Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: pneumonia? History: cough, SOB Cardiomediastinal silhouette is unchanged and normal. Low lung volumes. Mild bibasilar subsegmental atelectasis. No specific evidence of infection or edema.

Output: Mild bibasilar atelectasis without other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: Intubated; ETT placement monitoring History: see above Bilateral pleural drains are unchanged with no pneumothorax. Loculated pleural fluid is unchanged.Stable patchy air space opacities.ET tube tip 3 cm above the carina.Right jugular catheter tip in SVC.NG tube coiled in proximal stomach.

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


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: ETT moved Endotracheal tube tip 2.5 cm above the carina. Enteric tube tip and sideholes project over the region of the gastric body.The cardiomediastinal silhouette is stable.Stable subsegmental basilar opacities and scar-like right upper lobe opacity. No pleural effusion.

Output: ETT 2.5 cm above the carina. Stable subsegmental basilar opacities and scar-like right upper lobe opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: balloon pump History: same Moderate cardiomegaly with aortic balloon catheter in the proximal descending aorta, unchanged. Swan-Ganz catheter tip in the area of the right ventricle.Bilateral interstitial opacity compatible with edema, unchanged. No new findings.

Output: CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 97 years old.Reason: Cause for SOB History: a fib with RVR, acute SOB Cardiomegaly with pleural effusions and basilar opacities suggestive of edema and atelectasis, unchanged.

Output: Unchanged pulmonary edema, atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: cough for 5days STAT please History: cough Right lower lobe airspace opacity consistent with infection or aspiration.Mild subsegmental atelectasis left lower lobe.Heart size normal.Possible right hilar fullness.

Output: Right lower lobe opacity suspected with pneumonia, but should be followed to complete resolution to exclude underlying tumor.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tubes History: chest tubes Right chest tube is in place with a small residual apical pneumothorax, decreased from previous.Nonspecific opacity in the right lung consistent with edema and atelectasis, with a small right effusion.

Output: Decreased right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: pulmonary edema, infection History: dyspnea on exertion Bilateral pleural effusions best seen on the lateral view.No other significant abnormality.Right axillary surgical clips.

Output: Bilateral pleural effusions, unknown etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval for infiltrates History: syncope, tachycardia to 120 Left lower lobe atelectasis over a mildly elevated left hemidiaphragm, unchanged.Elsewhere, the lungs are unremarkable.Mild cardiomegaly.Left subclavian pacemaker, leads unchanged in position.

Output: Nonspecific left basilar subsegmental atelectasis, but no reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: line placement History: line placement Significant progression of perihilar and basilar air space opacities.No change in position intertracheal tube.A right central venous catheter has been placed, the tip in the projection of the spurted vena cava. There is no pneumothorax. Line position otherwise stable.The cardiomediastinal silhouette remains within normal limits.

Output: 1. Development of bilateral perihilar and basilar airspace opacities.2. Interval placement of right internal jugular venous catheter. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Device placement Unchanged to lead left subclavian ICD without evidence of interval associated superimposed complication. Specifically lungs remain clear and well expanded.Cardiac and mediastinal contours remain within normal limits

Output: Left subclavian ICD placed without complication


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: chest pain History: chest pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: s/p oht History: -- Cardiomegaly status post sternotomy.Mild basilar edema and small pleural effusions unchanged.Unchanged support devices.

Output: Cardiomegaly with mild edema and pleural effusions unchanged. No new findings.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of large cell non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Right lower lobe subsegmental atelectasis. Early pneumonia cannot be excluded. Emphysema, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver, unchanged.SPLEEN: Splenomegaly. Ill-defined hypodense area at the periphery of the spleen likely represents an area of focal infarct.PANCREAS: 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: Multiple compression fractures involving the thoracic and lumber vertebral bodies are again noted. Compression fracture involving the L4 vertebral body looks more sclerotic on today's study.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: No significant abnormality notedOTHER: No significant abnormality noted

Output: Cirrhotic liver. Splenomegaly. Focal splenic infarct area has slightly increased in size.Small areas of air space opacity in the right lower lobe which may represent subsegmental atelectasis, however, early pneumonia cannot be excluded. Multiple compression fractures involving the lumbar and thoracic vertebral bodies.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: eval position of swan ganz Swan-Ganz catheter terminates within the interlobar pulmonary artery. Other iatrogenic devices, unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar Unchanged cardiomegaly. No pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old. Reason: Urothelial cancer, evaluate for progression in lungs History: urothelial cancer Heart size is normal with a calcified aorta.Large lung volumes with flattening of the diaphragms compatible with COPD.No focal areas of consolidation.No suspicious pulmonary nodules or masses.No pleural effusion or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Age: 18 yearsGender: FemaleReason for Study: Reason: intuBATED History: as above ET tube, left IJ venous catheter, and Dobbhoff tube unchanged.Cardiomediastinal silhouette unremarkable.Lungs are clear.No pleural effusions.

Output: Unchanged in position. No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: pulmonary edema? pneumonia? History: shortness of breath No focal opacity to suggest pneumonia. No evidence of significant pulmonary edema. Heart size stable.

Output: No evidence of pneumonia or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: sob, wheezing Volume loss and mild scarring in the left hemithorax consistent with previous upper lobectomy.No change and no sign of infection or other active disease.IVC filter in place.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Cardiogenic shock, ischemic cardiomyopathy. Right jugular Swan-Ganz catheter has been slightly advanced with tip at the level of the right main pulmonary artery. LVAD similar in position.Lung volumes remain low with significant basal atelectasis/consolidation. No pneumothorax or signs of pulmonary edema. Unable to exclude pleural fluid.

Output: No acute change in basal atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with renal cell carcinoma, status post chemotherapy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No change in expansile courteous but predominantly sclerotic lesion involving the right rib.ABDOMEN:LIVER, BILIARY TRACT: Multiple metastatic lesions are unchanged. Most of the liver parenchyma is replaced with these masses. Lesion in the left lateral segment measures 5.5 x 3.0-cm image number 100, series number 3. A second reference lesion in the right lobe measures 6.9 x 5.4 cm image number 113, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Evaluation of the left kidney is limited due to lack of IV contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination with a right rib lesion and multiple liver metastases


Instruction: Generate impression based on medical findings.

Input: 11 years, Male. Chest pain. Cardiac size is enlarged and increased in size as compared to prior exam. Retrocardiac opacity is noted, new as compared to previous exam. No pleural effusion or pneumothorax.

Output: New retrocardiac opacity, with increase in cardiomegaly as compared to prior exam, compatible with acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Interval mild repositioning of the IABP marker, currently 2 cm from the aortic archLVAD, mediastinal chest tubes and Swan-Ganz are all otherwise unchanged, the latter extends into the right pulmonary outflow tractModerate nonspecific cardiomegaly with layered effusions and mild perihilar and basilar edema

Output: IABP repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: suspission of TOS History: Pain Normal chest

Output: Normal chest. No evidence of cervical ribs.


Instruction: Generate impression based on medical findings.

Input: Age: 38 yearsGender: MaleReason for Study: Reason: eval lung fields History: s/p bivad Support devices unchanged.Stable cardiac enlargement.Increasing perihilar airspace interstitial opacities compatible with worsening edema.Bilateral pleural effusions.No evidence of pneumothorax.

Output: Support devices unchanged. Increasing perihilar airspace and interstitial opacities, particularly on the left, compatible with worsening edema.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Infiltrates History: fever Severe emphysema.Nonspecific basilar opacities with a small right pleural effusion, and possible focal pneumonia in the left midlung.Heart size normal.

Output: Severe emphysema. Possible edema and/or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Status post MVR and CABG,, history of rheumatic mitral stenosis. Evaluate lung fields POD #2. ETT tip about 2.5 cm above the level of the carina. Other hardware and support devices unchanged in position.Severe pulmonary edema, perhaps slightly worse even allowing for differences in technique.

