Instruction: Generate impression based on medical findings.

Input: Elevated left hemidiaphragm. Possible diaphragmatic paralysis.EXAMINATION: Diaphragm fluoroscopy 08/25/16 No focal opacity is seen on the scout radiograph of the chest. The cardiac silhouette size is normal. The left hemidiaphragm is slightly higher than the right. There is a right thoracic curve. Vagal nerve stimulator device and lead are in place. A surgical clip is present in the left upper quadrant.The hemidiaphragms move normally with quiet respiration.

Output: No evidence of diaphragm paralysis.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: s/p Swan Ganz placement History: heart failure Swan-Ganz catheter terminates within the proximal interlobar pulmonary artery. Enteric tube extends inferiorly off the field-of-view. Perihilar opacity, improved from previous study. Increase in dense left lower lobe opacity. Small pleural effusions again noted. No pneumothorax. Unchanged cardiomegaly.

Output: Improvement in pulmonary edema. Small pleural effusions again noted.Worsening dense left lower lobe opacity consistent with atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Stroke Enteric tube tip in the stomach with sidehole near the GE junction. Cardiomediastinal silhouette is unremarkable. Low lung volumes. No large pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No specific findings of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: consolidation, edema History: SOB Small lung volumes with chronic interstitial opacity compatible with scarring.No specific evidence of pulmonary edema or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Cardiomyopathy Enteric catheter removed. Right jugular vascular catheter and ICD unchanged.Lungs remain clear. Cardiac and mediastinal contours are within limits

Output: Enteric catheter removed


Instruction: Generate impression based on medical findings.

Input: Reason: s/p PICC line placement History: NA PICC line tip at the junction of the left subclavian and axillary veins.Cardiomegaly with basilar opacity compatible with edema, atelectasis and moderate pleural effusions.

Output: 1. New PICC line with no complications.2.CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Pneumothorax. Left chest tube is again noted to be directed medially at the level of the hilum. No significant pneumothorax. Left PICC tip appears to be deflected toward the RV. Increase in opacity at the left lower lung with probable small pleural effusion.

Output: Interval worsening of airspace disease at left base. Retraction of left PICC advised.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: evaluate for infiltrate History: cough Moderate to severe cardiomegaly with a left atrial enlargement pattern. Minimal pleural effusions, but no sign of edema.No specific evidence of infection.Right subclavian single lead ICD, tip and RV apex, unchanged.

Output: Moderate to severe cardiomegaly, with small pleural effusions. No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Intubation. Medium right pleural effusion with right greater than left pulmonary opacities have progressed from prior and may reflect progression of CHF or possibly infection. ET tube tip is suboptimally visualized but likely approximately 5 cm above the carina. Right jugular catheter tip over the SVC. No pneumothorax. NG tube tip in the distal stomach.

Output: Progression of right greater than left pleural and pulmonary opacities with cardiomegaly suggesting progression of CHF or possibly infection. ET tube approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: new cough, h/o History: new cough, generalized weakness, history of COPD/CHF Interval increase in basilar interstitial opacities, right greater than left which can represent aspiration, atelectasis and/or infection.No pneumothorax. No pleural effusion.Heart size normal.

Output: Interval progression of basilar interstitial opacities which can represent atelectasis, aspiration and/or infection.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of asbestosis exposure. Chest pain. Evaluate for mesothelioma. Evaluation of the solid organs and for that adenopathy is not sensitive without the administration of contrast.LUNGS AND PLEURA: Multiple bilateral pleural plaques several of which are calcified are unchanged since prior study. Previously measured left mediastinal pleural thickening measures 6 mm (sees image 54, series 3) and is unchanged. No pulmonary nodules or new areas of pleural thickening or plaques.MEDIASTINUM AND HILA: No significant adenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Unchanged pleural plaques consistent with previous asbestos exposure. Pericardial soft tissue opacity stable from the most recent previous exam favoring plaque over mesothelioma. Continued monitoring is recommended.


Instruction: Generate impression based on medical findings.

Input: 49 year old male with IABP IABP marker unchanged in the proximal descending thoracic aorta. Left sided AICD with lead unchanged. Right PICC tip in right axillary vein.No focal airspace opacities. No pleural effusion or pneumothorax. Cardiomegaly unchanged.

Output: IABP marker unchanged in location.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA History: fever, hypotension Severe cardiomegaly with vascular redistribution and distention of mediastinal veins.Underinflated lungs with no significant evidence of pulmonary edema or infection.

Output: Severe cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male 28 years old Reason: PICC line placement History: PICC Redemonstration of median sternotomy with chest tubes and no significant pneumothorax.No focal opacity or significant pleural effusion is identified.Left jugular Swan-Ganz catheter tip is in the right main pulmonary artery.Right jugular introducer again noted.No right upper extremity PICC is visualized.

Output: No acute cardiopulmonary abnormality. No significant interval change. No right upper extremity PICC is visualized.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old. Swan-Ganz catheter tip in the right main pulmonary artery.Aortic balloon catheter and port catheter unchanged.Extensive upper zone scarring with calcified lymph nodes in the mediastinum compatible with previous granulomatous infection.

Output: Catheters in appropriate position with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male 15 years old Reason: s/p L vats and rule wedge resection VIEW: Chest AP (one view) 4/24/15 at 540 hours. Right-sided chest tube and left lung surgical sutures again noted and unchanged. Cardiac silhouette size is normal. Persistent left-sided hydropneumothorax. Normal right lung.

Output: Persistent left-sided hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: 59 years old Female. Reason: fever. History: fever. The study is slightly limited due to motion artifact. Within the limitations that appears increased lung markings in the right lower lung. Cardiac silhouette is normal.

Output: Increase normal kidney in the right lower lung. If clinically indicated, PA and lateral chest x-ray can be obtained for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Swan placement History: as above Swan-Ganz catheter has been pulled back slightly terminating in the pulmonary artery. No new focal lung opacity. Small amount of right-sided subcutaneous emphysema again noted. Unchanged cardiomegaly. No pneumothorax. No large pleural effusion.

Output: Swan-Ganz catheter has been pulled back slightly.


Instruction: Generate impression based on medical findings.

Input: Reason: interval eval for intubation/ARDS History: as above ET tube tip approximately 5 cm above the carina.Catheter tip in the SVC.Swan-Ganz catheter tip in the right main pulmonary artery.Cardiomegaly and pulmonary opacity compatible with edema, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of renal cell cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Innumerable hepatic lesions are again identified consistent with metastatic disease. Reference lesion in segment 4 measures 12 x 11 mm image number 74, series number 4. This is unchanged. Diffuse fatty infiltration and postsurgical changes are also unchanged. Liver is enlarged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst is unchanged. Status post right nephrectomy. No evidence of recurrence in the right nephrectomy bed.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: 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: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old Reason: perforation? prior to EGD tomorrow. 49F esophageal ca; mets to brain/lungs; R pleural effusion; R pleural empyema; esophageal stent obstruction History: requested prior to EGD tomorrow. Limited scout radiograph of the chest showed a right-sided chest tube unchanged in position with bilateral patchy airspace opacities, right greater than left. Right CVC tip overlies the right atrium. Distal esophageal stent partially visualized. Limited study due to poor patient positioning. Inial test bolus was administered and patient began to cough and stated contrast "went down wrong pipe". The study was terminated given aspiration risk. A couple of spot images were obtained and demonstrated no frank extravasation of contrast.TOTAL FLUOROSCOPY TIME: 1:05 minutes.

Output: Limited study terminated early due to aspiration risk. No frank extravasation of contrast to suggest a perforation on initial test bolus.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: PICC line placement History: as above Cardiomegaly, status post sternotomy.Gradually improving pulmonary opacities suggestive of edema or ARDS.A Dobbhoff tube extends below the lower margin of the image.LVAD and ICD unchanged.Left jugular catheter, tip in left brachiocephalic to the left of midline.Right PICC, tip in axillary region.

