Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Left thoracentesis evaluate for pneumothorax. No pneumothorax. Tubes and lines unchanged, NGT may be advanced. Decreased volume of pleural fluid on the left with reexpansion of the left lung. Moderate volume of pleural fluid on the right. Diffuse interstitial and airspace opacities bilaterally. There appears to be a nodule in the medial aspect of the left upper lobe at the level of the clavicular head which is new from earlier prior studies and could be infectious or less likely metastatic.

Output: Reexpansion of left lung postthoracentesis, no pneumothorax. Peribronchial opacities could be infectious. NGT may be advanced.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Cough for one week rule out pneumonia Normal heart size. Mild basal scarring, similar to previous. Prominence of the pulmonary hila unchanged.No specific signs of pulmonary edema.Subtle bronchovascular crowding and opacity cranial to the right hilum, nonspecific and could reflect reflect infection.

Output: Nonspecific faint opacity cranial to the right hilum could reflect infection the appropriate clinical setting. Chronic mild hilar lymphadenopathy. Recommend follow-up PA and lateral chest radiographs in 6 weeks.


Instruction: Generate impression based on medical findings.

Input: White blood cell elevation and altered mental status Mild patient rotation accounts for mediastinal contour changes however persistent borderline cardiomegaly is again observedPersistent decreased lung volumes without discrete superimposed focal airspace abnormalities

Output: Decreased lung volumes without discrete superimposed focal air space abnormality


Instruction: Generate impression based on medical findings.

Input: Reason: change to effusion/edema History: respiratory failure Tracheostomy tube and venous catheter unchanged.Small lung volumes with bilateral opacity compatible with edema and atelectasis. Moderate pleural effusions.

Output: Pony edema and pleural effusions with no significant change allowing for projection.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with history of thyroid cancer. LUNGS AND PLEURA: Pleural plaques, unchanged. Basilar ground glass is slightly improved and likely due to chronic aspiration.MEDIASTINUM AND HILA: Prominent right hilar adenopathy, unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Scattered pleural plaques are unchanged and are likely post inflammatory etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Evaluate for pleural effusion. Cardiomediastinal silhouette is unchanged with redemonstration of known lymphadenopathy. Multiple nodular opacities compatible with known pulmonary and chest wall metastatic disease. No new focal airspace opacities or evidence of significant pleural effusions.

Output: Stable cardiopulmonary appearance without acute interval change or pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Neutropenic fever question infection. Left PICC has been removed.Volumes remain low. Minimal basal opacity on the right medially unchanged, favored to represent atelectasis but can be followed.

Output: Minimal opacity at the right cardiophrenic angle is favored to represent atelectasis but can be followed to exclude development of pneumonia if patient remains symptomatic.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: please eval for fluid collection in chest History: shortness of breath Chest tube unchanged with no pneumothorax.Lower lung zone opacities and pleural effusions including edema are stable.Pericardial drain unchanged in position.

Output: Pleural effusions and pulmonary opacities are stable. Pericardial and left pleural drain stable as well.


Instruction: Generate impression based on medical findings.

Input: 56 year-old female with metastatic colon carcinoma baseline evaluation. CHEST:LUNGS AND PLEURA: Diffuse bilateral lung metastases. Based on comparison to the lung bases the June 21, 2009 study, the lesions are more numerous. New bibasilar atelectasis or consolidation.MEDIASTINUM AND HILA: A nodule right lobe of the thyroid gland is unchanged. Coronary artery calcification noted. No pathologic sized mediastinal nodes.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs, particularly the liver, due to lack of intravenous contrast. Given that limitation the following observations are made: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: New bilateral nephroureterostomy catheters in place with bilateral perinephric fat stranding greater on the right than on the left. Air in the collecting system of the kidneys presumably from the catheter placement.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes not amenable to measurement.BOWEL, MESENTERY: New generalized ascites and nodularity diffusely in the omentum consistent with progression of carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Distal end of the pigtail catheter is in the urinary bladder as expected.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Generalized ascites with heterogeneous variable density fluid and soft tissue in the pelvis consistent with carcinomatosis. Marked probably hypoattenuating component measured previously on the June 21, 2009 series 2 image 94 scan is that comparable today's study series 2 image 147/210 measuring 13.4 x 11-cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Progression of carcinomatosis. Progression of lung nodules. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: PNA History: AMS Evaluation of the lung bases limited by respiratory motion. Cholecystectomy clips noted in the right upper quadrant. Surgical clips are distributed along the lateral aspect of the neck. Mild streaky bibasilar opacities suggest atelectasis. The cardiac and mediastinal contours are within normal limits for size. No pleural effusion or pneumothorax is evident. The bones and upper abdomen are unremarkable.

Output: No cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Pancreatic cancer CHEST:LUNGS AND PLEURA: Index left lower lobe nodule is unchanged measuring 5 mm in image number 75, series number 5. Left upper lobe ground glass opacity on image number 25, series number 5 is also unchanged measuring 1.4-cm in diameter.MEDIASTINUM AND HILA: Bilateral thyroid nodules, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter hypodense lesions in the liver and fatty infiltration of the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes in the pancreas. Residual pancreas is unremarkable.ADRENAL GLANDS: Nodular adrenal glands are stable.KIDNEYS, URETERS: Renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing umbilical hernia is stable.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: Previously described right adductor muscle mass is smaller and demonstrates calcification. It cannot be well measured. Fracture of right pubic bone is again noted.OTHER: No significant abnormality noted.

Output: Interval significant decrease in the size of the pelvic mass. Fractures involving the sacrum and right pubic bone are unchanged. No other significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: Status of bilateral effusions History: as above No change in bilateral pleural effusions. Lungs hypoinflated. Subcutaneous air involving the neck as on prior.

Output: No change in bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Swallowed pop can top. No metallic radiopaque foreign body is identified. Normal heart size. No pneumomediastinum or pneumothorax. The lungs are clear.

Output: No acute pulmonary abnormality. No radiopaque foreign body is identified in the thorax. Plain films of the neck and abdomen may be considered for complete exclusion if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with history of testicular cancer CHEST:LUNGS AND PLEURA: Nonspecific 3-mm nodule in the right upper lobe on image number 21, series number 4. Another subcentimeter nodule on image number 69, series number 4 in the left lower lobe.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. There efferent subcarinal lymph node measures 18 x 10 mm image number 40, series number 3. Other precarinal and pretracheal lymph nodes are also present.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Nonspecific borderline enlarged inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Nonspecific subcentimeter lung nodules. Borderline enlarged mediastinal lymph nodes. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female status post procedure for staging of cancer. Evaluate for presence of perforation or infection CHEST:16 x 8 mm spiculated mass in the left upper lobe suspicious for primary bronchogenic carcinoma. Diffuse emphysema.Subcentimeter, subpleural opacity in the left lower lobe on image number 48, series number 5. Other subcentimeter nodule is in the lower lingula image number 51, series number 5. 11 x 6 mm nodule on image number 56 , series number 5 in the lower lingula..Multiple nonenlarged mediastinal lymph nodes. Index AP window lymph node measures 10 x 9 mm image number 36 on series number 3.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion on image number 101, series number 3 in the right lower liver. Minimal pneumobilia, likely secondary to recent procedure.SPLEEN: No significant abnormality notedPANCREAS: Ill-defined mass in the pancreatic head associated with surrounding fat stranding, which range date tumoral invasion and/or inflammation secondary to mild pancreatitis. Ancreatic duct is dilated in the body and detailed.There is peripancreatic adenopathy. Metallic stent in the common bile duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Severe atherosclerotic changes in the abdominal aorta causing approximately 50% stenosis and focal dissection.Proximal left common iliac artery aneurysm measuring 2-cm in diameter. Extensive atherosclerotic changes throughout the iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.

