Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.+PPD needing screening for job. Normal heart size. Tortuous thoracic aorta unchanged.Interval development of asymmetric pleural thickening at the left apex.Subtle subpleural reticulation anteriorly in the left lung suggestive of radiation fibrosis.No signs of active intrathoracic tuberculosis.Surgical clips project over the left chest wall.

Output: Interval development of left apical pleural thickening. Although this may be the result of fibrosis if the patient received chest wall irradiation in this region it is higher than typically seen. An enhanced thoracic CT is recommended for further evaluation to exclude possibility of malignancy unless the referring clinical service can obtain and submit outside exams documenting that this is a benign process. This was discussed with Joan Bigane (1019) at approximately 11:55 a.m. on 3/18/2016.No evidence of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: eval for pneumonia History: chest pain, L CVAT Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Nondisplaced fracture lateral ninth rib, possibly the 10th.

Output: No specific evidence of infection. Nondisplaced left rib fracture ninth laterally.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with metastatic myoepithelial carcinoma CHEST:LUNGS AND PLEURA: Status post right pneumonectomy.Stable left lower lobe nodule on image number 139, series number 5 and image number 188, series number 5. Small right-sided pleural effusion is unchanged.MEDIASTINUM AND HILA: Shift of mediastinal structures the right side. Subcentimeter mediastinal lymph nodes are stable. Left paratracheal reference node measures 15 x 11 mm on image number 26, series number 3.CHEST WALL: Status post right thoracoplasty. Postsurgical findings are stable.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hypodense lesion in the left lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are stable. Hyperdense lesion in the upper pole of the right kidney is stable measuring 12 mm.RETROPERITONEUM, LYMPH NODES: ABOWEL, MESENTERY: Unchanged left posterior lateral flank hernia containing nonobstructed bowel loops.BONES, SOFT TISSUES: Numerous metastatic disease throughout the skeleton are unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive bone metastases are stable.OTHER: No significant abnormality noted

Output: Stable study.


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath History: as above Basilar opacities compatible with atelectasis, not significantly changed allowing for position and projection.No new findings.

Output: Basilar atelectasis which may be secondary to aspiration, unchanged since the previous day but increased compared to earlier radiographs.


Instruction: Generate impression based on medical findings.

Input: 61 year-old female with metastatic sarcoma CHEST:LUNGS AND PLEURA: Left upper lobe nodule is more prominent and now measures 5-mm image number 99, series number 4. A new nodule in the left lower lobe measures 5-mm image number 59, series number 5, suspicious for metastatic disease.MEDIASTINUM AND HILA: Small nodular density in the prevascular space which may represent residual thymus or a small lymph node is unchanged measuring 9 x 9 mm image number 32, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst and punctate left lower pole stone without hydronephrosis are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval development of a new punctate nodule in the left lower lobe suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: trach History: trach Progression of basilar opacities which may represent pleural effusions. No change in the degree of mild cardiomegaly.Support devices stable.Dilated, air-filled bowel seen once again below the diaphragm.

Output: Interval progression of basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female 87 years old Reason: 87 yo F w/ pSBO 2/2 adhesive disease, eval for small bowel distension, air fluid levels, stool History: 87 yo F w/ pSBO 2/2 adhesive disease, eval for small bowel distension, air fluid levels, stool Lungs are clear. Mild cardiomegaly.Dilated loops of small bowel in the midabdomen similar to CT dated 7/7/2016 and likely represents a small bowel obstruction. No free air.

Output: Findings compatible with small bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Pneumothorax evaluate change. No significant sized pneumothorax. Pleural fluid and pulmonary nodules unchanged. Improving pulmonary edema.

Output: No significant pneumothorax. Improving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Chest tube removed Interval removal of mediastinal chest tubes without associated new postprocedural complication.Lungs remain decreased in overall volume with retrocardiac partial consolidation and small effusion. Borderline cardiomegalyStimulation wires again observed

Output: Chest tubes removed and persistent left lower lobe nonspecific partial consolidation


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pneumonia, ACS History: h/o Hgb-SS, shortness of breath yesterday Single-lumen port catheter with tip in the right atrium. H-shaped vertebral bodies noted.The cardiomediastinal silhouette is normal.There is bibasilar scarring and pleural thickening, right greater the left, but no focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: leukocytosis, r/o PNA History: as above No specific evidence of infection or edema. Streaky opacity at the left costophrenic angle from subsegmental atelectasis or scar. Heart size is within limits of normal. No pneumothorax. There are surgical clips compatible with prior cholecystectomy.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval tachypnea History: eval tachypnea Right IJ central catheter is unchanged position. Low lung volumes remain with bilateral basilar opacities. No evidence of pneumothorax.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Asthma with dyspnea, chills and hemoptysis. Normal heart size. Bronchial wall thickening consistent with provided history of asthma.Hazy opacity in the right upper lobe has been present since 2012, of unclear etiology The possibility of chronic ABPA may be considered in the appropriate clinical context.Several high density nodular opacities seen elsewhere in the right upper lobe suggestive of chronic mucoid plugging or possibly granulomas.

Output: No signs of bacterial pneumonia however the chronic findings in the right upper lobe could be the result of chronic indolent ABPA in an asthmatic. If no other sources of the patient's symptoms are identified and if the patient remains symptomatic, CT of the thorax may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: s/p TECAB History: s/p TECAB The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval lung fields History: sob, cp There is near complete atelectasis of the left upper lobe which is likely secondary to obstructing mass in patient with known lung cancer. The right lung field is clear. No large pleural effusion or pneumothorax.

Output: Near complete atelectasis of the left upper lobe likely secondary to obstructing mass in patient with known lung cancer.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: swan daily film History: swan in place Right pleural thickening and blunting the costophrenic angle; a small right effusion is also possible.No specific evidence of infection or edema.Moderate cardiomegaly.Right jugular Swan-Ganz catheter, tip in right pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Unchanged lung appearance. Right jugular Swan-Ganz catheter, tip in right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: eval for LLL effusion/ consolidation History: Left For improvement in LLL effusion/ consolidation Multiple right upper quadrant surgical clips. Bilateral pleural effusions, left greater than right, unchanged. Increasing streaky bibasilar/perihilar opacities suggest atelectasis. Retrocardiac opacity unchanged. There is a nonspecific 9 mm nodular opacity in the right midlung field. The cardiac and mediastinal contours are unchanged.

Output: 1.Unchanged bilateral pleural effusions, with increased associated atelectasis/consolidation. 2.Nonspecific 9 mm nodular opacity in the right midlung field, for which special attention on follow-up examinations is suggested.


Instruction: Generate impression based on medical findings.

Input: Patient with breast cancer, invasive ductal, status post left mastectomy with sharp pleuritic pain at the second costochondral junction. PULMONARY ARTERIES: There are no filling defects in the pulmonary arteries to suggest pulmonary embolism.LUNGS AND PLEURA: There are innumerable bilateral round nodules, the largest of which measure about 12 mm in the right lower lobe and 18 mm in the left lower lobe, highly suspicious for metastatic disease. There is a developing area of consolidation in the left upper lobe measuring approximately 3.5 x 3.4 cm which is new since the prior study. This finding could reflect post radiation therapy change/fibrosis if the patient received radiation therapy and this area was included in the radiation field of the left breast. Conversely, this could reflect an area of developing pneumonia, though given its linear appearance on the sagittal view, postradiation change is favored.MEDIASTINUM AND HILA: There is an enlarged 19 x 12 mm carinal lymph node with enlarged bilateral hilar lymph nodes, the largest on the right measuring 16 x 20 mm. Clips are present in the left axilla.CHEST WALL: The patient is status post left mastectomy. The midsternum has a mottled appearance with cortical break in its lateral margin on the right. A pathologic fracture fracture- at this location is possible. Correlation with nuclear medicine bone scan is recommended. There is a small seroma in the left axilla measuring 2.0 x 1 .3 cm, likely prior secondary to prior resection.UPPER ABDOMEN: There is mild splenomegaly of uncertain etiology. Sutures around the stomach may reflect sequelae of prior gastric bypass.