Output: Improving pulmonary opacities. Right PICC, tip in axillary region.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval for pneumo, compare to previous History: eval for pneumo, compare to previous Resolution of prior pneumothorax.Known right upper lobe adenocarcinoma.Elsewhere, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Resolution of prior pneumothorax with no new findings. Stable lung cancer.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: Rule out worsening of pleural effusion History: SOB Moderate to large right and partially loculated left pleural effusions are not significantly changed compared to prior exam. Heart size is at the upper limit of normal. Diffuse interstitial opacities with underlying left lower lobe atelectasis are unchanged. Pleurx catheter extends over the left apex.

Output: No significant change in bilateral pleural effusions and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of sarcoidosis. Left AICD/pacemaker unchanged. Postsurgical changes from median sternotomy. Stable cardiomegaly. Bilateral right greater left pleural effusions and basilar-predominant interstitial opacities are present. New right midlung opacity may represent consolidation. No pneumothorax.

Output: New right midlung opacity may represent infection or aspiration. Cardiomegaly, basilar-predominant interstitial opacities and bilateral pleural effusions appear similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: 37 y/o with CHF with swan eval placement History: sob Right IJ Swan-Ganz catheter with tip again overlying the right pulmonary artery at the level of the hilum. LifeVest again in place and partially obscuring pulmonary assessment.Enlarged cardiac silhouette is unchanged. Minimal right infrahilar atelectasis. No pneumothorax.

Output: Cardiomegaly with mild right infrahilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with progressive lung cancer, status post aggressive hydration, evaluate for pulmonary edema. Moderate right and small left pleural effusions unchanged from the prior.Right upper lobe opacity and volume loss similar to prior, consistent with the patient's known primary lung cancer.Rib metastases similar to prior. The cardiomediastinal silhouette is unchanged.

Output: Right apical opacity consistent with the patient's primary lung cancer and rib metastases, similar to prior. No reliable evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Fever Scoliosis without underlying cardiopulmonary abnormality

Output: Mild scoliosis


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Assess ET tube placement. The ET tube is located 8 cm superiorly from the carina. No pneumothorax. Stable cardiomegaly. Persistent left lower lobe consolidation suspicious for pneumonia. Bilateral pleural fluid collections similar in volume, loculated the right. Right apical scarring.

Output: 1. ET tube is located 8 cm superiorly from the carina.2. Left lower lobe consolidation suspicious for pneumonia.3. Unchanged pleural fluid collections.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: 75M hx bladder cancer. Routine surveillance History: as above Low lung volumes. No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No visible pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: SOB History: above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Clinical concern for small bowel obstruction including pain and distention. No free air is visualized under the diaphragm on upright imaging. No acute cardiopulmonary abnormalities.Nonobstructive bowel gas pattern. Suture material projects over the right hemiabdomen from prior right hemicolectomy.

Output: Nonobstructive bowel gas pattern without pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: eval lung fields History: medical clearance Scarlike opacity left lower lobe periphery.No specific evidence of infection or edema.Heart size normal.

Output: Left basilar scarring, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Evaluate ileus Percutaneous gastrostomy tube. Worsening in degree of diffuse gaseous bowel dilatation.Calcified fibroid uterus. Right lower quadrant/groin postsurgical sequela related to prior hernia repair.Please see same day chest radiography for additional findings.

Output: Findings compatible with worsening ileus.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with history of tongue cancer status post neck surgery. Evaluate for lung metastases. CHEST:LUNGS AND PLEURA: Scattered, nonspecific micronodules bilaterally, with two nodules noted in the left lower lobe (series 6, images 43 and 64). The largest nodule is in the superior segment of the left lower lobe with irregular margins and measuring 6-mm. The smaller nodule more inferiorly is round and well-marginated. Both nodules are indeterminate and continued follow-up is recommended.A micronodule seen along the right major fissure is compatible with an intrapulmonary lymph node (series 6, image 53).Mild scarring in the lingula.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Left adrenal nodule (series 4, image 99) is indeterminate. However, given its morphology and the absence of known metastases, favor a benign etiology. However, continued follow-up is recommended.

Output: 1. Two indeterminate pulmonary nodules in the left lower lobe, for which continued follow-up is recommended.2. Left adrenal nodule. Favor benign etiology given its morphology and lack of known metastases; however continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 39 yearsGender: MaleReason for Study: Reason: Intubated pt with respiratory failure, eval interval change of pna History: intubated Evaluation is limited with patient motion and body habitus.ET tube with its tip probably 2 cm above the carina.NG tube poorly visualized.Left IJ venous catheter with its tip poorly visualized as well.There is now complete opacification left hemithorax compatible with acute atelectasis and pleural effusion.

Output: ET tube with its tip above the carina. New opacification left hemithorax compatible with atelectasis and probable accompanying pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Postop. Interval extubation. Unchanged positioning of the right chest tubes, with the side hole of the lateral and inferior chest tube outside of the bony thorax. Prosthetic mitral valve. Increased retrocardiac opacity, probably atelectasis. Unchanged small pleural effusion.

Output: 1.Interval extubation. 2.The sidehole if the lateral and inferior chest tube is external to the bony thorax, unchanged from prior. 3.Increased left retrocardiac opacity, probably atelectasis. 4.Remaining findings are unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pulmonary edema History: dyspnea on exertion x1 week Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: eval for pleural effusion/infiltrate History: chest pain, SOB No substantial change in mid and lower lung preponderance articular abnormality. No new focal lung consolidation. Mild cardiomegaly again noted. Mild esophageal dilation, unchanged. No pleural effusion or pneumothorax. No definite acute bony abnormality on radiography.

Output: No new focal lung consolidation, pneumothorax, or definite acute bony abnormality on radiography.Stable mid and lower lung reticulation consistent with interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old. History: Status post coronary bypass. Cardiomegaly and widening of the right paratracheal stripe, slightly improved from previous study.Unchanged basilar atelectasis.Small bilateral pleural effusions.Stable left peripheral midlung opacity.

Output: Nonspecific left peripheral midlung opacity, compatible with infarction, atelectasis or contusion.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: On Rapamune History: Cough Median sternotomy presumably for CABG.Heart size normal.No significant pulmonary or pleural abnormality.

Output: No specific evidence of infection or edema. Status post sternotomy.


Instruction: Generate impression based on medical findings.

Input: 73 old male with large cell lymphoma with shortness of breath and cough. Evaluate bronchial stent obstruction. LUNGS AND PLEURA: Peripheral reticular interstitial opacity, more predominant in the dependent portions of the lower lobes, has increased in the interval. No pleural effusions or suspicious new nodules.MEDIASTINUM AND HILA: Bronchial stent in the right main bronchus and bronchus intermedius has increased soft tissue density within the stent and now appears completely occluded. Ill-defined subcarinal and pretracheal soft tissue density is unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Soft tissue density occluding the right bronchial stent has slightly increased and is now completely occlusive.2. Progression of interstitial fibrosis. This may be due to aspiration or drug reaction.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: evaluation of incidentally noted mediastinal mass on VFA with DXA History: none Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of a mediastinal mass, although there are tortuous brachiocephalic vessels.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: s/p extubation, tracheal stent placement History: tracheal stent placement Large mediastinal mass unchanged.Status post extubation, and despite the clinical history no radiopaque tracheal stent is visible.Small right pleural effusion unchanged.A Dobbhoff tube extends below the lower margin of the image.

Output: Status post extubation. No radiopaque tracheal stent visible despite the clinical history.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: RIJ trialysis line adjustment History: As above Patchy interstitial and airspace opacities are unchanged suggestive of aspiration or infection.Two right jugular catheters terminate in the SVC.Presternal ICD unchanged.An NG tube terminates in the stomach.

Output: Unchanged patchy pulmonary opacities suggestive of aspiration and/or infection.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with increased shortness of breath. Evaluate for interstitial pulmonary fibrosis. Evaluate for infectious source. CHEST:LUNGS AND PLEURA: Peripheral, subpleural groundglass opacities with architectural distortion and bronchiectasis, all of which are predominantly in the lower lobes. Note is made of mild microcystic honeycombing, particularly in the lung bases as well.No significant airtrapping.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild enlargement of the main pulmonary, compatible with pulmonary hypertension.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: Findings compatible with pulmonary fibrosis; favor fibrosing NSIP pattern.


Instruction: Generate impression based on medical findings.