Output: No free intra-abdominal air to suggest perforation.Left upper lobe spiculated mass suspicious for primary bronchogenic carcinoma.Large pancreatic head mass causing pancreatic ductal dilatation. Stranding on the mass likely represents invasion of the mass and mild pancreatitis.Severe atherosclerotic changes causing approximately 50% stenosis of the, abdominal aorta as well as proximal left common iliac artery aneurysm.Dr. Trilisky was notified and acknowledged about the above findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: FemaleReason for Study: Reason: Eval for lead placement History: s/p pacemaker placement Presternal pacemaker unchanged.Stable marked cardiac enlargement.Basilar atelectasis, interstitial opacities, and possible small effusions similar to the prior exam.No new pulmonary opacities identified.Subcutaneous emphysema identified in the left axillary and left supraclavicular regions.No pneumothorax noted.

Output: Presternal ICD unchanged. Persistent subcutaneous emphysema within the left axilla and left supraclavicular region. Stable cardiopulmonary appearance with cardiomegaly, basilar atelectasis, probable small effusions, and interstitial opacities which may be a reflection of edema and/or chronic interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: 51 year old female with sigmoid colon cancer. Evaluate response. CHEST:LUNGS AND PLEURA: Right middle lobe scarlike opacities are unchanged. A lingular micro-nodule is also unchanged. Right basilar subsegmental atelectasis/scarring. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Right chest wall port catheter in place.ABDOMEN:LIVER, BILIARY TRACT: Punctate segment 7 hypodense lesion is too small to characterize. No suspicious mass lesions. No intrahepatic biliary dilatation. The portal and hepatic vasculature is patent. The gallbladder is unremarkable.SPLEEN: A splenic hypodensity is unchanged, probably benign.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severe left hydronephrosis and hydroureter is grossly unchanged. The cause of this finding is presumed to be a mass in the left lower pelvis as described below. The right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A previously referenced mass in the left lower pelvis measures 5.1 x 3.6 cm on axial image 162/215 which is slightly smaller when compared to the prior exam where it measured 5.9 x 3.6 cm. The previously noted soft tissue density at the rectal stump suture line is not clearly visualized on today's exam. Right lower quadrant ostomy is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Tubular cystic structure in the left adnexa is unchanged and probably represents hydrosalpinx.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval decrease in the size of a left lower quadrant mass.2.Stable left hydronephrosis and hydroureter.3.Stable left hydrosalpinx.


Instruction: Generate impression based on medical findings.

Input: Reason: Is there pulmonary edema? History: shortness of breath Cardiomegaly with bilateral interstitial and airspace opacities, compatible with pulmonary edema, slightly improved over the past week.Venous catheters extending to the SVC.Probable small pleural effusions.

Output: Diffuse nonspecific opacity, greater in the upper zones, compatible with pulmonary edema, slightly improved over the past week.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Traumatic injury. Fall. Displaced right lower rib fractures are noted laterally. Probable small chest wall or extrapleural hematoma near the right costophrenic angle laterally. Mild pulmonary edema as well and signs of chronic bronchitis. No pneumothorax.Small volume of pleural fluid posteriorly, nonspecific and could be a hydrothorax or hemothorax in the setting of acute displaced rib fracture.Part metallic mechanical device projects over the right proximal humerus overlying the axilla.

Output: Multiple displaced right lower rib fractures, very poorly visualized by this technique. There is an adjacent chest wall or subpleural hematoma. Small volume of ipsilateral pleural fluid; unable to differentiate between hydrothorax and hemopneumothorax on the basis of the plain film. Recommend serial short-term same day follow-up to exclude possibility of expanding hemothorax in the setting of rib fracture.ED notified of recommendation via stat consult webpage dialogue.


Instruction: Generate impression based on medical findings.

Input: SOB question pneumonia. No focal airspace opacities suggest pneumonia. Flattening of the diaphragm may be seen in the setting of COPD. Normal heart size.

Output: No signs of pneumonia. Probable COPD but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 6 years old. ARDS. Evaluate for interval change.VIEW: Chest AP (one view) 3/28/15, 0335 ET tube tip below the thoracic inlet and above the carina. Enteric tube terminates in the stomach. Bilateral chest tubes are unchanged in position. Left arm PICC, tip at the brachiocephalic vein/SVC confluence.The cardiothymic silhouette is normal.Bilateral lower lobe airspace opacities, not significantly changed from the prior exam, but markedly improved from 3/26/15. No new focal opacities, pleural effusion, or pneumothorax.

Output: Improving bilateral lower lobe opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: 79 yo M known MRSA PNA/empyema + E. coli empyema s/p multiple chest tubes. Mediastinal hematoma vs pleural fluid connection on CT Chest WO 5/3/15. Not a surgical candidate. Daily CXR for mediastinal monitoring. History: see above Tracheostomy tube, left pleural drain and feeding tube unchanged.Drainage catheter in the area of the left axilla, also unchanged.Enlarged cardiac silhouette and diffuse nonspecific bilateral opacities compatible with a history of pneumonia and empyema.No new findings.

Output: Bilateral pulmonary opacities and pleural effusion with no acute change.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with CNS lymphoma and atelectasis on chest x-ray. Neutropenic fever. CHEST:LUNGS AND PLEURA: Large pleural effusions bilaterally with overlying atelectasis/consolidation. Moderate bronchial wall thickening is seen bilaterally as well.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal with small pericardial effusion. Mild atherosclerotic calcification near the origin of the LAD.Small left thyroid nodule.CHEST WALL: Probable benign hemangioma in the T4 vertebral body; probable benign bone island in the T8 vertebral body. Left chest port with tip terminating in the distal SVC. Right jugular central venous catheter with tip terminating in distal SVC.UPPER ABDOMEN: Several, well-defined hypoattenuating lesions are noted in the liver; probable benign hepatic cysts.

Output: Large pleural effusions bilaterally with overlying atelectasis/consolidation. Moderate bronchial wall thickening.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Evaluate right apical pneumothorax History: s/p Chest tube removal 12/19 Unchanged cardiac enlargement and bilateral interstitial pulmonary opacities.No evidence of residual pneumothorax.Loop recorder device projects over the lower left thorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old Reason: evaluate for pna and hemorrhage History: cough, blood tinged sputum New right basilar focal opacity suggestive of infection.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is unremarkable.

Output: New right basilar focal opacity suggestive of infection/aspiration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. Right jugular catheter extending to the SVC with no pneumothorax or other complications.Left port catheter also extending to the SVC.No significant cardiopulmonary abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female 68 years old Reason: stem cell transplant patient with crackles on exam. Previous ARDS History: crackles, tachypnea, tachycardia Right internal jugular central venous catheter tip at the cavoatrial junction.Improved right perihilar opacities, with residual left perihilar opacity.Interval improved aeration in the left lower lobe.Small left pleural effusion.Cardiomediastinal silhouette unchanged.

Output: Improved right perihilar interstitial opacity, with residual abnormality in the left hemithorax compatible with resolving ARDS.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.MVR, AVR, CABG. Normal heart size. Valvular prostheses. No pleural fluid or pneumothorax. No focal air space opacities. Sternotomy appears intact with chronic healed deformity of the sternotomy fracture.

Output: Valvular prostheses. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough Mildly decreased lung volumes unchanged without additional discrete acute cardiopulmonary abnormality. Extensive atherosclerotic changes

Output: No distinct acute abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old. Right Port-A-Cath with its tip in the SVC.Right IJ venous catheter with its tip in the SVC.Loculated right pleural effusion overlying the apex similar in appearance to the prior exam.Right perihilar mass and upper lobe opacities unchanged.No new pulmonary opacities identified.Stable cardiomediastinal silhouette.No pneumothorax.

Output: Interval placement of right IJ venous catheter without complication. Stable cardiopulmonary appearance with loculated right pleural effusion and right perihilar and right upper lobe opacities


Instruction: Generate impression based on medical findings.

Input: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Normal heart size with a focal fluid collection adjacent to the right cardiac border as previously demonstrated by CT scan which may represent a seroma or loculated pleural effusion.Small lung volumes with streaky opacities on the right consistent with scarring.Fracture deformities of the third ribs bilaterally, unchanged.No new findings.

