Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Aortic arch repair. Surgery longer than eight hours, corrected counts. Evaluate for retained foreign object. Status post sternotomy for aortic repair, with no reliable evidence of mediastinal hemorrhage.Postop basilar opacities left greater than right with small pleural effusions are present.Multiple chest tubes are seen, with no pneumothorax.ET tube tip approximately 5 cm above the carina.Right jugular Swan-Ganz catheter, tip in pulmonary outflow tract.

Output: Status post aortic repair, with postop basilar atelectasis and pleural effusions. No significant pneumothorax. Findings were discussed with Dr. Brian Mitzman by phone by the radiology resident on call 3/2/2016 at 7:25 PM. A text page indicating no retained foreign object was sent to the attending surgeon Dr. Ota.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p LVAD, assess for pulmonary edema, pneumonia, LVAD positioning History: new patient ICD leads, mitral valve prosthesis, left atrial clamp and LVAD in place.Mild blunting of the left costophrenic angle compatible with a small effusion or scarring.Mild lower zone interstitial opacity compatible with atelectasis and scarring. No reliable evidence of pulmonary edema.Moderate cardiomegaly, decreased from previous with vascular redistribution.

Output: Cardiomegaly with vascular redistribution and possible small effusion but no reliable evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Improving left basilar atelectasis, persistent on the right where there is also a right pleural effusion.Right jugular catheter, tip at cavoatrial junction.NG tube removed.

Output: Persistent right pleural effusion and atelectasis, but improvement in left basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Aspiration pneumonia. There is some residual peribronchial opacity at the left base, minimally over the last few days. Chronic appearing abnormalities elsewhere unchanged. Heavily calcified thoracic aorta. Probable scarring right upper lobe

Output: Slight improvement in left lower lobe opacity now consistent with aspiration pneumonia


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: L subclav TLC reposition eval History: as above Left subclavian catheter reposition the tip now in the SVC.Basilar edema and pleural effusions are unchanged.Mediastinal drains unchanged in position. ET tube tip approximately 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: Left subclavian catheter, tip in SVC, repositioned.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: evaluate cannulas and lines History: VA ECMO Swan-Ganz catheter terminates in the right pulmonary artery. Other lines and tubes are unchanged. Low lung volumes. Increased diffuse pulmonary edema. Dense left lower lobe opacification again noted. Increased small pleural effusions.

Output: Swan-Ganz catheter terminates in the right pulmonary artery.Increase in diffuse pulmonary edema and pleural effusions.Dense left lower lobe atelectasis or consolidation again noted.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Cardiomediastinal silhouette is within normal limits. Tortuous aorta.Large lung volumes and flattened diaphragms consistent with COPD. No consolidation, pleural effusion, or or pneumothorax.

Output: COPD. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: SOB w/ cough Unremarkable cardiac and mediastinal silhouette. Small lung volumes with no gross abnormalities.A questioned small right upper lobe nodule is likely artifactual secondary to rib suppression and image processing.A follow-up radiograph could be obtained in approximately 6 months to confirm this.

Output: No sign of pneumonia. A questioned right upper lobe nodule is likely artifactual but this could be confirmed with follow-up chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for CHF History: worsening SOB Markedly enlarged cardiac silhouette, particularly on the lateral view, which may be due to cardiomegaly or pericardial effusion.Single-lead AICD extending to the area of the apex of right ventricle.No evidence of pulmonary edema or pneumonia.

Output: Enlarged cardiac silhouette, compatible with cardiomegaly or pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: rule out pneumonia History: cough Cardiac silhouette is within normal limits in size.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Hypotension status post aortic valve repair. Failure to wean from vent. Cardiopulmonary monitoring and support devices appear similar to prior. Low lung volumes with patchy interstitial and air space opacities, not significantly changed.

Output: Extensive persistent patchy interstitial and air space opacities which may reflect a combination of atypical edema, aspiration bronchiolitis pneumonitis and possibly infection.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: Swan positioning History: as above Left IJ Swan-Ganz has been placed with its tip in the right pulmonary artery.Left-sided ICD, right pleural drain, right IJ introducer unchanged.Stable cardiac enlargement.The pulmonary edema and pleural effusions similar appearance the prior exam.No evidence of pneumothorax.

Output: Placement of a left IJ Swan-Ganz with tip in the right pulmonary artery. Stable cardiopulmonary appearance with cardiomegaly, edema, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.ETT advancement 6 to 7 cm. ETT tip about 1.5 cm above the expected level of the carina. Right jugular catheter and left chest tube unchanged in position. Bilateral basal atelectasis. Small to moderate volume of pleural fluid on the left. Small volume of pleural fluid on the right. No visible pneumothorax.

Output: Low endotracheal tube. Basal atelectasis and at least a small volume of pleural fluid bilaterally.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Short of breath in CHF patient History: SOB Right pleural effusion and overlying atelectasis unchanged.Small lung volumes.Heart size normal.Right jugular catheter pulled up into the right jugular from the brachiocephalic.

Output: Persistent right pleural effusion with overlying atelectasis, consistent with CHF. Right jugular catheter partially withdrawn.


Instruction: Generate impression based on medical findings.

Input: Neck pain following motor vehicle accident. Fracture? Alignment is anatomic. No acute fracture. Prevertebral soft tissues are unremarkable.

Output: No acute fracture or malalignment.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with AML, status post chemotherapy, now with chest pressure LUNGS AND PLEURA: Interval development of a moderate bilateral pleural effusions. Scattered ground glass nodular opacities with associated bronchiolar thickening are noted in the right lower and middle lobes may represent aspiration/bronchiolitis. No areas of consolidation can be identified. Paraseptal and centrilobular emphysema is again identified, predominantly in the upper lobes.MEDIASTINUM AND HILA: Interval development of a mild pericardial effusion. No mediastinal or hilar lymphadenopathy. Coronary artery and aortic calcifications. Central Port-A-Cath with its tip in the SVC.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: cholelithiasis

Output: Interval development of bilateral pleural effusions and a small pericardial effusion. This may be on a basis of CHF. No evidence of consolidation. Underlying emphysema.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: assess position of intra aortic balloon pump History: status post exchange today Stable cardiac enlargement with atherosclerotic changes of aorta.IABP marker now identified in the proximal descending aorta.The lungs are clear.No pleural effusions.

Output: IABP marker repositioned and now within the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pulm edema. pna History: sob Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 18year old female with LP shunt, pop when moved neck. Evaluate for LP shunt malfunction SHUNT DEVICE: LP shunt catheter enters the spine at approximately L3/L4 with tip not clearly visualized however appears to extend superior to T8. The shunt catheter extends anteriorly into the left upper quadrant where it forms a curve and courses inferiorly towards the right hemiabdomen with tip terminating in the left hemipelvis unchanged from prior study. No kinking or discontinuity is seen in the visualized radiopaque portions of the shunt.SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: No significant abnormality noted.ABDOMEN: Average stool burden.

Output: No evidence of LP shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: effusion History: no Left-sided chest tube unchanged.No pneumothorax identified.Minimal subcutaneous emphysema noted along the left chest wall.Cardiomediastinal silhouette is unremarkable.Mild basilar scarring/discoid atelectasis.No large pleural effusions.

Output: No interval change without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT; ADMISSION TO ICU Swan-Ganz catheter with tip looped in the right ventricular outflow tract.Multiple bilateral chest tubes unchanged in position.Retrocardiac atelectasis, unchanged.Small bilateral apical pneumothoraces.No large pleural effusion.

Output: Small bilateral apical pneumothoraces.Swan-Ganz catheter with tip looped in the right ventricular outflow tract.


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath History: wheezing Retrotracheal and retrocardiac opacity compatible with a massively dilated fluid-filled esophagus. In the absence of previous surgery such as gastric interposition this is suggestive of achalasia.No significant cardiopulmonary abnormalities.Calcific opacity in the area of the gallbladder suggestive of cholelithiasis.