Input: Reason: 66yr old male with history of MM; pre-auto sct evaluation History: evaluate Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 30-year-old male with headaches, nausea, and blurred vision. Evaluate shunt. SHUNT DEVICE: A left transparietal approach shunt catheter with intracranial tip in the midline middle cranial fossa. The radiopaque, extracranial component of the catheter courses through the soft tissues of the left side of the neck and anterior chest wall. It enters the left upper quadrant with tip in the pelvis. No evidence of kinking or discontinuity.SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: Mild right thoracic spine curve. The lungs are unremarkable.ABDOMEN: Left lumbar spine curve. The ventriculoperitoneal shunt catheter tubing terminates in the pelvis with the tip in the right lower quadrant. There is an additional intrathecal catheter with tip at the T11/12 level exiting at L1/L2 level and entering the abdomen in the right lower quadrant with tip in the left upper quadrant.

Output: No evidence of shunt discontinuity or kinking.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Status post repair of paraesophageal hernia. No focal lung opacity, pleural effusion, or pneumothorax. The heart size is normal. Calcification within the right breast.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Mechanical ventilator. PE. Right subclavian catheter unchanged in position. Endotracheal tube tip 4.5 cm above the level of the carina. Enteric tube unchanged in position.Blunting of the left posterior costophrenic angle consistent with at least a small volume of subpulmonic fluid and adjacent atelectasis. Diffuse pulmonary opacities suspicious for bronchiolitis and atelectasis, likely the result of aspirated secretions. Shifting areas of subsegmental atelectasis on the right, mild.

Output: Signs of aspiration with bronchiolitis and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: fever, sob History: sob Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Known left upper lobe opacity, presumably biopsied.No pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: signs of volume overload? infection? hx of advanced heart failure. History: sob, wheezing, cough Cardiomegaly with ICD leads projected in the area the right atrial appendage and right ventricular apex.Vascular redistribution but no specific evidence of pulmonary edema or pleural effusions.

Output: Cardiomegaly and increased upper zone blood flow but no reliable evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Swan-Ganz placement. Left IJ Swan-Ganz catheter tip projects over the right main pulmonary artery. Additional catheters are coiled in the left upper chest. Cardiomegaly and moderate layering bilateral pleural effusions are not significantly changed. Diffuse interstitial and airspace opacities are not significantly changed.

Output: Swan-Ganz catheter tip projects over the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Indeterminate Quantiferon gold. Assess for TB. Narrow AP dimension of the thorax. Normal heart size. Mild apical scarring. Lung volumes appear high normal however this could be due to good inspiratory effort in a patient of this age.No acute focal pulmonary opacities.Narrowing of the central airways and heart in the AP dimension may be related to the patient's bodily habitus. The aortic knob is within normal limits but somewhat prominent for the patient's age.

Output: No radiographic signs of active intrathoracic tuberculosis. Narrowing of the airways and heart in the AP dimension related to patient's bodily habitus. If the patient has Marfan syndrome, then consider CT when feasible to assess anatomy.Case discussed with Dr. Dalal (1059) on 11/25/2015 on 2:21pm.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: eval ETT History: eval ETT ET tube tip 5 cm above carina. NG tube tip in stomach. Venous catheter unchanged.Persistent bilateral pleural effusions with nonspecific basilar opacities.

Output: ET tube tip 5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old. AMS concerning for sepsis of unclear source. Evaluate for cardiopulmonary process. Heart size is top normal to mildly enlarged.No evidence of infection or edema.Mild left basilar atelectasis.

Output: No evidence of infection. Mild left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Fatigue History: Fatigue Lobulated diaphragms may indicate COPD and I suspect there are bulla in the upper lung zones.No specific evidence of infection or edema.Heart size normal.

Output: Probable emphysema, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: S/P CABG History: S/P CABG Intraoperative balloon pump terminates approximately 7.9 cm from the top the aortic arch. Other lines and tubes, not substantially different.Diffuse pulmonary opacities, unchanged. Improvement in bibasilar opacities and pleural effusions. Unchanged heart size. No significant pneumothorax.

Output: Pulmonary edema again noted. Improvement in bibasilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Right IJ central venous catheter placement. Interval placement of a right-sided central venous catheter with the tip in the low right atrium. Endotracheal tube is approximately 6 cm above the carina. No pneumothorax. Basilar opacities and atelectasis suggested suggestive of sequelae of aspirated secretions.

Output: Low positioning of the right internal jugular central venous catheter. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 50 years old Male. Reason: ETT eval History: Pt intubated in MICU. Airspace and interstitial opacities predominantly in the lower lungs and perihilar regions unchanged as compared with prior study. The support devices are stable in position. There is no evidence of pneumothorax.

Output: Airspace and interstitial opacities in both lungs, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o PNA History: cough Left subclavian AICD unchanged. Mitral valve prosthesis, sternotomy fixation, and multiple mediastinal surgical clips are noted.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Mild to moderate cardiomegaly.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.SOB question pulmonary edema or pneumonia. Hardware, monitoring and support devices similar in position. Mild elevation of the left hemidiaphragm unchanged. Basal and retrocardiac atelectasis but no specific signs of edema. Cardiomediastinal silhouette unchanged.

Output: No acute change in cardiopulmonary appearance. No specific evidence of CHF or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Hypotension. Motion artifact at the bases. Low normal lung volumes, similar to previous. No pneumothorax or visible pleural fluid. No focal airspace opacities.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: increased work of breathing History: increased work of breathing Perihilar predominant airspace opacities right greater than left, consistent with acute edema with aspiration, and possible superimposed infection particularly on the right, unchanged.Median sternotomy for aortic valve replacement, heart size normal.Small pleural effusions are unchanged. Tracheostomy tube tip approximately 5 cm above the carina.Right PICC, tip in right subclavian.

Output: Unchanged linear opacities compatible with edema/aspiration as well as infection, with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: pna? History: 45657 Basilar interstitial/groundglass opacities better appreciated on prior CT study. No other air space opacities.Poor inspiratory effort. No pneumothorax. The cardiomediastinal silhouette within normal limits.

Output: Basilar interstitial ground glass opacities better appreciated on CT. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: eval for effusion or infiltrate History: SOB Stable cardiac enlargement status post sternotomy.Right pleural effusion/scarring and overlying edema-like opacities are slightly worsened, in particular in the right upper lobe.

Output: Diffuse pulmonary opacities with interval progression, right greater than left.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: pt presenting septic History: septic Stable cardiomegaly.Stable support devices.No pleural effusion. No pneumothorax.No focal opacities.

Output: Stable support devices with no specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: 44 yo male with ILD p/w PNA History: worsening fever Decreased lung volumes with stable mild cardiac enlargement.Diffuse chronic interstitial opacities compatible fibrosis unchanged.No new focal airspace consolidation.No pleural effusions.

Output: The appearance of ILD without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Hypoxemia, increasing oxygen requirement. Right jugular catheter unchanged in position. Lung volumes low normal, similar to previous. Large bulla in the right upper lobe, but no pneumothorax. Right perihilar region consolidation and fluid persists over multiple prior films, as does the background of hazy airspace opacity in the mid and lower lungs which may be chronic.

Output: No acute change in consolidation or presumed fluid filled bulla on the right suggestive of edema and infection.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Pneumonia, fluid History: Altered mental status, crackles on lung exam Cardiomediastinal silhouette is unremarkable. Atherosclerotic calcifications aortic arch noted. Low lung volumes. No large pleural effusions or pneumothorax. Left retrocardiac streaky opacity suggestive of subsegmental atelectasis or aspiration.

