Instruction: Generate impression based on medical findings.

Input: 70 year old female with pain. Evaluate for GIST recurrence. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Heterogeneously-enhancing thyroid gland with stable right thyroid mass (series 7, image 17), again measuring 5.2 x 6.6 cm. Its mass effect on the right brachiocephalic vein and the trachea also appears similar prior study. Patent SVC.Mild atherosclerotic calcifications of the LAD and left circumflex arteries.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Stable bilobar cystic foci. No new cystic or abnormally enhancing lesions.Patient is status post cholecystectomy with mild central biliary prominence appearing similar to prior study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable renal cysts bilaterally. Punctate nonobstructing right renal stone is also again seen.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lower lumbar spine.

Output: 1. No evidence of GIST metastasis or recurrence.2. Right thyroid mass is unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: eval s/p RUL wedge resection History: - Moderate right hydropneumothorax, not significantly changed, with a right chest tube in place.Underlying opacity compatible with atelectasis and effusion.Mild atelectasis and small effusion on the left.

Output: Persistent moderate right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Surgical clips again noted within the upper abdomen.

Output: No convincing evidence of metastatic disease on radiography.


Instruction: Generate impression based on medical findings.

Input: History of CHF. Chest pain Mildly diminished lung volumes without additional cardiopulmonary abnormality. Specifically lungs are clear.2-lead left subclavian ICD unchanged and well positioned

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.History of pancreatic cancer and abdominal pain, evaluate for free air. Normal heart size. Aortic atherosclerotic calcifications.Right apical pulmonary nodule better seen on recent CT. No new focal pulmonary opacities or pleural effusions.No intraperitoneal free. Right upper quadrant surgical clips and biliary stent.

Output: No pneumoperitoneum detected.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with mesothelioma and outside hospital CT showing pancreas abnormality. Evaluate mass in uncinate process of pancreas. CHEST:LUNGS AND PLEURA: A loculated right pleural effusion has decreased in size with residual loculated effusion at the right base. There is slightly increased pleural thickening, more superiorly in the right hemithorax. There is no pleural effusion or pleural thickening on the left.MEDIASTINUM AND HILA: AICD leads in right atrium and ventricle. Cardiomegaly is again noted. There is no enlarged mediastinal or hilar lymphadenopathy.CHEST WALL: Left chest wall AICD.ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis with fissural prominence compatible with cirrhosis. Cholelithiasis is noted.SPLEEN: No significant abnormality notedPANCREAS: No masses are visualized. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesion in the left kidney compatible with a simple renal cyst.RETROPERITONEUM, LYMPH NODES: Reactive portacaval and porta hepatis lymphadenopahy is noted. Abdominal aortic atherosclerotic calcifications are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No masses are visualized in the pancreas.2. Increased right pleural thickening is likely sequela of loculated pleural effusion but mesothelioma cannot be completely excluded.3. Hepatic steatosis and fissural prominence with reactive lymphadenopathy is compatible with cirrhosis of the liver.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: infection? 60M relapsed AML; persistent neutropenic fevers History: as above No significant cardiopulmonary abnormality.Left jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: s/p ICD r/o pneumothorax History: s/p ICD r/o pneumothorax Stable cardiomegaly. Interval placement of single lead ICD. The tip of the lead overlies the right ventricle, although exact localization is indeterminate in this single AP projection.Interval removal of right IJ Swan-Ganz catheter. There is a new right upper extremity PICC overlying the proximal SVC.Pulmonary venous hypertension. There is minimal interstitial basilar predominant pulmonary edema, associated with trace right pleural effusion.No pneumothorax.

Output: Unusual trajectory of a new single ICD lead, which is indeterminate in location despite overlying the right ventricle in this single AP projection. Recommend repeat PA and lateral chest radiograph for adequately assessment.The new right approximately PICC overlies the proximal SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Encounter for screening for respiratory tuberculosis. Normal cardiomediastinal silhouette. No pleural fluid or pneumothorax. No focal airspace opacities.

Output: Normal chest. No radiographic evidence of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Assess pleural effusion. Mild interval improvement of right pleural effusion, with persistent left pleural effusion. Bibasilar atelectasis, likely compressive. No evidence of pneumothorax.Cardiomediastinal silhouette is unchanged.Pericardial drain unchanged.

Output: Mild interval improvement of right pleural effusion, with persistent left pleural effusion and basilar compressive atelectasis.


Instruction: Generate impression based on medical findings.

Input: Hypotension Persistent small suspected left effusion with basilar interstitial changes in left basilar atelectasis/scarring, greatest retrocardiac. No discrete new superimposed focal airspace process. Scoliosis

Output: Suspected left basilar atelectasis and/or resolving more acute process, such as infection


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Chest tube. Emphysema. Moderate right hydropneumothorax, apical pneumothorax component is slightly larger. There is also worsening of subcutaneous emphysema along the right lateral chest wall adjacent to site of minimally displaced surgical rib fractures. Right chest tube unchanged in position. Suture line from prior wedge resection on the right.Groundglass opacities in the left lung are new, suspicious for bronchiolitis and evolving pneumonitis.

Output: Right hydropneumothorax with increasing lucency at the right apex suspicious for an enlarging pneumothorax component. Air leak at site of right chest wall surgical fracture.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: SOB, cough Small lung volumes with basilar subsegmental atelectasis, unchanged.Postsurgical abnormalities in the right fifth rib with associated soft tissue opacity, not definitely changed allowing for differences in position and rotation.No new findings.

Output: Subsegmental atelectasis with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: r/o disease process History: productive cough for a week There is mild cardiac enlargement.Increased lung findings compatible COPD.Scattered areas of scarring/discoid atelectasis in the left lung.No focal consolidation.No large pleural effusions.

Output: COPD. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: FemaleReason for Study: Reason: 74 yo f w fever, n/v History: fever Right IJ venous catheter unchanged.Stable cardiac mediastinal silhouette with decreased lung volumes.Nonspecific basilar opacities compatible with atelectasis.No focal areas of consolidation.

Output: No interval change without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: intubated History: intubated No acute abnormality.ET tube tip approximately 4 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.An NG tube terminates in the stomach.Right upper quadrant surgical drain.Left PICC, tip in axillary region.

Output: No acute abnormality. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Shortness of breath Cardiomegaly with mild-to-moderate interstitial abnormalities in the small right pleural effusion have progressed from previous consistent with CHF. Linear areas of atelectasis or scarring are again noted. No pneumothorax.

Output: Mild to moderate CHF pattern, progressed from previous.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: increasing cough and crackles/? failure vs infection History: crackles and cough Stable cardiomediastinal silhouette.Mild increased left basilar opacities corresponding to the recent CT.No focal areas of consolidation.No pleural effusions.

Output: No interval change with nonspecific basilar opacities compatible with aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: sob History: sob No change in complete left hemithorax opacification with calcification and marked chest wall deformity, suggestive of a thoracoplasty in the remote past.Right lung unremarkable with stable apical scarring.No specific evidence of infection or failure.

Output: Prior left pneumonectomy and or thoracoplasty, with no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with AML and pneumonia, likely fungal. Please evaluate for response to therapy. CHEST:LUNGS AND PLEURA: Reference left upper lobe nodule (series 5, image 26) measures 10 x 7 mm; previously measuring 12 x 11 mm. The multiple other nodules seen bilaterally have also decreased in size (for example, series 5, images 47, 48, and 63).Right basilar scarring, unchanged.No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Mild degenerative changes of the spine.Right breast implant.Left upper extremity PICC tip in subclavian vein.UPPER ABDOMEN: No significant abnormality noted.

Output: Interval decrease in the previously seen pulmonary nodules bilaterally.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Cough, shortness of breath, dyspnea on exertion and bilateral lower extremity edema. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No focal pulmonary opacities to suggest infection. Moderate emphysematous changes. Marked degenerative changes of the thoracic spine.

Output: Moderate emphysema, but no acute cardiopulmonary abnormality. Please see same-day CT chest for further findings.


