Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: pleural effusion History: pre Thora exam Right IJ port catheter with tip overlying the SVC.Partially obscured cardiac silhouette is normal in size.Redemonstration of moderate sized partially loculated effusion with adjacent atelectasis. Right infrahilar masslike lesion and bilateral nodularity seen on recent PET/CT study is poorly demonstrated on this examination.

Output: Redemonstration of right moderate sized partially loculated effusion with localized component along the minor fissure.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with shortness of breath. Evaluate for parenchymal disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. Specifically, no interstitial process identified and no significant air trapping.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Heterogeneous, enlarged thyroid gland compatible with the nodular goiter seen on comparison study.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Cholecystectomy clips.

Output: No evidence of pulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Patient with increased SOB, LE edema, concern for volume overload; please eval for pulm edema vs. effusion History: As above Left upper lobe radiation related volume loss.There may be increased hilar density in the subcarinal region which is better evaluated by CT, also extending towards the right hilum.No specific evidence of infection or edema.

Output: No acute abnormality such as edema or pneumonia. Possible increased subcarinal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: lung eval History: lung eval Pneumothorax no longer visualized. Line position stable.Stable cardiomediastinal silhouette.No change in patchy basilar opacities.

Output: Resolution of right apical pneumothorax. Remaining findings are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.SOB evaluate lung fields. Basilar scarring and atelectasis. No focal airspace opacities, visible pleural fluid or pneumothorax.

Output: Chronic basilar scarring/atelectasis but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female; 73 years old. Reason: interval change History: pulm htn, intubated Stable ETT, enteric tube, and right jugular central venous catheter with tip in SVC.Stable cardiomediastinal silhouette.No significant interval change in bilateral airspace opacities, right greater than left. No pneumothorax.

Output: No significant change in diffuse air space opacities.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of prostate cancer and pulmonary nodules, follow-up LUNGS AND PLEURA: Previous identified reference subpleural nodule in the superior right lower lobe (image 48, series 5) is stable, measuring 5 mm in size. Additional right lower lobe subpleural nodule (image 39, series 5) is also stable.Mild paraseptal emphysema in the apices.No new pulmonary nodules identified.MEDIASTINUM AND HILA: Severe aortic and coronary calcifications.Cardiac size is normal without evidence of a pericardial effusion.No hilar or mediastinal lymphadenopathy identified.CHEST WALL: Degenerative changes in the thoracic spine.UPPER ABDOMEN: No significant abnormality noted.

Output: Stable small peripheral nodules in the right lower lobe. No new nodules identified.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lung fields after chest tube removal History: S/P CT Removal Cardiomegaly with small bilateral pleural effusions and basilar atelectasis.Pacemaker leads in place, unchanged.No sign of pneumothorax or other acute change.

Output: Cardiomegaly and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 33 years, Female. Reason: assess for obstruction History: abd pain, no BM/flatus x 3 days Lungs clear. Port-A-Cath right chest tip in distribution of SVC RA junction. Osseous and soft tissue structures of the chest are unremarkable.Abdomen shows slightly greater than average stool burden in the right colon. No evidence of obstruction intramural air or free air. Osseous and soft tissue structures are unremarkable.

Output: No evidence of obstruction or free air. Greater than average stool burden distributed primarily in the right colon.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with questionable esophageal pleural fistula.Esophageal perforation. CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions are seen, stable.Mild interstitial edema is noted within the bases.MEDIASTINUM AND HILA: A small amount of oral contrast is noted to be extravasating into the mediastinum with layering in the right pleural space. The possible point of extravasation (series 4, image 65) is just inferior to the tip of the NG tube on the right, where the esophageal wall is thinned. A right-sided chest tube terminates in the paraesophageal region, stable. The right posterior chest tube may communicate with the extravasated contrast in the mediastinum. It is uncertain whether the tract extends along the chest tube into the pleural space.Linear left pleural hypodensities are unchanged and not likely related to extravasation. A few small pockets of pneumomediastinum are seen.The nasogastric tube is coiled in the distal esophagus, stable. Right-sided central lines are evident. A tracheostomy is noted.Coronary calcifications are seen.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructive right nephrolithiasis is noted. A right renal cyst is again seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G and J-tubes are noted. Evidence of prior bowel resections are noted. No evidence of obstruction. Contrast is present in the gastric fundus from a patent GE junction. BONES, SOFT TISSUES: No significant abnormality noted OTHER: Mild ascites is seen.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Stones are noted within the bladder. The bladder is not well distended but appears thickened.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple areas of fatty density are scattered throughout the colon, from enteric feeds.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic disease is seen.

Output: Contrast extravasation from the esophagus, which extends to the right pleural space. Small perforation in the distal esophagus on the right just distal to the kink in the OG tube. No evidence of bowel obstruction.Multiple chronic findings as above.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of Burkitt's lymphoma/leukemia now with mesenteric node involvement. Presents with abdominal cramping. CHEST:LUNGS AND PLEURA: Few subcentimeter cavitary lesions in both lungs are new/more prominent than prior. Likely etiology would be infectious and clinical correlation is recommended.MEDIASTINUM AND HILA: Left hilar calcifications, similar to prior. Aorto-esophageal soft tissue mass identified on outside CT scan in 9/3/10 with continued decrease in size, currently nonmeasurable due to small size.CHEST WALL: Right-sided PICC terminates at the superior caval atrial junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Tiny anterior splenule, similar to prior. Focal hypodense lesion is nonspecific and incompletely visualized on prior. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Parapelvic cyst in the midpole of the left kidney.RETROPERITONEUM, LYMPH NODES: Few prominent retroperitoneal lymph nodes. Retrocrural node (series 3, image 96) measures 1.1 x 1.5 cm. Aortocaval node (series 3, image 122) measures 1.5 x 0.8 x 3.8 cm. No prior abdominal scans for comparison measurements.BOWEL, MESENTERY: Few mesenteric enlarged lymph nodes seen. The largest node (series 3 image 130) measures 2.3 x 1.0 cm. Confluent/infiltrating higher attenuation almost linear in nature within the mesentery surrounding this node is compatible with evolving lymphoma involvement --- without prior scans it cannot be determined whether resolving or increasing.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate atherosclerotic disease of the thoracic and abdominal aorta with significant stenosis below the level of the renal arteries.PELVIS:PROSTATE, SEMINAL VESICLES: Post operative appearance of prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Pelvic lymphadenopathy with prominence of left common iliac lymph node chain. Bilateral external iliac lymphadenopathy, measuring 2.0 x 0.9 cm on the right (series 3 image 183) and 1.5 x 0.9cm on the left (series 3, image 177).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1) Few subcentimeter lung cavitations, new/increased from prior. Correlate for infectious etiology.2) Interval resolution of aortoesophageal lymphadenopathy compared to outside exam 9/3/10.3) Retroperitoneal/pelvic lymphadenopathy and mesenteric soft tissue masses, compatible with lymphoma.3) Moderate atherosclerotic disease with significant infrarenal aortic stenosis.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Chest pain. The cardiomediastinal silhouette is within normal limits. No focal airspace opacity, significant pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: assess ET tube History: s/p ET tube ET tube tip approximately 3 cm above the carina. Catheter tip in the SVC.Feeding tube tip in stomach.Nonspecific diffuse interstitial and airspace opacity, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 40-year-old female with +PPD. Evaluate for tuberculosis. Cardiomediastinal silhouette within normal limits.No acute focal airspace opacity. Small left perihilar calcified granuloma is again evident. No pleural thickening or cavitary lesions.No pneumothorax or pleural effusion.

Output: Nonspecific left perihilar calcified granuloma. No radiographic evidence for acute cardiopulmonary process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Oxygen requirement rule out consolidation or effusion. Right jugular catheter unchanged in position. Large pleural fluid collections, right greater than left with associated atelectasis but no specific signs of pulmonary edema. Retrocardiac opacity may reflect atelectatic or consolidated lung, infection in this area cannot be excluded.Mild mediastinal widening about the same.No visible pneumothorax.