Output: 1.No evidence of pulmonary embolism.2.Multiple bilateral lung nodules with hilar and mediastinal lymphadenopathy as described above are highly suspicious for metastatic disease given the patient's known breast cancer.3.Developing opacity in the left upper lobe is nonspecific but favored to reflect postradiation fibrosis if the patient has undergone radiation therapy for left breast cancer. Otherwise, this finding could reflect developing pneumonia.4.Mottled appearance of the sternum with discontinuity of the lateral cortex on the right side, near site of patient symptomatology. This could reflect metastatic disease to the sternum with a pathologic fracture, though this is equivocal. If clinically desired, further evaluation with bone scan can be obtained. There are no other osseous lesions identified.These findings were discussed with the clinical team at time of interpretation


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: Rule out widened MS History: chest pain Chronic elevation left hemidiaphragm with overlying subsegmental atelectasis.Unchanged dilated and tortuous aorta, and enlarged main pulmonary artery.No specific evidence of infection or edema.

Output: Persistent widening of the mediastinum likely from the known dilated tortuous aorta and large pulmonary artery; this could be confirmed by CT if symptoms persist.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: fever and incr WBC, hx of flu and lung cancer, please eval for new consolidation History: as above Worsening right upper lobe opacity consistent with infection or aspiration, with stable edema elsewhere.Unchanged small pleural effusions.

Output: Increasing right upper lobe opacity consistent with infection or aspiration, with diffuse pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 76 years old Female. Reason: low O2 sats on 5L facemask History: shortness of breath. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema, worse as compared with prior study. There is also bilateral patchy air-space edema, new as compare with post body. Small amount of bilateral pleural effusions are noted, new as compare with prior study.The right chest port and cardiac pacemaker/defibrillator electrodes are stable in position. A surgical drain is seen in the left upper quadrant of the abdomen. The tip of the NG tube projects over the mid abdomen.

Output: The above findings are consistent with severe congestive heart failure, significant worse as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Missed dialysis, concern for fluid overload. No signs of CHF. No pleural fluid or pneumothorax. Normal heart size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: eval for cardiomegaly History: syncope 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, 74 years old.Reason: eval ETT, lung fields History: s/p AVR, MVR The endotracheal tube terminates 2.5 cm from the carina. Swan-Ganz catheter terminates in the RPA. Mediastinal and chest drains again noted. Mild pulmonary edema with bibasilar opacities and pleural effusions again noted. No pneumothorax.

Output: Expected postoperative appearance.


Instruction: Generate impression based on medical findings.

Input: Aspiration history Interval placement of a Dobbhoff, tip projected 3 to 4 cm beyond the GE junction. Otherwise cardiopulmonary appearance is similar given differences in technique. Severe multifocal airspace changes with predominant interstitial opacities otherwise remains similar

Output: Dobbhoff placement


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: pneumothorax History: left pneumothorax s/p vent Cardiomediastinal silhouette is unremarkable. Persistent moderate left pleural fluid collection with underlying compressive atelectasis, unchanged. No evidence of pneumothorax.Spinal fixation hardware is again identified. Partial resection of the left ninth and a displaced fracture of the lateral left eighth rib unchanged, correlate with surgical history.

Output: Persistent left pleural fluid with no evidence of pneumothorax. Displaced left rib fracture.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.IABP placement. Dextrocardia with situs inversus. No visible pneumothorax. IABP marker similar in position, overlying the proximal descending thoracic aorta at the level of T5/T6. No visible pleural fluid.

Output: IABP marker projects over the T5/6 level. No visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: r/o pneumonia History: cough, SOB, chills Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: above ET tube tip approximately 5 cm above the carina.NG tube tip in the stomach with the sidehole in the distal esophagus.Nonspecific mainly basilar interstitial opacity suggestive of edema with small pleural effusions.

Output: ET tube in acceptable position. Proximal location of NG tube. Increased pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Phrenic nerve palsy Moderately elevated right hemidiaphragm with underlying scarring and/or atelectasis persists and Is mildly advanced. Lungs are otherwise grossly clear.Cardiac and mediastinal contours are main significant for mild tortuosity of the aorta unchanged

Output: Diaphragmatic appearance consistent with known phrenic nerve palsy on the right


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: assess swan placement History: assess swan placement Intra-aortic balloon pump metallic marker overlies aortic arch. Swan-Ganz catheter terminates in the RPA. Cardiac lead, unchanged. Basilar pleuroparenchymal opacities, not substantially changed. Unchanged cardiomegaly. No pneumothorax.

Output: Lines and tubes, as above. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 57 years, Female. Reason: Please eval for obstruction, stool burden, possibly History: Persistent Nausea, occ vomiting ever since an abdominal hysterectomy and pelvic abscess last year. Intestinal adhesions/tethering noted on a 10//30/15 CT scan Please note that the bilateral flanks are excluded from the field of view.No radiographic evidence of obstruction or ileus. Average colonic stool burden. No pneumoperitoneum evident.Cholecystectomy clips noted.Unremarkable cardiomediastinal silhouette. No focal lung opacities.

Output: No radiographic evidence of obstruction or ileus.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: CHF, volume overload History: A-flutter/volume-up on exam Lines and tubes are unchanged. Bilateral pleural effusions and bibasilar opacities again noted. No pneumothorax. Unchanged heart size.

Output: Unchanged pleural effusions and bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Fever and history of recurrent infection. Left PICC tip in SVC. Unchanged mild cardiomegaly. Interval development of moderate bilateral pleural effusions and basilar airspace opacities.

Output: Interval development of bilateral pleural effusions and basilar airspace opacities, compatible with CHF. However, superimposed acute infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: shortness of breath History: shortness of breath Cardiomegaly with mild basilar interstitial opacities suggestive of edema, and equivocal pleural effusions.Basilar subsegmental atelectasis is new.Upper lobe nodular opacities were present 6/25/2010.Left subclavian dual chamber right ventricular ICD, the left ventricular recapture lead in a different position presumably reinserted over the last 5 years, and the right atrial lead also different in position but still appropriately located.

Output: CHF with pulmonary edema and cardiomegaly.Upper lobe nodules unchanged, but a follow up CT should be referenced.ICD leads are in adequate position but seen to have been modified since the prior study 5 years ago.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: eval for infiltrate, edema; recent kidney transplant History: fever, abdominal pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.SOB and cough, new diffuse infiltrates question progression. Low lung volumes. No pleural fluid or signs of pulmonary edema. Normal heart size.Diffuse interstitial and airspace opacities bilaterally, about the same.

Output: No acute change in diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Chest pain question infection or mediastinal widening. Normal heart size. No mediastinal widening. Bilateral diaphragmatic eventration.No focal airspace opacities, pleural fluid or pneumothorax.

Output: No signs of pneumonia or mediastinal widening.


Instruction: Generate impression based on medical findings.

Input: Evaluate mass in right chest wall. History of lymphoma and recent excisional biopsy of a right chest wall mass. Within the right chest wall there is an area of heterogeneous echogenicity measuring 2.8 x 2.2 x 4.0 (size likely underestimated), which contains increased vascularity and internal echoes. No preprocedural ultrasound is available.

Output: Right chest wall subcutaneous area of heterogeneous echogenicity and increased vascularity, most likely represents abscess given recent excisional biopsy. However residual neoplastic foci cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: cough and fever, please eval for PNA History: cough Right upper lobe post radiation volume loss unchanged.No evidence of pneumonia.