Output: Massively dilated fluid-filled esophagus which could be better defined by CT scan and/or esophagram.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of metastatic renal cell carcinoma. Please evaluate extent of disease. CHEST:LUNGS AND PLEURA: Multiple scattered pulmonary nodules are noted bilaterally, consistent with metastatic disease. The pleural-based nodule in the right lung measures 0.9 cm x 1.4 cm (series 8, axial image 74/103).MEDIASTINUM AND HILA: Small mediastinal nodes are visualized. Incidentally noted is a thrombus surrounding the central venous catheter at the level of the SVC/subclavian junction.CHEST WALL: Right-sided Port-A-Cath is present. ABDOMEN:LIVER, BILIARY TRACT: Multifocal liver lesions consist with metastatic disease with surrounding vascular flow phenomenon. One lesion (on series 7, axial image 82/212) measures 0.9 cm x 1.1 cm; the hypoattenuating component was measured, excluding the surrounding hyperattenuating thickness.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland appears to be surgically absent.KIDNEYS, URETERS: Surgically absent left kidney. Double renal vein is noted on the right side (normal variant).RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymphadenopathy, along with a small portacaval node, small nodes in the porta hepatis, as well as small nodes in the gastrohepatic ligament.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Wide inguinal canals containing fat (series 7, axial image 182/212).

Output: 1.Multiple scattered pulmonary nodules are noted bilaterally as well as multifocal liver lesions, consistent with metastatic disease as described above.2.Incidentally noted is a thrombus surrounding the central venous catheter at the level of the SVC/subclavian junction.3.Diverticulosis.4.Normal variant double renal vein on the right.


Instruction: Generate impression based on medical findings.

Input: Check intubation, CHF ETT remains 5 cm above the carina. NG tube projects beyond the inferior edge of the imageModerate nonspecific cardiomegaly with mild mixed interstitial and airspace opacities concerning for edema with compression atelectasis greater on the left with a small effusion

Output: ETT unchanged with CHF


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Right chest pressure and sob w/ known mass on RUL History: right chest pressure and sob Mild cardiomegaly.No specific evidence of infection or edema.No mass identified.Surgical clips GE junction region.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Eval for hemothorax History: decreased chest tube output Right chest tubes with a minimal right apical pneumothorax, and fluid in the fissure.Heart size normal.No edema identified.ET tube tip approximately 5 cm above the carina.NG tube high, tip in distal esophagus.Two right jugular catheters are unchanged.

Output: High NG tube. Minimal pneumothorax and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Pain in shoulder and chest No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: assess pulm edema History: assess pulm edema Endotracheal tube tip projects approximately 6 cm above the level of the carina. Mild to moderate cardiomegaly. Perihilar and basilar interstitial and airspace opacities appear similar to the radiograph dated 11/21/2016, but significantly increased from the radiograph dated 11/11/2016. Likely small bilateral pleural effusions. There is persistent consolidation in the medial left lower lobe.

Output: Mild to moderate pulmonary edema and aspiration. There is persistent consolidation in the medial left lower lobe, query signs of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reexpansion of lung status post pleurectomy Stable position to right apically directed chest tubes. Angiocatheter projects at the base of the right neckStable sized right hydropneumothorax with basilar opacities of edema and atelectasis. Lucency at the right hemidiaphragm may represent trace pneumoperitoneum. Subcutaneous emphysema right inferolateral chest wall stable. Left lower lobe atelectasis without pneumothorax.

Output: Stable sized right pneumothorax basilar opacities of edema and atelectasis. Possible trace pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of scalp melanoma CHEST:LUNGS AND PLEURA: Stable calcified granulomata. Chronic elevation of left hemidiaphragm with secondary atelectasis in the left lower lobe, unchanged.MEDIASTINUM AND HILA: Calcified bilateral hilar and subcarinal nodes.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: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: cough, sob, acute chest? History: sob, cough Cardiomediastinal silhouette is unchanged.Postsurgical volume loss in the right hemithorax. No new focal pulmonary opacities.No pleural effusion or pneumothorax.Unchanged mild skeletal abnormalities reflecting sickle cell disease.

Output: No acute cardiopulmonary abnormality. No specific evidence of acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Pulmonary congestion. Mild right upper lobe scarring, unchanged.Otherwise, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.No significant change.

Output: Right upper lobe scarring, otherwise unremarkable and unchanged.


Instruction: Generate impression based on medical findings.

Input: ETT adjustment ETT minimally advanced, tip currently projects 3 cm above the carina. NG and right PICC line unchangedMildly decreased lung volumes with minimal basilar suspected atelectasis. Borderline cardiomegalyUnchanged right hilar masslike change

Output: ETT adjusted


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: r/o tuberculosis History: occasional cough and night sweats. Exposed to TB through business associate. H/O positive PPD preceding exposure 1 month ago. Cardiomediastinal silhouette is within normal limits.No focal opacity, pneumothorax, or significant pleural effusion is identified.No lymphadenopathy is present.

Output: No acute cardiopulmonary abnormality. No specific evidence of tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: eval for TB; PCP, PNA History: sob, hx of HIV Unchanged cardiomediastinal silhouette.Persistent right basilar interstitial opacities which may represent scarring, with new superimposed right middle and lower lobe patchy airspace opacities suggestive of infection. No pleural effusion or pneumothorax.

Output: Increased right basilar opacities, compatible with pneumonia. However, this is not a typical pattern for PCP or TB.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: shortness of breath History: short of breath Perihilar bronchial wall thickening could indicate asthma or bronchitis.No specific evidence of infection or edema.Heart size normal.

Output: Possible asthma or bronchitis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: post thora History: sob ] PICC line with its tip in the right axilla.Stable cardiomediastinal silhouette.Small right pleural effusion identified.No evidence of a pneumothorax post procedure.Cavitary lesions and pulmonary nodules noted on recent CT only faintly visualized.Discoid atelectasis identified at the left lung base.G-tube in place.

Output: No evidence of a pneumothorax post thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: eval for pulmonary edema History: dyspnea Cardiomegaly status post sternotomy for CABG and valve replacement.In addition to pulmonary edema, focal right upper lobe airspace opacities suggestive of infection.Left subclavian pacemaker, leads unchanged in position.

Output: CHF with edema and right upper lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: new oxygen requirements, concern for pulmonary edema History: as above Normal heart size with an ICD lead extending to the area of the apex of the right ventricle.Right lateral pleural thickening with extensive pleural calcification on the left. On the right the pleural opacity may represent chronic pleural thickening and/or effusion.Underlying interstitial pulmonary opacities suggestive of scarring.No specific evidence of pulmonary edema or pneumonia.

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


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: ETT placement History: see above Moderate to severe cardiomegaly with unchanged left lower lobe consolidation and a left pleural effusion.Right lower lung zone edema pattern is stable.Right jugular catheter, tip in SVC.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Rule out pneumonia History: As above Tracheostomy tube and venous catheter unchanged.Feeding tube tip in the body of the stomach.Small lung volumes with diffuse nonspecific airspace and interstitial opacity, compatible with the clinical diagnosis of ARDS, not significantly changed.No new findings.

Output: Diffuse nonspecific pulmonary opacity compatible with ARDS with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, wheeze, desats. Abnormality? History: SOB, wheeze, desats Small lung volumes with nonspecific basilar opacity compatible with atelectasis and small effusions, generally unchanged.Catheter with its tip in the upper right atrium. Enteric tube traversing the esophagus.

Output: Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions, without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: r/o pneumonia History: productive cough, new O2 requirement Low lung volumes makes detailed cardiopulmonary assessment difficult.Increased basilar opacities. No pneumothorax. Question of small left-sided pleural effusion. Unchanged heart size.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Increased basilar opacities which may represent atelectasis and/or consolidated lung. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old with chest pain. There are decreased lung volumes.The cardiomediastinal silhouette is unremarkable.The lungs are clear. No large pleural effusions.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalites identified without 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, 61 years old.Spiking fevers, unclear source. Left subclavian chest port tip unchanged in position. A right upper lobe perihilar mass is again seen as well as a left apical mass. New nodular densities lateral to the right hilum may reflect metastases, nonspecific by plain film. Hilar and mediastinal enlargement suspicious for lymphadenopathy, progressed in the mediastinum.

