Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Pre-op clearance for right hip hemiarthroplasty History: Pre-op clearance workup Increase in cardiomegaly and vascular congestion.No focal pulmonary opacity, pleural effusion or pneumothorax.Interval removal of central venous catheter.

Output: Mild interval increase in cardiomegaly and vascular congestion. No specific evidence of infection or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Rectal cancer Minimal basilar scarring without additional superimposed airspace abnormality. No effusions. Mild tortuosity of the aorta with an otherwise unremarkable cardiac silhouette. Left PICC line remains within the mid SVC.Sternotomy

Output: PICC line unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o pna History: seizures Median sternotomy status post CABG with a stable appearing coronary stent.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old. ET tube has been placed with its tip 2 cm above the carina.Left PICC line with its tip in the SVC.Right IJ venous catheter with its tip in the SVC.Decreased lung volumes with stable cardiomediastinal silhouette.Streaky perihilar opacities compatible with atelectasis.No new opacities identified.No large pleural effusions.

Output: Interval intubation with ET tube in satisfactory position. Mild increase in perihilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: acute chest with infarct History: Sickle cell with high back pain Clear lungs other than left basilar atelectasis or scar. No pleural effusion or pneumothorax. Normal heart size. Bony changes consistent with sickle cell disease.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: cough History: cough Right central venous catheter with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 66-year-old man with unknown primary tumor status-post two cycles of chemotherapy. Compare with previous PET/CT findings. CHEST:LUNGS AND PLEURA: Few scattered subcentimeter nodules are unchanged.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes are unchanged.CHEST WALL: Right axillary lymph node measures 20 x 20 mm on image number 30, series number 913.ABDOMEN:LIVER, BILIARY TRACT: Multiseptated cystic lesion in the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right external iliac lymph node measures 2 x 1.7 cm image number 161, series number 913.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Penis and scrotum are significantly enlarged with nodular: Cohen thirst, progress from previous CT. These findings are suspicious for lymphoma involvement. Further evaluation with pelvic ultrasound may be helpful.

Output: No significant change in the right inguinal adenopathy. Stable liver lesions. Interval increase in the possible scrotal and penile involvement.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: ng History: ng Feeding tube with tip in upper esophagus, subsequent advanced into the right main bronchus, then corrected.Mild basilar atelectasis.An NG tube terminates in the stomach.ET or tracheostomy tube tip at or above the thoracic inlet level.

Output: Feeding tube in upper esophagus.


Instruction: Generate impression based on medical findings.

Input: Male 41 years old Reason: eval OG History: OG placed The enteric tube tip is within the gastric body. Swan-Ganz catheter tip is in the right main pulmonary artery. A right sided chest tube, and three surgical drains are noted. Sternotomy hardware is partially visualized. The pelvis is excluded from the field-of-view but the visualized bowel gas pattern suggests mild ileus.

Output: Enteric tube tip is within the gastric body.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumothorax s/p thoracentesis History: bilateral pleural effusions Large right pleural effusion, and smaller left pleural effusion, decreased from the previous exam. No pneumothorax or other complications.

Output: Decreased left pleural effusion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: edema? effusion? wide mediastinum 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: Male, 62 years old.Reason: S/p CABG, trach History: asx Unchanged pulmonary opacities and pleural effusions.Tubes and catheters are unchanged.

Output: No change in pulmonary opacities and pleural effusions, tubes or devices.


Instruction: Generate impression based on medical findings.

Input: Right ureteral cancer and right nephrectomy Mild scoliosis without superimposed acute cardiopulmonary abnormality superimposed upon moderate COPD changes. Specifically no findings to suggest metastatic disease. Cardiac silhouette is borderline enlarged with moderate tortuosity of the aorta.No discrete lytic or osseous blastic lesions

Output: No acute disease and moderate COPD


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: cp History: cp Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: swan History: swan Support devices unchanged with Swan-Ganz tip in the pulmonary artery.Stable cardiac enlargement.Mild nonspecific basilar opacities similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged with Swan-Ganz catheter tip in the pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: eval lung fields History: desaturation- requiring facemask Left PICC line with its tip in the SVC.Stable cardiomediastinal silhouette.Mild left basilar scarring/discoid atelectasis.No focal airspace opacities.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 100 years old.Altered mental status. Stable cardiomediastinal silhouette with ectatic and calcified aorta.Stable calcified pleural thickening along the right lateral chest wall.There is worsening left lung base/retrocardiac consolidation/atelectasis with small effusions superimposed on mild chronic interstitial opacities.Healing posterior left seventh rib fracture.

