Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of lung cancer CHEST:LUNGS AND PLEURA: left upper lobe spiculated nodule is stable measuring 10 by 7 mm on image number 49, series number 5. Emphysema. No new nodules. MEDIASTINUM AND HILA: Left hilar lymph node measuring 1.9 by 1 cm image number 42, stable. Subcarinal adenopathy is also stable measuring 2.5 by 1.9 cm image number 48.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Simple cyst in the left lobe is unchanged. No new liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left kidney is surgically absent. There is a new ill-defined hypodense lesion in the right kidney measuring 1.3 x 1.9 cm image number 112. Further evaluation of this lesion with dedicated renal mass protocol CT or MRI is recommended.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New hypodense lesion in the right kidney, concerning for renal cell carcinoma. Further evaluation with dedicated renal mass protocol CT or MRI is recommended.Left lung nodule and mediastinal and hilar adenopathy are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: ET tube placement History: see above Bilateral pleural effusions and basilar opacities are worse than on the prior study.ET tube tip approximately 6 cm above the carina.Right jugular catheter, tip in SVC.

Output: Worsening pleural effusions and basilar opacities. ET tube tip approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: evaluation ET position History: intubated Lines and tubes are unchanged with endotracheal tube terminating 6 cm from the carina. Diffuse pulmonary opacities and pleural effusions again noted. Probable very small right apical pneumothorax. Unchanged appearance of the mediastinum.

Output: Very small right apical pneumothorax. Diffuse pulmonary opacities and pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: CTICU History: Daily Patchy airspace opacities unchanged consistent with edema or ARDS.ECMO cannulae stable in position.LVAD partially imaged unchanged, as well as a right subclavian ICD.Left jugular Swan-Ganz catheter tip in right ventricular outflow tract.A Dobbhoff tube extends below the lower margin of the image.

Output: Unchanged airspace opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Essentially unchanged diffuse chronic appearing interstitial opacities correlating with previously described known fibrotic changes bilaterally and greater both bases. Moderate nonspecific cardiomegaly. No distinct definite effusions.Midline sternotomy.

Output: Unchanged diffuse fibrotic changes without distinct definite findings to suggest a new superimposed focal acute abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: Please eval for pneumonia or pneumothorax History: severe pain under Right rib cage, worse with deep breathing Cardiomegaly status post sternotomy.Gradually increasing interstitial opacities suggestive of edema or aspiration with bronchial wall thickening and small pleural effusions.No significant pneumothorax.Azygos vein distention unchanged.

Output: Small pleural effusions with increased opacity suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: s/p tavr History: see above Patient status post TAVR. low lung volumes with patchy bibasilar opacities and probable small pleural effusions. Probable mild pulmonary edema. Mild cardiomegaly. No pneumothorax.

Output: Mild pulmonary edema with patchy bibasilar opacities and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with recurrent ovarian cancer CHEST:LUNGS AND PLEURA: New subcentimeter nodule abutting the fissure on the right side measuring 5-mm image number 59, series number 4.MEDIASTINUM AND HILA: Paratracheal adenopathy measuring 14 x 7 mm on image number 28, series number 3 is unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval resection of the hepatic mass. Small amount of fluid accumulated in the hepatectomy bed.SPLEEN: Surgically absent.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evidence of gastric surgery, omentectomy, and splenectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New subcentimeter right lung nodule.Interval resection of the patient's known hepatic metastases with small amount of postsurgical fluid in the hepatectomy bed.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: Evaluate ETT placement, RLL infiltrate History: ETT in place, intermittently febrile, infiltrate on prior CXR, aspiration risk Endotracheal tube in right subclavian port catheter remains unchanged. Interval removal of enteric tube with 3 metallic clips now projecting over the left upper quadrant. Embolization coils again seen.Stable cardiomediastinal silhouette.Bibasilar consolidation again seen, stable to slightly worsened since prior study. No pneumothorax.

Output: Stable to mild worsening of bibasilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: s/p right pleurectomy and decortication History: leak One chest tube removed, one still extending in the apex, with a 3.7 cm apical pneumothorax which has enlarged.Right basilar subsegmental atelectasis is stable, and there appears to be mild edema or subsegmental atelectasis in the left lung base.

Output: Right chest tube is been removed, one still in place, with a apical pneumothorax larger than before.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: post op, eval lung fields History: s/p MVR ET tube has been removed.Remaining support devices unchanged.Stable cardiomediastinal silhouette.Redemonstration of a mild amount of pneumopericardium.Mild basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Interval extubation. Stable cardiopulmonary appearance with mild amount of pneumopericardium.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: hypoxia, history of COPD Low lung volumes. Left basilar atelectasis. Diffuse reticular interstitial opacities likely related to atelectasis. Focal left lower lobe consolidation, which could be related to aspiration or infection. No pleural effusion or pneumothorax.

Output: 1. Postoperative atelectasis.2. Left basilar airspace opacity which may be related to aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Reason: cough and weight loss History: cough and weight loss Unremarkable cardiac and mediastinal silhouette. Small calcified nodules and calcified lymph nodes, consistent with previous granulomatous infection. No sign of active infection or neoplasm.

Output: No apparent cause for reported symptoms.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumonia History: cough and chills Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of altered mental status and hypercalcemia. Right pleural effusion has increased in size. Right lower lobe tumor is inconspicuous on today's exam due to the aforementioned effusion. The right heart border is obscured. The left lung appears unremarkable.

Output: Increasing right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Evaluate for active TB History: Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild spinal curvature.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate volume status and infiltrates History: s/p AVR Cardiomegaly with bilateral pleural effusions and underlying atelectasis, not significantly changed allowing for position and projection.No new findings.

Output: Cardiomegaly with pleural effusions and atelectasis consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pulmonary edema or acute cardiopulmonary change History: SOB Normal heart size with a moderately tortuous aorta. Mild streaky opacity at the right base compatible with scarring, unchanged from previous. Mild blunting of the posterior costophrenic angles is also unchanged compatible with scarring. No specific evidence of pulmonary edema or infection.

Output: Mild basilar scarring and no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old. Reassess for infection in the right lower lobe. Dyspnea. Left subclavian dual chamber pacemaker, unchanged.Small lung volumes with patchy basilar opacities suggestive of atelectasis. No new focal pulmonary opacity.Stable cardiomediastinal silhouette.

Output: Basilar opacities suggestive of atelectasis. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval for infiltrates, tube position History: intubated Cardiomegaly with unchanged pulmonary opacities and pleural effusions.ET tube tip approximately 5 cm above the carina.A Dobbhoff tube terminates in the stomach.IVC filter.

Output: Unchanged pulmonary opacities, pleural effusions and support devices.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with abdominal pain and weight loss. CHEST:LUNGS AND PLEURA: Mild bronchial wall thickening. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Ill-defined soft tissue density is also noted in the anterior mediastinum (series 3, image 26).No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Mildly enlarged axillary lymph nodes (series 3, images 17 and 31). Enlarged lymph node is also noted anterior to the right pectoralis muscle laterally.Heterogeneous thyroid.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly enlarged inguinal lymph nodes are seen bilaterally. For reference, a right inguinal lymph node (series 3, image 180) measures 1.3 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lower lumbar spine.

Output: Scattered, mildly enlarged axillary and inguinal lymph nodes. Given patient's symptoms, findings are suspicious for a low-grade lymphoma. Continued follow-up is suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: Interval development of right sided PTX noted on AM CXR 2/11/16 History: Interval CXR to compare to prior image (chest tubes placed to suction) Near resolution of a right pneumothorax, with only a very small component over the right apex.Chest tubes unchanged following lung transplant.Interstitial and airspace opacities are stable.Tracheostomy tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Left jugular and left subclavian catheters both terminate in the SVC.

Output: Near resolution of prior right pneumothorax, chest tube stable.


Instruction: Generate impression based on medical findings.

Input: Crackles assess for pulmonary edema or pneumonia. Moderate bilateral pleural effusions. Left lower lobe consolidation persists, suspicious for pneumonia. Patchy airspace opacity and atelectasis at the right base is now partially obscured due to pleural fluid.