Instruction: Generate impression based on medical findings.

Input: Reason: fever History: fever Bilateral patchy pulmonary opacities, affecting both upper and lower lobes with probable small pleural effusions.Apparent interval change is partially due to marked differences in projection due to patient rotation.However an apparently new opacity is present in the left upper lobe with questionable cavitation.A CT scan is recommended if feasible for further evaluation.

Output: Bilateral nonspecific opacities compatible with infection with a questionable area of new cavitation in the left upper lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: swan placement History: above Swan-Ganz catheter terminates in the right main pulmonary artery proximal right interlobar artery. ICD is unchanged. Cardiomegaly, unchanged. No significant pleural effusion or pneumothorax. Low lung volumes.

Output: Swan-Ganz catheter terminates in the right pulmonary artery or proximal right interlobar artery.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: R/O consolidation/effusion History: Productive cough The cardiomediastinal silhouette is stable.Mitral valve opacity is again noted. Status post sternotomy.There is interval improvement in pleural effusions and perihilar edemaNo new opacities.

Output: Marked interval improvement in pleural effusions and perihilar edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: sob History: sob No change in interstitial and airspace opacities as well as partial atelectasis of the right middle lobe.Unchanged pleural effusions right larger than left.Heart size upper normal.

Output: Unchanged pulmonary opacities and pleural effusions, findings suggestive of metastases from the patient's known thyroid cancer. Superimposed hypervolemia is possible.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for ptx, s/p b/l chest tube removal History: above Interval removal of both chest tubes with no evidence of pneumothorax. The remainder of support devices are unchanged. Endotracheal tube tip remains at 5 cm above the carina.Cardiomediastinal silhouette is stable. Basilar opacities compatible with effusions and atelectasis appear similar to prior exam.

Output: Interval removal of both chest tubes with no evidence of pneumothorax. No significant interval change in the remainder of the devices and lines and cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: new hypoxia, CP History: above Linear atelectasis or scarring left lung perforate, otherwise unremarkable.Heart size normal.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumo, rib fractures History: fall Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with chest pain. D-dimer is 0.51. Evaluate for PE. PULMONARY ARTERY: In this technically adequate study, no pulmonary emboli identified.LUNGS AND PLEURA: Right middle lobe granuloma. Minimal dependent changes at the bases. No pleural effusions. MEDIASTINUM AND HILA: Normal cardiac size. No pericardial effusions. No significant mediastinal or hilar lymphadenopathy. Calcified right thyroid hypodense lesion. Please refer to the ultrasound of the thyroid performed on 12/20/07.CHEST WALL: No significant axillary lymphadenopathy.UPPER ABDOMEN: Small hiatal hernia.

Output: No PE.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, 80 years old.Cough Tortuous aorta. Otherwise unremarkable cardiomediastinal silhouette.Left midlung scarring, similar to prior.No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: COPD Exacerbation, Check Pulmonary Status History: COPD Exacerbation, Check Pulmonary Status Slight increase in bibasilar opacities. No pneumothorax. Mild cardiomegaly again noted.

Output: Increased bibasilar opacities which may represent atelectasis and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.History: shortness of breath, rule out pneumonia, assess for fluid. Moderate to large left-sided pleural effusion with underlying atelectasis/consolidation as seen on CT from 12/7/2016. There is been interval removal of an enteric tube. Slightly retracted positioning of the left-sided PICC line still terminating within the SVC. Postsurgical clips right upper quadrant.

Output: Moderate to large sized left pleural effusion with underlying atelectasis/consolidation. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: rule out pneumonia History: fever, sputum, previously SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: s/p olt History: s/p olt Support devices unchanged.Stable cardiomediastinal silhouette.Basilar atelectasis with right pleural effusion similar to the prior. Nono new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary parents with basilar atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: hx of CHF, ESRD p/w SOB and tachycardia; eval for cardiomegaly, infiltrate, edema History: SOB and tachycardia Mild cardiomegaly.Right pleural effusion and right basilar atelectasis, unchanged.Left jugular catheter, tip at right atrial level.

Output: Right pleural effusion with overlying atelectasis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: ett tube, effusions/consolidation History: as above Interval development of right basilar atelectasis. No specific evidence of infection or edema.Line position stable.

Output: Right basilar atelectasis. No evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Headache and neck pain, assess shunt. SHUNT DEVICE: Stable appearance of the lumboperitoneal shunt, with proximal tip extending cephalad into the thoracic spinal canal. Radiopaque tubing of the shunt approaches a connecting device in the left upper quadrant which is unchanged in appearance compared to previous examination. Again noted is an orphaned piece of radiopaque shunt tubing in the pelvis.SKULL: No significant abnormality noted.CERVICAL SPINE: Multilevel joint space narrowing and vertebral body osteophytosis appears similar to prior.CHEST: Nonspecific basilar opacities.ABDOMEN: Gaseous distention of multiple loops of bowel, with air and stool seen distally within the rectum. No evidence of obstruction. Atherosclerotic calcification affects the aorta.

Output: Stable appearance of lumboperitoneal shunt, without evidence of malfunction.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval pneumonia History: sob,fevers,wheezing No significant cardiopulmonary abnormality.Left subclavian ICD, leads unchanged in position.

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


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.ETT placement. ETT 3.5 cm above the level of the carina.NGT looped in the stomach.A peripheral catheter from the right terminates in the projection of the mid right subclavian vein.Lung volumes remain low normal with moderate to large bilateral pleural effusions and associated atelectasis.

Output: ETT 3.5 cm above the level of the carina. No acute change in pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Assessment metastatic disease, renal cancer The lungs and pleural spaces are clear. The heart size remains normal.

Output: No suspicious pulmonary nodule visualized.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval picc line tip position History: new picc line New left PICC doubled back upon itself in the axillary region.Mild cardiomegaly status post sternotomy.No significant pulmonary or pleural abnormality.

Output: New left PICC doubled back upon itself in the axillary region.


Instruction: Generate impression based on medical findings.

Input: Ventriculopleural shunt with vomiting.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views) 06/10/16 Ventriculostomy tip is adjacent to the midline in the anterior cranial fossa. The tubing exits via a right parietal burr hole and extends along the right head and neck into the right chest. The tip is in the posterior pleural space overlying the posterior medial third and fourth ribs. No discontinuity is seen.Spinal fusion instrumentation is noted. The intraspinal catheter has its tip at C4.The skull has a narrow transverse diameter. No focal lung opacity is present. Moderately dilated bowel loops are seen in the upper abdomen.

Output: No evidence of extracranial ventriculopleural shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: assess for source of infection History: sepsis, DIC Examination limited by patient positioning.The cardiomediastinal silhouette is unchanged given differences in patient positioning. Scattered foci of atelectasis. Large pleural fluid collections, left greater than right, with associated atelectasis. No pneumothorax.

Output: Interval increase in bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Right lower lobectomy Persistent right pleural small effusion and postsurgical changes from known right lower lobectomy. Remaining lungs are clear. Cardiac and mediastinal contours are within limits

Output: Postsurgical changes from right lower lobectomy unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube placement History: s/p L VATS pleurodesis 2 chest tubes extending to the left apex with a very small residual apical pneumothorax. Mild perihilar opacity compatible with edema and atelectasis.

Output: Small residual left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: Evaluate for worsened effusion/hemothorax History: hypotension after thoracentesis Elevation of the right hemidiaphragm again noted. Port catheter tip overlies the lower mediastinum. Right-sided pleural effusion again noted. Patchy bibasilar opacities, unchanged. No pneumothorax.

Output: No substantial change compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval for acute chest History: cough Interval placement of right chest port with catheter tip at the cavoatrial junction. Heart size is normal. Postsurgical changes on the right including volume loss and scarring. No focal airspace opacity. No large pleural effusions. Osseous changes compatible with sickle cell disease.

