Instruction: Generate impression based on medical findings.

Input: 78-year-old male with metastatic prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Widespread metastatic bone lesions.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval increase in the widespread blastic metastatic bone lesions.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. Postsurgical changes in the pelvis.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval increase in the blastic metastatic lesions in the pelvis.OTHER: No significant abnormality noted

Output: Interval increase in the extent of the blastic metastatic disease in the pelvis.


Instruction: Generate impression based on medical findings.

Input: Reason: routine CXR for CT ICU post-op patient History: routine CXR for CT ICU post-op patient Interval removal of a Swan-Ganz catheter with the catheter sheaths in the area of the right brachiocephalic vein.Cardiomegaly with diffuse nonspecific airspace opacity suggestive of edema with probable small effusions.

Output: Interval removal of a Swan-Ganz catheter and no other acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Hypoxia, preoperative exam. Tube placement. Endotracheal tube tip 2 cm above the level of the carina. Diffuse opacity throughout the right hemithorax with compression and complete consolidation of the lung parenchyma, presumably due to pleural fluid. Hazy opacities in the left perihilar region nonspecific and may reflect edema, infection or aspiration.

Output: Right pleural effusion with diffuse atelectasis and consolidation throughout the right lung, correlate for possibility of mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Postthoracentesis Persistent large bilateral pleural effusions observed without superimposed focal post procedural complication. Underlying compression atelectasis.

Output: Large pleural effusions persist


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Device placement in EP lab. Left subclavian pacemaker is in place.Median sternotomy and skin staples noted.Stable cardiomediastinal silhouette, with mild cardiomegaly.Moderate bilateral pleural effusions and underlying bibasilar atelectasis, slightly increased on the rightNo pneumothorax.

Output: Pleural effusions and bibasilar atelectasis, slightly increased on the right. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with fever, neutropenia, elevated amylase, increased diarrhea and abdominal pain CHEST:LUNGS AND PLEURA: The lungs again demonstrate mosaic attenuation, compatible with small airways disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The right central line terminates at the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: Trace periportal edema is seen, unchanged. Sludge/stones are seen within the gallbladder. Trace perihepatic ascites.SPLEEN: No significant abnormality.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: Numerous loops of jejunum demonstrate wall thickening, not significantly changed. Haziness of the mesentery is compatible with inflammation/congestion. No intra-abdominal abscess is identified.Small fat containing periumbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Wall thickening involving numerous loops of jejunum, not significantly changed. Findings can represent graft versus host disease or infectious enteritis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: assess for focal consolidation, atelectasis Tracheostomy tube is in place. Diffuse pulmonary opacities consistent with edema are improved compared to the prior exam. Small pleural effusion. Heart size is normal. Surgical clips overlie the lower neck.

Output: Pulmonary opacities consistent with edema are mildly improved compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: PICC Line Placement History: none Partially imaged right PICC terminates in the right axilla. Interval removal of left PICC. No pleural effusion or pneumothorax. Unchanged cardiomegaly.Septal lines compatible with mild edema.

Output: Partially imaged right PICC terminates in the right axilla. Interval removal of left PICC.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: Rule out edema/infection History: chest pain, history of HbSS, remote Acute chest Stable mild cardiomegaly with cephalization of pulmonary vasculature. No pleural effusion or pneumothorax. No radiographic evidence of infection or edema. Vertebral body deformities are consistent with history of sickle cell disease.

Output: Mild cardiomegaly. No radiographic evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: increasing oxygen requirement, fluid resuscitation History: increasing oxygen requirement Increasing basilar opacities consistent with edema and atelectasis, with enlarging pleural effusions.An NG tube terminates in the stomach.

Output: Worsening basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: PNA? History: tachy, chills, cough Lower lung zone opacities consistent with edema as well as infection.Moderate size bilateral effusions are present left greater than right.The heart is partially obscured but does not appear significantly enlarged.Left subclavian catheter, tip in SVC.

Output: Basilar opacities suggestive of edema or infection, or both. Moderate-sized pleural effusions are present.


Instruction: Generate impression based on medical findings.

Input: Male 44 years old Reason: Patient s/p exchange of L IJ line; please evaluate for line placement, rule out pneumothorax History: As above Left subclavian ICD, lead position unchanged.New left internal jugular central venous catheter tip is difficult to see secondary to overlying AICD lead, but likely terminates in the SVC.Cardiomegaly unchanged.Mild basilar interstitial opacities persistent similar to prior.No pneumothorax.

Output: New left internal jugular central venous catheter tip, likely in the SVC, but difficult to see secondary to overlying AICD lead. No pneumothorax.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: 62 year-old female with metastatic adenocarcinoma of unknown primary. CHEST:LUNGS AND PLEURA: Severe emphysematous changes. 6 x 6 mm pulmonary nodule in the right lobe on image 15, series 4, unchanged.No pleural effusion is present.MEDIASTINUM AND HILA: The heart size is normal. The pulmonary arteries remain borderline enlarged. A right hilar lymph node measuring 15 x 11 mm, not significantly changed (series 3; image 47).Coronary calcifications are seen.CHEST WALL: Enlarged axillary lymph nodes have improved. A reference node measures 6 x 6 mm in the right axilla (series 3; image 17), previously 13 x 10 mm.ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar hepatic lesions are again demonstrated, the largest in the left lobe, mildly increased in size but not in number. The index lesion in the medial segment of the left lobe measures 3.3 x 2.5 cm (series 3; at 90), previously 2.6 x 2.0 cm.The liver is enlarged. The portal vein is dilated.Moderate biliary dilatation involves the lateral segment of the left lobe, unchanged. The left hepatic vein is narrowed not visualized in the periphery, also unchanged. The portal drain remains narrowed in the left lobe.SPLEEN: The spleen remains greatly enlarged with homogeneous enhancement.PANCREAS: No definite pancreatic lesion is identified.ADRENAL GLANDS: The left adrenal gland is nodular.KIDNEYS, URETERS: Small bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: Gastrohepatic, portacaval, porta hepatis and periaortic/portacaval adenopathy is again identified. The reference portacaval lymph node measures 26 x 13 mm (series 3; image 106), not significantly changed. The reference periaortic lymph node measures 24 x 23 mm (series 3; image 125), previously 23 x 21 mm. The reference gastrohepatic lymph node measures 18 x 17 mm (series 3; image 90), previously 15 x 14 mm.BOWEL, MESENTERY: BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal ascites, increased.Haziness and mild nodularity of the omentum is seen, not significantly changed, suspicious for carcinomatosis.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: An enlarged left external iliac chain lymph node at the groin measuring 23 x 11 mm (series 3; image 176), not changed. Another enlarged external iliac lymph node measures 1.9 x 1.5 cm (series 3; image 161, previously 1.8 x 1.4 cm).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 1.8 x 1.4 cm soft tissue metastatic lesion involves the superior aspect of the posterior sacrum on the right (series 3; image 148). In retrospect, it measured 8 x 7 mm, but did not have a soft tissue component.OTHER: Large amount of pelvic ascites, increased.Right common iliac artery stent. Stent extending from the left common artery to the external iliac artery.

Output: Mild increase in size of the hepatic lesions. Increase in size of the right sacral metastatic lesion. Stable metastatic adenopathy.Haziness and mild nodularity of the omentum suspicious for carcinomatosis, unchanged.Increased ascites.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: H/o renal mass eval for progression History: see above Cardiac silhouette is normal in size.Low lung volumes with no focal consolidation, sizable effusion or pneumothorax.No acute osseous abnormalities.

Output: No radiographic evidence of thoracic metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: tachypnea, acidosis, eval for worsening effusion History: sob Unchanged edema pattern with pleural effusions and moderate cardiomegaly.Right jugular catheter in the right atrium.

Output: Unchanged pleural effusions and pulmonary opacities consistent with edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval effusion History: sob Partial reaeration of the left upper lobe with residual atelectasis and effusion. A more recent radiograph has been interpreted.Cardiopulmonary monitoring and support devices, unchanged.

Output: Partial reexpansion of the left upper lobe.


Instruction: Generate impression based on medical findings.