Output: Large pleural effusions with significant atelectasis; superimposed pneumonia in the left lower lobe cannot be ruled out.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pneumonia History: fever in immunocompromised (chemo) pt, altered mental status Mild basilar opacities suggestive of subsegmental atelectasis, not significantly changed.No specific evidence of pneumonia.Elevated right hemidiaphragm, unchanged.Extensive destruction of the right sixth and seventh ribs laterally compatible with metastatic disease, better shown on previous CT scans.

Output: Basilar atelectasis with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with history of metastatic renal cell carcinoma status post 6 cycles of chemotherapy. Please evaluate extent of disease. CHEST:LUNGS AND PLEURA: Previously noted interstitial thickening remains stable. Unchanged scattered micronodules.MEDIASTINUM AND HILA: Bihilar adenopathy. Previously referenced subcarinal lymph node (series 3, axial image 52/232) measures 16 mm x 14 mm.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Previously noted mass in the pancreatic head (series 3, axial image 122/232) measures 3.1 cm x 2.6 cm and remains stable.ADRENAL GLANDS: Left adrenal mass has decreased in size, measuring 1.9 cm x 1.4 cm (series 3, axial image 103/232).KIDNEYS, URETERS: Right nephrectomy site is clear. Left upper pole mass measures 3.6 cm x 3.3 cm, decreased in size on comparison to previous exam.Previously noted smaller heterogeneous lesions inferiorly remained stable. Punctate left renal stones.RETROPERITONEUM, LYMPH NODES: Reference retroperitoneal mass anterior to the right psoas muscle measures 1.9 cm x 1.5 cm, smaller compared to previous study (series 3, image 144/232). Portacaval and paraceliac adenopathy is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large left posterior acetabular mass remains stable.OTHER: No other significant abnormality noted.

Output: Overall stable exam with minimal changes on comparison to prior study as detailed above. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Reason: pre-op History: pre-op Normal heart size with a tortuous aorta.Skin folds overlying the left lung but no pneumothorax.Mild scarring and calcified granuloma at the right base.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: 51 yo M with history of lymphocytic myocarditis, s/p total artificial heart, needing CT ICU daily assessment History: lymphocytic myocarditis s/p total artifical heart implantation IJ lines terminating near the cavoatrial junction. Other iatrogenic devices, unchanged. Diffuse pulmonary opacities unchanged. Loculated right pleural effusion, as before. Unchanged cardiomegaly. Size of pericardial effusion has slowly increased over time but is unchanged compared to last study.

Output: Jay lines terminating near the cavoatrial junction. No pneumothorax. Size of pericardial effusion has slowly increased over time but is unchanged compared to last study.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: intubated History: intubated ET tube tip 3-4 cm above carina. NG tube tip in stomach. Venous catheter tip at RA/SVC junction.No change in pleural effusions and basilar atelectasis.

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


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: evaluate lung fields, s/p ex lap with respiratory insufficiency on BIPAP History: tachypnea, hypercarbia Mild cardiomegaly. Low lung volumes with basilar atelectasis. No specific evidence of infection or edema.There is a line which is coiled, projecting over what would be the course of the esophagus. If nasogastric tube has been placed, removal and reinsertion will be required.

Output: 1. Mild cardiomegaly with low lung volumes and basilar atelectasis2. No specific evidence of infection3. Nasogastric tube has been placed, removal and reinsertion will be required.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: MaleReason for Study: Reason: 27yoM septic shock History: as above Left Port-A-Cath with its tip in the right atrium.Mild cardiac enlargement.Decreased lung volumes .Minimal basilar atelectasis.No focal areas consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: r/o infiltrate History: SCD w/ CP and previous ACS Stable cardiomediastinal silhouette.Slightly coarse interstitial opacities likely sequela of patient's sickle cell disease. Low lung volumes with no new focal consolidation or sizable pleural effusion.Vertebral bodies deformities in keeping with patient's history of sickle cell disease.

Output: Chronic stigmata of sickle cell disease with no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: eval for PTX History: R sided chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: s/p thoracentesis History: thoracentesis Large left pleural effusion probably improved compared to the prior CT, with no pneumothorax.Small right pleural effusion.Innumerable pulmonary metastases are present.Compression atelectasis affects the left lower lobe.

Output: No pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Motion degrades sensitivity.Left ventricular predominant moderate CHF is observed with basilar atelectasis, greater on the left. No discrete superimposed new airspace abnormality. Dobbhoff again projects. The inferior edge of the image

Output: Improving aeration without new superimposed acute airspace abnormality other than previously observed atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old leukocytosis, concern for pneumonia. Stable decreased lung volumes with small bilateral pleural effusions. There appears to be resolution of reticulonodular opacities in the right lower lobe although due to decreased lung volumes evaluation is suboptimal. Stable calcified right perihilar lymph node. There is persistent multifocal discoid atelectasis without signs of pneumonia. The heart is size appears within normal limits. No pneumothorax. Multilevel degenerative changes within the spine.

Output: Stable decreased lung volumes with small bilateral pleural effusions and areas of persistent multifocal discoid atelectasis, however no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Check TLC placement. Regional enteritis small intestine. Interval removal of previously seen left jugular introducer. A new left jugular catheter terminates at the SVC. Right chest port unchanged in position. No pneumothorax. Small pleural effusions are new.

Output: Appropriate position of new left jugular catheter, no pneumothorax. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: intubated History: as above Endotracheal tube terminates 5 cm above the carina. There is persistent rightward tracheal deviation. A left endobronchial stent remains in stable position. Remaining devices are stable in position.There is a loculated left inferior lateral pneumothorax. Diffuse airspace and interstitial opacities, greatest at the bases, are unchanged. Small right pleural effusion. The right costophrenic angle is excluded from the field-of-view.

Output: Persistent loculated left inferior hydropneumothorax. Diffuse pulmonary opacities of edema or ARDS unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval R PTX History: eval R PTX Minimal right basilar pneumothorax with two right chest tubes. Small bilateral pleural effusions are stable left lower lobe consolidation has improved.ET tube tip is 6 cm above the carina.Right jugular catheter, tip in SVC.

Output: Very small right pneumothorax with two right chest tubes. Improving retrocardiac consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant New right subpulmonic or right upper quadrant drain, with decrease in size of a right effusion and decreased atelectasis.Mild retrocardiac subsegmental atelectasis may be from aspirated secretions. Heart size normal. ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.A Dobbhoff tube extends below the lower margin of the image.Right jugular Swan-Ganz catheter tip in main pulmonary artery.Left subclavian catheter, tip at right atrial level.Second right jugular catheter, tip at cavoatrial junction.

Output: Improvement in right effusion and atelectasis, with a new right subpulmonic or right upper quadrant drainage catheter. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.History of tracheal stenosis status post 2/24 flexible and rigid bronchoscopy with tracheal dilatation and injection of steroids. Follow-up. At the level of the thoracic inlet, the trachea measures 9-mm in transverse dimension. This appears stable to slightly improved from appearance on the most recent prior studies and significantly improved from the exam of 10/10/2014 where in retrospect the lumen of the trachea at this level was not visible.Elevation of the right hemidiaphragm unchanged. No focal pulmonary opacities. Normal heart size. Atherosclerotic calcification of the thoracic aorta at the level of the arch.

Output: Improved transverse dimension of the tracheal lumen at the level of the thoracic inlet. More accurate assessment may be made with cross-sectional imaging if required.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval for PNA History: aspiration? Heart size upper normal with patchy pulmonary opacities worse on subsequent studies.

Output: Pulmonary opacities consistent with edema and/or infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Sepsis question pneumonia. Enteric tube tip projects over the proximal stomach with sidehole just beyond the GE junction.Interval removal of right jugular introducer and endotracheal tube.Skin staples project over the chest wall.Lung volumes remain small with dependent atelectasis in the posterior lung fields and bases and an improving fine interstitial abnormality. Small pleural effusions, not significantly changed.

Output: Improving pulmonary edema. Small pleural effusions. Left retrocardiac opacity most consistent with atelectasis, superimposed infection is considered much less likely.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Status post robotic-assisted laparoscopic prostatectomy with dyspnea. Evaluate for atelectasis versus pneumonia. Low lung volumes. Bibasilar atelectasis without focal consolidation to suggest pneumonia. No pleural abnormalities.Cardiomediastinal silhouette is within normal limits.