Output: Postsurgical changes with no specific evidence of pneumonia or acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: change in apical pneumothorax, new or worsening opacities History: increased oxygen requirements Increase in diffuse pulmonary opacities. Increased right-sided pleural fluid. Resolution of small right apical pneumothorax. Unchanged heart size.

Output: Marked increase in diffuse pulmonary opacities consistent with pulmonary edema, alveolar damage, multifocal pneumonia, and/or multifocal aspiration.Increased right pleural effusion.Resolution of small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: sob, R pleural effusion? History: above Large right pleural effusion occupying nearly 1/2 of the right hemithorax volume, with consolidation of the overlying lung.Mild cardiomegaly.Left lung unremarkable.Right jugular catheter, tip at right atrial level.

Output: Large right pleural effusion with overlying consolidation.


Instruction: Generate impression based on medical findings.

Input: Age: 19 yearsGender: FemaleReason for Study: Reason: eval for infiltrate History: sob/sputum production 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: 76-year-old male with shortness of breath for 6 months and CXR concerning for interstitial lung disease or cancer. LUNGS AND PLEURA: Dense foci of airspace disease and multiple nodular opacities bilaterally likely superimposed on chronic lung disease given the presence of bronchiectasis. The appearance is suggestive of multifocal pneumonia, but given the patient's age, bronchoalveolar carcinoma must be considered. Significant consolidation and volume loss noted on the left. No pleural effusions.MEDIASTINUM AND HILA: Multiple hypoattenuating lesions in the thyroid. Cardiac size is normal. No pericardial effusion. No evidence of significant mediastinal or hilar lymphadenopathy. Vascular calcifications noted. The pulmonary artery is large suggesting pulmonary artery hypertension.CHEST WALL: Degenerative changes affect the spine.UPPER ABDOMEN: Limited exam of the upper abdomen shows no gross abnormality.

Output: Dense, multifocal air space disease superimposed on chronic lung disease suggestive of multifocal pneumonia versus bronchoalveolar carcinoma.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female (with secondary malignant neoplasm of large intestine and rectum). Evaluate for progression. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are again identified. Some are stable, some with interval progression. Reference node in the right lung (series 4, image 42) now measures 2.0 x 1.7 cm (previously 1.8 x 1.7 cm). Nonreference node in the right upper lobe (series 4 image 39) now measures 1.0 x 0.9 cm (previously 0.6 x 0.6 cm).Large left pleural effusion with interval progression to complete atelectasis of the left lung. Multiple metastatic lesions in the left lung are identified with inability to compare these lesions to prior exam secondary to atelectasis. Small right effusion, similar to prior. MEDIASTINUM AND HILA: Large soft tissue mass encases the left pulmonary artery and left main bronchus (series 3 image 50) with subtle increase in size, now measuring 7.4 x 5.8 centimeters (previously 7.2 x 5.3 cm). Right hilar calcifications, similar to prior.CHEST WALL: Right-sided Port-A-Cath terminates in the superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: Left haptic lobe lesion (series 3 image 87) now measures 2.3 x 1.6 cm (previously 2.2 x 2.1 cm).SPLEEN: Multiple splenic metastatic lesions are increased in size. Conglomerated metastatic lesions (series 3 image 18) now measures 6.6 X 4.8 cm (previously 5.2 x 3.8 cm) Scattered tiny calcifications, similar to prior, suggestive of granulomatous disease.PANCREAS: Pancreatic ductal prominence, similar to priorADRENAL GLANDS: Right adrenal gland metastases (series 3 image 102), increased in size, measuring 5.0 x 2.8 cm (previously 2.2 x 3.6 cm).KIDNEYS, URETERS: Multiple bilateral cystic renal lesions are similar to prior. Complex cystic lesion in the superior pole of the right kidney with interval increase in size is suggestive of metastasis.RETROPERITONEUM, LYMPH NODES: Scattered slightly prominent retroperitoneal and lymph nodes, similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered, predominantly lucent lesions with slight bone expansion of the bony pelvis, left greater than right, and involving spine, suggestive of Paget's disease.OTHER: No significant abnormality noted.

Output: Interval progression of widespread metastatic disease. Large left pleural effusion with now complete collapse of left lung.


Instruction: Generate impression based on medical findings.

Input: 62 years, Female. Reason: OG tube History: OG tube The lower abdomen and pelvis are excluded from the field-of-view. Enteric tube tip in the distribution of the gastric antrum, similar to prior. Bowel gas pattern is incompletely assessed on this image. Bilateral pleural effusions and basilar air space opacities. Please refer to concomitant chest radiograph for detailed thoracic findings.

Output: Enteric tube tip in the distal region of the gastric antrum.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval for collapse post extubation History: tachypnea, tachycardia Right lower and middle lobe atelectasis presumably from mucous plugging, unchanged.Left lung unremarkable.ET tube tip approximately 4 cm above the carina.Left jugular catheter, tip in SVC.An NG tube terminates in the stomach.

Output: Right middle lobe atelectasis presumably from aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: PNA History: productive cough Questionable opacity at the periphery of the left lower lung zone, more likely artifact.Elsewhere, the lungs are unremarkable.Heart size normal.

Output: Questionable left lower lung zone peripheral opacity, more likely artifact. A repeat study in several days is recommended to the patient remains symptomatic.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: 70F s/p bilateral nephrectomy with new leukocytosis and worsening of chronic hypotension; please evaluate airspaces History: hypotension Pleural effusions and basilar opacities slightly worse than on the prior study.Status post median sternotomy.Right jugular catheter, tip in SVC.

Output: Worsening basilar opacities and pleural effusions, consistent with edema and superimposed infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval IR drain History: sp thoracentesis Interval placement of a right basilar pigtail pleural catheter. New small right pneumothorax. Interval reduction in size of the right pleural effusion. Left central catheter has been removed. No significant change in additional pulmonary opacities.

Output: Small right hydropneumothorax with reduction in pleural effusion following pleural pigtail catheter placement.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: s/p lvad, assess for congestion, pleural effusion, pna History: sob Cardiomegaly, with mild/moderate pulmonary edema and left lower lobe consolidation.Status post valve repair.LVAD unchanged.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly with edema and left lower lobe consolidation consistent CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: s/p lvad History: same Iatrogenic devices are unchanged. Left-sided pleural parenchymal opacities, unchanged. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged left-sided pleural-parenchymal opacities. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: r/o acs History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: eval for pathology History: SOB Severe cardiomegaly with pulmonary vascular redistribution.No specific evidence of infection or failure.

Output: Severe cardiomegaly, but no evidence of acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male with history of testicular cancer. Evaluate for metastatic disease. The cardiomediastinal silhouette is unremarkable. No focal airspace opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality or evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with history of dyspnea. Evaluate for edema. The heart size is mildly enlarged. Bilateral small pleural effusions and basilar edema. Right upper lobe opacities are thought to represent edema rather than infection.

Output: Increasing pulmonary edema, probably with an acute component, with bilateral pleural effusions compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with relapsed non-Hodgkin's lymphoma status post chemotherapy. CHEST:LUNGS AND PLEURA: Previously noted right lower lobe pulmonary nodule measures 6 mm and is unchanged and seen on series 5, image 66, (previously measuring 6 mm).MEDIASTINUM AND HILA: No significant lymphadenopathy.CHEST WALL: Previously noted soft tissue prominence anterior to the spine appears smaller on today's study. Adjacent sclerosis of the T11 vertebral body is unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing calculus is noted in right kidney.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and common iliac arteries are unchanged. No significant lymphadenopathy is noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesion in the L3 vertebral body is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There has been interval decrease in the right pectineus muscle soft tissue infiltration. OTHER: No significant abnormality noted

Output: 1.Interval decrease in right thoracic paraspinal soft tissue prominence and right pectineus muscle infiltration/thickening. 2.Stable right lower lobe pulmonary nodule.


Instruction: Generate impression based on medical findings.