Input: Reason: Swan interval change History: Swan placement Swan-Ganz catheter tip in the right main pulmonary artery.Cardiomegaly with bilateral opacities compatible with atelectasis and pleural effusion, greater on the right.

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


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: ICU survey; eval lines and lung fields History: esophageal perf s/p stent Iatrogenic devices are unchanged. Bibasilar opacities and pleural effusions, slightly increased. Improvement in subcutaneous emphysema. Small right apical pneumothorax, as before. Unchanged heart size.

Output: Slight worsening in bibasilar opacities and pleural effusions. Improvement in subcutaneous emphysema. Small right apical pneumothorax, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: s/p bronch, right lower lobe pleural based mass resection. Final path consistent with solitary fibrous tumor. Unchanged heart and mediastinal silhouette.Persistent left pleural effusion/scarring and left basilar atelectasis.No significant pneumothorax.Stable calcified nodule in the right upper lung zone.

Output: Persistent left pleural effusion/thickening and basilar atelectasis. No new pulmonary opacities or specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Liver masses. CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions are identified.MEDIASTINUM AND HILA: Incidental note is made of a aberrant right subclavian artery.Diffuse coronary calcifications are seen. The left atrium is enlarged. Calcific densities are seen at the atriocaval junction. A few calcified mediastinal lymph nodes are noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The left lobe of the liver is enlarged. An ill-defined hypodense lesion centered in segment 8 with apparent extension into segment 4 is identified, measuring 5.6 X 5.6 cm. adjacent capsular retraction is noted. There is regional decreased attenuation of the liver which may be due to irregular fatty infiltration and limits evaluation. Several other small hypodense lesions are noted in the right lobe in segment VII. Small esophageal varices are noted . Mild ascites.Cholecystectomy clips.SPLEEN: The spleen is prominent (14.6 cm)PANCREAS: The pancreas is somewhat atrophicADRENAL GLANDS: The adrenal glands are small in size.KIDNEYS, URETERS: The kidneys are small. A small simple cyst is identified in the midpole of the left kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Severe atherosclerotic disease. Degenerative changes noted throughout the spine.

Output: Limited study due to lack of IV contrast.Cirrhosis with signs of portal hypertension (mild ascites, splenomegaly, collateral vasculature). Large hypodense lesion in the liver-biopsy may be beneficial.Atrophic kidneys.Small bilateral pleural effusionsSevere atherosclerotic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: FemaleReason for Study: Reason: eval for infiltrate/hemorrhage History: h/o CF with hemoptysis Right Port-A-Cath with its tip in the SVC.Multiple embolization coils unchanged.Upper lobe predominant bronchiectasis and fibrosis consistent with cystic fibrosis similar in appearance to the prior exam.No new focal pulmonary opacities identified.G-tube in place.

Output: No interval change in the severe upper lobe bronchiectasis and fibrosis. No acute abnormalities identified. No specific evidence of acute or hemorrhage infection.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: worsening cough History: worsening cough No change in the presternal ICD.Stable cardiomegaly.Lungs are clear. No focal opacities.No pleural effusions. No pneumothorax.

Output: No acute cardiopulmonary abnormalities. No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of ILD, possible aspiration pneumonia. Evaluate for interval change. LUNGS AND PLEURA: Diffuse interstitial opacity, honeycombing, and traction bronchiectasis, similar to prior, consistent with history of idiopathic pulmonary fibrosis. New dense consolidation in the left base, suggestive of aspiration/infection.MEDIASTINUM AND HILA: Multiple mildly enlarged mediastinal lymph nodes, some with coarse calcifications, similar to prior.Severe coronary artery calcifications. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Evaluation of solid organs is limited by lack of intravenous and oral contrast. Cholelithiasis. Splenic granulomata. Small right adrenal calcification.

Output: 1) UIP-like ILD pattern, consistent with IPF diagnosis.2) New left basilar consolidation, consider aspirate or infection.


Instruction: Generate impression based on medical findings.

Input: 58 year-old male with stage IV metastatic melanoma CHEST:LUNGS AND PLEURA: Severe emphysema predominantly in the upper lobes is unchanged. A dominant mass at the left medial lung base measures 3.2 x 3.2 cm (series 5, image 67), previously measuring 4.3 x 4.1 cm. MEDIASTINUM AND HILA: Small hiatal hernia. Unchanged right thyroid nodule.A prominent right hilar lymph node (series 3, image 42) is unchanged.CHEST WALL: Left chest wall port with tip in the left brachiocephalic veinABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged right renal cyst.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter. Abdominal aortic atherosclerotic calcifications.BOWEL, MESENTERY: A soft tissue mass in the stomach lumen measures 7.9 x 6.1 cm in parentheses series 3, image 87), previously measuring 8.7 x 6.1 cm. Colonic diverticula without evidence of acute diverticulitis. Small, broad-based intra-abdominal wall hernia containing fat and small bowel, with no evidence of complication.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: 1. Slight decrease in size of left lung base mass.2. Slight decrease in size of gastric intraluminal mass.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: MaleReason for Study: Reason: SOB and chills x2 days; hx of asthma; assess for PNA History: SOB and chills The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Check ET tube ET tube tip approximately 7 cm above the carina. Enteric tube seen coursing below the diaphragm, but courses out of the field of view and the tip is not visualized.Small lung volumes with interval improvement in nonspecific basilar opacities.

Output: ET tube tip approximately 7 cm above the carina. Interval improvement in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval lung fields History: s/p CABG Unchanged chest tubes with no pneumothorax.Small lung volumes with edema and left basilar atelectasis unchanged.Right jugular introducer removed.

Output: No change in pulmonary opacities, and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: acute dyspnea History: acute dyspnea Chronic right hemidiaphragm elevation.No specific evidence of infection or edema.Heart size normal.Status post left chest wall resection and mastectomy.Tortuous brachiocephalic vessels and probable goiter.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Left jugular catheter tip in left jugular vein. No evidence of pneumothorax. Other findings, including previously described reticulonodular appearance of lung parenchyma, unchanged.

Output: Left jugular catheter tip in left jugular vein. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: fractured ribs History: pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.No displaced rib fractures.Bilateral nipple shadows projected over the lower lungs.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Check for metastatic disease. Ureter cancer No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Please evaluate for infection. Cardiac mediastinal silhouette is within normal limits. Right chest port terminates in the SVC. Increasing bilateral basilar atelectasis. No pleural effusion or pneumothorax.

Output: Increasing mild bilateral basilar atelectasis without other acute cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: pneumonia? History: shortness of breath The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: r/o pneumonia History: 61 yo with fever (now resolved), chills, myalgias and diffuse rales Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.Cervical spine stabilization hardware noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Evaluate volume status in intubated/sedated patient History: intubated and sedated Endotracheal tube terminates approximately 3 cm from the carina. Feeding tube appears to terminate within the jejunum. Diffuse pulmonary opacities, not substantially different. Unchanged cardiomegaly. No pneumothorax. Question of small left pleural effusion.

Output: Unchanged diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Fluid overload. Left subclavian ICD has been placed with proximal coil projecting over the SVC/artery, distal coil projecting over the RV, and leads overlying the right atrium and probably the coronary sinus.Hazy perihilar opacities most consistent with edema. Focal subsolid opacity projecting over the medial aspect of the right upper lobe could reflect acute atypical edema or infection.Aortic bioprosthetic valve.

Output: Mild CHF. Subsolid opacity in the right upper lobe could reflect infection in the appropriate clinical context.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: for VQ Scan History: DOE Prominent nodular-appearing hila, especially the right, consistent with lymphadenopathy or a pulmonary nodule inferior to the right hilum.Large lung volumes consistent with COPD.No specific evidence of infection or edema.