Output: Left retrocardiac subsegmental atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male. Response assessment after four cycles DTIC for metastatic melanoma. CHEST:LUNGS AND PLEURA: Scattered micronodules as seen previously. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No pericardial effusion, however there are new soft tissue cardiophrenic nodes.CHEST WALL: Reference left lateral chest wall subcutaneous nodule is stable, measuring 7.7 x 7.6, previously 8.1 x 7 mm (series 3, image 44). Associated soft tissue infiltration adjacent to this node is also unchanged. ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic cysts. Cholelithiasis without evidence of acute inflammation. Patent hepatic and portal vasculature.Enlarged portacaval lymph node which has become partially necrotic measures 2.6 x 2.6, previously 1.5 x 2.7 cm (series 3, image 101).SPLEEN: Status post splenectomy. Subdiaphragmatic nodule seen posteriorly (series 3, image 96) again may represent residual splenule.PANCREAS: Small, stable cystic nodule abutting the pancreatic tail (series 3, image 89); it measures approximately 10 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Progression of left para-aortic lymphadenopathy.BOWEL, MESENTERY: There is new extensive enhancing soft tissue mass throughout the leaves of the mesentery. Additionally there is recurrence of tumor involvement of the small bowel along the surgical margin (series 3, image 118). Mild to moderate ascites is also noted. There is extensive omental involvement.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: see aboveBONES, SOFT TISSUES: No significant abnormality noted.

Output: Progression of disease with new extensive peritoneal carcinomatosis and bowel involvement.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: eval for fracture History: left chest wall pain with inspiration s/p MVC with airbag deploy The cardiac and mediastinal contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities.The pleural spaces and visualized bones are within normal limits. Specifically, no evidence of displaced fractures.Assessment of the sternum is very limited.

Output: No evidence of displaced fractures or traumatic lesions.


Instruction: Generate impression based on medical findings.

Input: History of shortness of breath and increased seizures today Mild underlying interstitial changes without focal consolidation.Stable cardiomediastinal silhouette. Calcified mediastinal lymph nodes and pulmonary nodules consistent with prior granulomatous disease.No pleural effusions or pneumothorax.

Output: Mild underlying interstitial changes without new acute superimposed abnormality.


Instruction: Generate impression based on medical findings.

Input: 26-year-old female patient with history of VP shunt presents with headache. SHUNT DEVICE: The intracranial shunt exits the skull via a left-sided burr hole and courses down the left neck and chest wall, entering the abdomen and terminating in the pelvis. Portions of the shunt device overlying the skull are relatively radiolucent and hence difficult to evaluate, but we see no radiographic signs of complication. Orphaned shunt tubing is noted in the right neck and abdomen.SKULL: The aforementioned shunt device is again noted, but no acute abnormalities are seen.CERVICAL SPINE: There is straightening of the normal cervical lordosis, which may be due to positioning.CHEST: The lungs are clear and the cardiomediastinal silhouette is within normal limits.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Shunt device as described above without evidence of kinking or discontinuity.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: seizure, assess for aspiration History: Seizure Possible right infrahilar opacity otherwise unremarkable.Heart size normal.

Output: Possible right infrahilar opacity which could be from aspirated secretions, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Shortness of breath and chest tightness. The cardiomediastinal silhouette is within normal limits. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with dyspnea. Evaluate for pneumo in setting of cavitary lung lesion. CHEST:LUNGS AND PLEURA: Moderate right pneumothorax without mediastinal shift. Complex cavitating right upper lobe mass is reidentified.Also again seen is atelectasis/consolidation in the right lower lobe with suggestion of new cavitation (series 5, image 71; series 80276, coronal image 13).Left lower lobe consolidation and pleural effusion persists.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Tracheostomy tube. Debris is seen in the trachea and mainstem bronchi.CHEST WALL: Right jugular central venous catheter with tip in SVC. Sternal fixation devices intact.UPPER ABDOMEN: Ascites as seen previously. Gastrostomy tube is partially visualized.

Output: 1. Moderate right pneumothorax as seen on chest radiograph from earlier today. No mediastinal shift.2. Reidentification of a cavitating mass in the right upper lobe, unchanged. New cavitation seen in consolidated right lower lobe. These findings remain suggestive for fungal infection.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: LLL biopsy - pneumo? History: Left lower lobe lesion status post biopsy Basilar opacities and small left pleural effusion worse than on the prior study, suggestive of aspiration or edema.No pneumothorax following biopsy.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 26 years old Unknown. Reason: ET tube History: ET tube advanced. There is diffuse increased attenuation of the right lung with minimal shift of mediastinal silhouette to the right. The tip of the ET tube is about 2.7 cm above the carina. The tip of the NG tube projects over the stomach. There is no evidence of focal pleural effusion or pneumothorax.

Output: Apparent increased attenuation of the right lung with the minimal shift of mediastinal silhouette to the right hemithorax, which is most likely due to positioning of the patient. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with history of bladder cancer, status post cystectomy and chemotherapy. CHEST:LUNGS AND PLEURA: Several scattered nonspecific micronodules in both lungs are stable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions throughout the vertebral bodies likely representing degenerative changes.Increased density of the C7 vertebral body is only seen and partially much on the very first image, stable. The etiology is uncertain.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy. Status post prostatectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Previously described benign appearing fluid dense lesion in the left inguinal hernia sac, stable. Right hip prosthesis.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: infection History: cough Unremarkable cardiac and mediastinal silhouette. Streaky opacity at the left base laterally on obscuration of the silhouette of the left hemidiaphragm posteriorly on the lateral view are suggestive of a chronic process scarring and possibly bronchiectasis, however the acuity is uncertain.No other significant findings.

Output: Left lower lobe streaky opacity with obscuration of the hemidiaphragm, compatible with infection, of uncertain chronicity.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with metastatic colorectal cancer status post resection CHEST:LUNGS AND PLEURA: Right apical scarring. Multiple subcentimeter calcified nodules in both lungs. Bilateral emphysema. Moderate right-sided pleural effusion.MEDIASTINUM AND HILA: Paratracheal adenopathy measuring 1.5 by 0.9-cm image number 35, series number 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple new liver metastases. Existing small lesions have also enlarged. Previously measured lesion on image number 23 now measures 2.9 x 2.7 cm on image number 88, series number 4.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral benign cysts.RETROPERITONEUM, LYMPH NODES: Peripancreatic and para-aortic metastatic adenopathy. The reference peripancreatic adenopathy measures 1.2 x 1 .2 cm, image number 106, series number 4.BOWEL, MESENTERY: Small amount of ascites. No evidence of bowel obstruction.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: Emphysema. Right apical scarring. Moderate right-sided pleural effusion.Interval increase in the size and number of the hepatic metastases and retroperitoneal adenopathy.I. Interval increase in the size of the patient's known hepatic abscess.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Evaluate pneumonia, S.O.B. Allowing for differences in technique, extensive perihilar distribution air space and interstitial opacities are not significantly changed. Left upper extremity catheter tip projects over the left brachiocephalic vein to the right of midline. No pneumothorax.

Output: No significant change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Leukocytosis. Low lung volumes with moderate pleural effusions and associated basal compressive atelectasis, with persistent collapse of the left lower lobe. Tracheostomy tube tip at the level of the clavicular heads.

Output: Bilateral pleural effusions and atelectasis unchanged. The left lower lobe remains collapsed.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval ETT tube placement s/p advance History: intubated, advanced 2 cm ET tube tip still difficult to visualize, but probably still at least 5 cm above the carina.NG tube in place the side port above the GE junction.Right jugular catheter, tip in SVC.Markedly hyperexpanded lungs.

Output: Markedly hyperexpanded lungs. ET tube still difficult to visualize probably at least 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: assess lungs for infiltrate History: newly diagnosed leukemia; 2 weeks progressive DOE Unremarkable cardiac and mediastinal silhouette. Fixation rods in the thoracolumbar spine.No sign of pneumonia or other acute disease. Splenomegaly.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 94 year-old female with left upper lobe mass improved on recent CT (8/18/2008) also with improvement in mediastinal/hilar lymphadenopathy. Follow up CT 6 months. Review of medical records indicate history of non-small cell lung cancer. CHEST:LUNGS AND PLEURA: Previously referenced left upper lobe mass measures 19 x 16 mm (stable), series 5, image 37. Right lower lobe scarring versus atelectasis, unchanged. Right greater than left basilar bronchiectasis also unchanged.MEDIASTINUM AND HILA: Previously referenced right tracheobronchial lymph node measures 14 x 7 mm, previously 15 x 7 mm; relatively stable accounting for differences in technique.Large goiter.CHEST WALL: Stable degenerative changes of the spine.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable levoscoliosis of the lumbar spine.