Output: Right pericardiac fluid collection and right basilar scarring without significant change.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female evaluate for right lung empyema and groin abscess CHEST:LUNGS AND PLEURA: Large right sided pleural effusion. Pleural effusion demonstrates loculations. Empyema cannot be excluded. Dependent atelectasis in the right lung base. Superimposed pneumonia cannot be excluded. Linear atelectasis in the right middle lobe and upper lobe.Groundglass opacities in the left lower lobe is nonspecific may represent edema.MEDIASTINUM AND HILA: Cardiomegaly. Multiple borderline enlarged mediastinal lymph nodes. A precarinal enlarged lymph node measures 21 x 11 mm on image number 29, series number 3.CHEST WALL: Right axillary adenopathy measuring 13-mm.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 infrarenal abdominal aortic aneurysm is again identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: An enlarged bilateral inguinal lymph nodes, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen large hematoma around the fem-fem graft and the fem-fem graft itself are not visualized. Small amount of collection with air and tissue defect on the left side likely representing postop changes are present. Collection measures 5 x 1.5 cm on image number 169, series number 3 in the subcutaneous tissues anterior to the symphysis pubis.OTHER: No significant abnormality noted.

Output: Interval excision of the fem-fem graft and the surrounding collection. Small collection and postsurgical changes are noted in the pelvis wall as described above.Large right sided pleural effusion demonstrating loculations. Right lower lobe consolidation which may represent pneumonia. Empyema cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.IABP placement. IABP proximal marker projects 2.5 cm below the top of the aortic arch. Left subclavian ICD unchanged.Motion artifact with unchanged chronic appearing pulmonary opacities and scarring.

Output: IABP proximal marker projects 2.5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Distal thoracic aortic aneurysm with mural thrombus. Evaluate size. Also has infrainguinal aortic aneurysm (stable) with patent stent grafts. No evidence of endoleak. CHEST:LUNGS AND PLEURA: Bilateral emphysema. Scarring at both lung bases. Subcentimeter nodule along the right major fissure (image 57; series 4). No effusions.MEDIASTINUM AND HILA: Substernal thyroid. Small mediastinal lymph nodes are not enlarged using CT size criteria. Ascending aorta measures 4.5 cm in diameter. Proximal descending thoracic aorta measures 4.0 cm in diameter (image 52; series 10). At the level of the diaphragm, the aorta measures 6.1 x 6.6 cm (image 92; series 10).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large bilateral renal cysts as seen previously (stable)RETROPERITONEUM, LYMPH NODES: The supraceliac portion of the abdominal aortic aneurysm appears to have increased in size minimally. On direct side to side comparison, it measured 6.5 x 5.9 cm (image 35; series 9; 10/13/2009 study) previously and currently measures 6.7 x 6.3 cm at the same level (image 97; series 9).Status post endovascular aortic stent placement. The stent, aortic sac, and residual patent lumen are all stable compared to prior. The sac again measures 5.1 cm in diameter (image 136; series 9). Delayed images show no evidence of endoleak. TheThe celiac, superior mesenteric, and renal arteries are patent.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left common iliac artery stent graft is also patent with no evidence of endoleak. Right femoral graft is patent.

Output: 1. Slight increase in size of supraceliac portion of aortic aneurysm as above (approximately 3 to 4 mm in growth since the prior exam).2. Infrarenal aortic aneurysm is stable in size with patent vascular stent grafts and no evidence of endoleak or stent migration.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: recent dx pna, unclear abx compliance History: eval Right basilar consolidation and small right pleural effusion consistent with infection. However, focal subpleural opacity in the left costophrenic angle as well raises the possibility of infarction rather than infection. Heart size upper normal.

Output: Basilar opacities consistent with infection although infarction is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ETT History: OG tube placement Cardiomegaly with lower lung zone predominant interstitial and airspace opacities and pleural effusions, slightly worse.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter tip at cavoatrial junction.

Output: Worsening pulmonary opacities. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: cause of fevers History: fevers There decrease lung volumes with mild cardiac enlargement.Left basilar consolidation/atelectasis and small left pleural effusion.Right upper quadrant drainage tubing identified.

Output: Left basilar consolidation/atelectasis and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 34 years old Male. Reason: r/o infection History: cough. Streaky/patchy opacities are noted in the right upper lobe with prominence of the right lung hilum. Patchy opacities also seen in the left lower lobe. There is no evidence of pneumothorax or pleural effusion. The cardiac silhouette is normal.

Output: Multifocal pulmonary opacities, suspicious for infection. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Increasing hypoxia. Right internal jugular catheter has been removed.Normal heart size.Prominent and indistinct pulmonary vasculature and small left greater than right pleural effusions suggesting pulmonary edema appear slightly improved compared to 12/11/2015 CT. Additional superimposed airspace opacities suggestive of aspiration/infection also appear slightly improved compared to 12/11/2015 CT.

Output: Effusions as well as opacities of edema and infection/aspiration slightly improved compared to 12/11/2015 CT. Pulmonary nodules better visualized on recent CT, and follow-up imaging following this acute exacerbation is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: confirm stable iABP placement History: advanced heart failure Left-sided ICD and right PICC line unchanged.IABP marker in the distal aortic arch.Cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old. Reason: r/o acute process History: chest pain Cardiomediastinal silhouette is within normal limits.No focal airspace consolidation. No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusion History: pt with anemia, shortness of breath Marked cardiomegaly with a single lead ICD device, unchanged from previous.No evidence of pulmonary edema or pleural effusions.

Output: Cardiomegaly with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Concern for pneumonia The cardiac and mediastinal contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities to suggest pneumonia.The pleural spaces are within normal limits.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: eval post bronch History: s/p bronch Lines and tubes are unchanged. No substantial change in mild pulmonary edema, bibasilar opacities, and small pleural effusions. No pneumothorax. Unchanged heart size.

Output: No substantial change in pulmonary edema and bibasilar opacities. Small pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with tachypnea and shortness of breath. Assess for pulmonary embolus. PULMONARY ARTERIES: Study is technically adequate. No pulmonary embolus is identified.LUNGS AND PLEURA: Decrease in size of left pleural effusion. Loculated fluid noted in the left major fissure. A left-sided chest tube is in place with its tip located in the left apex. Right sided atelectasis is seen adjacent to the gastric pull up. Nonspecific right apical micronodules are unchanged. MEDIASTINUM AND HILA: Postoperative changes of a gastric pull up is seen with a fluid filled proximal esophagus. NG tube has been removed. Cystic lesion in the right lobe of the thyroid is unchanged and likely benign.Heart size is normal. No pericardial fluid. Coronary artery calcifications are noted. No lymphadenopathy.CHEST WALL: Right chest wall port catheter, tip in the SVC. Subcutaneous air is present in the left posterior lateral chest and abdominal wallUPPER ABDOMEN: Ascites is present with foci of air noted within the ascitic fluid. A peritoneal drain is incompletely seen on this examination.

Output: 1.No pulmonary embolus2.Status post left chest tube placement with decrease in size of left pleural effusion with an additional loculated collection of fluid in the left major fissure.3.Stable ascites with foci of air likely related to peritoneal drain. Correlate with recent abdominal interventions as the possibility of intra-abdominal pathology cannot be ruled out on this examination.4.5.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with previous history of SLE, chronic pleuritis and decreased lung volumes and evaluate for any ILD, pulmonary vascular disease, or pleural abnormalities LUNGS AND PLEURA: Prominent bilateral pleural calcifications are noted at the lung bases. This is quite globular in shape in the left lung base and most likely is secondary to previous empyema or a previous hemothorax .There is mild interlobular and intralobular septal thickening at the bases with a small focal area of groundglass opacity within the right upper lobe. There is no convincing evidence of underlying interstitial lung disease or evidence of pulmonary masses. MEDIASTINUM AND HILA: Considerable coronary artery atherosclerosis as well as valvular calcifications. There is also cardiac enlargementCHEST WALL: Marked degenerative changes are noted of the right sternoclavicular joint. There is collapse of the T10 vertebraeUPPER ABDOMEN: No significant abnormality noted.

Output: 1. Evidence of previous pleural disease with marked pleural calcifications at both bases, presumably representing previous empyema and or previous hemothoraces2. No significant interstitial lung disease identified. Minimal fibrotic changes are noted at both bases, as well as a small area of groundglass opacity within the right upper lobe.3. Significant partial collapse of the T10 vertebrae. Marked degenerative changes are also noted within the right sternoclavicular joint


Instruction: Generate impression based on medical findings.

