Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: status post Y-stent placement with known RLL collapse History: shortness of breath Right IJ port catheter with tip overlying the cavoatrial junction.Cardiac silhouette is significantly obscured on the right.There is again complete opacification of the right lung with small cavitary focus, although air bronchograms are now evident over the right lower lung.Left lung remains clear except for a discrete left lung base granuloma.

Output: Persistent complete opacification of the right lung and volume loss with small cavitary focus, although air bronchograms are now evident.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: assess for signs of PNA History: fever, productive cough Blunting of bilateral costophrenic angles are chronic. This may be attributed to scarring or trace pleural effusions. Chronic appearing left mid to lower zone reticular opacities with suspected superimposed subsegmental atelectasis. No new consolidation. Heart size is normal. The right descending pulmonary artery caliber is large but is unchanged.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: is there any bleed History: hypertension, headache Marked cardiomegaly, not significantly changed, possibly with pericardial effusion.Tortuous and calcified aorta consistent with age. Calcified thyroid nodule with probable asymmetric thyroid enlargement.No significant pulmonary or pleural abnormalities.Partial collapse of a mid thoracic vertebra.

Output: Marked cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Chest pain rule out acute pathology. Low normal lung volumes. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: Low normal lung volumes but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Cough Lungs are slightly underinflated but clear. No significant cardiopulmonary abnormality.

Output: Lung slightly underinflated but clear.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: interval exam, s/p heart transplant History: interval exam Intra-aortic balloon pump has been slightly repositioned superiorly overlying the inferior margin of the aortic arch. Swan-Ganz catheter has been more distally repositioned in the truncus anterior and can be pulled back. PICC unchanged. Left basilar pleuroparenchymal opacity, not substantially changed. Unchanged heart size.

Output: Swan-Ganz catheter has been more distally repositioned in the truncus anterior and can be pulled back.


Instruction: Generate impression based on medical findings.

Input: 86-year-old male with pulmonary fibrosis and iron deficiency anemia, abdominal pain and nausea. Suspect GI bleed CHEST:LUNGS AND PLEURA: Bilateral moderate sized pleural effusions, new from previous CT. bilateral dependent atelectasis.MEDIASTINUM AND HILA: Cardiomegaly. Elevated right hemidiaphragm is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Atrophy of the anterior segment of the right lobe and medial segment of the left lobe is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign appearing multiple left renal cysts. Atrophic right kidney with hydronephrosis. Multiple calcifications within the right kidney likely representing stones and vascular calcifications.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction.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: Redundant sigmoid colon. 1 cm polypoid lesion within the sigmoid colon may represent polyp, neoplasm versus retained stool. Colonoscopy is recommended for further evaluation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Colonoscopy is recommended for the possible polypoid lesion within the sigmoid colon. Bilateral pleural effusions and cardiomegaly.Atrophic right kidney with multiple stones and hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: LVAD History: h/o aspiration Iatrogenic devices are unchanged. Improvement in lung volumes. Diffuse pulmonary opacities. Unchanged cardiomegaly. Small left pleural effusion or thickening. No pneumothorax.

Output: Mild diffuse opacities, consistent with mild edema. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: Check Pulmonary Status History: Malignant neoplasm of liver. Diffuse nonspecific airspace and interstitial opacity with probable bilateral pleural effusions.Atelectasis and consolidation in the left lower lobe, unchanged. Catheter tip in the SVC.

Output: Nonspecific pulmonary opacity with atelectasis and effusions, unchanged from previous.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: post impella manipulation History: as above Gradually worsening pulmonary edema with enlarging pleural effusions.Moderate cardiomegaly.Impella device unchanged.ET tube tip approximately 4 cm above the carina.A Dobbhoff tube terminates in the stomach.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.

Output: Gradually worsening edema and enlarging pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Reason: eval for acute process History: L mid axillary rib pain s/p bicycle accident Cardiomediastinal silhouette is upper limits of normal. No specific evidence of infection or edema. No rib fractures identified. No pneumothorax.

Output: Cardiomediastinal silhouette upper limits of normal. No rib fractures identified.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female follow-up metastatic endometrial carcinoma. Occasional abdominal discomfort uncertain relationship to disease. CHEST:LUNGS AND PLEURA: Emphysema. Elevated left hemidiaphragm with atelectasis left lower lobe, unchanged. Few scattered micronodules are unchanged.MEDIASTINUM AND HILA: Small non-pathologically enlarged nodes are unchanged. Atherosclerotic calcification coronary arteries and aorta.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs its lack of intravenous contrast.LIVER, BILIARY TRACT: Granulomata.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Vascular calcifications.RETROPERITONEUM, LYMPH NODES: Multifocal lymphadenopathy redemonstrated, some heavily calcified, and measured as follows:Reference peri-portal node series 3 image #80, 1.7 x 1.7 cm. Previously 1.5 x 1.4 cm.Reference left para-aortic node 2.3 x 1.4 cm, series 3 image #91. Previously 1.7 x 1.4 cm.Node dorsal to the uncinate process of the pancreas measures 2.4 x 2 cm, series 3 image 105, previously 2.3 x 1.6 cm. BOWEL, MESENTERY: Clips presumably from omentectomy. No evidence of carcinomatosis or ascites.BONES, SOFT TISSUES: Degenerative changes. Midline surgical scar.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: Small non-pathologically enlarged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Midline surgical scar.OTHER: Atherosclerotic changes no aneurysm.

Output: No new sites of disease. Measurements as above.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: chest pain, sob Severe multichamber cardiomegaly with vascular redistribution, increased.No specific evidence of pulmonary edema or pleural effusion.No sign of pneumonia.

Output: Severe cardiomegaly possibly with pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: CABG Right jugular sheath again terminates at the confluence the subclavian. Left and right chest tubes appear similar, without associated significant pneumothoraces.Unchanged cardiopulmonary appearance a small lung volumes and retrocardiac opacities most likely representing compression atelectasis, however partial consolidation cannot be excluded

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: swan History: swan Tip of the Swan-Ganz catheter has been withdrawn and now is in the E. more proximal right pulmonary artery.Increasing small right effusion. No change in left basilar opacity in position otherwise stable.

Output: Repositioning of Swan-Ganz catheter as above. Slight increase in pleural effusions and left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Resected gist tumor. Follow-up. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter well-defined hyperdense lesion near the dome is unchanged on image number 95/225. Another hypodense lesion likely representing a cyst in the right posterior segment inferiorly on image number 121 is also unchanged. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable presumed right renal cyst. No new findings.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Intubated. Hypotension. Endotracheal tube terminates one cm above the level of the carina. Right jugular catheter unchanged in position.Hardware projects over the left thorax, limiting assessment of the lung parenchyma. Within this limitation, no conclusive air space opacities are appreciated. Atelectasis overlying the right hemidiaphragm and in the retrocardiac region likely compressive. Clearance of previously seen aspirated secretions.

Output: Low endotracheal tube. Interval clearance of opacities suggestive of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: r/o PNA History: pleuritic CP, back pain Hypoinflation. Mildly increased basilar interstitial markings compatible with atelectasis. No signs of infection. The cardia mediastinal silhouette is within normal limits.No pleural effusion.No pneumothorax.

Output: Hypoinflation with mild basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: found down initial vfib cardiac arrest. now intubated History: cardiac arrest Endotracheal tube terminates 11 cm from the carina. Enteric tube side-port is at gastroesophageal junction. Left greater than right diffuse pulmonary opacities. Mild cardiomegaly. No pneumothorax.

