Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of IPF. CHEST:LUNGS AND PLEURA: Severe, diffuse fibrosis and honeycombing is unchanged.The left lingular mass is larger measuring 3.1 x 5.4 cm on axial image 70/94 (compared to 3.3 x 1.9 cm on 10/15/07). Pleural involvement with this mass is likely, but no evidence of bony erosion is seen.A left hilar mass is also larger measuring 4.6 x 6.9 cm in image 56/131. The mass demonstrates encasement of the pulmonary artery as well as encasement and narrowing of the left-sided bronchi. This mass probably represents adenopathy, although some component of post obstructive pneumonitis may also be present.A left apical nodule is unchanged. Mild emphysema unchanged. No evidence of new mass lesions. No pleural effusions.MEDIASTINUM AND HILA: Significant progression of mediastinal and hilar lymphadenopathy. Cardiac size is normal. No pericardial effusion. The main pulmonary artery is enlarged suggestive of pulmonary artery hypertension.CHEST WALL: Left chest pacer generator in place.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Focus of high attenuation within a small bowel loop may represent an undissolved pill or fecalith. A few colonic diverticula noted with no evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Interval progression of left lung and left hilar masses highly suggestive of malignancy. 2.Stable interstitial lung disease as above.3.No evidence of metastatic disease to the abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: intubated, assess ETT History: intubated, assess ETT The patient is positioned with the chin over the thoracic inlet which obscures the superior thorax. Given the limitation due to patient position, the support devices appear to remain in stable position.Decreased lung volumes with persistent retrocardiac consolidation and likely small left pleural effusion. No significant pneumothorax. Increasing perihilar opacities suspicious for aspiration.

Output: Perihilar opacities suspicious for aspiration. Persistent retrocardiac consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Leukemia. Recent fever. The cardiac and mediastinal contours are within normal limits.Right IJ port catheter terminates in the superior cavoatrial junction.Low lung volumes. Left lower lobe discoid atelectasis. No radiographic findings to suggest pneumonia.The pleural spaces are normal.

Output: No radiographic findings to suggest pneumonia, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of shortness of breath. There is severe cardiomegaly. There are bibasilar opacities suggesting atelectasis/aspiration with small bilateral pleural effusions.

Output: Cardiomegaly and bibasilar opacities suggesting atelectasis/aspiration with small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: IABP placement History: IABP placement Stable position of support devices.Heart size remains stable. No interval edema or evidence of infection.

Output: Intra-aortic balloon pump remains in appropriate position.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: eval infection History: DKA No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: patient came from OSH, want to eval for PNA History: baseline CXR Small lung volumes with increased interstitial markings suggestive of edema, but no evidence of pneumonia.Small pleural effusions noted.Mild to moderate cardiomegaly.

Output: Mild CHF with edema, but no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: eval ETT, lung fields History: s/p MVR Postop mitral valve repair with a right chest tube but no pneumothorax.Mild basilar postop subsegmental atelectasis and small pleural effusions noted.Two right jugular introducer catheters are in place. ET tube tip approximately 5 cm above the carina.

Output: No significant pneumothorax. Mild postop basilar atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Chest pain and SOB. Pneumonia versus ACS. There appear to be areas of cortical discontinuity in the posterior lateral left eighth and ninth ribs. Although the ninth rib lesion may have callus formation the findings remain suspicious for pathologic fractures from myeloma or metastatic disease.No pneumothorax or focal airspace opacity. Heart size is normal.

Output: Indeterminate lytic appearing lesions in the left eighth and ninth ribs suspicious for myeloma or metastases with age-indeterminate pathologic fracture. Recommended dedicated bone-technique radiographs for further evaluation. No acute pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Device placement 3-lead left subclavian ICD appears unchanged in position and without associated interval complicationRadial pulmonary appearance is also otherwise similar with basilar scarring and/or small right effusion and mild scarring/fibrotic changes superimposed upon emphysema. Midline sternotomy CABG clips

Output: Left subclavian ICD placed without complication


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Patient with history of renal cell carcinoma, evaluate for renal cancer surveillance. Cardiomediastinal silhouette is normal. No focal opacities, pleural effusion, or pneumothorax are identified.

Output: No acute cardiopulmonary abnormalities with no radiographic evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: cp History: cp Mild nonspecific bronchial wall thickening but no evidence of pneumonia. Heart size normal.

Output: Mild nonspecific bronchial wall thickening but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: RIJ placement History: RIJ placement Small lung volumes with left retrocardiac subsegmental atelectasis. ET tube tip approximately 2 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter tip at cavoatrial junction.

Output: Right jugular catheter tip at cavoatrial junction. ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: cough Normal heart size with a tortuous aorta.Large lung volumes suggest COPD with no acute findings.Anterior cardiophrenic angle opacity on the lateral view is compatible with prominent pericardial fat pads.

Output: COPD with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: line History: line Interval removal of right central venous line. No pneumothorax.Chronic elevation of right hemidiaphragm with associated volume loss. Likely associated progression of right basilar atelectasis. Follow-up recommended.Stable cardiomediastinal silhouette.No specific evidence of infection or edema

Output: Chronic elevation right hemidiaphragm with right basilar atelectasis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: rule out reactivation TB History: History of positive PPD now with hemoptysis. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Evaluate ET tube placement. History: Endotracheally intubated New temperature probe terminates in the superior aspect of the mediastinum. Other lines and tubes, not substantially changed. Large degree of ectopic gas again noted including large degree of subcutaneous gas, pneumomediastinum, and likely retroperitoneal gas. Apparent small pneumothoraces, most likely represent extension of extrapleural gas. Diffuse pulmonary opacities, unchanged. Unchanged heart size.

Output: Diffuse pulmonary opacities, unchanged. Large degree of ectopic gas again noted.


Instruction: Generate impression based on medical findings.

Input: 69 years old Male. Reason: desaturation History: increased WOB, desaturation. Tracheostomy tube and left venous catheter unchanged.Small lung volumes with diffuse interstitial opacity compatible with ARDS.No new findings.

Output: ARDS with no acute change.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male, IABP placement. IABP marker at the level of the descending aortic arch 2.6 cm below the top of the aortic arch unchanged compared to chest radiograph on 6/1/2016. Right subclavian introducer device remains in place. Right chest wall AICD device with leads unchanged.Faint patchy ground glass opacity in the right lung base. Mild perihilar bronchial wall thickening persists. No pleural effusions or pneumothorax. Heart size upper limits of normal.

Output: 1. IABP marker at the level of the descending aortic arch. 2. Faint patchy groundglass opacity in the right lung base which could represent aspirated secretions or mild edema however an early manifestation of drug reaction or atypical infection is not entirely excluded. Continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: is there an infiltrate History: cough, recent diagnosis of pneumonia Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Fever and tachypnea. Lymphoma. Central line insertion and question of mediastinal widening.VIEWS: Chest PA/lateral (two views) 09/22/15 The mediastinum is normal in appearance. No widening is present. Left central line has its tip in right atrium. Subcutaneous emphysema is noted in left chest wall.No airspace disease is seen. Linear opacities are present in both bases. Cardiac silhouette size is normal.

Output: No mediastinal widening. Subsegmental atelectasis in both bases.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: ? Pneumonia History: fever 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, 61 years old.Reason: Pre-rigid bronchscopy/airway stenting eval History: Pre-rigid bronchscopy/airway stenting eval Interval extubation. The right port remains accessed. Large right layering pleural effusion partially obscures the right infrahilar mass, not significantly changed. Right-sided volume loss with rightward mediastinal shift. There is narrowing of the left mainstem bronchus, suspected secondary to lymphadenopathy. Right pleural parenchymal scarring and pleural fluid at the apex.

Output: Interval extubation. Persistent large right pleural effusion that partially obscures a right infrahilar mass with associated right-sided volume loss.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: infection. History: Altered mental status. Heart size is normal. Atherosclerotic calcifications in the thoracic aorta.No acute focal airspace opacity. Chronic COPD/emphysema changes. No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: fractures? History: pain, assault Streaky bibasilar opacities suggest mild scarring. There is no new focal consolidation, pleural effusion or pneumothorax. The cardiac and mediastinal contours are within normal limits for size. No displaced rib fracture is evident.