Output: Basilar opacities suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Infiltrates History: fever Unchanged cardiomediastinal silhouette and tortuous aorta.Unchanged appearance of left Bochdalek hernia.Chronic appearing basilar interstitial opacities, unchanged.Nonspecific left basilar opacity possibly representing atelectasis and small effusion.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Swan-Ganz catheter placement Right sided ICD a in place, unchanged. Swan-Ganz catheter tip projects at the level of the right main pulmonary artery. Sternotomy wires in place. Stable mild cardiomegaly. No focal opacity, large pleural effusion or pneumothorax.

Output: Swan-Ganz catheter tip projects at the level of the right main pulmonary artery.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: 67 year old female with history of colon cancer. Status post chemotherapy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Heterogeneity and low attenuating lesions in the left thyroid lobe appear stable.CHEST WALL: Right-sided Port-A-Cath terminates with tip in the SVC. Tiny focal calcifications in both breasts are similar to prior. ABDOMEN:LIVER, BILIARY TRACT: Apparent diffuse fatty infiltration, similar to prior. Previously identified hypoattenuating lesions with subtle decrease in size. Nonspecific lesion adjacent to the gallbladder neck (series 4, image 97) now measures 1.1 x 0.8 cm (previously 1.3 x 0.8 cm). Lesion in the right hepatic lobe (series 4 image 104) now measures 1.2 x 0.9 cm (previously 1.7 x 1.5 cm). No new lesions identified. SPLEEN: Surgically absent.PANCREAS: Previous identified low attenuating mass in the pancreatic tail (series 4 image 96) is less discrete and appears slightly decreased in size, measuring 1.4 x 1 .0 cm (previously 1.5 x 1.2 cm). Hypoattenuating pancreatic mass encasing the SMA (series 4 image 101) with subtle decrease in size, now measuring 2.0 x 1.7 cm superiorly (previously 2.7 x 2.0 cm).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple left renal cysts are stable in appearance.RETROPERITONEUM, LYMPH NODES: Subtle decrease in index left para-aortic lymph node (series 4 image 110) now measuring 1.4 x 0.9 cm (previously 1.8 x 1.2 cm).BOWEL, MESENTERY: Surgical clip adjacent to the descending colon unchanged from prior.BONES, SOFT TISSUES: Degenerative changes. No evidence of metastatic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Round hyperattenuating lesions in the uterus, likely representing fibroids.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: Minimal decrease in size of previously identified lesions in the liver, pancreas, and retroperitoneum. No new lesions.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: eval for pulm edema History: tachypnea, drop in sats, hypertensive urgency Marked interval development of bilateral interstitial and alveolar infiltrates in a perihilar and basilar distribution representing pulmonary edema.

Output: Acute pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: assess central line placement History: central line retracted slightly Left jugular catheter, tip in SVC.Large but clear lungs.

Output: Left jugular catheter, tip in SVC. No significant change in position.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: MaleReason for Study: Reason: Evaluate for infiltrate, worsening pulmonary edema History: shortess of breath, abdominal distention Stable cardiac enlargement.Left lobe opacities similar to the prior exam allowing for differences in patient positioning and technique.Right upper lobe scarring unchanged.No new pulmonary opacities identified.No large pleural effusions.

Output: Left upper lobe opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and recent MI Persistent mild and predominantly left-sided cardiomegaly. Decreased lung volumes and old postsurgical changes involving the right ribs also unchangedLungs remain clear other than mild COPD findings

Output: Cardiomegaly without superimposed acute pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: MaleReason for Study: Reason: r/o pna History: weakness There are decreased lung volumes.The cardiomediastinal silhouette is unremarkable.Mild left basilar atelectasis may be related aspirated secretions.No pleural effusions.Partially visualized right upper extremity vascular stent.

Output: Mild left basilar atelectasis possibly related to aspiration. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: Post-op CXR. Congestive heart failure. History: SOB Mild cardiomegaly with evidence of previous median sternotomy.Small lung volumes with streaky lower zone opacities compatible with scarring and atelectasis.Possible small pleural effusions.

Output: Basilar atelectasis and possible small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: s/p MVR. History: s/p removal of chest tubes x3 Left IJ introducer and chest/mediastinal tubes have been removed.No evidence of a pneumothorax.Stable cardiac mediastinal silhouette.Bilateral basilar atelectasis and possible small effusions unchanged.

Output: Interval removal of chest tubes and left IJ venous catheter. No significant pneumothorax identified. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Check ETT No appreciable significant interval change. Persistent small effusions and decreased lung volumes with mild nonspecific largely basilar interstitial and airspace opacities with mild cardiomegaly.ETT, right jugular catheter and NG are all otherwise similar

Output: Persistent bilateral pulmonary nonspecific opacities with small effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Post VT ablation with pericardial drain and impella in LV History: s/p device placement in EP lab Cardiomegaly with mild basilar subsegmental atelectasis possibly from aspirated secretions.Very small pleural effusions.Impella in place, the distal tip at or near the expected LVAD apex region.ET tube tip approximately 2 cm above the carina.Left subclavian dual chamber ICD.Pericardial drain.

Output: Pericardial drain and Impella, with mild basilar atelectasis and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Pleural effusion, SOB, assess chest tube placement. Left chest tube has been slightly retracted. No measurable pneumothorax. Left pleural fluid collection with associated atelectasis similar to previous. Consolidation on the right unchanged. Left PICC is similar in position. Subcutaneous emphysema left chest wall is improving.

Output: Slight retraction of left chest tube. No acute change in pulmonary or pleural abnormalities.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormality noted.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Status post LVAD, evaluate Hardware and devices are unchanged in position. Right loculated fluid collection appears decreased in size. There is interval improvement in left pleural fluid.Diffuse pulmonary opacities consistent with atelectasis, mild edema, and changes related to underlying sarcoidosis are grossly unchanged.

Output: Interval decrease in size of right loculated fluid and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: is there an infiltrate History: edema Cardiomegaly with mild interstitial edema and subsegmental atelectasis.Small left pleural effusion.

Output: Edema and atelectasis with pleural effusions suggestive of CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Fever. Elevation of the right hemidiaphragm is chronic. VP shunt tubing projects over the right hemithorax, incompletely visualized. Right jugular chest port terminates at the level of the superior vena cava.No focal pulmonary opacities or visible pleural fluid.

Output: No visible signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: postop History: na ECMO cannulae and basilar chest tubes unchanged in position.Small right hydropneumothorax. Basilar opacities of atelectasis. Small left pleural effusion.

Output: Small right hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: Swan in place History: On ionotropes Lines and tubes are unchanged. Unchanged cardiomegaly. Basilar pleuroparenchymal opacities in the left hemithorax, not substantially changed. No pneumothorax.

Output: Basilar pleuroparenchymal opacities in the left hemithorax, not substantially changed.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: 9 months after completion of induction chemotherapy and radiation therapy, followed by MIE for management of initial T2N1 distal esophageal adenocarcinoma with residual T1bN2 disease in the specimen with a microscopically involved margin History: follow up New pleural effusions.Right hilar enlargement may be present.Air fluid level in the distal portion of the gastric pull-up.Right subclavian catheter, tip in SVC.

Output: New left pleural effusion and right hilar lymphadenopathy. A thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: 68 year old male with CVL repositioning Right internal jugular venous catheter has been retracted with tip in the distal SVC. ET tube and feeding tube unchanged.Multifocal airspace opacities are unchanged.Stable cardiomediastinal silhouette.

Output: 1. Right internal jugular venous catheter tip in the distal SVC.2. Unchanged multifocal airspace opacities suggestive of infection.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of non-small cell lung carcinoma. The cardiomediastinal silhouette is unremarkable. No focal airspace opacities, pleural effusions, or pneumothorax. Right upper lobe biopsy proven primary lung cancer is not well visualized. Right chest port with tip in the SVC.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: cirrhosis, ascites, liver transplant evaluation History: pain when takes deep pain Right pleural and parenchymal scarring, better seen on the recent CT.No significant pneumothorax.Heart size normal.Amplatz occluder identified.