Output: Endotracheal tube is quite high terminating 11 cm from the carina. This has been repositioned on subsequent imaging. Left greater than right diffuse pulmonary opacities consistent with asymmetric pulmonary edema, multifocal pneumonia, and/or pulmonary hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: New Left IJ central line History: Uremia Interval placement of left IJ catheter with tip in the right atrium. Support devices otherwise unchanged in position.Stable left greater than right layering pleural effusions and diffuse pulmonary opacities.Stable cardiomediastinal silhouette.No evidence of pneumothorax.

Output: Interval placement of left IJ catheter with tip in the right atrium. No evidence of pneumothorax. Stable pleural effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.MVC with left-sided anterior chest pain. Hurts to breathe. Unlikely rib fracture. Question contusion. No pneumothorax or pleural fluid. Normal heart size. No focal pulmonary opacities. No visible signs of pulmonary contusion by plain film.

Output: No acute pulmonary abnormality. No visible signs of pulmonary contusion by plain film.


Instruction: Generate impression based on medical findings.

Input: Reason: interval changes History: as above ET tube tip approximately 2 cm above the carina.Catheter tip in the SVC or right atrium.NG tube tip in the stomach with the sidehole in the distal esophagus.Small lung volumes with basilar nonspecific opacity compatible with atelectasis, consolidation and effusions.

Output: Basilar opacities and pleural effusion without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: esophageal stent for esophagus cancer. Concern for migration of stent due to vomiting and pain increased recently - please evaluate stent placement History: vomitting/pain The left port is currently accessed. The stent previously traversing the gastroesophageal junction has migrated inferiorly, now projecting over the left upper abdominal quadrant, likely within the stomach. The lungs and pleural spaces are clear. The heart size is normal.

Output: Inferior migration of the gastroesophageal stent.


Instruction: Generate impression based on medical findings.

Input: Female 3 months old Reason: what amount of pleural effusion History: chest tube placementVIEW: Chest AP (one view) 3/6/15 and 1625 hrs. ET tube tip is below the thoracic inlet. NG tube terminates at the stomach. Central line tip is in the right atrium. Interval left-sided chest tube placement.Cardiac silhouette size is normal. Interval improvement in left-sided pleural effusion on a background of diffuse lung haziness.

Output: Interval improvement in left-sided or effusion after chest tube placement.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: s/p CABG. +Fever History: Fever Stable cardiomediastinal silhouette.Pleural effusions with right mid lung opacities most likely representing loculated effusion similar appearance the prior exam.No new airspace opacities noted.Median sternotomy is intact.

Output: Pleural effusions with loculation on the right unchanged. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Fever and left chest pain. Evaluate for pneumonia The cardiomediastinal silhouette is normal.No pleural effusion, pneumothorax, or abnormal pulmonary opacity.

Output: Normal chest radiograph. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: rule out pneumonia History: cough x 6 wks 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: Cough No cardiopulmonary acute abnormality.

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female 64 years old with history of shortness of breath, cough, evaluate for pulmonary edema, pneumonia Left AICD unchanged in position.Stable cardiomegaly. Mild bibasilar opacities without evidence of focal consolidation. No pleural effusions.

Output: Bibasilar atelectasis without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of non-Hodgkin lymphoma status post stem cell transplant CHEST:LUNGS AND PLEURA: Stable punctate bilateral nodules, not changed.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered nonenlarged mesentery lymph nodes.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: Stable study.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Esophageal cancer. Large bilateral pleural effusions, slightly increased compared to prior, with increased bibasilar atelectasis, particularly on the left.Right apical upper lobe aeration is slightly improved.The cardiac silhouette is obscured.Unchanged right chest port, esophageal stent, and right upper abdominal drain.

Output: Increased large pleural effusions and bibasilar atelectasis, particularly on the left


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: evaluation for appropriate placement of NGT History: sbo Small lung volumes, otherwise unremarkable.Right subclavian catheter crosses the midline retrograde into the left brachiocephalic vein.High NG tube, the tip above the GE junction.

Output: Malpositioned right subclavian catheter and high NG tube.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Patient with dyspnea and increased oxygen requirement. Evaluate. Cardiomediastinal silhouette is normal. Bilateral basilar streaky opacities without evidence of consolidation, pleural effusions, or pneumothorax.

Output: Bilateral basilar opacities may represent atelectasis with superimposed infection/aspiration not excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: r/o infiltrate History: fatigue Multicavitary right lower lung zone opacity with a right pleural effusion likely progressed since the prior PET CT, and new ill-defined nodular opacities in the left mid and lower lung zone. Heart size normal.

Output: Progression of right lower lobe opacity with multiple cavities, and left lower lung zone opacity. A thoracic CT is recommended for follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Pacemaker leads in the area of the right atrial appendage and right ventricular apex.No pneumothorax or other complications.Mild blunting of both costophrenic angles compatible with small effusions, greater on the right.

Output: The pacemaker device in the expected location with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Chest pain Motion degrades sensitivityPersistent cardiomegaly with decreased lung volumes and mildly tortuous aorta, unchanged. The appearance and changes are again partially secondary to semiupright portable technique. No distinct superimposed new airspace process within this limited exam.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: May 2015 s/p bronch, L VATS resection of lingula and anterior segment of the left upper lobe for T1aN0 moderately differentiated adenocarcinoma. Staple line margin +. History: none Persistent left paramediastinal scarring and subsegmental atelectasis. The staple line along the left superior mediastinum is unchanged in appearance. Reticular opacities at the left hemidiaphragm represents scarring and/or subsegmental atelectasis. No evidence of edema or visible pulmonary nodule. The heart size remains normal. Multilevel degenerative changes of the thoracic bodies are noted.

Output: Stable appearance of the left paramediastinal location at site of previous wedge resection. No visible pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: R pneumothorax s/p thoracic vent placement History: dyspnea Small right pneumothorax with large apical bullae unchanged, with a thoracic vent in place.

Output: Unchanged right apical pneumothorax with extensive paraseptal emphysema.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with left upper quadrant pain and shortness of breath. Rule out PE PULMONARY ARTERIES: In this technically adequate study, no pulmonary emboli identified.The pulmonary artery is enlarged measuring 3.5 cm which can be seen in pulmonary arterial hypertension.LUNGS AND PLEURA: Bilateral small pleural effusions. There is extension of the pleural fluid into the left major fissure. No suspicious pulmonary nodules. Diffuse groundglass opacity may be secondary to the scan being performed in expiration versus mild edema.MEDIASTINUM AND HILA: Mild cardiomegaly. No pericardial effusion. Prominent soft tissue in anterior mediastinum which may be secondary to residual thymus or adjacent small pericardial effusion. No significant hilar lymphadenopathy. Aberrant right subclavian artery.CHEST WALL: Mild bilateral axillary nonspecific lymphadenopathy.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No PE.2. Small bilateral pleural effusions with cardiomegaly and mild edema compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP placement History: NA Catheter tip at the aortic arch, and ICD lead unchanged. Cardiomegaly and basilar opacities with atelectasis and small effusions also unchanged.

Output: Balloon catheter in the proximal descending aorta with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: ? infiltrate History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: hx cabg c/b sternal dehiscence, s/p repair, with gradual onset dyspnea History: tachypnea, dyspnea Patient is status post sternotomy with hardware and skin staples overlying the midline of the chest.Stable nonspecific basilar opacities compatible with atelectasis or aspiration. Pleural effusions, left greater than right, unchanged.