Output: Mild basilar scarring, but no pneumothorax or displaced rib fracture is evident.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: sp thoracotomy, decort History: none Unchanged right central catheter and chest tubes. Unchanged right moderate hydropneumothorax.Bibasilar edema and left retrocardiac opacity, unchanged.

Output: Unchanged right hydropneumothorax, bibasilar edema and left retrocardiac opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.IABP. CHF. Lungs are clear. Heart size is normal. No pneumothorax. Aortic balloon marker stable over the aortic arch. Left subclavian ICD tip unchanged over the RV apex.

Output: Clear lungs without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: ADHF History: SOB Mild left basilar scarring and/or atelectasis again noted. No new focal pleural parenchymal opacity. Unchanged heart size. Patient again status post sternotomy. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: evaluate for pneumonia History: cough, wheezing, shortness of breath No acute cardiopulmonary abnormality.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: infection, fx, pneumo History: CP, s/p ?defibrillator went off Normal heart size within ICD lead extending to the area of the apex of the right ventricle.Mild blunting of the posterior right costophrenic angle compatible with a very small effusion, new from previous.No other significant pulmonary or pleural abnormalities.

Output: Possible small right pleural effusion and no other significant findings. This was discussed with J.Wang in the ED at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia? History: fever Interval removal of aortic balloon catheter.Presternal ICD lead in place.No significant cardiopulmonary abnormalities.Free intraperitoneal air, confirmed on an abdominal radiograph of the same day, increased from previous.

Output: Free intraperitoneal air, confirmed on an abdominal radiograph of the same day. A text page was sent to Dr. Vohra and to pager 7582 at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Sepsis and acidosis Moderately elevated right hemidiaphragm with underlying mild scarring and/or atelectasis. Decreased lung volumes, lungs are appear clear.Cardiac and mediastinal contours are grossly within limits for technique

Output: No acute disease of the then suspected and mild atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval for PNA History: pleuritic pain, cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Coronary artery calcifications are seen on the lateral view.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Rales and wheezing assess for pneumonia. Mediastinal widening similar to most recent previous study but appears progressed compared to 2008. This may be at least partially exaggerated a decrease in lung volumes.Interval development of patchy airspace opacities bilaterally. Right fourth rib sclerotic lesion unchanged.

Output: Highly tortuous thoracic aorta with possible ectasia or aneurysm of the ascending segment, new from 2008 but of unclear chronicity. Bilateral airspace opacities most consistent with diffuse aspiration pneumonitis and bronchiolitis and/or aspiration pneumonia.Findings discussed with Dr. Choi via telephone on 11/25/2015, 1:56 PM.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: r/o PNA History: cough None heart size normal.Lungs clear.5 mm calcified granuloma seen in left midlung zone.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 57 years old Male. Reason: assess central line History: assess central line. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is interval improvement of the bilateral interstitial edema as compared with prior study.Tubes and lines are stable in position.

Output: The above findings are consistent with mild congestive heart failure, improved as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: chest pain, productive cough, hx sickle cell History: above The heart is normal in size.Lung volumes are normal. No abnormal focal lung opacities.The pleural spaces are within normal limits.Both humeral heads are partially included in the field-of-view. Mild endplate deformity, in keeping with history of sickle cell disease. No acute osseous lesions are noted.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: left pleural effusion History: none Unremarkable cardiac and mediastinal silhouette. Moderate bilateral pleural effusions with a Pleurx catheter on the left, not significantly changed.Underlying lower zone interstitial opacities suggestive of edema and atelectasis.

Output: Pleural effusions and lower zone interstitial edema without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Status post esophageal stent. Unchanged positions of the multiple esophageal stents. Unchanged positions of the tracheostomy tube, right chest tube, right jugular catheter, and right PICC.Enteric tube tip in the distal esophagus, similar to prior. Stable cardiomediastinal silhouette.Small to moderate right pleural effusion and right basilar atelectasis are similar to prior.

Output: Unchanged right pleural effusion and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: follow-up for pleural effusion History: follow-up pleural effusion Persistent moderately large left pleural effusion with underlying atelectasis.Probable small right pleural effusion.No significant change.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: 44 yo with h/o HTN here with SOB History: SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of metastatic bladder cancer CHEST:LUNGS AND PLEURA: Index left upper lobe pulmonary nodule is stable measuring 4-mm image number 36, series number 5. Right lower lobe nodule has increased in size and now measures 17 x 14 mm image number 69, series number 5. Left lower lobe nodule is also increased in size.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A moderate left-sided hydroureter and hydronephrosis, new from previous CT.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: The patient is status post cystectomy. Ileal pouch is unremarkable.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the lung nodules. Interval development of left-sided moderate hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Follow-up on atelectasis/mucous plugging in left lower lobe. History of Ewing's sarcoma. Right chest port unchanged in position. Left anterolateral chest wall surgical hardware. Interval resolution of previously seen left lower lobe opacity. No focal airspace process is appreciated. Scarring at the left lung base with chronic mild elevation of the lateral aspect of the diaphragm.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: monitor for aspiration History: intubated Bilateral pleural effusions and lower lung zone edema with left lower lobe consolidation, unchanged.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: Unchanged pleural effusions and basilar edema. Left lower lobe retrocardiac atelectasis could be the result of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: where is ett? History: osh transfer with ett ET tube tip approximately 5 cm above the carina.ICD leads and LVAD unchanged.No sign of CHF or infection.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: pleural effusions, poss PNA History: pleural effusions, poss PNA NG tube tip in stomach. No change in cardiomegaly with small bilateral pleural effusions with basilar opacities, likely atelectasis, though aspiration or infection cannot be excluded.

Output: No change in cardiomegaly with small bilateral pleural effusions with basilar opacities, likely atelectasis, though aspiration or infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: Pt with known left pneumothorax. Receiving aggressive fluid resuscitation. Eval for worsening pulm edema/ effusion/ status of pneumothorax History: As above Unchanged pneumoperitoneum, with further gas distention of the stomach.Moderate size left pneumothorax. Small lung volumes with a slight atelectasis and possible edema.Right jugular catheter, tip in SVC.

Output: Unchanged left pneumothorax. Stable pneumoperitoneum. Unchanged basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: pt with questionable pneumonia on cxr, recheck per pulm History: abnormal CXR finding Previously demonstrated right basilar opacity is no longer apparent. Slight increase in right basilar subsegmental atelectasis or scarring. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Unchanged port catheter.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Cough. The cardiomediastinal silhouette is normal.Very small left upper lobe focus is non-specific. No definite evidence of infection.Right axillary surgical clips.

Output: Very small left upper lobe focus is non-specific and could represent atelectasis, focal aspirate or possible a very small early or resolving infection; follow-up may be obtained as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: eval for PNA History: sob Stable cardiomediastinal silhouette. Vascular redistribution with no specific evidence of infection or edema.No pleural effusion. No pneumothorax.

Output: Stable cardiac mediastinal silhouette. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: evaluation History: dyspnea Left Port-A-Cath and right basilar chest tube unchanged.Small right basilar loculated pneumothorax again noted.Stable cardiac enlargement.Right pleural effusion/thickening and basilar consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance. Persistent small right-sided pneumothorax and right basilar consolidation/atelectasis with associated pleural effusion


Instruction: Generate impression based on medical findings.

Input: Female 27 years old Reason: Evaluate for mediastinal mass or hiatal hernia History: swallowing difficulty, chest pain with eating Normal cardiomediastinal silhouette. No focal air space opacities, pleural effusion or pneumothorax. The upper trachea is slightly shifted towards the right but normal in caliber. This may be positional and is only partially visualized.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: pulmonary edema? Pneumonia? History: SOB Moderate cardiomegaly.Mild/moderate pulmonary edema with small pleural effusions consistent with CHF.Left subclavian pacemaker, leads unchanged in position.