Output: Right pleural parenchymal scarring, similar to the recent abdomen CT which showed the lung bases.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Concern for pulmonary edema History: SOB Small lung volumes, but no acute edema or pneumonia.Minimal basilar atelectasis.Prior PICC removed.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 67 years, Female. Reason: rule out bowel obstruction History: vomiting, nausea, distension Lungs are hypoinflated with relative elevation right hemidiaphragm. Cannot exclude subpulmonic effusion.Rotatory levoscoliosis thoracolumbar spine.Markedly dilated loops of jejunum measuring about 4.2 cm in diameter with no ileal gas and only small volume colonic gas. There are differential air-fluid levels on the erect view. This is concerning for mechanical small bowel obstruction. No intramural air or free air. Average stool burden in the colon.Scoliosis and degenerative changes lumbosacral spine.

Output: Findings consistent with mechanical small bowel obstruction. No intramural air or free air.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: mediastinal lymphadenopathy-s/p bronchoscopy/medianstinoscopy History: mediastinal lymphadenopathy-s/p bronchoscopy/medianstinoscopy Mild right paratracheal lymphadenopathy.No other significant abnormality.Prior soft tissue air has resolved.

Output: Unchanged right paratracheal lymphadenopathy. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Unexplained WBC count elevation. Question infiltrate. Low lung volumes. Cardiomegaly and mediastinal widening about the same. Interval removal of nasogastric tube. Near complete resolution of upper lobe opacities seen previously.Persistent retrocardiac opacity on the left, unchanged, most likely atelectasis though infection is not excluded. Aspirate versus dependent atelectasis in the right lung, mild.

Output: Basilar/dependent opacities may be the result of atelectasis, aspiration or infection. Opacities in the upper lobes have cleared and were most likely the result of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: r/o new opacity History: dyspnea, crackles on exam Gradually increasing left basilar atelectasis, with enlarging pleural effusions.Mild atelectasis right lung base.Mild to moderate cardiomegaly.

Output: Increasing basilar opacities suggestive of edema/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old Reason: r/o acs History: chest pain, 76yoF h/o CVA. Low lung volumes.Cardiomediastinal silhouette is upper limits of normal.No focal opacity, pneumothorax, significant pleural effusion.Mild dextroscoliosis of the thoracic spine.Redemonstration of surgical clips in the region of the gastroesophageal junction.

Output: No acute cardiopulmonary abnormality without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old. Reason: eval lung fields, device placement History: s/p LVAD placement Mild advancement of a right basilar chest tube. LVAD, ICD leads, chest tubes appear otherwise similar to prior.Stable cardiomegaly. Nonspecific basilar opacities compatible with small effusions and atelectasis. No pneumothorax or other acute findings.

Output: Postoperative findings and mild nonspecific basilar opacities without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: colon cancer with lung, liver and peritoneal mets. please mesure using recist criteria. Non contrast ct ordered due to allergy to IV contrast History: pre chemotherapy This examination is limited by the absence of IV contrast. CHEST:LUNGS AND PLEURA: Multiple new pulmonary nodules consistent with metastatic disease. For reference a lesion within the right lung measures 2.7 x 1.2 cm (image 50, series 5). The previously identified left basilar subpleural nodule is unchanged and is likely benign. Right greater than left moderate pleural effusions.MEDIASTINUM AND HILA: New supraclavicular and posterior mediastinal lymphadenopathy. Heart size is normal without pericardial effusion. Coronary artery calcification. CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: There are extensive hepatic metastatic lesions which have increased in size and number. The reference lesion is in the posterior right hepatic lobe measures approximately 5.1 x 4.7 cm (image 74, series 3) previously 1.8 x 1.8 cm. There is no ductal dilatation. SPLEEN: Splenomegaly. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal gland is indistinct and cannot be completely identified.KIDNEYS, URETERS: There is a nonobstructive right renal calculi.RETROPERITONEUM, LYMPH NODES: New foci of retroperitoneal lymphadenopathy. There is a portacaval lymph node which measures 1.3 x 2.6 cm (image 94, series 3) previously 9 mm x 19 mm. BOWEL, MESENTERY: Peritoneal carcinomatosis with new ascites.BONES, SOFT TISSUES: Interval placement of a new sigmoid colon stent.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES:No pelvic lymphadenopathy noted.No lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval placement of a new rectosigmoid colon stent.OTHER: Small amount of free fluid in the pelvis.

Output: This examination is limited by the absence of IV contrast. 1. Multiple new pulmonary nodules consistent with metastatic disease. Enlarging and new hepatic metastases.2. Interval development of peritoneal carcinomatosis. 3. Additional findings as detailed above.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: Shortness of breath, h/o CHF, evaluate for acute cardiopulmonary abnormalities History: Shortness of breath Markedly enlarged cardiac silhouette may be due to cardiomegaly or pericardial effusion, unchanged. ICD unchanged. No new opacity to suggest pneumonia. No significant pulmonary edema.

Output: Markedly enlarged cardiac silhouette may be due to cardiomegaly or pericardial effusion, unchanged. No new opacity to suggest pneumonia. No significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Staging for newly diagnosed lung cancer CHEST:LUNGS AND PLEURA: Right upper lobe mass measuring 1.3 x 1.3 cm on image number 24, series number 5. Right-sided pleural catheter placed for pneumothorax. Right lower lobe segmental atelectasis. Minimal residual right-sided pneumothorax.MEDIASTINUM AND HILA: Right-sided supraclavicular adenopathy measuring 3 by 2 cm on image number one, series number 3, incompletely imaged. Extensive mediastinal adenopathy. Index right superior mediastinal adenopathy measures 2.1 x 2.5 cm on image number 15, series number 3. Precarinal adenopathy measures 2.3 by 1.6 cm on image number 32, series number 3. The esophagus is dilated throughout its course.CHEST WALL: Subcutaneous emphysema on the right side likely secondary to recent biopsy.ABDOMEN:LIVER, BILIARY TRACT: 9-mm hypodense lesion in the left lobe of the liver image number 63, series number 3 likely represents partial volume averaging with the surrounding fat. Pneumobilia is present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Laxity of the anterior abdominal wall with protruding nonobstructed bowel loops in the midline.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right upper lobe mass consistent with patient's known history of lung cancer. Mediastinal and right supraclavicular adenopathy.Right-sided pneumothorax catheter there was minimal amount of residual right-sided pneumothorax and extensive right-sided subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: evaluate for infection History: leukocytosis Interval resolution of cardiac enlargement likely consistent with resolved pericardial effusion.Multiple areas of nodular opacities compatible with known pulmonary and chest wall metastatic disease.Mediastinal widening secondary to known lymphadenopathy is redemonstrated.No new focal airspace opacities.No definite evidence of pleural effusions.

Output: Interval resolution of pericardial and pleural effusions. No definite evidence of infection, however, could consider a PA and lateral chest radiograph as the right chest wall mass partially obscures the right upper lung area.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: 55-year-old female with cough, DIE, SLE. Right calcified chest node, old. Decreased DLCO. LUNGS AND PLEURA: 4-mm right middle lobe micronodule on axial image 50/94. 3-mm left upper lobe micronodule on axial image 36/94. In a low-risk patient, no follow-up is required. With a history of smoking or other high clinical suspicion, a 12 month CT follow-up is recommended.No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Large right paratracheal calcified lymph node is grossly unchanged when compared to the prior chest radiograph. No other pathologically enlarged hilar or mediastinal lymph nodes.Cardiac size is normal. Small pericardial effusion.CHEST WALL: Prominent right axillary lymph node of uncertain clinical significance on axial image 22/94.UPPER ABDOMEN: Limited examination given the lack of IV contrast enhancement. Splenic and liver calcifications likely represent prior granulomatous disease.A low attenuation lesion in the upper pole of the right kidney is incompletely evaluated.