Output: Interval worsening of mediastinal lymphadenopathy since the 12/31/2015 film. There may be new nodules in the right lung which are more likely to be metastatic than infectious.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Cough and hypotension. Unremarkable cardiac and mediastinal silhouettes.Stable biapical scarring. Chronic right middle lobe bronchiectasis and subsegmental opacity appearing similar to 2014 CT.No new focal opacities or pleural effusions.

Output: Chronic right middle lobe bronchiectasis and subsegmental opacity without new abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.ETT placement. ETT approximately 4 cm above the level of the carina. Nasogastric tube tip looped in the stomach.Retrocardiac consolidation on the left with improvement in adjacent atelectasis. Patchy opacity on the right with bronchial wall thickening suggestive of aspirated secretions.

Output: ETT 4 cm above carina. Persistent left basal opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: Swan, IABP, CHF History: as above Left-sided ICD and IVC Swan-Ganz unchanged.IABP marker in the proximal descending aorta.Decreased lung volumes with stable cardiac enlargement.Mild interstitial opacities suggestive of edema.No new pulmonary opacities identified.No large pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Chest pain. Vascular redistribution towards the upper lungs, with diffusely prominent vasculature especially in the perihilar regions. There is no frank edema or pleural effusions.Stable cardiomegaly.

Output: Prominent pulmonary vasculature with redistribution. No frank pulmonary edema, though concerning for early CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: LLL Effusion History: hypoxia Bilateral basilar opacity, greater on the right, compatible with effusions and underlying atelectasis.Extensive skeletal sclerosis compatible with metastasis.No new findings.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Chest pain. Rule out abnormality. Low lung volumes. Linear scarring/atelectasis within bilateral lower lobes. Left upper lobe nodular density, which may be calcified. Nonspecific left lower lobe opacity, atelectasis on-end versus consolidation.Fullness in the AP window region.

Output: Nonspecific left lower lobe opacity and bilateral lower lobe atelectasis/scarring. Fullness in the AP window region. Further evaluation recommended with PA and lateral chest radiographs.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.SOB question pneumothorax status post orthotopic heart transplant. Right jugular catheter tip at the superior cavoatrial junction. Cardiomediastinal appearance is unchanged. Clip or marker, possibly an IABP, 5 cm below the top of the aortic arch.Absence of vascular markings in the deep left costophrenic angle on the lateral radiograph without visible pleural line or evidence of pneumothorax elsewhere, probably related to rotation although follow-up is recommended. Mild basal atelectasis is improving. No specific signs of pulmonary edema.

Output: No conclusive pneumothorax however there is an unexplained lucency in the deep left posterior costophrenic angle on the lateral radiograph. Given clinical concern for pneumothorax, short-term follow-up erect PA and lateral chest radiographs are recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: MaleReason for Study: Reason: eval device placement History: IABP, femoral swan Redemonstration of dextrocardia and situs inversus.There is cardiac enlargement.Lungs are clear.No large pleural effusions.IVC Swan-Ganz catheter looped within the main pulmonary artery and tip extending into the right descending pulmonary artery.IABP marker in the proximal descending aorta.

Output: Redemonstration of dextrocardia and situs inversus with cardiac enlargement. IVC Swan-Ganz and IABP marker unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: r/o lung path History: chest pain, dyspnea The cardiomediastinal silhouette is within normal limits. No focal consolidation, pneumothorax, or effusion.

Output: No acute cardiopulmonary process is identified. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acs History: chest pain Unremarkable cardiac and mediastinal silhouette. Mild streaky lower zone opacities compatible with subsegmental atelectasis.No sign of pulmonary edema or pneumonia.

Output: Mild subsegmental atelectasis and no other acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p OLT History: s/p OLT Basilar atelectasis and small pleural effusions are unchanged.Unchanged support devices.

Output: Stable basilar atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Colon cancer, status post chemotherapy and resection of hepatic metastases. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver is unchanged. Previously described lesion at the paraphrenia the segment two is unchanged measuring 11 x 10 mm. No other focal hepatic lesions.SPLEEN: Stable splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small renal cysts.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: Changes secondary to colonic resection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Perforated gastric ulcer, ETT. Endotracheal tube tip approximately 5 cm above the level of the carina. Other hardware and support devices unchanged in position.Large layering pleural effusions, right greater than left probably similar in volume allowing for differences in patient position. SVC distention consistent with hypervolemia. Dependent and basal atelectasis is severe.

Output: ETT 5 cm above the carina. Large pleural effusions with extensive compressive atelectasis about the same.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Sleep apnea and hypoxia rule-out pneumothorax. Oxygen requirement and prior right-sided chest tube. Interval removal of right-sided chest tube on this pneumothorax. Asymmetric lung volumes, lung greater right. Blunting of the costophrenic angles unchanged. Sternotomy hardware unchanged in alignment. Bronchial wall thickening and atelectasis in the posterior lung fields, nonspecific but could be due to aspirated secretions.

Output: No pneumothorax. Atelectasis and bronchial wall thickening in the posterior lung fields nonspecific but could be due to previously aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with epigastric abdominal pain. Cardiomediastinal silhouette is normal.No focal pulmonary opacity or pleural effusion. The

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for hypoxia History: shortness of breath Unchanged patchy pulmonary opacities suggestive of edema and/or infection.Right jugular catheter placed, terminating at the SVC/RA junction level.

Output: Unchanged pulmonary opacities. New right jugular catheter placement.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: cardiogenic shock, increased wob History: see above Small moderate right pleural effusion present the right lung base, unchanged.Mild basilar atelectasis is stable.Right jugular catheter tip at SVC/RA junction level.An NG tube terminates in the stomach.

Output: Cardiomegaly with pleural effusions right larger than left, likely cardiogenic and unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: r/o new infiltrate or volume overload History: tachypnea Stable cardiac enlargement.Patchy bilateral air space and interstitial opacities seen on the prior exam.Mild interval improvement in basilar atelectasis.Small bilateral pleural effusions.

Output: Bilateral interstitial and air space opacities compatible with edema are not significantly changed allowing for differences in technique. Mild interval improvement in aeration within lower lobes.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old with history of CHF with right ventricular failure Support devices stable in position. Stable cardiomediastinal silhouette. Bibasilar atelectasis without new focal airspace opacities identified. No significant pleural effusions.

Output: Stable cardiopulmonary exam without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: ET placement History: advanced ET Interstitial opacities with left lower lobe consolidation and left pleural effusion are unchanged.ET tube tip 7 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary opacities. ET tube tip 7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Chest pain. Evaluate for pneumothorax. No focal consolidation, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No pneumothorax or other acute cardiopulmonary process.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, 31 years old.AML and new hypoxia. Left PICC tip projects over the right atrium, unchanged in position. Mediastinal fullness bilaterally may be the result of hypervolemia.Interval worsening of pleural fluid, interstitial edema and superimposed basal predominant airspace opacities, right greater than left.

Output: Moderate to severe CHF. Basal airspace opacities may reflect atypical edema however superimposed to drug reaction, pulmonary hemorrhage or infection could have a similar radiographic appearance and cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male; 58 years old. Reason: Surveillance for history of bladder cancer History: surveillance Normal cardiomediastinal silhouette. Stable mild scar-like opacity in the right upper lobe.No suspicious pulmonary nodules are evident.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre kidney transplant evaluation, end stage renal disease. Rule out cardiomegaly and infilitrates. History: Pre-Kidney Transplant Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. Improvement in lung volumes and basilar atelectasis noted on previous study. No new focal pleural parenchymal opacity. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: ? PNA History: SOB Consolidation within the right upper lobe. Normal heart size. No pleural effusion or pneumothorax. Pacer leads, unchanged.