Output: CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Fitting and adjustment of IABP. Left subclavian ICD unchanged in position. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No pneumothorax. IABP unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: re-evaluate linear hyperdensity above carina: foreign body vs external History: linear hyperdensity seen on last film The previously described metallic density projected at over the area of the carina is no longer visible and was presumably external to the patient. Similar opacities are now projected over the left upper lung and probably represent tubing connectors.ET tube tip approximately 3 cm above the carina. Catheter tip in the SVC.Patchy bilateral airspace opacities suggestive of infection are still present, not significantly changed.

Output: No evidence of internal radiopaque foreign body. Other findings not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male with testicular cancer CHEST:LUNGS AND PLEURA: Calcified subcentimeter granuloma in the left upper lobe. Punctate nodule on image number 51, series number 5 in the left lower lobe, nonspecific.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ill-defined punctate hypodense lesion on image number 86, series number 3 in the left lobe of the liver.5.7 x 2.2 cm lesion in the right lobe of the liver, demonstrating heterogeneous enhancement. Although this lesion most likely represents hemangioma, and multiple phase CT or MR may be helpful for confirmation.A third hepatic lesion measures 11 mm image number 106, series number 3 in the medial segment of the left lobe. This likely represents an area of perfusion defect or focal fat. A true focal solid lesion is a much less likely possibility.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Multiple liver lesions, most likely benign in etiology. Liver MRI may helpful for confirmation of benign etiology of these lesions. Other option for further evaluation of these lesions can be the follow-up imaging.


Instruction: Generate impression based on medical findings.

Input: 63 year-old woman with anaplastic large cell lymphoma status post stem cell transplant. One-year evaluation. CHEST:LUNGS AND PLEURA: Minimal bilateral basilar atelectasis is stable.MEDIASTINUM AND HILA: Central venous catheter is seen with the tip in the distal SVC.CHEST WALL: Port-A-Cath in the subcutaneous tissues overlying the right chest is unchanged in position. Small bilateral axillary lymph nodes are unchanged. Reference lymph node in the left axilla measures 1.3 x 0.9 cm (series 3, image 23) and is also unchanged.ABDOMEN:LIVER, BILIARY TRACT: Status-post cholecystectomy. Hypodensity at the dome of the liver is unchanged.SPLEEN: Splenic calcifications are unchanged and may represent prior granulomatous disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable right adrenal nodule measuring 2.0 x 1.3 cm (series 3, image 105). Stable left adrenal nodule measuring 1.1 x 0.9 cm (series 3, image 95).KIDNEYS, URETERS: Minimal dilatation of the left collecting system is unchanged. Bilateral renal hypodensities are unchanged.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter is noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disease affect the lower lumbar spine.OTHER: No significant abnormality noted.

Output: 1.Stable axillary lymphadenopathy. No evidence of new lesions or of disease progression.2.Stable bilateral adrenal nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: SOB History: sob Mild/moderate cardiomegaly with basilar interstitial edema and small pleural effusions, consistent with CHF.Left subclavian ICD, leads unchanged in position.

Output: CHF without infection.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old, with history of amiodarone toxicity and Legionella, now with nodules. Concern for fungal infection. LUNGS AND PLEURA: Bilateral, predominantly lower lobe nodular opacities are redemonstrated. The reference nodule in the right lower lobe now measures 1.4 cm in diameter, increased from 8 mm. The reference left lower lobe nodule measures 12 x 9 mm, probably unchanged. Both demonstrate peripheral hazy groundglass opacity highly suggestive of fungal infection, likely invasive aspergillosis. A nodular opacity in the right lower lobe on axial image 57/110 is new.Peribronchial groundglass opacity persists and can be seen in aspiration, viral infection or hemorrhage. Debris within the left mainstem bronchus favors aspiration.MEDIASTINUM AND HILA: AICD leads in the right atrial appendage and right ventricle. Mediastinal surgical clips. Cardiac size is mildly enlarged. No pericardial effusion. Coronary artery calcifications. No significant change in small mediastinal lymph nodes.CHEST WALL: Left chest wall pacemaker generator. Median sternotomy wires. Sclerosis and mild compression deformity of the T4 and T6 vertebral bodies, unchanged. Deformity of the left T5 and T6 ribs suggestive of healed fractures.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Progression of nodular opacities highly suggestive of invasive fungal infection.2.Peribronchial groundglass most likely represents aspiration, although viral infection and hemorrhage may also be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: evaluate for source of cough History: cough Stable bibasilar subsegmental atelectasis or scarring. No focal lung consolidation. No pleural effusion or pneumothorax. Heart size and the upper limit of normal. Patient again status post sternotomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Evaluate for edema. History of congestive heart failure with dyspnea on exertion. No focal consolidation, pleural effusion or pneumothorax. Mild interstitial changes of unclear etiology, probably chronic. Mildly enlarged cardiomediastinal silhouette, unchanged.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Two months of shortness or breath/wheeze/productive cough. Unremarkable cardiac silhouette. Moderately tortuous thoracic aorta, unchanged.No evidence of infection or edema.

Output: No significant acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: pneumonia History: SOB Stable bilateral pleural effusions, right greater than left, and right-sided pleural thickening. No new opacity.

Output: Stable bilateral pleural effusions, right greater than left, and right-sided pleural thickening. No new opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: eval ETT placement History: ETT in place Lines and tubes are unchanged. Increased aeration of the left lung. Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable small pleural effusions. Unchanged cardiomegaly.

Output: Improved aeration of the left lung. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: SOB, cough Normal heart size with a tortuous aorta.Large lung volumes with surgical staples in the right apical area.No sign of pneumothorax or pneumonia.

Output: Probable COPD with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: SOB, tachypnea Diffuse nonspecific airspace opacity and pleural effusions, suggestive of edema, increased in the upper lung zones compared to previous.NG tube tip in the stomach.

Output: Findings suggestive of pulmonary edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: ett History: as above ET tube tip approximately 5 cm above the carina.Bilateral catheters extending to the SVC.Right perihilar airspace opacity compatible with aspiration and infection, not significantly changed from the previous day but new since an earlier radiograph.Right lower lobe atelectasis has largely cleared.

Output: Persistent right perihilar opacity suggestive of infection and aspiration.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with cough and a concerning chest x-ray. Evaluate for infection versus malignancy versus sarcoid. CHEST:LUNGS AND PLEURA: Scattered micronodules with peribronchovascular thickening and areas of architectural distortion in both lungs with associated traction bronchiectasis.Focal area of atelectasis/consolidation is noted in the lateral segment of the right middle lobe along the minor fissure. In this region there is also focal cystic bronchiectasis versus an intrapulmonary cavity (series 5, image 49).MEDIASTINUM AND HILA: Enlarged mediastinal and hilar lymph nodes. For reference, a right paratracheal node (series 3, image 17) measures 1.6 x 0.9 cm. Heart size normal without pericardial effusion.Coronary calcifications.CHEST WALL: Probable bone island in a midthoracic vertebra. UPPER ABDOMEN: Mildly enlarged lymph nodes noted in the upper abdomen.

Output: 1. Peribronchovascular thickening with reticular interstitial thickening and associated traction bronchiectasis; enlarged mediastinal and hilar lymph nodes as well. Findings are most compatible with sarcoidosis. Postinfectious etiology and hypersensitivity pneumonitis are less likely differential considerations.2. Focal area of atelectasis/consolidation in the right middle lobe along the minor fissure which may be due to superimposed infection or sarcoid-related bronchial stenosis.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: evaluate for recurrent HCC as lung metastases History: s/p OLT for HCC Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.Surgical clips overlie the left upper chest and the upper abdomen.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Assess for Swan placement. Right subclavian Swan-Ganz catheter tip at the level of the right main pulmonary artery. IABP marker unchanged in position projecting over the aortic arch level. Left subclavian ICD unchanged.The visualized lung parenchyma appears clear. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: Right subclavian Swan-Ganz catheter tip at the right main pulmonary artery level. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with atypical chest pain. Cardiomegaly, similar to prior. Prominent pulmonary arteries suggestive of pulmonary hypertension.No focal consolidation, pleural effusion, or pneumothorax.