Output: Unchanged pleural effusions and nonspecific basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male 9 months old; Surgical repair of complete AV canal.VIEW: Chest AP (one view) 8/15/2016, 1741 The right internal jugular central venous catheter has been removed. Endotracheal tube tip is above carina. Bilateral chest tubes and right chest drain are unchanged. Two atrial lines, left internal mammary arterial catheter, temporary and permanent epicardial pacer leads are unchanged. Surgical clips in the mediastinum and neck and 2 surgical sponges overlying the left upper chest are unchanged. The pacemaker battery pack is again seen in the epigastrium. Gastrostomy tube is present and unchanged. The cardiac silhouette is within normal limits. There are no focal opacities. The left lung base is hyperlucent and the left hemidiaphragm is slightly depressed.

Output: Possible left subpulmonic pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: follow-up DOE after Nov 2015 fracture, L effusion, evidence of osteo 2nd CC jct? History: persistent pain L 2nd CC junction - on immunosuppression with elevated CRP No acute cardiopulmonary abnormality. Subacute rib fractures on the left.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with history of metastatic laryngeal cancer CHEST:LUNGS AND PLEURA: Tracheostomy catheter is in place, unchanged. Left upper lobe mass size and now measures a 6 x 4.9 cm image number 29, series number 6. Again this mass demonstrates central cavitation and necrosis. The lingular lesion is slightly smaller measuring 20 x 17 mm image number 47, series number 6.New, moderate left-sided pleural effusion.MEDIASTINUM AND HILA: Left hilar lymph node now measures 2.6 x 2 cm, slightly smaller compared to previous study, on image number 55, series number 6. This lesion may also represent a left lower lobe mass.CHEST WALL: Interval progression of right seventh posterior rib metastatic disease which destroys the rib and extends into the pleural space. Vertebral body is also involved at that level.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific punctate hypodensity in the right lobe of the liver on image number 89, series number 6 and left lobe on image number 91, series number 6. These are too small to characterize.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: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: Interval progression of the left upper lobe mass and right rib metastatic lesion. New left-sided pleural effusion.Left lingular and left lower lobe masses are slightly smaller.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: new O2 requirement Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: palpitations, afib, sleep apnea History: palpitatoins Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: LVAD History: LVAD : Cardiopulmonary hardware and support devices unchanged in position.Course interstitial and air space opacities bilaterally not significantly changed. Small pleural effusions.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: Infiltrates History: fever Decreased lung volumes with unremarkable cardiac mediastinal silhouette.Basilar opacification compatible with atelectasis.No focal airspace consolidation.No large pleural effusions.Median sternotomy is intact.

Output: Basilar opacities, left greater than right, compatible with atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: monitoring on ECMO History: see above Endotracheal tube terminates 2 cm above the carina. Right IJ flexible cannula terminates at the level of the intrahepatic IVC. Interval placement of external defibrillator pads.No significant change in the extensive airspace and interstitial opacities that obscure the cardiac silhouette. No significant pneumothorax.

Output: Extensive bilateral airspace opacities compatible with ARDS, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: Infxn History: above Unremarkable cardiac and mediastinal silhouette. Mild interstitial basilar opacities, greater on the left, probably chronic.No specific evidence of pneumonia.

Output: Chronic basilar abnormalities possibly related to recurrent aspiration. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: PICC line insertion History: s/p PICC line placement Small lung volumes with minimal basilar scarring.Heart size normal.Right PICC, tip in right subclavian.

Output: PICC placement. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: ? SOB History: SOB Moderate cardiomegaly, increased from previous.Small lung volumes with mild blunting of the posterior costophrenic angles possibly due to small effusions.No reliable evidence of pulmonary edema or infection.

Output: Cardiomegaly and possible mild CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.RFO, complex surgery. Previously noted sponge markers no longer identified, with closure of the previously open sternotomy wound.Small pleural effusions and left lower lobe consolidation persists.ET tube tip approximately 2 cm above the carina.Right jugular Swan-Ganz catheter, tip in main pulmonary artery.Esophageal probe seen.Remnants of a left subclavian ICD are in the chest wall.

Output: No radiodense foreign object, status post sternotomy closure. Findings were discussed with Dr. Onsager by telephone at the time of dictation, 10/9/2015 12:40 PM.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 43 old female complaining of bilateral lower quadrant pain and pelvic pain. Please evaluate for appendicitis. CHEST:LUNG BASES: 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is well visualized and appears normal without evidence of inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Fibroid uterus with prominent ovarian cysts/follicles bilaterally.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Fibroid uterus with prominent ovarian cysts/follicles bilaterally. Pelvic ultrasound may aid in further characterization. No evidence of appendicitis.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.ALL status post HCT several weeks ago. Fever. The right jugular catheter has been removed in the interim. No pneumothorax.Normal heart size.Faint reticulonodular opacities in the left upper lobe nonspecific. No focal airspace opacities to conclusively suggest the presence of a bacterial pneumonia.

Output: Nonspecific faint reticulonodular opacities in the left upper lobe, consider reduced dose unenhanced thoracic CT for further evaluation if the patient is at risk for viral pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: pleural effusion History: pleural effusion Interval extubation. Left chest tube unchanged in position. No pneumothorax.No change in bilateral pleural effusions and retrocardiac opacity.

Output: Interval extubation. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: SOB History: SOB Stable cardiomediastinal silhouette.No new focal airspace opacities.No pleural effusions.

Output: Borderline cardiac enlargement without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: assess ET tube History: s/p intubation COPD.Developing left basilar opacity suggestive of infection or aspiration.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.

Output: COPD with developing left basilar opacity suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: S/P left thoracentesis History: SOB Port catheter terminates in the superior aspect of the RA. Small to moderate-sized left pleural effusion. Small right pleural effusion. No significant pneumothorax. Probable perihilar pulmonary edema. Moderate cardiomegaly.

Output: Left greater than right pleural effusion with perihilar pulmonary edema. Moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Respiratory failure, follow-up air leakVIEW: Chest AP (one view) 2/11/2016 0529 hours Endotracheal tube, enteric tube, and right IJ catheter are unchanged. Left chest tube continues in place. The left pneumothorax has increased in size. Bilateral pulmonary opacities are unchanged. There is no pleural effusion. The cardiac silhouette is normal in size.

Output: Increasing left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: ?PTX History: SOB Left chest tube in place with a very small residual apical pneumothorax and bilateral pleural effusions with basilar atelectasis.No new findings.

Output: Small residual left apical pneumothorax, decreased over the past 2 days.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Dyspnea. Stable cardiomediastinal silhouette. Low lung volumes with bibasilar opacities and small to moderate bilateral pleural effusions, right greater than left. There are fixation devices in the left sixth, seventh, and eighth ribs. Abdominal skin staples are noted.

Output: Low lung volumes with bibasilar atelectasis and pleural effusions, appearing similar compared to prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.ETT adjustment. Low lung volumes. Cardiomediastinal appearance unchanged. Endotracheal tube tip projects 3 cm above the level of the carina. Right subclavian catheter can be followed to the SVC. A nasogastric tube can be followed to the level of the distal esophagus near the GE junction but is poorly visualized. Dependent and basal atelectasis.Superior mediastinal widening unchanged, suggestive of hypervolemia. The presence of superimposed mediastinal hematoma on the right may be considered in the appropriate clinical context.

Output: 1. ETT 3 cm above carina.2. Persistent right greater than left superior mediastinal widening suspicious for mediastinal hematoma superimposed upon venous distention related to hypervolemia. Correlate with labs.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: hypoxic with fever, pna vs aspiration History: hypoxic with fever Worsening interstitial and airspace opacities with pleural effusions consistent with infection or aspiration, or evolving ARDS.Heart size normal.Massive upper esophageal dilation.

Output: Worsening pulmonary opacities with pleural effusions suggestive of infection or aspiration, or evolving ARDS.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for aspiration History: respiratory alkalosis Small lung volumes with bilateral nonspecific basilar opacities consistent with atelectasis and consolidation, compatible with aspiration.Deviation of the trachea to the right in the neck suggestive of asymmetric thyroid enlargement.