Output: Stable left upper lobe mass. Stable mediastinal adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Rule out pulm edema, pna History: SOB Cardiomegaly status post sternotomy.Moderate left pleural effusion with overlying consolidation, and patchy opacity right lung base.

Output: Cardiomegaly and pulmonary opacities consistent with infection and CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: r/o pna, edema, infarct History: sob, left sided cp Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: r/o aspiration History: see above Complete left hemithorax opacification with volume loss suggestive of bronchial obstruction from right bronchial intubation.Near complete right upper lobe atelectasis.ET tube in right main bronchus, subsequent repositioning.

Output: Complete left hemithorax opacification from right bronchial intubation, as well as right upper lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Confirm ETT placement History: Respiratory Failure, Intubation Patchy right upper and mid lung airspace opacities.Left lower lung zone volume loss and left pleural effusion.ET tube tip approximately 3 cm above the carina.

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


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old. Reason: f/u on infiltrate History: sob Interval removal of esophageal temperature probe. NG tube extends below the lower margin of the image.Cardiac mediastinal silhouette is unchanged.Low lung volumes. Streaky basilar opacities compatible with atelectasis are unchanged. Stable left partially loculated pleural effusion

Output: Persistent atelectasis and effusions without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: pneumonia? History: cough Cardiac silhouette is at the upper limits of normal. Low lung volumes with minimal left retrocardiac atelectasis. No focal consolidation, sizable effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: eval ett History: ett No change in endotracheal tube position.No change in pulmonary opacities.

Output: No change in line position or pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: r/o effusion vs PTX History: SOB, O2 requirement, h/o diaphragmatic injury s/p primary repair Right IJ central catheter are unchanged in position.Relatively low lung volumes with right infrahilar opacities have retained secretions of atelectasis. No pneumothorax. In this semierect radiograph, lucency at the upper abdominal midline was a question of pneumoperitoneum; repeat imaging with upright PA radiograph recommended.

Output: Upright radiograph recommended for further evaluation of possible pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: 33 y/o F w/ Hx of sickle cell here w/ crisis r/o acute chest History: Sore throat/strep +, low back pain Heart size normal.No evidence of infection or infarction, or other acute abnormality.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: eval for acute lung issue History: desaturation, tachycardia - off the vent this morning Tracheostomy tube is in place. Enteric tube terminates within the body of the stomach. Right-sided PICC again terminates in the right subclavian vein. VP shunt catheter again noted. Increase in diffuse pulmonary opacities though right upper lobe atelectasis appears to have resolved. Heart size, likely unchanged. No pneumothorax.

Output: Improvement in right upper lobe atelectasis. However, there is now a new diffuse pulmonary opacities most consistent with pulmonary edema or diffuse aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: Sept Peripheral groundglass opacities in the right lung with aspiration -- interval clearing? History: as above -- occasion mild cough The cardiomediastinal silhouette is unremarkable.Increased lung volumes compatible with COPD.The lungs are clear without focal areas of consolidation or airspace opacities.No pleural effusions..

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


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with chest pain and pressure. Rule out PE. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Stable type A aortic dissection, which begins at the distal aspect of the ascending aorta and terminates near the origin of the celiac trunk, is stable. Aneurysmal dilatation of the thoracic aorta is stable when compared to prior exam.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Multiple subcentimeter hypodense hepatic lesions, which are too small to characterize, are reidentified.

Output: 1. No pulmonary embolus.2. Stable type A aortic dissection.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: cticu patient, line eval History: line eval Unchanged lower lung zone predominant opacities with pleural effusions. ET tube tip approximately 1 cm above the carina.Left subclavian pacemaker, leads unchanged in position.An NG tube terminates in the stomach.Left PICC, tip in left subclavian.

Output: Unchanged pulmonary opacities. Low ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: lung cancer History: s/p LLL lobectomy Left hemithorax volume loss from thoracotomy, with improved left basilar opacity compared to the prior study.Residual left pleural thickening or fluid.Right lung unremarkable.Heart mildly enlarged.

Output: Improving basilar opacity following left lower lobectomy.


Instruction: Generate impression based on medical findings.

Input: 93-year-old female with increasing lactate, mixed acidosis. CHEST:LUNGS AND PLEURA: Large bilateral pleural effusions are seen with associated passive atelectasis. Ground glass opacities have developed in the right upper lobe, mostly in the periphery.MEDIASTINUM AND HILA: Endotracheal tube in satisfactory position. The right central line terminates in the SVC. The heart size is enlarged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic granulomata are seen. Cholelithiasis.SPLEEN: Splenic granulomataPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are small in sizeRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of pneumatosis. Collapse of the colon limits evaluation for wall thickening. Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anasarca. Mild ascites. Diffuse atherosclerotic disease.Hyperdensity in the proximal SMA is compatible with previously described short segment thrombosisPELVIS:UTERUS, ADNEXA: Uterine fibroids, calcified.BLADDER: A Foley catheter is seen within the bladderLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: DiverticulosisBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anasarca. Mild ascites.

Output: Large bilateral pleural effusions with associated atelectasis. Patchy opacities have developed in the right upper lobe, which can be related to infection.No definite wall thickening, though collapse of the large bowel limits evaluation.Cholelithiasis.Atrophic kidneys.Anasarca and mild ascites.Atherosclerotic disease.Diverticulosis.


Instruction: Generate impression based on medical findings.

Input: Breast cancer, check effusions Bilateral moderate to large pleural effusions greater on the left with underlying edema and atelectasis. Suspected mild to moderate cardiomegaly

Output: Large effusions with suspected associated CHF


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: Eval for evidence of TB - pt had +QFN. No symptoms at this time. Travel to Uganda/Kenya/SE Asia History: Asymptomatic Cardiac silhouette is normal in size.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax. No calcified granulomas or cavitary lesions are present.

Output: No radiographic evidence of acute cardiopulmonary process or active tuberculosis.


Instruction: Generate impression based on medical findings.

Input: LUNGS AND PLEURA: Status post left lower lobe partial resection. Scattered micronodules, up to 3 mm, are not significantly changed. Moderate to severe centrilobular emphysema.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN

Output: Unchanged postsurgical findings without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old. Stable cardiomegaly. Interval placement of right central venous catheter with tip in projection of the right atrium. No pneumothorax.Increased bilateral pleural effusions and vascular congestion. Stable basilar opacities.

Output: 1. Line placement with no pneumothorax.2. Increased pleural effusion and cardiomegaly.3. Stable basilar opacities.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with fever, neutropenia, elevated amylase, increased diarrhea and abdominal pain CHEST:LUNGS AND PLEURA: The lungs again demonstrate mosaic attenuation, compatible with small airways disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The right central line terminates at the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: Trace periportal edema is seen, unchanged. Sludge/stones are seen within the gallbladder. Trace perihepatic ascites.SPLEEN: No significant abnormality.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: Numerous loops of jejunum demonstrate wall thickening, not significantly changed. Haziness of the mesentery is compatible with inflammation/congestion. No intra-abdominal abscess is identified.Small fat containing periumbilical hernia.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: Wall thickening involving numerous loops of jejunum, not significantly changed. Findings can represent graft versus host disease or infectious enteritis.


Instruction: Generate impression based on medical findings.