Output: Severe pulmonary edema. ETT 2.5 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female with palpitations and history of sickle cell disease. Evaluate for acute chest. Right Port-A-Cath with tip in the SVC, unchanged. No focal pulmonary opacities, pleural effusions, or pneumothorax. Right upper quadrant surgical clips again seen.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p bivad w/ L effusion History: s/p cardiac surgery Cardiopulmonary monitoring and support devices, unchanged, with the aortic balloon catheter tip in the descending aorta about the level of T7.Small lung volumes with bilateral opacity compatible with atelectasis and a layered out left pleural effusion.No pneumothorax or other acute change.

Output: Possible increase in the left pleural effusion and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: evaluate lung expansion s/p thoracotomy History: post-op day 1 Left-sided chest tube unchanged.Stable cardiomediastinal silhouette.Pleural effusions left, greater than right, and basilar atelectasis similar in appearance to the prior exam.No new pulmonary opacities identified.No pneumothorax identified.

Output: Stable cardiopulmonary appearance. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: pna History: cough productive Low lung volumes makes detailed cardiopulmonary assessment difficult. Patchy basilar opacities. No large pleural effusion or pneumothorax. Mild cardiomegaly. Mild aortic atherosclerosis.

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


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: 54yoF w/ Hx of Asthma and PEs (on Lovenox) p/w recent Fall (5 days ago) and SOB : r/o PTX, hemothorax History: R-sided Rib pain, SOB Cardiac size is within normal limits. No pleural effusions, hemothorax, or pneumothorax. IVC filter partially seen on lateral view. Surgical clips overlie the bilateral breasts.

Output: No evidence of hemothorax or pneumothorax. Please see dedicated rib report for additional details.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: r/o mass, pna, obstructive lung dz, pe History: worsening sob x 1mo with doe, pmh a-fib on ac, steroid course for myasthenia gravis, 20+ pack years New basilar edema with pleural effusions.Moderate cardiomegaly unchanged.Left subclavian catheter, tip in SVC.Right subclavian pacemaker leads unchanged.

Output: New CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 36 yearsGender: MaleReason for Study: Reason: r/o cardiomegaly History: palpitations The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: screen pulm TB -- green card physical The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax. No evidence of tuberculosis.

Output: No acute cardiopulmonary disease. No evidence of tuberculosis.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with neuroendocrine tumor (additional history: thymic carcinoid) CHEST:LUNGS AND PLEURA: Left paramediastinal fibrosis with associated volume loss is again identified, compatible with prior radiationMEDIASTINUM AND HILA: Surgical clips remain in the mediastinum along with a small amount of fluid.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple small low attenuation lesions in the liver throughout both lobes are stable in size and number. One of these at the dome is a hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: The retroperitoneal mass adjacent to the left diaphragmatic crus measures approximately 4.3 x 1.4 cm (series 7; image 113), previously 4.6 x 1.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable lesion involving the left diaphragmatic crus. No other focus of disease.


Instruction: Generate impression based on medical findings.

Input: Evaluate for ileus Interval improvement in degree of bowel dilatation compared to prior abdominal radiography. Right-sided postprocedural sequela. Small to moderate residual contrast seen in right lower and pelvic bowel loops.Looped enteric tube seen with side-port in gastric body.Incompletely imaged patchy airspace disease.

Output: Improved bowel dilatation.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.History of heart failure. Preprocedure examination for ICD placement. Cardiomegaly with pulmonary vascular redistribution and underlying atelectasis/consolidation. No pleural effusion or pneumothorax. Sternotomy wires and mediastinal surgical clips in place. Aortic calcification.

Output: Cardiomegaly with pulmonary vascular redistribution and underlying atelectasis/consolidation.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: Right Pleurx catheter Moderate interval increasing and now large left pleural effusion with underlying atelectasis, however associated decrease in right pleural effusion with a similar position and right Pleurx catheter projected across the lung base.Upper lungs remain clear. No cardiac or mediastinal contour change

Output: Unchanged right Pleurx catheter with decreasing associated and now small effusion. Increasing left pleural collection


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: sob History: sob Improving right upper lobe but worsening left upper lobe opacities consistent with recurrent infection or aspiration.Small right pleural effusion.

Output: Pulmonary opacities consistent with ongoing infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: intubated History: intubated Lines and tubes are unchanged. Increased hazy left basilar opacity. Right lung is clear. Unchanged heart size. No pneumothorax.

Output: Increased hazy left basilar opacity which may represent small effusion or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Screening for respiratory tuberculosis Normal cardiac and mediastinal contours. No pleural or parenchymal abnormality.

Output: No evidence of respiratory tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Swan-Ganz projects to the right pulmonary tract just down the bifurcation. ETT removedMediastinal and bilateral basilar chest tubes are otherwise similar. Underlying cardiopulmonary appearance is also similar with layered effusions, mild cardiomegaly and diminished volumes with atelectasis

Output: Chest tubes unchanged and ETT removed


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Obstructive/restrictive lung disease with significant hypoxemia, ten-year smoking history Cardiomediastinal silhouette is top normal.No pleural effusion or pneumothorax.Enlarged right pulmonary artery. Large lung volumes suggestive of COPD. Mild reticular opacities in bilateral lung bases may represent scarring/interstitial changes. No focal airspace opacity.

Output: Large lung volumes suggestive of COPD with possible mild scarring/interstitial changes in the lung bases.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: ECMO History: above Severe cardiomegaly with moderate to severe pulmonary opacities consistent with edema, accompanied by pleural effusions.IABP catheter tip still at the top of the aortic arch. ECMO cannulae unchanged.ET tube tip approximately 1 cm above the carina.An NG tube terminates in the stomach.Left subclavian ICD, leads unchanged in position.

Output: Low ET tube. Unchanged severe pulmonary opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old. Fell a few months ago and has consistent pleuritic chest pain. Cardiomegaly.No evidence of infection or edema. No significant pneumothorax.Interval removal of left jugular catheter.Median sternotomy.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed lung cancer metastatic to scapula. Please evaluate disease status. CHEST:LUNGS AND PLEURA: 2.2 x 2.7-cm mass in the left lower lobe causing distal post obstructive pneumonia. 17 x 15 mm left lower lobe nodule suspicious for metastatic disease. Emphysematous changes. Biapical scarring.MEDIASTINUM AND HILA: Numerous mediastinal lymph nodes. A reference right paratracheal lymph node measures 17 x 13 mm image number 44, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple small hypodense lesions in the liver which are too small to accurate characterize. A reference lesion measures 15 x 11 mm. possible to metastatic disease cannot be excluded. Follow-up imaging is recommended.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm treated with stent graft. Largest AP dimension measures 4.7 x 4.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Possible lytic lesion in the left pubic ramus. Lytic lesion in the T11, L3 vertebral body and left scapula consistent with metastatic disease.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left pubic ramus lytic lesion suspicious for metastatic disease as described above.OTHER: No significant abnormality noted

Output: Left lower lobe mass with metastatic left lower lobe lung lesions and mediastinal adenopathy.Bone metastases as described above.Small nonspecific hypodensities in the liver, metastatic disease cannot be excluded. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: check pulmonary status ; hx chf History: Check pulmonary status ; hx chf Right IJ sheath remains in place. Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar pleuroparenchymal opacities, not substantially changed. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male 42 years old Reason: interval change in diffuse opacities History: worsening SOB, increasing FiO2 Cardiomediastinal silhouette is difficult to evaluate given opacities. Extensive bilateral interstitial and airspace opacities, appear increased on the right. No large pleural effusion identified. Bullet fragment again noted in the right hemithorax.