Output: 1.Nonspecific micronodules. For a low-risk patient, no follow-up required. Otherwise, 12 month CT follow-up is recommended.2.Stable calcified right paratracheal lymph node.3.Enlarged right axillary lymph node of uncertain clinical significance.4.A low attenuation right renal lesion is incompletely evaluated.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: Interval change History: Interval change No significant change in basilar opacities and pleural effusions, right worse than left.Stable cardiomegaly.Tracheostomy tube tip approximately 6 above the carina.An enteric tube extends below the lower margin of the image.Bilateral jugular catheters terminate in the SVC.

Output: Unchanged basilar opacities and pleural effusions, right worse than left.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Cystectomy, ileal conduit compensated by ileus now with PICC placed. Left upper extremity PICC tip at the SVC level. Nasogastric tube looped in the projection of the stomach.Low lung volumes with basal atelectasis and probable small pleural effusions, left greater than right, unchanged.

Output: Left PICC tip at the SVC level.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: et tube placement History: et tube Lines and tubes are unchanged. Diffuse nodular opacities again noted in the lungs. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged diffuse pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Eval lung fields History: Lung transplant Small lung volumes with dense pulmonary opacities and pleural effusions, not significantly changed.Tracheostomy tube tip approximately 5 cm above the carina. Dobbhoff tube with tip in transverse portion of the duodenum. Right jugular catheter, tip in SVC.

Output: No change in extensive pulmonary opacities and pleural effusions. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: pulmonary edema History: using supplemental O2 Right PICC tip in SVC. Left subclavian dual lead pacer with leads in right atrium and right ventricular apex.Left lower lobe consolidation with probable associated left pleural effusion.

Output: Left lower lobe consolidation with probable associated left pleural effusion. This could be due to aspirate, infection or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: optic perineuritis; r/o sarcoidosis History: optic perineuritis; r/o sarcoidosis Stable mild cardiac enlargement with tortuosity of the aorta.Minimal left basilar atelectasis.No focal airspace opacities.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: evaluate lung fields s/p chest tube removal History: 2 apical chest tubes removed Apica chest tubes have been removed. Enteric tube terminates within the proximal aspect of the stomach. Low lung volumes. Mid and lower lung patchy opacities, unchanged. Unchanged heart size. No definite pneumothorax.

Output: Interval removal of chest tubes, as above without evidence of significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: cause of SOB History: SOB No significant cardiopulmonary abnormality.Scoliosis.

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


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Support hardware unchanged in position. Swan-Ganz catheter tip in right pulmonary artery. No evidence of pneumothorax.Low lung volumes. Left greater than right basilar opacities are likely due to atelectasis with a probable small effusion on the left. No evidence of pneumothorax. Stable cardiomegaly.

Output: Left greater than right basilar opacities are likely due to atelectasis with a probable small effusion on the left. No evidence of pneumothorax. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: intubated History: intubated Unchanged pulmonary opacities and pleural effusions.Multiple support devices including ECMO cannulae are unchanged. ET tube tip approximately 4 cm above the carina. A forcep support of the tines broken is still in place, and was previously discussed with the clinical service.

Output: Unchanged pulmonary opacities and pleural effusions. Stable support devices including a broken surgical clamp.


Instruction: Generate impression based on medical findings.

Input: History of right CDH status post repair now with chest x-ray suggesting re-herniation. A large amount of small bowel herniates through a Bochdalek hernia into the right hemithorax causing significant volume loss on the right and mediastinal shift to the left. The herniating bowel occupies a volume of approximately 7 x 7 x 7 cm. The superior-most loops of herniating bowel show a lobulated contour on coronal views suggesting reherniation rather than ballooning of the repair patch.Left lung parenchyma is normal with no mass lesions, edema or pleural effusion.Evaluation of the abdomen is limited given lack of IV contrast, but no gross abnormality is seen. Multiple surgical clips are identified within the abdomen (axial images 43/65, 56/65 and 60/65).

Output: Reherniation of bowel into the right hemithorax with other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: SOB History: see above Gradually increasing perihilar opacities consistent with edema and/or aspiration.Hilar and mediastinal adenopathy present as reported on a recent CT.

Output: Gradually increasing perihilar opacities consistent with acute edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: eval infection History: s/p renal+pancreas transplant, fevers Right-sided venous catheter tip at right jugular/subclavian confluence.No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: neutropenic fever History: fever No lung volumes. No focal lung consolidation. Likely unchanged heart size given the lung volumes. Unchanged central venous catheter.

Output: Low lung volumes. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Postop transplant POD #2. Right chest tubes unchanged in position. Left subclavian Swan-Ganz catheter tip remains at the pulmonary outflow tract.Right hydropneumothorax unchanged. Dense opacity surrounding the right infrahilar region with prominence of the right interlobar artery again noted. Edema-like pulmonary opacities unchanged. Subcutaneous emphysema right chest wall.

Output: Unchanged right hydropneumothorax, edema-like pulmonary opacity and nonspecific dense opacity surrounding the right hilum and infrahilar region. CT may be considered if there is concern for hematoma or other postoperative complication.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval sgc History: eval sgv Cardiomegaly status post sternotomy and mitral valve replacement.Mild interstitial opacities suggestive of edema but no sign of infection.No significant sized pleural effusions.Right jugular Swan-Ganz catheter, tip in the right interlobar pulmonary artery.Left subclavian dual-chamber pacemaker, leads in expected locations.

Output: Cardiomegaly with mild edema. Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: IABP check IABP marker remains 2 cm from the aortic arch unchanged. ICD, right jugular catheter are also similar and unchanged in position.Moderate nonspecific cardiomegaly without a distinct new superimposed pulmonary abnormality

Output: IABP unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Lingula sparing left upper lobectomy for lung cancer, evaluate for pneumothorax Left pleural catheter without significant pneumothorax. Left basilar atelectasis, edema, effusions, are not significantly changed. The mediastinal silhouette is unchanged.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Abdominal pain. Evaluate for obstruction. No focal airspace opacity, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.Scattered foci of air within a nondistended colon. Average stool burden. No pneumoperitoneum.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: DOE and mild cough past 2 - 4 weeks History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: evaluate for pleural effusion History: dyspnea, recent CABG with diminishing return from chest tubes Median sternotomy with no substantial pleural effusion.Minimal basilar interstitial opacities are nonspecific.Heart very mildly enlarged.

Output: No acute abnormality. No significant sized pleural effusions. Mediastinal drains incompletely visualized.


Instruction: Generate impression based on medical findings.

Input: Reason: interval eval for CHF; swan placement History: as above Mild cardiomegaly. Swan-Ganz catheter in the area of the right main pulmonary artery but not clearly visible due to motion artifact. PICC tip in the SVC.Sternal fixation devices in place with migration of a screw which is projected over the left upper mediastinum, unchanged.No acute abnormalities.

Output: Mild cardiomegaly with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Heterotaxy and Kawashima (similar to bidirectional Glenn) procedure. Increased transpulmonary gradient.VIEW: Chest AP (one view) 02/24/16, 1859 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in distal gastric body and left sided stomach. Right internal jugular line tip is at level of right sided superior vena cava. Mediastinal surgical clips are noted. There is a mediastinal drain. An atrial line is identified. There is a chest tube in each hemithorax. Epicardial pacer leads are seen.Cardiac apex and aortic arch are right-sided. Cardiac silhouette size is upper limits of normal. There may be right apical pleural fluid. No pneumothorax is seen. No focal opacity is present. Hyperlucency is noted at the right costophrenic sulcus.

Output: No evidence of complication after surgery.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with shunt placement. SHUNT DEVICE: There is a intracranial shunt with its tip projecting approximately 3 cm left of the clinoid process. It exits the skull via a left parietal-occipital burr hole and courses down the neck, anterior chest wall, and enters abdomen. It coils anteriorly in the left upper quadrant of the abdomen. We see no radiographic features shunt complication. Surgical changes of the skull have been described in previous CT reports (see report dated July 11, 2016).SKULL: Surgical changes of the skull have been described in previous CT reports as above.CERVICAL SPINE: Multiple level degenerative disc disease.CHEST: The lungs are underinflated, but we see no focal pulmonary opacities.ABDOMEN: There is a feeding tube in the antropyloric area. There are coils in the anterior abdominal wall likely from a prior ventral hernia repair. There is a nonobstructive bowel gas pattern.

