2 cm above the carina. Mild interval increase in basilar atelectasis with associated pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Status post esophagectomy with chest tube. Right chest tube in place with no significant pneumothorax.Opacity on the right consistent with gastric interposition, pleural effusion and atelectasis.Atelectasis at the left base.. Exam limited by noninclusion of the left costophrenic angle.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Normal heart size with a tortuous aorta and moderate scoliosis.Vascular stent in the thoracoabdominal aorta.Sclerotic lesion in the head of the right clavicle with bone destruction, unchanged from previous, better characterized on recent CT scan.No evidence of lung metastases or other significant pulmonary abnormalities.

Output: 1.Suspicious destructive lesion in the head of the right clavicle better characterized on recent CT scan.2. No other evidence of metastases in the chest.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: eval lung fields History: s/p LVAD exchange ET tube has been removed.Left central venous catheter with its tip in the SVC.Left-sided ICD and LVAD unchanged.Stable cardiac enlargement.Perihilar basilar interstitial opacities compatible with edema.Air is identified underneath the right hemidiaphragm.

Output: Interval extubation. Mild increase in interstitial edema. Free air now identified underneath the right hemidiaphragm.


Instruction: Generate impression based on medical findings.

Input: Reason: uneven, breath sound, acute hypoxia History: as above ET tube and venous catheter unchanged.Bilateral lower lobe airspace opacities and small pleural effusions without significant change.A more recent radiograph has been interpreted.

Output: Lower lobe airspace opacities suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: post op History: SOB Cardiomegaly, with small pleural effusions improving on the right, and adjacent atelectasis.No new findings.

Output: Improving right pleural effusion with unchanged cardiomegaly and subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: s/p kidney transplant on 1/27/2016 History: desaturation Left internal jugular catheter tip at the junction of the left innominate vein and SVC.Stable enlargement of the cardiac silhouette and low lung volumes. New basilar-predominant air space opacities are consistent with acute pulmonary edema or aspiration.Right subphrenic free air is normal in the postoperative setting.

Output: Basilar predominant air space opacities are consistent with acute pulmonary edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: assess et tube placement History: intubated, sedated due to alpha 1 antitrypsin deficiency causing severe emphysema ET tube tip approximately 3 cm above the carina.Severe bullous disease in the right lung with adjacent atelectasis.Mild atelectasis at the left base.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old. Status post esophageal perforation. Evaluate stent placement. Esophageal stents, unchanged in position. Interval removal of left chest tube without significant pneumothorax. Right PICC tip in the axillary region.Small bilateral pleural effusions with underlying atelectasis, unchanged.

Output: Interval removal of left chest tube without significant pneumothorax. Pleural effusions and atelectasis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: chest tube placement s/p wedge resection History: chest tube placement s/p wedge resection Left apical chest tube noted. No definite pneumothorax. No focal lung consolidation.

Output: Left apical chest tube in place. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: PICC line placed Interval IVP marker removed. ICD unchanged. Left PICC line advanced, tip extends into the axillary and subclavian junctionMild cardiomegaly with improving overall aeration, specifically decreased anterior complete resolution of effusions and pulmonary edema

Output: Left PICC line placed


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: eval central PICC placement History: PICC line placed Left-sided PICC terminates in the inferior aspect of the SVC. 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, 70 years old.History of bladder cancer. Evaluate for metastatic disease. The cardiomediastinal silhouette is within normal limits. There are low lung volumes with left basilar subsegmental atelectasis. No focal airspace opacity, significant pleural effusion, or pneumothorax. No pulmonary nodule visualized.

Output: No acute cardiopulmonary abnormality or pulmonary nodule visualized.


Instruction: Generate impression based on medical findings.

Input: Reason: 30 y/o with leukocytosis, eval for infection History: epigastric pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: MaleReason for Study: Reason: eval lung fields History: eval lung fields Decreased lung volumes with moderate cardiac enlargement and evidence of pulmonary vascular redistribution.Perihilar opacities suggestive of edema.Moderate sized right pleural effusion with underlying atelectasis.

Output: Findings consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: evaluate s/p trach placement History: above Tracheostomy is in place. Lines and tubes are unchanged, otherwise. Slight increase in bibasilar opacities with probable small pleural effusions. Small left apical pneumothorax, as before. Unchanged heart size.