Output: Hilar lymphadenopathy, and nodular on the right versus an adjacent pulmonary nodule, suggestive of sarcoidosis but confirmation by CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: cardiac History: chest pain and SOB, NSTEMI No pleural effusion or pneumothorax. No focal pulmonary consolidation. No evidence of mediastinal widening, although the thoracic aorta is mildly tortuous.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with history of ovarian cancer status post chemotherapy and surgery. CHEST:LUNGS AND PLEURA: Resolution of previously seen pleural effusions. No pulmonary opacities are visualized.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart size is normal. No pericardial effusion. Aortic arch atherosclerotic calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. The portal system and hepatic vasculature are patent. The gallbladder is normal.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: Retroperitoneal surgical clips are visualized. A 5.5 x 4.0 cm lymphocele is visualized in the right lower pelvis (series 3, image 155) which previously measured 3.3 x 2.2 cm.BOWEL, MESENTERY: No peritoneal seeding or soft tissue lesions. The bowel is normal in appearance.BONES, SOFT TISSUES: Healing of surgical site in anterior abdominal wall with evidence of wound healing.OTHER: Resolution of previously seen ascites.PELVIS:UTERUS, ADNEXA: Status-post hysterectomy with post surgical changes.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Resolution of pleural effusions and ascites.2. Enlarged right cystic lesion, likely a lymphocele.3. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Stridor and respiratory distress.VIEWS: Chest right lateral decubitus/left lateral decubitus (two views) 03/13/15, 2035 and 2034 On the left lateral decubitus radiograph the narrowing of the trachea at the thoracic inlet is appreciated.No air trapping is identified. The hemidiaphragms move appropriately with decubitus positioning. Cardiac silhouette size is normal. No focal lung opacity is present.

Output: No air trapping. Probable granuloma or stenosis of the trachea at the thoracic inlet.


Instruction: Generate impression based on medical findings.

Input: Reason: Temp Pacer History: Temp Pacer Temporary pacemaker from the IVC extending to the area of the lateral wall of the right ventricle.Catheter tip in the SVC.Skin folds over the apices but no pneumothorax or other acute findings.Mild cardiomegaly and probable small pleural effusions.

Output: Pacemaker tip in the area of the right ventricle.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Endotracheal tube tip 3 cm from the carina. Left IJ catheter tip in the mid SVC. Dobbhoff tube coiled in the stomach, with tip inferior to the field-of-view.Extensive bilateral pulmonary opacities suggestive of edema with large effusions, not significantly changed.Stable cardiomediastinal silhouette.

Output: Edema and large pleural effusions not substantially changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old. Reason: pt NPO with h/o fistula, pneumonia? History: cough, sob The cardiomediastinal silhouette is within normal limits.Right basilar scarring, similar to prior. No focal airspace opacity. No pleural effusions. No significant pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p thoracentesis History: as above New left lower lobe atelectasis with volume loss.Minimal pleural effusions are present.Heart size normal.No significant pneumothorax.

Output: New left lower lobe atelectasis possibly from aspirated secretion to mucous plugging. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: Cough and wheezing for one week. The cardiomediastinal silhouette is normal. There is a slight rightward curve of the thoracic spine. There is no focal opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Eval for pneumothorax and or effusion History: S/P Chest tubes out Unchanged basilar atelectasis suggestive of aspirated secretions or mucous plugging.Small pleural effusions are present.No significant pneumothorax.

Output: Basilar atelectasis and pleural effusions. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Cough and fevers. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: CABG and mitral valve replacement Bilateral basilar and mediastinal chest tubes along with Swan-Ganz, bilateral jugular catheters, ETT and NGT are all unchangedMild cardiomegaly with diminishing edema-like changes in both bases demonstrate mild improvement

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Check IABP IABP marker projects 2 cm from the aortic arch. Motion degrades sensitivity.An additional catheter is partially and incompletely observed from the inferior approach projecting into the IVC and potentially within the hepatic vein. Please consider follow-up imaging given possible Swan-Ganz catheter.Decreased lung volumes without additional cardiopulmonary acute focal abnormality

Output: IABP marker well-positioned


Instruction: Generate impression based on medical findings.

Input: Reason: atelectasis vs. pulmonary congestion History: dyspnea Small lung volumes with bilateral opacity compatible with layering effusions and posterior atelectasis, greater at the lung bases.Right jugular catheter tip in right atrium.No new findings.

Output: Pleural effusions and atelectasis, unchanged allowing for markedly decreased pulmonary inflation


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: assess for pna, overload History: assess for pna, overload Mild hyperinflation of the lungs. Mild basilar atelectasis or scarring. Focal granuloma again noted within the right lung. Mild cardiomegaly with prominent central pulmonary arteries again noted. Atherosclerotic aorta, as before. Unchanged defibrillator lead. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: infiltrate History: cough Streaky basilar opacities of atelectasis and or scar. No pneumothorax or consolidation. The heart size is normal.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent hilar fullness and basilar changes suggesting atelectasis. No distinct new superimposed focal abnormality given semiupright positioning and mild motion artifact. Again nonspecific basilar opacities are suspected in cannot entirely be excluded. Consider serial imaging and/or dedicated two view imaging if patient can tolerate to improve sensitivity.

Output: Suspected nonspecific basilar opacities, see recommendation provided


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: acute chest syndrome History: shortness of breath, sickle cell crisis Cardiomegaly with pulmonary vascular congestion.Mild interstitial opacities could be chronic from prior views of occlusive events.No reliable evidence of acute infection or infarction.Right shoulder arthroplasty.

Output: Cardiomegaly. No reliable evidence of acute infection or infarction.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with history of right chest tube placement, evaluate for hemothorax and pneumothorax. Right chest tube positioned at the lung base with the side-port situated within the mid lower lung.Extensive right thorax, axillary, and neck subcutaneous emphysema.Interval decrease in right pleural effusion with stable left lower lobe subsegmental atelectasis.No evidence of pneumothorax.

Output: Improvement in right pleural effusion s/p chest tube placement. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 58 year old female with small cell lung cancer status post chemo/RT. Now needs disease evaluation. CHEST:LUNGS AND PLEURA: Volume loss and atelectasis at the right apex likely represents sequela of radiation therapy.Moderate right pleural effusion, increased since prior study from July 26, 2010.MEDIASTINUM AND HILA: Residual soft tissue density from previously noted right mediastinal mass continues to decrease in size, measuring 2.2 x 1 cm (series 3, image 32); previously measured 3.1 x 2.3 cm on study from 5/2008.Interval decrease in size of right hilar adenopathy, measuring 1.5 x 1.2 cm (series 3, image 36); previously measuring 2.3 x 1.7 cm on study from 5/2008. Heart size normal without a pericardial effusion. Moderate atherosclerotic calcifications involving the left circumflex and anterior descending arteries as well as the aortic annulus.Heterogeneous enhancement of the thyroid again noted.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Probable fatty liver. No focal hepatic lesions identified. Portal and hepatic vasculature are patent.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: Atherosclerotic calcifications involving the descending aorta and its branch vessels, including the iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Interval decrease in reference measurements. Moderate right pleural effusion, increased since prior study from July 2010.


Instruction: Generate impression based on medical findings.

Input: Age: 22 yearsGender: FemaleReason for Study: Reason: s/p PICC reposition. Please confirm placement History: s/p picc reposition Left PICC line has been repositioned with its tip now in the SVC.The cardiomediastinal silhouette is unremarkable.Increasing left retrocardiac consolidation/atelectasis and small left pleural effusion.Free peritoneal air slightly decreased.

Output: Interval repositioning of the left PICC line with its tip in the SVC. Small pneumoperitoneum and increasing left basilar atelectasis/consolidation with associated small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: r/o cardiopulm abnormality History: chest pain No pleural effusion or pneumothorax. No superimposed focal pulmonary opacity. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Rule out pneumothorax status post Swan, line removed. No pneumothorax. Large pleural effusions. Diffuse nonspecific interstitial and airspace opacities about the same.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Patient with abnormal finding on XRT, need chest x-ray to characterize History: cough, abnormal finding on CT No significant cardiopulmonary abnormality.No specific evidence of infection or edema.Very small right pleural effusion seen on the lateral view.Right jugular catheter, tip in SVC.

Output: Very small right pleural effusion, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: 71F with poor oxygenation postop History: hypoxia Right jugular catheter with tip in the SVC. Subsegmental right midlung and subsegmental left lower lobe atelectasis. No specific evidence of infection or edema. No pneumothorax or pleural effusion.

Output: Scattered subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Chest pain. Evaluate for an acute process. No focal lung opacity, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.Shunt tubing is identified traversing the right hemithorax and the right upper abdomen.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: FemaleReason for Study: Reason: ards History: ards ET tube with its tip 2 cm above the carina.NG tube with its tip in the stomach.Right central venous catheter with its tip in the SVC.Stable cardiac mediastinal silhouette.Basilar opacities compatible with pleural effusions and atelectasis similar to the prior exam.