Output: Prominent pulmonary arteries suggestive of pulmonary hypertension. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: Organ transplant History: Organ Transplant Persistent left basilar subsegmental atelectasis. No signs of pulmonary edema.High lying esophageal temperature probe again noted in the cervical esophagus. Enteric tube courses below the diaphragm.Limited assessment for pleural effusions. No pneumothorax.

Output: Persistent left basilar discoid atelectasis.Advancement of esophageal temperature probe is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: eval for SOB History: hypoxia to 40%, tachypnea, tachycardia Opacities may be worse than before, with some minimal pleural fluid.Heart size normal.More recent radiographs have been obtained.

Output: Dense airspace opacities consistent with acute edema or ARDS, or inhalational injury including drug toxicity.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Edema History: Chest pain Lungs hypoinflated though there is no acute cardiopulmonary abnormality.

Output: Lungs hypoinflated though there is no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: FemaleReason for Study: Reason: here with VOC, now with fever. new opacity?? History: VOC Stable cardiomediastinal silhouette.Minimal discoid atelectasis at the left lung base.No focal areas of consolidation.No pleural effusions.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Intubation. Altered mental status. Scattered bibasilar opacities likely reflecting atelectasis and scarring are stable. ET tube is 6 cm above the carina. NG tube at least in the stomach. No pneumothorax.

Output: Unchanged bibasilar atelectasis/fibrosis. ET tube 6 cm above the carina. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval lung fields. Burn, s/p ARDS, + tracheal cultures. History: hypoxia Tracheostomy and left IJ catheter not significantly changed. Enteric tube terminates beyond the field-of-view.Diffuse bilateral interstitial and airspace opacities have slightly improved from the prior exam.Stable cardiomediastinal silhouette.

Output: Slight interval improvement in diffuse bilateral interstitial and airspace opacities.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: 70-year-old female admitted for hip fracture, recent seizure now irregular breathing. Evaluate for pneumonia. Evaluation of the lungs is suboptimal secondary to patient positioning and overlying anatomy. Lucency along the anterior mediastinum likely represents aerated lung tissue as there appears to be pulmonary vasculature coursing through it. Bibasilar hazy opacities which may represent atelectasis.

Output: Suboptimal evaluation secondary to patient positioning. Repeat radiograph with more optimal positioning is recommended when feasible.


Instruction: Generate impression based on medical findings.

Input: Reason: is there lung cancer? History: weight loss and sob Unremarkable cardiac and mediastinal silhouette. Large lung volumes consistent with COPD.No sign of lung cancer or other significant interval change.

Output: COPD with no specific evidence of lung cancer or other acute disease.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery ET tube tip in right main bronchus and the left lung partially collapsed. Chest tubes with no pneumothorax.Left jugular introducer.

Output: ET tube in right main bronchus, subsequently repositioned.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Shortness of breath. Volume overload. Upper normal heart size. SVC is distended. Mild vascular redistribution, but no septal thickening.Sclerotic lesions in the right first and second ribs chronic and unchanged.Mild atelectasis at the right base.Sternotomy hardware similar in alignment.

Output: Signs of hypervolemia, but no specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: shortness of breath, evaluate for infection Vs fluid overload History: shortness of breath Known large right-sided lung mass again noted with other areas of pleural nodularity in the right hemithorax. Left lung remains essentially clear. Likely normal heart size with aortic atherosclerosis.

Output: No new focal lung consolidation compared to recent chest CT though comparison of CT to radiography is difficult.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: dialysis line exchange History: see above Small lung volumes and possible subpulmonic effusions.Mild retrocardiac atelectasis since questionable basilar edema.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.New right jugular catheter, tip in SVC.Left jugular catheter tip at right atrial level.

Output: Small lung volumes with basilar opacities overall unchanged. Right jugular catheter exchange.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: progression of infection History: increasing WBC, altered Unchanged right PICC. Mild pulmonary edema with bibasilar opacities and pleural effusions again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged left greater right bibasilar atelectasis and/or consolidated lung with small pleural effusions and moderate cardiomegaly. Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT, lung fields History: s/p ECMO Interval removal of a catheter from the mediastinum.ECMO catheters in place.ET tube and other devices unchanged.Cardiomegaly with mild interstitial edema and left lower lobe consolidation and atelectasis, unchanged.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with abdominal pain and nausea CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral axillary adenopathy. Reference left axillary lymph node measuring 14 x 12 mm image number 24, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis with distended gallbladder, mild gallbladder wall thickening and small amount of pericholecystic fluid suggestive of acute cholecystitis. No biliary dilatation. No focal liver lesions. Mild hepatomegaly.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large right ovarian cystic lesion measuring 6.2 x 2.5 cm. Further evaluation with pelvic ultrasound is recommended. Enlarged uterus. A fibroid may be present near the lower body measuring 6 x 4.7 cm.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: Shotty bilateral inguinal lymph nodes.

Output: Cholelithiasis with acute cholecystitis.Bilateral axillary adenopathy of uncertain etiology.Pelvic ultrasound is recommended to evaluate the right ovarian cystic lesion enlarged uterus.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: known fibrosis; transplant work up; eval for consolidation History: sinusitis Low lung volumes and chronic fibrosis, unchanged. No new focal air space opacity. Normal heart size.

Output: Chronic lung disease with no superimposed acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pt with HfpEF, undergoing work up for heart transplant, eval for pulmonary edema History: DOE Moderate cardiomegaly with ICD leads in place, unchanged.Increased upper zone blood flow but no sign of pulmonary edema or visible effusions.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: evaluate for pneumonia History: cough x 3 weeks, history of fever, dyspnea Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: s/p LLLobectomy, eval for PTX History: LLLobectomy 2 chest tubes overlie the left apex. Decreased size of left pneumothorax, approximately 4 mm in the left apex.Stable postsurgical changes following left lower lobectomy, with elevation of the left hemidiaphragm and hyperexpansion of the left upper lobe. Right basilar and mid lung scarring. No pleural effusion.Status post AVR and mitral annuloplasty. Surgical clips in the abdomen and staple line overlying the left mediastinum.

Output: Decreased size of left apical pneumothorax, 4 mm.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: et tube History: et tube Coarse interstitial opacities slightly worse suggestive of atypical edema or aspiration.Tracheostomy tube tip 7 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Left PICC, tip in the SVC.Right jugular catheter still doubled back in the right jugular.

Output: Tracheostomy tube tip 7 cm above the carina. Worsening pulmonary opacities suggestive of edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Cough and shortness of breath. No focal opacities to suggest acute infection. No evidence of pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. Elongated opacities projecting over the left lower lobe are likely artifactual/external to the patient and are not visualized on the lateral view.

Output: No evidence to suggest acute infection.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain, evaluate for obstruction Dilated small bowel, measuring up to 4.8 cm, with relatively less air seen in colon. Postsurgical suture material seen in right lower abdomen. Transition point suggested in right lower quadrant. Multilevel degenerative changes of spine and scoliosis seen. Pelvic radiation seeds.

Output: Findings suspicious for small bowel obstruction. This may be further assessed with dedicated CT imaging if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: FemaleReason for Study: Reason: Hx of HTN History: intermittent chest pain w/radiation to back The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Intubated, aspiration pneumonia. ETT tip 3.5 cm above the level of the carina. Enteric tube unchanged in position.Moderate volume of pleural fluid bilaterally, about the same. Mild volume loss in the upper lobes bilaterally.Diffuse edema-like abnormality, moderate to severe, with relative sparing of the left lower lobe; this may be seen with PE in the appropriate clinical setting.

Output: Moderate to severe edema-like abnormality with relative sparing of the left lower lobe parenchyma, this may seen with PE in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: New lung CA. Normal heart size. Right hilar and suprahilar contour abnormality consistent with lymphadenopathy/mass. The right paratracheal stripe is prominent which may be due to lymphadenopathy and partial collapse of the upper lobe. The contralateral lower paratracheal region also appears prominent but is indeterminate for lymphadenopathy. No signs of pulmonary edema or additional parenchymal lung nodules by plain film technique.