Output: Lines and tubes, as above.Slight increase in bibasilar opacities with probable small pleural effusions. Small left apical pneumothorax, as before.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Correct placement of PICC line History: N/A Left-sided PICC terminates in the SVC. Mild bibasilar subsegmental atelectasis or scarring. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Mild cardiomegaly.

Output: No acute cardiopulmonary process on radiography. Left-sided PICC terminates in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male; 40 years. Reason: Stage IV colon cancer please assess prior to start of chemo please provide bi-dimensional measurements History: none CHEST:LUNGS AND PLEURA: Few pulmonary micronodules and nodules, bilaterally some of which are suspicious. The largest in the right lower lobe (series 5 image 66) measures 0.8 x 1.2 cm. Somewhat spiculated lesion in the right upper lobe (series 5 image 38) may represent primary or a metastatic lesion. Emphysema.MEDIASTINUM AND HILA: Mediastinal and hilar adenopathy. A right paratracheal lymph node (series 3 image 27) measures 2.2 x 2.4 cm. Right cardiophrenic lymphadenopathy with reference node (series 3 image 65) measuring 1.1 x 2.2 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse metastatic capsular implants in the right hepatic lobe. A reference lesion (series 3 image 97) measures 1.9 x 4.9 cm.Cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Portacaval, peripancreatic, and retroperitoneal lymphadenopathy. Reference gastrohepatic lymph node (series 3, image 90), measures 2.2 x 2.6 cm.BOWEL, MESENTERY: Scattered mesenteric and omental metastatic implants with reference lesion (series 3, image 117) measuring 1.7 x 2.3 cm.Focal circumferential thickening of the right colon (series 3 image 134) with surrounding inflammatory changes, soft tissue masses, and lymphadenopathy, consistent with primary colonic neoplasm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Pelvic and inguinal lymphadenopathy with left inguinal lymph node (series 3 image 178) measuring 1.7 x 2.5 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Right colon malignancy with advanced regional disease and metastatic disease as detailed above.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Shortness of breath rule out infiltrate. Severe emphysema. Normal heart size. No pneumothorax. No specific signs of pulmonary edema. Scattered pulmonary nodules were described on a recent CT.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Eval for infection, edema, effusions History: AMS Cardiomegaly with mild pulmonary edema unchanged.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.Left subclavian ICD lead stable.Right PICC, tip in SVC.

Output: Cardiomegaly with mild edema but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old Reason: 59F with COPD, p/w increasing sputum, ?infiltrate History: 59F with COPD, p/w increasing sputum, ?infiltrate No focal air space opacities to suggest infection.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is normal.

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


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with esophageal cancer CHEST:LUNGS AND PLEURA: Subcentimeter subpleural pulmonary nodule left lower lobe (series 5; image 64), unchanged. Mild dependent atelectasis/scarring.MEDIASTINUM AND HILA: Paraesophageal lymph node measures 15 x 14 mm (series 3; image 48 was prior, previously 18 x 12 mm. Morphologically normal paratracheal lymph node measures 7 mm in short axis, not significantly changed.Hypodense right thyroid nodules. Coronary calcifications are seen.Stable trace chronic right lower lobe pulmonary embolism (series 3; image 45).An esophageal stent extends from the lower esophagus into the stomach, not significantly changed. Persistent esophageal wall thickening is identified.CHEST WALL: The right-sided port terminates in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: 6-mm hypodensity in the posterolateral right lobe, continues to decrease in size (series 3; image 101), previously measuring 8 mm. The other previously described metastatic foci cannot be resolved.SPLEEN: No significant abnormality noteddPANCREAS: No significant abnormality noteddADRENAL GLANDS: No significant abnormality noteddKIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: A small gastrohepatic lymph nodes remain.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: No significant abnormality noteddBONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd

Output: Continued decrease in the hepatic metastatic foci, with only one able to be discretely resolved on this exam. Otherwise, stable examination.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pulmonary edema History: rales on exam, Afib w/ RVR Heart size upper normal with an moderately tortuous aorta.No specific evidence of pulmonary edema or pneumonia.Status post left mastectomy with surgical clips in the left axilla.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Fever No definitive cardiopulmonary abnormality. Right jugular dialysis catheter extends into the proximal cc