Output: Bibasilar atelectasis without focal consolidation to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 32 years, Male. Reason: Evaluate for obstruction History: abdominal pain, no flatus Cardiomediastinal silhouette and visualized lung fields unremarkable.Nonobstructive bowel gas pattern. There is a moderate to large stool burden.

Output: Nonobstructive bowel gas pattern. 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, 60 years old.ALL with persistent fevers. Right jugular chest port tip at the SVC/artery junction. Normal heart size. No focal pulmonary opacities. Mild blunting of the right posterior costophrenic angle.

Output: No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Evaluate for cause of cp/sob, crushing substernal cp, transient approximately 10min, diaphoresis. Patient is status post sternotomy. Left-sided ICD leads and generator appears stable over multiple prior studies. There is an unusual course of one of the leads which curves along the azygos arch to abut the left atrium with coil in the projection of the left hemiazygos vein.Stable enlarged cardiac silhouette. Lingular scarring/atelectasis. Pulmonary vascular prominence without frank edema. No large pleural effusions or pneumothorax. No specific evidence of infection.

Output: Stable cardiomegaly and pulmonary vascular prominence. Unusual ICD coil position in the left hemiazygos vein unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: post op, eval ETT, lung fields History: s/p CABG Postop with chest tubes and equivocal small apical pneumothoraces as well as left supraclavicular soft tissue emphysema.Postop basilar atelectasis.Right jugular catheter, tip in right innominate artery.

Output: Minimal apical pneumothoraces, with postop basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Right radical nephrectomy and left partial nephrectomy evaluate for disease. No visible suspicious pulmonary nodules or masses. Calcified mediastinal lymph nodes. Basilar scarring and emphysema.

Output: No signs of pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Crohn's disease, evaluate for obstruction Interval worsening of small bowel dilatation, small bowel measures up to 5.6 cm. Some air seen distally in colon. Right lower quadrant bowel anastomotic suture material. Evaluation for free air suboptimal as only supine images submitted but no large pneumoperitoneum identified.

Output: Worsening small bowel obstruction; while some air seen distally in colon, given degree of small bowel dilatation seen proximally and in the central abdomen, appearance concerning for an increasingly high-grade obstruction.


Instruction: Generate impression based on medical findings.

Input: 13-year-old female with scoliosis with BiPAP overnight.VIEW: Chest AP (one view) 8/19/2015, 0818 Right upper extremity PICC tip terminates at the SVC. Gracile ribs and abnormal chest shape. Right thoracic and left thoracolumbar curves are present.Cardiothymic silhouette is normal. Persistent right upper and left lower lobe opacities with development of air bronchograms in the right upper lobe.

Output: Persistent opacities with development of air bronchograms in the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: 60M s/p esophagectomy History: s/p esophagectomy Stable cardiac enlargement and mediastinal widening .Pleural effusions and basilar atelectasis similar in appearance to prior exam.No new pulmonary opacities identified.

Output: No significant interval change in pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Hypoxia rule out pulmonary opacity/volume overload. Right chest port tip at the SVC/artery junction. Lung volumes remain low.Left chest wall mass. No new pulmonary nodules not visible by this technique.Lung volumes slightly decreased with basal atelectasis on the left. Pleural fluid/thickening on the left about the same.

Output: Low lung volumes with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: eval for pulmonary edema History: cough, RLL crackles Nonspecific left base opacity suggestive of infection or aspiration.Large lung volumes.Heart size normal.

Output: COPD and left basilar/lingular opacity suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Check ICD and IABP IABP marker unchanged, tip projects into the aortic arch. Mild cardiomegaly persists without new cardiopulmonary abnormalities.Right PICC line extends into the axilla unchanged

Output: IABP unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: eval lungs History: eval lungs Right chest tube and right jugular catheter unchanged.Small lung volumes with basilar atelectasis and small effusions.No significant pneumothorax.

Output: Basilar atelectasis and effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Cough and SOB. Evaluate if change in left pleural effusion with daily HD. Moderate large left pleural fluid collection decreased in volume but appears to be at least partially loculated. Left lower lobe partially collapsed and consolidated. Cardiothoracic ratio continues to improve, consistent with decreased volume of pericardial fluid. Minimal pleural fluid on the right. Enteric tube has been removed. Right jugular catheter and left subclavian pacemaker similar in position.

Output: Decreased nonspecific pericardial and left pleural fluid collections. Left lower lobe remains partially collapsed/consolidated, underlying infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Sepsis Motion degrade sensitivity. New patchy streaky densities in both bases greater in the left lower lobe, concerning for possible aspiration and/or infection. Mild cardiomegaly. Decreased lung volumes. Small effusions cannot be excluded, specifically on the rightLeft subclavian ICD unchanged

Output: Nonspecific cardiac and pulmonary changes, concerning for possible infection versus aspiration given history, specifically left lower lobe


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Status post AVR/CABG postoperative day number one. IABP marker near the top of the aortic arch.Left chest tube, mediastinal and pericardial drains unchanged in position. Right jugular Swan-Ganz catheter has been slightly retracted to the position of the right main pulmonary artery. Aortic valve bioprosthesis. Sternotomy hardware appears in alignment.Large area of lucency projecting over the expected location of the left ventricle probably pneumopericardium and air associated with the sternotomy site.

Output: Increased air lucency projecting over the left ventricle, probably anterior pneumopericardium and air associated with the sternotomy. Serial follow up radiographs were discussed with the clinical service. The patient is currently stable.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Hx of sarcoidosis History: shortness of breath Interval decreased lung volumes with rightward buckling of the trachea. Bilateral pleural thickening and/or effusions unchanged. Reticulonodular opacities, greatest in the upper zones and to the right base, not significantly changed. Interval cardiac enlargement raising the question of a pericardial effusion. No pneumothorax.

Output: Interval enlargement of the cardiac silhouette raising question of a pericardial effusion. Low lung volumes with atelectasis and previously described reticulonodular opacities. Stable small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: h/o of endometrial cancer - 1 year ago pleural effusion - now good response with hormones History: none Right Port-A-Cath with its tip in the SVC.Cardiac mediastinal silhouette is unremarkable.Lungs are clear.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: Shortness of breath. Motion artifact grades image quality. Within this limitation, there has been improvement in lung volumes and interval worsening of diffuse airspace opacities.

Output: Interval worsening of diffuse airspace opacities which most likely reflects aspiration pneumonitis/pneumonia with superimposed acute edema. Additional considerations include diffuse pulmonary hemorrhage in the appropriate clinical context.


Instruction: Generate impression based on medical findings.

Input: Assess degenerative changes and orthopedic hardware 3 views of the pelvis reveal extensive degenerative changes at the left hip with some heterotopic bone formation in orthopedic hardware. This been no change from the previous hip x-rays of May 27.

Output: Extensive degenerative disease and orthopedic hardware


Instruction: Generate impression based on medical findings.

Input: 10-month-old female with history of resolving TB infection and the widening of the upper mediastinum on chest radiographs. LUNGS AND PLEURA: Interval decrease in size and number of multiple pneumatoceles in both lungs, the largest in the right upper lobe measuring 2.3 cm. No air-fluid levels are noted within the pneumatoceles. Patchy airspace opacities predominantly in the dependent aspect of the lungs are also decreased since prior study and likely secondary to atelectasis. Interval resolution of small bilateral pleural effusions. There are new calcified right hilar nodes and small calcified nodules in the right upper lobe and left lower lobe, likely representing sequela of tuberculosis.MEDIASTINUM AND HILA: Tracheostomy tube tip is above the carina. Well circumscribed homogeneous soft tissue mass in the anterior mediastinum which is new or significantly increased measures 6.4 x 4.3 cm (TR/AP) likely represents thymus.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Gastrostomy tube is partially visualized. Previously demonstrated small ascites is not evident on the current study.

Output: Large anterior mediastinal mass likely represents enlarged thymus secondary to rebound hyperplasia.Interval decrease in pneumatoceles in both lungs measuring up to 2.3 cm. Bilateral dependent opacities in the lungs, likely related to atelectasis. Interval resolution of small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: intubated History: shortness of breath ET tube approximately 3 cm above the carina.Stable cardiomediastinal silhouette.Persistent patchy pulmonary opacities which may represent infection, aspiration, or atypical edema, similar in appearance to the prior exam.