Output: New right upper lobe consolidation consistent with pneumonia, eosinophilic pneumonia, and/or allergic bronchopulmonary aspergillosis/mycosis. Consider correlation with eosinophil levels as well as IgE levels. Chest radiographic follow-up is suggested in 8 weeks to ensure resolution.


Instruction: Generate impression based on medical findings.

Input: Reason: 58 y/o lady w/ dyspnea and a productive cough History: 58 y/o lady w/ dyspnea and a productive cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: cardiomegaly History: cp The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: History of ALL, post chemo, pre-bone marrow transplant workup. LUNGS AND PLEURA: Irregular opacity measuring 14 x 12 mm (image 64, series 80340) with internal cavitation is seen in the right apex, which is new since 5/26/10 and was seen as irregular opacity without cavitation on 6/18/10. On prior study dated 6/18/10, similar appearing multiple irregular opacities were seen in the right upper lobe, left upper lobe and bilateral lower lobes, most of which are no longer present. Small residual nodular opacity is noted in the left lower lobe, which has decreased in size.No pleural effusion.MEDIASTINUM AND HILA: Stent seen at the area of left anterior descending coronary artery. Left PICC line tip in the SVC.No pericardial effusion.No evidence of mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Irregular opacity with cavitation in the right apex and small nodular opacity in the left lower lobe, which have decreased in size since 6/18/10. Previously seen other multiple irregular opacities are no longer present. Findings are likely resolving infection such as fungal.


Instruction: Generate impression based on medical findings.

Input: 73 years old Male. Reason: intubated, mucus plugging History: as above. Diffuse bilateral coarse interstitial changes, unchanged as compared prior study. The tube and lines are stable in position. There are small bilateral pleural effusions, unchanged as compared with prior study.

Output: No substantial changes of the diffuse pulmonary opacities as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Restaging CT for gastric GIST CHEST:LUNGS AND PLEURA: Emphysematous changes again seen. Prior referenced left lower lobe nodule which may represent a lymph node in the major fissure is unchanged at 5 mm (image 47; series 9). MEDIASTINUM AND HILA: Stable thyromegaly with an enlarged multinodular right lobe extending into the right paratracheal area. No lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: On arterial weighted study, there is a subcentimeter hyperdense region in laterally in the left lobe adjacent to the stomach (image 25; series 6). This area is isodense to liver on venous phase studies and may represent a flash filling hemangioma. Arterial weighted images were not obtained on the prior exam and the nodule therefore cannot be directly compared to that study. It can be evaluated on subsequent studies to confirm stability.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral benign appearing renal cysts are again seen. A higher density nodule at the inferior right kidney which has been discussed in detail previously is again noted and unchanged in size.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical changes from prior partial gastric resection are stable. The small and large bowel contour appears normal without wall thickening or mesenteric masses or fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent or atrophic uterus. No change in appearance of the adnexa with no abnormal masses.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small and large bowel contour appears normal without wall thickening or mesenteric masses or fluid..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Overall no significant interval change compared to prior. Subcentimeter pulmonary nodule. Stable presumed hyperdense renal cyst. Possible hemangioma in the left lobe of the liver should be assessed on subsequent studies for stability.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Marked interval improvement with decreased left pleural effusion, currently moderate in size. Minimal basilar atelectasis with otherwise clearance of the left lower lobe. Right lung remains clearCardiac and mediastinal contours are within limits. Mild scoliosis

Output: Resolving improved aeration of left lower lobe with a decreasing and nearly resolved overlying effusion


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: r/o edema History: hx CHF Stable cardiomegaly.Perihilar interstitial opacities compatible with pulmonary edema are slightly less prominent than on prior study. Bilateral pleural effusions right greater than left.No focal airspace opacity.

Output: Moderate pulmonary edema, improved from prior.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: eval for esophageal perforation History: CP, dysphagia, esophagitis Increased soft tissue and air density in the mediastinum may represent a dilated and/or perforated esophagus.Cardiac size is normalNo pulmonary opacities identified.No pleural effusions.

Output: Questionable increased soft tissue and air within the mediastinum which may represent either mild esophageal dilatation or perhaps a perforation. If clinically warranted CT of the chest is recommended for further evaluation with intravenous and oral contrast..


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: evaluate for aspiration pneumonia History: dysphagia, vomiting Elevated right hemidiaphragm with bowel superimposed between the liver and right hemidiaphragm.Impression atelectasis right lung base.Left lung unremarkable.Heart size normal.

Output: Chronically elevated right hemidiaphragm with bowel between the liver and hemidiaphragm. Mild overlying atelectasis, but no other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: Infiltrates History: fever Interval removal of left PICC line.Cardiomediastinal silhouette appears unremarkable. Lungs are normal without areas of consolidation.No evidence of a pneumothorax or pleural effusion.Subtle curvilinear lucency underneath the right hemidiaphragm compatible with intraperitoneal free air.

Output: Intraperitoneal free air, please refer to CT abdomen from today for further characterization.No other acute cardiopulmonary abnormalities. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: evaluate for infection History: hypotension despite multiple boluses Coarse interstitial opacities are suggestive of edema with the heart size upper normal.No specific evidence of infection.A Dobbhoff tube extends below the lower margin of the image.

Output: Interstitial opacities suggestive of edema from CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: trialysis line pulled back, re-evaluate position History: as above Central venous line in good position. No pneumothorax. Significant change in effusions and pulmonary edema. Stable heart size.

Output: Central line in good position.No change in cardiomegaly and pulmonary edema


Instruction: Generate impression based on medical findings.

Input: 69 years, Female. Reason: 69F s/p ex lap parastomal hernia repair, colostomy creation. Worsening abdominal pain History: abdominal pain, please obtain obstructive series Chest: There are low lung volumes. A right central line tip projects at the cavoatrial junction. A right internal jugular catheter projects at the upper superior vena cava. There is left basilar subsegmental atelectasis. There is no evidence of free intraperitoneal air.Abdomen: The stomached is distended with air. There are mildly dilated loops of small bowel measuring up to 4.9 cm. No air is identified distally.

Output: 1.Dilated small bowel loops with differential air-fluid levels, suspicious for developing small bowel obstruction.2.Right central line tip projects at the cavoatrial junction.3.Right internal jugular catheter tip projects at the upper superior vena cava.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: 33 y/o with hypox resp failure History: sob Continued improvement in right upper lobe consolidation. Unchanged mild edema and right pleural effusion.Moderate cardiomegaly.Unchanged epicardial pacemaker leads.

Output: Continued improvement in right upper lobe consolidation with stable edema and right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: PNA History: cough and fever No acute cardiopulmonary abnormality.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with metastatic prostate cancer -- assessment after 8 cycles of investigational therapy. CHEST:LUNGS AND PLEURA: No infiltrates, nodules or effusions.MEDIASTINUM AND HILA: No significant change in the reference AP window lymph node (series 4 image 33) measuring 1.4 by 1.0-cm. Other small subcentimeter mediastinal lymph nodes are unchanged in size and appearance. Coronary artery calcification again seen.CHEST WALL: No change in appearance of scattered sclerotic bony metastatic foci.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Again, small benign renal cyst left upper pole kidney. No other abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted -- no enlarged lymph nodes identified..BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No change in the diffuse sclerotic metastatic bony lesions seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prior prostatectomy. No change in appearance of surgical bed.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No change in the distribution of bony sclerotic metastatic fociOTHER: No significant abnormality noted

Output: 1. Stable appearance to small mediastinal lymph nodes measured and visualized above. 2. No change in appearance or distribution of bony sclerotic metastatic foci throughout chest abdomen and pelvis. 3. No other abnormality seen in stable appearance compared with prior CT examination.


Instruction: Generate impression based on medical findings.