Output: Persistent nonspecific basilar opacities, consistent with aspiration.


Instruction: Generate impression based on medical findings.

Input: Aortic dissection repair Essentially stable bilateral pleural effusions greater on the left with underlying opacification left lower lobe, presumed atelectasis versus consolidation.ETT, Swan-Ganz and mediastinal and right basilar chest tubes are all otherwise unchanged.

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: FemaleReason for Study: Reason: Preop MAZE History: Preop MAZE Left-sided ICD unchanged.Stable cardiomediastinal silhouette.Small bilateral pleural effusions mildly increased from the prior exam.Chronic appearing interstitial opacities of both lungs again noted.

Output: Small bilateral pleural effusions with mild interval increase compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: serial eval for possible infectious source given leukocytosis History: WBC elevation, cough New pulmonary nodules one possibly cavitary in the right upper lobe, suggestive of septic emboli.Small right pleural effusion unchanged.Right sixth and seventh rib destruction noted, with an associated soft tissue mass, which may have progressed even over the last two days.

Output: Septic emboli, or metastases, for which a thoracic CT is recommended. Rib lesions with associated soft tissue mass possibly progressed over even just two days.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: 52yo F w/ shock, eval for pulm source History: as above Moderate cardiomegaly with mild basilar interstitial edema.Median sternotomy, the inferior most wire suture fractured.Possible small pleural effusions.No specific evidence of infection.Right jugular catheter, tip at cavoatrial junction level.

Output: Cardiomegaly with mild edema consistent with CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: ro PNA, pulm edema History: COPD hx, acute resp distress Worsening pulmonary opacities consistent with edema.Heart size upper normal.No reliable evidence of pneumonia.

Output: Worsening pulmonary edema pattern consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: Eval for cardiopulmonary disease. History: Chest pain No significant cardiopulmonary abnormality.Left subclavian ICD, leads unchanged in position.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Biliary cancer with liver METs CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions in the left lobe of the liver which have increased in size consistent with metastatic disease. Reference lesion measures 17 x 14 mm in image numbers 81/240. This lesion was previously measuring 9 x 8 mm.pneumobilia and minimal intrahepatic biliary dilatation, unchanged.SPLEEN: No significant abnormality notedPANCREAS: Minimal pancreatic ductal dilatation. A soft tissue density mass surrounding the metallic stent cannot be differentiated from the surrounding pancreas so an accurate measurement cannot be obtained.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple appearing bilateral cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple ventral hernias containing nonobstructing all segments and peristomal hernia are unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the liver metastases. Interval placement of biliary stent into the common bile duct.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of lung cancer and prostate cancer. Status post chemotherapy. Evaluate disease status. CHEST:LUNGS AND PLEURA: Spiculated mass measuring 2.4 x 1.5 cm image number 33, series number 3 in the left upper lobe consistent with primary bronchogenic carcinoma. Small satellite nodules are seen in the left upper lobe.A right upper lobe spiculated nodule measures 12 x 11 mm on image number 33, series number 3. Biapical scarring. Emphysema.MEDIASTINUM AND HILA: Enlarged nodular thyroid gland. Left hilar adenopathy measures 2.7 x 1.5 cm at axial image 38/227 of series 3. AP window adenopathy measuring 8 x 9 mm, series number 3, image number 45.CHEST WALL: Borderline enlarged right axillary lymph nodes. ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodense lesions in the liver are too small to accurately characterize but are likely cysts.SPLEEN: No significant abnormality noted1PANCREAS: Punctate calcifications in the pancreas and mildly prominent duct may be compatible with chronic pancreatitis.ADRENAL GLANDS: Bilateral adrenal glands are diffusely enlarged.KIDNEYS, URETERS: Bilateral numerous simple appearing small 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: Ill-defined soft tissue between the rectum and bladder are suspicious for recurrent or residual disease.BLADDER: No significant abnormality notedLYMPH NODES: Left perirectal adenopathy measuring 22 x 19 mm in image number 190/227.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesion in the left iliac bone likely represents a bone island.OTHER: Bilateral ectatic common femoral arteries.

Output: Multiple spiculated nodules in both lungs consistent with history of primary bronchogenic cancer. Mediastinal and left hilar adenopathy. Probable chronic pancreatitis.Soft tissue between the bladder and the rectum and in the left perirectal region suspicious for recurrent and/or metastatic prostate cancer.No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Eval LLL opacity History: productive cough Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography. 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, 51 years old.Reason: eval PICC position History: as above No significant cardiopulmonary abnormality.Left subclavian ICD, leads unchanged in position.Left PICC, tip just entering the subclavian region.

Output: PICC placement.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: Advanced 3cm ET tube tip approximately 5 cm above the carina.Mediastinal widening in the right paratracheal area compatible with a known aneurysm although an aberrant right subclavian artery, previously confirmed by CT. Basilar opacities, greater on the left, compatible with atelectasis and pleural effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: CHF, new rales in left base. R/O infiltrate. History: CHF, new rales in left base. Cardiomediastinal silhouette is unremarkable. No pleural effusion or focal air space opacity.Dual lead left subclavian ICD with leads projected over the right atrium and right ventricle.

Output: No pleural effusion or focal air space opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p chest tube removal History: asymptomatic The right-sided chest tube has been removed.There is a persistent small right hydropneumothorax. Opacification of the inferior one half of the right hemithorax from atelectasis, consolidation and pleural effusion. Streaky opacities at the left base of aspirated secretions or atelectasis unchanged. Extensive subcutaneous emphysema is probably right-sided.

Output: Removal of right-sided chest tube. Other findings are essentially stable.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: s/p IVC filter removal, r/o pneumothorax History: see above,asymptomatic. Mild cardiomegaly. The film is slightly rotated.Right retrocardiac and basilar atelectasis.No pneumothorax or large pleural effusion.

Output: 1.No evidence of pneumothorax. 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: 72-year-old female with history of islet cell carcinoma metastatic to the liver CHEST:LUNGS AND PLEURA: Stable micronodules. Stable mosaic attenuation of the lungs. The right middle lobe lateral segmental nodular opacity not significantly changed.MEDIASTINUM AND HILA: Stable mildly enlarged bilateral hilar and mediastinal lymph nodes. Lack of IV contrast precludes optimal detection of these lymph nodes. A measurement cannot be provided for the referenced mediastinal lymph node. Again noted dilatation of the descending aorta measuring up to 3.9 cm in its greatest AP dimension.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Large bilateral balky hepatic metastatic lesions are less well seen on today's study to lack of IV contrast. Reference left lobe mass measures 12.3 x 8.9 cm on image number 96, slightly enlarged from previous study.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is displaced anteriorly by the large retroperitoneal mass uncinate process and head of the pancreas cannot differentiate from this partially calcified mass. This retroperitoneal mass measures 9.4 x 6.9 cm on image 122, series number 3.ADRENAL GLANDS: Right suprarenal mass measures 6.4 x 2.5 cm in width and one at 5, series number 3.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: See discussion on the pancreas title.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Posterior paintball for degenerative changes. Stable anterior wedge compression fracture at L1. No bony metastases.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited study due to lack of IV contrast. Hepatic mass is slightly enlarged from previous study, the metastatic lesions are stable.


Instruction: Generate impression based on medical findings.