Output: ET tube with its tip 2 cm above the carina. Stable cardiopulmonary appearance with pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Motion degrade sensitivity.Overall unchanged small pleural effusions with basilar opacities suggesting edema and/or atelectasis. Left subclavian ICD and right jugular catheters are unchanged, consider serial imaging

Output: Small unchanged pleural effusions with basilar suspected opacities, likely edema and atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.RFO Endotracheal tube tip approximately 3 cm above the carina. Dobbhoff tube with tip in the gastric antrum. Left ICD and leads, unchanged. ECMO cannulae unchanged. Right Swan-Ganz catheter with tip in main pulmonary artery, unchanged. Interval removal of one right chest tube with one right chest tube remaining. Two left chest tubes remain in place. Interval placement of mediastinal drain. Interval removal of sternal retracting device. New sternal closure devices and midline skin staples.No unexpected radiopaque foreign body.Bibasilar atelectasis. There may be a trace left apical pneumothorax.Cardiomegaly, unchanged. Aortic valve prosthesis faintly visualized.

Output: 1.No unexpected radiopaque foreign body. Discussed with Dr. Ota by phone at 11AM.2.Interval removal of sternal retracting device with new sternal closure devices.3.Possible trace left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.History: Cough, shortness of breath, fever. Stable bibasilar atelectasis/scarring.Stable cardiomediastinal silhouette.No focal pulmonary opacity, or pleural disease.

Output: No significant interval change, no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with metastatic renal cell carcinoma. Restage. CHEST:LUNGS AND PLEURA: Previously noted pleural-based and parenchymal bilateral metastatic nodules again noted. Reference medially-located, right lower lobe pleural-based lesion measures 1.3 x 2.0 cm (image 77; series 3), equivocally enlarged compared to previous. Loculated fluid at the right lung base. MEDIASTINUM AND HILAAgain noted mediastinal and bilateral hilar metastatic lymph nodes. Previously referenced subcarinal lymph node (image 53; series 3) appears to have enlarged slightly compared to previous and measures 4.3 x 2.9 cm. Small supraclavicular nodes are stable.CHEST WALL: No significant abnormality noted..ABDOMEN:LIVER, BILIARY TRACTStable bilobar hypoattenuating foci, likely representing benign hepatic cysts.. Hydropic appearing gallbladder.SPLEEN: No significant abnormality noted..PANCREAS: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: Stable right renal lesion (image 111), measuring 2.3 cm x 1.5 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No other significant abnormality noted..PELVIS: Evaluation of the pelvis is limited by streak artifact from patient's bilateral hip arthroplasties.PROSTATE, SEMINAL VESICLES: No significant abnormality noted..BLADDER: No significant abnormality noted..LYMPH NODES: No significant pelvic lymphadenopathy..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No other significant abnormality noted..

Output: Equivocal interval disease progression with measurements given above. Hydropic appearing gallbladder is new compared to prior.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.S.O.B. A peripherally inserted inserted venous catheter terminates at the right axillary/subclavian venous juncture.Moderate to large left and moderate right fluid collections, about the same. Left lower lobe is partially collapsed. Edema and atelectasis elsewhere similar to previous. Air space opacities in the right upper lobe appear slightly more pronounced and could represent pneumonia.

Output: Right upper lobe air space opacities may represent pneumonia. No acute change otherwise.


Instruction: Generate impression based on medical findings.

Input: 67 years old Male. Reason: pna? abd pain, prca History: abd pain. Interval near complete resolution of the consolidation in the left middle lung field. Residual streaky opacities are seen in the left upper lung with adjacent pleural thickening. There is a small left pleural effusion.

Output: Interval resolution of the consolidation in the left middle lung with residual streaky opacity consistent with resolving pneumonia. Left pleural effusion and pleural thickening, new as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: ET tube History: Intubated Pleural effusions, left lower lobe consolidation and the suggestion of lower lung zone edema are unchanged.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.

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


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: 80 M s/p PICC placement for home IV antibiotics History: PICC Left-sided PICC terminates within the axilla. No new focal lung consolidation. No pneumothorax or pleural effusion. Unchanged heart size.

Output: Left PICC terminates within the axilla.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: elevated WBC History: elevated WBC Persistent mild elevation of the right hemidiaphragm and right basilar discoid atelectasis. No new abnormal lung parenchymal opacities to suggest pneumonia.The pleural spaces are within normal limits.Cholecystectomy clips are noted.

Output: Persistent elevation of the right hemidiaphragm and adjacent right basilar subsegmental atelectasis. No radiographic findings to suggest pneumonia, considering the limitations of a single AP expiratory projection.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with history of gist tumor CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. Centrilobular opacities in the lingula and minimal bronchiectasis are stable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple, well-circumscribed, hypodense lesions scattered throughout the liver are stable in size and number. Deformity of the hepatic dome is unchanged with postsurgical changes.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney demonstrates mild atrophy and decrease in cortical thickness compared to the right side. Bilateral medullae are prominent and somewhat rounded in shape. Significance and etiology of this appearance is unknown. Correlation of this finding with renal function tests is recommended. No definite solid focal lesions are noted in the kidneys.RETROPERITONEUM, LYMPH NODES: Subtle increased density along the retroperitoneal vessels is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of chest or metastatic lesions.Prominent renal medulla, more prominent on the right compared to the left with rounded shapes. The etiology and significance of this finding is unknown and correlation of this finding with patient's renal function tests is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old. Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Cardiomediastinal silhouette is unremarkable.Right lower lung calcified granuloma and right hilar calcified lymph nodes.No additional focal pulmonary opacity, pleural effusion, or pneumothorax.Ventriculoperitoneal shunt courses down the right anterior chest wall.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: as above Interval removal of the Swan-Ganz catheter and feeding tube.Cardiomegaly and postoperative mediastinal widening unchanged.Bilateral pleural thickening or loculated effusions and basilar atelectasis.No pneumothorax or other acute change.

Output: Removal of Swan-Ganz catheter and feeding tube, and no other acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ards progression History: ards Slight improvement in inflation, but nonspecific opacities persist, left side predominant, with small pleural effusions.An NG tube terminates in the stomach, the side port at the hemidiaphragm level.Right jugular catheter, tip in SVC.Left jugular catheter, tipIn the left brachiocephalic just to the right of midline. ET tube tip approximately 3 cm above the carina.

Output: Improved inflation, otherwise no change in pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Age: 35 yearsGender: MaleReason for Study: Reason: Hypoxia to 90% on RA History: Hypoxia, fever The cardiomediastinal silhouette is unremarkable.Patchy left basilar subpleural opacity suggestive of infection or possibly infarction.No pleural effusions.

Output: Left basilar subpleural ill-defined opacity may represent infection or possible infarction. If clinically indicated a CT PE study may be of value.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: PICC line placement History: as above Left upper extremity PICC tip in the right atrium.The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: Left upper extremity PICC tip in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia, respiratory status History: respiratory distress Nonspecific airspace and interstitial opacity compatible with edema and possibly pneumonia, with pleural effusions. Venous catheters unchanged.

Output: Nonspecific pulmonary opacities, slightly improved over the past 2 days.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: new SOB, history of malignant pleural effusion-- concern for reaccumulation vs. Pna History: SOB Right pleural effusion and thickening unchanged.Prior right pleural drain removed.No new findings. Unremarkable left lung.

Output: Stable right pleural effusion or pleural thickening. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Diminished breath sounds left greater than right. Asthma presenting with SOB and cough. No pneumothorax. No focal airspace opacities or significant atelectasis.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 45 years old with line placement, post-surgical transplant Interval placement of a right IJ catheter with tip projecting over the SVC.Cardiomegaly without significant pleural effusions. No focal consolidation. No evidence of pneumothorax.

Output: Right IJ catheter with tip projecting over SVC and without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: Left subclavian line placement, evaluate. Left subclavian central venous catheter terminates in the junction of the left brachiocephalic vein with superior vena cava.Cardiac size is normal. Central pulmonary arteries are prominent, suggestive of pulmonary arterial hypertension, similar to the prior exam. New left lower lobe consolidation is identified. No pleural effusion or pneumothorax.