Output: Worsening left lung base/retrocardiac consolidation/atelectasis with small effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval position of impella History: alarm on impella for malposition Low ETT, 1 cm above the carina.Stable appearance of venous ECMO cannula.The coiled portion of the Impella device appears somewhat angulated.Inferior approach pulmonary artery catheter has been repositioned and is now directed into the distal left main pulmonary artery.Left subclavian ICD device with leads in the right atrial appendage, right ventricle, and coronary vein, stable.Stable cardiomegaly.Low lung volumes with increasing perihilar airspace opacities, consistent with worsening pulmonary edema.No pneumothorax.

Output: 1. Low ETT, 1 cm above the carina.2. Worsening pulmonary edema.3. Pulmonary artery catheter tip directed into the distal left main pulmonary artery.4. Impella device position is difficult to assess due to lordotic patient positioning; the distal coiled portion of the device in the LV appears somewhat angulated. It is difficult to determine the position of the outflow area relative to the aortic valve. Follow-up plain film recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: Edema? History: chest pain Stable mild cardiac enlargement. Vasculature normal. Lungs clear of air space opacities.Stable position of single lumen chest port. No pneumothorax. No pleural effusion.

Output: No acute abnormality or interval change


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: assess for infiltrates History: intubated Endotracheal tube approximately 10.5 cm above the carina. Left upper extremity PICC terminates over the cavoatrial junction. Right internal jugular sheath has its tip overlying the superior vena cava. An enteric tube traverses the diaphragm and is incompletely evaluated on this study.Heart size is at the upper limits of normal. Mild prominence of the right hila. Stable diffuse mixed interstitial and airspace opacities. No large pleural effusion. No pneumothorax.

Output: Endotracheal tube tip is inadequately positioned. Recommend advancement.Paged Dr. Retti Greenwald at the time of dictation to discuss findings.


Instruction: Generate impression based on medical findings.

Input: Testicular cancer No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: s/p esophagectomy History: s/p esophagectomy Left chest tube with no significant pneumothorax.Lower lung zone opacities consistent with edema and atelectasis accompanied by pleural effusions are unchanged.An NG tube traverses a gastric pull-up, stable in position.Right jugular catheter, tip in SVC.

Output: No pneumothorax. Stable pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Swan ganz catheter position History: s/p Swan ganz catheter placement for decompensated heart failure Right jugular IVC Swan-Ganz catheter looping deep into the IVC from before terminating in the main pulmonary artery, subsequently repositioned.Right subclavian ICD leads are present, appropriate positions.Cardiomegaly with lower lung zone edema and pleural effusions consistent with CHF.

Output: IVC Swan-Ganz catheter loops into the IVC, subsequently repositioned. CHF with moderate edema and pleural effusions noted.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval for pneumothorax History: s/p intra-op pneumothorax and chest tube placement Technically limited examination in this postoperative radiograph. There is a left apically directed chest tube.Trace left pneumothorax. Left perihilar and right mid zone subsegmental atelectasis.

Output: Trace left pneumothorax in the setting of a chest tube.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: eval iabp, swan History: iabp IABP again fairly low terminating 4.6 cm from the top of the aortic arch, unchanged compared to previous study. Swan-Ganz catheter and defibrillator lead, unchanged. No focal lung consolidation. Unchanged cardiomegaly. No pneumothorax or large pleural effusion.