Input: 57 year-old female metastatic vaginal cancer with lung metastases. Shortness of breath. CHEST:LUNGS AND PLEURA: Decrease in the number and size of the lung nodules. Index nodule in the right upper lobe previously seen on series 5 image 49 measuring 7.2 x 6.6 mm is seen on today's study series 5 image 46 measuring 4.5 x 4.5 mm.Persistent moderate-sized right pleural effusion and small left pleural effusion. The mass and the left posterior costophrenic angle is also decreased. Redemonstration of pleural calcifications on the right. No new lesions.MEDIASTINUM AND HILA: Index right pectoral node previously measured on series 2 image 31 is 15.6 x 10 mm is decreased in size and is seen on today's study series 2 image 28 to measure 11.1 x 6 mm. The other right axillary nodes are also decreased in size. No new nodes are seen.All the mediastinal nodes have decreased in size. The index precarinal node previously measuring 21.1 x 2.7 mm on series 2 image 41, is seen on today's study series 2 image 38 to measure 7.9 x 6.5 mm. Bilateral hilar nodes and as ago esophageal noted similarly decreased in size markedly.CHEST WALL: Previously described chest wall node is described above in the pectoral area. Port-A-Cath has been removed and a new Port-A-Cath has been placed in the left chest wall.Diffuse blastic metastases is seen throughout the thoracic spine. These were not seen previously. They could be new however occasionally aggressive lytic disease not apparent on CT may appear blastic and response to therapy.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypoattenuating foci unchanged. No definite evidence of metastases.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 evidence of ascites. The nodule previously described lateral to the liver on series to image 119 is no longer visible. No evidence of carcinomatosis.BONES, SOFT TISSUES: Numerous soft tissue masses previously seen enhancing in the right abdominal subcutaneous tissues and musculature have all markedly decreased in size.New diffuse blastic lesions are seen throughout the lumbar spine. As noted above these could be new or could represent a response to therapy.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse blastic metastases throughout the pelvic bones. A few of these lesions were subtly present previously.OTHER: No significant abnormality noted.

Output: Marked decrease in all lung lesions and soft tissue masses. Diffuse blastic disease could represent progression or could represent response to therapy where lesions were previously less conspicuous on CT


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old. Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: baseline eval pre kidney transplant Moderate size right hemidiaphragmatic eventration. Calcified granuloma noted at the right lung base. Small left sided pleural effusion versus thickening, favor thickening given presence on only PA view. Heart is at the upper limit of normal. Aortic atherosclerosis. No pneumothorax. Patient is status post cholecystectomy.

Output: No acute cardiopulmonary process on radiography. Heart size at the upper limit of normal. Aortic atherosclerosis.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o TB History: none, h/o BCG Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with prostate cancer Evaluation of the visceral organs is limited by lack of IV contrast.CHEST:LUNGS AND PLEURA: Calcified pulmonary granulomataMEDIASTINUM AND HILA: No adenopathy. The esophagus is dilated and air-filled. Trace pericardial effusion.CHEST WALL: Gynecomastia. Scattered lytic and thoracic lesions in the thoracic spine.Lipoma in the left subscapularis.ABDOMEN:LIVER, BILIARY TRACT: Hepatic granulomata.Small stones are seen within the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Numerous enlarged paraortic and interaortocaval lymph nodes are identifiedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered lytic and sclerotic lesions in the lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is greatly enlarged and indents the base of the urinary bladderBLADDER: No significant abnormality notedLYMPH NODES: Enlarged lymph nodes extend along the sigmoid colon, some conglomerate.Enlarged right common iliac, perirectal, bilateral obturator and right inguinal lymph nodes are seen. A reference right common iliac lymph node measures 2.3 x 1.7 cm (series 3; image 137). A reference left obturator lymph node is the largest, measuring 1.5 x 1.4 cm (series 3; image 164).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scattered lytic and sclerotic lesions throughout the pelvis, including the proximal femurs,OTHER: No significant abnormality noted

Output: Diffuse metastatic osseous lesions along with metastatic abdominal/pelvic adenopathy.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: Evaluate for volume overload, cardiomegaly History: Signs of edema Borderline cardiac enlargement.Decreased lung volumes.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Hypoxemia ETT remains 5 cm from the carina. NG extends beyond inferior edge of the imageNo appreciable interval change in cardiopulmonary appearance, specifically persistent basilar opacities with atelectasis and moderate right pleural effusion appear similar. Overall appearance again may correlate with patient's history of aspiration

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male; 51 years old. Reason: rt chest pain x yr. History: rt chest pain smoker. Normal cardiac and mediastinal silhouettes. No abnormal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 14-day-old female (former 26 week gestational age patient) with respiratory distress syndrome of the newborn.VIEW: Chest and Abdomen AP (two views) 12/20/2016 20:45 Endotracheal tube tip is at the carina. Enteric tube sidehole and tip are in stomach. Right upper extremity PICC tip is in right brachiocephalic vein. The cardiothymic silhouette is mildly enlarged. No significant change in moderate diffuse hazy pulmonary opacities. No pleural effusion or pneumothorax.Mildly dilated loops of bowel. No intraperitoneal free air, pneumatosis intestinalis or portal venous gas.

Output: 1. Probable PDA.2. Mildly dilated bowel.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval for edema History: sob, doe Cardiomegaly with mild cephalization of blood flow but no frank pulmonary edema.

Output: Cardiomegaly with mild cephalization of blood flow but no frank pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Tachypnea, sepsis Inferior margins are cut off limiting sensitivity, however within this limitation, no new cardiopulmonary abnormality observed. Mild edema changes with moderate effusions greater on the left are again observed. NG extends beyond the inferior edge of the image. Right jugular catheter terminates in the mid SVC

Output: Stable pleural effusions and nonspecific basilar changes suggesting mild edema


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Reason: evaluate for infectious process History: cough x 6 weeks Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Reason: Rule out PNA History: PNA Facial weakness No evidence of pneumonia. Postop change involving the shoulders. Healed rib fracture on the left.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old with history of SAH and VP shunt, evaluate VP shunt, surveillance SHUNT DEVICE:An intracranial shunt exits the skull via a right posterior-inferior parietal burr hole and courses down the scalp, neck, and anterior chest wall entering the abdomen and terminating within the right hemiabdomen. Portions of the shunt device overlying the skull are relatively radiolucent and are thus difficult to evaluate, but no specific findings to suggest shunt complication are seen. The notch in the pressure valve points anteriorly.SKULL: Small sutures or clips are noted within the skull base near the foramen magnum.CERVICAL SPINE: Minimal degenerative disc disease affects the mid cervical spine.CHEST: The lungs are underinflated but clear.ABDOMEN: Nonobstructive bowel gas pattern noted. An IVC filter projects anterior to L3-4.

Output: Shunt device as described above.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with new tongue cancer. Evaluate disease. CHEST:LUNGS AND PLEURA: Few, scattered micronodules bilaterally (all smaller than 3 mm). No suspicious nodules, masses, or pleural effusion. Mild pleural nodularity in the left hemithorax posteriorly is likely postinflammatory in etiology and can be followed on subsequent studies.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal with small pericardial effusion.CHEST WALL: Punctate sclerotic focus in the left T11 vertebral body likely represents a benign bone island. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta, iliac arteries, and proximal left renal artery.BOWEL, MESENTERY: Limited evaluation of the bowel given the absence of GI contrast material with no gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the spine. Benign hemangioma in the L4 vertebral body.

Output: No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: is there pul edema History: chest pain, history cad with cabg Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Status post median sternotomy for CABG.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax History: hypoxia Moderate right pneumothorax, increased compared to previous with the apex of the lung 3 cm from the chest wall.Interstitial opacity, lymphadenopathy and small pleural effusions unchanged.Catheter tip in the SVC.

Output: Moderate right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Line placement IABP marker has been minimally retracted, currently projects 3 cm from the aortic arch.Swan-Ganz mildly retracted as well, tip remains however in the right main pulmonary outflow tract. ICD unchangedMarked cardiomegaly with otherwise clear lungs

Output: Minimal repositioning of the IABP and Swan-Ganz catheter


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: O2 requirement ET tube tip approximately 4 cm above the carina.New NG tube extending to stomach.Catheter tip in the SVC.Mild basilar and perihilar opacity in the right transplanted lung consistent with edema and atelectasis with a small effusion. Severe chronic interstitial disease in the left native lung consistent with fibrosis.

Output: Mild edema and pleural effusion with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: eval pneumonia History: eval pneumonia Stable cardiac enlargement.No focal areas of consolidation.No pleural effusions.Increased lung volumes compatible with COPD.Degenerative changes in thoracic spine.

Output: COPD without acute cardiopulmonary.


Instruction: Generate impression based on medical findings.

Input: 81 years old Male. Reason: 81yo M s/p cystectomy c/b post-op hemorrhage, aggressive volume resuscitation. Eval pulmonary edema History: hypoxia. Stable linear densities are seen in the lower lungs. The Port-A-Cath is stable in position. The cardiac silhouette is normal. There is no evidence of pleural effusion or pneumothorax.