Output: Left subclavian central venous catheter terminates at the junction of the brachiocephalic vein and superior vena cava. New left lower lobe consolidation which may represent atelectasis and/or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: Eval cardiac History: above hypertension Borderline heart size. No acute cardiopulmonary abnormality.

Output: Borderline heart size. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Status post AVR evaluate lung fields POD #2. No pneumothorax. Mediastinal and pericardial drains unchanged in position. Decreased volume of pleural fluid on the right, on the left is similar to previous. Extensive basal atelectasis.

Output: Decreased volume of pleural fluid on the right.


Instruction: Generate impression based on medical findings.

Input: 62 year old male with abd pain, distension, and nausea/vomiting. Eval for ileus vs obstruction Lungs are clear. Cardiomediastinal silhouette is unremarkable.Average stool burden. Nonobstructive bowel gas pattern. No intramural or free air.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Thoracic aortic dissection repair pneumothorax status post tube thoracostomy. Near complete reexpansion of the right lung. Small residual pneumothorax near the lung apex post chest tube placement. Subcutaneous emphysema right chest wall likely iatrogenic. Other tubes and lines unchanged in position. Reexpansion of the right lower lobe with air space opacities diffusely. Air space opacities seen elsewhere similar to previous, with persistent left lower lobe consolidation. Decreased pneumopericardium.

Output: Interval placement of right chest tube with near complete reexpansion of the right lung. Diffuse pulmonary opacities suspicious for diffuse aspiration pneumonia. Acute atypical edema remains in the differential but is considered less likely based on the relatively static to worsening appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Tobacco use and asthma. Normal heart size. No pneumothorax or pleural fluid. Mild thickening of the left fissure on the lateral radiograph, nonspecific. No focal air space opacities. Mild bronchial wall thickening.

Output: Mild bronchial wall thickening consistent with asthma. Mild thickening of the fissure on the left, but otherwise no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: s/p thoracentesis today. Evaluate for pneumothorax or other acute changes History: Tachypnea Cardiac size is difficult to evaluate due to obscuring of the cardiac border. Moderate right pleural effusion with fluid tracking into the fissure is unchanged. Severe fibrotic changes of the bilateral lungs stable from prior study. No evidence of pneumothorax as clinically questioned.

Output: No evidence of pneumothorax as clinically questioned. Otherwise stable exam.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Status post MVR, TVR evaluate ETT and lung fields. ETT 5 cm above the expected level of the carina. Right jugular Swan-Ganz catheter tip projects over the right main pulmonary artery. Mediastinal drains in place.No pneumothorax. Moderate volume of pleural fluid bilaterally, left greater than right, with associated atelectasis. Chronic interstitial abnormality with superimposed mild pulmonary edema.

Output: Mild CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Hx of bladder cancer. Eval for mets History: As above The cardiomediastinal silhouette is normal.There are no focal pulmonary opacities, nodules, or pleural effusions.

Output: No evidence of metastatic disease on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: Assess status of pleural effusions. Pt has HFrEF, cardiomegaly, bilateral pleural effusions noted yesterday History: Shortness of breath, pitting edema to mid-thighs, history of asthma No change in effusions and pulmonary opacities. Stable cardiomegaly.No pneumothorax.

Output: No change in effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: chest pain post op History: left sided sudden onset chest pain Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax. Left nephrostomy tube is partially imaged.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.ETT. Low position of endotracheal tube, less than 1 cm above the level of the carina and directed over the right mainstem bronchus orifice.Cardiomegaly, pulmonary nodules and masses and edema-like abnormality are unchanged.

Output: ETT has been retracted but still remains low, directed just over the right mainstem bronchus orifice. Recommend repositioning.


Instruction: Generate impression based on medical findings.

Input: 72 year-old female past medical history colon cancer with midline lower anterior no abdominal wall lesion and history abdominal abscess. Off therapy. Evaluate status. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Port-A-Cath right chest wall.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: Clusters or retroperitoneal nodes approximately unchanged. Largest node left para-aortic area series 3 image 111 1.2 x 0.8 cm.BOWEL, MESENTERY: Marked decrease in size of intraperitoneal loculated collections. The collection underneath the right rectus muscle including an enhancing rim is seen on series 3 image 111 to measure 2.5 x 1 cm. The bowel is intrinsically normal. No ascites.BONES, SOFT TISSUES: Previously seen collection in the anterior abdominal wall is markedly decreased in size and difficult to measure. Residual hypodense component seen just to the left of midline on image 128 measures 1 x 0.6 cm.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue density to the right of midline in or beneath right rectus muscle on series 2 image 159 measures 1.9 x 1.4 cm. Previously, on 5/5 study image 119 it measured 1.2 x 1 cm.OTHER: No significant abnormality noted.

Output: Decrease in size of abdominal wall and intraperitoneal collections. Persistent adenopathy and some collections as measured above. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Evaluate Swan-Ganz catheter position. Interval adjustment of the IABP marker, now 4 cm below the expected level of the top of the aortic arch. Tubes and lines are otherwise unchanged. No acute pulmonary abnormality. Unchanged cardiomegaly.

Output: Interval adjustment of the IABP marker, now 4 cm below the level of the top of the aortic arch.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: fall, eval for fx, PTX History: fall Cardiomegaly with perihilar bronchial thickening, unchanged. No pneumothorax or visible fractures.

Output: Cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: FemaleReason for Study: Reason: f/u malignant effusion History: o2 requirement Left-sided Port-A-Cath with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Loculated right pleural effusion and right basilar consolidation/atelectasis.Mild left basilar interstitial opacities.Right axillary surgical clips and right mastectomy.

Output: Loculated right pleural effusion and right basilar consolidation/atelectasis compatible with history of malignant effusion.


Instruction: Generate impression based on medical findings.

Input: Check IABP The IABP marker remains projected in the aortic arch. ICD and underlying cardiopulmonary appearance is also similar with mild nonspecific patchy opacities in both bases and moderate to severe nonspecific cardiomegaly. Probable atelectasis

Output: Unchanged IABP


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: MaleReason for Study: Reason: fule out pneumonia History: fever, tachycardia, vomiting, AMS The cardiomediastinal silhouette is unremarkable.There are decreased lung volumes.Mild left basilar subsegmental atelectasis.No focal areas of consolidation.

Output: Mild left basilar subsegmental atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male with shortness of breath, decreasing oxygen saturation, clinical concern for sarcoid/CVD/ILD. LUNGS AND PLEURA: Bilateral, predominantly basilar groundglass and interstitial opacities with bronchiectasis and bronchiolectasis in the lung periphery are noted. No evidence of honeycombing. No evidence of airtrapping on expiration views.Calcified right upper lobe granuloma. No suspicious nodules or masses. No focal consolidation. No pleural fluid.MEDIASTINUM AND HILA: Prominent precarinal and subcarinal lymphoid tissue. Mildly prominent bilateral hilar lymphoid tissue. For reference, a right paratracheal lymph node measures 1.5 x 2.0 cm in image 21/109.CHEST WALL: Prominent axillary lymph nodes are noted.UPPER ABDOMEN: Prominent gastrohepatic and celiac lymph nodes of uncertain significance.

Output: Predominantly peripheral and basilar interstitial abnormality consisting of bronchiectasis/bronchiolectasis and groundglass opacity as described above. The pattern and distribution favors fibrotic NSIP, perhaps associated with collagen vascular disease. However, given the presence of lymphadenopathy, sarcoid may also be considered.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for cardiomegaly. History: lightheadedness Normal heart size with a tortuous aorta.Small pulmonary and hilar calcifications compatible with previous infection.No acute disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: pna History: as above NG has been advanced and extends beyond the field-of-view of study. HeRO catheter and tracheostomy tube unchanged.Slight increase in pleural effusions and basilar edema.

Output: Slight increase in pleural effusions and basilar edema.


Instruction: Generate impression based on medical findings.

Input: Age: 96 yearsGender: FemaleReason for Study: Reason: shortness of breath, wheezying History: shortness of breath Stable cardiomediastinal silhouette.Improved aeration in the left lower lobe.No new pulmonary opacities noted.Mild blunting of left costophrenic angle may represent scarring.