Input: Previous groundglass opacities on an outside exam, complains of chronic cough, LUNGS AND PLEURA: There is interval clearing of the groundglass opacities present on the prior outside exams.Postsurgical changes are noted in the right midlung with evidence of mild pleural and parenchymal scarring.Stable right middle lobe nodular opacity (image 67, series 4).No evidence of interstitial fibrosis.There is significant peripheral air trapping noted in both lungs.No evidence of pleural effusion.MEDIASTINUM AND HILA: Substernal extension of the thyroid gland.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Interval clearing of the multiple groundglass opacities identified on the prior outside exams.2.Bilateral extensive areas of airtrapping compatible small airways disease.3.No evidence of interstitial fibrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Swan placement Right IJ pulmonary arterial catheter tip in the right main pulmonary artery. Right ventricular apical cardiac lead is not completely imaged distally. The right atrial lead is unchanged. Calcified hilar lymph nodes without evidence of infection, edema, or effusions. Stable cardiomegaly with LV prominence.

Output: Pulmonary arterial catheter with tip in the right main pulmonary artery, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p PICC History: s/p PICC Mild cardiomegaly with an aorta that is tortuous but consistent with age.No significant pulmonary or pleural abnormality.Right PICC, tip at cavoatrial junction.Prior left PICC removed.

Output: Right PICC, with cardiomegaly but no acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infiltrate History: SOB, dizzy Unremarkable cardiac and mediastinal silhouette.Mildly tortuous aorta.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: r/o infiltrate History: chest pain Nonspecific basilar scarring, stable.Heart size upper normal.No evidence of acute infection or infarction.Bilateral shoulder prostheses.Cholecystectomy clips.

Output: Chronic scarring from sickle cell disease, but no acute abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: assess for recurrent disease History: s/p cystectomy and neobladder for bladder cancer No pleural effusion or pneumothorax. Low lung volumes. Unchanged right calcified lymphadenopathy, consistent prior granulomatous disease. On lateral projection, a prominent bridging osteophyte is seen. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: clinical deterioration, hypoxia History: 3383087 New atelectasis and consolidation in both lower lobes suggestive of aspiration.No other significant change.

Output: New bilateral lower lobe atelectasis and consolidation suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Evaluate for cardiopulmonary disease. History: Possible aspiration PNA. Mild cardiomegaly and vascular distribution. Mildly tortuous appearance of the aorta. No significant pleural effusion or focal consolidation.Surgical clips are present in the bilateral axilla and left breast.

Output: Cardiomegaly and vascular redistribution without specific evidence of infection or failure.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: 55 male with diffuse large b-cell lymphoma, now s/p PICC line. confirm position History: Lymphoma Large unchanged mediastinal mass.Increasing pulmonary opacities, decreasing lung volume and enlarging pleural effusions.Left PICC tip in innominate vein, looping into the jugular, subsequently repositioned.

Output: PICC placement, looping into the jugular, subsequently repositioned.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: r/o infection, edema, effusion History: chest pain, sob 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 or edema.


Instruction: Generate impression based on medical findings.

Input: Soft tissue sarcoma of the left thigh No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Shortness of breath question pulmonary edema, pneumonia or cardiomegaly. Left pneumonectomy with chest wall deformity and high density in the upper left thoracic cavity suggestive of prior thoracoplasty. Scarring in the right upper lobe at site of known cavitary lesion not well appreciated.Normal heart size. No specific signs of CHF. Scarlike opacity in the right cardiophrenic angle, please refer to a subsequently performed abdominal CT.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT repositioning History: ETT repositioning ET tube tip about the level of the carina with the neck in flexed position.Feeding tube coiled in the stomach.Mild basilar subsegmental atelectasis, unchanged.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male, preop CT chest, assess cardiac anatomy in relationship to the sternum LUNGS AND PLEURA: Scattered micronodules several are calcified. No pulmonary masses can be identified. No evidence of pleural effusion.MEDIASTINUM AND HILA: There is cardiac enlargement with evidence of a previous CABG. The right ventricle is abutting the posterior margin of the sternum with sternal wires extending to the pericardium. Extensive calcification of the aortic valve with corner artery calcifications.CHEST WALL: Median sternotomy and degenerative changes in the dorsal spine.UPPER ABDOMEN: Atherosclerotic disease of the aorta and its branches

Output: Marked cardiac enlargement with the right ventricle effacing the retrosternal space and abutting the posterior margin of the sternum. No evidence of CHF or acute pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Fever Unchanged mild scarring and minimally decreased lung volumes similar to prior exam. No superimposed new airspace abnormalities however a small nonspecific focal opacity in the left lung base is again observed. This focus may represent a residual nonspecific scarring, however recurrent disease cannot entirely be excluded. The cardiac and mediastinal contours significant for moderate aortic tortuosity. Midline sternotomy.

Output: Mild scarring and small persistent left basilar focal nonspecific opacity. No additional new intrapulmonary acute disease. Persistent serial imaging will be needed to confirm clearance


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: evaluate for pneumothorax History: post transbronchial biopsy Bibasilar opacities likely reflect atelectasis. No large pleural effusion or pneumothorax. Mild cardiomegaly is unchanged.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.New right IJ CVC. Right jugular catheter tip at the superior cavoatrial junction level. Enteric tube looped in the stomach, the distal tip is off the caudal margin of the film. Left subclavian ICD unchanged.Motion artifact. Basal subsegmental atelectasis bilaterally with improvement in the left lower lobe atelectasis/consolidation. No pneumothorax.

Output: Right jugular catheter tip at the superior cavoatrial junction. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess for acute lung changes such as pleural effusions, pneumothorax History: respiratory distress Stable support devices.No change in bilateral lung opacities. No significant pneumothorax.

Output: No change in extensive bilateral lung opacities. No evidence of pneumothorax. Lines stable.


Instruction: Generate impression based on medical findings.

Input: Reason: icu History: Dissection of the thoracoabdominal aorta. Enlarged cardiac and mediastinal silhouette, unchanged from previous. Bilateral opacity compatible with layered out pleural effusions, atelectasis and possibly edema.Right jugular catheter unchanged.No new findings.

Output: Pleural effusions, atelectasis and possibly mild edema, without significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: daily am cxr History: Atrial fibrillation. Unremarkable cardiac and mediastinal silhouette. Bilateral mainly perihilar interstitial and airspace opacity compatible with edema or aspiration.Possible small left pleural effusion.NG tube tip in the stomach.

Output: Bilateral perihilar opacities suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: hx of positive PPD History: hx of positive PPD There is moderate cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Moderate cardiac enlargement without acute abnormality. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: R-rib fracture? PNA? History: fall, URI Marked COPD.No specific evidence of infection or edema.Heart size upper normal.No evidence of a displaced rib fracture or pneumothorax.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: secretions, atelectasis History: atelectasis Small lung volumes with basilar opacity compatible with atelectasis.Tracheostomy tube and venous catheter unchanged.No new findings.

Output: Basilar atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with history of shortness of breath, evaluate for pulmonary edema Normal cardiomediastinal silhouette. No lung or pleural abnormalities. No blunting of costophrenic angles.

Output: No acute cardiopulmonary abnormalities. No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Right radical nephrectomy and left partial nephrectomy for papillary RCC question metastases. Calcified mediastinal and hilar lymph nodes.Normal heart size.Pleural and parenchymal scarring at the lung bases.No visible pulmonary nodules or masses.

Output: No visible pulmonary nodules or masses by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: FemaleReason for Study: Reason: evaluation for acute chest History: dyspnea, hypoxia Stable cardiac enlargement with considerable prominence of the pulmonary arteries.Mild chronic appearing interstitial opacities unchanged.No new focal areas of consolidation.No pleural effusions.

Output: Cardiac enlargement with prominence of the pulmonary artery compatible with pulmonary arterial hypertension. No acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Chest pain, atrial flutter. Normal heart size. Chronic blunting of the costophrenic angles. Mild chronic appearing interstitial abnormality, but no specific signs of pneumonia or other acute process.