Output: Persistent opacities which may represent infection, aspiration, or atypical edema. Given a known history of bronchopulmonary dysplasia, recommend CT imaging for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Chest pain. Left-sided dual-lead AICD is unchanged. The cardiomediastinal silhouette is within normal limits in size. Bibasilar streaky opacities appear worsened compared with the previous exam, and may represent atelectasis or possibly aspiration.

Output: Worsening bibasilar streaky opacities concerning for infectious process.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Post left thoracentesis. Increased moderate left pleural effusion and adjacent atelectasis. No pneumothorax. The right lung is clear.

Output: Increased moderate left pleural effusion with adjacent atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: first neutropenic fever History: see above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Central venous catheter terminates near the cavoatrial junction.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Tachycardia and shortness of breath. Swelling of limb. No focal airspace opacities, pleural fluid or pneumothorax. Minimal dependent atelectasis in the lung bases. Normal cardiomediastinal silhouette.

Output: Normal chest. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Evaluate for pneumothorax and reexpansion pulmonary edema status post large volume pleural effusion Interval decrease in pleural fluid volume on the left, no significant pneumothorax. Large right pleural effusion without significant change. Interstitial opacities in the left lower lung field consistent with atelectasis and probable reexpansion edema, mild. Additionally, left basal airspace opacities are seen, suspicious for infection. Tracheostomy tube and gastrostomy tube retention device noted.

Output: Decreased volume of pleural fluid on the left, with mild reexpansion edema and nonspecific airspace opacity which could potentially represent pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: FemaleReason for Study: Reason: mediastium History: CP The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Hematemesis and leukocytosis, evaluate for aspiration. Right internal jugular central venous catheter tip terminates near the cavoatrial junction. Numerous surgical clips are again seen in the upper abdomen. There are persistent basilar interstitial opacities, left greater than right. The cardiac and mediastinal contours are within normal limits.

Output: Persistent basilar interstitial opacities left greater than right which may reflect a combination of edema and/or possibly aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Eval for left lung effusion History: SOB Left subclavian ICD remains unchanged. Status post median sternotomy, CABG and likely aortic valve surgery.Stable cardiac silhouette.Marked improvement in left mid lung and basilar aeration with residual atelectasis and likely small effusion.

Output: Marked improvement in left midlung and basilar aeration with residual atelectasis and likely small effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: heart failure with swan History: swan in place Iatrogenic devices are unchanged. Dense left lower lobe opacification again noted. No new focal pleural parenchymal opacity in the right hemithorax. Unchanged cardiomegaly. No pneumothorax.

Output: Dense left lower lobe opacification again noted. No new focal pleural parenchymal opacity in the right hemithorax.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: ett placement Endotracheal tube terminates approximately 3 cm from the carina. Right apical chest tube remains in place. Percutaneous gastrostomy tube is noted. No substantial change in bibasilar pleural-parenchymal opacities. Postoperative changes again noted in the right hemithorax. Very small right-sided pneumothorax may be present. Increase in right-sided subcutaneous emphysema. Unchanged heart size.

Output: Increase in right-sided subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: confirm PICC line placement. History: s/p PICC, placement was fine last month, but pt has been managing at home. No significant cardiopulmonary abnormality.Residual contrast material is seen in the renal collecting systems.Left PICC, tip in the SVC.

Output: Left PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: chest pain History: chest pain Chronic right hemidiaphragm elevation, otherwise unremarkable with small lung volumes.Heart size normal.Stimulator generator projects over the right chest wall.

Output: Elevation right hemidiaphragm, chronic, with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male 72 years old Reason: any abnormal diaphagm movement (decreased movements, or dyskinesia)? History: exertional dyspnea, but spirometry relatively normal. Evaluation of diaphragmatic motion with deep inspiration and expiration revealed normal, symmetric diaphragmatic excursion. No evidence of dyskinesia.Fluoroscopy Time: 0 minutes 36 secondsDose area product: 757.34 uGy*m2Entrance dose: 14.40 mGy

Output: Normal, symmetric diaphragmatic excursion.


Instruction: Generate impression based on medical findings.

Input: 57 years old Female. Reason: icu History: icu. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is enlarged. The tube and lines are stable in position.

Output: Cardiomegaly, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of bladder cancer. Evaluate for metastatic disease. Surgical clips project over the left axilla. The cardiomediastinal silhouette is unremarkable. A faint nodular opacity projects over the left upper lung field. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No conclusive evidence of metastatic disease; faint left upper lobe nodular opacity may be external to the patient, however a follow-up PA lateral chest radiograph is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: r/o tuberculosis History: postive tuberculosis skin test The heart size is normal. There is no focal pulmonary opacity, pleural effusion, or pneumothorax. No pleural thickening, cavitary lesions or calcified granulomas evident.

Output: No radiographic evidence of TB.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, 41 years old.Reason: lung donation evaluation History: intubated, organ donation Endotracheal tube stable position.Nasogastric tube unchanged in position.No pneumothorax. No pleural effusion. Lungs clear.Stable cardiomediastinal silhouette.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, pneumonia? History: SOB Unremarkable cardiac and mediastinal silhouette. Mild right apical opacity compatible with scarring.No sign of pneumonia or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: swan placement History: swan placement Severe cardiomegaly without edema or significant sized pleural effusions.Right jugular Swan-Ganz catheter still looped in the right atrium before terminating in the main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter looped in the right atrium before terminating in the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: reassess ETT position History: s/p ETT adjustment The endotracheal tube terminates 3 cm from the carina. Enteric tube tip in the gastric body. Central venous catheter tip in the right atrium, unchanged. Diffuse right-sided pulmonary opacities and moderate right pleural effusion, unchanged. Slight interval worsening of left-sided pulmonary opacities. Unchanged cardiomediastinal silhouette with cardiomegaly. No evidence of pneumothorax.

Output: Endotracheal tube in acceptable position. Unchanged appearance of bilateral pulmonary opacities compatible with congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Presenting with hematuria and chest pain CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules suspicious for metastatic disease. There efferents nodule measures 5-mm image 46, series number 3.Small right pleural effusion.MEDIASTINUM AND HILA: Left lower lobe bronchopulmonary adenopathy. Lymph node measures 24 x 23 mm, image number 60, series number 3. Distal esophageal wall thickening consistent with patient's known history of cancer. Right anterior third rib metastases causing pleural bulging anteriorly. Proximal esophagus is slightly dilated.CHEST WALL: Right axillary adenopathy. A reference necrotic lymph node measures 11 by 11 image image number 20, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Multiple metastatic lesions in the liver. There efferents lesion in the right lobe measures 31 x 30 mm image number 84, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule measuring 36 x 19 mm. Left adrenal gland is nodular and diffusely thickened.KIDNEYS, URETERS: Heterogeneous, ill-defined focal area of hypodensity in the left lower pole. This may represent focal pyelonephritis. Although, much less likely, Metastatic disease or a primary renal cell carcinoma cannot entirely exclude. Follow-up imaging is recommended for further evaluation. 10-mm heterogeneous round high density lesion in the upper pole of the left kidney. This represent a complex cyst or a small solid lesion. This lesion is too small to accurately characterize.Minimal fat stranding in the left-sided retroperitoneal fat associated with the left psoas muscle atrophy. Etiology is uncertain.RETROPERITONEUM, LYMPH NODES: Borderline enlarged lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral borderline enlarged pelvic lymph nodes. A left external iliac lymph node measures 18 x 9 mm image number 177, series number 8, 0268.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Hepatic, pulmonary and right rib metastases. Mediastinal adenopathy. Distal esophageal wall thickening.Presumed right adrenal metastasis.Ill-defined hypodense focus in the left lower pole which represent pyelonephritis. Possibility of metastatic disease or primary renal cell carcinoma although less likely, cannot be excluded.Small complex lesion in the upper pole. The left kidney. This lesion is too small to accurate characterize, but has high density, and may represent a complex cyst or small solid neoplasm. Borderline enlarged pelvic and retroperitoneal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: sob History: sob Cardiomediastinal silhouette is normal. Lungs clear airspace and interstitial opacities. No pneumothorax. No pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: intubated, pls assess positioning History: intubated Line position stable. Improvement in left basilar opacity.No change in subcutaneous emphysema.