Output: VP shunt as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: copd History: chronic cough Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 16 year old female with history of intermittent gastrointestinal bleeding with irregular menstrual cycles and history of normal colonoscopy and EGD. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, 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: Suboptimal opacification of the small bowel secondary to poor contrast intake. The small bowel is collapsed. There are no obvious small bowel abnormalities. There are no secondary inflammatory changes. There are borderline enlarged right lower abdominal nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Suboptimal opacification of the small bowel secondary to poor contrast intake. The small bowel is collapsed. There are no obvious small bowel abnormalities. There are no secondary inflammatory changes. There is right lower quadrant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Suboptimal opacification of the small bowel secondary to poor contrast intake secondary to patient emesis. No obvious small bowel abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old. Swan placement. Cardiomegaly with retrocardiac opacity is stable. Right jugular Swan-Ganz catheter tip in right main pulmonary artery. No pneumothorax. Other devices are stable.

Output: Cardiomegaly with retrocardiac opacity, stable. Right jugular Swan catheter catheter tip over the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Increased work of breathing. History of pleural effusion.VIEW: Chest AP (one view) 2/2/15 at 339 hours. ET tube tip is below thoracic inlet. NG tube is present. Left-sided chest tube again noted. Cardiac silhouette size is normal. Streaky opacities of the right and left upper lobes on a background of diffuse right haziness. Interval improvement in left-sided pleural effusion.

Output: Interval improvement in left sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Kidney donor evaluate for cardiopulmonary abnormalities. Low lung volumes. No focal pulmonary opacities, pleural fluid or pneumothorax. Normal heart size.

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


Instruction: Generate impression based on medical findings.

Input: Male; 52 years. Reason: F/U on cholangiocarcinoma CHEST:LUNGS AND PLEURA: Pulmonary nodule in left base (series 4 image 70), unchanged compared to 5/7/11MEDIASTINUM AND HILA: Subcarinal lymphadenopathy measuring 1.3 cm, unchanged. Other borderline enlarged mediastinal lymph nodes are not significantly changed.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Pneumobilia with right and left hepatic lobe internal metallic biliary stents extending into the duodenum. Soft tissue attenuation in the porta hepatis/gallbladder fossa is similar to prior.SPLEEN: Splenomegaly, measuring 17 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple enlarged and borderline enlarged retroperitoneal lymph nodes with retroperitoneal stranding are not significantly changed. Left para-aortic lymph node (series 3 image 128) measures 1.3 x 1.7 cm, unchanged. Partially calcified portacaval lymph node (series 3 image 26) measures 3 x 1.6 centimeters, unchanged.BOWEL, MESENTERY: Multiple borderline enlarged mesenteric lymph nodes.There may be a focal circumferential wall thickening of the cecum (series 3 image 153), raising the possibility of a primary mass as this would be atypical for metastases.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small free fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Stable soft tissue attenuation in the porta hepatis/gallbladder fossa with periportal and retroperitoneal lymphadenopathy, consistent with known cholangiocarcinoma.2. Apparent focal circumferential wall thickening of the cecum, may represent primary neoplasm as this is atypical for metastases. Recommend correlating with colonoscopy.


Instruction: Generate impression based on medical findings.

Input: Reason: sp thoractomy History: none Right chest tubes in place with minimal residual pneumothorax.Bilateral pulmonary opacity compatible with atelectasis and effusion, greater on the right.Moderate subcutaneous emphysema.

Output: Post operative findings with minimal right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Palpitations, evaluate for acute abnormality. Normal cardiomediastinal silhouette. The lungs are clear. No focal air space opacity, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: Cough for one week. Cardiomediastinal silhouette is normal.No focal opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: trached History: trached Support devices unchanged.Improved aeration of the lung bases with residual opacities are nonspecific. Small pleural effusions. Mild cardiomegaly. No pneumothorax.

Output: Improved aeration of the lung bases.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: dz? History: pre-op Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: S/P Left thoracotomy History: NA Postoperative change on the left with a chest tube directed towards the apex. No evidence of significant pneumothorax. Left lower lobe atelectasis versus aspiration. Lungs hypoinflated.

Output: No evidence of significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: please assess vol status History: DOE Cardiomegaly with vascular redistribution.Opacity in the posterior costophrenic angles suggestive of small pleural effusions.Pleural thickening in the upper right hemithorax may also be due to loculated effusion or pleural thickening.

Output: Cardiomegaly with probable small pleural effusions but no specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: position of swan ganz catheter History: position of swan ganz catheter Swan-Ganz catheter tip in the right main pulmonary artery.ICD leads unchanged.Cardiomegaly with pleural effusions, greater on the right with underlying atelectasis.No new findings.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Bilious emesis Inferiormost pelvis excluded. Right upper quadrant surgical clips and midline skin staples. Additional postsurgical changes seen in mid and left abdomen, including anastomotic material in expected area of mid descending colon. Overall paucity of bowel gas particularly in small bowel. Nonobstructive bowel gas pattern.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Neutropenic with fever and cough. Cardiothoracic ratio appears enlarged, though this could be the result of magnification from portable technique. There are at least small pleural fluid collections bilaterally. Hazy opacity in the lung bases with reticulonodular opacities in the lung parenchyma suspicious for infection.Severe edema-like interstitial abnormality seen previously has resolved.

Output: Resolution of edema-like interstitial abnormality. New reticulonodular and groundglass opacities are atypical for edema and suspicious for infection.


Instruction: Generate impression based on medical findings.

Input: Reason: lunge eval History: lung eval Cardiomegaly and diffuse airspace and interstitial opacity compatible with edema with moderate pleural effusions.Tracheostomy tube in place.No acute change.

Output: Pulmonary edema and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p MVR History: s/p MVR Partial clearing of dense right upper lobe airspace opacity.Cardiomegaly with moderate bilateral pleural effusions and basilar atelectasis, not significantly changed.

Output: Resolving right upper lobe airspace opacity compatible with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: Where is Cordis? History: Triple lumen fell out of Cordis 2. Left jugular catheters extending to the area of the left brachiocephalic vein at its junction with the SVC. The more distal of the catheters has its tip directed slightly cephalad, and this has been corrected on a subsequent radiograph.Severe cardiomegaly, pulmonary hypertension and moderate right pleural effusion, unchanged.

Output: Catheters extending to the left brachiocephalic vein and SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: rule out pneumothorax History: thoracentesis Small to moderate size left pneumothorax. New consolidation at the left lung base. Small left-sided pleural effusion. Unchanged right-sided pleural thickening and patchy right basilar opacity. Probable skinfold overlies the lower aspect of the right hemithorax. No acute bony abnormality.

Output: Small to moderate size left pneumothorax. New left basilar consolidation. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: COPD. History: COPD Cardiomediastinal silhouette is normal.Large lung volumes suggestive of COPD. No pleural effusion or pneumothorax. Focal reticular and nodular opacities in the right midlung and left lower lung.

Output: Focal reticular and nodular opacities in the right midlung and left lower lung likely corresponding to areas of bronchiolitis and possibly mucous plugging of uncertain chronicity. Follow-up is recommended if patient has acute symptoms.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: 68 yo male with history of lymphoma; pre-auto SCT evaluation History: evaluate Mild left base scarring or subsegmental atelectasis, otherwise unremarkable.No specific evidence of infection.Unremarkable mediastinal contours and cardiac silhouette.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: evaluate ETT position after pulling back History: ETT position Endotracheal tube tip now 3.5 cm superior to the carina. Enteric tube again overlying the mid gastric body. Ventriculoperitoneal shunt tubing again courses over the right hemithorax.Cardiac silhouette is normal in size.Lungs are clear. No pneumothorax.