Output: No acute pulmonary abnormality. Mild nonspecific chronic interstitial abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: f/u left chest white-out History: left chest white-out, respiratory failure Right IJ line terminates deep within the RA, extending into the IVC. Mediastinal drains again noted. Improved aeration of the left lung. Diffuse pulmonary opacities demonstrate trend toward worsening. Unchanged cardiomegaly.

Output: Right IJ line terminates deep within the RA, extending into the IVC. Improvement in aeration of the atelectatic left lung. Trend toward worsening in diffuse pulmonary opacities most consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval msk chest pain History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 30 years old, Female, Reason: SOB History: SOB Unchanged ballistic fragments and surgical changes in the upper chest. Mild elevation of the left hemidiaphragm appears similar to prior exam without evidence of acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: CHF vs pneumonia History: sob/fever Slight increase in basilar markings more likely subsegmental atelectasis than edema, although the latter is possible.No new findings.Heart size normal.Tracheostomy tube and right jugular catheter are unchanged.

Output: Nonspecific basilar opacities more likely atelectasis from aspirated secretions than edema.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Status post left knee arthroplasty. Post op CHEST pain Cardiomediastinal silhouette is unremarkable. No focal consolidation. No pleural effusion or pneumothorax. Right hemidiaphragm is slightly elevated.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: PNA vs effusion History: Cough and COPD exacerbation Heart size unchanged.Scattered linear interstitial opacities likely atelectasis or scarring.No large pleural effusions. No pneumothorax. Hyperexpanded lung fields and flattening of the diaphragm, findings compatible with COPD.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: LVAD History: Leukocytosis The heart is normal in size. Status post mitral valve replacement. LVAD in place. Abandoned epicardial leads are noted. Intact median sternotomy wires.Increased lung volumes and signs of upper lobe predominant emphysema. No signs of pulmonary edema.Persistent minimal right basilar pleural thickening. No pleural effusion or pneumothorax.

Output: LVAD in place. Status post mitral valve replacement. No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: FemaleReason for Study: Reason: swan placement History: as above Right IJ Swan-Ganz in place with its tip in the right pulmonary artery.No pneumothorax.Left-sided ICD unchanged.Stable cardiac enlargement with subtle increase in interstitial opacities suggestive of edema.Upper lobe cavitary lesions better seen on current CT of the chest.

Output: Interval placement of a right IJ Swan-Ganz with its tip in the right pulmonary artery. Increasing septal lines suggestive of pulmonary edema. Upper lobe cavitary lesions better seen on current CT.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: r/o new infection History: leukocytosis Patient is status post sternotomy. Sternotomy wires are intact. Mediastinal clips noted. Right IJ central venous catheter tip in the SVC. Cardiomediastinal silhouette is within normal limits. Calcified left lung nodules unchanged. No pleural effusions or pneumothorax. Right upper quadrant clips noted.

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


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Swan-Ganz catheter check placement Right jugular Swan-Ganz catheter tip in the projection of the main pulmonary artery. Left subclavian ICD unchanged in position.Diffuse interstitial opacities bilaterally, slightly increased on the right. Pleural fluid on the right is new.

Output: Swan-Ganz catheter tip at the level of the main pulmonary artery. Diffuse edema-like opacities and a pleural fluid collection are slightly worse on the right.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: acute pathology History: chest pain and SOB, mutliple complaints, port in place Left Port-A-Cath with tip in the SVC.Cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: dyspnea on exertion, eval for infiltrates History: DOE Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: CHF vs pneumonia History: shortness of breath Moderate cardiomegaly with redistribution of the pulmonary blood flow.Mild interstitial edema is present.No specific evidence of infection.

Output: CHF with cardiomegaly and mild pulmonary edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate IABP placement History: s/p IABP Balloon catheter tip in the proximal descending aorta, unchanged.Swan-Ganz catheter tip in a right lower zone the branch of the pulmonary artery.Cardiomegaly with no evidence of pulmonary edema.

Output: Balloon catheter in the descending aorta with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.ET tube and balloon pump 0K? Heart transplant status IABP repositioned with marker 1.5 cm below the top of the aortic arch. ETT tip 6 cm above the level of the carina. Right jugular Swan-Ganz catheter tip at the right main pulmonary artery. NGT can be followed to the stomach.Large bore cannula projects over the IVC extending cranially to the level of the left brachiocephalic vein, the tip is near the orifice of left jugular vein.Lung volumes remain low with hazy opacities consistent with improving aspirated secretions and atelectasis.Small pleural effusions.

Output: ETT 6 cm above carina. IABP repositioned with marker 1.5 cm below the top of the aortic arch. Improving pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Chest pain, malaise and fatigue evaluate status post heart transplant. Cardiomediastinal silhouette appears unchanged. Bilateral basal atelectasis. Blunting of the costophrenic angles unchanged. No specific signs of pulmonary edema. No pneumothorax. The uppermost sternal wires are fragmented, unchanged.

Output: Bilateral basal atelectasis, a subsequent CT has been performed


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: pneumonia? History: chest pain Patchy upper lung nodular opacities again noted, better seen on chest CT dated 7/29/2016. No change in heart size given differences in technique and lower lung volumes. No new focal consolidation, pleural effusion, or pneumothorax.

Output: Upper lung opacities, better characterized on chest CT dated 7/29/2016. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: r/o asp History: low sat Moderate cardiomegaly. Prominent aortic arch and tortuous thoracic aorta.Bibasilar subsegmental atelectasis/scarring. Mild perihilar and basal interstitial and airspace opacities compatible with edema, aspirate or atelectasis.

Output: Mild perihilar and basal interstitial and airspace opacities compatible with edema, aspirate or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: r/o edema, pna History: sob, chest pain x1wk No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Status post IVF. End-stage renal disease Unchanged right jugular catheter extending into the mid SVC.Under expanded lungs with nonspecific patchy basilar opacities with small to moderate effusions, greater on the right persist. Lung volumes likely exaggerate the appearance of borderline cardiomegaly. Mild interval increasing basilar atelectasis or even aspiration cannot entirely be excluded. Serial imaging will be helpful.

Output: Persistent basilar nonspecific opacities, see details provided


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: hx Bladder cancer evaluate for metastasis History: see above Stable mild cardiac enlargement.Upper lobe predominant subtle interstitial opacities unchanged from the prior exam.No focal areas of consolidation.No suspicious pulmonary nodules or masses.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: FemaleReason for Study: Reason: chest pain History: chest pain 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: Reason: et tube History: et tube ET tube tip approximately 3 cm above the carina.Catheter from the left arm extending to the left axilla.2 bronchial valves in the right upper lobe.Underlying pulmonary opacities previously characterized by CT scan compatible with sarcoidosis.Extensive mediastinal and subcutaneous emphysema, without significant change.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.History of migraine and dizziness, evaluate for inflammatory or infectious process. The cardiomediastinal silhouette is normal.No focal pulmonary opacities. There is slight blunting of the left costophrenic angle, likely scarring.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with malignant pleural mesothelioma status post-pleurectomy/decortication. CHEST:LUNGS AND PLEURA: Significant interval decrease in the nodular pleural thickening seen on recent PET/CT from 7/2010 with residual scarring and atelectasis at the left base. Given the lack of IV contrast on prior PET/CT, comparison measurements were not made to that study.1] main pulmonary artery (series 4, image 37): No measurable disease at any position. 2] aortic root (series 4, image 46): No measurable disease.3] left costophrenic angle (series 5, image 62): No measurable disease.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Moderate calcifications of the LAD with mild to moderate calcifications of the proximal left circumflex artery.CHEST WALL: Nondisplaced fracture of the left sixth rib is new since the PET/CT scan from 7/6/2010. Left chest wall Port-A-Cath with tip near the SVC/RA junction.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small loculated and possibly subcapsular fluid collection is seen at the posterolateral aspect of the spleen (series 4, image 74).PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: 1. Significant interval decrease in the nodular pleural thickening in the left hemithorax with residual postsurgical scarring and atelectasis at the left lung base. 2. Small, loculated and possibly subcapsular fluid collection at the posterolateral aspect of the spleen. It is of uncertain significance but measures near water density and likely does not represent hemorrhage.3. Nondisplaced fracture of the left sixth rib is new since the PET/CT scan.