Output: Interval increase in airspace and interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female with history of pancreatic cancer. Status post chemotherapy needing restaging CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. Again noted bilobar metastatic lesions. Index lesion in the right lobe measures 3.7 by 4 cm on image number 96, series number 3, increased from previous study. Other metastatic lesions have also slightly increased in size compared to previous study.SPLEEN: Small nodules around the spleen likely representing splenules not significantly changed from previous study.PANCREAS: Larger cyst in the pancreatic body measures 2.9 x 3 cm on image number 100, series number 3, not significantly changed. Other cystic lesion in the tail measures 2.3 by 2.1-cm image number 107, series number 3, not significantly changed. Ill-defined heterogeneous area between the cystic lesions in the body of the pancreas likely representing patient's known adenocarcinoma is also grossly stable.Celiac trunk and SMA are encased by tumor and splenic vein is chronically thrombosed. Collateral vessels in the left upper quadrant.ADRENAL GLANDS: Stable left adrenal gland enlargement.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index peripancreatic lymph node measures 17 by 12-mm image number 101, series number 3, not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small fat containing paraumbilical hernia.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: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval increase in the size of the hepatic metastases.Pancreatic lesions are grossly unchanged. Retroperitoneal lymph nodes are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old with left chest pain for several months. Evaluate for intrathoracic lesion. The cardiomediastinal silhouette is normal. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax. No evidence of lymphadenopathy. No displaced rib fracture.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Hypoxia. Low lung volumes. The cardiac silhouette is at the upper limits of normal in size. The hila and pulmonary vasculature are within normal limits. Mild bibasilar atelectasis. Blunting of the left costophrenic angle may represent airspace disease or small effusion.

Output: Left basilar airspace disease versus small pleural effusion. Follow-up until resolution advised.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: ? Pna History: sob Heart size upper normal.No significant pulmonary or pleural abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: Evaluate lung fields History: decompensated heart failure. Right internal jugular central venous catheter is unchanged, likely in the superior vena cava.Bilateral moderate-sized pleural effusions with likely basilar atelectasis.No pneumothorax.

Output: Persistent bilateral moderate-sized pleural effusions with bibasilar atelectasis. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of cholangiocarcinoma, status post resection The study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Subcentimeter nodule in image number 64 series number 5, in the right middle lobe is unchanged.MEDIASTINUM AND HILA: Esophagus is dilated throughout its course.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Postsurgical findings involving the liver. Small hypodense lesions described on the previous contrast enhanced study are not well seen on this noncontrast CT. No new hypodense lesions.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: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study. Limited study due to lack of IV contrast.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: intubated History: intubated ET tube has tip 2 cm above the carina. An enteric tube tip extends beyond the field-of-view.Cardiac silhouette is normal. Diffuse interstitial opacities appear mild improved. No pleural effusion or pneumothorax.

Output: Mildly improved diffuse interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval ETT, r/o PNA / consolidation History: as above Stable cardiomediastinal silhouette with cardiomegaly. Chronic elevation of the right hemidiaphragm with right basilar subsegmental atelectasis/scarring. No new pulmonary opacity. No definite pleural effusions. No pneumothorax.Sternotomy wires appear intact. Incompletely imaged left subclavian ICD with a single ventricular lead. Numerous surgical staples overlie the mediastinum and upper abdomen.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Pt s/p tumor debulking and HIPEC and has bilateral pleural effusions after surgery with SOB - please eval for resolution of effusions History: SOb Pleural effusions and basilar consolidation improved.Heart size normal.No new findings.

Output: Improving pleural effusions and basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated pt, proned History: intubated pt, proned ET tube tip approximately 6 cm above the carina.NG tube tip in the gastric antrum. Catheter tip in the SVC.Small lung volumes with diffuse nonspecific airspace and interstitial opacity, slightly improved compared to recent previous radiographs.

Output: Nonspecific pulmonary opacity, slightly improved.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female status post chemotherapy for non-small cell lung cancer. CHEST:LUNGS AND PLEURA: Redemonstration of extensive left-sided pleural thickening and fluid and nodularity. Previously measured lesion in the left base now changed its configuration and its no longer doughnut-shaped. The amount of soft tissue thickening in that location as increased. A chest tube is again in place within the loculated left sided pleural collection.Numerous subcentimeter metastatic lesions in both lungs and increase in size and number.MEDIASTINUM AND HILA: Reference left prevascular space adenopathy measures 19 x 12-mm image number 33, series number 3. Other enlarged mediastinal lymph nodes are also unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Previously mentioned fluid density lesion within the right lobe of the liver is unchanged measuring 2.7 x 1.5 cm image number 69, series number 3. No new lesions in the liver. Cholelithiasis is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal mass measures 3.4 x 3.1 cm. Interval enlargement of the left adrenal gland. A left adrenal nodule now measures 11 x 13 mm.KIDNEYS, URETERS: Bilateral renal cysts are unchanged. Previously described partially enhancing lesion in the lower pole of the left kidney now measures 14 x 15 mm, not significantly changed.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes, slightly more prominent compared to previous study. IVC filter is in place.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 increase in the left-sided pleural thickening and the number and size of the subcentimeter lung metastases. New left adrenal nodule.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: Abd pain, SOB Small lung volumes with mild basilar opacity compatible with subsegmental atelectasis.No specific evidence of pneumonia.

Output: Mild basilar atelectasis which may be secondary to intra-abdominal disease.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with shortness of breath. Question mass, hilar lymphadenopathy versus pulmonary vessels on radiograph. Examination is limited by lack of intravenous contrast.LUNGS AND PLEURA: Main pulmonary artery is enlarged (4.4 cm), suggesting pulmonary hypertension. Scarring/atelectasis of the bases. Diffuse mosaic ground glass pattern, suggestive of small airways or small vessel disease and compatible with pulmonary hypertension. No interlobular septal thickening or evidence of advanced interstitial lung disease. No pleural effusions.Calcified granuloma right upper lobe.MEDIASTINUM AND HILA: Cardiomegaly. Small pericardial effusion. Moderate coronary artery calcifications. Calcified right paratracheal lymph node, suggestive of prior granulomatous disease. CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: No significant abnormality noted.

Output: Severe pulmonary hypertension. No evidence of mediastinal or pulmonary mass.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: s/p intubation, swan, OG placement History: VT/VF Interval intubation with the endotracheal tube 5 cm superior to carina. Nasogastric tube terminates inferior to the caudal margin of the image. Interval placement of a right IJ Swan-Ganz catheter that terminates in the right pulmonary artery; the tip is not well visualized. Remaining support devices are unchanged.Persistent cardiomegaly with retrocardiac consolidation and atelectasis. No pneumothorax.

Output: Interval intubation and nasogastric tube placement.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval effusions History: as above Slight improvement in pulmonary opacities but still present in the bases however, with pleural effusions.Mediastinal or pericardial drain still in place.Tracheostomy tube tip 7 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Slight improvement in pulmonary opacities with persistent basilar atelectasis and edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Tachycardia rule out pulmonary edema. Motion artifact, rotation and patient positioning limit evaluation.Within this limitation, no large areas of consolidation, visible pulmonary edema or visible pneumothorax are appreciated. Cardiomediastinal silhouette appears similar to prior.

Output: No acute pulmonary abnormality on this limited film.


Instruction: Generate impression based on medical findings.