Input: 56 year old male with testicular seminoma. Evaluate disease status. CHEST:LUNGS AND PLEURA: Unchanged curvilinear scar is noted in the left midlung.MEDIASTINUM AND HILA: Coronary atherosclerotic calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Butterfly mid thoracic vertebral body, unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Left testicle was surgically excised.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination without evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval pna History: cough, seizure No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules are unchanged. Reference nodule in the left lower lobe is on image number 71, series number 6.MEDIASTINUM AND HILA: Stable enlarged thyroid gland.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: Postsurgical changes secondary to graft placement into infrarenal abdominal aneurysm.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: Degenerative changes involving the bones, unchanged.OTHER: No significant abnormality noted

Output: No significant change in bilateral scattered subcentimeter non-dose in the lungs.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Hemoptysis for 2 days and weight loss. Evaluate for etiology. No cardiopulmonary abnormalities.Metallic implants visualized in the right shoulder.

Output: No cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Heart failure, check IABP IVP marker remains within the aortic arch. I see also similar position.Lungs and mediastinal contours are within limits. Cardiac silhouette is borderline in size

Output: IABP marker remains well positioned


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: MaleReason for Study: Reason: Effusions History: CP and vomiting Right central venous catheter with its tip in the SVC.NG tube with its tip in the stomach.The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: NG tube with its tip in the stomach. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Stevens Johnson syndrome History: as above Moderate cardiomegaly.Small lung volumes, but no edema or pneumonia.Nasogastric or Dobbhoff tube extends below the lower margin of the image.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: hypoxia History: as above There are bibasilar interstitial opacities and a small right pleural effusion/pleural thickening. No pneumothorax. The heart size is stable given differences in positioning.Right chest port catheter terminates in the right atrium.

Output: Bibasilar interstitial opacities suggestive of edema. Correlate with fluid status.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: Swan placement History: Swan placement Swan-Ganz catheter tip in the right descending pulmonary artery.Cardiomegaly and ICD leads unchanged.No sign of pulmonary edema or pneumonia.

Output: Slightly more proximal location of the Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with history chronic lymphocytic leukemia CHEST:LUNGS AND PLEURA: Calcified micronodules unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Bilateral axillary , adenopathy, more prominent on the left, unchanged from previous study. Index left axillary lymph node measures 1.4-cm in diameter on image number 25, series number 3. ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liverSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. Index left or a tic lymph node measures 1.5 x 1.1 cm in image number 136, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral peri-iliac adenopathy. Right peri-iliac lymph node measures 1.3 x 1.1 cm in image number 162, series number 3. There is additional bilateral inguinal adenopathy.BOWEL, MESENTERY: Borderline enlarged mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral axillary, retroperitoneal and pelvic adenopathy. Diffuse fatty infiltration of the liver.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: chest pain History: shortness of breath, chest pain, crackles, dialysis patient. Stable peribronchial wall thickening suggests chronic bronchitis/asthma. Small right-sided pleural effusion. Stable mild cardiomegaly without evidence of pulmonary edema. No pneumothorax.

Output: Stable mild cardiomegaly without evidence of pulmonary edema. Stable peribronchial wall thickening suggest chronic bronchitis or asthma.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: et tube placemrnt History: intubated ET tube tip between the thoracic inlet and the carina.Cardiopulmonary monitoring and support devices are unchanged.Unchanged cardiac mediastinal silhouette including superior mediastinal widening.Bilateral pleural effusions and basilar airspace opacities are not significantly changed.

Output: Unchanged cardiac support devices, pleural fluid, and basilar airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: IABP placed History: IABP placed The IABP marker overlies the proximal descending thoracic aorta.Left upper extremity PICC tip in the SVC.Unchanged cardiomegaly and asymmetric elevation of the left hemidiaphragm, with bilateral opacities suggestive of subsegmental atelectasis.

Output: No significant interval change in position of balloon pump or basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: s/p decortication for necrotizing PNA, eval resolution History: as above Right chest tube removed with no pneumothorax.Improving basilar atelectasis and persistent small pleural effusions.

Output: No pneumothorax following right chest tube removal with improved atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of h\T\n cancer, g-tube dependent, has been taking PO, productive cough History: rhonchi Coarse bilateral interstitial opacity, greater in the lower lung zones, nonspecific but compatible with recurrent aspiration. More severe bilateral opacity was present previously.Normal heart size with a left jugular catheter extending to the SVC.

Output: Bilateral nonspecific mainly interstitial opacity of uncertain chronicity but compatible with recurrent aspiration. If clinically indicated a CT scan could be performed for more definitive evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Malignant pleural effusion s/p pleurex History: none Stable position apically directed left chest tube.Stable size of the left hydropneumothorax. Persistent leftward tracheal bowing secondary to left-sided volume loss. The right lung is fully expanded and remains clear.

Output: Stable size of left hydropneumothorax in the setting of a chest tube.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: Eval PPM / PTX History: SOB Median sternotomy and aortic valve repair.No specific evidence of infection or edema.No significant pneumothorax.New left subclavian dual chamber pacemaker, leads in appropriate position with no pneumothorax.

Output: No pneumothorax following pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old. pre op clearance Study limited by leftward rotation. Low lung volumes makes detailed cardiopulmonary assessment difficult. No focal lung consolidation or evidence of overt left-sided heart failure. Calcified granulomas in the left hilar and mediastinal region. Patchy bibasilar subsegmental atelectasis or scarring. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: 29 yo with new central line for exchange transfusion History: new central line Small right pleural effusion are chronic blunting right costophrenic angle.Heart size normal.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: cough, cold Sx x 3 weeks, fatigue, weight loss, tobacco use, HIV+ History: cough, wt loss The cardiomediastinal silhouette is unremarkable.Mild chronic appearing interstitial opacities more prominent at the lung bases and apical scarring similar to the prior exam.No focal areas of consolidation.Calcified left hilar lymph node compatible with a prior granulomatous disease.No pleural effusions.

Output: Mild basilar predominant chronic appearing interstitial opacities. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Dyspnea on exertion. History lung cancer Extensive confluent pulmonary nodules greater on the right is associated fullness in both hilar regions. No distinct new superimposed focal airspace abnormality, however correlation with chest CT may be indicated if suspicion remains high clinically. Mildly decreased lung volumesCardiac and mediastinal contours are within limits

Output: Extensive confluent pulmonary nodules bilaterally representing known metastatic and primary malignancy. No findings to suggest a distinct superimposed focal acute process


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: sp PICC line placement History: none Right PICC tip in high right atrium. ET tube and NG tube have been removed. Other findings stable.

Output: Right PICC tip in high right atrium.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: PICC line placement History: ileus Right PICC tip in SVC. NG tube tip in stomach. Dual-lead left-sided pacemaker unchanged.Persistence of left upper lobe masslike opacity.

Output: Right PICC tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: Concern for L pneumothorax History: Hx of L thoracotomy and now w increased L CP Low lung volumes. Mild reticulation again noted at the right lung base, likely postinfectious or postinflammatory residua. Postsurgical changes in the left hemithorax again noted. Unchanged heart size, normal. No convincing evidence of pneumothorax radiography.

Output: No convincing evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: evaluate for infection History: CVA symptoms No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: small volume hemoptysis History: as above Cardiomegaly with a small right pleural effusion with minimal basilar edema.No specific evidence of infection.

Output: CHF with cardiomegaly, small right pleural effusion and minimal edema.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: PA catheter position History: PA catheter position Cardiomegaly with pulmonary edema consistent with CHF.Unchanged tubes and devices including an IABP catheter site marker projected over the aortic arch.Dobbhoff tube has been removed, however.

Output: Cardiomegaly with pulmonary edema. Stable tubes and devices except for a Dobbhoff tube withdrawal.


Instruction: Generate impression based on medical findings.