Output: Stable radiograph with no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality. Midline sternotomy unchanged

Output: Postsurgical changes without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: Acute SOB, RRT with cough, hypotensive. Eval for aspiration other acute event History: As above Small lung volumes with no specific evidence of aspiration or other acute change.Small pleural effusions in the posterior costophrenic angles, confirmed on the subsequent CT scan.Upper zone emphysema and focal right apical scarring, also confirmed on the CT scan.

Output: Small pleural effusions and no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: ? pna History: hypotense Right Port-A-Cath with tip in the SVC.Large right pleural effusion and increase compared to the prior exam.Left sided nodular opacities unchanged.No new focal areas of consolidation.

Output: Large right-sided pleural effusion slightly increased from the prior exam. Multiple pulmonary nodules unchanged. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: chest pain History: worse w/ leaning forward The lungs and pleural spaces are clear. Very mild bronchial wall thickening which can be seen in the presence of asthma or bronchitis. The heart size is normal.

Output: Mild bronchial wall thickening which can be seen in the presence of asthma or bronchitis. No pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: r/o pna History: productive cough Large lung volumes are consistent with COPD.No specific evidence of infection or edema.Heart size normal.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Chest pain or shortness of breath. Evaluate for etiology. Left-sided pacemaker with leads unchanged in position. Heart and mediastinal silhouette is unchanged. Bilateral basilar opacities without evidence of large pleural effusions or pneumothorax.

Output: Bilateral basilar streaky opacities may represent atelectasis/aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Status post right IJ line. Unchanged cardiomegaly with left pleural effusion and adjacent atelectasis. Worsening pulmonary effusions and edema. Interval placement of Swan-Ganz catheter that terminates in the right ventricle. Interval removal of intra-arterial balloon pump catheter, and interval placement of ECMO catheter and endotracheal tube. Surgical sequelae from sternotomy with unchanged fracture of sternal wires.

Output: Interval placement of Swan-Ganz catheter terminates in the right ventricle. Subsequent imaging demonstrates interval advancement into the right descending pulmonary artery. Interval worsening of pulmonary effusions and edema.


Instruction: Generate impression based on medical findings.

Input: 74 year-old female with end stage renal disease and history of stage II colon cancer 4/06. CHEST:LUNGS AND PLEURA: Calcified granulomataMEDIASTINUM AND HILA: Calcified mediastinal and right hilar nodes. 18 x 12 mm paratracheal lymph node (series 3; image 30), not significantly changed.The heart size is mildly enlarged.The esophagus is dilated with an air fluid level.CHEST WALL: The right-sided port terminates in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Borderline cortical thinning.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Subtotal colectomy with ileostomy without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic disease.PELVIS:UTERUS, ADNEXA: Tubal ligation bilaterally. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Subtotal colectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subtotal colectomy with ileostomy. No evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: r/o lung path History: asymptomatic, + PPD 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: 44-year-old male assess for migration of bovina, regurgitating tube feeds around trach, concern that coming from TE fistula Tracheostomy tube tip unchanged. Right jugular catheter tip unchanged. Enteric tube tip terminates beyond the inferior margin of the image.Increasing bilateral interstitial and airspace opacities with relative sparing in the left upper lobe. Persistent pleural effusions with adjacent atelectasis/consolidation.Unchanged cardiomediastinal silhouette.

Output: Nonspecific increasing bilateral pulmonary opacities could represent multifocal infection, edema or aspiration. Persistent pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of lung adenocarcinoma status post right upper lobe resection. Elevation of the right hemidiaphragm, right lung volume loss, and chest tubes in place with tips at right apex. Heart size is normal. No focal consolidation, pleural effusion, or pneumothorax. Right-sided healing rib fractures.

Output: No acute cardiopulmonary abnormality without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: SOB History: SOB The heart is normal in size. Coronary stent is noted.Lung volumes in the lower limits of normal. Bilateral bronchial wall thickening likely represents chronic bronchitis.No abnormal focal lung opacities.The pleural spaces are within normal limits.The degenerative changes of the thoracic spine.

Output: No abnormal radiographic findings to explain shortness of breath.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old. Reason: pneumonia History: history of OHT on immunosuppression, fever Interval removal of left central venous catheter.Unchanged median sternotomy and surgical clips projecting over the right upper lung.Large right-sided pleural effusion which has increased since prior study. Nonspecific bibasilar opacities which may represent atelectasis.

Output: Large right pleural effusion which is increased in size since prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Hypotension in patient on chemo The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No focal pulmonary opacity. Cholecystectomy clips noted. Calcified pancreatic parenchyma compatible with chronic pancreatitis. Gastric band in place.

Output: No acute cardiopulmonary abnormality without interval change.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Cough and fever. Evaluate for pneumonia. The cardiomediastinal silhouette is within normal limits. No focal airspace opacity, significant pleural effusion, or pneumothorax. Suture anchors are noted in the right humeral head.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: post bronch History: sob Increased patchy opacity at the right lung base, possibly bronchoscopic lavage fluid. No pneumothorax. Mild left basilar atelectasis, as before. Unchanged heart size.

Output: Presumed bronchoscopic lavage fluid at the right lung base. This may also represent aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: status of pulmonary edema History: volume overload leading to hypoxia, on Bipap overnight Severe cardiomegaly.Lower lung zone opacities suggestive of edema and atelectasis with large pleural effusions.Lucency projected over the right lower lung zone could be a deep sulcus sign suggesting a pneumothorax.

Output: CHF. Possible right subpulmonic pneumothorax, a follow-up examination recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: R IJ stent, R hemothorax, chest tube placement History: R IJ stent, R hemothorax, chest tube placement Right pleural catheter in right IJ venous catheter extending through an IJ stent stent unchanged.Stable cardiomegaly with increasing pulmonary vascular redistribution and perihilar edema.Pleural effusions, right greater than left, are similar in appearance to prior exam.No evidence of a pneumothorax.

Output: Support devices unchanged. Worsening CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: evaluate for infection History: sepsis Median sternotomy with mild cardiomegaly.Worsening pulmonary opacities and enlarging right pleural effusion.Left jugular catheter tip in SVC.

Output: Worsening pulmonary opacities and enlarging right pleural effusion, consistent with worsening edema or hypervolemia, although superimposed right lower lobe pneumonia is possible.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: s/p right partial thoracoplasty of right chest cavity with latissimus muscle transposition into pleural space for management of chronic air space/empyema. History: none Right pleural drain removed with no pneumothorax.Loculated right pleural effusion and basilar consolidation are unchanged.Left lung unremarkable.

Output: No change in loculated right effusion and basilar consolidation, pleural drain removed.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: evalute for infiltrate History: chest pain Nodular opacity at the right eighth /ninth interspace suspicious for nodule, not present on the prior study 2005. Basilar subsegmental atelectasis. Heart size is normal. No edema.

Output: Nodular opacity in the right for which a CT thorax is recommended to exclude nodule.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: Metastatic head and neck cancer, new left lower posterior rib pain, rule out bone mets History: as above No change in known metastases.No evidence of superimposed pneumonia or edema.Heart size normal.No obvious skeletal lesions by conventional radiography.Right subclavian catheter, tip in SVC.

Output: Unchanged metastases with no acute abnormalities. No obvious displaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Status post cholecystectomy.

Output: No acute cardiopulmonary process on radiography. No radiographic evidence of metastatic disease to the thorax.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath . Exam limited with extensive motion. Interval development of multifocal airspace abnormalities largely in a perihilar distribution and greater on the right. Moderate nonspecific cardiomegaly with decreased pulmonary volumes. Questionable small effusions.Single lead left subclavian ICD grossly unchanged

Output: Nonspecific pulmonary opacities, asymmetric. Possible pulmonary edema, however multifocal infection cannot entirely be excluded. Serial imaging will be helpful to confirm


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Focal opacity observed in the mid right lung, correlating with suspected related history of a nodule and presumed postprocedural endoscopy-induced hemorrhage and/or edema. No additional cardiopulmonary abnormality

Output: Suspected immediate post endoscopy edema and/or focal hemorrhage


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with history multiple myeloma, chronic sinusitis, vocal cord mass, and actinomycosis of the larynx LUNGS AND PLEURA: Mild bronchial wall thickening and upper lobe predominant centrilobular emphysema are stable. Scattered micronodules are unchanged. No new pulmonary or pleural nodules are identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Mild bronchial wall thickening and upper zone predominant centrilobular emphysema.2.Stable scattered micronodules. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: new line placement History: eval line New left-sided venous catheter is in the midline of the mediastinum and may not be intravascular. There is no evidence of pneumothorax. Right jugular catheter tip in SVC. ET tube tip 1 cm above carina.Enteric tube tip in stomach.Bilateral diffuse airspace opacities with small pleural effusions, improved aeration in the upper lobes.