Input: Shortness of right, chest pain and risk factors of pulmonary embolism. LUNGS AND PLEURA: No pulmonary embolism was identified. Normal pulmonary artery branching.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with metastatic gist tumor. Presenting with diabetic ketoacidosis. Concern for infection. CHEST:LUNGS AND PLEURA: Biapical and left lung base scarring, unchanged. New ill-defined ground glass opacity in the left upper lobe in image number 36, series number 6, is nonspecific and may represent early pneumonia. New small right-sided pleural effusion.MEDIASTINUM AND HILA: Heterogeneously enhancing right thyroid lobe lesion is stable. Further evaluation with thyroid ultrasound may be helpful. Multiple small superior mediastinal lymph nodes are stable. Reference lymph node in the AP window is stable measuring 12 by 12-mm image number 36, series number 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval increase in the size of the hepatic metastases. Index lesion in the lateral segment of the left lobe now measures 3.8 by 4.4 cm, image number 99, series number 4. Other hepatic lesions are also increased in size.SPLEEN: Status post splenectomy.PANCREAS: Distal pancreatectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index lymph nodes measures 14 x 9 mm in image number 106, series number 4, not significantly changed. Other enlarged lymph nodes are also stable.BOWEL, MESENTERY: Postsurgical changes surrounding the stomach.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: Slight interval increase in the size of the hepatic metastases.New small ground glass opacity in the left upper lobe. Early pneumonia cannot be excluded.Heterogeneous enhancing right-sided thyroid nodule. Further evaluation with thyroid ultrasound may be helpful.New right-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: chest pain History: as above Or the cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions. Interval sternotomy and CABG with sternotomy intact.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Bilateral lung transplant. Unchanged small to moderate hydropneumothoraces and atelectasis. Slight improvement in edema-like abnormality. Tracheostomy tube and Dobbhoff tube unchanged in position. Diffuse subcutaneous emphysema lower thorax and upper abdomen.

Output: No significant change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: hx rcc. surveillance for mets History: As above The cardiomediastinal silhouette is normal in size.Streaky bibasilar opacities likely reflect subsegmental atelectasis. No focal airspace opacity, pleural effusion or pneumothorax.Multiple surgical clips project over the upper abdomen.

Output: Bibasilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Desaturation, rule out acute process. No focal airspace opacity, pleural fluid or pneumothorax. Minimal retrocardiac opacity on the left most consistent with atelectasis.

Output: Mild atelectasis, but no other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 53 female with gastrointestinal stromal tumor status post resection.Additional history: Ovarian cancer. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The right-sided port terminates in the right atrium.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: Small mesenteric lymph nodes, not pathologically enlarged, unchanged.BOWEL, MESENTERY: The gastric GIST has been resected. No evidence of recurrence is seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hysterectomy. BSO.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 resection of the gastric GIST without evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Reason: UPRIGHT CHEST History: perf? ulcer? No pneumoperitoneum. Nonobstructive bowel gas pattern. No acute cardia pulmonary abnormality.

Output: As above.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: hx of seizures, increase in frequency of seizures Unremarkable cardiac and mediastinal silhouette. Mild basilar interstitial opacity compatible with scarring and atelectasis.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT, lung fields History: s/p IABP Swan-Ganz catheter tip in the right descending pulmonary artery. Balloon catheter marker in the proximal descending aorta. ICD leads unchanged.No sign of an endotracheal tube, though the upper most trachea is not shown on the radiograph.Left jugular catheter tip at the area of the junction of the jugular and subclavian veins.Cardiomegaly and perihilar hazy opacity, increased from previous, suggestive of edema.

Output: Increased perihilar opacity suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Reason: ? of PE History: desaturation while on 50% FIO2 Normal heart size and mediastinum.Small lung volumes with bilateral perihilar and basilar airspace opacity, increased compared to previous, suggestive of aspiration.Pulmonary embolism is also possible though the radiographic findings are not typical.

Output: Probable aspiration pneumonia.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of cough and shortness of breath. Previous opacities on previous chest CT. Evaluate lungs and compared to previous. History of chronic renal failure. CHEST:LUNGS AND PLEURA: Air trapping is again seen between inspiration and expiration views. There has been interval resolution of previously seen right basilar opacities. No new opacities identified.Basilar interstitial changes with suggestion of subpleural honeycombing are again seen; this may represent early, mild UIP-pattern versus fibrotic changes and scarring from chronic aspiration.Previously seen right upper lobe nodule (series 5, image 39) is relatively unchanged on comparison to prior study, again measuring 1 x 0.8 cm. Subcentimeter left apical nodule (series 5, image 9) appears relatively unchanged on comparison to prior studies from 1/20/2010 and from 5/16/2009.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Cardiomegaly with stable pericardial effusion.CHEST WALL: Right chest wall AICD with leads in expected locations. Degenerative changes of the spine. UPPER ABDOMEN: Atherosclerotic disease of the aorta, renal arteries, and splenic artery.

Output: 1. Interval resolution of previously seen right basilar opacities. 2. Stable right upper lobe nodule. Recommend 6 month CT follow-up to confirm continued stability.3. Basilar interstitial changes with suggestion of subpleural honeycombing; this may represent mild UIP-pattern versus fibrotic changes and scarring from chronic aspiration.Findings communicated to Dr. Strek via telephone.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with metastatic epithelial trophoblastic neoplasia. Interval TAH/BSO with increasing bHCG. CHEST:LUNGS AND PLEURA: Innumerable bilateral pulmonary nodules are decreased in size and number. Previously identified index lesion in the left base (series 5 image 74) now measures 4 mm (previously 5 mm).MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. No focal hepatic lesions or intra-or extrahepatic biliary ductal dilatation.SPLEEN: Soft tissue lesions in the splenic hilum are nonspecific, but similar to prior.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: Mild scoliosis of the thoracolumbar spine, similar to prior.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postoperative changes of hysterectomy salpingo-oophorectomy. Previously identified right ovary (series 3, image 162) with interval decrease in size, now measuring 2.4 x 1 .0 cm (previously 2.4 x3.5 cm).BLADDER: No significant abnormality noted.LYMPH NODES: Right iliac index lymph node with interval decrease in size, now measuring 1.2 x 0.8 cm (previously 1.1 x 1.4 cm).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postoperative findings of a midline abdominal wall incision with nonspecific extraperitoneal fluid collection and superficial wound dehiscence. Soft tissue mass in the right inguinal canal (series 3 image 188) now measures 1.8 x 1.5 cm (previously 2.1 x 1.9 cm).OTHER: No significant abnormality noted.

Output: 1) Interval decrease in size/number of innumerable pulmonary masses.2) Slight decrease in size of index lesions in the abdomen/pelvis and right inguinal canal. 3) Status post recent TAH/BSO.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Acute decompensation likely due to septic shock History: Hypotension Median sternotomy and multiple mediastinal surgical clips, aortic valve prosthesis, and left shoulder arthroplasty are again noted.Cardiomediastinal silhouette is unchanged. There is been interval increase in large loculated left and small right effusions. Interstitial opacities bilaterally suggestive of edema. Retrocardiac consolidation due to effusion and underlying atelectasis.

Output: Interval increase in bilateral pleural effusions, left greater than the right, and underlying compressive atelectasis. Superimposed infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: The 26-year-old female with pain and chest radiating to back. Rule out PE. PULMONARY ARTERIES: Generally adequate technical quality with no sign of pulmonary embolism.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.Normal aortic caliber.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Surgical clips in the gallbladder bed.

Output: No sign of pulmonary embolism or other significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old. History: Cough. Unremarkable cardiac and mediastinal silhouettes. No pulmonary or pleural disease.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: r/o PNA History: fevers, cough, dyspnea Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Reason: eval for pneumonia History: chest pain and sob No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: eval ETT, IABP History: s/p CABG Support devices unchanged with IABP marker in the distal aortic arch and IVC Swan-Ganz tip in the pulmonary artery.Decreased lung volumes with stable cardiac enlargement.Bilateral pleural effusions and perihilar/basilar edema similar to the prior exam.No new pulmonary opacities noted.

Output: Support devices unchanged with IABP marker in the distal aortic arch. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: right pleural biopsy, ? ptx History: right pleural biopsy, ? ptx Lobulated right pleural thickening, but decreased pleural fluid since the prior study without pneumothorax.Left lung unremarkable.