Input: Cardiac arrest. IABP positioning. Exam limited by motion artifact. IABP marker about 4.5 cm below the top of the aortic arch.No visible pneumothorax.Retrocardiac atelectasis/consolidation. Small to moderate pleural effusions. Signs of mild hypervolemia. Hazy opacity in the left lung consistent with edema and atelectasis.

Output: IABP marker about 4.5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: 75 year old female with lung cancer, status post chemo radiation. CHEST:LUNGS AND PLEURA: Volume loss in the left hemithorax with partial left upper lobe atelectasis, similar to prior. Left upper lobe soft tissue mass (series 5 image 46) is unchanged in size measuring 4.2 x 2.7 cm (previously 4.3 x 2.8 cm). Septal thickening and scarring in the left upper lobe, compatible with radiation fibrosis. Scattered micronodules, unchanged. Mild emphysema.MEDIASTINUM AND HILA: Reference right paraesophageal lymph node (series 3 image 63) is unchanged in size, measuring 1.4 x 1 cm. No cardiomegaly or pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Few scattered hypodensities are unchanged and likely represent an benign hepatic cysts. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticula with no evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes with partial fusion T12/L1, similar to prior.OTHER: Moderate vascular calcifications.

Output: Stable exam. No new lesions or recurrence.


Instruction: Generate impression based on medical findings.

Input: 26-year-old female with right lower quadrant pain and history of appendectomy. Evaluate for abscess. CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips. No evidence of intra-or extrahepatic biliary duct dilatation.SPLEEN: Not visualized.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged nodes. For reference, a gastric node (series 4, image 48) measures 1.6 x 1.7 cm.BOWEL, MESENTERY: Normal bowel. Numerous enlarged mesenteric nodes, predominantly in the right lower quadrant (series 4, image 94). For reference, a right mesenteric node (series 4, image 91) measures 2 x 1.7 cm.Surgical suture line in the cecum consistent with history of appendectomy. No abnormal fluid collections to suggest abscess.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent inguinal lymph nodes. For example, conglomerate of nodes in the right groin (series 4, image 153) measures 2.1 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Diffuse lymphadenopathy as above with a dense cluster of enlarged mesenteric nodes in the right lower quadrant. Findings may represent mesenteric adenitis.2. No discrete fluid collections to suggest abscess as clinically questioned.3. Absent spleen.


Instruction: Generate impression based on medical findings.

Input: Age: 92 yearsGender: FemaleReason for Study: Reason: Rib Fx? History: RIb Pain Left central venous catheter with its tip in the SVC/RA junction.The cardiomediastinal silhouette is unremarkable.Mild chronic interstitial opacities similar to the prior exam.No new pulmonary opacities identified.No pleural effusion.Possible nondisplaced fracture involving the anterolateral aspect of the left 10th rib.No evidence of a pneumothorax.

Output: Questionable nondisplaced rib fracture involving the anterolateral aspect left 10th rib. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: Eval for infection History: SOB, URI, chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Increased secretions History: As above Unchanged left upper lobe consolidation.Elsewhere, the lungs are unremarkable.Heart size normal.Tracheostomy tube tip approximately 6 above the carina.

Output: Unchanged left upper lobe consolidation. Tracheostomy tube tip approximately 6 above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.COPD, intubated with acute respiratory failure. Cardiopulmonary monitoring and support devices unchanged in position. Moderate pleural effusions, similar to previous. Course interstitial abnormality suggestive of edema and bronchiolitis, possibly related to aspiration. Additional patchy airspace foci could potentially reflect sites of developing infection, appearing increased in the right lower lobe.

Output: Pleural fluid volume is moderate, similar to previous. Right lower lobe opacities continue to worsen and are suspicious for developing aspiration pneumonia. Diffuse pulmonary opacities suggesting edema, atelectasis and diffuse aspiration are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Intubated. ETT tip 3 cm above carina. Right subclavian catheter can be followed to the superior vena cava. Enteric tube tip off the caudal margin of the film.Enlarged cardiomediastinal silhouette unchanged.Perihilar opacities consistent with edema and atelectasis, about the same.

Output: Unchanged pulmonary edema. Cardiac configuration remains suspicious for pericardial fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: evaluate for pneumothorax History: chest pain, dyspnea No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: evaluate for volume overload versus progressive infilrate History: hypoxia Diffuse opacity in the right lung with relative sparing of the right lung base, again noted. Left lung remains relatively clear. Unchanged heart size. No definite pneumothorax.

Output: No substantial difference compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pleural effusions History: fever Bilateral pleural effusions, considerably larger on the right, with underlying atelectasis.Enteric tube traversing the esophagus.

Output: Pleural effusions and atelectasis with no significant change in line for position and projection.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Chest pain and hypertension. Large lung volumes with apical scarring and bullous emphysema, unchanged. No specific evidence of infection or edema.Heart size normal, the aorta is mildly tortuous.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Neutropenic fever Unchanged moderate to largely basilar fibrotic changes with mildly decreased lung volumes. No discrete superimposed focal airspace process and appearance suggest previously described known UIP.Cardiac and mediastinal contours are otherwise within limits and unchangedLeft PICC line projects into the upper SVC

Output: Basilar fibrotic changes unchanged, no superimposed discrete acute new abnormalities


Instruction: Generate impression based on medical findings.

Input: Reason: eval for ET placement History: ET placed ET tube tip approximately 5 cm above the carina.ICD leads unchanged.Mild basilar opacity compatible with aspirated secretions and atelectasis.A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: status post Lorenz Bar removalVIEW: Chest AP The left lateral chest wall is excluded from the field-of-view. Status post Lorenz Bar removal without pneumothorax. Overlying the right inferior hemithorax is a portion of surgical wire presumably orphaned after bar removal. No pleural effusion or pneumothorax. The cardiothymic silhouette is within normal limits.

Output: Orphaned surgical wire overlying the right inferior hemithorax. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval for infiltrates History: septic No change in chronic right hemithorax volume loss and pleural effusions.Heart size normal.Scoliosis.

Output: No change in chronic appearing right hemithorax volume loss with small pleural effusions. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Pleural effusion. SOB. Near complete opacification of the right hemithorax with only a minimal amount of remaining right upper lobe aeration. Left lung slightly better aerated with decreased pleural fluid and atelectasis. Elevation of the right hemidiaphragm is obscured.

Output: Continued enlargement in right pleural fluid collection. This is entirely nonspecific by plain film technique however please correlate for possibility of hemothorax given rapid reaccumulation.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Assess PTX History: CT in place Right-sided chest tube again seen in place. Superolateral to the chest tube is, what appears to be, a skinfold. Follow-up chest x-ray is recommended.Cardiomediastinal silhouette is unremarkable.Pulmonary nodules are again identified and unchanged.No pleural effusion.

Output: 1. Right-sided chest tube. Likely skinfold noted however follow-up should BE obtained.2. Pulmonary nodules are unchanged.No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: SOB, congestion, eval for PNA History: SOB, congestion, eval for PNA The cardiomediastinal silhouette is normal in size.No focal airspace opacity, pleural effusion or pneumothorax.Focal proximal tracheal stricture is unchanged.

Output: No acute cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: fever and leukocytosis No significant cardiopulmonary abnormalities.Pneumoperitoneum, as previously described.

Output: No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval PTX History: hypoxia Right chest tubes endobronchial valves in place with a small residual right apical pneumothorax.Severe bullous emphysema bilaterally with extensive interstitial opacity and pleural scarring.No new findings.

Output: Small right pneumothorax and no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: r/o acute chest History: CP, sickle cell Cardiomegaly.Right pleural and parenchymal scarring.No sign of infection.

Output: No acute abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.History of RCC, please evaluate for metastatic disease. Normal heart size. No focal airspace opacities or discrete lung nodules. Mild blunting of the right costophrenic angle may represent a small pleural effusion or scarring.Partially air-filled hiatal hernia; the posterior wall of the hernia is dense and may represent retained fluid or debris. However, other pathology cannot be ruled out on plain radiographs.