Output: New left-sided venous catheter is in the midline of the mediastinum and may not be intravascular. There is no evidence of pneumothorax. Findings communicated to referring service by Dr. Alexander.


Instruction: Generate impression based on medical findings.

Input: 79 year old female with history of pericardial effusion. On CT, nodules noted in the lung. Mass versus post inflammatory? CHEST:LUNGS AND PLEURA: Scattered micronodules are again seen. 5-mm left upper lobe nodule is stable since prior study from 9/12/2009. No suspicious nodules or masses.Large right pleural effusion and overlying compressive atelectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Cardiomegaly and biatrial enlargement again seen; no pericardial effusion.Enlarged and heterogeneously enhancing thyroid gland containing multiple calcifications; note is again made of a calcified nodule in the right lobe (series 4, image 5), which appears similar to prior study.CHEST WALL: Small bilateral axillary lymph nodes, similar to prior study. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Large right pleural effusion, significantly increased from prior study from one year ago.2. 5 mm left upper lobe nodule stable since prior study from September 2009. Likely postinflammatory in etiology. Only if this is a high-risk patient (i.e. smoking history), an additional CT follow-up is recommended in one year.3. Enlarged and heterogeneously enhancing thyroid gland with dominant right nodule appearing similar to prior study as well.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess L pneumothorax and worsening vs. improvement History: L pneumothorax, apical, measured 29.9 mm, then 24 mm; assess progression/stability/improvement Minimal residual left apical pneumothorax, decreased compared to previous.Small lung volumes with streaky bilateral opacities compatible with subsegmental atelectasis.Medial left upper lobe opacity compatible with consolidation/contusion.

Output: Minimal residual left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: chf History: sob Mild lordosis. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: 80F with crackles and fever History: fever and crackles on exam Cardiomegaly with interstitial and more focal basilar opacities as well as being bilateral pleural effusions are present. The effusions have progressed from prior may reflect progression of CHF or aspiration/infection. Right jugular line tip over the SVC. No pneumothorax.Dobbhoff tube at least in the stomach.

Output: Cardiomegaly with interstitial airspace opacities with increasing pleural effusions may reflect progression of CHF or aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Heart mate ventricular device insertion, CABG x1 using LIMA, MVR, tricuspid DeVega of procedureSurgery over 8 hours, counts correct. Intraoperative radiographs at 18:27 hours.ETT tip well above the expected level of the carina.Right jugular Swan-Ganz catheter tip at the level of the main pulmonary artery.Esophageal probe near the level of the carina. Surgical retractors.Cardiac assist device, mediastinal and pleural drains partially visualized.Left subclavian ICD unchanged in position.Open sternotomy.Layering pleural fluid with atelectasis and pulmonary edema, moderate, right greater than left.

Output: Intraoperative film demonstrating moderate layering pleural fluid, pulmonary edema and atelectasis. No unexpected RFO.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: shortness of breath History: shortness of breath, wheezing, rhonchi on exam Left IJ venous catheter with its tip in the RA.Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Rule out infection History: Has head and neck cancer, reporting productive cough with elevated WBC and fever New left upper lobe opacity compatible with infection or radiation reaction, depending on the clinical situation.Mild streaky opacity at the left base compatible with atelectasis.Port catheter with its tip in the SVC.

Output: New left apical opacity compatible with infection or radiation reaction depending on the clinical history.


Instruction: Generate impression based on medical findings.

Input: Reason: TOA History: Fever 40.7 Unremarkable cardiac and mediastinal silhouette. Mild blunting of the posterior costophrenic angles suggestive of small pleural effusions and atelectasis.No signs of pneumonia.

Output: Probable small pleural effusions and atelectasis but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Chest pain and shortness of breath. Median sternotomy hardware and cardiomediastinal silhouette are unchanged. Low lung volumes with nonspecific basilar opacities, which may represent atelectasis.

Output: Lung volumes with nonspecific basilar opacities, which may represent atelectasis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: pulm edema History: sob Moderate cardiomegaly, as before. Prominent azygos vein, unchanged. Dense retrocardiac opacities, unchanged. No acute bony abnormality. No definite pleural effusion or pneumothorax.

Output: Unchanged moderate cardiomegaly and prominent azygos vein. Persistent dense retrocardiac atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval infection vs edema History: hypoxia NG tube tip in stomach.No change in nonspecific basilar opacities likely atelectasis or aspiration.

Output: No change in nonspecific basilar opacities likely atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: s/p MVR; h/o AVR/Septal Myomectomy History: SOB Limited assessment of the mediastinum.Status post median sternotomy, valvular replacement and CABG.Lung volumes. Assessment of the lungs in the lateral view is very limited. No signs of pulmonary edema.Small bilateral pleural effusions are noted. No pneumothorax.

Output: Status post valvular replacement and CABG. No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 82 year old male with shortness of breath Interval extubation. Bilateral patchy and reticular opacities are again noted, slightly increased in the left perihilar region. Probable small pleural effusions. No pneumothorax. Stable cardiomediastinal silhouette. Right posterior lateral rib deformity unchanged.

Output: Chronic interstitial opacities with slight increase in the left perihilar region which could be due to aspiration or edema.


Instruction: Generate impression based on medical findings.

Input: Swan position. Swan-Ganz catheter tip projects over the proximal left main pulmonary artery. Central pulmonary vasculature is markedly enlarged, consistent with severe pulmonary hypertension. Chronic right diaphragmatic elevation and pleural retraction and superimposed small to moderate volume of pleural fluid about the same. Partially circumscribed opacity projecting over the left scapular tip, probably in the chest wall.No specific evidence of pulmonary edema.

Output: Swan-Ganz catheter tip at the proximal left main pulmonary artery. There appears to be a large left chest wall mass at or near the level of the left scapular tip which may be assessed with CT when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Status post liver transplant. Bilateral mid and lower lung parenchymal opacities are again present, slightly improved on the left. This may reflect slightly improved edema or possibly infection. Tracheostomy tube again noted. Bilateral jugular catheters tips both over the SVC. No pneumothorax.

Output: Bilateral lower lung opacities, slightly improved in the left.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Shortness of breath question pulmonary edema Right jugular catheter tip at the SVC. Left subclavian ICD unchanged. Low lung volumes with increase in basilar subsegmental atelectasis. No specific signs of pulmonary edema. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: No specific signs of pulmonary edema however dependent and basilar atelectasis is slightly worse along with a decrease in lung volumes.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Lung field progression. History of cough. Right IJ central venous catheter is in stable position terminating near the cavoatrial junction. Stable cardiomegaly. There is improved interstitial opacities with stable small effusions. No pneumothorax.

Output: CHF with mild improvement in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 44 years old Male. Reason: eval for effusions or pna History: ventilated. There is interval improvement on the bilateral pleural effusions and patchy opacities as compared with prior study. The tracheostomy tube is stable in position. There is a no evidence of pneumothorax.