Input: Female; 54 years old. Reason: Evaluate for aortic dissection, PE. History: chest pain, sob CHEST:LUNGS AND PLEURA: Contrast timing bolus slightly suboptimal for identification of pulmonary embolism. Given this limitation, no PE is identified. Diffuse bronchial thickening with scattered atelectasis and air space opacities, suggestive of bronchitis. No evidence of pneumonia.MEDIASTINUM AND HILA: Mediastinal soft tissues are slightly prominent, however, no measurable lymphadenopathy is identified. Scattered calcifications of the aortic arch and aortic valve. Mild cardiomegaly with trace pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: A cystic lesion in the pancreatic tail with peripheral calcification (series 9 image 125) measures 4.1 x 2.9 cm.ADRENAL GLANDS:KIDNEYS, URETERS: Small non-obstructing stone in a dilated right calix.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged retroperitoneal lymph nodes, nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No aortic dissection or PE.2. Cystic lesion in the pancreatic tail with peripheral calcification is incompletely evaluated. May represent a mucinous cystic neoplasm, serous cystic neoplasm, or pancreatic pseudocyst. Pancreas protocol MR/MRCP is recommended for further evaluation.3. Bronchial thickening with scattered atelectasis and airspace opacities, suggestive of bronchitis.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: fever Unremarkable cardiac and mediastinal silhouette. Mild chronic lower zone interstitial opacity compatible with scarring.Port catheter with its tip in the SVC.No sign of pneumonia or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval pleural effusion, infection, edema History: sob, h/o cancer Loculated left pleural thickening or fluid unchanged. Right pleural effusion stable. Unchanged basilar opacities. Port tip in SVC.

Output: Loculated left pleural thickening or fluid unchanged. Right pleural effusion stable.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: PNA? History: bibasilar crackles New basilar opacities consistent with infection or aspiration, left worse than right.Mild cardiomegaly.Right jugular catheter, tip in SVC/RA junction level.

Output: New basilar opacities suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for infiltrate, cardiomegaly; hx of DM, HTN History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old. Reason: evaluate for infection. History: chest pain, dyspnea Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: chest tube placement History: s/p RLL wedge resection Right sided chest tube has been repositioned with its tip directed towards the apex.No significant pneumothorax identified.Subcutaneous emphysema notable in the right lateral chest wall.Decreased lung volumes with stable cardiomediastinal silhouette.Mild basilar atelectasis.

Output: Interval repositioning of a right-sided chest tube. No significant pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrate, pneumo? History: right sided pleuritic chest pain Unremarkable cardiac and mediastinal silhouette. Calcified lymph nodes compatible with previous infection.Mild streaky basilar opacities compatible with scarring.No sign of pneumothorax or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: assess for pna History: cough sob Patient is status post sternotomy. Prior CABG surgical material overlying the mediastinum. Cardiac size is within normal limits. Low lung volumes. Diffuse reticulonodular interstitial opacities. 21 x 17 mm lung nodule in the left mid lung zone. No large pleural effusion.

Output: No change in appearance of diffuse reticular-nodular interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: pneumonia vs volume overload, assess interval change History: hypoxia, sepsis IABP marker overlies the aortic arch and is about 2 cm below the superior margin of the aortic knob. Left retrocardiac and left perihilar patchy opacities are mildly progressed from prior examination. No pleural effusion or pneumothorax.

Output: IABP marker overlies the aortic arch. Retrocardiac and left perihilar opacities suggestive of asymmetric edema or bronchopneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Please re-evaluate pneumothorax History: Pneumothorax, oxygen requirement Small residual left apical pneumothorax, improved.Diffuse interstitial/airspace opacities suggestive of edema are stable.Small pleural effusions unchanged.Left subclavian catheter, tip in SVC.A Dobbhoff tube extends below the lower margin of the image.

Output: Near resolution of left apical pneumothorax with stable pulmonary opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Reason: ? infiltrate History: SOB Unremarkable cardiac and mediastinal contours.Blunting of the right costophrenic angle, compatible with a small pleural effusion or less likely scarring.No sign of pneumonia or other significant findings.

Output: Small right pleural effusion of uncertain etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Fatigue, CHF. No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits. Sternotomy wires and surgical clips in place, unchanged.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Fever and sickle cell disease. No pleural effusion or pneumothorax. No focal pulmonary opacities to suggest infection. Heart and mediastinal silhouette is within normal limits. Left PICC terminates in the left subclavian vein.

Output: Left PICC terminates in left subclavian vein.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: post op History: 6666 The patient is rotated to the right. Endotracheal tube is low, within 1 cm of the carina. The remaining support devices are unchanged.Mild cardiomegaly stable. No interval edema or pneumothorax.

Output: Endotracheal tube is low, repositioning recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: evaluate lung fields and chest tube History: s/p decortication and pleurodesis One of two left chest tubes removed, with no pneumothorax.Persistent left pleural effusion and pulmonary opacities.Increasing right-sided edema like abnormality.

Output: Tube removal with no pneumothorax. Increased right-sided edema.


Instruction: Generate impression based on medical findings.

Input: 84-year-old man with decreased appetite and weight loss of 12 pounds since 2/08. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules seen in both lungs; the largest nodule seen in the superior aspect of the right upper lobe measures 0.8 x 0.9 cm (47/110 series 6). No pleural effusion is seen.MEDIASTINUM AND HILA: There are mildly enlarged lymph nodes in the mediastinum with reference pretracheal lymph node as seen on image 37/205 measuring 1.4 x 0.7 cm. No hilar lymphadenopathy is appreciated.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No parenchymal lesions in the liver are seen. The gallbladder is normal in appearance with a questionable gallstone in the neck of the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: There is bilateral nodular enlargement of the adrenal glands which displays greater than 50% contrast washout on delayed scan. This finding is likely consistent with bilateral adrenal adenomas.KIDNEYS, URETERS: There are multiple simple cysts in the right kidney. There is no evidence of hydronephrosis.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: Enlarged prostate gland is seen.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Suspicious pulmonary nodule in the superior right upper lobe.2. Enlarged pretracheal lymph node.3. Bilateral adrenal adenomas.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: pna History: cough No focal opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Pain with breathing. Low lung volumes. Cardiomediastinal silhouette is normal. No pneumothorax. Left basilar opacity and pleural effusion.

Output: Left basilar atelectasis/consolidation with pleural effusion.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: Concern for aspiration PNA in the setting of emesis and new O2 requirement. History: See above. Small lung volumes with heart size about upper normal.Mild bilateral basilar opacity compatible with atelectasis, possibly related to aspiration.No specific evidence of pneumonia.

Output: Increased basilar atelectasis, possibly related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Pleural effusion check Mildly increasing in now moderate bilateral pleural effusions greater on the right with underlying parahilar and basilar predominant mild to moderate edema and cardiomegaly.

Output: Mildly increasing and now moderate CHF


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: ? Pneumonia History: SOB No focal airspace opacity, pleural effusion, or pneumothorax.Mild cardiomegaly unchanged.Increasingly visible osseous findings of multiple myeloma and right multiple rib fractures. Of note, a right fourth rib posterolateral lesion is enlarging over the last several studies.

Output: No specific evidence of infection. However, an expansile right chest wall lesion causes mass effect upon the pleura of the right upper lobe, correlate for site of discomfort.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: post op cabg History: post op cabg Interval removal of Swan-Ganz catheter.Lungs hypoinflated with persistent bibasilar atelectasis.

Output: Lungs hypoinflated with persistent bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Chest tube placement. Left chest tube with tip near the left lung apex, similar to prior.Moderate left and small right pleural effusions, without pneumothorax.Decreased interstitial opacities of edema.Left lower lobe retrocardiac opacity likely representing atelectasis.Vertebral body stabilization hardware and IVC filter noted.