Output: Bibasilar linear atelectasis, unchanged as compared with prior study


Instruction: Generate impression based on medical findings.

Input: Pain in the thoracic spine. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: LVAD Motion degrades sensitivity. LVAD similar in positionEssentially unchanged marked to severe nonspecific cardiomegaly with underlying pulmonary nonspecific opacities and suspected compression of the left lower lung.ICD and two right jugular catheters unchanged

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: 35yoF with h/o recent GIB s/p IR embolization with hematemesis History: hematemesis No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: chest pain History: hx colon, pancreas and bone ca, pain with point ttp underneath left breast. Left chest wall port, with its tip in the atriocaval junction. Normal heart size. There is an apparent pleural line extending along the right hemithorax, however interstitial opacities are seen more peripherally (see arrows), indicating scarring and possibly partially loculated lung or loculated pneumothorax rather than a pneumothorax. No focal pulmonary opacities. Mild bibasilar atelectasis/scarring. No pleural effusion. No focal bony abnormalities.

Output: Right lower lung peripheral loculated lung loculated pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Shortness of breath, history of COPD, evaluate for infiltrate or CHF Basilar atelectasis, with chronic elevation of the left hemidiaphragm. No evidence of infection or edema. Cardiomediastinal silhouette is normal.

Output: Basilar atelectasis and chronic elevation of left hemidiaphragm without evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval for infiltrate History: fever, cough Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p shunt revision History: AMS Small lung volumes with basilar atelectasis and small pleural effusions.Shunt catheter projected over the right hemithorax .Minimal right apical pneumothorax but the margin of the lung a few millimeters from the chest wall.

Output: Basilar atelectasis and small pleural effusions. Minimal right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: evalaute for PNA History: sob, O2 requirement Bilateral interstitial opacity compatible with edema with small pleural effusions.No sign of pneumonia or other acute change.

Output: CHF with slightly increased right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p MVR History: s/p MVR Small left pleural effusion with basilar atelectasis.Heart size at least upper normal status post mitral valve repair.

Output: Small left pleural effusion, with small lung volumes and retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: post-op cardiac surgery History: post-op cardiac surgery Remaining support tubes and lines unchanged.Stable bilateral pleural effusions and increased associated compressive atelectasis/consolidation.Multifocal pulmonary nodules and masses, some of which are cavitary without significant interval change.No pneumothorax

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: assess for effusions and lines History: access for effusions and lines IVC Swan-Ganz with its tip in the right pulmonary artery.IVP marked in the proximal descending aorta.NG tube with its tip in the stomach.Cardiac mediastinal silhouette is unremarkable.Right upper lobe and left perihilar airspace and interstitial opacities suggestive of infection or possibly aspiration.

Output: Upper lobe and right-sided predominant airspace and interstitial opacities may represent aspiration/infection and possibly atypical edema.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval for pneumonia, fluid overload History: new oxygen requirements, febrile Increased streaky bibasilar opacities, left greater than right, are consistent with atelectasis. No definite pleural effusion is evident. There is no pneumothorax. The cardiac and mediastinal contours are unchanged.

Output: Mild basilar atelectasis without reliable evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: ETT History: ETT Cardiomegaly with basilar atelectasis unchanged.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male presents with constipation, evaluate stool burden. Mild gaseous distention of multiple small bowel loops. Below average stool burden. Partially visualized bilateral pulmonary fibrosis.

Output: Mild gaseous distention of multiple bowel loops may reflect an ileus versus developing obstruction. Below average stool burden. Continued follow-up is suggested.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with history of renal cell carcinoma status post partial nephrectomy. Cardiomediastinal silhouette is within normal limits.Streaky opacity at right lower lung zone likely represents atelectasis or scarring. No pneumothorax, or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old Reason: s/p swan ganz catheter adjustment History: see above. Cardiomegaly is unchanged. IABP marker slightly more superiorly located, just inferior to the aortic arch. Swan-Ganz catheter tip is retracted slightly, but still appears to be in the right interlobar pulmonary artery. ICD leads are unchanged in position.

Output: IABP marker slightly more superiorly located, just inferior to the aortic arch. Swan-Ganz catheter tip is retracted slightly, but still appears to be in the right interlobar pulmonary artery


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: atelectasis History: none Improving left basilar consolidation with a moderate sized left pleural effusion.Mild subsegmental atelectasis right lower lung zone periphery, improved.Tracheostomy tube tip approximately 5 cm above the carina.

Output: Improving left basilar consolidation with stable left pleural effusion. Improved right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate cause of fever History: fever. head and neck cancer Tracheostomy tube and gastrostomy tube in place.PICC line tip in the right axilla.No significant cardiopulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: eval for effusion/pna History: palpitations/cp 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 or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: position of ETT History: intubated patient ET tube tip approximately 2 cm above the carina.External artifacts projected over the right upper lobe. No significant pulmonary abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: stroke, c/f aspiration History: above The heart is normal in size.Mild bilateral bronchial wall thickening. Limited assessment of the hila.No evidence of aspiration pneumonitis or aspiration pneumonia, considering the limitations of a single AP projection.No pneumothorax.

Output: No radiographic evidence of aspiration pneumonia, as clinically questioned, considering the limitations of a single AP projection.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for possible infection History: rising wbc ET tube tip approximately 3 cm above the carina.NG tube tip in the stomach.Interval removal of a right jugular catheter with remaining catheters unchanged.Partial clearing of bilateral opacities compatible with atelectasis.

Output: Resolving atelectasis and no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: resp insuf History: same Interval extubation. Moderate cardiomegaly status post sternotomy for valve repair and LVAD placement.Mild right midlung subsegmental atelectasis unchanged with low lung volumes, and the suggestion of mild basilar edema.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Interval extubation. Remaining findings are unchanged.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of carcinoid tumor. CHEST:LUNGS AND PLEURA: Pleural-based, soft tissue density lesion seen adjacent to the right seventh rib (series 3, image 61); it is suspicious for metastasis.Small right pleural effusion with bibasilar atelectasis/scarring. Scattered calcified granulomata.MEDIASTINUM AND HILA: Enlarged left paratracheal lymph node at the level of the aortic arch (series 3, image 28; series 80228, coronal image 47). It measures 1.4 cm in short axis in the axial plane. No other pathologically enlarged lymph nodes identified. Heart size normal without pericardial effusion.CHEST WALL: Right chest pacemaker with leads in expected locations. ABDOMEN: LIVER, BILIARY TRACT: Multiple, hypoattenuating lesions in the liver compatible with metastases. For reference, a lesion seen in the right hepatic lobe containing metallic clips (series 3, image 97) measures 5.8 x 5.6 cm in the axial plane. Additionally, the cystic lesion seen more superiorly extending to the hepatic dome abuts the diaphragm (series 3, image 81; series 80228, coronal image 41) with atelectatic and the adjacent right lung base seen in the adjacent right lung base. Diaphragmatic invasion cannot be entirely excluded at this location.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts bilaterally.RETROPERITONEUM, LYMPH NODES: Soft tissue mass abutting the pancreas and portal vein contains surgical clips (series 3, image 112) and measures 2.8 x 2.5 cm in the axial plane. This lesion may represent disease recurrence in a surgical bed if the patient has history of prior surgery.An enlarged porta hepatis lymph node abuts the caudate lobe and pancreas more inferiorly (series 3, image 109), measuring 3.7 x 2.5 cm in the axial plane.BOWEL, MESENTERY: Small periumbilical hernia containing a small portion of bowel without evidence of obstruction (series 3, image 138).BONES, SOFT TISSUES: Heterogeneous bone marrow, particularly in the upper thoracic spine, may represent metastatic disease.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous marrow seen in the pelvis with focal lesions suspicious for metastatic disease (series 3, image 156; series 80228, coronal image 22 for example).

Output: 1. Multiple lesions in the liver compatible with metastases. A predominantly cystic lesion in the hepatic dome abuts the diaphragm with parenchymal changes in the adjacent right lung base. Diaphragmatic invasion cannot be entirely excluded at this location.2. Retroperitoneal lymphadenopathy with soft tissue mass adjacent to the portal vein and pancreas.3. Heterogeneously appearing bone marrow suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: 24 yo M w spina bifida, scoliosis, resp failure. Pls eval effusion. History: effusion Very small lung volumes with dense pulmonary opacities unchanged.Support devices are stable in position.