Output: Improvement of the bilateral pleural effusions and basilar opacities as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: 61 year female with history of pancreatic cancer CHEST:LUNGS AND PLEURA: Calcified right middle lobe granuloma.MEDIASTINUM AND HILA: Calcified right hilar and mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mildly nodular inferior aspect of the liver.Cholecystectomy. Mild intrahepatic prominence persists.SPLEEN: SplenectomyPANCREAS: Distal pancreatectomy.8 x 4-mm hypodensity in the pancreatic uncinate process is gradually increasing in size over several examinationsADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Duplicated collecting system on the right.RETROPERITONEUM, LYMPH NODES: Persistent soft tissue infiltration along the celiac axis is again identified. Small mesenteric and retroperitoneal lymph nodes remain.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: Subcentimeter cystic lesion in the uncinate process, slowly increasing in size. Stable soft tissue infiltration along the celiac axis status post distal pancreatectomy.


Instruction: Generate impression based on medical findings.

Input: Edema, cardiopulmonary evaluation. No specific signs of pulmonary edema. No focal airspace opacities, visible pleural fluid or pneumothorax. Heart size appears normal.Metallic chain or wire looped overlying the midline cervical spine and airway incompletely visualized, correlate with physical exam.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with lactic acidosis, tachycardia CHEST:LUNGS AND PLEURA: Bilateral, extensive, dense groundglass opacities, more centrally oriented, however, involving most of the bilateral lung parenchyma. Bilateral small pleural effusions, more on the left side than on the right.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metallic artifact within the lower thoracic spinal canalOTHER: Right common iliac artery is occluded. There is a stent in the proximal left common iliac artery. Vascular graft in the left lower extremity is thrombosed.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Percutaneous cystostomy catheter. Bladder is not well distended, therefore its wall cannot be optimally evaluated.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multiple fluid collections in the pelvis centered around the left hip joint. Largest pocket measures 5 x 2.5 cm image number 186/223. Bone destruction involving bilateralhips, sacrum and coccyx. The patient is status post bilateral hip disarticulation. Myositis ossificans in the pelvis and upper thighs.Extensive inflammatory changes and edema involving the soft tissues of the pelvis and subcutaneous tissues of the pelvis. OTHER: No significant abnormality noted

Output: Bilateral extensive dense, groundglass opacities replacing most of bilateral lung parenchyma. These may be secondary to ARDS versus pneumonia.Multiple pelvic soft tissue abscesses with extensive destruction of the pelvic bones. MRI of the pelvis may better delineate these abscesses.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute process History: chest pain Probable mild cardiomegaly or pericardial effusion, though the cardiac silhouette is magnified by portable technique.No evidence of pulmonary edema or other acute pulmonary disease.

Output: Probable cardiomegaly or pericardial effusion, but no significant pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: s/p bilateral lung transplant History: none Interval removal of right basilar chest tube. There is very small residual right apical pneumothorax as well as a small amount subcutaneous emphysema in the soft tissues of the right lateral chest.Stable position of left-sided chest tube with no evidence of left pneumothorax.Stable appearance of cardiomediastinal silhouette.

Output: Minimal right apical pneumothorax following removal of right-sided chest tube. Remaining findings are unchanged with no other acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: r/o pna, pulm edema History: fatigue Severe cardiomegaly and/or a pericardial effusion.No specific evidence of infection or failure.Left subclavian ICD, leads unchanged in position.Left PICC, tip in left innominate vein.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: Patient is a 67 year old female with DM2, dementia, s/p DKA who spiked fever History: febrile Dobbhoff tube tip in stomach.New right middle lobe airspace opacity which may be due to infection, aspiration or atelectasis.

Output: New right middle lobe airspace opacity which may be due to infection, aspiration or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: Persistent cough x 5-6 weeks, evaluate for cause History: cough Cardiac silhouette is normal in size.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: fall, xray History: fall , chest pain No significant cardiopulmonary abnormality.Heart size upper normal.No specific evidence of infection or edema.No evidence of a displaced rib fracture or pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.LVAD. Chronic congestive heart failure. Hardware and devices unchanged in position.Minimal basal/dependent atelectasis. No specific signs of pulmonary edema.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 62F coughx3 weeks, look for PNA, effusion History: productive cough, fever Unremarkable cardiac and mediastinal silhouette. Perihilar bronchial thickening compatible with bronchitis.Mild focal scarring in the lingula.No sign of pneumonia

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 19 years old Male. Reason: assess for PNA History: intubated. There is interval worsening of extensive pulmonary opacities and bilateral pleural effusions. The tip of the ET tube is about 3 cm above the carina. The NG tube and right jugular catheter are stable in position. There is no evidence of pneumothorax. Cardiac silhouette appears prominent.

Output: Interval worsening of extensive of pulmonary opacities, which are most likely due to edema. Interval worsening of the bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: Post extubation History: post extubation Interval extubation. Bilateral venous catheters unchanged.Bilateral pleural effusions with underlying atelectasis.No new findings.

Output: Interval extubation with persistent effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: eval for pna History: shortness of breath, COPD Small lung volumes with increasing retrocardiac consolidation and an enlarging left pleural effusion.Stable right pleural effusion still compressing the right lung.Right PICC, tip in axillary region.

Output: Increasing left lower lobe consolidation and left pleural effusion, with extensive consolidation on the right.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated and assessing ET tube placement History: intubated ET tube tip approximately 3 cm above the carina.Catheters extending to the SVC.Small lung volumes with moderate pleural effusions and underlying atelectasis, unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of chest, status post hepatic resection CHEST:LUNGS AND PLEURA: Biapical scarring. Bibasally or subsegmental atelectasis. Stable micronodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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: Previously measured pelvic implant is increased in size and now measures 6.4 by 6 cm on image number 169, series number 7.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.

Output: Interval increase in the size of the pelvic implant.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: IABP Aortic balloon catheter marker in the proximal descending aorta.Right jugular catheter and ICD leads unchanged.Cardiomegaly with no specific evidence of pulmonary edema or infection.

Output: Cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Right IJ placement History: none Cardiomegaly, grossly unremarkable but limited technique.Right jugular catheter, tip in SVC.ET tube tip approximately 3 cm above the carina.

Output: Right jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: 15 years old male with CGD with new findings on prior CT for indolent infection, repeat CT for prep for lung biopsy.IMAGE ACQUISITION:No contrast was administered. The chest was scanned from lung apices to hemidiaphragms. Reconstructions were performed axially and coronally. MIP, minIP, and high-resolution reconstructions were also done. LUNGS AND PLEURA: Again seen are scattered patchy air space opacities within the right upper lobe, some of which extend along the right upper lobe segmental bronchi to the peripheral parenchyma. Air space opacities are also seen in the left hilum with minimal extension along the lingular bronchus. These findings are unchanged from the prior examination. MEDIASTINUM AND HILA: Excess soft tissue is again seen in the subcarinal space which may represent lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Multiple foci of pulmonary air space opacities which could represent opportunistic infection such as fungal lesions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Acute respiratory failure ICD, LVAD, tracheostomy tube and Dobbhoff are all unchangedUnchanged cardiopulmonary appearance, basilar consolidation and large effusions persist

Output: LVAD unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: Pain to Left Chest was in a car accident 2 days ago History: Pain to left chest, short of breath was in a car accident 2 days ago Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval line placement History: triple lumen placed Partial right upper lobe collapse increased. Basilar atelectasis may also be from aspirated secretions or mucous plugging.Two NG tubes appear to be in place.Left jugular catheter, tip in SVC.ET tube tip approximately 4 cm above the carina.

Output: Increased right upper lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: extubated, line assessment History: line assessment Moderate cardiomegaly with enlarging pleural effusions and worsening basilar opacities.Status post extubation. Right jugular catheter, tip in SVC.

Output: Worsening pleural effusions and basilar opacities following extubation.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: evaluate for resolution vs expansion of Rt apical PTX History: as above Interval resolution of right apical pneumothorax. A small right pleural effusion remains with a component of fluid into the right apex. Bibasilar opacities and a moderate left pleural effusion are unchanged. The heart size is stable. Interval removal of an enteric tube.