Input: Fever and status post bronchoscopy Faint airspace opacity projects over left lung base, possibly minimal edema and/or hemorrhage from recent bronchoscopy and possible biopsy. Remaining lungs are otherwise clear.The cardiac and mediastinal contours are within limits. Specifically no additional postprocedural complications

Output: Questionable left lower lobe focal hemorrhage and/or edema


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab. Left subclavian AICD grossly unchanged accounting for patient rotation.Low lung volumes.No focal air space opacity, pleural effusion, or pneumothorax.Mild cardiomegaly redemonstrated.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: weakness History: weakness Stable position of support devices.Cardiomegaly with left ventricular enlargement. Patchy mid to lower zone opacities slightly improved with bilateral small pleural effusions. No interval pneumothorax.

Output: Decreased mid to lower zone opacities which may be the result of aspiration with atelectasis, small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: s/p TECAB, evaluate. Cardiomediastinal silhouette is unremarkable. Small effusions and underlying atelectasis have nearly resolved. Right lower lobe granuloma again noted. No focal airspace opacities, pleural effusion, or pneumothorax.Bilateral reverse total shoulder arthroplasties are partially imaged.

Output: Near resolution of bilateral effusions and underlying atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: chest pain, possible pneumothorax History: chest pain. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male history of Hodgkin's lymphoma, status post chemo completed 5/2006. CHEST:LUNGS AND PLEURA: Left apical scarring redemonstrated. No nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given that limitation, the following observations are made: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: Scattered colonic diverticulosis. No evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No measurable disease.


Instruction: Generate impression based on medical findings.

Input: Valve replacement Motion degrades sensitivity.Similar pleural effusions with pulmonary opacities suggesting edema greater on the left and on both bases. No distinct new superimposed focal abnormality. Small lung volumes. Moderate cardiomegaly. Postsurgical changes including sternotomy and surgical staples

Output: Postsurgical changes without interval change


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: Pre-Kidney Transplant Evaluation History: Pre-Kidney Transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Renal osteodystrophy noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Atelectasis Bilateral layered moderate to large pleural effusions greater on the left with associated retrocardiac opacity suggesting partial collapse and/or consolidation.ETT and right jugular catheters are unchanged, however the NG tube has been retracted and the side-port is now seen at the level of the GE junction, consider advancing.IVC filter partially visualized

Output: NG repositioned, see recommendation provided


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: ett repositioned History: ett positioned; ards; proned Motion limits sensitivity.The inferior portion of the chest are not included on the image.ET tube and NG tube unchanged.Extensive diffuse pulmonary opacities without significant interval change.

Output: Support devices unchanged with the ET tube tip 6 cm above the carina. Stable appearance of extensive bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: eval for edema History: sob, increased O2 requirement There are decreased lung volumes with stable cardiac enlargement.Basilar opacities are compatible with pleural effusions and atelectasis/edema ,increased from the prior exam.Left retrocardiac consolidation/atelectasis now noted.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: PneumothoraxVIEW: Chest AP ET tube, NG tube and umbilical venous catheter again noted. Right chest tube in place. The large pneumothorax on the right has increased in size. Cardiothymic silhouette cannot be evaluated. Left lung opacification unchanged.

Output: Large right pneumothorax increased in size.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: Ro Pneumonia History: Ro Pneumonia. Redemonstration of mild asymmetric lung volumes which are unchanged, compatible with postsurgical changes.No focal opacity, pneumothorax, or significant pleural effusion is identified.

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


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: intubated History: as above ET tube tip 3-4 cm above carina. NG tube tip in stomach. Venous catheter tip at RA/SVC junction.No change in bilateral pleural effusions with perihilar interstitial opacity likely due to edema.

Output: ET tube tip 3-4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: r/o PNA History: orthostatic hypotension, fevers, elevated WBC The cardiomediastinal silhouette is within normal limits. Streaky retrocardiac opacities may represent atelectasis. No focal airspace opacity, significant pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: cough. r/o pneumonia History: cough, congestion Large lung volumes with mild basilar subsegmental atelectasis.No specific evidence of infection or edema.Bilateral shoulder prostheses.

Output: COPD and mild basilar atelectasis, but no sign of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer CHEST:LUNGS AND PLEURA: Emphysema.5-mm nodule in the right lower lobe on image number 50, series number 4.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter foci in the liver, too small to characterize, more likely to be benign.SPLEEN: No significant abnormality notedPANCREAS: Pancreas is unremarkable. However, there multiple pair of early enhancing fluid density lesions around the pancreas largest measuring 7.3 x 3.4 cm in image number 111, series number 4. A smaller focuses near the tail of the pancreas and another small focus in the right lower quadrant on image number 137. These likely represent pseudocysts. Correlation with previous history of acute pancreatitis is recommended. These lesions are very unlikely to represent cystic metastatic disease.ADRENAL GLANDS: 16 x 16 mm right adrenal nodule.KIDNEYS, URETERS: 17 x 16 mm minimally complicated cyst in the lower pole of the right kidney, likely Bosniak type II. Follow-up imaging in 6 months is recommended. Simple appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm measuring 2.5-cm in its largest AP dimension.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The patient is status post prostatectomy. Postsurgical changes in the pelvis.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Multiple low-density lesions around the pancreas suspicious for pseudocyst. Clinical correlation with history of previous acute pancreatitis is recommended. Follow-up imaging is also recommended for further evaluation of these lesions.Right adrenal nodule, indeterminate. Dedicated adrenal MRI may be helpful for further characterization.Postsurgical changes secondary to prostatectomy.Nonspecific single subcentimeter nodule in the right lung. Follow-up imaging is recommended for further evaluation.Minimally complicated right renal cyst, likely Bosniak type II. Follow-up imaging in 6 months is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: wheezing History: wheezes Focal streaky opacity in both lower lobes, greater on the right, compatible with subsegmental atelectasis which may be secondary to bronchial mucous plugging.Catheter tip in the SVC.No specific evidence of pneumonia.

Output: Increased basilar opacities suggestive of atelectasis possibly due to mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: infiltrate History: SOB, Hbss with VOC Right chest wall port terminates in the cavoatrial junction. Right brachiocephalic and superior vena cava stents are again noted.Moderate cardiomegaly is stable. Right lower lobe focal opacity and right pleural effusion are new as compared to the prior exam, suggestive of pneumonia.

Output: New right lower lobe focal opacity and right pleural effusion, suggestive of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: swan and IABP placement History: swan and IABP placement Intra-aortic balloon pump marker is at the top of the aortic arch, as before. Swan-Ganz catheter terminates in the RPA. Right IJ sheath is in place. Left greater than right pleural-parenchymal opacities again noted. Mild pulmonary edema. Unchanged cardiomegaly.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.History of sickle cell disease with chest pain and recent fever, evaluate for acute chest. The cardiomediastinal silhouette is borderline enlarged.Nonspecific basilar opacity is again seen at the right lung base. No focal pulmonary opacities or pleural effusions.

Output: Nonspecific basilar opacity at the right lung base similar to prior exams, likely atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: edema? worsening pna? History: sob, recent pna, many med problems Median sternotomy, heart size normal.No specific evidence of infection or edema.

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


Instruction: Generate impression based on medical findings.

Input: Reason: eval 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: ETT check Tracheostomy tube and right jugular dual port unchangedLarge layered pleural effusions underlying nonspecific mixed interstitial and airspace opacities observed large in both bases and greater on the right appear similar.

Output: Nonspecific bilateral patchy opacities, unchanged given differences in positioning and technique


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with history of stage IIB colorectal cancer, for follow up. Evaluate disease status. CHEST:LUNGS AND PLEURA: The mild right apical scarring is unchanged. Calcified granuloma, unchanged, noted in the lingular segment.MEDIASTINUM AND HILA: No significant abnormality noted . Thymic remnant in anterior mediastinum. CHEST WALL: Interval removal of Right sided venous access device. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality noted. Splenule at the hilum. Calcified granuloma noted within the splenic parenchyma, unchangedPANCREAS: Pancreatic duct measures up to 2 mm, appropriate for patient age. No focal lesions within the pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Several low attenuation lesions in both kidneys most likely nonspecific, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sutures along the lesser and greater curvature of the stomach appear intact. No evidence of bowel obstruction. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications noted.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 measurable disease. Stable examination.