Output: Interval improvement in left basilar atelectasis. No acute abnormalities identified..


Instruction: Generate impression based on medical findings.

Input: 64-year-old male status post lung cancer and resection. History and M.A. I. Lung nodules or bronchiectasis?. LUNGS AND PLEURA: Postsurgical changes of left upper lobe resection stable. No evidence of new pulmonary nodules. No pleural effusion.MEDIASTINUM AND HILA: No mediastinal adenopathy. No pericardial effusion. Check, linear-shaped calcification seen throughout the heart would be consistent with coronary stents or calcification. A large thyroid is stable compared to the previous examination and causes mild tracheal narrowing at thoracic inlet.CHEST WALL: Stable left upper lobe posterior rib deformities. UPPER ABDOMEN: Hypodense lesion in the left kidney most likely due to a cyst is unchanged compared to the previous examination. No other significant abnormalities in the visualized part of the upper abdomen.

Output: 1. Stable thyroid findings. 2. Stable postsurgical changes without evidence of residual or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Evaluate Swan-Ganz placement. Swan-Ganz catheter tip mildly retracted but remains in the main pulmonary artery. ICD, aortic, and mitral valve prostheses unchanged. Unchanged basilar scarring without new focal lung opacity. Stable moderate cardiomegaly.

Output: Swan-Ganz catheter tip mildly retracted in the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Cough and wheezing No cardiopulmonary abnormality

Output: NormalI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and severe pulmonary arterial hypertension with question of the ILD LUNGS AND PLEURA: Mild bronchial wall thickening and centrilobular emphysema again seen. Some scattered areas of scarring / mild focal fibrotic change. Mild nonspecific patchy/centrilobular opacities are again seen in the apical areas.There may be small pleural effusions especially on the left.MEDIASTINUM AND HILA: Enlarged main pulmonary artery again seen consistent with pulmonary arterial hypertension.Some borderline sized mediastinal lymph nodes again seen.Enlarged right heart again seen which was better demonstrated with contrast on previous exam.CHEST WALL: No significant abnormality noted.

Output: Mostly emphysema and some bronchial wall thickening with some scattered scarring and pulmonary arterial hypertension but no definite significant interstitial lung disease seen


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p 3/10 Excision of mediastinal tumor. Left thoracoscopic right upper lobectomy, Mediastinal lymph node dissection History: follow up Postsurgical right-sided volume loss with right hilar architectural distortion and scarring at the right hemidiaphragm. Resolution of previous right pneumothorax. Left lung remains fully inflated and clear. Heart size is normal.

Output: Resolution of previous right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval for pna History: respiratory distress Cardiomegaly with large central pulmonary arteries consistent with pulmonary arterial hypertension.No evidence of acute edema or pneumonia.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly with pulmonary arterial hypertension, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: eval for cardiomegaly History: SOB w/ exertion Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p bronchoscopy, mediastinoscopy with endobronchial and lymph node biopsies History: see above Enlarging left pleural effusion.Increased left lower lung zone consolidation.No significant pneumothorax.Nonspecific bronchial wall thickening.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: RIJ central line placement History: GIB Right jugular central venous catheter terminates in the proximal superior vena cava.Moderate cardiomegaly with enlarged bilateral pulmonary arteries are unchanged. Mild bibasilar opacities, suggestive of atelectasis. No pleural effusions or pneumothorax.

Output: Mild bibasilar opacities, suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: CP History: CP Cardiomegaly, unchanged.Mild basilar scarring or atelectasis, unchanged.Catheter tip in the SVC.

Output: Cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: ro fb History: swallowed plastic No radiopaque foreign objects are visible, though a plastic object is not likely to be radiopaque.No significant cardiopulmonary abnormalities.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 66 old female with shortness of breath. Perihilar interstitial opacities, septal lines and pleural effusions. No pneumothorax.Mild cardiomegaly.

Output: Findings are most compatible mild to moderate CHF.


Instruction: Generate impression based on medical findings.

Input: ETT check Motion degrades sensitivity. Mild edema with otherwise unchanged ETT, right jugular catheters and NG tube

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: 63M with chest pain radiating to the back. History: chest pain Interval placement of right subclavian single-lead ICD.Moderate to severe cardiomegaly without evidence of mediastinal widening.No focal consolidation, pleural effusion, or pneumothorax.

Output: Cardiomegaly without mediastinal widening or other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: possible lung pathology, fever workup History: fever Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Cardiomyopathy, CHF, S.O.B. Severe cardiomegaly consistent with history of cardiomyopathy. Left subclavian ICD/pacemaker with proximal pacing lead in the right atrial appendage, proximal well in the SVC/RA and distal coil in the right ventricle projection.Moderate CHF. Pleural thickening or fluid on the right, mild to moderate, suggest follow-up. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: Moderate CHF. Suggest follow up to radiographic resolution of pleural thickening or fluid on the right.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Right pleural drain, with a small right hydropneumothorax by basilar consolidation.Moderate left pleural effusion.

Output: Right pleural drain placement with a small right hydropneumothorax, left pleural effusion and basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with a previous right lower lobe pneumonia, evaluate for follow-up and compare to old films LUNGS AND PLEURA: Scattered nonspecific micronodules some which are calcified. No other pulmonary or pleural abnormality is identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Mild anterior wedging of the T11 vertebra of indeterminate age. Surgical screw within the left scapula.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant pleural or pulmonary abnormalities


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: sickle cell pain crisis, concern for ACS History: pain crisis No significant cardiopulmonary abnormality.Right-sided catheter tip at SVC level.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for pneumonia History: cough, HIV Nonspecific interstitial and airspace opacities without pleural effusions.Unremarkable mediastinal contours and cardiac silhouette.

Output: Atypical pneumonia including pneumocystis given the HIV history.


Instruction: Generate impression based on medical findings.

Input: Reason: metastatic breast Ca to lungs. on chemo. Followup film History: cough Diffuse bilateral nodular opacities compatible with metastatic disease with some underlying interstitial and airspace components compatible with lymphangitic spread of tumor, edema secondary to lymphatic/venous obstruction, and possibly infection or drug toxicity.Port catheter with its tip in the SVC.

Output: Increased nonspecific pulmonary opacity compatible with metastatic disease and possibly a superimposed process such as infection or drug toxicity. A CT scan would more accurate evaluation.


Instruction: Generate impression based on medical findings.

Input: History stage II C. borderline tumor of the ovary status post staging surgery 2/2010. Ill-defined soft tissue in the right adnexa on CT of 4/23/10. Follow-up right adnexal lesion. Evaluate for recurrent disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted. Small left thyroid nodule was not visualized on the prior examination due to being below the plane of the thyroid. This measures 1.0 x 0.7 cm (image 3; series 4). Left subclavian vein stenosis or occlusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The punctate subcapsular liver lesion (image 92; series 4) probably stable and too small to characterize. No intrahepatic biliary ductal dilatation or enhancing masses are evident.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter probable simple cysts in the right kidney are stable.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: Ill-defined soft tissue in the right adnexa is again noted and too ill-defined for measurement currently. I cannot localize a discrete mass. The area does not appear to have changed since the prior examination.BLADDER: No significant abnormality noted.LYMPH NODES: Small inguinal lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain, ileus, nausea and vomiting Upper abdominal clips and endovascular coils unchanged in position. Evidence of ascites with centralized appearance of bowel. Above average stool burden. No specific evidence of bowel obstruction. Enteric contrast noted.Please see same day CT of abdomen/pelvis and chest radiography for additional findings.