Output: Improvement in right pleural effusion with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 91-year-old male with malignant lymphoma CHEST:LUNGS AND PLEURA: Mild emphysema.Bilateral scattered nodules in both lungs. A reference nodule in the right lower lobe measures 10 x 6 mm image number 61, series number 3. The nodule in the left upper lobe has been resected compared to 3/2007. Some of the nodular opacities noted in 2007 are smaller or resolved, however, there are also some new nodular opacities in both lungs compared to 2007. Atelectasis and scarring in the right middle lobe, unchanged. However now, there is new associated linear and nodular opacities adjacent to the scarring which may represent atelectasis versus early pneumonia. New peripheral consolidations in the left lung base again which may represent atelectasis versus pneumonia.MEDIASTINUM AND HILA: Enlarged right lobe of the thyroid. Multiple nonenlarged mediastinal lymph nodes. Largest measures 17 x 12 mm image number 39, series number 3. These are unchanged compared to previous CT dated 3/2007.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: This study is limited due to lack of IV contrast. Multiple hypodense lesions in the liver are grossly unchanged compared to previous CT dated 2/11/2008.SPLEEN: Hypodense lesion in the spleen is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm is unchanged. Borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the abdomen and pelvis. Mediastinal small lymph nodes are unchanged. Enlarged thyroid gland is unchanged.Mixed changes in the lung parenchyma. Multiple irregular nodular opacities in both lungs , some of which are new. However some of the previously detected lung nodules have resolved with in the interval.New possible consolidations in the right middle lobe and left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Reason: resp distress History: above Moderate cardiomegaly.Bilateral mainly right-sided airspace and interstitial opacities suggestive of pulmonary edema.Possible small effusions.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: pt intubated w/ possible ARDS, eval lung fields and tube placement History: intubated Endotracheal tube terminates 3 cm above the carina. Nasogastric tube terminates inferior to the caudal margin of the image.Persistent low lung volumes with partial clearing of the right lower lobe opacities suspicious for aspiration. Pulmonary opacities elsewhere are unchanged.

Output: Partial clearing right lower lobe opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: is there an infiltrate History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Evaluate for PNA, confirm ICD lead placement History: shortness of breath x2 days Small lung volumes with basilar subsegmental atelectasis.No specific evidence of infection or edema.Left subclavian biventricular ICD, leads unchanged in position.

Output: No acute abnormality. Unchanged ICD leads.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: sob, palpitations Moderate cardiomegaly. The main pulmonary artery is at least upper normal in caliber Left ICD with lead in the right ventricle. Mild bibasilar atelectasis. No pleural effusion or pneumothorax. Persistent opacity associated at the upper edge of the pulse generator may be in the chest wall, correlate with physical exam, present since 1/30/2015. No focal pulmonary consolidation.

Output: Cardiomegaly without acute cardiopulmonary abnormality. Chronic opacity overlying the upper edge of the pulse generator may be in the chest wall or could reflect a partially radiopaque component of the pulse generator, correlate with physical exam.


Instruction: Generate impression based on medical findings.

Input: Reason: Mucus plug History: Mucus plug Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with a large left pleural effusion and underlying atelectasis, not significantly changed compared to previous.Right lower zone opacity compatible with edema, atelectasis and moderate effusion.

Output: Diffuse opacity in the left hemithorax consistent with effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: short of breath History: psych hx, short of breath, hx COPD Large lung volumes with hypovascular upper lobes consistent with severe emphysema.No sign of infection or other acute change.

Output: COPD with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: chest pain History: chest pain Heart size upper normal.No specific evidence of infection or edema.Cholecystectomy clips.

Output: Heart size upper normal, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 60 year old female with unresolved chest pain. Technically adequate exam.PULMONARY ARTERIES: No PE.LUNGS AND PLEURA: Patchy opacities in the right lateral lower lobe extending to the pleura, likely atelectasis and infection. Mucus in bronchioles leading to this opacity (series 12 image 82) suggests possible aspiration.Multiple nonspecific bilateral small nodules, largest (series 12 image 61) measures 8 x 5 mm.Mild centrilobular emphysema with bronchial wall thickening.MEDIASTINUM AND HILA: Few prominent mediastinal and hilar lymph nodes. Focal anterior pericardial thickening versus small amount of pericardial fluid.CHEST WALL: Partially calcified soft tissue nodule in the right lateral breast (series 10 image 108) can better evaluated on mammography. Nonspecific bilateral lymphadenopathy.UPPER ABDOMEN: Multiple hypodense hepatic lesions are nonspecific, but likely benign hepatic cysts. Left renal hypodense lesion, compatible with simple renal cyst. Right renal hypodense lesions are too small to characterize.

Output: 1) Probable mild aspiration into right lower lobe.2) Left upper lobe pulmonary nodules. Recommend follow-up CT in 3-6 months for high risk patients.


Instruction: Generate impression based on medical findings.

Input: Neutropenia. Fever. Interval removal of left central line. Right chest port unchanged in position. No pneumothorax. Dependent atelectasis. Hazy opacities in the right upper lobe suspicious for aspiration or infection. Minimal atelectasis elsewhere.

Output: Opacities in the right upper lobe suspicious for aspiration or infection. Short-term plain film follow-up suggested.


Instruction: Generate impression based on medical findings.

Input: Reason: assess balloon pump positioning History: balloon pump Cardiopulmonary monitoring and support devices, unchanged.Layered out pleural effusions and left lower lobe atelectasis, not significantly changed.No new findings.

Output: Devices in appropriate position with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Colorectal CA with fevers during IR drain procedure and hypotension. Patchy airspace opacities bilaterally, left greater than right. Atelectasis at the lung bases. No pleural fluid or pneumothorax. Normal heart size. Catheters project over the right upper quadrant, incompletely included on the image.

Output: Patchy airspace opacities and basal atelectasis nonspecific but could reflect acute aspiration. Follow-up chest radiograph recommended to exclude development of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Lung transplant Interval removal of the right jugular sheath without postprocedural complication. A single left chest has also been removed with interval increasing chest wall emphysema. The remaining chest tube projects at the level of the hila, no associated significant pneumothorax observed.Underlying decreased lung volumes and chronic appearing fibrotic changes largely in the right lung is similar.Cholecystectomy clips

Output: A single left chest tube and right jugular sheath removed with increasing chest wall emphysema.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with metastatic RCC status post right middle lobectomy receiving radiation therapy and history of pneumonitis presenting with shortness of breath partially improved by Lasix. Evaluate lungs for pneumonitis or gross lesions in this dyspneic patient. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are again seen and have increased in size. Left upper lobe nodule on image 40/101 and pleural-based left lower lobe opacity on image 66/101 are larger with prior study. A previously referenced left upper lobe nodule measures 1.1 x 1.1 cm on axial image 30/101 and is unchanged to slightly larger (previously measured 10 x 9 mm on image 28/111). Right lower lobe pleural based nodule on axial image 54/101 has increased in size. Postoperative changes again seen in the right upper lobe. Increased right pleural effusion with patchy groundglass opacity and consolidation predominantly in the right lower lobe. Underlying progression of metastatic disease cannot exclude. New left pleural effusion.MEDIASTINUM AND HILA: Right hilar mass measures 5.3 x 4.9 cm on axial image 52/101 and is unchanged when compared to the prior exam where it measured approximately 4.9 x 5.3 cm (51/111). A soft tissue mass in the posterior mediastinum causing lateral displacement of the esophagus appears larger when compared to prior study. Multiple borderline mediastinal lymph nodes are unchanged to slightly larger when compared to prior.CHEST WALL: Again identified is a metastasis at the level of T7 which causes surrounding bony destruction. This metastasis enters the right aspect of the spinal canal and obliterates the epidural fat causing mass effect on the thecal sac. Overall, the lesion is unchanged when compared to the prior exam. Sclerosis and deformity of the right T8 and T9 ribs is unchanged.UPPER ABDOMEN: Please note this noncontrast exam is limited for the evaluation of solid organ pathology. No significant abnormality is noted. Patient is status post left nephrectomy.