Instruction: Generate impression based on medical findings.

Input: Reason: ET History: et placement ET tube tip approximately 4 cm above the carina.Unremarkable cardiac and mediastinal silhouette. Mild streaky basilar opacities consistent with subsegmental atelectasis and aspirated secretions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: evaluate for effusion, empyema History: pneumonia, failing to resolve Previous right basilar opacity has improved but not completely resolved.Elsewhere the lungs are unremarkable and the heart size normal.

Output: Slowly resolving right basilar opacity still consistent with infection.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: SOB, eval for pulmonary edema History: SOB Interval removal of venous catheter. Lungs hypoinflated with minimal nonspecific basilar opacity. No new focal opacity to suggest pneumonia.

Output: Lungs hypoinflated with minimal nonspecific basilar opacity. No new focal opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Shortness of breath. Increased size of the left midlung zone nodule, likely due to portable technique. Scattered calcified pulmonary nodules, compatible with sequela of granulomatous infection. No evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: Increased size of left midlung zone nodule, likely due to technique. No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: MaleReason for Study: Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices Right IJ Swan-Ganz unchanged with tip in the right pulmonary artery.Chest/mediastinal tubes in place without evidence of a pneumothorax.Decreased lung volumes with stable cardiac enlargement.Perihilar/basilar opacities compatible with atelectasis, edema, and possible small effusions.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: dyspnea, eval for fluid overload vs. consolidation vs. other History: as above Cardiomegaly. Slight improvement in pulmonary edema. No new opacity.

Output: Cardiomegaly. Slight improvement in pulmonary edema. No new opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: compare to previous History: pleural effusion Chronic left hemithorax volume loss from treatment of lung cancer.New small right pleural effusion.No evidence of tumor recurrence.

Output: New small right pleural effusion. No other evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Shortness of breath and cough for one week. Evaluate for acute process. The cardiomediastinal silhouette is normal. No pleural effusion, pneumothorax or abnormal pulmonary opacity.

Output: No acute cardiopulmonary abnormality or evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT placement History: as above Interval advancement of the ET tube with the tip about 3 cm above the carina.Other tubes and cannulae unchanged.Diffuse pulmonary opacity compatible with edema, atelectasis and pleural effusions, not significantly changed.

Output: Interval advancement of ET tube.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with left hip pain and history of prostate cancer CHEST:LUNGS AND PLEURA: Pleural-based plaque-like lesion with spiculation measures 15 by 11-mm on image number 75, series number 5. Its shape has changed, but is grossly stablein size. Right upper lobe linear atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver, unchanged. Status post cholecystectomy. Mild intra-and extrahepatic biliary prominence is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: New sclerotic lesion involving the left acetabulum, consistent with metastatic disease. The lesions also extends into the left iliac bone.OTHER: No significant abnormality noted

Output: Interval development of new metastatic lesions involving the left acetabulum and left iliac bone.Left pleural-based spiculated lesion is grossly stable in size.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Evaluate progression of pulmonary edema History: hypoxia Reduction of the bilateral airspace and interstitial opacities from 24 hours earlier. The cardiac silhouette is better defined and appears enlarged.

Output: Partial reduction in airspace opacities from 24 hours earlier.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess for worsening pleural effusion History: tachypneic The left port is now accessed. Dobbhoff tube unchanged in position.Partial interval clearing of the right upper lobe airspace and interstitial opacities. Persistent large left and moderate right layering pleural effusions. No interval pneumothorax.

Output: Partial interval clearing right upper lobe opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Patient with NSTEMI s/p IABP please eval placement History: As above Left central catheter with tip at the cavoatrial junction. IABP marker approximately 1 cm from the top of the aortic arch. Cardiac size is mildly enlarged. No specific evidence of infection or edema. No pleural effusion or pneumothorax.

Output: IABP marker approximately 1 cm from the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: 65 years, Male. Reason: SBO History: SBO Nasogastric tube coiled in the fundus with tip projecting over the proximal gastric body. There are multiple dilated loops of small bowel, measuring up to approximately 5.4 cm in maximal diameter, with associated air-fluid levels. Surgical clips and skin staples in place. There is persistent subcutaneous emphysema of the abdominal wall.

Output: Nasogastric tube coiled in the fundus with tip projecting over the proximal gastric body. Small bowel obstruction pattern; however, given postoperative state this may also represent a postoperative ileus. Continued follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: assess swan positioning History: swan Small lung volumes with mild basilar subsegmental atelectasis on the left.Heart mildly enlarged.Left subclavian ICD, leads unchanged in position.Right jugular Swan-Ganz catheter tip in right pulmonary artery.

Output: Mild basilar atelectasis. New Swan-Ganz placement, see above.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with stage IV colorectal cancer on Xelox; first CT University of Chicago; baseline CT CHEST:LUNGS AND PLEURA: There is a left basilar subpleural nodule, which measures 7 mm x 4 mm on image 47, series 4. No pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: There are extensive hepatic metastatic lesions, some of which are calcified. The reference lesion is in the posterior right hepatic lobe and measures 1.9 cm by 1.8 cm as seen on image 74, series 3. There is no ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a nonobstructive right renal calculi.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are noted. There is a portacaval lymph node which measures 9 mm x 19 mm as seen on image 86, series 3. There is also a partially calcified left external iliac node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is infiltration of the fat surrounding the celiac axis and mesenteric artery.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: As aboveBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.Staging CT shows extensive hepatic metastases; measurements as above.2.Retroperitoneal adenonpathy.3.Infiltration of the fat planes surrounding the celiac axis.This may represent lymphatic involvement in the area.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Markedly increased lung volumes compatible with COPD.The cardiomediastinal silhouette is unremarkable.No focal air space opacities.Kyphosis of the thoracic spine with mild degenerative changes.

Output: COPD without acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: lung txp History: ct One chest tube has been removed on each side. Otherwise support hardware is stable. Small right apical medial pneumothorax. Small left apex pneumothorax. Basilar edema and atelectasis unchanged.

Output: Small right apical medial pneumothorax. Small left apex pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Swan-Ganz continues to project in right pulmonary outflow tract, minimally retractedCardiomegaly with otherwise unchanged cardiopulmonary appearance persists. Detail minimally diminished secondary to motion

Output: Swan-Ganz minimally repositioned and retracted 2 cm


Instruction: Generate impression based on medical findings.

Input: CHEST: Examination limited by field of view and range of coverage.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality noted in the extracardiovascular portions of the examination.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: eval for perforation s/p egd with overtube for food impaction History: s/p egd with overtube for food impaction No convincing evidence of ectopic gas though small amount of pneumoperitoneum could been invisible on this study due to different positioning of the patient. Consider repeat imaging for reevaluation. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Mild left-sided pleural thickening is likely. Unchanged heart size at the upper limit of normal.

Output: No convincing evidence of ectopic gas though small amount of pneumoperitoneum could been invisible on this study due to different positioning of the patient. Consider repeat imaging with less lordotic positioning for the PA radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: ro new infiltrate History: fever Severe emphysema with large right apical bullae. Progressive right middle lobe atelectasis and patchy consolidation compatible with pneumonia. Associated moderate right pleural effusion. Trace left pleural effusion. Stable heart size.