Output: Right hilar and paratracheal contour abnormality likely reflecting the patient's known lung cancer. There is also questionable low left paratracheal lymphadenopathy. CT may be obtained when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval for effusion History: dyspnea Chest port tip projects over the superior cavoatrial junction.Left greater than right bilateral pleural effusions with adjacent atelectasis.Low lung volumes. No pneumothorax.

Output: Interval increase in size of large pleural effusions, left greater than right, with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: on supplemental oxygen, known left pleural effusion, History: on supplemental oxygen, known pleural effusion, Low lung volumes with basilar opacities have not changed significantly.Stable line position.No pneumothorax.

Output: Basilar opacities representing atelectasis with no other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Assess pulmonary edema. Left internal jugular central venous catheter tip terminates in the right atrium.Right internal jugular central venous catheter tip terminates in the upper atrium.The right upper extremity PICC has been removed.Small bilateral pleural effusions unchanged. Diffuse predominantly interstitial opacities and cardiomegaly unchanged.

Output: Removal of the right upper extremity PICC. Diffuse, predominately interstitial opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old, short of breath, possible CVA. LUNGS AND PLEURA: Nonspecific right upper lobe micronodule (image 31, series 5) probably represents a post infectious/inflammatory etiology given the patient's age.No focal airspace disease or pleural fluid. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The cardiac size is normal. No significant pericardial effusion. No pathologically enlarged hilar or mediastinal lymph nodes.UPPER ABDOMEN: No significant abnormality noted.

Output: Unremarkable examination with no specific finding to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: leukocytosis History: leukocytosis Right-sided venous catheter has been removed. Enteric tube tip near the pylorus. Left jugular dialysis catheter in SVC. Right jugular catheter tip in inferior aspect in right jugular vein. No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: sp AVR, MVR ET tube tip approximately 2 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery.Bilateral airspace and interstitial opacity compatible with edema, not significantly changed.

Output: Interval advancement of Swan-Ganz catheter and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: new central line, confirm placement History: new central line Small lung volumes.Mild cardiomegaly.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: s/p ICD shock. confirm IABP placement History: s/p ICD shock Unchanged cardiomediastinal silhouette including mild cardiomegaly.Unchanged position of the ICD leads.IABP marker in the aortic arch, not significantly changed in position.Interval removal of right IJ catheter.Surgical clips project over the right upper chest wall.Right peripheral inserted catheter terminates in the right axilla.No significant pleural effusion or pneumothorax.Splenic artery calcifications.

Output: Stable cardiomegaly. IABP marker not significantly changed in position.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Check pulmonary status. New Dobbhoff tube, with tip inferior to the field-of-view.Perihilar and basilar opacities, likely reflecting edema, effusions and atelectasis better evaluated on recent CT.Stable cardiac silhouette size.

Output: Stable cardiopulmonary appearance, with edema, effusions, and basilar atelectasis.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 pneumonia History: hemoptysisVIEWS: Chest PA/lateral (two views) 6/7/2016 at 21:59. The cardiothymic silhouette is normal.Large lung volumes. No focal pulmonary opacities, pleural effusion or pneumothorax.

Output: Large lung volumes. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Intubation.. Endotracheal tube tip terminates in the cervical portion of the trachea above the thoracic inlet. Enteric tube extends at least to the stomach, but the tip is off the caudal margin of the film. Cholecystectomy clips right upper quadrant.Chronic elevation of the right hemidiaphragm with basal scarring and atelectasis bilaterally. No specific evidence of CHF or pneumonia.

Output: High position of endotracheal tube which terminates in the cervical trachea.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: 37 y/o man with cardiomyopathy now s/p single chamber ICD History: cardiomyopathy Cardiomegaly, with a mild edema pattern unchanged.Left subclavian single lead ICD place, the tip in the expected location of the RV apex.No significant pneumothorax.

Output: Single chamber ICD placed, without complication.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Essentially unchanged cardiopulmonary appearance with extensive skeletal deformities previously described. Persistent small lung volumes which remain grossly clear.Right jugular port unchanged, tip projects into the proximal SVC.

Output: Unchanged right jugular port


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: 41M with severe ARDS, monitoring ETT placement History: see above Lines and tubes are unchanged. Unchanged diffuse pulmonary opacities. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Unchanged diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.CHF and PE on Eliquis with increased SOB assess for pneumonia or pulmonary edema. Unchanged moderate to severe multichamber cardiomegaly. Retrocardiac opacity most consistent with atelectasis. No specific signs of pulmonary edema or pneumonia. No pneumothorax or pleural fluid. Partially visualized catheter projects over the anterior right upper abdomen, unclear if this is internal or external to the patient.

Output: Retrocardiac compressive atelectasis related cardiomegaly, but no specific signs of CHF or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: dht placement History: dht placed Enteric tube has been placed which terminates inferior to the caudal margin of the image. Multiple additional catheters appear external to the patient.Slight increased lung volume without other significant change. Heart size remains normal.

Output: Enteric tube has been placed which terminates inferior to the caudal margin of the image.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: infiltrate/edema/effusion History: new heart txp Median sternotomy with chest tubes but no pneumothorax.Unchanged basilar opacities post op areaLeft jugular Swan-Ganz catheter tip in main pulmonary artery.Left PICC, tip in axillary region.

Output: No significant pneumothorax. No new findings.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent small right pleural effusion with patchy opacities in larger in the right lung base, nonspecific. Concern for aspiration versus multifocal infection are most likely. The cardiac and mediastinal contours remain within limits and unchanged. Right PICC line extends into the upper SVC

Output: Nonspecific bilateral, greater on the right, patchy opacities and small effusions


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: PNA? History: PNA? Small lung volumes with a slight improvement in basilar opacities that may be the result of aspirated secretions.Tracheostomy tube tip 5 cm above the carina.

Output: Slight improvement in basilar opacities with no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o mass or infiltrate; History: new onset seizure Approximately 2 cm right upper lobe nodule.No specific evidence of infection or edema.Heart size normal.

Output: Right upper lobe nodule suggestive of lung cancer, for which a CT examination is recommended, including an abdomen with contrast, for complete staging.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: eval for intrathoracic abnormality. hx of afib s/p cardioversion with cp. History: R sided chest pain 5/10 Stable cardiomediastinal silhouette.Mild deviation of the trachea from left-to-right most likely related to a goiter.Apical pleural thickening again noted.Left basilar scarring/discoid atelectasis.No new pulmonary opacities.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: s/p right lower lobectomy, right chest tubes x 2 History: right chest tubes x 2 Interval placement of 2 right chest tubes, with tips along the right hemidiaphragm and overlying the posterior right fifth rib.The side port of the more inferior chest tube is external to the pleural space.No significant pneumothorax.Unremarkable cardiomediastinal silhouette.Possible small left pleural effusion and basilar atelectasis.Subcutaneous emphysema in the right lateral chest wall is likely postprocedural.

Output: Interval placement of right chest tubes, without significant pneumothorax. Please note, the side port of the inferior chest tube is external to the pleural space.Findings conveyed to ordering provider, Dr. Henry, at pager 1558, on 09/11/15 at 16:27


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval lung fields History: CP, sob Chronic left hemidiaphragm elevation with overlying atelectasis.No specific evidence of infection or failure.Heart size at least mildly enlarged.

Output: Mild cardiac enlargement with chronic left hemidiaphragm elevation. No specific evidence of infection or failure.


Instruction: Generate impression based on medical findings.

Input: 11-year-old male patient with history of cerebral palsy, increased irritability, and cough.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 09/17/2015 at 22:26 hours. Cephalic shunt tip is to the left of midline in the middle cranial fossa. Distal shunt tubing courses along the left head and neck and continues over the left chest. Tubing enters the abdomen in the left upper quadrant. Distal shunt tip is in the left hemiabdomen.There is scaphocephaly; the skull has a long AP diameter.No focal airspace opacity.There is mild to moderate dilatation of a small bowel loop in the upper mid abdomen.