Output: No radiographic evidence of pulmonary metastases. Incompletely evaluated hiatal hernia, correlate with patient's symptoms.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, 50 years old.Chest pain Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o pneumo History: chest pain Median sternotomy for CABG, with heart size normal, the aorta tortuous.Linear scarring or subsegmental atelectasis noted.No significant pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 61 year old female with history of PE now with shortness of breath. Question new PEs. Sign of pulmonary congestion? Cardiomegaly, also has history of multiple myeloma. CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: Mild bronchial wall thickening with nodular opacities at the bases suggesting mild aspiration. No suspicious nodules, masses, or pleural effusion.Moderate centrilobular emphysema. Mild chronic basilar scarring, unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Scattered lucencies involving the sternum, clavicles, and spine are compatible with patient's history multiple myeloma. Spinal stabilization hardware involving the thoracolumbar spine, as seen previously.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Findings compatible with mild aspiration.2. No evidence of pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: Confirm nasogastric tube placement Thick-walled enteric tube seen with tip directed retrograde into distalmost esophagus, repositioning recommended. Nonobstructive bowel gas pattern. Present on prior imaging as well is a 6 mm nodular focus in lateral left lower lobe, may be a pulmonary granuloma but nonspecific.

Output: Repositioning of enteric tube recommended.Unchanged nodular focus in left lower lobe, may be a pulmonary granuloma but confirmation with dedicated CT imaging should be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Status post extubation. Status post extubation. The remaining support hardware is unchanged in position. Underinflated lungs with retrocardiac consolidation/atelectasis.

Output: Status post extubation with underinflated lungs and retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: cough History: cough Normal cardiomediastinal silhouette. No focal lung opacities. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: s/p PPM History: s/p PPM Stable cardiomediastinal silhouette with evidence of a mitral valve prosthesis.Scattered areas of scarring/discoid atelectasis.No focal areas of consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lung transplant History: s/p lung transplant Mild blunting of both costophrenic angles consistent with small pleural effusions, similar or decreased compared to previous.Normal heart size with surgical artifacts in the mediastinum compatible with previous clamshell sternotomy and bilateral lung transplant.No new findings.

Output: Small pleural effusions and no other significant findings.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Status post AVR assess lung fields. Aortic valve bioprosthesis and pericardial drain in place. Interval removal of right jugular introducers and endotracheal tube. No pneumothorax.Low lung volumes decreased from prior, with worsening basal atelectasis and nonspecific retrocardiac opacity. Questionable mild edema versus underinflation artifact at the right base.

Output: Decreased lung volumes with worsening atelectasis post extubation.


Instruction: Generate impression based on medical findings.

Input: Check for cardiomegaly. End-stage renal disease Mild COPD changes with scattered granuloma. Old healed rib fractures involving numerous left ribs yet no superimposed acute cardiopulmonary abdomen. Specifically no cardiomegaly. Mild tortuosity of the aorta.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Partial nephrectomy No interval change or new cardiac or pulmonary abnormality. Decreased lung volumes with minimal basilar scarring and/or atelectasis. Superimposed monitor overlying the AP window unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Status post cardiac surgery. Tracheostomy with tip approximately 4 cm above the carina. Esophageal stent unchanged. Partially visualized jejunostomy tube retention device.Stable cardiomediastinal silhouette.Predominantly interstitial opacities and small pleural effusions similar to the prior exam.

Output: Stable cardiopulmonary appearance including mild interstitial opacities compatible with aspiration/edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: eval progression of bilateral opacities History: peripheral edema, bilateral opacities, hypoxemia IJ venous catheter with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Interval improvement in the airspace and interstitial opacities.Pleural effusion again noted.

Output: Mild improvement in the bilateral airspace and interstitial opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Liver transplant No cardiopulmonary abnormality. Postsurgical staples and midline sternotomy unchanged

Output: Postsurgical changes without acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: evaluate lung fields History: fever, cough Nonspecific patchy opacities may have slightly recurred on the right, improved in the left lower lobe behind the heart.Heart size upper normal, status post sternotomy for CABG.

Output: Recurrent pulmonary opacities, which could be the result of aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: hypoxia, eval for infiltrates History: SOB Mild cardiomegaly.Small lung volumes with interstitial edema pattern, although underlying fibrosis is possible.

Output: Cardiomegaly with interstitial edema, possible underlying fibrosis. A more recent CT is in progress.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: Chest Wall Pain hx of Sickle Cell and PE History: Chest wall pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Cholecystectomy clips.

Output: No significant abnormality. No evidence of infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Trauma History: MVA Mild blunting of right costophrenic angle. Linear opacity right lower lung zone likely atelectasis or scarring. Median sternotomy hardware and mediastinal surgical clips are noted. No airspace opacities. No pneumothorax.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: evidence of worsening effusion History: SOB, hypoxia, rales Surgical clips are noted about the GE junction. A right basilar pigtail drain again noted. Large right pleural effusion has increased in size since the prior exam with adjacent atelectasis/consolidation.Mild pulmonary edema pattern is present.Interstitial nodularity is noted compatible with known sarcoidosis.No pneumothorax is present.Cardiomediastinal silhouette is unremarkable.

Output: Pulmonary edema pattern with interval increase in right pleural effusion, now large, with adjacent atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Intubation Interval repositioning of the ETT, tip currently projects 3 cm above the carina in good position. NG extends to and inferior to the image. Right jugular catheter terminates in the upper SVCPersistent left lower lobe retrocardiac consolidation with air bronchograms. Probable infection in the appropriate setting and less likely atelectasis

Output: No significant interval change and persistent left lower lobe partial consolidation, nonspecific


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Shortness of breath Evaluation is limited by patient's body habitus.Mild cardiomegaly, similar to prior.Mild bibasilar opacities may represent atelectasis, early edema, or bronchial wall thickening.No large pleural effusions.

Output: Mild bibasilar opacities may represent subsegmental atelectasis, early edema, or bronchial wall thickening.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: Pneumonia? History: Chronic cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.History of known sarcoidosis. Concern for pneumonia. The heart is normal in size.Diffuse thickening of the right paratracheal stripe associated with a lobulation of both hila, in keeping with history of known mediastinal and bilateral hilar lymphadenopathy associated with known sarcoidosis, stable from priors.Lung volumes are normal. No abnormal focal lung parenchymal opacities to suggest pneumonia.The pleural spaces and visualized bones are within normal limits for age.Cholecystectomy clips in place.

Output: Stable mediastinal and bilateral hilar symmetric lymphadenopathy, associated with known history of sarcoidosis. No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: pt with cough, lung CA on chemo RO pneumonia History: pt with cough, lung CA on chemo RO pneumonia Right upper lobe mass has enlarged since the prior radiograph and probably since the prior CT.Stable left upper lobe partially calcified nodule/mass.Elsewhere the lungs are unremarkable.No obvious lymphadenopathy in the mediastinum.

Output: Enlarging right upper lobe mass, but no other reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of lymphoma CHEST:LUNGS AND PLEURA: Scarring and atelectasis involving the right upper lobe is slightly less prominent. Previously mentioned subcentimeter not in the right middle lobe is not well seen. Subsegmental atelectasis and subpleural density in the left lower lobe best seen image number 75, series number 5 has not significantly changed. Left lower lobe density measures 15 x 10 mm image number 75, series number 5.MEDIASTINUM AND HILA: Borderline enlarged right paratracheal lymph nodes measuring 13 by 10-mm image number 16, series number 3 and other borderline enlarged right paratracheal lymph node unchanged. No evidence of significantly enlarged mediastinal lymph nodes.CHEST WALL: Bilateral axillary lymph nodes are unchanged. The left are pathologically enlarged.ABDOMEN:LIVER, BILIARY TRACT: Findings suggestive of chronic liver disease are unchanged. Cholelithiasis is unchanged. No evidence of biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference para-aortic lymph node measures 14 by 10-mm image number 111, series number 3, not significantly changed. Other scattered retroperitoneal lymph nodes are also unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland, unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Check chest tube The inferior left chest tubes has been removed. The apical lateral chest tube however is otherwise unchanged and without additional significant pneumothorax. Overlying severe soft tissue emphysema unchanged .Endobronchial valves are present on the left however the ETT has been removed .