Output: Interval right middle lobe atelectasis with patchy foci of consolidation and moderate right pleural effusion compatible with infection. Severe emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old, with shortness of breath. Evaluate progression of pleural effusions and the liver (increasing LFTs). History of large B-cell lymphoma obtained on prior radiology requisition. CHEST:LUNGS AND PLEURA: A left-sided pleural effusion has improved significantly. A small right-sided pleural effusion is unchanged. Adjacent compressive atelectasis noted.Innumerable ground glass centrilobular nodules, worse on the right. This finding is nonspecific but may reflect aspiration bronchiolitis, infection (atypical, mycobacterial, fungal or viral) or hypersensitivity reaction.Dense consolidation at the left base, more so than expected from the degree of pleural effusion, may represent aspiration. Lingular scarring or atelectasis.MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. The cardiac size is normal. The pericardial fluid.CHEST WALL: Right chest wall port catheter, tip in the SVC. Sclerosis of a mid thoracic vertebral body is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Scattered small liver hypodensities are reidentified and may represent metastatic disease. A reference lesion adjacent to the gallbladder fossa measures 1.0 x 0.8 cm on image 119, series 3, decreased from 1.6 x 1.3 cm.Small amount of perihepatic ascites.SPLEEN: Scattered hypodense lesions in the spleen likely represent metastatic disease. A reference lesion measures 2.1 x 3.0 cm on image 95, series 3, decreased from 3.5 x 3.9 cm, although this difference may in part reflect the phase of contrast enhancement.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small right renal cystic lesion unchanged and probably benign.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy has improved. The reference lymph node on axial image 138, series 3, measures 1.7 x 1 .0 cm, decreased from 2.1 x 1.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See above.OTHER: No significant abnormality noted

Output: 1.Improvement in left pleural effusion.2.Diffuse centrilobular nodules may represent aspiration, infection or hypersensitivity reaction.3.Lymphoma reference lesions in the abdomen are improved.


Instruction: Generate impression based on medical findings.

Input: 37 year old female with history of non-small cell lung cancer, restaging. CHEST:LUNGS AND PLEURA: Postoperative changes status post right upper lobectomy unchanged. Dense air space consolidation in the superior segment of the right lower lobe unchanged.New large right pleural effusion. New right lower lobe peri-fissural nodule on axial image 35/157. A reference left upper lobe nodule measures 6.4 x 5.9 mm on axial image 42/157 and is unchanged. Additional left lung nodules are also unchanged.MEDIASTINUM AND HILA: Previously referenced right paratracheal lymph node is not well visualized. A reference subcarinal lymph node measures 3.6 x 2.9 cm on axial image 45/157 and has increased from the prior where it measured 1.8 x 2.0 cm. This lesion causes significant compression of the posterior wall of the left atrium without definite evidence of invasion. Right suprahilar low attenuation mass on axial image 43/157 is new and may represent lymphadenopathy versus loculated pleural fluid.CHEST WALL: Right-sided rib deformities compatible with prior surgery.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Heterogeneous right lower pole renal lesion compatible with metastatic disease has increased significantly in size. Additional hypoattenuating lesions within the right kidney are unchanged. The left kidney is unremarkable.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: New bilateral heterogeneous retroperitoneal masses axial images 110 and 111/157 suspicious for metastatic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcutaneous gas in the anterior abdominal. Correlate with history of recent subcutaneous injection.OTHER: No significant abnormality noted

Output: Progression of disease as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: Swan placement History: Swan Right IJ Swan-Ganz catheter terminates in the proximal right pulmonary artery. External defibrillator pads remain in place.Severe cardiomegaly unchanged. No interval edema.

Output: Severe cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: pulmonary edema, pna History: weight gain, SOB Mild cardiomegaly with no evidence of CHF.Postsurgical volume loss in the left hemithorax consistent with previous left upper lobectomy.No acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Cough for 2 weeks with right-sided mid/upper back pain. Wheezing, clear exam, afebrile, no SOB. History of bronchiectasis status post empyema RLL and right thoracotomy 5 years ago. Normal heart size. The left lung appears clear. No pleural fluid or pneumothorax.Chronic volume loss in the right lung remains, though in the interval there is some improvement in basal aeration. Bronchial wall thickening, bronchiectasis and endobronchial debris most pronounced in the right lower lobe at the base.There is no right upper lobe chest radiographic abnormality posteriorly to correlate with the location of patient's pain.

Output: Chronic findings in the right lower lobe consistent with bronchiectasis and endobronchial debris, this may account for the patient's symptom of wheezing. No chest radiographic abnormality to account for the patient's right-sided mid/upper back pain, though review of a CT performed in 2012 does show some scarring in the superior segment of the right lower lobe extending to the pleural surface occurring at the level of the right sixth rib, correlate with physical exam to determine whether this occurs at the site of pain.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.IABP in place and recent vomiting evaluate positioning and lobar infiltrate. IABP marker projects over the mid-descending thoracic aorta at the distal left main bronchus level, approximately 8 cm below the top of the aortic arch.Persistent airspace opacity at the level of the left hilum with associated lymphadenopathy. Surrounding groundglass opacity elsewhere in the left lung is improving but not entirely cleared as have opacities in the right lower lung. Lung volumes remain low. Peripheral catheter from the right terminates at the SVC level.

Output: IABP marker 8 cm below the top of the aortic arch. Persistent airspace opacity in the left lung.


Instruction: Generate impression based on medical findings.

Input: Reason: esophageal rupture? pneumonia? History: burning CP, SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: chf s/p subclavian baloon pump History: subclavian baloon pump Support devices unchanged and IABP marker in the aortic arch.Stable cardiac enlargement.Small right pleural effusion and nonspecific right basilar opacity similar in appearance to the prior exam.

Output: IABP marker in the aortic arch. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: check ett after transport . ECMO catheter has been removed. Right IJ line terminates in the SVC. No pneumothorax. Endotracheal tube terminates approximately 3 cm from the carina. This has been subsequently repositioned. Increase in small pleural effusions and bibasilar opacities. Unchanged heart size.

Output: Lines and tubes, as above. Increasing small pleural effusions and bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.CHF. IABP marker projects over the aortic arch. Left subclavian ICD unchanged in position. A peripheral catheter from the right terminates over the axillary vein region.Lung volumes remain low with mild pulmonary edema and atelectasis.

Output: Mild CHF


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Fever and cough. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality. Normal chest.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.SOB question possible pneumonia. Upper normal heart size. The thoracic aorta appears tortuous for age, correlate for systemic hypertension, nonspecific by plain film.Atelectasis and some adjacent minimal airspace opacity in the bases. No pneumothorax or pleural fluid.

Output: Basal atelectasis with small foci of consolidation could reflect sequelae of recent aspiration however infection is not excluded. Plain film follow-up may be obtained if symptoms worsen


Instruction: Generate impression based on medical findings.

Input: Female 30 years old Reason: History of +PPD skin test History: for placement for HD Redemonstration of markedly cardiomegaly, slightly increased from the prior examination when accounting for technical differences.Patchy left basilar opacity.No pneumothorax.Sternotomy wires are noted intact.

Output: 1. Left basilar opacity may represent atelectasis/consolidation.2. Marked cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old. ET tube with its tip 2 cm above the carina.Right IJ Swan-Ganz with its tip in the right pulmonary artery.Left central venous catheter with its tip in the SVC.NG tube with its tip in the stomach.Multiple surgical clips in the right upper abdomen.The cardiac mediastinal silhouette is unremarkable.Markedly decreased lung volumes with minimal basilar atelectasis.No focal airspace opacities or pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Eval pleural effusions History: O2 dependent after MV TV surgery Right chest tube position unchanged. Mediastinal drains, artificial mitral valve and sternotomy hardware unchanged. Interval removal of the Swan-Ganz catheter.Small left pleural effusion and mild bibasilar atelectasis similar to the prior. There is no pneumothorax. Mild cardiomegaly.

Output: Small left pleural effusion and basilar atelectasis similar to prior.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: concern for VAP History: post lung transplant patient Endotracheal tube terminates 1 cm above the carina. Interval removal of the left subclavian Swan-Ganz catheter. The left subclavian sheath remains in place. Bilateral superior chest tubes have been removed. The bilateral basilar chest tubes remain in place. The nasogastric tube side hole is positioned at the GE junction, advancement recommended.Improved aeration of both lungs with interval reduction in size of the pleural effusions. Severe pulmonary opacities with relative sparing of the left upper lobe. Cardiac contour raises a question of a pericardial effusion. No interval pneumothorax.