Output: Endotracheal tube tip now 3.5 cm superior to the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p central line removal, tachypnea History: tachypnea Support devices are unchanged in position.Small layering pleural effusions are unchanged. Stable mid to lower zone opacities of atelectasis. Heart size remains stable.

Output: Stable size of small layering pleural effusions, right greater than left. Mild basilar edema.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with new left lower lobe mass immediately for cancer and metastatic focus. CHEST:LUNGS AND PLEURA: Patient's known soft tissue mass in the left lower lobe, centered on the left hilum with extension into the adjacent lung parenchyma and subcarinal spaces unchanged. Large left-sided pleural effusion is unchanged. Small right-sided pleural effusion, unchanged.Left lower lobe atelectasis.MEDIASTINUM AND HILA: Infiltrative mass invading the mediastinum is unchanged. Multiple mediastinal adenopathy is unchanged. Left main pulmonary artery and its major branches are invaded by the mass.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal likely metastatic adenopathy. The index node measures 4.5 x 1.7 cm on image number 126, series number 3.BOWEL, MESENTERY: Small amount of ascites in the abdomen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Large left hilar mass invading the mediastinum and left lung and left hilum. Mediastinal and retroperitoneal metastatic adenopathy. Large left, small right-sided pleural effusion small amount of ascites.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: evaluate for pulmonary edema History: short of breath, peripheral edema and chest pain Focal retrocardiac opacity which may be the right lower lobe. No evidence of overt left-sided heart failure. Mild cardiomegaly. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: Focal retrocardiac opacity, possibly in the right lower lobe, which may represent a small focus of nodular atelectasis or superimposition of shadows. Early pneumonia or aspiration could also have this appearance. Repeat PA and lateral chest radiograph in 8 weeks is suggested for reassessment of this area.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: lung eval History: lung eval IABP marker overlies the proximal descending aorta. The endotracheal tube is about 4 cm above the carina. Swan-Ganz catheter is in the main pulmonary artery or proximal right main pulmonary artery. LVAD and ICD unchanged. Mediastinal and chest tubes unchanged. Sternotomy hardware intact.No pneumothorax. Interstitial basilar predominant opacities are not significantly changed.Right pleural effusion with unchanged basilar atelectasis.

Output: Unchanged basilar opacities, suggestive of edema and atelectasis. Support devices are unchanged described above.


Instruction: Generate impression based on medical findings.

Input: PICC line check Left PICC line has been repositioned, the distal tip has been positioned at the confluence of the innominate and SVC without redundancy. Underlying cardiopulmonary appearance otherwise unchanged

Output: Left PICC line repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old, and with shortness of breath, decreased blood pressure and O2 saturation. PULMONARY ARTERIES: Technically adequate exam. No evidence of pulmonary embolus.LUNGS AND PLEURA: Multifocal regions of ground glass opacity and patchy consolidation, particularly in the left lung, are nonspecific but may reflect aspiration, infection or hemorrhage. No pleural effusion.MEDIASTINUM AND HILA: The cardiac size is normal. No pericardial effusion. Mildly prominent mediastinal and hilar lymphoid tissue is nonspecific.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.No PE.2.Nonspecific pulmonary opacities may reflect aspiration, infection or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: ETT adjustment History: Advanced 1 cm Basilar interstitial opacities and bronchial wall thickening suggestive of aspiration, unchanged since yesterday's radiograph but new compared to 10/25/2011 CT.Heart size normal, the aorta tortuous.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: Basilar opacities with bronchial wall thickening suggestive of aspiration. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Chest tube removal. Right jugular catheter remains low in position projecting over the lower right atrium or suprahepatic IVC region. Interval placement of a Dobbhoff tube which extends to the right of midline in the upper abdomen projecting over the distal stomach. Sternotomy hardware similar in alignment.No pneumothorax. Drains projecting over the mediastinum have been removed.No significant change in pleural fluid volume, large on the left left and small to moderate on the right.Patchy airspace opacities in the right lung may reflect aspiration/infection or less likely acute alveolar edema. Cardiomediastinal silhouette about the same level with contour abnormality in the AP window region and mild postoperative mediastinal widening.

Output: No visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: worsening balance and falls; eval for source of infection History: see above Small lung volumes.Mild cardiomegaly.No specific evidence of infection or edema.

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


Instruction: Generate impression based on medical findings.

Input: Reason: assess for infection History: as above Tracheal deviation at the thoracic inlet consistent with a goiter, unchanged.Small lung volumes with no gross abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Median sternotomy for mitral valvuloplasty.No specific evidence of infection or edema.Right upper extremity vascular stent.

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


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Evaluate for IABP Severe cardiomegaly with medium right pleural effusion and right basilar interstitial opacities are stable. IABP marker approximately 1 cm below the top of the aortic arch. No pneumothorax. Other devices are stable.

Output: Stable right pleural and basilar interstitial opacities with cardiomegaly. IABP marker proximally 1 cm below the top of the aortic arch. Other devices stable. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: r/o metastasis History: history of osteosarcoma No evidence of metastatic disease. Postop change right humerus

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: O2 requirement ET tube tip approximately 3 cm above the carina.Small lung volumes with nonspecific perihilar and basilar opacities compatible with aspirated secretions, consolidation and atelectasis.

Output: Slightly increased perihilar opacity suggestive of aspirated secretions and possibly infection.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with metastatic RCC CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Expansile lesion involving the left second rib, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the inferior aspect of the liver is unchanged. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 14 x 12 mm left adrenal nodule, not significantly changed.KIDNEYS, URETERS: Status post right nephrectomy without evidence of recurrence in the postsurgical bed.Scattered focal scarring affects the left kidney, unchanged. Circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Reference 10 x 8 mm para-aortic lymph node (series 4; image 100), unchanged. A slightly larger enhancing lymph node posterior to the IVC is stable.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: Extensive sigmoid diverticulosis.BONES, SOFT TISSUES: A 2.2 x 2.1 cm soft tissue lesion now invades the right aspect of the L1 vertebral body.OTHER: Moderately severe infrarenal atherosclerotic disease

Output: New metastatic osseous lesion affecting the L1 vertebral body. Other findings are stable.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: 63 y/o f with sarcoid and influenza like sx/LLL consolidation, eval for infiltrate. History: cough, shortness of breath Stable cardiomediastinal silhouette. Mild chronic appearing interstitial opacities unchanged.No new focal areas of consolidation.No pleural effusions.

Output: Mild chronic interstitial abnormality without significant interval change. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old, status post left upper lobe lobectomy for T1 N2 M0 non-small cell lung cancer. Evaluate for interval change. CHEST:LUNGS AND PLEURA: Postoperative and post therapy change on the left including volume loss and paramediastinal fibrosis compatible with history of left upper lobectomy and radiation, unchanged.Left subpulmonic pleural effusion is unchanged. No pleural fluid on the right.Groundglass micronodule in the right minor fissure is unchanged as are other scattered pulmonary micronodules, some of which demonstrate calcification.MEDIASTINUM AND HILA: Normal cardiac size without pericardial effusion. Coronary artery and aortic calcifications are noted.No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Fracture of the left second rib is likely postoperative.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: Spinal degenerative disease is similar to the prior exam.

Output: Stable postoperative change with no evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: PICC placement History: s/p placement of PICCVIEW: Chest AP (one view) obtained on 6/2/2016 at 15:45. Cardiothymic silhouette is at the upper limits of normal. No focal opacities, pleural effusion or pneumothorax is present. Left-sided PICC terminates in the superior vena cava.

Output: PICC terminates in the superior vena cava.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA History: elevated WBC, recent PTX, upper abd pain Normal heart size and mediastinum.Small left pleural effusion, slightly decreased from earlier radiographs.Multiple healed rib fractures bilaterally.No sign of pneumonia.

Output: Small residual left pleural effusion and no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ET tube position History: ET tube position Unchanged radiation fibrosis, small lung volumes and interstitial opacities.Small left pleural effusion now be present.Heart size normal.ET tube tip approximately 5 cm above the carina.Right jugular catheter tip in SVC.