Output: No specific evidence of bowel obstruction. Above average stool burden. Ascites.Please refer to same day CT abdomen/pelvis for additional findings.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with a history bladder cancer status post cystectomy, prostatectomy, ileal conduit and radiation therapy presenting with hematuria in urostomy pouch, hematemesis and questionable SBO. Evaluate for SBO, malignancy, masses and fistulous. Hematuria, hematemesis, diarrhea. ABDOMEN:LUNG BASES: Atelectasis versus consolidation patchy right middle lobe and right lower lobe with small effusion. Rule out aspiration pneumonia.LIVER, BILIARY TRACT: Multifocal small well-defined hypoattenuating lesions in the multiple lobes consistent with metastatic disease. For baseline purposes a lesion in segment 7 as measured on series 11 image 25, 2.2 x 2.2 cm. Small area of globular calcification is seen in the parenchyma adjacent to this lesion. There is no biliary dilatation. Portal and hepatic veins are patent.SPLEEN: No significant abnormality notedPANCREAS: Somewhat atrophic.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small kidneys with multifocal areas of cortical scarring bilaterally. Left nephroureterostomy in place. No evidence of hydronephrosis or hydroureter on either side.RETROPERITONEUM, LYMPH NODES: Caval filter in place. Atherosclerotic changes aorta. Small shotty nodes not pathologic by size criteria.BOWEL, MESENTERY: NG tube in antrum. Diffuse small bowel dilatation consistent with mechanical small bowel obstruction high-grade but incomplete. See below.BONES, SOFT TISSUES: Scoliosis and degenerative changes. Anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Surgically absent. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Matted loops of bowel versus soft tissue mass midline pelvis adjacent to the surgical staples. This is seen on series 11 image 111 and measures 4.9 x 4.3 cm. This could be the cause of the more proximal marked small bowel dilatation consistent with a mechanical but incomplete small bowel obstruction. The distal ileum and colon are not distended and have fluid and some gas within.No evidence of intramural air or free air.Ileostomy right lower quadrant with a left-sided nephroureterostomy catheter extending through the ostomy.Small nonobstructive midline incisional hernia containing omentum and bulging of dilated small bowel. This is not the cause of the obstruction however. There is little if any ascites.BONES, SOFT TISSUES: Right hip prosthesis. Dextroscoliosis lumbar spine with associated moderate to severe degenerative changes. No definite lytic or blastic disease.Mild anasarca.OTHER: Hypoattenuation in the left femoral vein consistent with deep venous thrombus. Series 11 image 132.

Output: Multifocal hypoattenuating lesions in liver consistent with metastases. Atelectasis or consolidation right lower lobe rule out aspiration pneumonia.Incomplete small bowel obstruction. Matted loops of bowel versus midline pelvic mass. Correlate with surgical report. Expected surgical changes of cystectomy with left nephroureterostomy catheter in place.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: swan ganz,CHF History: CHF Left-sided ICD and right IJ Swan-Ganz unchanged.Stable cardiac enlargement.Mild basilar interstitial opacities compatible with edema and atelectasis similar to the prior exam.No new pulmonary opacities noted.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: 53y/o M s/p PICC pullback assess placement History: as above Left PICC no longer extends into the azygos, the tip now straight.No significant cardiopulmonary abnormality.An NG tube terminates in the stomach.Upper abdominal drainage catheter.

Output: PICC repositioned, the tip no longer bent back. No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o cardio pulm process History: chest pain Unremarkable cardiac and mediastinal silhouette.Surgical clips in the lower mediastinum and stabilization device in the cervical thoracic spine.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: ams History: ams 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: Male, 35 years old.Reason: pna? Pneumocystis? History: hx HIV not on HAART for 7mo p/w 2-3 week productive cough, f/c/diaphoresis Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: SOB, eval for CHF History: DOE, LE edema Swan-Ganz catheter has been removed. Other iatrogenic devices, unchanged. No large pleural effusion or pneumothorax. Unchanged cardiomegaly. No new focal pleural parenchymal opacity. Patchy bibasilar subsegmental atelectasis or scarring.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with history of collagen vascular disease and shortness of breath. Please rule out vasculitis of the pulmonary bed. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.No evidence of air trapping is seen on expiration views, and no mosaic perfusion abnormalities identified.No evidence of PE.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Pulmonary artery is enlarged, compatible with pulmonary hypertension.A small amount of debris seen in the esophagus.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Small, hypoattenuating lesion in the left hepatic lobe appear similar to prior study.

Output: 1. Enlarged pulmonary artery is compatible pulmonary hypertension.2. No evidence of interstitial lung disease, air trapping, or mosaic perfusion abnormalities.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent mixed interstitial and patchy airspace opacities again greater both bases and on the right. Overall mild minimal interval improvementBorderline cardiomegaly.Midline sternotomy

Output: Persistent yet minimally improving nonspecific bilateral mixed opacities compatible with previously diagnosed pneumonia


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: intubated, History: intubated ET tube with its tip 5 cm above the carina.NG tube with its tip in the stomach.Stable cardiomediastinal silhouette.Multifocal airspace opacities similar to the prior exam.Left pleural effusion and left basilar atelectasis unchanged.

Output: Support devices unchanged. Stable cardiopulmonary appearance with interstitial and multiple airspace opacities compatible with edema and possible concomitant infection.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Pulled PA catheter back 6 cm, evaluate position. Left subclavian Swan-Ganz catheter tip now in the right ventricle. Interval placement of tracheostomy tube with tip 5 cm above the level of the carina. ECMO cannula terminates overlying the low right atrium. Bilateral chest tubes in place with very small postoperative pneumothorax on the right. Moderate volume of pleural fluid bilaterally. Diffuse opacification of the lung parenchyma. Large postoperative pneumopericardium/pneumomediastinum. Subcutaneous emphysema bilaterally.

Output: Left subclavian Swan-Ganz catheter has been retracted with tip now in the right ventricle.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: hx AML now with upper respiratory infection +rhinoirus need to r/o Pneumonia History: cough The heart is normal in size.Lung volumes are normal. Mild bilateral bronchial wall thickening. No abnormal focal lung opacities.The pleural spaces the right upper extremity PICC has been removed in the interval.No osseous lesions are present.

Output: No radiographic findings suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: abnormality History: chest pain with inspiration No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: eval for acute process History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: assess swan position History: as above Swan-Ganz catheter tip in right pulmonary artery. ICD unchanged. Cardiomegaly with basilar atelectasis as on prior.

Output: Swan-Ganz catheter tip in right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Acute respiratory failure Exam limited due to motion and positioning, obscuring the right upper chest. Within this limitation however marked new mixed interstitial and patchy opacities greater both bases with moderate effusions and mild cardiomegaly correlate with suspected CHF. Consider serial imaging to improve sensitivity

Output: Moderate CHF within limitations described


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: cause of worsening hypoxia? History: history of MRSA PNA leading to ARDS, extubated 48 hours ago, becoming more hypoxic Stable cardiomediastinal silhouette.Decreased lung volumes.Multifocal airspace opacities and pleural effusions similar to the prior exam.

Output: Redemonstration of multifocal air space opacities and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of metastatic prostate cancer CHEST:LUNGS AND PLEURA: Scattered micronodules unchanged.There lung apices, right greater then left.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Unchanged T10 vertebral body metastatic focus.ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral adrenal nodules, stable.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Left femoral lymph node is unchanged measuring 1.8 x 1.3 cm on image number on 178 series number 3BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small sclerotic bone metastases are unchanged.OTHER: No significant abnormality noted

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent near complete opacification of the left hemithorax with hyperexpansion of the right lung end deviation of mediastinal structures. No superimposed new right lung abnormality.

Output: Postsurgical changes related to the left pneumonectomy without superimposed evidence of acute right lung abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old. Post op status post LVAD. Cardiomegaly with basilar opacities consistent with edema/atelectasis, unchanged.Interval removal of Swan-Ganz catheter.ICD leads, LVAD, and bilateral chest tubes unchanged. Right PICC tip is in the right axillary region, unchanged.

Output: Interval removal of Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: Colorectal cancer restaging after two months of chemotherapy break. CHEST:LUNGS AND PLEURA: Index left upper lobe lesion with surrounding groundglass opacity is equivocally larger measuring 2.4 x 2.1 cm (image 38; series 4). Reference right upper lobe nodule is also slightly larger measuring 3.1 x 1.9 cm (image 40; series 4). Left lower lobe nodule in the left posterior costophrenic angle measures 2.1 x 1.9 cm (image 82; series 4), unchanged.MEDIASTINUM AND HILA: Coronary artery calcifications.CHEST WALL: Chest portABDOMEN:LIVER, BILIARY TRACT: Mild fatty infiltration of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small hypodense lesion in the midportion of the left kidney is stable (image 111; series 3).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hiatal hernia. A ventral hernia repair.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with a large median lobe protruding into the bladder base.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Presacral soft tissue densityBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval minimal progression of disease with reference measurements given above


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: PNA History: leuko Moderate cardiomegaly with increased upper zone blood flow.Basilar hazy opacity compatible with edema, atelectasis and small pleural effusions, mildly improved from prior.