Instruction: Generate impression based on medical findings.

Input: Reason: check pulmonary status History: check pulmonary status Marked cardiomegaly with bilateral nonspecific air space opacity, consolidation and pleural effusions.Enteric tube traversing the esophagus and catheter from the left extending to the SVC.Air space opacity in the right upper lobe has increased compared to previous.

Output: Increasing nonspecific air space opacity with consolidation and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: sp AV replacement History: - Unchanged patchy pulmonary opacities suggestive of edema and superimposed infection or aspiration.The right upper lobe opacity is wedge-shaped raising the question of underlying pulmonary infarction from PE.Tracheostomy tube tip approximately 6 above the carina.An NG tube terminates in the stomach.Right jugular catheter tip at right atrial level, left jugular in the left brachiocephalic vein.

Output: Unchanged pulmonary opacities suggestive of edema and superimposed infection or aspiration, or even right upper lobe infarction.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Malaise and fatigue rule out pneumonia. S.O.B. Normal cardiomediastinal silhouette. The lungs are clear. No focal air space opacities and pleural fluid. No pneumothorax. Cholecystectomy clips project over the right upper quadrant.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: pna? CHF? History: sob No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Chest tubes. Swan-Ganz catheter. Right apical chest tube has been advanced slightly. Lines and tubes are unchanged otherwise. No substantial change in diffuse pulmonary opacities. Small pleural effusions. Unchanged cardiomegaly. No significant pneumothorax.

Output: Stable diffuse pulmonary opacities, likely edema.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: Chronic cough History: chronic cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No abnormalities of the bony thorax. Specifically no evidence of a cervical rib.Mild degenerative changes in thoracic spine with stable anterior wedging is several mid thoracic vertebrae.

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


Instruction: Generate impression based on medical findings.

Input: Reason: ICU; assess lung fields History: s/p bivad, h/o postop resp failure Interval removal of the Swan-Ganz catheter with a catheter sheath in the area of the right brachiocephalic vein.Other devices unchanged.Severe cardiomegaly with perihilar opacity compatible with edema.Dense atelectasis and consolidation in the left lower lobe, unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: 59 y/o pneumo, interval change History: SOB ET tube tip approximately 3 cm above the carina.Left venous catheter tip in the SVC.Right chest tube projects over the right midlung.Enteric tube tip in the stomach.Stable cardiomediastinal silhouette.Extensive subcutaneous emphysema over the entire chest wall and visualized lower neck is grossly similar to prior.No significant pneumothorax is evident.Streaky bibasilar opacities likely due to atelectasis.

Output: ET tube tip 3 cm above carina. NG tube tip in stomach.


Instruction: Generate impression based on medical findings.

Input: Chest pain and tachycardia rule out pneumonia, pneumonia. Chronic right diaphragmatic elevation with associated scarring or atelectasis. Left cardiophrenic angle opacity is new, nonspecific.Tortuosity of the thoracic aorta, incompletely evaluated by this single view plain film.

Output: Left basal opacity, probably in the medial basal segment of the left lower lobe, nonspecific and could represent aspiration/infection or possibly an area of pulmonary infarction, correlate for possibility of PE.


Instruction: Generate impression based on medical findings.

Input: Screening for tuberculosis. Normal heart size was moderately tortuous and calcified aorta.Extensive coronary artery calcification indicative of atherosclerosis.Large lung volumes compatible with COPD with mild chronic appearing interstitial opacity of the bases.No sign of infection.

Output: COPD with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Swan advanced. Right jugular Swan-Ganz catheter tip at the level of the right ventricle proximal to the pulmonary outflow tract. Other tubes and devices unchanged. No pneumothorax on the right. Trace pneumothorax on the left. Right pleural fluid collection unchanged. Left lung reexpanded with residual patchy opacity consistent with aspirate.

Output: Right jugular Swan-Ganz catheter tip proximal to the right ventricular outflow tract.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and cough Mild cardiomegaly with out additional cardiopulmonary abnormality given semiupright positioning. G-tube projected over left upper quadrant

Output: Mild cardiomegaly without additional abnormalityI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 58 years old Female. Reason: check status of hemorrhage History: intubated. Endotracheal tube tip 3 cm above the carina. Partially imaged gastrostomy tube projecting over the stomach. There is now complete opacification of the right hemithorax which may be a combination of pleural effusion, consolidation and atelectasis. There is a shift of the mediastinal to the right. The left lung remains clear.

Output: Complete opacification of the right hemithorax which may be a combination of pleural effusion, consolidation and atelectasis. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA/cardiac causes History: Chest pain/SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: eval lung fields History: s/p AVR Interval removal of endotracheal tube and right IJ line. Otherwise, no substantial change in iatrogenic devices. Diffuse pulmonary edema with small left-sided pleural effusion. Unchanged heart size. No pneumothorax.

Output: Interval extubation and removal of right IJ line. Increase in pulmonary edema and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: cough with green sputum production Heart size about upper normal or mildly enlarged.Moderate perihilar bronchial thickening but no sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.ETT adjustment. Endotracheal tube is low, projecting just above the level of the carina, suggest repositioning. NGT tip off the caudal margin of the film. A right sided central venous catheter can be followed to the SVC.Asymmetric superior mediastinal widening, right greater than left, about the same. Cardiothoracic ratio unchanged. Significant patchy atelectasis which may be related to underinflation and aspirated secretions.

Output: Low endotracheal tube, suggest repositioning. Persistent mediastinal widening.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: infection History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval ETT History: eval ETT No change in left lower lobe consolidation and left pleural effusion.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter tip in proximal right main pulmonary artery.IABP catheter distal tip 3 cm below the top of the aortic arch.Multiple chest tubes remain in place with no pneumothorax.

Output: ET tube tip approximately 4 cm above the carina. Stable pulmonary opacities and pleural effusions, and other tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: FemaleReason for Study: Reason: respiratory failure, intubated on vent History: intubated on ventilator ET tube and right central venous catheter unchanged. NG tube with side port in the region of the GE junction.Stable cardiac enlargement.Extensive bilateral pulmonary opacities and left retrocardiac consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with cardiomegaly, pulmonary opacities, and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: 51 yo female with chest pain History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: coarse breath sounds Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mildly tortuous thoracic aorta. Mild disc degeneration.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 77 years, Male. Reason: feeding tube position History: seems further out Tip of feeding tube appears to be overlying the mid esophagus and needs to be advanced. Retained barium is seen in the colon. Nonspecific bowel gas pattern. Examination is limited by respiratory motion. Pelvis is excluded from the field-of-view. This information was paged to the first call intern Xuan Han on 7/17/2016 at 1130.See same-day chest x-ray for chest findings.

Output: Tip of feeding tube appears to be overlying the midesophagus.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with history of urothelial bladder cancer status post radiation therapy, radical cystoprostatectomy with neobladder, status post adjuvant chemotherapy. Evaluate for disease progression. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. Please note that lack of IV contrast significantly limits evaluation of solid organs. Given this limitation, the following observations are made:ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Previously seen subcentimeter liver lesions are not seen on this non-infused study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hydronephrosis and hydroureter with atrophy of the left kidney appear similar to prior study.RETROPERITONEUM, LYMPH NODES: Prominent left para-aortic lymph nodes appear similar to prior study (series 3, image 117).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Patient is status post cystoprostatectomy.BLADDER: Distended neobladder is intact. Status post radical cystectomy. LYMPH NODES: No pelvic lymphadenopathy noted. Previously noted mesenteric adenopathy adjacent to the neobladder is not seen on current study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat containing left inguinal hernia.

Output: Overall stable exam with no evidence of tumor recurrence


Instruction: Generate impression based on medical findings.