Output: ETT and basilar left chest tube removed


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: pacemaker placement History: pacemaker placement Right upper lobe focal opacity consistent with prior treated lung cancer.Heart size mildly enlarged.No specific evidence of infection or edema.New right subclavian single chamber pacemaker, lead in expected location of artery apex without pneumothorax.Left axillary subclavian vascular stent.

Output: 1. No evidence of pneumothorax following pacemaker placement.2. Known right upper lobe lesion likely consistent with known lung cancer.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Fever of unknown origin, no respiratory sx History: FUO as above Mild to moderate cardiomegaly is present, not significantly changed.Lower lung zone predominant interstitial abnormality could represent viral infection, much less likely pulmonary edema as there are no pleural effusions.No focal consolidation, however.

Output: Cardiomegaly, with an interstitial abnormality suggestive of viral infection given the patient's history, although edema is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: evaluate for hilar adenopathy; 2 Bell's palsy attacks History: SOB. No focal air space opacity.No pneumothorax, pulmonary edema, or significant pleural effusion.Unremarkable cardiomediastinal silhouette.

Output: No evidence of hilar lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Intubated. AV canal repair.VIEW: Chest AP (one view) 08/03/16, 0502 Endotracheal tube tip is between thoracic inlet and carina. A chest tube is present in each hemithorax. Right neck and mediastinal surgical clips are identified. There are two atrial lines. Epicardial pacer leads remain in place.Cardiothymic silhouette is mildly enlarged. Bilateral small pleural effusion continues. Mild hazy opacities are seen in both lungs.Soft tissue edema continues.

Output: Continued pulmonary edema pattern with bilateral pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: assess for pna History: sob ET tube with its tip 4 cm above the carina.Right IJ venous catheter with its tip in the RA.NG tube with tip in stomach.Stable cardiomediastinal silhouette.Multifocal air space opacities are unchanged and compatible with infection or edema.

Output: Support devices unchanged. Stable cardiopulmonary appearance with multifocal airspace opacities compatible with edema and/or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old. PICC line from the left arm with its tip in the SVC.Bilateral calcified pleural plaques suggestive of previous asbestos exposure.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. URI symptoms. Ketoacidosis and diabetes No cardiopulmonary evaluate given semiupright portable technique

Output: No acute disease given limitations


Instruction: Generate impression based on medical findings.

Input: Shortness of breath with cold like symptoms in patient with smoking history. Is there pneumonia or other pathology. Moderate septal thickening consistent with edema, probably superimposed upon emphysema. Small pleural effusions. No specific signs of pneumonia. Upper normal heart and pulmonary artery size.

Output: Mild CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: post op, eval lung fields History: s/p MVR Cardiomegaly with mild basilar subsegmental atelectasis, unchanged.Status post extubation.Stable right jugular catheters.Chest tubes with no pneumothorax.

Output: Mild basilar subsegmental atelectasis, unchanged following extubation.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: tb? History: hemoptysis, presents from hd with note of cxr that "cannot exclude TB" Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Patient is status post sternotomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: chest tube placement History: s/p left lung wedge resection Interval left chest tube placement, with tip near the left lung apex. No significant pneumothorax.Cardia mediastinal silhouette is unchanged.Surgical changes of a left lung wedge resection. Increased linear basilar atelectasis. No focal airspace consolidation. No large pleural effusions.

Output: Left chest tube with tip near the left lung apex, without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: ett position History: intubated ET tube tip approximately 1 cm above the carina with the neck in the flexed position.Venous catheters unchanged. NG tube tip in the stomach.Left lower lobe nonspecific opacity compatible with atelectasis and consolidation, likely secondary to aspirated secretions.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: trach/tube on vent after respiratory failure History: on mechanical ventilation Cardiomegaly with a slight increase in edema and enlargement of pleural effusions.Stable tubes and devices.

Output: Slight worsening of basilar edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval free air History: diarrhea, c.diff Only the lower chest and upper abdomen are shown on the radiograph.Small pleural effusions.No sign of intraperitoneal air.A CT scan of the abdomen has been performed subsequently and provides more detailed evaluation.

Output: No sign of free air.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Lung nodule status post right VATS wedge. Lung volumes have improved. Right chest tube has been removed without visible pneumothorax. Atelectasis near the left costophrenic angle region, but no focal airspace process. Trace pleural fluid.

Output: Improved lung volumes with minimal atelectasis and pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: s/p chest tube removal and placement of another chest tube History: pneumothorax Chest tube has been repositioned with tip in the left apex. Small amount of left chest wall subcutaneous emphysema. Minimal residual pneumothorax is present.Left subclavian pacemaker unchanged. Cardiomediastinal silhouette is unchanged. Elevation of the left hemidiaphragm and mild left basilar atelectasis.

Output: Chest tube has been repositioned with tip in the left apex. Minimal residual pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: r/o infection History: cough and tachy The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Returned stage III ovarian cancer. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the apical segment of the left lower lobe is unchanged.MEDIASTINUM AND HILA: No significant abnormality noted. Right hilar lymph node measures 8mm on image number 47/220, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Peritoneal thickening near the dome of the liver measures 3 by 0.8 cm on image number 91/220.SPLEEN: Parasplenic low attenuation area is unchanged. This lesion measures 2 x 0.9 cm on image number 112/220.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right-sided hydronephrosis, unchanged. Ureteral stent extending to the bladder is unchanged.RETROPERITONEUM, LYMPH NODES: Left para-aortic lymph node is unchanged and measures 16 x 10 mm on image number 139 x 220. Previously mentioned mesenteric lymph node is also unchanged and measures 10 x 10 mm on image number 156 / 220.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left adnexal soft tissue density adjacent to the sigmoid colon and small soft tissue density adjacent to the rectum as well as left pelvic lymph node on image number 182/220 are unchanged. No new disease is noted in the pelvis or abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Overall stable disease as described above.


Instruction: Generate impression based on medical findings.

Input: Coughing up blood No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old. Relatively low lung volumes with chronic basilar streaky opacities scar. The heart size is normal. No pneumothorax or pleural effusion. No specific evidence of infection.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Post nasal drip, cough, congestion, deconditioning, dx with PE months ago, on Coumadin History: As above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: respiratory distress s/p extubation. Stable cardiomediastinal silhouette. Low lung volumes and stable elevation of left hemidiaphragm. Left retrocardiac/basilar consolidation or atelectasis is noted as seen previously.Stable hilar/mediastinal lymphadenopathy.Nodular opacities in bilateral lobes stable.Diffuse interstitial opacities redemonstrated.

Output: Stable hilar/mediastinal lymphadenopathy, left basilar consolidation and bilateral lower lobe nodular opacities.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: ETT tube placement eval History: see above Endotracheal tube is seen 5 cm above the carina.Stable multiple bilateral pulmonary opacities.

Output: Good position of endotracheal tube. No change in extensive bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Shortness of breath, rule acute process. Low lung volumes. No focal air space opacities, pleural fluid or pneumothorax.

Output: Low lung volumes, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 39 yearsGender: MaleReason for Study: Reason: CF History: cough and sputum Airspace opacities and volume loss in both the right middle lobe and probably the lingula.Mild increased upper lobe interstitial opacities and bronchiectasis/bronchial wall thickening may represent cystic fibrosis.The cardiomediastinal silhouette is unremarkable.Old rib fracture deformity on the left.No pleural effusions.