Output: 1.New left pleural effusion and increased right pleural effusion with patchy groundglass opacity and consolidation predominantly in the right lower lobe, cannot exclude underlying progression of metastatic disease.2.Large right hilar mass appears unchanged while multiple bilateral pulmonary metastatic foci have increased in the interval.3. Stable chest wall and mediastinal masses including one paraspinal soft tissue mass at the right of T7 with invasion of the spinal canal.4.Stable sclerotic rib lesions as above.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: eval for pulmonary edema History: dyspnea Small lung volumes.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: baseline eval pre kidney transplant Mild cardiomegaly with pulmonary vascular redistribution.Subtle perihilar opacities could reflect borderline edema with thickening of the fissures.No specific evidence of infection.

Output: Cardiomegaly with borderline pulmonary edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 45-year-old man with Hodgkin's lymphoma in liver, bone marrow, with persistent fever, anemia below baseline, platelets 51, increasing LFTs. Concern for retroperitoneal hematoma. Concern for fluid collection or abscess. Concern for subclinical pnu. Oral contrast only. CHEST:LUNGS AND PLEURA: Nodular opacities seen bilaterally, most are stable. Some are resolved and some are new - for example pleural based lesion on the right image 44 series 4 (larger of the two lesions) is new. There is minimal atelectasis in the bases but no pleural effusions.MEDIASTINUM AND HILA: Scattered small mediastinal adenopathy is stable. Right retrocrural node stable.CHEST WALL: Bilateral axillary adenopathy pathologic in size, stable. Minimal gynecomastia stable.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Minimally prominent 13 cm in length with a few calcific granuloma, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal nodes pathologic in size but unchanged. Previously measured left para-aortic node Series III image image 23 unchanged of about 1.9 x 1.1 cm.No evidence of retroperitoneal hematoma.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No lytic or blastic disease. Levoscoliosis at lower lumbar spine, unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral inguinal adenopathy may be minimally increased. The index node in the right inguinal area seen on series 2 image 195 and measures 2.1 x 1.9 cm. Previously on 4/6/2008, I remeasured as 2.8 x 1.7 cm on series 4 image 141.BOWEL, MESENTERY: Small amount of generalized ascites in the dependent portions of the pelvis, unchanged.BONES, SOFT TISSUES: No significant abnormality noted small bladder air in the left rectus muscle and Series III image 136 probably related to subcutaneous injections.

Output: No evidence of retroperitoneal hematoma. Small amount of ascites in the dependent portion of the pelvis is unchanged. Lymphadenopathy mostly unchanged in the chest and abdomen possibly slightly increased in size of the nodes in the inguinal areas. Nodular lung opacities with minimal changes as detailed above. Rule out infection.These findings were communicated to the clinical service by the resident on call the time of examination with no discrepancy


Instruction: Generate impression based on medical findings.

Input: Reason: ETT position History: ETT ET tube tip approximately 3 cm above the carina.Focal nodular opacity with central lucency projected over the medial right upper lobe, suspicious for a cavitary pulmonary lesion. This could be confirmed on subsequent radiographs.. A text page was sent to Dr.ONYEALI at the time of reporting.

Output: 1.ET tube in acceptable position. 2.Probable right upper lobe cavitary nodule for which follow-up and/or CT scan is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA History: SOB Cardiopulmonary monitoring and support devices, unchanged.Increased opacity at the right base consistent with pleural effusion, consolidation and atelectasis.Focal airspace opacity at the left lower lobe, unchanged.The findings are nonspecific but compatible with pneumonia.

Output: Increased consolidation and atelectasis at the right base with bilateral airspace opacities, nonspecific but compatible with infection.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of renal cell carcinoma CHEST:LUNGS AND PLEURA: Right upper lobe nodule is unchanged measuring 8mm image number 49, series number 5. The nodular pleural thickening involving bilateral pleura, most prominent on the right side, especially toward the apex is unchanged. Linear atelectasis in the left lower lobe, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Scattered bilobar subcentimeter hypodense lesions in the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: Soft tissue density mass abutting the SMV measures 4.4 by 3.3 cm, image number 123, series number 4, not significantly changed. Surrounding fat stranding is also unchanged. SMV is invaded by this mass.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrectomy. No lesion within the nephrectomy bed. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Reservoir and penile prosthesis are unchanged.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: rule out infection History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval for pna History: sepsis Moderate cardiomegaly with pleural effusions and left lower lobe consolidation, progressed compared to the prior study.Right PICC, tip in the SVC.ET tube tip approximately 6 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Worsening pleural effusions and new left lower lobe consolidation, most likely CHF related although left lower lobe pneumonia is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: sob History: sob Increasing left-sided opacities suggestive of edema or aspiration.Persistent loculated right pleural fluid with patchy right base consolidation.Left PICC, tip in the SVC.

Output: Increasing pulmonary opacities suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: pna History: cough/cold Mild bronchial wall thickening which is nonspecific but most commonly seen in asthma or bronchitis. No evidence of pneumonia.

Output: Mild bronchial wall thickening which is nonspecific but most commonly seen in asthma or bronchitis. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: cough History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Palpitations Unremarkable cardiac mediastinal silhouette.No specific evidence of infection or edema

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Desaturation, rheumatic tricuspid valve Mildly improved yet persistent mild edema with layered effusions, greater on the right. No new superimposed airspace abnormalityScattered surgical clips in incomplete visualization of lower lumbar spine fixation

Output: Mildly improving edema, without new superimposed discrete abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: tachypnea History: as above Unchanged basilar subsegmental atelectasis.Small lung volumes.Heart size normal.

Output: Unchanged basilar subsegmental atelectasis which may be the result of aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with metastatic adrenal gland tumor. Reevaluate for disease staging. CHEST:LUNGS AND PLEURA: Multiple small, ill-defined right upper lobe nodules are again seen and are nonspecific. Some of these nodules are new while others evident on the prior exam have resolved. A more solid appearing nodule in the right middle lobe measures 7 mm and axial image 54/101 and is unchanged. No pleural effusion.MEDIASTINUM AND HILA: Right hilar lymphoid tissue measuring 1.4 x 2.1 cm on axial image 44/227 has increased in size from the prior exam where it measured 1.3 x 1.4 cm. Small mediastinal lymph nodes are unchanged. No pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: A hypoattenuating lesion in the dome of the liver on axial image 78/227 is new. Segment 3 liver lesion has increased in size and now measures 6.5 x 7.0 centimeters on axial image 108/2027 compared to 6.1 x 6.2 cm on the prior exam. A segment 5 lesion measures 7.4 x 6.0 cm on axial image 132/227 and has increased in size from the prior exam where it measured 5.6 x 7.1 cm. A more inferior segment 5 lesion has also increased in size measuring 2.7 x 2.6 cm on axial image 136/227 compared to 2.0 x 1.7 cm on the prior exam. Additional scattered hypoattenuating lesions have increased in size as well. Hepatic vasculature is patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Large, heterogeneous left adrenal mass is grossly unchanged in size measuring 11.1 by 18.1 cm on axial image 103/227.KIDNEYS, URETERS: Left perinephric fluid is unchanged.RETROPERITONEUM, LYMPH NODES: Venous collaterals are again seen in the left abdomen and appear unchanged. Left para-aortic retroperitoneal lymph node measures 1.5 x 3.0 cm on axial image 133/227 and is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Stable 7-mm right middle lobe nodule. Other small, nonspecific lung nodules as described above.2.Progression of metastatic disease in the liver.3.Stable left adrenal mass.4.Stable retroperitoneal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval ETT History: s/p intubation Median sternotomy with chest tubes but no pneumothorax.Patchy airspace opacities slightly improved on the left still consistent with infection or aspiration.ET tube low, within 1 cm of the carina.Left jugular Swan-Ganz catheter, tip directed towards the right main pulmonary artery.Right jugular catheter tip in right jugular vein.