Output: IABP again fairly low terminating 4.6 cm from the top of the aortic arch, unchanged compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure ETT terminates 3 cm above the carina. Swan-Ganz terminates in the right pulmonary outflow tract. NG well-positioned and beyond the inferior edge of the image.Mild cardiomegaly with decreased lung volumes and diffuse pulmonary edema and patchy nonspecific basilar changes suggesting both edema and atelectasis. Small effusions suspected

Output: Mild CHF


Instruction: Generate impression based on medical findings.

Input: 46 year old female with chest pain. Recent history of saddle embolus. CHEST:PULMONARY VASCULATURE: Interval decrease in embolic burden with residual emboli involving the main pulmonary arteries and lobar branches.LUNGS AND PLEURA: Mild basilar atelectasis. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size mildly enlarged with trace pericardial effusion. Enlarged main pulmonary artery again compatible with pulmonary hypertension.CHEST WALL: Nodule in right breast, unchanged (series 5, image 97). Left chest pacer device.UPPER ABDOMEN: No significant abnormality noted.

Output: Interval decrease in embolic burden with residual emboli in the main and lobar pulmonary branches.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: crackles on exam, suspect fluid vs atelectasis History: as above Unchanged basilar opacities suggestive of aspirated secretions with atelectasis.Right basilar pneumonia is also in the differential diagnosis.Heart size normal.A Dobbhoff tube extends below the lower margin of the image.

Output: Unchanged basilar opacities suggestive of aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: eval for worsening pleural effusion History: sob, hx of ESRD Stable cardiomegaly.Left pleural effusion and/or thickening.Bilateral lower lung predominant interstitial opacities.

Output: Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: productive cough and right flank pain x 3 weeks. Assess etiology The heart size is normal. The lungs are clear. No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ett placement History: ett in place ET tube tip approximately 6 cm above the carina.NG tube tip in the gastric fundus.Moderate perihilar bronchial thickening.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p RLL lobectomy decort History: CT in place X 2 Cardiac mediastinal silhouette is unchanged.Low lung volumes. Moderate right pleural effusion is similar to prior. Bibasilar opacities without significant interval change. Small right apical hydropneumothorax.Single live mesenteric feeding tube. Right chest port with tip in the SVC and right sided chest tubes unchanged in position.

Output: Small right apical hydropneumothorax. Moderate right pleural effusion and bibasilar opacities without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: ? Pleural effusion History: abdominal surgery with R diaphragmatic stripping Small lung volumes with increased retrocardiac opacity and small left pleural effusion.Heart size normal.The NG tube is been removed and the stomach is less distended than before.Status post extubation.

Output: Status post extubation with increased left basilar opacity possibly retrocardiac atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: eval post thoracentesis History: post thoracentesis ] PICC line with its tip in the SVC.Decreased lung volumes with stable cardiomediastinal silhouette.Pleural effusions and pulmonary opacities appearance the prior exam.No evidence of a pneumothorax.Embolization coils noted in left upper abdomen.

Output: Pulmonary opacities and pleural effusions unchanged. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval please History: chest pain, shortness of breath Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Bullet fragments overlie the left supraclavicular region.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p trach. pls assess pulmonary opacities History: s/p trach, pls assess for improvement/worsening of pulmonary opacities New tracheostomy tube in place with its tip about 5 cm above the carina and no visible complications.Venous catheters, feeding tube and right chest tube unchanged.Focal bilateral opacities have improved.No significant pneumothorax.

Output: Interval improvement in nonspecific pulmonary opacities


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: ? pna History: resp distress New left basilar opacity which may be due to atelectasis, aspiration, or pneumonia.

Output: New left basilar opacity which may be due to atelectasis, aspiration, or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Asthma and recurrent cough, dyspnea. Report of LLL infiltrate evaluate for resolution. There is a hazy 16 mm nodular opacity in the left upper lobe projecting over the anterior left second rib where it crosses the posterior left seventh rib. This occurs in a area which may be obscured on the lateral radiograph.Subsegmental atelectasis or scarring in the left lower lobe. Bronchial wall thickening and associated volume loss/peribronchial opacity in the lower lobes bilaterally which may be postinfectious or postinflammatory. No pleural fluid, pneumothorax or visible pneumomediastinum.