Output: Improved aeration both lungs with decreased size of pleural effusions. Persistent diffuse pulmonary opacities with sparing of the left upper lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.With history of left pleural effusion and worsening shortness of breath. Opacification of the right hemithorax remains consistent with history of right pneumonectomy. Slight interval increase in left pleural effusion and persistent interstitial edema. Left pulmonary nodules and mass stable from previous exam.

Output: Slight increase in left pulmonary effusion and persistent left interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Chest tube check and cough Interval increasing multiquadrant changes supporting extensive pulmonary edema and probable CHF given cardiomegaly and layered effusions. Changes remain greater on the right and now involving right upper lobe extensively.

Output: Increasing pulmonary edema with enlarging effusions


Instruction: Generate impression based on medical findings.

Input: Female 46 years old Reason: 46 yo with previous SBO who presents with recurrent symptoms after recent discharge History: nausea/emesis, obstipation Lungs are clear. Heart size is normal. Bilateral nephroureterostomy catheters. There is a distended small bowel loop in the left hemiabdomen suggestive of bowel obstruction. No free air.

Output: Distended small bowel loop in the left hemiabdomen suggestive of small bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: F/u fluid overload History: SOB Right central venous catheter with its tip in the RA.Cardiac size is normal.Right pleural effusion and bilateral pleural and parenchymal masses unchanged.Right-sided interstitial opacities have increased from the prior exam.Left lung is clear.

Output: Interval increase in interstitial opacities within the right lung may represent volume overload as well as lymphedema related to extensive pleural and parenchymal metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with duodenal Gist tumor, status post resection CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Exophytic lesion arising from the upper pole of the right kidney is 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: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: hypoxia, intubation History: intubation Interval intubation with the endotracheal tube approximately 8 cm above the carina. The cuff is likely at or immediately inferior to the cords. Repositioning is recommended.Persistent retrocardiac consolidation. No associated edema and pleural effusion or pneumothorax. Heart size is upper limits normal.

Output: Endotracheal tube is high with the cuff at or close to the cords. Repositioning is recommended. Retrocardiac consolidation unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: reassess b/l opacities, ET tube History: on vent Improvement in right pleural effusion but persistentCentral airspace and interstitial opacities suggestive of ARDS or aspiration.ET tube tip approximately 5 cm above the carina.A Dobbhoff tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Improvement in right pleural effusion but extensive pulmonary opacities persist suggestive of ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: eval pna History: fall Small lung volumes.No specific evidence of infection or edema.Cholecystectomy clips.

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


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Yes for etiology of pleuritic chest pain in the setting of cough, URI symptoms History: pleuritic chest pain Low lung volumes. Lungs otherwise clear of airspace or interstitial opacities. The cardiomediastinal silhouette is normal. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old with chest pain. Again seen is peribronchial thickening and bibasilar interstitial opacities. No new focal consolidation or pleural effusion. No pneumothorax.

Output: Peribronchial thickening and bibasilar interstitial opacities unchanged from prior exam.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: 69 years, Male. Reason: Evaluate for small bowel obstruction History: Prostate cancer with 2 weeks of nausea and vomiting Nonobstructive bowel gas pattern with above average stool burden. Visualized lung fields are clear. Normal cardiomediastinal silhouette.

Output: Nonobstructive bowel gas pattern with above average stool burden.


Instruction: Generate impression based on medical findings.

Input: 66 year old male with history of NHL. Reevaluate and compare to previous. CHEST:LUNGS AND PLEURA: Unchanged scarring in bilateral apices. Chronic pleural based thickening, stable. MEDIASTINUM AND HILA: Stable mildly enlarged mediastinal lymph nodes. Reference right peri-tracheal lymph node best seen on image 25 series 3 measures 1.3 x 0.7 cm compared to 1.2 by 0.6 cm on the prior. Another slightly increased reference subcarinal lymph node, best seen on image 44, series 3, measures 1.7 x 1.2 cm compared to 1.6 x 1.2 cm on the prior.CHEST WALL: No change in extensive collateral subcutaneous vessels consistent with known SVC syndrome.ABDOMEN:LIVER, BILIARY TRACT: Stable, fatty infiltration of the liver without mass, lesion orductal dilatation. Hepatic vessels patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Stable mildly enlarged bilateral external iliac and femoral lymph nodes. Reference right femoral lymph node, best seen on image 180 of series 3, measures 1.3 x 1.1cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination with virtually no change in mildly enlarged mediastinal, and pelvic lymph nodes. No new adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: pneumothorax; post-device placement in EP Lab Left subclavian pacemaker with leads in the right atrium and right ventricle.The heart size is normal. Mildly tortuous, ectatic thoracic aorta. Hiatal hernia. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: Evaluate for pleural effusion, PNA History: Shortness of breath with copd Stable cardiomediastinal silhouette.Large lung volumes with flattening of the diaphragms consistent with COPD. Cardiomediastinal bullae and coarse peripheral interstitial opacities and bronchiectasis appear unchanged. There is no specific evidence of infection.No pleural effusion or pneumothorax.

Output: COPD and chronic interstitial opacities without interval change. No evidence of infection or pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: intubated ET tube tip approximately 6 cm above the carina.Feeding tube tip in the stomach. Moderate cardiomegaly with mild residual basilar atelectasis, improved compared to previous.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxemia History: hypoxemia Tracheostomy tube and venous catheter unchanged.Diffuse nonspecific airspace opacity suggestive of edema and/or ARDS.No new findings.

Output: Diffuse airspace opacities suggestive of edema/ARDS without significant change.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with chest pain and fever. Evaluate for pneumonia. Cardiomediastinal silhouette is unremarkable.No significant pulmonary or pleural abnormality.Right upper quadrant surgical clips are noted.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: eval fluid overload History: chest pain, SOB Heart size is at the upper limits of normal.Low lung volumes. Focal airspace opacity, pneumothorax or large pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for pneumothorax History: S/P CT removal No significant pneumothorax following chest tube removal.Cardiomegaly with moderately large bilateral pleural effusions with partial loculation in the left major fissure, and underlying atelectasis.Aortic valve prosthesis and catheter with its tip in the SVC.

Output: CHF with no pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pna History: sob Severe chronic interstitial disease in the right native lung.No significant abnormalities in the left transplanted lung.No significant change.

Output: No acute radiographic abnormalities are evident. However bilateral pulmonary emboli were identified on a CT scan of 8/29/2015.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Eval for Effusion and ateletasis History: S/P Chest Tube Removal Interval removal of left chest tube with no evidence of pneumothorax. Left base slightly better aerated. Right jugular catheter removed. Other findings stable.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Right lung infiltrate History: Right lung infiltrate Card he megaly with a mild interstitial edema pattern unchanged.ET tube tip approximately 4 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular or subclavian catheter tip at RA level.

Output: Mild interstitial edema but no evidence of pneumonia. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: r/o infection History: cough with green sputum, hyperglycemia to 500s here. Mild left basilar scarring, the lungs are otherwise unremarkable.No specific evidence of infection or edema.Heart size normal.Two shot fragments are seen in the left neck and left lower chest region, unchanged.