Output: Low ET tube, a subsequent radiograph has already been requested. Improvement in left perihilar opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: FemaleReason for Study: Reason: effusion History: SOB 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: Female, 94 years old.Reason: cath alert, fall History: chest pain Stable moderate cardiomegaly but no acute findings.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Shortness of breath Marked cardiomegaly and vascular redistribution. Bilateral pleural effusions, right greater than left have minimally increased from prior exam. The right pleural effusion is partially loculated. There is improved aeration, especially in the right lower lobe.

Output: CHF with persistent effusions as outlined above and improved aeration of the right lung.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: PNA? edema? History: weakness, fatigue Cardiomediastinal silhouette is unremarkable.Small calcified nodules and pleural thickening are stable.No specific evidence of infection or edema.No pleural effusion. No pneumothorax. Healed rib fractures again noted.

Output: No specific evidence of infection or edema or interval change compared to prior.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with cough, fever, abdominal pain. Evaluate for pneumonia. Cardiomediastinal silhouette is at the upper limits of normal.No focal pulmonary consolidation or pleural effusion.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 6 years old, with AML, persistent fever and neutropenia and perirectal fissure with erythema. Evaluate for any evidence of abscess, especially near perirectal area as well as evidence of fungal infection. CHEST:LUNGS AND PLEURA: A left lower lobe micronodule on axial image 35, series 4, may be new but is nonspecific. No additional suspicious nodules or masses, and in particular, no evidence of a fungal infection.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Left chest wall port catheter, tip in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild thickening of the wall of the rectosigmoid colon persists but is much improved over prior studies.BONES, SOFT TISSUES: The cortex of the left iliac wing remains thickened with patchy sclerosis within the marrow space, unchanged.OTHER: No significant abnormality noted

Output: 1.Nonspecific left lower lobe micronodule with no evidence of pulmonary fungal infection.2.Mild residual thickening of the rectosigmoid colon.3.Stable patchy sclerosis of the left iliac wing.


Instruction: Generate impression based on medical findings.

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

Output: Small hiatal hernia and mild associated distal esophageal wall thickening. No additional abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Evaluate ETT placement and NG placement. NGT was then esophagus. The nasogastric tube remains looped in the esophagus with tip near the thoracic inlet.Endotracheal tube tip 3 cm above the level of the carina.Low position of right jugular catheter tip, projecting over the right atrium. Mediastinal widening may be artifact of underinflation.Low lung volumes with mild elevation of the right hemidiaphragm. Mild blunting of the left costophrenic angle which could be due to pleural fluid and atelectasis. Surgical drain and staples project over the upper abdomen, incompletely visualized.

Output: NGT remains looped in the esophagus. Apparent mediastinal widening and low position of the right jugular catheter may be due to low lung volumes and can be reassessed on a subsequent film.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Swan placement History: swan placement Heart moderate cardiomegaly without significant edema.Right jugular Swan-Ganz catheter with tip directed towards the right interlobar pulmonary artery.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: unresolving leukocytosis. Evaluate for HCAP History: leukocytosis Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: post operative film History: as above Moderate cardiomegaly with pleural effusions right larger than left and basilar opacities suggestive of edema and atelectasis.An NG tube terminates in the stomach.Upper abdominal surgical drains.

Output: Postop CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.History of sarcoid with diabetic ketosis. The cardiac silhouette is at the upper limits of normal in size. The hila and pulmonary vasculature are within normal limits. No airspace opacity, large pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Cough and shortness of breath x3 days. The cardiomediastinal silhouette is within normal limits. Streaky retrocardiac opacity is noted. No pleural effusion or pneumothorax.

Output: Streaky retrocardiac opacity may represent atelectatic lung versus a small area of pneumonia. Follow-up radiograph can be performed in 7-10 days if patient remains symptomatic.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: ET tube History: et tube push ET tube with its tip 10 cm above the carina.Right IJ venous catheter and left-sided ICD unchanged.Stable cardiomediastinal silhouette.Patchy bilateral pulmonary opacities not significantly changed.No new pulmonary opacities identified.

Output: ET tube still in high position with its tip at the thoracic inlet. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: swan placement History: swan placement Stable cardiac enlargement. Support devices unchanged.Basilar opacities representing atelectasis.Swan-Ganz catheter with tip in projection of the main right artery.

Output: Good position of support devices. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with history of gastric cancer, adenopathy, and liver metastases CHEST:LUNGS AND PLEURA: Stable right lower lobe nodule measuring 5-mm on image number 52, series number 5. Again seen Small calcified micronodules.MEDIASTINUM AND HILA: Left supraclavicular node has increased in size and now measures 3.3 x 2.7 cm on image number 6, series number 4. Previously measured 2.1 x 2.4 cm on image number 4, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Significant interval increase in the size and number of the liver metastases. Previous described subcentimeter lesion near the dome of the liver now measures 3.2 x 3.2 cm in image number 17, series number 4. Measured index left medial hepatic lobe lesion is not well seen on today's study.SPLEEN: No significant abnormality notedPANCREAS: Significant interval increase in the size of the peripancreatic and retroperitoneal adenopathy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval increase in size of the retroperitoneal adenopathy. Index aortocaval lymph node now measures 3.8 by 2.5 cm, image number 105, series number 3.Adenopathy now extends into the pelvis in the bilateral air iliac regions, more prominent on the left.BOWEL, MESENTERY: Postsurgical changes from total gastrectomy. Dilated esophagus, unchanged. Interval increase in the size of the mesenteric adenopathy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Significant interval increase in the size of the left supraclavicular adenopathy.  Significant interval increase in size and number of hepatic metastases and retroperitoneal adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: s/p PICC History: s/p PICC line needs to be central for TPN Right PICC tip is in the right atrium. Enteric tube is coiled in the stomach fundus with tip in the stomach body.The cardiomediastinal silhouette is normal.No focal pulmonary opacities or large pleural effusions. No pneumothorax.

Output: Right PICC tip in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval for pathology History: leukocytosis Left basilar subsegmental atelectasis and left pleural effusion improved.Right lung unremarkable.Heart size normal.

Output: Improving left basilar atelectasis and pleural effusion, with no new findings.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: worsening l effusion? History: dec sat Support devices unchanged with Swan-Ganz catheter tip in the left descending pulmonary artery.Marked cardiac enlargement.Left pleural effusion appears to be increased from the prior exam.The right lung is clear.

Output: Support devices unchanged. Large left pleural effusion increased from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: S/P 2/4/15 Bronchoscopy, Right video-assisted thoracoscopy, Excision of the right lower lobe lung mass History: follow up Right chest tube removed with no pneumothorax.The right pleural effusion is much smaller than before with decreased right basilar atelectasis.Left lung now unremarkable in appearance.Clamshell sternotomy for lung transplant.Heart size normal.Left jugular catheter, tip in SVC.

Output: Improved basilar opacities and reduction in size of the right pleural effusion, with chest tube removed.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: eval infection, edema, effusion History: R sided weakness Tortuous aorta; otherwise normal cardiac and mediastinal contours.No pleural or parenchymal abnormalities.

Output: No evidence of pneumonia or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: Infiltrates History: fever Interval increase in vascular congestion and interstitial opacities with right basilar interstitial opacity. Findings likely represent mild fluid overload with right basilar atelectasis.Mild interval increase in cardiac size.Interval placement of chest port with tip in right atrium.No significant pleural effusion. No pneumothorax.