Output: Resolution of right pneumothorax with grossly unchanged bilateral pleural effusions.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, 83 years old.Reason: cough, ams, History: cough ams Mild cardiomegaly.Right base scarring or subsegmental atelectasis.No specific evidence of infection or edema.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: MaleReason for Study: Reason: post thora History: none Left-sided ICD unchanged.Stable cardiomediastinal silhouette.Increased aeration left lower lobe with mild residual atelectasis.No new pulmonary opacities identified.Surgical clips in the left neck.No evidence of a pneumothorax post thoracentesis.

Output: Interval decrease in left pleural effusion and improved aeration of the left lung base post-thoracentesis. No pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT History: ETT ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Bilateral lower zone airspace opacities suggestive of aspiration, unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: assess swan position History: swan Swan-Ganz catheter tip in the right main pulmonary artery.Interval removal of aortic balloon catheter and extubation.Bilateral opacity compatible with edema, atelectasis and small pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Cough, heart failure Moderate cardiomegaly. Mild interstitial pulmonary edema. No acute bony abnormality. Defibrillator lead terminates in expected location of the RV.

Output: Moderate cardiomegaly. Mild interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o ptx History: rt sided cp Unremarkable cardiac and mediastinal silhouette. Moderate perihilar bronchial thickening suggestive of asthma in this age group.No sign of pneumothorax or other acute change.

Output: Bronchial thickening suggestive of asthma and no acute change.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with stage III follicular lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Six by 8mm pretracheal lymph node on image number 20, series number 3.CHEST WALL: Bilateral axillary extensive adenopathy. The left axillary referenced lymph node measures 3 x 2 cm in image number 27, series number 3.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: Left extrarenal pelvis. Right extrarenal pelvis and dilated collecting system and dilated pelvis, unchanged from previous study and may represent a UPJ obstruction. Stone in the upper pole of the left kidney without evidence for hydronephrosis.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. A left aortic lymph node measures 13 x 12 mm on image number 138, series number 3. This lymph node was measuring 10 x 10 mm image number 56, series number 7 on the previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: Right external iliac referenced lymph node measures 3 x 1.2 cm image number 181, series number 3. This lymph node was measuring 2.9 x 1.3 cm image number 100, series number 7 on previous study. Bilateral pelvic adenopathy.Bilateral inguinal adenopathy. Right inguinal referenced lymph node now measures 20 x 60 mm image number 194, series number 3. Previously was measuring 19 x 60 mm image number 112, series number 7.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral axillary, retroperitoneal and pelvic adenopathy. No significant change in the size of the abdominal and pelvic adenopathy compared to previous study.Possible right UPJ obstruction. Left renal stone. Left extrarenal pelvis.


Instruction: Generate impression based on medical findings.

Input: Reason: seizure History: seizure Unremarkable cardiac and mediastinal silhouette. Port catheter with its tip in the SVCFocal streaky opacity in the left lower lobe consistent with subsegmental atelectasis or scarring.No specific evidence of pneumonia.

Output: Left lower lobe subsegmental atelectasis which may be due to aspirated secretions, and no other acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: r/o ptx, contusion History: assault No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: chronic cough for a few weeks History: cough for a few weeks- needs to rule out occult cardiopulmonary issues Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.ET tube placement ET tube tip is 4.7 cm above the carina. Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: ET tube tip is 4.7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with history of pulmonary MALT lymphoma CHEST:LUNGS AND PLEURA: Postoperative changes from right thoracotomy with stable parenchymal scarring and pleural thickening. Previous is seen right lower lobe nodule is smaller measuring 5-mm on image number 59, series number 4. Other subcentimeter nodules in the right middle lobe and right lower lobe are unchanged. No new lung nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. Previously seen low density lesions in the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Anterior third fibroid is stable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in one of the right lower lobe nodules. Other nodules are stable. No other significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: PNA? History: see above Moderate and possibly worsening pulmonary opacities suggestive of edema or ARDS.Severe scoliosis.Tracheostomy tube, the tip at the level of the thoracic inlet.Right PICC, tip in the SVC.

Output: Pulmonary opacities suggestive of edema or ARDS, possibly worse and fairly intense. Diffuse infection is also in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: 82 year old female with non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Left lower lobe subsegmental atelectasis unchanged. Emphysema, unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable vena cava filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic L1 vertebral body lesion.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 significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: recent pneumonia, sob, palpitations History: sob Right middle lobe consolidation consistent with infection, not significantly changed.Elsewhere, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Unchanged right middle lobe opacity consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: MaleReason for Study: Reason: Soft tissue sarcoma left leg, evaluate for metatasis History: above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: pna? History: copd/asthma with focal lung findings Stable cardiomediastinal silhouette.Emphysematous changes again seen. Again seen is a cavitary lesion with air-fluid level in the superior right lower lobe. Mild bibasilar pleural thickening. No pneumothorax.

Output: No significant interval changes with redemonstration of cavitary lesion with air-fluid level in the superior right lower lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: hx aspiration pneumonia currently on treatment History: hx aspiration pneumonia currently on treatment Patchy right-sided opacity consistent with focal pneumonia, not significantly changed.No new findings.Stable spinal hardware, gastrostomy tube, left subclavian catheter and tracheostomy tubes.

Output: Persistent right-sided opacity suggestive of infection.


Instruction: Generate impression based on medical findings.

Input: 52 year-old female with metastatic breast cancer CHEST:LUNGS AND PLEURA: Pleural nodularities in the lung bases posteriorly remain, with a reference area measuring 6 x 4 mm in the right midlung posteriorly, previously 5 x 4 mm (series 3; image 52)MEDIASTINUM AND HILA: Prominent lymph nodes posterior to the pectoralis major are unchanged in size.CHEST WALL: Right axillary lymph node measuring 2.3 x 1.3 cm, previously 2.3 x 1.5 cm (series 3; image 32)The previously described left breast mass has not grossly changed in appearance but cannot be reliably measured. Left mastectomy.The right portal terminates in the right atrium. ABDOMEN:LIVER, BILIARY TRACT: Presumed hemangioma in segment VII of the liver, unchanged SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild caliectasis, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic focus in the midline the sacrum remains.OTHER: No significant abnormality noted.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Reason: resp failure History: s/p bronch Extensive opacification of the left hemithorax, with underlying nonspecific consolidation and atelectasis. Focal opacity at the right base consistent with consolidation and atelectasis. New ET tube with its tip about 2 cm above the carina. Swan-Ganz catheter tip in the right main pulmonary artery.LVADs unchanged.

Output: Continued extensive consolidation and atelectasis in the left lung.ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Swan-Ganz. Assess tubes and lines. Right jugular Swan-Ganz catheter projects over the right interlobar artery. IABP marker no longer identified and may have been removed. Right-sided aortic arch, normal variant anatomy.Coarse interstitial markings superimposed upon emphysema unchanged.Vascular calcifications in the distribution of the left carotid artery.

Output: IABP marker no longer identified. Unchanged position of Swan-Ganz catheter. Static appearance of coarse interstitial markings may indicate fibrosis rather than pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: Hx - COPD ? Infiltrate Pre-op for AAA repair History: Cough COPD with large lung volumes.Heart size normal.Status post CABG.

Output: Severe COPD. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: line placement History: line placement Stable position right IJ central catheter. Blunting of the left costophrenic angle from scar or subsegmental atelectasis. Right infrahilar opacities nearly completely resolved. The heart size remains normal. No pneumothorax.

Output: No pneumothorax. Right central catheter is unchanged in position.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: r/o infiltrate History: cough, weakness, occ productive The cardiomediastinal silhouette is unremarkable.Left basilar scarring/discoid atelectasis new from the prior exam.No focal areas of consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 70 years old Female. Reason: tube placement History: as above. Stable extensive airspace opacities in the left upper lobe superimposed upon severe emphysema. Faint hazy opacity in the right upper lobe and left lower lobe about the same. The right jugular catheter, ET tube and NG tube are stable in position.