Output: Mild left basilar scarring, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Non-small cell lung cancer status post 4 cycles of therapy. Compare to previous. CHEST:LUNGS AND PLEURA: Stable to equivocal decrease in size of right middle lobe reference lesion (image 38; series 5) which currently measures 2.6 x 2.2 cm. Linear atelectasis in the right middle lobe.MEDIASTINUM AND HILA: Right chest port with a small amount of thrombus at the insertion site and at the midportion of the catheter (image 6, 30; series 4). Small hiatal hernia. No significant adenopathy in the mediastinum.CHEST WALL: Equivocal sclerotic focus in a lower right rib (image 76; series 4). Suggest correlation with bone scanABDOMEN:LIVER, BILIARY TRACT: Tiny reference hypodense lesion in the right lobe measuring 5 x 5 mm (image 92; series 4) is is equivocally decreased in size compared to previous.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: Previously identified right buttock subcutaneous nodule is clinically decreased in size measuring 7 x 6 mm (image 124; series 4).Compression fracture with associated lytic and sclerotic lesions in T8 vertebral body. This has not significantly changed from previous study. A similar lesion is seen on T4 vertebral body. This has also not significantly changed. Metastatic disease cannot be excluded.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: Possibly new sclerotic lesion in the region of the left iliac bone (image 154; series 4) measuring 33 x 18 mm. Second vaguely sclerotic area superiorly in the left iliac bone (image 133). Suggest correlation with bone scan.OTHER: No significant abnormality noted.

Output: 1. Interval equivocal decrease in the size of the right middle lobe mass, hepatic lesion and right buttock lesion. 2. No significant change in the compression fractures involving T4 and T8 vertebral bodies.3. New sclerotic areas in the left iliac bone, left coracoid, and in the lower right rib. Suggest correlation with bone scan. Note that these could represent existing metastases which have become sclerotic as a result of therapy rather than new metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Shortness of breath. Rule out pneumothorax. History of adenocarcinoma with mucinous features. Multifocal consolidation and nodules bilaterally with areas of lucency consistent with internal cavitation. No conclusive pneumothorax. Although findings appear minimally increased compared to the most recent chest radiograph, there probably similar compared to a more recent CT performed on 4/2/2016.

Output: No visible pneumothorax. Extensive bilateral multifocal consolidation and nodules without significant change compared to most recent prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old. Hemoptysis, evaluate for alveolar filling. Left jugular catheter tip at the left brachiocephalic vein confluence.Basilar interstitial opacities with retrocardiac atelectasis, not significantly changed, likely representing CHF. Small left pleural effusion persists.Stable mild cardiomegaly.No new finding.

Output: Basilar interstitial opacities and retrocardiac atelectasis, likely representing CHF, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old Reason: s/p cardiac surgery History: s/p cardiac surgery Tracheostomy tube, median sternotomy hardware, central venous catheter, and chest tubes are unchanged. Enteric tube tip below the inferior margin of the image. Nonspecific basilar opacities, increased in the right likely representing atelectasis, edema and effusions. Cardiomediastinal silhouette is unchanged.

Output: Increased right basilar opacities. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: volume overload History: SOB, LE swelling Cardiomegaly with ICD leads and venous catheters are unchanged.Diffuse interstitial edema and small pleural effusions consistent with CHF, not significantly changed.

Output: CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Evaluate for retained foreign object, removal of previous packing sponges. Open sternotomy wound with three chest tubes.Previously radiopaque sponge markers no longer visible.Mild edema accompanied by left lower lobe consolidation are present.Open sternotomy wound.ICD and LVAD unchanged in position.ET tube tip 7 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Esophageal probe at the carina level.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.

Output: Removal of previously seen packing sponges.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: overload History: SOB Fine detail is limited by technique and body habitus. Low lung volumes that are nonspecific, a component attributed to subsegmental atelectasis due to underinflation. No significant pneumothorax. Further assessment for edema with upright PA radiograph recommended when the patient can tolerate.

Output: Examination is limited by body habitus and portable technique. Lung volumes are low with new mid to lower zone opacities. Further evaluation for edema can be made with upright PA radiograph when the patient can tolerate.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: Status post bronchial stent revision 5/20/2015 History: cough Status post right pneumonectomy with stable volume loss and mediastinal shift. There is persistent white out of the right hemithorax. Tracheal and bronchial stents unchanged. Right upper quadrant surgical clips again seen.No new focal pulmonary opacity.Moderate hiatal hernia.

Output: Stable appearing tracheal and bronchial stents. Persistent white out of right hemithorax.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pulmonary or medistinal cause of chest pain History: left sided chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Spinal catheter faintly visible projected over the left upper quadrant of the abdomen and the spinal canal, with its tip above the level of T4-T5.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: SOB, increased O2 requirement History: see above Improvement in multifocal lung consolidation. Normal heart size. No pleural effusion or pneumothorax.

Output: Improvement in multifocal lung consolidation..


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Previously identified left lower lobe nodule on image number 63, series number 6 measuring 5-mm is now smaller measuring 2-mm on image number 60, series number 5. A few others punctate nodules are unchanged.MEDIASTINUM AND HILA: New left sided pulmonary embolus involving the left lower lobe segmental arteries and right lower lobe segmental arteries.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Previously seen ring enhancing mass in the medial right hepatic lobe has been resected. There are postsurgical changes in that location around the liver. Ill-defined hypodensity around the right lobe of the liver likely represent postsurgical changes, however, follow-up imaging is recommended to exclude recurrence. An IVC graft is noted. There is nonocclusive thrombus in the distal IVC close to the confluence of bilateral common iliac veins best seen on coronal image 41.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: An IVC graft is noted. There is nonocclusive thrombus in the distal IVC close to the confluence of bilateral common iliac veins best seen on coronal image 41. There is an enhancing soft tissue mass posterior to the IVC measuring 31 by 16mm on image number 113, series number 3, new from previous study and concerning for recurrent disease.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: New, bilateral segmental pulmonary arteries emboli. Nonocclusive thrombus in the inferior IVC.Enhancing soft tissue mass posterior to the IVC suspicious for recurrent disease.Postsurgical changes involving the liver. Follow-up imaging is recommended to exclude recurrence.Interval decrease in the size of the left lower lobe nodule.Dr. Clark was notified about these findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval volume status No focal lung consolidation or evidence of overt left-sided heart failure. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: trach. Eval airspaces History: asx Moderate pulmonary edema with pleural effusions unchanged.Right pleural pigtail catheter unchanged.Left PICC, tip in the SVC.Right jugular catheter tip at cavoatrial junction level.Tracheostomy tube, the tip at the level of the thoracic inlet.A Dobbhoff tube extends below the lower margin of the image.

Output: Unchanged moderate pulmonary edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.History of acute chest. Cardiomediastinal silhouette is slightly enlarged from last study. Stable streaky basilar opacities compatible with scarring. No new focal airspace opacity to suggest acute chest.

Output: No acute cardiopulmonary abnormality or findings to suggest acute chest.


Instruction: Generate impression based on medical findings.

Input: Cough Persistent increased basilar consolidation with interval removal of the left chest tube and right jugular sheath. No residual or new pneumothorax.Interval decreased gastric distention.

Output: Left chest tube removed.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for effusion and atelectasis. History: SOB. S/P Aortic Dissection repair Large bilateral pleural effusions with underlying atelectasis, probably not significantly changed allowing for differences in position.Status post median sternotomy.

Output: Large pleural effusions without appreciable interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: congestion History: cough Unremarkable cardiac and mediastinal silhouette. Abnormal streaky opacity in the right upper lobe with associated volume loss, compatible with infection, atelectasis and scarring, of uncertain chronicity.Small nodular opacities are present elsewhere and a larger nodule measuring almost 3 cm in diameter is projected behind the heart in the left lower lobe.Volume loss and probable scarring in the left upper lobe with elevation of the left hilum.Port catheter in place with its tip in the SVC.A text page sent to Dr.ALKHALIFAH, at the time of reporting.

Output: Abnormal right upper lobe opacity and volume loss of uncertain chronicity, compatible with infection with poorly defined nodules elsewhere in the lungs.A CT scan is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o device displacement History: shortness of breath, chest discomfort Pacemaker device with the generator in the left anterior chest wall and leads projected in the area of the right atrial appendage and right ventricular apex. Unremarkable cardiac and mediastinal contours. Aortic and mitral valve prostheses.Blunting of the costophrenic angles compatible with small pleural effusions.Scarring and volume loss both apices and surgical clips in the right supraclavicular area.

Output: Small bilateral pleural effusions, possibly due to CHF.