Output: 1. Mild pulmonary edema2. Interval placement of chest Port-A-Cath


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: r/o pneumonia History: crackles on LLL, febrile, tachy New patchy opacities in the left lower lobe. Small pleural effusions. Unchanged heart size. No pneumothorax.

Output: Left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male; 70 years old. Reason: IABP placement History: HF Left-sided ICD and IABP marker unchanged.Stable cardiomediastinal silhouette.Lungs are clear. No new pulmonary opacities or pneumothorax.

Output: Support devices unchanged. Stable cardiopulmonary appearance without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: as above ET tube tip approximately 3 cm above the carina.Venous catheters unchanged.Bilateral opacity consistent with layered out effusions, atelectasis and possibly edema.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.CHF, shortness of breath, noncompliance with diuresis. Question of volume overload. Low lung volumes without specific evidence of infection or edema. No large pleural effusion or pneumothorax. There is mild cardiomegaly.

Output: Low lung volumes and cardiomegaly without reliable evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.History of right middle and superior segmental lobectomy for lung cancer. Cardiomediastinal silhouette is unchanged. Postsurgical changes related to lung cancer resection on the right including surgical clips and volume loss.Right mid and lower lung zone opacity compatible with a pleural effusion appearing similar to prior. Previously seen small right pneumothorax is no longer identified. Left lung is clear. No new focal opacities.

Output: Interval resolution of right pneumothorax. Postsurgical changes and right pleural effusion appearing similar to prior without new focal opacities.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with shortness of breath, anuria. Evaluate lungs and evaluate for ureteral obstruction including hydronephrosis/kidney stone CHEST:LUNGS AND PLEURA: Collapse of the left lower lobe is noted without evidence of a central, obstructing mass. This may be due to chronic aspiration or multiple prior infections at this location. Left pleural effusion is also seen.Significant, predominantly upper lobe paraseptal emphysema. Few scattered micronodules are also identified bilaterally. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.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: Small, homogenous left adrenal nodule, probable adenoma. Normal right adrenal gland.KIDNEYS, URETERS: No evidence of nephrolithiasis or ureteral stones. No hydronephrosis. Lobulated contour to the kidneys may represent scarring.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Submucosal fat deposition is seen in the ascending colon which likely represents old, inactive inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Complete left lower lobe atelectasis, possibly from chronic aspiration versus multiple prior infections at this location. Significant, predominantly upper lobe paraseptal emphysema.2. No evidence of hydronephrosis or nephrolithiasis as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 2-day-old male with worsening respiratory distress. Evaluate pneumothorax.VIEW: Chest AP (one view) 12/10/2015 at 0433 hours Endotracheal tube tip at the thoracic inlet. Two right-sided and one left-sided chest tubes are unchanged in position. Partially visualized umbilical venous catheter tip in the right atrium and the umbilical arterial catheter tip at T8.Changes from oligohydramnios consisting of left thoracic curve and bell-shaped thorax are again seen. Mild soft tissue edema persists.Cardiothymic silhouette is normal in size. Bilateral pneumothoraces persist. No pleural effusions.

Output: Bilateral persistent pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: check ett placement History: intubated Heart size normal.Mild right basilar subsegmental atelectasis, the lungs otherwise unremarkable.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Stem cell donor No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: s/p pleurectomy, decortication History: chest tube Chest tubes directed towards the left apex with no significant pneumothorax.Nonspecific air space opacity at the left base compatible with atelectasis and consolidation.A more recent radiograph has been interpreted.

Output: Unremarkable postoperative chest


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with GBM. Arrest. Hypoxic. Tumor expansion? PE? LUNGS AND PLEURA: Bilateral pleural fluid with associated atelectasis at lung bases bilaterally.MEDIASTINUM AND HILA: Mild pericardial thickening/effusion. No mediastinal lymphadenopathy. Heart size within normal limits. Left internal jugular line tip terminates at the level of the brachiocephalic/SVC junction. Endotracheal tube traverses the trachea with the tip terminating approximately 1 centimeter or less above the level of the carina, deviating slightly to the right.The thyroid gland appears slightly asymmetric. The left lobe of the thyroid extends more inferiorly than the right.CHEST WALL: Within the subcutaneous tissues, between the right chest wall and the pectoral muscles, is an enlarged heterogeneous appearing mass which may represent a hematoma possibly posttraumatic in etiology. Clinical correlation suggested to exclude previous surgical intervention.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Noncontrast CT examination inadequate for evaluation of pulmonary embolism. 2. Mild pericardial thickening/effusion.3. Bilateral pleural effusions with adjacent atelectasis/consolidation.4. Asymmetric thyroid gland may be further evaluated with ultrasound.5. Chest wall mass likely posttraumatic hematoma. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: new hyperglycemia, tachycardia -- c/f sepsis History: c/f sepsis No significant cardiopulmonary abnormality.Left PICC, tip in axillary region.Dobbhoff tube with tip in transverse portion of the duodenum.Chest wall drains removed.

Output: No specific evidence of infection or edema, or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: rll aspiration/volume overload History: as above Moderate cardiomegaly with a markedly ectatic and ectatic aorta, unchanged.Dense calcification in the mitral annulus.Bilateral interstitial opacity compatible with edema, or less likely aspiration, slightly increased over the past 2 days.

Output: Increased pulmonary edema compatible with volume overload.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: eval for pna. persistent fever History: fever Right port unchanged in position. Gastrostomy tube present. Lungs hypoinflated though there is no new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: 66M w/ RLL NSCLC s/p right-sided thoracocotomy and lung resection History: s/p thoracocotomy and lung resection 1 of the right-sided chest tubes has been removed. New very small right apical pneumothorax. Increased right basilar opacity and pleural effusion. Left lung remains clear except for mild basilar atelectasis. Small amount of right-sided subcutaneous emphysema again noted. Healed clavicular fracture, as before. Iatrogenic changes of the right ribs.

Output: Interval removal of one right-sided chest tubes with small right apical pneumothorax and slight increase in right pleural effusion and right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: fevers History: fevers Unchanged right chest wall ICD. Left basilar atelectasis, not significantly changed. No pleural effusion or pneumothorax. No new focal pulmonary opacities. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality or specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with metastatic prostate cancer CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the right middle lobe other subcentimeter nodules in the right lung are also stable.MEDIASTINUM AND HILA: Small mediastinal nodes are unchanged.CHEST WALL: Sclerotic rib metastases, several rib and sternum are stable.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small left adrenal myolipoma is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Well-defined 20 x 15 mm, hypodense lesion in the second portion of duodenum on image number 121, series number 21, unchanged from previous CT. This may represent a benign neoplasm in the wall of the duodenum such as gastrointestinal stromal tumor.Small mesenteric lymph nodes are stable.BONES, SOFT TISSUES: Multifocal osteosclerotic metastases are stable compared to prior exam.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy..BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic bone metastases are stable.OTHER: No significant abnormality noted

Output: Sclerotic bone metastases are stable.Well-defined, hypodense lesion in the wall of the second portion of duodenum is stable. This may represent a gist tumor. Further evaluation with endoscopy may be helpful.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ards/fluid status History: hypoxia Diffuse patchy nonspecific air space and interstitial opacities with bilateral pleural effusions and basilar atelectasis.Slightly decreased aeration at the right lung base and no other significant interval change.

Output: Extensive nonspecific pulmonary opacities with a somewhat patchy distribution, not typical of ARDS, though there is likely some component of pulmonary edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: SOB History: SOB Cardiomegaly stable. Small bilateral pleural effusions. Retrocardiac opacity compatible with atelectasis/consolidation. Thickened septal lines consistent with pulmonary edema.Left-sided ICD leads and generator unchanged.

Output: Mild pulmonary edema. Small pleural effusions. Retrocardiac atelectasis/consolidation.