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: chest pain, eval for pNA, HX of sickle cell History: see Heart size upper normal.No significant pulmonary or pleural abnormality.No evidence of infection or infarction.Cholelithiasis.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with recurrent low-grade endometrial stromal sarcoma admitted with anemia after radiation therapy. Loose stools. CHEST:LUNGS AND PLEURA: Calcified right upper lobe granuloma.MEDIASTINUM AND HILA: Calcified right hilar lymph node. Small subcarinal lymph node is unchanged.Coronary artery calcifications. Moderate cardiomegaly.Stable hypodense left thyroid nodule.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mild periportal edema is seen. A peripheral, wedge-shaped hypodensity has developed in segment 4 of the liver (series 3; image 80), possibly related to perfusion variation. A new, ill-defined hypodensity is seen near the dome of the liver (series 3; image 62), and could represent a metastatic lesion.A peritoneal lesion along the anterior margin of the liver has increased in size (series 3; image 96).Cholelithiasis is identifiedSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Sutures are identified in the region of the third portion of the duodenum. Small mesenteric lymph nodes are identified.BOWEL, MESENTERY: The right common iliac mass lesion has increased in size (series 3; image 133), measuring 7.1 x 5.5 cm, previously 4.8 x 3.4 cm. Numerous other abdominal peritoneal metastases, most in the left paracolic gutter have also greatly significantly increased in size.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A large peritoneal metastasis adjacent to the rectosigmoid colon (series 3; image 160) has greatly increased in size. Several other metastatic peritoneal lesions are now visualized, significantly enlarged.Hyperenhancing small bowel loops in the pelvis remain, suggestive of post radiation changes. Dilatation of two small bowel loops in the lower abdomen/pelvis are noted, mildly increased. However, oral contrast has progressed through this region.The rectum is thickened, which may be due to post radiation changes.Small ventral hernia containing a loop of small bowel without evidence of obstruction, not significantly changed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: Marked progression of metastatic disease, with questionable involvement of the dome of the liver.Persistent dilatation of two loops of small bowel in the pelvis, increased from the prior study. Contrast has traversed this region.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Hypoxia. Emesis with desats. Multiple ill-defined pulmonary nodular opacities have progressed since the prior examinations. Cardiomegaly again noted. Right subclavian line with tip over the SVC. Tracheostomy tube again noted.

Output: Multiple ill-defined pulmonary nodular opacities appear progressed from prior exams and could represent septic emboli or possibly metastases. Thoracic CT would be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: shortness of breath and chest pain History: Shortness of breath and chest pain Borderline interstitial edema.Heart size upper normal.No specific evidence of infection.

Output: Borderline pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: assess ng placement History: ng placement Nasogastric tube has been placed which is coiled in the stomach.Low lung volumes with basilar opacities of subsegmental atelectasis. No pneumothorax. The cardiomediastinal silhouette is unremarkable.

Output: Nasogastric tube is coiled in the stomach.


Instruction: Generate impression based on medical findings.

Input: Reason: Bilateral lung transplant with AKI, recieving fluid boluses, now with SOB and increased O2 requirment, eval for fluid overload/effusion History: SOB, chest is tight Diffuse pulmonary opacity compatible with edema with moderately large pleural effusions and underlying atelectasis.Probable moderate cardiomegaly.No new findings.

Output: Pulmonary edema, slightly increased in the upper lobes, and moderately large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PTX History: increased hypoxia Diffuse bilateral nonspecific interstitial opacity, not significantly changed from previous.Well-defined left perihilar air collection that may represent a pulmonary cyst or less likely loculated pneumothorax.Feeding tube tip in the stomach.

Output: Nonspecific interstitial opacity, with a differential diagnosis that includes pneumocystis infection, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: SOB, assess for PNA, edema History: see above Very low lung volumes which makes detailed pulmonary evaluation difficult. Unchanged port catheter. Patchy bibasilar opacities, likely atelectasis though superimposed consolidated lung cannot be excluded. No definite pleural effusion given low lung volumes. No pneumothorax. Heart size difficult to assess due to low lung volumes. Stent and clips noted within the mid abdomen. Nonspecific bowel gas pattern.

Output: Study limited by low lung volumes. Patchy bibasilar opacities which may represent atelectasis and/or consolidated lung. Repeat radiograph in full inspiration is suggested.