Output: Line position stable. Improvement in left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.History of MS on copaxone on with persistent cough and MS flare symptoms rule out pneumonia. Normal heart size. No focal airspace opacity, pleural fluid or pneumothorax.

Output: No signs of pneumonia or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: evaluate for pulmonary edema History: SOB No acute abnormality.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Cardiac arrestVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Left chest tube in place. Bilateral lung opacities with small pleural effusions not significantly changed. The left subpulmonic pneumothorax is not identified.

Output: Bilateral lung opacities with small pleural effusions not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of left lower lobe pneumonia. Evaluate resolution. Cardiomediastinal silhouette within normal limits.Left basilar subsegmental atelectasis. No acute focal airspace opacity.No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.History: Shortness of breath Unremarkable cardiopulmonary silhouette.Nonspecific mild interstitial abnormality in both bases, left greater than right. No focal consolidation. No pleural effusion.

Output: Nonspecific interstitial abnormality, suggestive of chronic process.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: ETT placement, PaO2 41% History: see above Left pleural effusion and unchanged basilar opacities.ET tube tip approximately 2 cm above the carina.Right jugular catheter, tip in SVC.Left jugular catheter, tip in SVC.An NG tube terminates in the stomach.

Output: Unchanged opacities and left pleural effusion. Low ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Heart size normal, the aorta is calcified and tortuous.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: SOB, cough, tachycardia Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: sob History: sob Mild cardiomegaly.No significant pulmonary or pleural abnormality.

Output: Mild cardiomegaly. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Status post CABG. Bilateral basilar chest tubes are unchanged in position without associated pneumothoraces. Mild persistent decreased volumes with mixed interstitial and airspace patchy opacities in both bases, likely mild edema with small effusions.Mild cardiomegalyRight jugular sheath extends into the upper SVCSmall metallic focus projected over left apex, however given lordosis is within the anterior neck soft tissues, unchanged.

Output: Chest tubes unchanged, however new minimal basilar changes suggesting early edema


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: post CABG/AVR ET tube, Swan-Ganz catheter and chest tubes unchanged.Hazy opacity, mainly on the left, consistent with pleural effusion and atelectasis.No pneumothorax or other acute change.

Output: Postoperative findings with pleural effusions and atelectasis, greater on the left.


Instruction: Generate impression based on medical findings.

Input: Reason: CHF History: dyspnea ICD device with leads unchanged from previous.Small lung volumes with no specific evidence of pulmonary edema or visible effusions.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: rule out acute chest History: chest pain on R side Moderate cardiomegaly.No significant pulmonary or pleural abnormality.No evidence of acute infection or infarction.

Output: Moderate cardiomegaly, without acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p right thoracocentesis History: s/p right thoracocentesis Low lung volumes. Persistent right pleural effusion slightly increased from the prior examination, with associated atelectasis. There is no pneumothorax. The cardiac and mediastinal contours are within normal limits for size. Skin staples project over the upper and left axilla. Multiple surgical clips are noted in the right upper quadrant.

Output: Slight interval increase in size of the persistent right pleural effusion and associated atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: infiltrate History: tachypnea, on bipap Lower lung volumes. Increased right basilar opacity. Patchy left basilar opacity, unchanged. Unchanged iatrogenic devices. Right-sided PICC again terminates over the superior right hemithorax. Unchanged cardiomegaly. No pneumothorax.

Output: Increased right basilar opacity which may represent atelectasis, consolidation, or effusion and can be reevaluated and imaging follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: s/p FT in lungs. check for PTX History: see above Median sternotomy, heart size upper normal.Small right pleural effusion, with adjacent subsegmental atelectasis.Prior feeding tube removed which likely entered the right lung base.No significant pneumothorax.Right jugular catheter tip at right atrial level.ET tube tip approximately 3 cm above the carina.Left jugular catheter tip in brachiocephalic vein at the midline.

Output: Prior feeding tube in right lung removed, with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: chronic cough History: chronic cough Tortuous and ectatic thoracic aorta, correlate for systemic hypertension. No evidence of pneumonia though the lung volumes are slightly large which may be a sign of COPD. Degenerative change involving spine.

Output: No evidence of pneumonia though the lung volumes are slightly large which may be a sign of COPD.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: evaluate for infection, volume overload History: wheezing, cough, missed dialysis Low lung volumes. Mild basilar atelectasis. No focal lung consolidation. Moderate cardiomegaly again noted. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: evaluate for recurrent pleural effusion History: pleural effusion Persistent left basilar retrocardiac atelectasis but no new findings.Heart size normal.Minimal right pleural effusion.A distal esophageal stent extends into the proximal stomach.Right jugular catheter, tip in SVC.

Output: Small right pleural effusion and stable retrocardiac atelectasis or scarring. Stable tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Pre op MVR History: Preop MVR Good position of ICD leads.Right central venous catheter with tip in projection of superior vena cava.Sternotomy wires intact.Lungs clear of airspace opacities.Scarring or atelectasis at lung bases.Heart size normal.No pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: evaluate lungs s/p chest tube removal History: s/p 2 chest tubes removed 2 of the right-sided chest tubes has been removed. Very small right apical pneumothorax. Diffuse pulmonary opacities in the right lung, unchanged. Unchanged heart size.

Output: Interval removal of 2 of the right-sided chest tubes. Very small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Cough Cardiomegaly, similar to prior.No specific evidence of infection or edema.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.History of chest pain. The cardiomediastinal silhouette is normal.Linear opacities in the lower lobes likely scarring from prior pneumonia and/or atelectasis. No new focal opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cardiac surgery interval film History: above Patchy bilateral airspace opacities have increased in the upper lobe suggestive of aspiration and/or infection.Lower zone opacities suggestive of effusions and atelectasis have not significantly changed.Right jugular catheter tip in right atrium PICC line tip in the SVC and tracheostomy tube in place.

Output: Increased upper lobe airspace opacities suggestive of aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Interval change in chronic systolic congestive heart failure. High endotracheal tube, with tip greater than 7 cm above the level of the carina. Other tubes and lines similar in position.Cardiomegaly with enlargement of the central pulmonary vasculature unchanged.Pulmonary vascular redistribution with moderate pulmonary edema about the same. The distal left main bronchus and proximal left upper lobe bronchus are poorly seen, suggestive of internal debris. The left lower lobe airways are not visualized.

Output: High endotracheal tube. Pulmonary edema. Probable debris in the airways of the left lung with resultant atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Evaluate ET tube position ET tube terminates 5 cm above the carina. Left central venous catheter with tip in the SVC. Enteric tube projecting inferiorly beyond the visualized field.Persistent decreased lung volumes and cardiomegaly with bilateral moderate layering pleural effusions and bilateral interstitial opacities compatible with atelectasis.

Output: ET tube terminates 5 cm above the carina. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: cough r/o infiltrate History: cough No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: please assess for effusion, consolidations, etc History: s/p LVAD placement, CHF Stable ET tube, 4 cm above the carina. Unchanged appearance of median sternotomy, left ICD leads, Swan-Ganz catheter, LVAD, and bilateral chest tubes.IABP marker in the descending aorta.Stable cardiomegaly and basilar atelectasis.No significant pleural effusion or pneumothorax.