Output: Decreased pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Evaluate for infiltrate History: fever New basilar opacities suggestive of infection or aspiration. Patchy upper lobe opacities may be due to a similar cause. Small pleural effusions.Heart size normal.

Output: New basilar opacities and pleural effusions suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: dysfunctional PICC line, please eval placement History: dysfunctional pic line, please eval placement Right-sided PICC tip overlying the mid to distal SVC, slightly more retracted than on prior study.Cardiac silhouette remains within normal limits in size.Lungs are clear. No pneumothorax.

Output: Right-sided PICC tip overlying the mid to distal SVC, slightly more retracted than on prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: cough History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Median sternotomy.Left subclavian ICD, leads unchanged in position.

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


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Hypoxemia Left internal jugular central venous catheter tip is at the superior cavoatrial junction.Layering bilateral pleural effusions, right greater than left. Suture material in the upper and mid right hemithorax.Diffuse, nonspecific patchy airspace opacities with slight improvement in the right upper lobe.

Output: Diffuse, nonspecific patchy airspace opacities with bilateral pleural effusions appearing slightly improved in the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Small lung volumes with moderate to severe chronic interstitial lung disease suggestive of UIP/IPF.Heart size at least upper normal.

Output: Moderate to severe chronic interstitial lung disease, corresponding to findings of a 9/10/2015 outside CT.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: cough x 1 week History: fever/cough The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: pulmonary edema? History: SOB Right PICC with tip at the atriocaval junction.Deformity of the posterior right fourth rib again noted.Mild cardiomegaly.Streaky basilar and mid zone opacities remain unchanged.

Output: No interval change in the basilar and mid zone opacities, considerations include atelectasis and/or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: cardiac arrest History: cardiac arrest Cardiomegaly and mild basilar atelectasis with small pleural effusions.ET tube quite high, well above the thoracic inlet level.An NG tube terminates in the stomach.

Output: High ET tube, subsequently repositioned. More recent radiographs obtained and interpreted.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: Prior RML pneumonia History: SOB Interval improvement in right cardiac margin effacement. Heart remains normal in size.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.

Output: Interval improvement in previously identified right cardiac margin effacement. No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: is there a pleural effusion History: recent diagnosis pneumonia, worsening symptoms Heart size is at the upper limits of normal.Low lung volumes. Bibasilar atelectasis. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: FemaleReason for Study: Reason: s/p lung txp History: annual test Status post bilateral lung transplants with clamshell sternotomy.The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Anterior wedging of a mid thoracic vertebrae unchanged.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: asthma, increased cough History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No complication of asthma or sign of infection.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old Reason: evaluate for resolution of SBO History: 69 yo F with lymphoma of bowel. Enteric tube with tip in the proximal gastric body. Right-sided chest port with its tip in the cavoatrial junction. There are bilateral nephroureteral stents. There are low lung volumes with bibasilar atelectasis. Single air fluid level seen on upright film. Dilated small bowel seen at the mid abdomen and filled with contrast compatible with a partial bowel obstruction seen on the prior CT. Small amount of contrast is seen in the underdistended distal colon. Relatively featureless left colon presumably related to underdistention.

Output: Partial small bowel obstruction as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Pneumonia, Fluid overload History: Shortness of breath, wheezing Stable cardiomediastinal silhouette.Mild bibasilar subsegmental atelectasis. Small right pleural effusion. No new focal pulmonary opacities or pneumothorax.

Output: Bibasilar atelectasis and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: Post NG tube placement, not seen in abdomen History: Abdominal distension Right central venous catheter tip in the SVC. Left chest port tip in the right atrium. No enteric tube is identified.Basilar linear opacities, likely subsegmental atelectasis. Cardiac silhouette size is normal. No pneumothorax.

Output: Basilar subsegmental atelectasis. No NG tube identified.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: FemaleReason for Study: Reason: evaluate for infection History: newly hypotensive Right IJ venous catheter with its tip in the SVC.Stable cardiomediastinal silhouette.Interval improvement in left pleural effusion and perihilar opacities.No focal areas of consolidation.

Output: Interval improvement in left pleural effusion and perihilar opacities. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Fever question consolidation Chronic appearing interstitial lung abnormality with low lung volumes unchanged.Spiculated nodular opacity in the right upper lobe similar to recent previous, consistent with known history of lung cancer.No new airspace opacities.

Output: No new opacities to suggest pneumonia. Right upper lobe spiculated lesion consistent with known lung cancer.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: re-evaluating left pleural effusion History: shortness of breath Left pleural effusion slightly improved following Pleurx catheter placement.No significant pneumothorax.Improved left basilar consolidation.Unremarkable right lung.

Output: Improvement in left pleural effusion following Pleurx catheter placement.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: fever Cardiomegaly with small pleural effusions and partial atelectasis of the left lower lobe.Catheter tip in the SVC.No specific evidence of pneumonia.

Output: Cardiomegaly with effusions and atelectasis compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: hx lung nodule, present? History: reported hx lung nodule Upper normal heart size. Low normal lung volumes.Thickening of the fissures and vascular unsharpness suggestive of moderate hypervolemia. No pleural fluid or pneumothorax.Diffuse skeletal sclerosis consistent with chronic renal disease.

Output: Low lung volumes with signs of moderate hypervolemia; unable to exclude a pulmonary nodule. Consider follow-up PA and lateral chest radiographs immediately after dialysis.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval for pneumothorax History: failed left IJ central access No pneumothorax. Right IJ line is noted terminating at the cavoatrial junction within the right atrium. Bibasilar opacities and pleural effusions again noted. Unchanged heart size.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: lung infiltrate History: cough Unremarkable cardiac and mediastinal silhouette. Small lung volumes with mild nonspecific interstitial opacity, mainly in the lower lobes with bronchial thickening and possibly scarring. These findings are most likely chronic but there may be a superimposed acute component. If symptoms persist a CT scan may be considered for more definitive evaluation.

Output: Bronchial thickening and basilar predominant interstitial opacity of uncertain chronicity. If symptoms persist a CT scan is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old. SOB, tachypnea. Right basilar focal atelectasis or scarring, unchanged. No new pulmonary opacity.No evidence of infection or edema.Severe scoliosis. Stable cardiomegaly and tortuosity of the thoracic aorta.

Output: Right basilar atelectasis/scarring without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: pleuritic chest pain, eval for infection History: pleuritic chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: flu-like sxs History: flu-like sxs The cardiomediastinal silhouette is normal in size.There is a pulmonary nodule in the left upper lobe, which measures up to approximately 1 cm. No pneumothorax or large pleural effusion.

Output: 1. No evidence of pneumonia. 2. Left upper lobe nodule is nonspecific. Further characterization with PA and lateral chest radiographs for confirmation is recommended.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, 71 years old.Reason: Pt with unexplained hypoxia. Getting dopplers to look for DVT but also concerned for pna vs acute chest (hx ss disease) History: hypoxia Right pleural scarring and calcification from prior empyema.Stable right base fibrosis more likely than pneumonia.Chronic interstitial opacities from known sickle cell disease.No reliable evidence of acute infection or infarction.

Output: Chronic abnormalities from known sickle cell disease, but no reliable evidence of acute infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.To assess for pneumothorax post thoracentesis, right-sided pleural effusion. Right chest wall and middle lobe mass overlying the hilum with small ipsilateral pleural effusion, about the same. Right apical pleural thickening and retraction unchanged. Nodular opacities unchanged. Probable skin folds on the right, no conclusive pneumothorax.

Output: No conclusive pneumothorax however short-term follow-up is suggested if patient is symptomatic.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: f/u on pneumothorax History: above Tracheostomy tube remains in place. PICC line, unchanged. Unchanged bibasilar pleural-parenchymal opacities. Diffuse hazy opacity left lung again noted. Unchanged heart size. No pneumothorax.