Output: 1. 1.6 cm left upper lobe nodular opacity which may be infectious, inflammatory or nonbenign. If the referring clinical service can obtain and submit remote outside prior studies, an addendum to this report can be provided. Otherwise, six-week PA and lateral chest radiograph follow-up is recommended. 2. Low lung volumes with bronchial wall thickening, peribronchial opacity and atelectasis in the lung bases nonspecific without the benefit of a comparison study but may reflect sequela of bronchitis/bronchopneumonia or noninfectious eosinophilic or cryptogenic organizing pneumonia. This should be followed to complete radiographic resolution with initial PA and lateral chest films in 6 weeks.


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 projected in the area of the right atrial appendage and right ventricular apex with no visible complications.Moderate cardiomegaly with bilateral pleural effusions and underlying atelectasis consistent with CHF.Aortic valve prosthesis in place.

Output: Pacemaker leads in expected locations with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: s/p Left Lower Lobectomy History: Postop s/p left lower lobectomy Left hemithorax postsurgical volume loss.Left chest tube with no pneumothorax.Right midlung subsegmental atelectasis.

Output: No significant pneumothorax. Status post left lower lobectomy.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: cough x 4 weeks. History: cough x 4 weeks Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Pectus excavatum deformity, normal variant.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Intubated with left apical pneumothorax. Hardware and devices similar in position. Small left apical and medial pneumothorax with maximal pleural separation from the chest wall of about 6 mm, improving. Small pleural effusions. Free intraperitoneal air. Retrocardiac atelectasis.Dense nodular opacity at the left apex is new from previous, possibly atelectatic lung or less likely hematoma.

Output: 6 mm left apical pneumothorax. Dense nodular opacity at the left apex the prior studies, likely atelectatic lung or hematoma, unless the patient has signs of infection.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with history of non-Hodgkin lymphoma status post stem cell transplant CHEST:LUNGS AND PLEURA: Right upper lobe air space opacity suspicious for pneumonia. Pleural effusion in the left fissure. Mild emphysema. Dependent bibasilar atelectasis. Left upper lobe consolidation adjacent to the fissure is stable. Previously described right upper lobe nodule is stable on image number 30/209. Left lower lobe nodule stable image number 83.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Striated nephrogram involving the right kidney, especially lower pole. Pyelonephritis cannot be excluded.RETROPERITONEUM, LYMPH NODES: Very large infrarenal abdominal aortic aneurysm measures 4.7 x 5.9 cm in its greatest dimension. It extends to the level of the bifurcation. Significant atherosclerotic changes involving the iliac arteries and aorta.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: New consolidation in the right upper lobe consistent with pneumonia. Left upper lobe consolidation and loculated left pleural effusion is unchanged. Bilateral lung nodules unchanged.Possible pyelonephritis involving the right kidney as described above. large infrarenal abdominal aortic aneurysm exceeding the 5 cm size criteria and has interval increase in size compared to 11/30/2850.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: post op History: cough The cardiomediastinal silhouette is unremarkable.Mitral valve prosthesis redemonstrated.Interval clearing of the subcutaneous emphysema, basilar opacities, pleural effusions, and right-sided pneumothorax.Increased lung volumes compatible with COPDNo acute abnormalities identified.

Output: Resolution of previous pleural effusions, basilar edema, and right-sided pneumothorax. No acute cardiopulmonary modality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: new central line History: new central line Interval placement of left central venous catheter, with tip terminating at the confluence of the brachiocephalic veins. Interval placement of right central line, with tip terminating at the upper superior vena cava. Tracheostomy tube is unchanged.Low lung volumes. Scattered pulmonary opacities, probably subsegmental atelectasis. No pleural effusion.Cardiomediastinal silhouette within normal limits.