Output: No significant interval change. No significant pleural effusion or consolidation.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: Confirm placement of baloon pump History: ICM + Cirrhosis awaiting transplant The sided ICD unchanged.A BP marker in the distal aortic arch.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. IABP marker in the distal aortic arch.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of metastatic pancreatic cancer. Status post 8 cycles of chemotherapy/placebo. CHEST:LUNGS AND PLEURA: Multiple metastatic nodules are again seen bilaterally with interval progression on comparison to multiple prior studies, particularly to the first study performed at the University of Chicago on 2/4/2009. The reference nodule in the lingula again measures 11 x 13 mm as measured previously.However, a nodule seen in the right lung on series 4, image 61, for example, measures 9 x 6 mm and is slightly increased in size. It measured approximately 7 x 4 mm on study from 5/28/2009 (series 5, image 59) and approximately 6 by 3.5 mm on study from 2/4/2009 (series 5, image 56). Overall, metastatic nodules appear to be gradually increasing in size. MEDIASTINUM AND HILA: Mediastinal lymphadenopathy is again noted. Reference subcarinal lymph node measures 17 x 14 mm (previously 16 x 15 mm), relatively unchanged accounting for differences in technique. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Large mass in the pancreatic tail is also reidentified, measuring 8 x 5 cm (series 3, image 114). It previously measured 9 x 6.5 cm. directo comparison of tumor size is relatively inaccurate between studies due to changing slice orientation relative to anatomy. Despite gross stability in size measurements, there is worsening encasement of the celiac artery and SMA by tumor consistent with progressive disease.ADRENAL GLANDS: Tumor invasion of the left adrenal gland as seen previously. Normal right adrenal gland.KIDNEYS, URETERS: Bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Increased mesenteric lymphadenopathy as well as extensive omental disease that is worsening on comparison to prior studies. For example, a metastatic focus is seen on series 3, image 139; omental involvement is seen on series 3, image 135.Moreover, a focus of free intraperitoneal air is seen adjacent to the transverse colon, near the hepatic flexure (series 3, image 124), which may be secondary to microperforation at this location. There is no bowel wall thickening or evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Previously referenced left common femoral lymph node is relatively stable accounting for differences in technique, measuring 15 x 13 mm (series 3, image 25); it previously measured 17 x 14 mm.BOWEL, MESENTERY: Deep peritoneal seeding of tumor is noted in the pelvis on series 3, image 183. This is a new finding.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Increasing ascites.

Output: Continued progression of patient's tumor burden with worsening metastatic nodules in the lungs, increased vascular encasement of the celiac artery and SMA, as well as extensive mesenteric and omental involvement as described above. Furthermore, a focus of free intraperitoneal air is seen adjacent to the transverse colon near the hepatic flexure, which may be due to microperforation at this location.Findings were communicated to and acknowledged by Dr. Jasmin Patel of the hematology/oncology service via telephone at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Cardiac arrest. ET tube placement. Technique is slightly suboptimal and there is motion artifact present, limiting evaluation.ETT tip 6 cm above the level of the carina.NGT tip just beyond the GE junction, the sidehole projects over the distal thoracic esophagus.Esophageal temperature probe projects over the proximal third of the esophagus.Right subclavian catheter tip at the SVC level.Cardiomegaly, unchanged. Small pleural effusions. Mild basal/dependent atelectasis. No visible pneumothorax or large airspace opacity.

Output: NGT may be advanced. No specific evidence of pulmonary edema or significant aspiration.


Instruction: Generate impression based on medical findings.

Input: Post MI management and balloon pump removal. Flash pulmonary edema. Endotracheal tube tip 3 cm above the level of the carina. Enteric tube sidehole at the level of the GE junction, suggest slight advancement. IABP marker projects about 4 cm below the top of the aortic arch. Previously seen temporary pacing lead projecting over a hepatic vein or IVC has been removed.Unchanged cardiomediastinal silhouette.Improving pulmonary edema. Layering pleural fluid on the right with associated atelectasis, new from prior.

Output: Overall significant improvement in CHF with resolution of majority of the alveolar edema component. Moderate to large volume of layering pleural fluid on the right is new.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: PNA History: R basilar wheezing Massive hiatal hernia unchanged.Heart size normal.No significant pulmonary or pleural abnormality.

Output: No evidence of infection. Massive hiatal hernia unchanged.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with history of metastatic breast cancer CHEST:LUNGS AND PLEURA: Scarlike opacity in the anterior aspect of the right middle lobe is stable. Interval development of multiple new lung nodules mostly in the right lung. An index nodule in the right lower lobe measures 9 x 8 mm on image number 53, series number 5.MEDIASTINUM AND HILA: Thyroid gland is diffusely enlarged. Previously described index AP window lymph node measures 5-mm in diameter on image number 33, series number 3, not significantly changed compared to previous study.CHEST WALL: Interval development of a large soft tissue mass within the right breast. The mass measures 9.5 x 5.3 cm on image number 24,ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is unchanged. Nonspecific subcentimeter hypodense lesion at the periphery of the liver is unchanged. No focal lesions suspicious for metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: New likely metastatic compression fracture of T12 vertebral body causing more than 50% loss in the height of the vertebral body.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral ovarian cysts. Larger left ovarian cyst measures 3 cm in diameter. Uterus is not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval development of a large right breast mass.Interval development of new lung nodule suspicious for metastatic disease.Cholelithiasis and subcentimeter liver lesion is unchanged.Bilateral ovarian cysts. Larger is within the left ovary and measures 3 cm in diameter.New likely metastatic compression fracture of T12 vertebral body.Dr. Chhablani was notified and acknowledged about the above findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: MaleReason for Study: Reason: rib fractures History: pain on rt ant chest The cardiomediastinal silhouette.Scattered areas of scarring/discoid atelectasis.No focal airspace consolidation. No pleural effusions.No pneumothorax.Scattered sclerotic foci compatible with known metastatic prostate cancer.Scoliosis of the thoracic and lumbar spine.No obvious acute rib fractures identified.

Output: Stable cardiopulmonary appearance without acute abnormality. No obvious acute rib fracture identified in patient with known prostatic metastases. Dedicated rib imaging may be of value.


Instruction: Generate impression based on medical findings.

Input: 78 year-old female with new gastric cancer, presenting with perforation. Known free air on chest x-ray. CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions. Subcentimeter soft tissue nodule in the right base (series 5 image 43) is nonspecific, though cannot exclude metastatic disease. MEDIASTINUM AND HILA: Multiple heterogeneous cystic lesions of the thyroid, predominately left lobe. Coronary artery calcifications. Left-sided central venous catheter is incompletely visualized with tip terminating at the superior cavoatrial junction.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Subcentimeter hypodensity in segment 7 of the right hepatic lobe (series 3 image 58) is too small characterize. No intra-/extrahepatic biliary ductal dilatation.SPLEEN: Subcentimeter hypodensity in the spleen (series 3, image 75) is nonspecific.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few small hypodensities in the right kidney are too small to characterize. Cystic lesion superior pole of the left kidney, compatible with simple cyst.RETROPERITONEUM, LYMPH NODES: Few scattered retroperitoneal lymph nodes. BOWEL, MESENTERY: A large peripherally enhancing soft tissue mass of the gastric antrum (series 3 image 19) measures 6.2 x 5.4 cm, compatible with history of known gastric cancer. The stomach is massively dilated with fluid measuring 25 cm in craniocaudal dimension, suggestive of gastric outlet obstruction. Remainder of the small bowel is not markedly dilated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of free intraperitoneal air. Moderate vascular calcifications.PELVIS:UTERUS, ADNEXA: Surgically absent. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis, no evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free intraperitoneal fluid.

Output: 1) Large gastric antral mass causing gastric outlet obstruction, compatible with gastric cancer. 2) Massive free intraperitoneal air and small amount of free intraperitoneal fluid, compatible with perforation, presumed secondary to gastric antral mass.3) Heterogenously enlarged thyroid- consider additional imaging if clinically indicated. 4) Nonspecific pulmonary nodule- cannot exclude malignancy.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.SOB pre-op status post CABG. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed. Left subclavian dual lead ICD. Normal heart size. Sternotomy wires. Mild left pleural thickening and possible superimposed fluid with streaky atelectasis at the left lung base. The right lung is unremarkable. No pneumothorax.

Output: Left hemithorax pleural thickening and fluid is of unclear etiology given the lack of prior comparison studies. Possible etiologies include prior hemothorax or empyema. In the absence of such clinical history however, this finding should be further evaluated and/or followed to exclude a an active process. If the referring clinical service can obtain and submit remote outside prior studies, an addendum to this report can be provided if requested.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with synovial sarcoma CHEST:LUNGS AND PLEURA: Multifocal lung nodules are reidentified. Referenced nodule in the right middle lobe measures 3 x 2.2 cm on image number 15, series number 5, not significantly changed from previous study. No new lesions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 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: Lytic lesion left iliac bone measures 4.8 by 2.6 cm on image number 152, series number 3, not significantly changed.OTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male status post bilateral transplant and take back. Evaluate ETT Postsurgical changes with 3 chest tubes on the left and 3 chest tubes on the right. ET tube tip approximately 4.5 cm above the carina. Interval placement of right central venous catheter tip in the right atrium. Remaining support devices and lines unchanged. Surgical clips in the mediastinum. Multiple curvilinear radiopaque structures likely related to Ray tec sponges at the periphery of the lungs bilaterally.There is persistent near complete opacification of the lungs. Unable to visualize the cardiomediastinal silhouette due to overlying opacities.