Output: No evidence of extracranial shunt malfunction. Mild to moderate dilatation of a small bowel loop in the upper mid abdomen.


Instruction: Generate impression based on medical findings.

Input: Prolonged cough. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.Moderate degenerative changes of the thoracic spine with loss of intervertebral disc space height and endplate sclerosis.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: PNA v URI History: AMS Cardiomegaly with bilateral airspace opacities and pleural effusions, findings most compatible with congestive heart failure. Superimposed infection cannot be excluded.No pneumothorax.

Output: Findings most compatible with congestive heart failure. Superimposed infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: PICC line placed History: none Right upper extremity PICC tip is in the right atrium. Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities.

Output: Right upper extremity PICC tip is in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Reason: dobhoff placement History: dobhoff placement Dobbhoff tube tip in a proximal right lower lobe bronchus.Catheter tip in the area of the SVC.Small lung volumes with nonspecific bilateral perihilar opacity, not significantly changed.The findings were discussed with Dr. Shamaa at the time of reporting.

Output: Dobbhoff tube tip in the right lung. This has been subsequently repositioned, according to the clinical service.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Bilateral lower extremity weakness. Right IJ catheter central placement. Right jugular catheter tip at the SVC. No pneumothorax. No focal airspace opacities.

Output: Appropriate position of right jugular catheter with tip at the SVC. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: intubated History: evaluate ETT Pleural effusions and basilar opacities unchanged.ET tube low, cannulating the right main bronchus, subsequently repositioned.An NG tube terminates in the stomach.Left jugular catheter, tip at right atrial level.

Output: Unchanged basilar opacities. Low ET tube, subsequently repositioned.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: newly placed PICC History: assess tip Interval placement of a left PICC that terminates at the level of the azygos vein. Reticulation of the left costophrenic angle from scar or subsegmental atelectasis. No interval pulmonary edema or pneumothorax.

Output: Left PICC terminates at the azygos vein. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male status post APR and envelope the cystoprostatectomy and ileal conduit. Evaluate for fluid collection. CHEST: no evidence of enlarged mediastinal or hilar lymph nodes.Emphysematous changes. Left apical scarring. Follow-up CT is recommended to exclude a neoplasm. Atelectasis in the right upper lobe. Multiple bullae and blebs in both lungs.The pattern atelectasis and right-sided pleural calcifications.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Calcifications in the pancreas suggestive of chronic pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Not visualized. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Right lower quadrant ileostomy and left lower quadrant ostomy. No evidence of bowel obstruction.BONES, SOFT TISSUES: Posterior decubitus ulcer is unchanged.OTHER: Again noted is a collection in the pelvis with percutaneous drains in them. Collection has an air-fluid level and measures 3.8 x 4.4 cm. no significant change in size.

Output: Significant emphysematous changes. Follow-up chest CT is recommended for further evaluation of the left apex.Pelvic abscess has not significantly changed within the interval.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: r/o pneumonia History: previous cxr demonstrated possible aspiration vs. infection Significant interval improvement in the degree of interstitial and airspace opacities, likely representing improving pulmonary edema. Basilar opacities remain as well as cardiomegaly. No pneumothorax.

Output: Resolving pulmonary edema


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with chest pain, evaluate for aortic dissection. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Precarinal and prevascular lymph nodes are seen. Reference node measures 10.7 mm x 12.4 mm on series 3, image 41. There is mild cardiomegaly. There is no evidence of an aortic dissection. The pulmonary trunk is dialated and measures 3.8 cm (series 9, image 57).CHEST WALL: No significant abnormality noted. LUNG BASES: There is opacity in the left lung base, likely representing atelectasis.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: There is a large right renal cyst measuring 5.3 cm x 5 cm (series 3, image 142).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is mild dilatation of the infrarenal aorta with a maximum AP diameter of 3.0 cm (series 9, image 189).PELVIS:LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. No evidence of an aortic dissection; mild dilatation of the infrarenal aorta, measurements as above 2. Dilatation of the pulmonary trunk suggestive of pulmonary arterial hypertension3. Nonspecific mediastinal adenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: ? volume Moderately severe cardiomegaly with vascular redistribution but no specific evidence of pulmonary edema or pleural effusion.Free intraperitoneal air, similar to previous radiographs, likely secondary to peritoneal dialysis.No sign of pneumonia.

Output: Cardiomegaly and vascular redistribution consistent with chronic volume overload but no reliable evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: line exchange History: line exchange Moderate to severe cardiomegaly status post sternotomy, with left lower lobe consolidation and basilar edema unchanged.Circulatory assist catheters stable in position. Left jugular catheter, tip in SVC.Right jugular introducer.Left subclavian ICD, leads unchanged in position.

Output: Unchanged cardiomegaly, left lower lobe consolidation and edema. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: evaluate for consolidation History: new onset fever Small lung volumes.Heart size normal.Right jugular catheter tip at cavoatrial junction.Gastrostomy tube.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Chronic cough. Preop for AVR. Moderate multichamber cardiomegaly. Enlargement central pulmonary vasculature consistent with pulmonary hypertension. Atherosclerotic calcification of the aorta at the level of the arch noted.No focal pulmonary opacities or signs of CHF. No pleural fluid.

Output: Cardiomegaly and signs of pulmonary hypertension. No acute pulmonary abnormality to account for the patient's symptom of cough.


Instruction: Generate impression based on medical findings.

Input: Diabetic cardiomyopathy.VIEWS: Chest PA/lateral (two views) 04/06/15 Pacer device in the left chest has its lead tip in the right ventricular apex.Cardiothymic silhouette is upper limits of normal in size. The aortic arch, cardiac apex, and stomach are left-sided. No focal lung opacity is identified.The BMI is abnormally increased.

Output: Transvenous pacer tip in right ventricular apex.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: 35 y/o female with nasopharyngeal cancer pain with deep breath left lower chest History: pleuritic pain Right chest port with tip in the SVC. G-tube in place.Cardiothymic silhouette is normal and unchanged. No pleural effusion or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality. Interval placement of G-tube.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with cough and low-grade fever. Evaluate for pneumonia. Low lung volumes. Cardiomediastinal silhouette is unremarkable. No focal pulmonary opacity, pleural effusion, or pneumothorax. Interval removal of left central venous catheter. Calcified shunt tubing tract in the right hemithorax is again visualized.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with abdominal pain. Patient had abnormal CT scan with recurrent suspected in multiple liver METs in tail of pancreas. CXR showed lung lesions. Biopsy of liver is adenocarcinoma more consistent with lung and pancreas. LUNGS AND PLEURA: Multiple, scattered subcentimeter well-defined soft tissue density lesions, bilaterally, consistent with metastatic disease. One of these metastatic lesions demonstrates cavitation with a pattern that can be see in metastatic colon cancer.MEDIASTINUM AND HILA: No significant lymphadenopathy or other abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Multiple poorly defined hypodense lesions throughout the liver the largest of which measures 2.5 x 2.7 cm, (image 85/147) consistent with patient's history of metastatic disease. Multiple gallstones in the gallbladder.Large, poorly defined low attenuation lesion in the tail of the pancreas may represent a metastasis.

Output: 1. Multiple lung lesions compatible with metastatic disease; one with a distinct area of cavitation.2. Multiple metastases in the liver.3. Low attenuation lesion in the tail of the pancreas.


Instruction: Generate impression based on medical findings.

Input: ETT check 2 right chest tubes are observed without a significant pneumothorax. Additional mediastinal chest tubes, Swan-Ganz and ETT are all otherwise unchanged. See subsequent report

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Sepsis, check for pneumonia Moderate nonspecific cardiomegaly with underlying clear yet with mildly decreased lung volumes is all unchanged. The right jugular dialysis catheter is also similar tip extending into the right atrium

Output: Moderate nonspecific cardiomegaly without superimposed additional new abnormality


Instruction: Generate impression based on medical findings.