Output: Mild improvement in edema.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Heart transplant. Stable cardiomediastinal silhouette.Low lung volumes. Bibasilar opacities likely represent subsegmental atelectasis. No specific evidence of infection or edema.Median sternotomy hardware and surgical clips again noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: sp tracheal dilation with significant chest pain and tachy History: sp tracheal dilation with significant chest pain and tachy No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval central line placement History: central line Right jugular catheter tip near confluence of brachiocephalic veins. No evidence of pneumothorax. Other findings stable.

Output: Right jugular catheter tip near confluence of brachiocephalic veins. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: pt with left IJ, confirm central line placement History: hypotension Cardiomegaly with the suggestion of basilar edema.No specific evidence of infection.Left jugular catheter, tip at cavoatrial junction.Prior right PICC no longer visualized.

Output: Cardiomegaly with suggestion of basilar edema. Left jugular catheter placement noted.


Instruction: Generate impression based on medical findings.

Input: Reason: any effusion? History: pancreatitis and copd exacerbation Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: interval assessment in ICU patient History: advanced heart failure with Impella ICD with leads unchanged. Impella device is again noted in the left ventricle, unchanged. Swan-Ganz catheter tip is in the right pulmonary artery.Moderate cardiomegaly.No large pleural effusion or pneumothorax.Mild subsegmental retrocardiac opacity, possibly atelectasis.

Output: Moderate cardiomegaly and Impella device without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiomegaly History: chest pain, abnl stress test Normal heart size with a moderately tortuous aorta. Multiple healed rib fractures on the left. No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval acute process History: ms flare Low lung volumes. Basilar opacities likely atelectasis. No air space opacities. Cardiomediastinal silhouette within normal limits.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Mild basilar interstitial changes consistent with old chronic change. No superimposed acute cardiopulmonary abnormality. No effusionsCardiac and mediastinal contours are within limits and exaggerated due to scoliosis

Output: Mild chronic interstitial change without superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Renal cell carcinoma No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with shortness of breath. Follow fibrosis and left upper lobe airspace opacities. CHEST:LUNGS AND PLEURA: Patchy subpleural reticulation and honeycombing and mild traction bronchiectasis that is slightly basilar predominant, without significant interval change since prior study from May 2011 but slightly progressed since study from June 2010. No significant air trapping on expiration views.Chronic left lung volume loss with left pleural thickening and calcifications consistent with prior empyema. Left upper lobe atelectasis has been unchanged over multiple prior studies and is likely secondary to scarring.Calcified granulomata in the right lung.Chronic elevation of the right hemidiaphragm.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes have been present since March 2005 and are grossly unchanged. Heart size normal without pericardial effusion. Coronary and aortic calcifications. Calcified saphenous vein graft.CHEST WALL: Sternal fixation wires intact. UPPER ABDOMEN: Scattered hypoattenuating lesions in liver unchanged since March 2005 and likely represent benign cysts.

Output: Patchy areas of fibrosis and honeycombing most consistent with UIP, slightly progressed since June 2010 but without significant interval change from prior study from May 2011. Likely chronic scarring in the left apex, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: 58F w/ Ludwig's angina c/b resp failure, eval for pulm edema History: vent requirement Low lung volumes. Interval extubation with interval placement of tracheostomy, terminating approximately 3 cm above the carina. Unchanged left pleural effusion with adjacent retrocardiac consolidation and diffuse right hazy opacities. Right jugular venous catheter terminates at the level of the right atrium. Chest drains and removed.

Output: Interval placement of tracheostomy. Diffuse opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: S/p MVA with elevated trop and chest pain, evaluate for widened mediastinum History: As above The cardia mediastinal mediastinal silhouette is unremarkable.Mild right basilar atelectasis.No evidence of a pneumothorax.No obvious rib fractures identified.

Output: Right basilar atelectasis. No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Pulmonary edema. HF, SOB. History: as above Cardiomegaly. No acute abnormality.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: septic Mild cardiomegaly with small lung volumes.Streaky basilar opacities compatible with subsegmental atelectasis.Mild blunting of the left costophrenic angle compatible with a small effusion or scarring.No specific evidence of pneumonia.

Output: Mild basilar atelectasis with no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: dizziness History: dizziness Size is at least upper normal.No significant pulmonary or pleural abnormality.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: liver failure acute dyspnea ams History: ams Left IJ line terminates in the superior aspect of the RA. Basilar stent again noted within the right axilla. New pleural effusions and increased bibasilar opacities, presumably atelectasis. Mild cardiomegaly, as before.

Output: New pleural effusions and increased bibasilar opacities, presumably atelectasis.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Cavitary spiculated lesion in the right upper lobe is now larger and measures 26 x 20 mm image number 36, series number 33. The left lower pulmonary nodule has also significantly increased in size and now measures 29 x 19 mm image number 65, series number 33. Emphysematous changes are stable.MEDIASTINUM AND HILA: Prevascular lymph node measures 12 x 7 mm image number 16, series number 21, stable. No new mediastinal enlarged lymph node.CHEST WALL: Reference right retrocrural lymph node is smaller, measuring 15 by 8mm on image number 76, series number 21. Diffuse cost discrete sclerotic bone lesions are again seen.ABDOMEN:LIVER, BILIARY TRACT: Multiple subcentimeter hypodense lesions in the liver and cirrhotic appearance of the liver is unchanged. Portal vein aneurysm is unchanged measuring 3.9 by 3.3 cm, image number 96, series number 21.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged. Reference left para-aortic lymph node is unchanged, measuring 14 by 8mm image number 121, series number 21.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse bone metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate, unchanged.BLADDER: No significant abnormality notedLYMPH NODES: Reference right internal iliac lymph node cannot be visualized for measurement.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse bone metastases.OTHER: No significant abnormality noted

Output: Interval increase in the size of the lung nodules. Overall, lymph nodes are either stable or smaller in the chest and abdomen.Extensive bone metastases are unchanged.Other findings are also stable.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with concern for mediastinal/thoracic mass with right atrial compression as well as renal failure. Cholangiocarcinoma with shortness of breath. CHEST:LUNGS AND PLEURA: Calcified left lower lobe granuloma. Numerous bilateral pulmonary nodules are identified, compatible with metastases. For reference purposes, one of the nodules in the left lung base measures 11 x 8 mm (series 8; image 59).Mild to moderate right pleural effusion, increased in size.MEDIASTINUM AND HILA: Diffuse mediastinal adenopathy is identified. The largest lymph node in is seen in the subcarinal region measuring approximately 21 x 18 mm (series 6; image 48)The right lateral aspect the right atrium is concave. However no extrinsic mass is seen in this region. No dilatation of the SVC. Coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Numerous masses are again identified in the liver, increased in size from the prior examination. A previously measured conglomerate lesion in the right lobe measures approximately 17.0 x 10.0 cm from previously 12.7 x 9.2 cm. One of the discrete lesions in segment two of the liver measures approximately 4.1 x 4.4 cm, previously approximately 3.5 x 3.1 cm (series 3; image 33).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter exophytic cyst with layering hyperdensity is seen in the midpole of the left kidney, unchanged, suggestive of a complex cyst with layering calcium, hemorrhage or protein. RETROPERITONEUM, LYMPH NODES: Diffuse abdominal adenopathy is again identified. The reference lymph node in the portacaval region measures 4.0 x 2.4 cm (series 6; image 108), previously 3.7 x 2.1 cm. Enlarged periaortic node measures approximate 3.3 x 2.0 cm (series 6; image 116), previously 3.2 x 1.8 cmBOWEL, MESENTERY: Nodules in the omentum are now more discrete, consistent with worsened peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate ascites, increasedPELVIS: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: Progression of widespread metastatic disease comment including peritoneal carcinomatosisMild-moderate right pleural effusion comment increased.Moderate ascites, increased.