Input: 82-year-old female status post proctectomy, antrectomy, sigmoid colectomy and TAH ABDOMEN:LUNG BASES: Minimal bibasilar scarring/subsegmental atelectasis. Dense coronary calcifications are seen.Small hiatal hernia.LIVER, BILIARY TRACT: CholecystectomySPLEEN: No significant abnormality notedPANCREAS: 9 x 4 mm cystic lesion in the head of the pancreas is grossly unchanged since 11/08, dilated side branch versus a side branch IPMN.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are identified. Mild right caliectasis is unchangedRETROPERITONEUM, LYMPH NODES: IVC filter.BOWEL, MESENTERY: Laxity of the anterior abdominal wall is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The descending colon exits through a left lower quadrant colostomy. Portions of the colon from the transverse colon through the descending colon are contained within a Spigelian hernia on the left, increased in size, without evidence of obstruction.A small bowel anastomosis is noted within the pelvis.A rectal suture line is seen. Adjacent presacral fat stranding is stable, likely postoperative.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with shortness of breath and cough. Please evaluate for infiltrate. CHEST:LUNGS AND PLEURA: Improving groundglass opacities persistent scattered centrilobular nodules and minimal apical septal thickening. The pleural effusions have resolved.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal with stable small pericardial effusion. Coronary artery calcifications.Low-attenuation of the circulating blood pool suggests anemia.CHEST WALL: Left PICC terminates in the subclavian vein. UPPER ABDOMEN: Distal esophageal thickening as mentioned previously.

Output: 1. Continued improvement in pulmonary opacities with resolution of pleural effusions.2. Stable small pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with history of anal cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right-sided port catheter terminates in the atriocaval junction. Small amount of nonocclusive thrombus around the catheter within the SVC. Large sized hiatal hernia containing most of the stomach.. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Fatty replacement of the pancreas, stable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney with a benign appearing left upper pole cyst, stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Swan placement History: As above Moderate cardiomegaly with new basilar pulmonary edema, and pleural effusions.Right jugular Swan-Ganz catheter, tip directed towards the right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter tip in right interlobar pulmonary artery. New basilar opacities suggestive of edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient with acute SOB; hx of NSLC concern for pleural effusion, please evaluate for infection/ consolidation/ effusion History: As above Small lung volumes with a large right pleural effusion and a smaller left effusion.Almost complete atelectasis of the right lung.Diffuse nodular of opacities on the left compatible with metastatic disease, appearing more dense than previously, at least partly due to decreased lung volume though there may be some underlying disease progression.

Output: Diffuse pulmonary metastatic disease with bilateral pleural effusions, larger on the right and underlying atelectasis. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest pain and shortness of breath No cardiopulmonary abnormality given mildly decreased volumes and semiupright portable technique. Questionably minimally tortuous aorta, unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: MaleReason for Study: Reason: interval change History: interval change Bilateral chest tubes unchanged.Persistent bilateral pneumothoraces, pneumomediastinum, and subcutaneous emphysema.Cystic disease tand interstitial opacities i similar to the prior exam.No new pulmonary opacities identified.

Output: Bilateral pneumothoraces and pneumomediastinum without interval change.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with nodules seen on prior chest x-ray. Evaluate for lung cancer. LUNGS AND PLEURA: No nodules or masses are noted.MEDIASTINUM AND HILA: No lymphadenopathy. Normal heart size without pericardial effusion. Aortic and coronary calcifications.CHEST WALL: Lytic bone lesion involving the T5 and T6 vertebral bodies and left transverse processes, which also extends into the spinal canal at this level (series 3, image 33). Lytic bone lesion is also seen in the right scapula (series 3, image 22).UPPER ABDOMEN: Punctate hepatic calcification. Left renal cysts in the superior, middle, and lower poles without evidence of septations or internal calcifications. The inferior pole cyst is the largest and extends medially to the aorta; however it is incompletely visualized on this study.

Output: 1. Lytic bone lesions at T5 and T6 vertebral bodies and left transverse processes. These lesions are of soft tissue attenuation and extend into the spinal canal at this level. Lytic lesion of the right scapula also noted.2. Incompletely visualized left renal cysts. Consider follow-up with dedicated renal protocol CT to further characterize if clinically warranted.Findings discussed with Dr. Zimmerman at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval for progression of pulm edema History: hypoxemia PICC has been pulled back slightly. Right IJ line is unchanged terminating in the SVC. Low lung volumes. Question of new nodular opacities in the mid upper aspect of the left lung. No large pleural effusion or pneumothorax. No change in cardiomegaly.

Output: Right PICC has been pulled back slightly. Question of new nodular opacities in the mid upper aspect of the left lung which may represent aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: assess swan position, ETT position, pleural effusions and pulmonary edema History: s/p swan placement, ADHF Stable cardiomediastinal silhouette.Stable layering pleural effusion on the right with associated atelectasis.ET tube with tip located approximately 6 cm above the carina. The IABP tip terminates in the proximal descending thoracic aorta. The Swan-Ganz catheter has been retracted with tip now at the level of the main pulmonary artery. Additional lines and support devices are stable.

Output: The Swan-Ganz catheter has been retracted with tip now at the level of the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: s/p AVR History: s/p AVR Cardiomegaly, status post sternotomy and valve replacement.Marked improvement in pleural effusions and basilar opacities with no new findings.

Output: Cardiomegaly status post sternotomy for valve replacement, with improvement in pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumonia, PE History: pleuritic chest pain 4 days. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: 53M w/ CD s/p proctectomy+EI w/ sepsis, ensure resolution of diffuse pulmonary opacities History: as above New opacity in the right mid lung periphery suggestive of atelectasis possibly from aspirated secretions,, and nonspecific interstitial opacities elsewhere slightly improved.Small pleural effusions are present.Heart size normal.

Output: Focal right lung atelectasis possibly from aspirated secretions or mucous plugging, with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male; 70 years old. Reason: eval et tube, infiltrates History: intubates Stable ETT and left PICC.Stable cardiac mediastinal silhouette.Redemonstration of perihilar opacities, right greater than left. Increasing focal right upper lobe opacity with questionable cavitation is difficult to separate from the right first costochondral junction; continued radiographic follow-up and possible CT evaluation is recommended.

Output: Persistent perihilar opacities. Focal right upper lobe opacity, for which continued radiographic follow-up and possible CT evaluation is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: r/o PNA History: cough/wheezing Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.ET tube placement ET tube tip terminates approximately 1 cm above the level of the carina. NG tube tip terminates in the distal thoracic esophagus and needs to be advanced. Left jugular catheter tip projects at the level of the left brachiocephalic vein.Persistent interstitial and airspace opacities and cardiomegaly.

Output: 1. ET tube tip terminates approximately 1 cm above the level of the carina.2. NG tube tip terminates in the distal thoracic esophagus and needs to be advanced.3. Persistent bilateral interstitial and airspace opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with metastatic carcinoid tumor. History of colon cancer LUNGS AND PLEURA: There is demonstration of an 8mm nodule in the superior segment of the right lower lobe (image 55, series 5) and may represent a pulmonary metastasis. A small micronodule identified adjacent to the minor fissure may represent an intrapulmonary lymph node. Upper lobe predominant centrilobular emphysema . Scattered areas of scarring within the upper lobes. No evidence of pleural effusionsMEDIASTINUM AND HILA: Multiple mediastinal lymph nodes are identified with the largest in the precarinal region measuring 26.5 mm x 19.9 mm (image 41, series 3).Extensive coronary artery calcification as well as calcification of the aorta is noted. There is a mild pericardial effusion and/or pericardial thickeningCHEST WALL: There is lymphadenopathy within the right axilla (image 20, series 3).Extensive degenerative changes within the thoracic spineUPPER ABDOMEN: Multiple hypodense lesions within the liver, consistent with hepatic metastases. Partially visualized right renal cyst

Output: 1. Right axillary and mediastinal lymphadenopathy and multiple hepatic masses consistent with metastatic disease. A solitary 8mm nodule within the superior segment of the right lower lobe may represent a solitary pulmonary metastasis.2. Underlying centrilobular emphysema.3. Cardiac enlargement with a small pericardial effusion or thickening, CAD, and atherosclerotic disease.


Instruction: Generate impression based on medical findings.

Input: Dyspnea, history of leukemia. Blunting of left costophrenic angle suggestive of scarring or possibly a small effusion. Normal cardiomediastinal silhouette.