Output: Postsurgical changes as above with persistent near complete opacification of the lungs. Findings were discussed by on call radiology resident Dr. Mikin Patel with Dr. Perkins by phone on 5/30/2015 at 15:18.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: ?pneumonia History: none other than leukocytosis Feeding tube appears to have been advanced. Unchanged IJ line. Probable mild basilar atelectasis. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with unresectable pancreatic cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Previously noted hypodense lesions in the liver demonstrates clear for rim enhancement in an increase in size compared to previous study consistent with metastatic disease. The lesion in the right lobe measures 22 by 25-mm image number 90, series number 3. Previously it was measuring 12 x 14 mm image number 30, series number 11. Other smaller metastatic lesions also developed within the interval. Diffuse fat infiltration of liver.SPLEEN: Small nodules around the spleen likely represents Daniels, not significantly changed from previous study.PANCREAS: Larger cyst in the pancreatic body measures 3 x 2.9 cm image number 96, series number 3, slightly smaller compared to previous study. Other cystic lesion in the tail is increased in size and measures 24 by 21-mm image number 103, series number 3. There is an ill-defined heterogeneous area within the pancreatic parenchyma between these cysts likely representing patient's known adenocarcinoma.Celiac trunk and SMA are encased by tumor, not significantly changed from previous study. Splenic vein is chronically thrombosed. Collateral vessels in the left upper quadrant.ADRENAL GLANDS: Stable left adrenal gland enlargement.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index lymph node measures 15 x 14 mm image number 97, series number 3. Not significantly changed from previous study.BOWEL, MESENTERY: Small fat containing paramedical hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size and number of hepatic metastases. Diffuse fatty infiltration of the liver.One of the cysts in the pancreas has slightly increased in size. Heterogeneous area within the pancreatic parenchyma likely representing patient's known cancer is grossly stable.Encasement of the major retroperitoneal vessels and chronic thrombosis of splenic vein are unchanged.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality on chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: MaleReason for Study: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left-sided ICD unchanged.Stable cardiomediastinal silhouette with mild interstitial opacities compatible with edema.No large pleural effusions.No evidence of a pneumothorax.

Output: Stable cardiopulmonary appearance with mild interstitial edema. No evidence of a pneumothorax post procedure.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Central line repositioning No significant change in central line position with tip in the SVC.Low lung volumes. Cardiomediastinal silhouette is moderately enlarged and unchanged.Probable layering right pleural effusion. No pneumothorax.Basilar interstitial airspace opacities compatible with pulmonary edema.

Output: No significant change in position of central line.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: R/o pneumonia History: Cough No significant cardiopulmonary abnormality.Near atelectasis left lung base.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: is there any infiltrate History: chest pain bilateral Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Trauma to left chest, pain with sitting up. Question fracture. Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended.Questionable fracture and cortical overlap of the posterior left ninth rib where the anterior fifth rib crosses.The left lower lateral chest wall is incompletely included on the image. . No pneumothorax or visible pleural fluid. No focal airspace opacities. Heart size is normal.

Output: Possible left ninth posterior rib fracture. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed non-small cell lung cancer. CHEST:LUNGS AND PLEURA: Left upper lobe spiculated mass measuring 2 x 1.5 cm image number 18, series number 4.Multiple left-sided pleural/subpleural nodules suspicious for metastatic disease.MEDIASTINUM AND HILA: Right subclavicular adenopathy measuring 2.2 x 2.4 cm on image number 13, series number 4. Right internal jugular vein is compressed or invaded by this mass.Additional extensive upper mediastinal adenopathy. A reference precarinal lymph node measures 2.3 x 1.6 cm image number 45.Right hilar mass measuring 2.1 x 2.5 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion at the T10 vertebral body on the left side suspicious for metastatic disease. Other smaller lytic lesions are present throughout the vertebral bodies. Not clear whether some of them are related tilts to process or actually represent metastatic disease. Correlation with bone scan may be helpful. Fusion of the vertebral bodies are compatible with ankylosing spondylitis.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Left upper lobe spiculated mass with metastatic mediastinal and right hilar adenopathy. Suspicious lesion in the T8 vertebral body for metastases. Further evaluation bone scan is recommended.


Instruction: Generate impression based on medical findings.

Input: Constipation, evaluate for ileus Predominantly colonic ileus. Spinal postsurgical sequela. Suture material noted in pelvis. Gas seen in left lateral abdominal soft tissues, favored to reflect subcutaneous emphysema, intraperitoneal gas is not entirely excluded; findings likely reflect sequela of patient's interval spinal surgery.Please refer to same day chest radiography for additional findings.

Output: Diffuse colonic ileus.Gas seen in left lateral abdominal soft tissues, favored to reflect subcutaneous emphysema, intraperitoneal gas is not entirely excluded; findings likely reflect sequela of patient's interval spinal surgery. Follow-up should be obtained as clinically indicated. Please note that radiographically speaking evaluation for free air is best done with upright or left lateral decubitus films.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: pna, History: fatigue, cough Chronic volume loss with right apical scarring and other evidence of healed granulomatous disease. Left basilar opacity may be chronic although superimposed infection or aspiration are possible.Minimal left pleural effusion.Heart size normal.

Output: Chronic abnormalities, although superimposed left basilar infection or aspiration are possible.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male hepatitis C, cirrhosis, and a right hilar mass LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Evaluation of the hila is limited without the use of intravenous contrast. A minimally prominent mediastinal lymph node is identified measuring 15.2 mm x 7.4 mmCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: There is fatty infiltration within the central portions of the liver. The previously described small mass in the inferior medial aspect of the right lobe of the liver is not identified on the current examination. In addition the multiple small enhancing regions within the liver identified on previous exams are not seen on the current exam.  There is a 2.3 cm x 2.7 cm cyst in the right kidney.Atherosclerotic changes are identified of the abdominal aorta with some narrowing noted at the origin of the SMA.A small anterior abdominal wall hernia is identified within the midline

Output: 1. No pulmonary or pleural abnormalities can be identified.2. There is one minimally prominent mediastinal lymph node. Hilar lymphadenopathy cannot be adequately evaluated without intravenous contrast.3. Previously noted enhancing nodules in the liver are not identified on the current examination. No hepatic mass can be noted. The there is central fatty degeneration within the liver.4. Incidentally noted is a right renal cyst. There are atherosclerotic changes of the abdominal aorta with minimal narrowing of the origin of the SMA.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old with shortness of breath and mild left parasternal chest pain. Evaluate for pneumonia, pulmonary or cardiac process. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 68-year-old man with chronic renal failure and status post heart transplant with abnormal chest x-ray with infiltrates and dyspnea. LUNGS AND PLEURA: Scattered areas of tree in bud opacities noted in the peripheral aspect of the right lower and middle lobes suggestive of infection, especially if the patient is immunocompromised. Focal areas of ground glass opacity in the bases bilaterally and areas of linear atelectasis or scarring in the posterior right lower lung. No pleural effusion. Multiple 1-2mm calcified micronodules randomly scattered in both lungs suggestive of prior granulomatous infection. Mild bronchiectasis in the lower lobes.MEDIASTINUM AND HILA: No pathologically enlarged lymph nodes in the mediastinum. No pericardial effusion. Prominent thyroid gland.CHEST WALL: Mildly enlarged lymph nodes in the axilla.UPPER ABDOMEN: Mildly enlarged infradiaphragmatic lymph node.