Output: Extensive airspace opacities in both lungs, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: assess for acute process History: chest pain Moderate cardiomegaly.No evidence of edema. No significant sized pleural effusions.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly, without acute edema, effusions or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval rib fracture, pneumothorax History: L sided chest pain s/p peds vs auto No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.No obvious displaced rib fracture identified.

Output: No pneumothorax.No obvious rib fracture. Note that chest radiograph is insensitive for rib fracture.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, 58 years old.Reason: PICC line placement History: PICC line placement, want to verify location Left upper extremity PICC tip projects over the left subclavian vessels, near the midportion of the left clavicle. Cardiomediastinal silhouette is within normal limits. Mild bibasilar subsegmental atelectasis. No specific radiographic evidence of edema or infection. Mild spinal curvature.

Output: Left upper extremity PICC tip projects over the left subclavian vessels, near the midportion of the left clavicle. 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: Chest tightness and pain No cardiopulmonary abnormality. Unchanged 2-lead left subclavian ICD

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Patient presents with cough and chest pain. No focal airspace opacity.The cardiomediastinal silhouette is normal.

Output: No significant cardiopulmonary abnormality. No specific evidence of pneumonia or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Tracking pleural fluid History: Pleural fluid Diffuse mainly lower zone interstitial and airspace opacity, compatible with edema or aspiration.Right pleural effusion and calcified pleural plaques on the left.Catheter tip in the SVC.

Output: Persistent right pleural effusion and pulmonary opacity, slightly improved on the left side.


Instruction: Generate impression based on medical findings.

Input: Sickle cell disease and chest pain Mildly improved aeration, however lung volumes remain decreased. Patchy streaky densities in both bases again suggest probable atelectasis mixed with scarring. Vascular redistribution pattern is also similar and is oblique baseline.Right PICC line removed.Extensive skeletal changes consistent with known sickle cell disease including AVN of both shoulders.

Output: Nonspecific pulmonary changes likely old scarring and atelectasis. No discrete distinct findings to suggest acute airspace abnormality however close serial imaging may be needed if suspicion remains high


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.ETT. Shortness of breath. Low position of the endotracheal tube with tip less than 1.5 cm above the level of the carina.Cardiomegaly, right hilar region mass, pulmonary nodules and perihilar edema-like abnormality without significant change.

Output: Low endotracheal tube, less than 1.5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Eval ETT placement, evaluate for consolidations History: OSH transfer, intubated, h/o VAP Endotracheal tube terminates approximately 4 cm from the carina. PICC and catheter appear to terminate near the cavoatrial junction. Enteric tube likely terminates in the stomach though the severe leftward patient rotation makes detailed evaluation difficult. Near complete whiteout of the left hemithorax has improved since previous study. Question new right basilar opacity. Heart size, difficult to assess.

Output: Endotracheal tube terminates approximately 4 cm from the carina. Near complete whiteout of the left hemithorax has improved since previous study. Question new right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: s/p R thora History: s/p R thora No pneumothorax following thoracentesis, the right pleural effusion significantly smaller than the prior study.Unchanged left pleural effusion with overlying atelectasis and diffuse pulmonary edema.Right jugular catheter, tip in SVC.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.

Output: No pneumothorax following right thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: s/p esophagectomy History: Needs walker NG tube has been removed.Right-sided chest tube unchanged.Persistent right apical pneumothorax.Pleural effusions with perihilar/basilar edema and left retrocardiac consolidation/atelectasis similar to the prior exam.Surgical clips left axilla redemonstrated.

Output: Removal of NG tube. Pleural effusions with perihilar/basilar edema and atelectasis similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. Swan-Ganz catheter tip in the right main pulmonary artery.ICD lead projected superior to the right ventricular apex.Cardiomegaly with increased upper zone blood flow but no sign of pulmonary edema.

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


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with history of Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Anterior mediastinal soft tissue mass measures 5 by 3.2 cm on image number 31, series number 3 at the level of the aortic arch. Bilateral hilar adenopathy is also present.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Spleen measures 10 cm, normal in size. No focal splenic lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small perigastric and portacaval lymph nodes. No evidence of enlarged lymph nodes by CT criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral ovarian cystic lesions, likely physiologic.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: Anterior mediastinal and bilateral hilar adenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p TPC with minimal output History: effusion Pleural catheter projected over the right lower lung with its tip directed superiorly at the level of the hilum.Loculated right pleural effusion and bilateral pulmonary metastases, not significantly changed.Port catheter with its tip in the SVC.

Output: Loculated right pleural effusion and multiple pulmonary metastases without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Left chest tube removed, a presumed pericardial drain still in place.Basilar consolidation left greater than right unchanged.ET tube tip 8 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular introducer unchanged.

Output: Left chest tube removed with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: is there an infiltrate History: cough and back pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.LV lead low impedance, check placement. Left subclavian ICD leads are unchanged in position and appear intact. No pneumothorax or focal airspace opacity. Upper normal heart size. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed. Atherosclerotic calcification of the thoracic aorta noted.

Output: Unchanged position of the ICD leads. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT; ADMISSION TO ICU ET tube with its tip 3 cm above the carina.Left IJ Swan-Ganz with its tip in the pulmonary artery.Bilateral chest tubes noted with tips at the bases and apices.Cardiac size is normal.Left basilar atelectasis and small pleural effusions compatible with postsurgical changes.No significant pneumothorax.Clamshell sternotomy.

Output: Postsurgical chest with left basilar atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, check for pneumonia Questionable early edema, greater on the left with decreased lung volumes and mild cardiomegaly. See subsequent reports

Output: Suspected mild early edema


Instruction: Generate impression based on medical findings.

Input: Sarcoidosis concern. Check for lymphadenopathy No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Edema vs. PNA History: SOB Stable cardiomediastinal silhouette. Low lung volumes. Right upper lobe and bilateral perihilar and basilar interstitial opacities, compatible with chronic fibrosis, not significantly changed accounting for differences in technique and lung volumes.No new focal air space abnormality. No large pleural effusions.

Output: Chronic interstitial lung disease, without significant interval change. Specifically, no evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: evaluate for PNA/consolidation History: tachycardic, SOB, cough, recent fevers Right mid and lower lung zone airspace opacities are consistent with infection.Heart size normal.Prior right jugular catheter removed.

Output: Right mid and lower lung zone opacities consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: hx hydropneumothorax, IR drain in subQ space History: above Left pleural drain projected outside of the thorax in the soft tissues, with a left subpulmonic pneumothorax.Small lung volumes with unchanged left basilar opacity.Tracheostomy tube tip approximately 3 cm above the carina.Left PICC and right jugular catheters terminate in the SVC.A Dobbhoff tube extends below the lower margin of the image.

Output: Left pigtail catheter projected in the soft tissue within underlying left hydropneumothorax, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: newly dx with lung CA History: hemoptysis Right upper lobe mass which may extend into the superior segment of the right lower lobe. Surrounding opacities raise the question of associated edema or hemorrhage. There is loss of the inferior cortex of the right sixth rib, raising the question of osseous invasion.In the left upper lobe, there is a partially calcified nodule. No significant pleural effusion or pneumothorax. The heart size is normal. Suspected right hilar lymphadenopathy.

Output: Right upper lobe mass with surrounding opacities suspicious for edema or hemorrhage. Left upper lobe, partially calcified nodule. Correlation to potential outside cross-sectional imaging may be performed when it becomes available or a CT thorax at this institution may be obtained for further characterization.


Instruction: Generate impression based on medical findings.