Output: Right middle lobe as well as possible lingular atelectasis/consolidation. This may represent mucous plugging and/or infection . Upper lobe predominant mild bronchiectasis compatible with CHF. CT of the chest would be of value.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Postop CABG. Interval extubation. Right jugular Swan-Ganz catheter, mediastinal drains and left chest tube unchanged in position. Unchanged right pleural effusion. Small volume of pleural fluid on the left, about the same. No pneumothorax.Right upper quadrant appear somewhat lucent which could be an indirect sign of pneumoperitoneum.

Output: Unchanged pleural fluid and atelectasis. Nonspecific relative lucency of the right upper quadrant which could be an indirect sign of pneumoperitoneum. If of clinical concern, left side down lateral decubitus views of the abdomen may be obtained.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma. CHEST:LUNGS AND PLEURA: Multiple, subcentimeter nodules in the right middle lobe are unchanged . Some of the nodules are within the fissure.MEDIASTINUM AND HILA: Bilateral hilar and mediastinal adenopathy is again seen. And has slightly increased in size. Reference subcarinal adenopathy measures 3.5 x 1.8 cm image number 49, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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: Subtle lytic lesion in the L4 vertebral body is unchanged. The etiology is unknown.OTHER: No significant abnormality noted.

Output: Slight interval increase in the size of the mediastinal adenopathy. Micronodules in the right middle lobe are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: eval for infiltrate History: fever Change in linear scarring or subsegmental atelectasis.Heart size normal.No specific evidence of infection or edema.

Output: Linear scarring or subsegmental atelectasis, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: eval for line placement History: thoracic central line came out Globular cardiac enlargement unchanged.Small lung volumes.Prior right jugular catheter longer present.Left subclavian ICD, leads unchanged in position.

Output: Right jugular catheter no longer present, otherwise unchanged with severe globular cardiac enlargement.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female status post battery. Worried about pulmonary contusion versus infiltrates. CHEST:LUNGS AND PLEURA: Groundglass opacities, more prominent in the bilateral lower lobes likely represent chronic changes. No evidence of pulmonary contusion.MEDIASTINUM AND HILA: Heart is enlarged. No evidence of enlarged lymph nodes in the mediastinum or hilum. Thyroid gland is enlarged with multiple calcified nodules.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No CT evidence of acute trauma injury.


Instruction: Generate impression based on medical findings.

Input: Metastatic sarcoma. CHEST:LUNGS AND PLEURA: Moderate emphysema. Scattered calcified micronodules are unchanged.MEDIASTINUM AND HILA: Ectatic ascending aorta is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large hepatic mass measures 22 .8 x 14.8 cm, unchanged from previous CT. the second lesion in the left lobe has significantly increased in the interval now measures 2.4 x 2.0 cm. previously closed measuring 8 x 8 mm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Soft tissue around the stump of the left renal artery is unchanged.RETROPERITONEUM, LYMPH NODES: Small lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Posterior stabilization rods in the lumber spine secondary to metastatic disease in the lumber vertebral body are unchanged.OTHER: The amount of ascites is slightly increased.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small left external iliac lymph node measuring 13 x 10 mm is unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval increase of ascites. Large liver mass is unchanged. Interval significant increase in the size of the left lobe hepatic lesion from subcentimeter to 2-cm in diameter.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: ett check History: ett Mild cardiomegaly status post sternotomy.Mild diffuse edema like abnormality consistent with CHF/hypervolemia.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Bilateral jugular catheters terminate in the SVC.

Output: Mild cardiomegaly and diffuse edema suggestive of CHF/hypervolemia. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: Evaluate balloon pump position History: s/p IABP Right-sided ICD and IABP marker unchanged.Decreased lung volumes stable cardiac enlargement.No new pulmonary opacities noted

Output: IABP marker in the proximal descending aorta. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with metastatic sarcoma. Evaluate disease status. CHEST:LUNGS AND PLEURA: Diffuse bilateral pulmonary metastases are slightly larger. 12 x 12 mm left upper lobe nodule (series 4, image 40); left upper lobe nodule in the parahilar region (series 4; image 40) measuring 14 x 14 mm; 10 x 10 mm right middle lobe nodule (series 4; image 49); 9 x 9 mm right middle lobe nodule (series 4; image 62). The other nodules are stable to minimally increased in size.MEDIASTINUM AND HILA: Calcified right hilar lymph nodesCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Calcified hepatic granulomas. Hypoattenuating lesions in the liver, the largest in the left lateral segment measuring 11.3 cm diameter at axial image 90/203 of series 3 is probably due to a simple cyst. Cholelithiasis. SPLEEN: Splenic granuloma. Soft tissue density posterior to the spleen is increased in size, and measures 2.8 x 3.4 cm. This lesion is probably metastatic given the changing size. A few scattered splenic hypodensities are stable.PANCREAS: The main pancreatic duct is dilated in the head and neck, measuring up to 4 mm in greatest diameter, not significantly changed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate calculus in the lower pole of the left kidney, unchanged, without evidence of obstruction.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter nodule in the anterior abdominal subcutaneous tissues on the left has decreased in size, and is barely detectable.Partial resection of the right sacrum and ilium with extensive metallic hardware. 19 x 17 mm lytic lesion in the right acetabular posterior column (series 3; image 175) has not significantly changed. Similar lesions are effect the ischia bilaterally. A small fluid collection is suspected in the postsurgical bed has resolved. 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: Posterior fixation hardware is again noted in the lower lumbar spine and pelvis.OTHER: No significant abnormality noted.

Output: Lack of IV contrast limits evaluation.No new lesions. Overall minimally increased size of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with metastatic pancreatic neuroendocrine tumor CHEST:LUNGS AND PLEURA: 7-mm nodule image number 62, series number 10 is unchanged. Another subcentimeter nodule in the lingula on image number 76, series number 9 is also unchanged.MEDIASTINUM AND HILA: Pulmonary venous return variant is unchanged. No adenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference hepatic lesion in the left lobe measures 4.7 x 3.7 cm on image number 97, series number 9, slightly enlarged. Multiple other hepatic lesions are less well seen but are grossly unchanged.SPLEEN: No significant abnormality notedPANCREAS: Ill-defined enlargement of the pancreatic head is grossly unchanged. Due to the ill-defined nature of the mass, it cannot be reliably measured. On image number 123, series number 9 pancreatic head mass measures 2.7 x 2.3 cm. Pancreatic duct is dilated. Thrombosis of the SMV is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral extrarenal pelvis are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal interval increase in the size of the reference hepatic lesion. Pancreatic head mass and lung nodules are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: s/p right thoracoscopy for malignant pleural effusion Interval placement of right chest tube with extensive subcutaneous emphysema that extends to the neck. Interval decrease in right pleural effusion. Small right basilar pneumothorax. Low lung volumes. Unchanged mild cardiomegaly.

Output: Small right basilar pneumothorax post chest tube placement.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Small lung volumes, with thickening of the fissures and bronchial wall suggestive of early edema.No large pleural effusions.No specific evidence of infection.Heart size upper normal.

Output: Very mild pulmonary edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 54 year old male. B-cell NHL status post autologous stem cell transplant 5/2004. CHEST:LUNGS AND PLEURA: Likely areas of scarring lingula, unchanged. No effusions.MEDIASTINUM AND HILA: Coronary artery calcification. No pathologic size lymph nodes. Small right retrocrural node series 2 image 86, 12.8 x 2.5 mm with some calcification, unchanged. Right-sided central line.CHEST WALL: No significant abnormality notedABDOMEN: Exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast.LIVER, BILIARY TRACT: Probable diffuse fatty liver the liver measuring about 16 HU versus spleen measuring 27 HU but no definite focal liver lesions. This finding is unchanged.SPLEEN: No significant abnormality notedPANCREAS: Fatty.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Focal dilatation seen in some portions of the distal third of the ureter, unchanged. No evidence of nephrolithiasis in the course of the ureters. A few punctate calcifications left kidney unchanged.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta no evidence of aneurysm. No pathologic size lymph nodes.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 noted. Focal dilatation in two portions of the right ureter including the terminal portion, unchanged. Correlate clinically.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No interval change.