Output: No change in pulmonary opacities or in support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna History: cough, chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Shortness of breath, for lung transplant evaluation. Right middle lobe opacity, likely atelectasis, though early infection cannot be excluded.Emphysema.

Output: Right middle lobe atelectasis, though an early infection is also possible.


Instruction: Generate impression based on medical findings.

Input: Reason: where is Swan? History: Swan in place Cardiopulmonary monitoring and support devices, unchanged.Diffuse pulmonary opacity compatible with edema with moderate pleural effusions.No new findings.

Output: Swan-Ganz catheter tip in the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Stable micronodules. Reference right middle lobe nodule is stable in size, measuring 4 mm number 48, series number 33. Stable left upper lobe nodule. (Image number 40, series number 33). New paragraph. Stable right lower lobe index nodule.MEDIASTINUM AND HILA: Reference right hilar node measures 14 by 11-mm image number 50, series number 21, slight and smaller compared to previous study. Left infrahilar node measures 24 by 22-mm image number 60, series number 21, slightly decreased in size on image number 60/series number 21.. No new nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference lesion in segments 8, series number 21, image number 98, measures 16 x 20 mm, smaller compared to previous study. No new lesions.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic tail mass measures 21 x 21 mm image number 113, series number 21, not significantly changed.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney is normal. Left kidney has been resected.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Incisional hernia left posterior lateral wall containing loops of bowel, unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No new sites of disease. Stable or minimal decrease in the size of the index lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: confirm line placement History: line Right jugular sheath in SVC. No evidence of pneumothorax. Other support hardware is stable.

Output: Right jugular sheath in SVC. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: s/p lung resection History: see above Interval removal of right apical chest tube.Cardiac silhouette is normal in size.Interval improvement in bibasilar predominant atelectasis. Right midlung surgical staple line laterally. Question trace posterior pleural effusions versus thickening.Remote fracture deformity of the left mid clavicle with suggestion of nonunion.

Output: Interval improvement in postoperative changes. No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval for infiltrate History: neutropenic fever No significant cardiopulmonary abnormality.No specific evidence of infection.Stable skeletal abnormalities from known multiple myeloma.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 36 years old Reason: s/p pleurX catheter insertion History: post-op, Pleurx catheter insertion. Cardiomediastinal silhouette is within normal limits.Interval placement of a left-sided Pleurx catheter and subsequent decrease in large left-sided pleural effusion.Left-sided pleural thickening is unchanged.Mild spinal curvature noted.No pneumothorax.

Output: Interval placement of a left-sided Pleurx catheter with no significant pneumothorax and interval decrease in large left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: eval LIJ line placement History: eval LIJ line placement Right pleural effusion layering posteriorly and stable retrocardiac consolidation.Heart size upper normal.ET tube high, above the thoracic inlet level.Left jugular and left subclavian catheters terminate in the SVC.An NG tube terminates in the stomach.A Dobbhoff tube extends below the lower margin of the image.

Output: Left jugular and left subclavian catheters described above. No change in lung appearance.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: FUO but now with cough. r/o pna History: fevers x 1 week, cough Mild right lower lobe bronchiectasis and associated mild increased opacity.The cardiomediastinal silhouette is unremarkable.No pleural effusions.

Output: Right basilar bronchiectasis and mild increased opacity. Active infection cannot be excluded. CT of the chest would be of value.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: SOB History: above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Presternal ICD device in place, unchanged.No pneumothorax or other complications.Multiple coronary artery stents in place.Partial clearing of a focal left upper lobe opacity.Mild basilar opacities compatible with atelectasis and small effusions, unchanged.

Output: Presternal ICD device in place with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Status post TECAB. Bilateral pneumothoraces, about the same. Bilateral chest tubes in place. Subcutaneous emphysema left chest wall. Pneumomediastinum also similar. Pneumopericardium has improved compared to earlier films.Assessment of the lung parenchyma is markedly limited due to density of breast prostheses which obscure the underlying lung parenchyma.Small pleural effusions with basal atelectasis.

Output: No significant change in pneumomediastinum, pneumothoraces or pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: eval ETT, lung fields History: s/p ASD repair Endotracheal tube terminates approximately 4 cm from the carina. Right IJ line terminates in the SVC. Right-sided chest tube/drain noted. Low lung volumes makes detailed cardiopulmonary assessment difficult. Hazy opacity at the right lung base which may represent small amount of aspiration and/or atelectasis. Unchanged heart size. No pneumothorax.

Output: Lines and tubes, as above. Hazy opacity at the right lung base which may represent aspiration and/or atelectasis can be reevaluated on imaging follow-up as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: for VQ scan History: sob, r/o CTEPH Large lung volumes, with a pulmonary perfusion pattern suggestive of emphysema.Heart size normal.Left Bochdalek hernia.Cholecystectomy clips.Cervical and upper thoracic spine stabilization hardware noted.

Output: COPD/emphysema, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: S/p line removal History: S/p line removal Median sternotomy with chest tubes but no pneumothorax.Unchanged left hemithorax volume loss basilar atelectasis possibly from mucous plugging.Right jugular Swan-Ganz catheter withdrawn.

Output: Right jugular Swan-Ganz catheter removed, with unchanged left basilar atelectasis possibly from mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: cough with phlegm History: cough The cardiomediastinal silhouette is unchanged. Right basilar opacity was present on prior radiograph dated 12/03/16 and likely represents mild atelectasis. Mild diffuse peribronchial interstitial prominence suggest chronic airways changes. No large pleural effusion or consolidation. No pneumothorax.

Output: Mild diffuse peribronchial interstitial prominence may represent component of acute on chronic bronchitis. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old. Catheter tip in the SVC.ET tube tip approximately 3 cm above the carina.NG tube tip in the stomach.Small lung volumes with diffuse mainly perihilar opacity compatible with edema.Increased basilar opacity in the left lower lobe area compatible with edema and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.OG-tube placement. Intubated. Endotracheal tube tip 4 cm above the level of the carina.Orogastric tube has been advanced, now looped in the stomach with tip near the GE junction.No focal pulmonary opacities.Metallic fragments project over the right chest near the axilla.

Output: ETT 4 cm above carina. OGT in stomach.


Instruction: Generate impression based on medical findings.

Input: 82 years old Male. Reason: Patient w/ deep neck space infection intubated for airway protection w/ concern for aspiration. Please eval ET tube placement, consolidation/ effusion History: As above. There is no significant change as compared with prior study. The ET tube and NG tube are stable in position.Basilar opacity and diffuse coarse bronchopulmonary markings are again identified.

Output: No acute interval change


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Pt complaining about SOB s/p distal pancreatectomy and splenectomy 7 days ago History: SOB Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild elevation the right hemidiaphragm. Bibasilar atelectasis or scarring. Question of small pleural effusions. Heart size difficult to assess due to low lung volumes. Postoperative changes in the abdomen.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild elevation the right hemidiaphragm which may represent phrenic nerve or hemidiaphragmatic dysfunction. Bibasilar atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: baseline eval pre kidney transplant Cardiomediastinal silhouette is within normal limits. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No evidence of cardiomegaly. No acute cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Reason: opacities? any signs of infection History: chest pain Cardiomegaly with probable pulmonary hypertension.Lower zone interstitial opacity mainly on the right and atelectasis with small right pleural effusion.No sign of pneumonia.Port catheter and SVC stent unchanged.

Output: Pulmonary hypertension with small right pleural effusion but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube placement History: ET tube replaced ET tube tip approximately 3 cm above the carina. Aortic balloon catheter marker at the level of the aortic arch.Other devices unchanged.Perihilar and basilar opacities compatible with edema, atelectasis and small effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: New LE edema and AKI, assess volume status/cardiomegaly History: as above Unremarkable cardiac and mediastinal silhouette.Low lung volumes with no significant pulmonary or pleural disease.Air-fluid levels are visible in the colon.

Output: No significant abnormalities.