Input: Male 6 days old; Reason: PCVC placement from Scalp, confirm line placement. History: Patient with cardiopulmonary failure on oscillator.VIEW: Chest AP (one view) 8/9/2016 0227 Endotracheal tube is between the thoracic inlet and carina. The enteric tube tip is beyond the field-of-view. The umbilical artery catheter is overlying T7 and the umbilical venous catheter tip is in the right atrium. The right peripheral venous catheter is seen in the right brachiocephalic vein. Diffuse, granular haziness persist. Cardiomediastinal silhouette is within normal limits. A small amount of fluid can be seen in the horizontal fissure of the right lung.

Output: Diffuse, granular hazy pattern of RDS persists.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for interval change and possible pleural effusion. History: Low-grade fevers and worsening respiratory. status. Small lung volumes with diffuse nonspecific airspace opacity, not significantly changed, suggestive of ARDS.No specific evidence of infection or other acute change.No visible pleural effusion though there may be small effusions in the posterior costophrenic angles.Tracheostomy tube and venous catheters unchanged.

Output: Diffuse nonspecific airspace opacities suggestive of gas, without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate for infiltrate/effusion History: none Mild nodular left basilar scarring also seen on prior CT, the lungs are otherwise unremarkable.Heart size normal, status post median sternotomy.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval for PNA versus pleural effusions History: SOB, Hx of cirrhosis Cardiomediastinal silhouette is unremarkable. Lungs clear of airspace and interstitial opacities. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.PICC third adjustment. Left PICC tip in the projection of the left jugular vein, cranial to the left subclavian vein. Enteric tube unchanged with tip projecting over the stomach.Moderate left and small right pleural effusions. Basal and dependent atelectasis is improving. Possible mild pulmonary edema.

Output: PICC tip projects over the left jugular vein.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.ETT pulled back. ETT tip 4 cm above the level of the carina.Enteric tube tip projects over the stomach but the sidehole is above the GE junction, suggest advancement.Well-circumscribed nodular opacity projecting over the right midlung on the comparison study is well-circumscribed and may reflect asymmetric nipple shadow, correlate with physical exam.

Output: ETT tip 4 cm above the carina. Suggest NGT advancement.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Sickle cell disease with crisis and chest pain. Mild scoliosis. Moderate cardiomegaly, progressed since the prior radiograph. Lung volumes diminished, low normal. Superior mediastinal widening may be secondary to hypervolemia and similar to the scout radiograph from CT dated 12/22/2009. Enlargement of the central pulmonary vasculature consistent with pulmonary hypertension. No pleural fluid. No focal air space opacities. Scarring at the lung bases. Diffuse skeletal sclerosis, present previously.

Output: Cardiomegaly has increased since the previous study, now with signs of pulmonary hypertension and hypervolemia. No focal air space opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: eval lung fields History: eval lung fields - s/p lung transplant Status post bilateral lung transplants. Support tubes and lines unchanged.Extensive pulmonary opacities with cystic appearing lesions in the right perihilar and right apical region and bilateral pleural effusions similar to prior exam.Cardiac mediastinal silhouette unchanged.No new pulmonary opacities identified.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Evaluate for edema History: recent MI with SOB, history of sarcoidosis Normal heart size. Dilated left main pulmonary artery, consistent with pulmonary arterial hypertension.Chronic elevation of the left hemidiaphragm with streaky linear opacities at the left greater than the right lung bases, consistent with segmental atelectasis/scarring. Stable biapical emphysematous changes.No pneumothorax.Left subclavian ICD with leads in unchanged position.

Output: Bibasilar opacities, consistent with subsegmental atelectasis/scarring. No specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: NG tube placement NG projects in the inferior to the image. Right jugular catheter extends into the SVC just be on the confluence.Underlying cardiopulmonary appearance is otherwise similar with diffuse unchanged mixed interstitial and patchy opacities again most suggestive of edema and/or ARDS. No distinct new superimposed focal airspace abnormality

Output: NG tube placement


Instruction: Generate impression based on medical findings.

Input: Reason: Preop MVR History: Preop MVR Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: cp History: cp Port catheter again noted terminating within the superior aspect of the right atrium. Improvement in pulmonary edema. No focal lung consolidation. No pleural effusion or pneumothorax. Mild cardiomegaly, improved from previous study. No acute bony abnormality.

Output: Improvement in pulmonary edema. No focal lung consolidation. Improvement in heart size.


Instruction: Generate impression based on medical findings.

Input: CABG and aortic valve replacement Swan-Ganz, ICD mediastinal and left chest tubes all unchanged. ETT remains 2 cm from the carina. No appreciable free pneumothorax however a small lucency overlying the lung base may represent a small loculated collection versus bowel gas, all unchanged.Persistent decreased lung volumes with mild basilar patchy changes most likely atelectasis with questionable small effusion

Output: Unchanged chest tubes


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with metastatic prostate cancer who failed chemotherapy. CHEST:LUNGS AND PLEURA: New focus of fibrosis is evident within the medial right lower lobe (axial image 71/91) which is unlikely to represent tumor.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: A hyper-attenuating segment 7 liver lesion measures approximately 2.3 x 1.7 cm on axial image 83/212 and is grossly unchanged in size. The lesion retains contrast on delayed images and probably represents a benign hemangioma. Multiple additional hypoattenuating lesions are identified within the right lobe of the liver, some of which are new. Some of these lesions are very low in attenuation and probably represent benign cysts while others (axial image 81/212 and 102/212) are intermediate in attenuation and may represent metastatic disease. The largest of these new lesions measures approximately 1 x 1 cm on axial image 102/212.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: The previously noted soft tissue nodule adjacent to the left adrenal gland has decreased significantly in size measuring 6 mm on axial image 93/212 (previously measured 0.9 x 0.9 cm). An additional soft tissue nodule adjacent to the upper pole of the right kidney has also significantly decreased in size measuring approximately 4 mm on axial image 88/212.BOWEL, MESENTERY: Multiple surgical clips evident within the abdomen.BONES, SOFT TISSUES: Bony metastatic disease is evident in multiple vertebral bodies, the pelvis, the right scapula and multiple ribs which appears grossly unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The region of the prostate is enlarged which may reflect the patient's primary tumor.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple surgical clips as above.BONES, SOFT TISSUES: See above.OTHER: No significant abnormality noted

Output: 1.New right lower lobe fibrosis, unlikely to represent tumor.2.Multiple new liver lesions which may reflect metastatic disease. Additional stable liver lesions as above which are likely benign.3.Previously noted soft tissue nodules have decreased in size.4.Extensive bony metastatic disease is grossly unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Patient with history of pneumonia. Evaluate. Endotracheal tube tip at the thoracic inlet. Enteric tube tip beyond the field of imaging. Low lung volumes. Interval worsening of bilateral basilar opacities which may represent atelectasis with underlying consolidation, specifically in the left base is not excluded. No pneumothorax.

Output: Low lung volumes with worsening bilateral basilar opacities which may represent atelectasis with underlying consolidation in the left base not excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.PPD in the past. Encounter for screening for respiratory tuberculosis. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Mild scoliosis.

Output: Unchanged cardiopulmonary appearance. No signs of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient with cough and fever. r/o pna History: cough, fever Mild cardiomegaly with small pleural effusions, decreased from previous.Mild interstitial opacity compatible with resolving edema.No sign of pneumonia.

Output: Resolving CHF with no new findings.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with history of intubation. Endotracheal tube has been retracted with tip 4 cm above the carina. Right internal jugular catheter tip in the SVC. Left internal jugular catheter tip in the left brachiocephalic vein. Left upper extremity PICC tip in the SVC. NG tube tip in the proximal gastric body with the sidehole at the GE junction.Stable cardiomediastinal silhouette. Diffuse bilateral patchy air space opacities appear similar to prior.

Output: Endotracheal tube has been retracted with tip 4 cm above the carina. NG tube tip in the proximal gastric body with the sidehole at the GE junction. Otherwise stable cardiopulmonary appearance.