Output: Unchanged pulmonary opacities. ET tube tip approximately 5 cm above the carina.. Possible new small left pleural effusion


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: r/o infection History: neutropenia, febrile The cardiac silhouette is markedly enlarged but stable.No new focal pulmonary opacity or large pleural effusion.

Output: Stable cardiomegaly without evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: pneumonia, edema, effusion History: copd, esrd, missed last session of dialyisis, sob Stable cardiac enlargement with widening of the mediastinum compatible with mediastinal fat deposition identified on prior CT.The lungs are clear.No pleural effusions.

Output: Stable cardiac enlargement without acute abnormalities. Specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: MaleReason for Study: Reason: r/o acute process History: sob Cardiac size is normal.Mediastinal and left hilar lymphadenopathy unchanged.The lungs are clear.No pleural effusions.

Output: Redemonstration of extensive mediastinal and hilar lymphadenopathy without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: MaleReason for Study: Reason: 80 M w/ valvular abscess, hypoxia History: see above Right-sided pacemaker unchanged.Cardiac enlargement with pulmonary vascular redistribution.Bilateral pleural effusions right greater than left and underlying atelectasis.Perihilar opacities compatible with edema.Median sternotomy is intact.

Output: Cardiomegaly with pleural effusions, basilar atelectasis, and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: 28yo F w/ chest pain, eval for cardiac or pulm cause History: as above No pleural effusion or pneumothorax. No focal airspace opacities. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.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, 66 years old.Reason: Fevers, evaluate for infection and interval changes History: Fevers Severe emphysema with left lung volume loss from pleural in parenchymal scarring.Basilar septal lines are suggestive of edema or fibrosis on the are no significant sized pleural effusions and the heart size is normal arguing against edema.No specific evidence of pneumonia.

Output: Severe emphysema with fibrosis and left hemithorax post inflammatory volume loss.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pulmonary edema History: PND, orthopnea, SOB, hx of CHF Moderate cardiomegaly.Diffuse bilateral nonspecific interstitial opacity with thickening of the pleural fissures but no substantial pleural effusions.

Output: Cardiomegaly with diffuse interstitial opacity which may be due to edema or a more chronic interstitial process. If this does not resolve a CT scan may be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: cough and fever with myalgias, assess for PNA History: cough 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: Female, 84 years old.Fever question infiltrates. New right basal opacity with blunting of the lateral costophrenic angle. Cardiomediastinal silhouette unchanged allowing for differences in projection.Retrocardiac opacity on the left favored to represent atelectasis but nonspecific.

Output: New right basal opacity suspicious for pneumonia. Suggest follow-up PA and lateral chest radiographs in 6 weeks.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.SOB. Motion artifact limits image quality.Low lung volumes, about the same. Basal atelectasis and bronchial wall thickening on the right slightly increased.

Output: Limited evaluation, please refer to subsequent CT of the thorax. There appears to be mild bronchial wall thickening and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: 73M hx prostate cancer s/p RALP. Persistent O2 requirement and desaturation despite 2L NC. History: SOB Small lung volumes with streaky lower zone opacities compatible with subsegmental atelectasis.No specific evidence of pneumonia or CHF.

Output: Small lung volumes with a similar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: CHF, SWAN, Impella History: chf, swan, impella Impella device and Swan-Ganz catheter, unchanged from previous. Marked cardiomegaly but no sign of pulmonary edema or visible effusions.Surgical drain projected over the area of the right axilla.

Output: Impella device and Swan-Ganz catheter in appropriate position.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: Evaluate for PTX History: s/p thora Prominent right basilar skinfold but no pneumothorax.Unchanged lower lung zone opacities and pleural effusions.Left jugular catheter, tip in brachiocephalic vein at the midline.

Output: No significant pneumothorax. Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Altered mental status Mixed interstitial and air space opacities suggestive of edema and possible superimposed infection increasing in the right upper lobe and right lung over left side. Changes remain superimposed on the underlying fibrotic changes previously described.ETT remains 4 cm above the carina. Right jugular PICC line unchanged.

Output: Increasing right upper lobe changes again concerning for a new infectious process.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate stent post bronch and stent placement History: respiratory distress Dense atelectasis in the right upper lobe, unchanged from previous.Adjacent hyperlucency probably representing compensatory hyperinflation hyperinflation of aerated lung. No significant interval change.

Output: Dense right upper lobe atelectasis with adjacent hyper aeration but no reliable evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: hypoxia History: hypoxia Right chest tube removed leaving a right pleural drain with a small amount of pleural fluid no pneumothorax.Right lung emphysema with endobronchial bowel is unchanged.Left lung shows prior wedge resections otherwise unremarkable.Left PICC, tip in left brachiocephalic vein.

Output: Chest tube removal with no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Patient with tracheostomy Tracheostomy tube tip below the thoracic inlet and above the carina. No pleural effusions or pneumothorax. Retrocardiac and right perihilar streaky opacity, likely atelectasis. Cardiothymic silhouette is normal.

Output: Retrocardiac and right perihilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Loss of appetite, dysphagia, rule out pneumonia. Normal heart size. Tortuous thoracic aorta. No pleural fluid or pneumothorax. Contour abnormalities in the region of the aortopulmonary window, unable to exclude lymphadenopathy. The left main bronchus appears slightly deviated. Cholecystectomy clips. No signs of pneumonia. Retrotracheal opacity could represent an aberrant vessel such as an aberrant right subclavian artery, poorly assessed by plain film, an intraesophageal lesion is unlikely to be visible by plain film.

Output: Mediastinal contour abnormalities and possible slight deviation of left main/left lower lobe airways. Recommend correlation with enhanced thoracic CT to exclude lymphadenopathy or other abnormality in this area.Dr. Helland was contacted via e-mail regarding this recommendation.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: effusion History: no Interval removal of nasogastric tube. Right apically directed chest tube and right port catheter unchanged in position.There is a skin fold at the thoracic inlet; no significant pneumothorax is identified. Stable mediastinal widening with rightward deviation of the trachea, attributed to patient position when correlated to the recent cross-sectional imaging. Stable bilateral pulmonary opacities with mildly displaced, postoperative right inferolateral rib fracture.

Output: No significant change following nasogastric tube removal.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with pancreatic islet cell cancer with metastases to liver. Please evaluate for interval change. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Coronary calcifications.CHEST WALL: Healing right ninth rib fracture, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic lesions are again identified, not significantly changed in size. No new lesions are seen. A reference lesion at the dome measures 3.1 x 2 .9 cm, previously 3.3 x 2.4 cm. Adjacent postsurgical changes are again identified.Cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Stable pancreatic atrophy and ductal dilatation. Pancreaticojejunostomy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left hilar cysts remainRETROPERITONEUM, LYMPH NODES: 15 x 10 mm lymph node in the mesentery which time its arterial enhancement, not significant changed (series 10; image 70), previously 16 x 11 mm.BOWEL, MESENTERY: Partial colectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrate History: cough 10 x 15 mm noncalcified nodule in the left upper lobe, confirmed on the lateral view with a slightly elongated configuration.Unremarkable cardiac and mediastinal silhouette. No pleural effusions or other significant findings.

Output: Small left upper lobe nodule, which in this age group is likely due to current or previous infection. A follow-up chest radiograph is recommended to confirm stability or resolution.


Instruction: Generate impression based on medical findings.

Input: Chest wall trauma, following fall Old healed rib deformities involving the right fourth and fifth and sixth ribs. No superimposed acute abnormalities. Bullet fragment projects over left shoulder. Underlying cardiopulmonary appearance is also otherwise within limits and normal

Output: Old rib deformities and and old bullet


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: cough History: Myasthenia gravis The cardiac and mediastinal contours are within normal limits and stable from prior studies.Lung volumes are normal. No abnormal focal lung parenchymal opacities.The right IJ port venous catheter terminates in the superior every 8-12 junction.No pleural effusion or pneumothorax.