Output: Tree in bud opacities suggestive of pulmonary infection especially if patient is immunocompromised.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with diffuse large cell lymphoma. Status post chemo and autologous stem cell transplant 4/08. Restaging of disease. Compared to scans of 5/9/08. CHEST:LUNGS AND PLEURA: Multiple new bilateral pulmonary nodules compatible with metastases. A nodule in the left lung apex measures 13 x 13 mm (image 24; series 4).MEDIASTINUM AND HILA: Small pericardial effusion.CHEST WALL: Right breast mass is increased in size and currently measures 6.2 x 13.6 cm (image 33; series 3). It appears to be extending through the chest wall into the pleura, and has a small fluid component laterally (image 49). Multiple small satellite nodules are also noted adjacent to the larger mass. Right chest port.ABDOMEN:LIVER, BILIARY TRACT: UnremarkableSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal metastases. For reference purposes, the left adrenal mass measures 3.4 by 2.9 cm (image 80; series 3).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter sclerotic right femoral lesion is unchanged.OTHER: No significant abnormality noted.

Output: Interval progression of disease. Enlarging right chest mass. New pulmonary metastases. New adrenal metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.New onset shortness of breath. Malignant neoplasm of the lateral wall of the bladder. Low lung volumes. Bibasilar subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax. Normal cardiomediastinal select. Atherosclerotic desiccation the aorta.

Output: Lung volumes with bibasilar subsegmental atelectasis. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Heart disease and transplant workup LVAD and ICD are unchanged.Persistent small lung volumes with right basilar suspected scarring mixed with atelectasis and a small right effusion. Scattered calcified granuloma

Output: Cardiomegaly without interval new superimposed acute cardiopulmonary abnormalities


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: Pt w/ AML w/ recurrent neutropenic fevers History: asymptomatic, febrile Left upper extremity PICC terminates in the SVC. Cardiomediastinal silhouette is stable. No superimposed pulmonary abnormality. No significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Check for pneumothorax. Kidney neoplasm ETT remains 4 cm above the carina. NG coiled in the proximal stomach. Right jugular catheter extends into the upper SVCUnderlying cardiopulmonary appearance significant for increased retrocardiac opacity suggesting further collapse of the left lower lobe and/or enlargement of the underlying moderate effusion. Small lung volumes on the right with otherwise persistent absence of definite focal discrete changes

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evaluate for infiltrate History: abnormal ekg Patient is status post sternotomy.Cardiac size is upper limits of normal. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary process. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain, distention Nonobstructive bowel gas pattern. IVC filter seen at L2/3 level. Spinal degenerative disease. Partially imaged sternotomy changes and mediastinal clips.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with history of base of tongue cancer. Please evaluate for recurrence. CHEST:LUNGS AND PLEURA: No suspicious nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Unchanged atrophy of the left hepatic lobe.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: ET tube placement History: unable to protect airway Interval intubation with the endotracheal tube 4 cm above the carina.Mild interval clearing of the left basilar opacities with the perihilar opacities unchanged. Right perihilar opacities have extended toward the right chest wall with new opacity at the right costophrenic angle. Small bilateral pleural effusions. No interval pneumothorax. Likely aortopulmonary window lymphadenopathy.

Output: Predominantly airspace opacities on the right have slightly increased. Slight improved aeration left lower lobe with dense left perihilar opacities remaining. Overall appearance favors infection.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: s/p removal of foreign body with perforation, mediastinitis History: perforation, mediastinitis Moderate interstitial opacities are present, more so than on the earlier CT, suggestive of aspirated secretions reviewed in edema.Very small right pleural effusion.Heart size normal.No mediastinal abnormality.

Output: Unremarkable mediastinal contours and cardiac silhouette. Interstitial opacities suggestive of edema or aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with intractable diarrhea, evaluate for inflamed colon. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No mediastinal lymph nodes are visualized. Heart size is normal without pericardial effusion.CHEST WALL: No significant abnormality noted. LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: There is a small, nonspecific, hypoattenuating lesion in the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The native kidneys are atrophic bilaterally, consistent with end-stage renal disease. A transplant kidney is located in the right iliac fossa, without evidence of perinephric stranding or parenchymal lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild bowel wall thickening, and fat stranding of the sigmoid, descending, and transverse colon, likely representing colitis. Sigmoid diverticuli are also noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: As aboveBONES, SOFT TISSUES: The right femoral head is collapsed, unchanged from the prior study. A sclerotic serpiginous lesion is seen within the anterosuperior left femoral head, also unchanged from the prior study. These findings are likely consistent with bilateral AVN, in light of the patient's end-stage renal failure.OTHER: No other significant abnormality noted.

Output: Mild colonic wall thickening and fat stranding, likely representing colitis; sigmoid diverticulosis


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with history of base of tongue cancer status post chemo/RT. Evaluate disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic focus within the left lateral aspect of the L1 vertebral body is unchanged from 2005.OTHER: Urinary bladder distention is unchanged.

Output: No evidence of metastatic disease to the chest or abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: eval edema History: SOB Reason: eval edema History: SOB Sternotomy wires remain well aligned.Cardiomegaly with left atrial chamber dilatation. Mild enlargement of the central pulmonary arteries. Streaky mid to lower zone opacities of mild edema. Trace pleural effusions. No pneumothorax.

Output: Mild edema with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.IABP, CHF. Serpiginous course of right upper extremity peripheral catheter which terminates at the right axillary/subclavian junction.IABP marker terminates at the aortic arch level. Left subclavian ICD unchanged in position. Unchanged cardiomegaly. No specific signs of pulmonary edema and no pneumothorax.

Output: No specific signs of CHF. IABP marker unchanged in position.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p central line placement History: see above Severe interstitial and airspace opacities unchanged consistent with acute edema.Very small pleural effusions.Heart size upper normal.Left jugular catheter tip at right atrial level.ET tube tip approximately 3 cm above the carina. Right jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.

Output: New left jugular catheter, tip in right atrium. Unchanged severe pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: r/o aspiration History: tube feeds leaking around trach in OR Iatrogenic devices are unchanged. Diffuse pulmonary opacities, unchanged. Unchanged cardiomegaly. No definite pneumothorax. Lucency at the right lung base, likely artifactual and can be reevaluated on imaging follow-up.

Output: No substantial difference compared to last study. Lucency at the right lung base is likely artifactual and can be reevaluated on interval imaging follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: 50F w/ history of bilateral lung transplant s/p thoracentesis Large pleural fluid collections with associated atelectasis. Dense basilar opacities nonspecific.

Output: Persistent basilar consolidation may reflect organizing pneumonia or infection, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Shortness of breath Unremarkable cardiomediastinal silhouette.No specific evidence of infection or edema. No pleural effusions. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: ETT check Underexpanded lungs with moderate effusions and underlying atelectasis. Suspected superimposed mild edema with borderline cardiomegalyETT placed, tip projects 2 cm above the carina

Output: ETT placed


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: assess for pulm edema History: as above Gradually worsening interstitial and airspace opacities with pleural effusions consistent with edema.Mild cardiomegaly.No reliable evidence of infection.

Output: Worsening CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: eval lung fields History: wheezing Markedly decreased lung volumes with cardiac enlargement. Bilateral basilar opacities are compatible with atelectasis and pleural effusions.No new pulmonary opacities identified.Right PICC line with its tip in the right axilla.

Output: Stable cardiopulmonary appearance with decreased lung volumes and basilar opacities compatible with atelectasis and effusions possibly related to aspiration.


Instruction: Generate impression based on medical findings.

Input: ECMO for diaphragmatic hernia.VIEW: Chest AP (one view) 04/06/15, 1029 Endotracheal tube tip is above the thoracic inlet. Feeding tube tip is in the stomach which is in left chest. ECMO cannulas remain in place. Umbilical venous lines are noted, one has its tip in right atrium, the other is coiled upon itself in the portal veins.Soft tissue edema persists.Mediastinum remain shifted to the right. Gas is present in bowel loops in left chest. Otherwise, the hemithoraces are completely opacified.

Output: Gas distended bowel loops in left chest.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Dialysis catheter. Cardiomegaly with mild diffuse interstitial abnormality suggesting CHF slightly improved. Right jugular catheter tip over the SVC. No pneumothorax.

Output: Mild CHF pattern, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Reason: post-op History: same ET tube tip approximately 2 cm above the carina. Swan-Ganz catheter tip in the right main pulmonary artery.Small lung volumes with basilar opacity compatible with atelectasis and nonspecific consolidation, not significantly changed.

Output: Basilar consolidation and atelectasis with no acute change.