Output: Left basilar scarring. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: PICC History: PICC Right PICC terminates in the right subclavian vein. Other support hardware is unchanged, including Swan-Ganz catheter terminating in the ventricular outflow tract or main pulmonary artery. Bilateral pleural effusions with bibasilar atelectasis. Interstitial opacities consistent with pulmonary edema.

Output: Right PICC terminates in right subclavian vein without complication. Pulmonary edema and pleural effusions are not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt. c/o of prolonged productive cough r/o pneumonia. History: Pt. c/o of prolonged productive cough r/o pneumonia. Mild cardiomegaly with distended mediastinal veins.Diffuse interstitial opacity with multiple septal lines compatible with edema and small pleural effusions.The findings are suggestive of CHF.

Output: CHF with pulmonary edema and small effusions. No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: eval for pna History: sob Interval increased right perihilar opacity which may represent aspiration or infection with atelectasis. Recommended PA and lateral radiograph.Otherwise, no significant change in the appearance of the lungs without pleural effusion. The heart size is normal.

Output: Right perihilar opacity which may represent infection, atelectasis or aspiration. Recommend PA and lateral radiograph.


Instruction: Generate impression based on medical findings.

Input: Reason: 48 yo F POD #3 with recent fever History: febrile, post-operative state Small lung volumes with left basilar opacity compatible with pleural effusion and underlying atelectasis.No specific evidence of pneumonia.

Output: Moderate left pleural effusion with underlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: r/o opacity History: productive cough, h/o asthma \T\ NHL Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.Stable position of surgically placed subclavian single lumen chest port

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with shortness of breath status post bronchoscopy of the right lung. Rule out pneumothorax. Cardiomediastinal silhouette within normal limits. Previously described left upper lobe pulmonary opacity no longer clearly identified. Stable emphysematous changes in the left lung. Increased patchy opacities in the right base likely related to recent procedure. No evidence of pneumothorax. No pleural effusions.Multiple surgical clips overlying the superior mediastinum again seen.

Output: No evidence of pneumothorax status post bronchoscopy of the right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: PA catheter placement? History: see above Swan-Ganz catheter tip in the right main pulmonary artery. Remaining support devices, including left chest ICD with an orphaned lead are unchanged.Cardiomegaly is not significantly changed compared to the prior exam. Increasing right pleural effusion and associated right basilar atelectasis. Mildly increased left basilar atelectasis.

Output: Increasing right pleural effusion and associated right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Fever and weight loss. Left-sided dual-chamber ICD/pacemaker is unchanged in position. Sternotomy wires are unchanged. A right-sided central venous catheter tip at the cavoatrial junction.No focal airspace opacity, pleural effusions or pneumothorax. The cardiomediastinal silhouette is stable.Broken sternotomy wires are unchanged.

Output: No acute cardiopulmonary abnormality or significant interval change.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: Pneumothorax; chest tube re-position History: As above Decreased size of right subpulmonic pneumothorax.Line position otherwise stable.No change in pulmonary opacities.

Output: Decrease in subpulmonic pneumothorax. No change in line position or in bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: sob, cough x 4 months History: cough, traveled from Qatar 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: Female, 50 years old.Reason: Where is the central line? History: Central line placed Cardiomegaly, mild interstitial edema and persistent retrocardiac consolidation.Stable pleural effusions.Left jugular catheter, tip in SVC.Prior right jugular catheter tip at cavoatrial junction.

Output: Left jugular catheter, tip in SVC. Unchanged pulmonary opacities and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: intubated in icu History: post op icu Persistently widened mediastinum consistent with known history of aortic dissection.Diffuse interstitial opacities and moderate pleural effusions are similar to the prior exam. No pneumothorax.Median sternotomy wires are intact. Mediastinal drains unchanged in position. ET tube is approximately 4 cm above the carina.

Output: Persistent pulmonary edema, similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: cxr in the event that he needs surgery History: none Study is limited by lordotic orientation. Mild bibasilar reticulation again noted. No pleural effusion or pneumothorax. Normal heart size. Aortic atherosclerosis.

Output: No acute cardiopulmonary process on radiography. Mild basilar reticulation again noted which may represent scarring or very early fibrosis.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with history of hypotension. Evaluate for pneumothorax. Endotracheal tube tip at the level of the thoracic inlet. Partially imaged right nephroureteral stent. Midline abdominal skin staples are present.Mild cardiomegaly. There are retrocardiac opacities representing atelectasis/consolidation. Large hiatal hernia. No pleural effusions or pneumothorax.

Output: Unchanged cardiopulmonary appearance with no evidence of pneumothorax as clinically queried.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: hemoptysis and cough since Friday febrile, abnormal lung sounds at bases. Rule out pneumonia vs reactivation tb vs other History: Left suprahilar and basilar opacities suggestive of infection.Right lung unremarkable.Heart size normal.

Output: Multifocal pneumonia. This should be followed to resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Fever. Tortuous aorta is noted. There is a layering left pleural effusion with overlying basilar opacity. Low lung volumes with right basilar subsegmental atelectasis.

Output: Layering left pleural effusion with nonspecific basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: ET tube advanced 2 cm from prior History: see above Patchy airspace opacities with pleural effusions slightly increased on the right, consistent with atypical edema or aspiration.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.IVC filter. Right jugular catheter, tip in SVC.

Output: Increased pulmonary opacities with pleural effusions. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.History: Sarcoidosis (on steroids, Remicade infusions), recurrent DVTs (on Coumadin). Signs and symptoms: Cough, sore throat, leukocytosis Stable cardiomediastinal silhouette.No new pulmonary or pleural abnormalities.Unchanged skeletal findings, as detailed on dedicated spine and rib views from 7/18/2015.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 65-year-old woman with stage IIIB papillary serous carcinoma of the ovary diagnosed 1/2006, status post surgery and chemotherapy. CT 11/1/2007 new left pleural based nodules. Please compare and comment if it can be biopsied. CHEST:LUNGS AND PLEURA: The previously seen nodule in the left lower lobe is decreased in size and now measures about 5.4 x 5 mm on image 58/93.A single new nodule is seen. It measures 4.7 mm in diameter on axial image 40/93.Previously seen nodule in the right middle lobe on image 55-56 is no longer presentthe previously seen nodule in the right lung on image 38 no longer present.None of these nodules would be amenable to percutaneous biopsy.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Port-A-Cath left chest wall.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 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: Many of the previously seen nodules disappeared or decreased in size and only one new nodule is seen. This raises the question whether these may be inflammatory in nature. None of them are large enough to be amenable to percutaneous biopsy. There is no measurable disease elsewhere.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: History multiple myeloma, prestem cell transplant evaluation. The heart size is upper normal to mildly enlarged.Tortuous aortic contour may reflect long-standing hypertension.No focal airspace opacities, pleural effusions, or pneumothorax. No suspicious pulmonary nodule or mass.Multiple destructive rib lesions are identified, notably in the left fourth rib.

Output: No acute cardiopulmonary process, or suspicious pulmonary nodule or mass. Destructive rib lesions, related to patient's multiple myeloma.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Stroke. Cardiopulmonary evaluation. Low lung volumes. Cardiomegaly. Superior mediastinal widening in the aortopulmonary window region.Mild bronchial wall thickening and peribronchial opacity suggestive of aspirated secretions bilaterally.

Output: Superior mediastinal widening may be secondary to ectasia or aneurysmal dilatation of the thoracic aorta, lymphadenopathy is considered less likely. Dr. Yano covering pager 6229 notified via WebXchange text page at the time of interpretation, 8:52 AM on 8/26/2015.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval for evidence of pneumonia History: ho copd, sob No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: OSH transfer Hx of OHT p/w fever History: SOB Left basilar scarring.Median sternotomy, heart size normal.No specific evidence of infection or edema. Healed right rib fracture.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: s/p stem cell transplant; non neutropenic fever. please compare with previous XR History: fever Lines and tubes are unchanged. Increase in basilar opacities. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Please eval for ETT placement History: Pt is intubated on mechanical ventilation ET tube and catheters unchanged.Left basilar opacity compatible with atelectasis and effusion also unchanged.No new findings.

Output: ET tube in acceptable position.