Input: Male 16 years old Reason: 16 yo M with spinal tumor and tumor thrombus of SVC/innominate vein, RA/RV s/p tumorthrombectomy. Evaluate for effusion or edema. History: s/p cardiac surgery.VIEW: Chest AP (one view) 313/15 at 730 hours. Lower cervical spine hardware, mediastinal clips, sternal wires, right-sided chest tube and atrial lines again noted. Cardiac silhouette size is normal. Interval development of left-sided pleural effusion and left retrocardiac opacity, likely acute disease or pneumonia.

Output: Interval development of left retrocardiac atelectasis and left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: 66 yo woman with cough. History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: pt with recently diagnosed PNA transferred from NH with SOB History: SOB Increase in diffuse pulmonary opacities, right greater than left with increase in pleural effusions. New patchy bibasilar opacities. Unchanged heart size at the upper limit of normal. No pneumothorax.

Output: Worsening pulmonary edema and pleural effusions. Patchy basilar opacities may represent pulmonary edema, atelectasis, and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Bandemia Focal opacity overlying the right first costochondral junction, likely musculoskeletal in origin. Underlying pulmonary lesion is less likely. No acute cardiopulmonary process on radiography. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Focal opacity overlying the right first costochondral junction, likely musculoskeletal in origin. Underlying pulmonary lesion is less likely. No acute cardiopulmonary process on radiography. Findings verbally discussed with Dr.Eric Shappell at 8:40 AM on 10/6/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Status post intubation. Location of ETT and Dobbhoff. Recent sternal washout per Dr. Martin. Air to the left of the sternotomy hardware consistent with dehiscence.Dobbhoff tube tip extends below the expected level of the left hemidiaphragm, but the tip is not visualized.The radiopaque portion of the aortic limb of the LVAD is lower than previously positioned, presumably related to the sternal dehiscence; the integrity and patency of the limb cannot be assessed on plain film.Interval opacification of the retrocardiac region on the left, probably the result of lower lobe atelectasis and pericardial fluid.Fluid in the fissure on the right. Layering pleural fluid bilaterally with atelectasis but no specific signs of edema.Left subclavian ICD unchanged.

Output: Subtle change in position of the LVAD may be due to sternal dehiscence however changes in patency of the aortic limb cannot excluded. This was discussed with Dr. Elizabeth Martin at 9:58 AM on 8/9/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Right pneumothorax status post chest tube, monitoring. Right chest port tip projects over the proximal right atrium. Decreased lung volumes. Right chest tube tip near the apex. There is probably a small residual subpulmonic component of the right pneumothorax, though it is not measurable. Diffuse predominantly interstitial opacities bilaterally and pleural nodules are without significant change. Sclerotic skeletal lesions consistent with osseous metastases. Unchanged cardiomediastinal appearance.

Output: Probable residual subpulmonic pneumothorax component, not measurable.


Instruction: Generate impression based on medical findings.

Input: 58 year old female with history of metastatic head and neck cancer. Compare to outside CTs. CHEST:LUNGS AND PLEURA: 4-mm nodule seen in right lung base (series 5, image 50) and left lung base measuring 0.9 x 0.5 cm (series 5, image 74). No pleural effusions or pleural masses are seen.MEDIASTINUM AND HILA: No significant adenopathy or other masses identified.CHEST WALL: Infusion port is in the anterior left superior chest wall with the infusion catheter tip in the proximal right atrium.ABDOMEN:LIVER, BILIARY TRACT: Too numerous to count solid mass lesions are seen throughout the liver diffusely. Representative reference lesions from measurement include superior segment 8 (series 3, image 84) measuring 3.7 x 2.1 cm; posterior segment 6 (series 3, image 103) measuring 2.3 x 2.1 cm.Gallbladder and biliary tract appearsSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered small subcentimeter cortical hypodensities, most likely benign cysts. Larger parapelvic cysts are seen, particularly in the left kidney. No other significant abnormality seen.RETROPERITONEUM, LYMPH NODES: Normal size, subcentimeter scattered periaortic lymph nodes are seen no enlarged lymph nodes or other retroperitoneal masses are seen.BOWEL, MESENTERY: Surgical clips seen in region of antrum/duodenum. Bowel itself shows no diagnostic abnormalities. No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple masses in and protruding from the uterus -- CT is not able to characterize uterine masses most likely these represent fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Bibasilar lung nodules as measured above. 2. Innumerable masses in the liver most likely liver metastases. 3. Multiple masses in uterus, most likely fibroid tumors. 4. If old films are submitted into the department of radiology PAC system, I would be glad to dictate an addendum comparison report.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: acute chest History: cough Basilar interstitial abnormality consistent with edema and scarring. Cardiomegaly. No significant pleural effusion.

Output: Basilar interstitial abnormality consistent with edema and scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: assess for post-thoracentesis pneumothorax History: s/p thora, pleural effusion The cardiac silhouette is within normal limits. There is a large right pleural effusion with leftward mediastinal deviation. Right basilar consolidation/compressive atelectasis. Multiple ill-defined nodular opacities in the left upper lobe, as seen on CT dated 8/11/2016. No pneumothorax. Multiple surgical clips in the left axilla.

Output: Large right pleural effusion and basilar consolidation. No pneumothorax. Left upper lobe pulmonary nodules better characterized on recent CT.


Instruction: Generate impression based on medical findings.

Input: Reason: wornsening PNA? History: fever and on treatment for legionella pna Catheter tip in the SVC. Feeding tube tip in the gastric antrum.Small lung volumes with bibasilar nonspecific opacity compatible with atelectasis and consolidation, not significantly changed.

Output: Nonspecific basilar consolidation and atelectasis without significant change.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with non-Hodgkin lymphoma, status post auto stem cell transplant. Restaging for disease. Compare with scans on 3/5/08 CHEST:LUNGS AND PLEURA: Right middle lobe lung nodules are stable. The reference nodule measures 14 x 9 mm (image 63; series 4).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: Stable left upper pole intermediate attenuation mass measuring 2.8 x 1.8 cm (image 95; series 3). Bilateral date renal cysts are also stable.RETROPERITONEUM, LYMPH NODES: No significant change in the mesenteric and retroperitoneal adenopathy. The reference mesenteric lymph node measures 2.2 x 1.5 cm (image 121; series 3). Reference periaortic lymph node is also unchanged and measures 1.5 x 1.5 cm (image 118).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: Post op fevers of 101.5, r/o infiltrate History: above 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: Female, 57 years old.Reason: pt with asthma w/ diffuse expiratory wheezing History: SOB No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: check ettt History: intubated Support devices unchanged.Stable cardiac mediastinal silhouette.Dense bilateral perihilar airspace opacities similar in appearance the prior exam.No new pulmonary opacities identified.Minimal small pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Pt is a 62 y/o male with met RCC, decreased breath sounds in right lung base, evaluate for effusion or pneumothorax. Pt dx with recent PE History: recent PEt, dyspnea, decreased breath sounds No significant cardiopulmonary abnormality.No evidence of metastases or other significant abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough and chest pain. History of bronchiectasis and common variable immunodeficiency. Motion artifact. Bilateral areas of scarring and architectural distortion. Worsening basal atelectasis bilaterally, now with near complete collapse of the posterior basal left lower lobe. The heart. Nodularity in the right lower and upper lobes consistent with endobronchial debris/bronchiolitis.

Output: Worsening basal atelectasis; the involved areas have intermittently partially reexpanded and collapsed suggesting extensive debris within the airways related to CVID.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Patient with non-small cell lung cancer on immunotherapy presents with cough. Evaluate for pneumonitis and infection. Right-sided chest port tip in the superior vena cava. Cardiac size within normal limits. There is a reticular opacity in the left upper lobe, compatible with posttreatment changes, as well as left lung volume loss. No pleural effusion or pneumothorax.

Output: Reticular opacity in the left upper lobe and volume loss are most compatible with posttreatment changes. If there is continued clinical concern for pneumonitis, a CT can be obtained.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: evaluation of lung fields History: s/p BL lung transplant Pulmonary air collections continue to diminish although extra thoracic soft tissue air has increased bilaterally.Pulmonary edema and foci of consolidation are stable.Tracheostomy tube tip approximately 5 cm above the carina.Left PICC, tip in left subclavian.