Output: Unchanged bibasilar pleural-parenchymal opacities. Diffuse hazy opacity left lung again noted.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o mets History: Needs total body scan about a week after therapeutic dose of RAI There is 3 foci of radiotracer uptake in the neck, consistent with residual thyroid tissue or tumor.

Output: There is 3 foci of radiotracer uptake in the neck, consistent with residual thyroid tissue or tumor.


Instruction: Generate impression based on medical findings.

Input: Male, 97 years old.Hypoxia, febrile rule out infection and aspiration. Low lung volumes with elevation of the left hemidiaphragm. The small to moderate volume of pleural fluid bilaterally. Basal atelectasis with some superimposed areas of consolidation at the left base suspicious for infection. Fine granular opacities throughout the right lung atypical for edema and could reflect bronchiolitis from aspiration or infectionUnclear etiology. Scarlike opacity at the right apex unchanged, incompletely evaluated.Left nephroureteral stent incompletely visualized.

Output: Signs of hypervolemia with findings suspicious for aspiration or infection. Follow-up to complete radiographic resolution recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: pna History: pna ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Moderate elevation of the left hemidiaphragm with gaseous distention of the stomach.

Output: ET tube in acceptable position with no interval changes otherwise noted.


Instruction: Generate impression based on medical findings.

Input: Scrotal leiomyosarcoma with liver metastases. On chemotherapy. Follow-up progression of metastatic disease. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are unchanged. Index right upper lobe pulmonary nodule measures 1.4 x 1.1 cm (series 5, image 40), unchanged.MEDIASTINUM AND HILA: The heart is normal in size. No pericardial effusion. Small mediastinal lymph nodes, not meeting size criteria.CHEST WALL: No axillary adenopathy. Increased soft tissue component of multiple osseous lesions. For example, increase soft tissue component of left lateral fourth rib metastasis measuring 3.8 x 2.9 cm (series 3, image 48), previously 3.6 x 2.4 cm. Unchanged posterior cervical spinal fixation hardware.ABDOMEN:LIVER, BILIARY TRACT: Status post total left hepatectomy. Multiple hypodense lesions within the remaining liver are increased compared to prior. For example, segment 8 hypodense lesion measures 5.0 x 3.1 cm (series 3, image 82), previously 4.1 x 2.9 cm. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal metastasis measures 4.1 x 3.2 cm (series 3, image 106), unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortocaval lymph node measures 3.0 x 2.3 cm (series 3, image 76), previously 2.5 x 2.1 cm.BOWEL, MESENTERY: Right paracolic gutter soft tissue metastasis measures 5.0 x 3.8 cm, previously 4.7 x 3.6 cm. Colon diverticulosis, without inflammatory changes to suggest diverticulitis. Additional smaller peritoneal nodules are stable to slightly increased in size.BONES, SOFT TISSUES: No significant abnormality.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Right paracolic gutter soft tissue metastasis measures 5.0 x 3.8 cm, previously 4.7 x 3.6 cm. Colonic diverticulosis, without inflammatory changes to suggest diverticulitis. Additional smaller peritoneal nodules are stable to slightly increased in size.BONES, SOFT TISSUES: Right inguinal hernia containing mesenteric fat. Unchanged L3 and L5 mixed lytic and sclerotic osseous lesions.OTHER: No significant abnormality noted

Output: 1.Increased size of hepatic metastases, peritoneal metastases and soft tissue component of osseous metastases.2.Unchanged pulmonary and right adrenal metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: pneumonia History: s/p legionella pneumonia Persistent left lower lobe pneumonia. Unchanged heart size. No pneumothorax.

Output: Persistent left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with stage III colon cancer CHEST:LUNGS AND PLEURA: Biapical scarring. Follow-up CT is recommended to exclude neoplasm.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific peripheral calcification the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: IVC filter is in place. No evidence of retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease in the chest abdomen and pelvis.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: intubated, IABP History: cardiogenic shock Interval removal of ECMO cannula. Otherwise, stable life support devices including an IABP projecting over the aortic arch.Stable cardiomediastinal silhouette.Interval worsening bibasilar aeration likely atelectasis and small pleural effusions. No pneumothorax.

Output: Interval removal of ECMO cannula. Slight worsening in bibasilar and retrocardiac aeration likely atelectatic in nature with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Preop MVR History: Preop MVR Upper lobe emphysema.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: Emphysema, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Eval intubation/swan History: intubated Unchanged basilar subsegmental atelectasis with small pleural effusions.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular Swan-Ganz catheter tip in main pulmonary artery.Right subpulmonic chest tube unchanged in position.

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


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Confirm a right basilic central PICC placement. Right upper extremity PICC terminates over a central vein approximately 1 cm above the level of the azygos arch.Mild basal scarring on the right, otherwise no focal pulmonary opacities are appreciated. No pneumothorax.

Output: Appropriate positioning of right PICC, terminating at the level of a central vein.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Cough Bilateral basilar opacities suggestive of infection or aspiration. Small right pleural effusion.Heart size at least upper normal.

Output: Basilar opacities consistent with multifocal pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: evaluate for pulmonary abnormality, evaluate for pneumothorax History: acute shortness of breath No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Hematemesis Improving aeration with mildly decreasing edema-like findings greater on the right however persistent minimal edema in both bases and on the left are again observed. Small effusionsBorderline cardiomegalyRight jugular catheter unchanged

Output: Resolving yet persistent mild edema with persistent decreased lung volumes


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Follow-up line placement. Status post left IJ line placement tip over the SVC. No pneumothorax. Lungs are clear. Heart size within normal limits.

Output: No pneumothorax post left IJ line placement with tip over SVC. Clear lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: eval for pulm edema History: dyspnea Diffuse osteophyte formation of the thoracic vertebral bodies. No specific evidence of edema. Pleural spaces are clear. Heart size is normal.

Output: No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: FemaleReason for Study: Reason: leukocytosis History: leukocytosis The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with rheumatoid arthritis and right lower lobe nodule being followed by serial scans. Former smoker. LUNGS AND PLEURA: Severe, diffuse paraseptal and centrilobular emphysema.Multiple scattered pulmonary nodules are stable. A reference right lower lobe nodule measures 12 x 11 mm on axial image 43/70, unchanged. No new nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: Hypodense lesions in both lobes of the thyroid, unchanged.The cardiac size is normal. No pericardial fluid. Aortic and coronary atherosclerotic calcifications are noted. Mild enlargement of the main pulmonary trunk at 3.4 cm (axial image 34/70) is unchanged and suggestive of pulmonary artery hypertension.CHEST WALL: Deformity of multiple posterior right ribs compatible with old healed fracture, unchanged.UPPER ABDOMEN: No significant abnormality noted.

Output: Stable pulmonary nodules. One year follow-up is suggested. If no change is evident at that point, no further follow-up is required.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with cough. The cardiomediastinal silhouette is within normal limits.No pleural effusion.Linear basilar predominant bilateral interstitial abnormality, likely chronic. This may represent UIP.

Output: Chronic appearing interstitial lung disease which may represent UIP. CT would provide more detailed characterization.


Instruction: Generate impression based on medical findings.

Input: ECMO for diaphragmatic herniaVIEW: Chest AP 4/8/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. ECMO cannulas unchanged. Right chest tube and umbilical lines again noted. Complete opacification of both hemithoraces are again noted. Body wall edema again noted.

Output: Complete opacification of both lungs not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: Edema History: SOB Cardiomegaly with basilar opacities and pleural effusions, unchanged.Stable tubes and devices.

Output: Unchanged cardiomegaly with basilar opacities and pleural effusions.