Output: No abnormal findings to explain patient's symptoms; specifically, no radiographic evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: 63M s/p lap chole now with persistent fever History: Persistent fever Slightly small lung volumes with nonspecific interstitial opacities and a small right pleural effusion suggestive of edema or hypervolemia.Aspiration is a consideration but there is no reliable evidence of pneumonia. Cholecystectomy clips.

Output: Interstitial opacities suggestive of edema, although aspiration is a consideration.


Instruction: Generate impression based on medical findings.

Input: 77 years old Male. Reason: SOB History: SOB. There is no significant change as compared with prior study. Right pleural effusion with underlying atelectasis and nonspecific consolidations. Small left pleural effusion.

Output: Bilateral pleural effusions, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: eval lungs History: cough, wheezing, sob Moderate cardiomegaly.Retrocardiac opacity could represent or a dilated left ventricle atelectasis, best seen on the lateral view.No reliable evidence of edema.

Output: Moderate cardiomegaly, with retrocardiac opacity suggestive of atelectasis, less likely infection.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: FemaleReason for Study: Reason: pna? AMS? History: delirium The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: cough since january, rhonchi, r/o pneumonia History: as above Mild cardiomegaly with evidence of previous median sternotomy. Intact sternal fixation devices. No sign of pneumonia or other acute pulmonary findings. Gastric band in the area of the GE junction, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history of metastatic pancreas cancer CHEST:LUNGS AND PLEURA: 5-mm intrapulmonary lymph node image number 58, series number 13. No parenchymal lung nodules.MEDIASTINUM AND HILA: Approximately 30 to 40 percent stenosis at the origin of the left subclavian artery.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Previously described index lesion in the left lobe liver is unchanged measuring 11 x 15 mm on image number 27, series number 11. No other liver lesions.SPLEEN: No significant abnormality notedPANCREAS: Patient's known locally invasive pancreatic mass measures 3.4 by 2.8 cm on image number 117, series number 14, increased in size compared to previous study. Again splenic vein is thrombosed.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Complex lesion in the midportion of the left kidney measures 15 x 13 mm image number 132, series number 14, not significantly changed from previous study. Possibility of a solid neoplasm cannot be excluded.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previous described index peritoneal nodules are are not well seen on today's study. Subcentimeter nodules in the peritoneum persistsBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.

Output: Slight interval increase in the size of the pancreatic massLiver lesion is stable.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: rule out pneumonia History: desaturation Increased right basilar atelectasis, and subsegmental atelectasis left lower lung zone, with pleural effusions.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: Increased basilar atelectasis possibly from aspirated secretions or mucous plugging given intubation.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: possible underlying CHF; h/o possible hemoptysis; recent ablation - evaluate for pericardial effusion History: shortness of breath Heart is upper limit of normal in size without visible pericardial effusion, though radiograph is insensitive. Calcified right hilar lymph nodes.No focal opacities or pleural effusions.Bilateral lower lobe streaky opacities, compatible with subsegmental atelectasis.No evidence of pulmonary edema.

Output: No visible signs of pericardial effusion; bibasilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 36 year old female with MALT lymphoma of the breast. Restaging. CHEST:LUNGS AND PLEURA: Few punctate micronodules remain in the lungs, some which are calcified. Azygos pseudolobeMEDIASTINUM AND HILA: Bilateral supraclavicular nodes are again identified, not pathologically enlarged by CT criteria.CHEST WALL: Small bilateral axillary lymph nodes are identified. The dominant right axillary lymph node has decreased in size, measuring 16 x 8 mm (series 4; image 24).The previously seen right breast fluid collection has resolved.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver with scattered areas of sparing.Cholecystectomy. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal surgical clip.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: Decrease in size of the dominant right axillary lymph node.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: NGT position History: interval NGT placement NG tube tip in stomach. Other findings stable.

Output: NG tube tip in stomach.


Instruction: Generate impression based on medical findings.

Input: Nine day old former 25 to 26 week gestational age patient with pneumothorax. Chest tubes in place.VIEW: Chest AP (one view) 04/09/15, 1549 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is distal to proximal body of stomach and not included on image. Two right chest tubes are present. Umbilical venous line tip is in right atrium. Umbilical arterial line tip is at T7/8.Right pneumothorax is located predominantly subpulmonicly and anteromedially. Coarse bilateral lung opacities continue. Pulmonary interstitial emphysema persists. Cardiac silhouette size is normal.Soft tissue edema is unchanged.

Output: Decrease in size of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz placement Swan-Ganz has been repositioned, tip now projects into the left pulmonary flow tract. New interval placement of an Impella device. Right PICC line otherwise unchanged, extending into the mid SVCPersistent decreased lung volumes with mild cardiomegaly, grossly unchanged.

Output: Impella device placement and Swan-Ganz repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old. SOB/cough. Left basilar subsegmental atelectasis and/or scarring. No evidence of infection or edema.Stable cardiomediastinal silhouette.

Output: Left basilar atelectasis and/or scarring. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: evaluate lung fields and swan placement History: as above Stable line position.Patient extubated.No pneumothorax.Decreasing right effusion.

Output: Interval extubation. No other significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: MaleReason for Study: Reason: eval ett History: eval ett ET tube with its tip 5 cm above the carina.NG tube with its tip in the marginally imaged.Decreased lung volumes and mild cardiac enlargement.No focal airspace opacities.No pleural effusions.

Output: ET tube with its tip 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: intubated History: intubated Endotracheal tube tip approximately 4 cm above carina. Right IJ central venous catheter with tip overlying the proximal SVC. Right IJ dialysis catheter with tip overlying the cavoatrial junction. Right-sided single lead pacemaker again projects over the right ventricle.Stable enlarged cardiac silhouette. Calcified aortic knob.Mild perihilar edema. Mild bibasilar atelectasis with interval improvement of left retrocardiac opacity. No pneumothorax.

Output: 1.Endotracheal tube tip 4 cm above the carina.2.Interval improvement in left retrocardiac opacity likely atelectatic in nature.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Preop nonrheumatic mitral valve insufficiency. Mild to moderate cardiomegaly with prominence of the central pulmonary vasculature. Left subclavian dual-chamber pacemaker with leads terminating in the right atrial appendage and the region of the apex of the right ventricle.Mild pulmonary edema at the lung bases and tiny pleural effusions. No focal airspace opacities

Output: Mild pulmonary edema/CHF. Cardiomegaly and possible signs of pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with chest pain radiating to left upper back for one day. Cardiomediastinal silhouette is within normal limits.Large lung volumes. No pleural effusion.No pneumothorax or obvious rib fractures.

Output: Large lung volumes compatible with COPD. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: History of lymphoma submandibular area. Now mass in pharynx. Biopsy pending. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Subcentimeter right thyroid nodule, unchanged.CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter lesion the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: r/o mets History: none Aortic arch dilation again noted, not substantially different compared to last study. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Patient again status post sternotomy.

Output: Aortic aneurysm, unchanged. No convincing evidence of metastatic disease on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: eval for evidence of pneumonia History: fever, weakness Low lung volumes with bilateral basilar opacities compatible with atelectasis. Mid and upper lung zones are clear.Normal cardiomediastinal silhouette.No pneumothorax. No pleural effusion.

Output: Bilateral lower lobe subsegmental atelectasis


Instruction: Generate impression based on medical findings.

Input: 69 old female with history of Neosar carcinoma status post left nephrectomy This study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Punctate right lower lobe nodule is unchanged. No new nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Nonenlarged axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: Mild cardiomegaly is unchanged.*SPLEEN: Splenectomy.PANCREAS: Previously seen metastatic lesion in the tail of the pancreas has been resected. Now there is a heterogeneous mass containing fat density with a rim adjacent to the staples. Lack of IV contrast limits optimal evaluation. This lesion may represent postsurgical changes and fat necrosis. Further imaging is recommended.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval resection of the pancreatic tail metastases. Heterogeneous mass near the surgical bed may represent postsurgical changes, and fat necrosis, however, follow-up imaging is recommended to exclude recurrence.