Output: Improving pleural air, but increased soft tissue air collections.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: Minimal pleural thickening involving the right upper lobe and dependent atelectasis are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left axillary adenopathy is smaller, measuring 1.6 x 1.6 cm on image number 28, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter hypodense lesion in the tail of the pancreas is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Redemonstration of the L1 and thoracic vertebral body hemangiomas.PELVIS:UTERUS, ADNEXA: Right adnexal lesion measures 3.8 x 3 .5 cm, image number 189, series number 3, not significantly changed from previous study. Pelvic ultrasonogram may be helpful for further evaluation.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the left axillary adenopathy.Right adnexal lesion is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: Fever/hypoxemia The cardiomediastinal silhouette is normal. No acute cardiopulmonary process is seen.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: Eval for PNA History: SOB, COPD Mild basilar interstitial opacities and left basilar septal lines suggest mild pulmonary edema. Streaky left basilar opacity suggests atelectasis. There is moderate cardiomegaly. The bones and upper abdomen are unremarkable.

Output: Cardiomegaly with mild basilar interstitial opacities and possible septal lines may reflect mild pulmonary edema secondary to CHF.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with history of metastatic mass carcinoma CHEST:LUNGS AND PLEURA: Index small intrapulmonary lymph node is unchanged on image number 44, series number 6, measuring 8 x 7-mm..Other punctate nodules, also unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Enhancing mass in the uncinate process of the pancreas measures 2 x 2.2-cm image number 118, series number 4.ADRENAL GLANDS: Status post right atherectomy. Left adrenal gland is unremarkable.KIDNEYS, URETERS: Status post right nephrectomy. Small left renal cysts are unchanged. Enhancing soft tissue mass in the right nephrectomy bed measures 17 x 16 mm on image number 115, series number 4, unchanged.RETROPERITONEUM, LYMPH NODES: Status post retroperitoneal lymph node to section.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Again noted Changes secondary to RF ablation in the left gluteal region.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 significant change from previous study. Index lesions are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: interval change History: SOB Tracheostomy unchanged in position. Persistent basilar pleural-parenchymal opacities likely due to chronic aspiration. No new opacity.

Output: Persistent basilar pleural-parenchymal opacities likely due to chronic aspiration. No new opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: re-eval for free air History: concern for evolving ischemia in setting of severe enteritis Support devices are unchanged in position.Low lung volumes with mid to lower zone opacities representing accommodation of subsegmental atelectasis and possible early edema. Small pleural effusions. No definite evidence of pneumoperitoneum. Multiple centralized, dilated loops of bowel compatible with obstruction.

Output: Persistent dilated loops of bowel compatible with obstruction. No definite evidence of pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Shortness breath. The cardiac size is upper limit of normal and there may be ectasia of the aorta, greater than expected given patient age. No signs of mediastinal hematoma. Prominence of the superior mediastinum above the level of the arch is likely due to tortuosity of the great vessels. There is mild diffuse bronchial wall thickening and scattered subsegmental atelectasis.

Output: Prominence of the thoracic aorta is greater than expected given patient age and may be associated with patient's known hypertension, however is suspicious for ectasia or aneurysm. When feasible, dedicated thoracic CT is recommended to establish baseline measurements. Diffuse bronchial wall thickening suggestive of asthma or bronchitis.Findings communicated via text page to Dr. Leukam via text page at 11:24 AM on 8/20/2016. Additionally, Drs. Ko and Leukam were sent a courtesy email regarding the recommendation.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Desaturation and fever. Compressive atelectasis at the lung bases. Mild retrocardiac atelectasis on the left. Blunting of the costophrenic angles, with minimal pleural fluid on the left. On the right, the appearance is similar to scout image from an abdominal CT dated 6/16/2016.No specific signs of pulmonary edema or pneumonia.

Output: No specific evidence of pneumonia; opacities in the lung bases are more consistent with atelectatic lung than infection.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Right upper quadrant pain. Nonspecific right lower lobe opacity. No pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: Nonspecific right lower lobe opacity. Recommend further evaluation with cross-sectional imaging.Findings discussed with Dr. Ehsan at 12:39am on 2/27/2016.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval PNA History: dyspnea Low lung volumes with bibasilar opacities likely representing atelectasis and small right pleural effusion. No pneumothorax. The heart size is stable.Partially imaged dilated loops of bowel.

Output: No significant change in bibasilar atelectasis and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: intubated patient History: trend intubated patient Right-sided PICC again terminates over the upper right hemithorax extending superiorly. The exact location of this PICC is indeterminate. Consider removal. Other lines and tubes, unchanged and as expected. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Right-sided PICC again terminates over the upper right hemithorax extending superiorly. The exact location of this PICC is indeterminate. Consider removal.No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: 62 y/o F COPD CHF History: sob Right PICC tip in SVC.Heart size is normal.COPD with bibasilar opacities compatible with edema and pleural effusions.

Output: COPD with superimposed CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: post bronch CXR History: post bronch CXR Improved aeration right upper lobe. Right chest tube at base. Right pleural effusion decreased. Left chest tube unchanged with stable left hydropneumothorax. Enteric tube extends beyond the field-of-view.

Output: Improved aeration right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: acute chest syndrome History: sickle cell, hypoxia Chronic interstitial opacities and osseous findings from sickle cell disease. There has been a cholecystectomy. No evidence of pneumonia or pleural effusion. Mild cardiomegaly is stable.

Output: No evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.AVR, endocarditis. Interval removal of Swan-Ganz catheter. Other tubes and lines unchanged in position, the left jugular catheter tip is noted to be low within the right atrium. Pleural fluid and atelectasis about the same. Unchanged superior mediastinal widening.Question of thin-walled cysts bilaterally, beyond the resolution of portable technique and appearance could merely reflect summation artifact however in the context of endocarditis, consider assessment with thoracic CT.

Output: Question of thin-walled cavities in the setting of endocarditis, consider CT if there is clinical suspicion for septic emboli. At a minimum, serial plain film follow-up is recommended. Unchanged pleural fluid or atelectasis.


Instruction: Generate impression based on medical findings.

Input: 61 year-old female with non-Hodgkin's lymphoma status post stem cell transplant. CHEST:LUNGS AND PLEURA: Diffuse centrilobular emphysemaMEDIASTINUM AND HILA: Bilateral thyroid nodules remain.Mild decrease in the mediastinal adenopathy. The reference paratracheal lymph node measures 14 x 12 mm (series 3; image 26), previously 16 x 14 mm.Mitral valve prosthesis. Aortic arch calcifications.CHEST WALL: Median sternotomy. The right port terminates in the SVC. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable mildly nodular left adrenal glandKIDNEYS, URETERS: Small scar in the mid pole of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fluid collection along the ventral mesh has decreased in size, compatible with seroma.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hysterectomy 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: Mild decrease in the thoracic adenopathy. Otherwise, stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Is there pathology on the right? History: right lower crackles on exam Numerous skeletal lesions consistent with known myeloma, with a large soft tissue component to a right anterior six rib abnormality.Moderate cardiomegaly noted.Right basilar subsegmental atelectasis and possible small right pleural effusion.

Output: Multiple myeloma. Possible right pleural effusion and overlying subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Status post TECAB. Cardiothoracic ratio about the same.Interval decrease in volume of loculated pleural fluid/thickening on the left, which has nearly resolved. Persistent right costophrenic angle blunting with adjacent atelectasis at the right lung base. No focal airspace opacity. Severe degenerative changes of the spine. No pneumothorax.

Output: Mild residual pleural fluid and/or thickening.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Unchanged cardiopulmonary appearance without new superimposed focal airspace discrete process. See subsequent report.

Output: Probable CHF, however appearance is nonspecific and serial imaging is again suggested to confirm clearance


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: SOB and palpitations x1 day History: SOB and palpitations Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.