Output: 1.Interval placement of left central venous catheter, with tip terminating at the confluence of the brachiocephalic veins. 2.Interval placement of right central line, with tip terminating at the upper superior vena cava. 3.Unchanged scattered subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 57 year old female with shortness of breath. Evaluate for PE. Technically inadequate exam, time 2205 hrs. Technically adequate exam, time 2220, diagnostic to the lobar level.PULMONARY ARTERIES: No evidence of PE.LUNGS AND PLEURA: Few scattered micronodules are nonspecific. Mild platelike atelectasis left lower lobe.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. No cardiomegaly or pericardial effusion.CHEST WALL: Small calcified nodule in left breast can be further characterized by mammography.UPPER ABDOMEN: No significant abnormality noted.

Output: No PE or acute cardiopulmonary findings. Few scattered micronodules, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Edema and check for effusion. Increasing patchy CHF changes with marked nonspecific cardiomegaly and effusions. ETT has been removed along with the left jugular sheathCoronary stent projects over the left ventricle

Output: Increasing CHF, currently moderate


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.History of mesothelioma with shortness of breath, evaluate effusions. Moderate cardiomegaly unchanged. Clamshell sternotomy.Bilateral pleural effusions, interstitial opacities of edema, and additional nonspecific basilar opacities not significantly changed.

Output: Pleural effusions and basilar pulmonary opacities not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: swan placement History: swan placement Swan-Ganz catheter tip in the main pulmonary artery, with a redundant loop extending towards the IVC.Marked cardiomegaly with basilar atelectasis, unchanged.Status post TAVR.

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


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with increased ventricular size on head CT. Evaluate VP shunt SHUNT DEVICE: VP intracranial shunt catheter tip noted at the midline and crosses the midline exiting the right calvarium through a burr hole in the right parietal lobe and courses through the soft tissues of the right neck, hemithorax and hemiabdomen with tip terminating in the left lower quadrant. No evidence of discontinuity or kinking throughout the radiopaque portions of the catheter.SKULL: No significant abnormality noted.CERVICAL SPINE: Severe degenerative disc disease of the cervical spine.CHEST: No significant abnormality noted.ABDOMEN: Bowel gas pattern is unremarkable.

Output: No evidence of VP shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: 91 y/o with COPD here with SOB, PNA? History: SOB Right upper lobe interstitial and airspace opacity consistent with pneumonia.Right apical pleural fluid loculated.Elsewhere, the lungs are unremarkable.

Output: Right upper lobe airspace opacity and adjacent pleural fluid suggestive of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: b/l pleural effusions, intubated ET tube tip approximately 2 cm above the carina.Small lung volumes with streaky basilar opacities compatible with atelectasis, with small effusions.Left jugular catheter tip now in the area of the junction of the jugular and left innominate veins.Right jugular catheter unchanged.

Output: Basilar atelectasis and small effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: lung infiltrate History: cough Heart size normal.Scarring or atelectasis right lung base.No specific evidence of infection or edema.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with non-small cell lung cancer CHEST:LUNGS AND PLEURA: Patient's known large right upper lobe mass is smaller now measuring 3.3 x 2.7 cm on image number 23, series number 4. Multiple bilateral pulmonary nodules are again identified in both lungs. Reference left upper lobe nodule measures 4-mm in diameter on image number 38, series number 4, slightly smaller compared to previous study. Other reference nodes are also slightly smaller.MEDIASTINUM AND HILA: Multiple bilateral thyroid nodules, stable. Large precarinal mass measures 2.4 x 1.3 cm on image number 34, series number 3, significantly smaller compared to previous study.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass measures 1.9 by 1.9 cm on image number 92, series number 3, not significantly changed from previous study.KIDNEYS, URETERS: Unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Ieiomyomatous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bony lysis involving L5 vertebral body appears similar.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the lung masses and mediastinal mass.Left adrenal mass and bony lesion involving L5 vertebral body are stable.


Instruction: Generate impression based on medical findings.

Input: Chest pain Persistent mildly diminished lung volumes with interstitial changes in both bases, essentially chronic and unchanged. No new superimposed focal airspace abnormality.The cardiac and mediastinal contours are within limits

Output: Mild chronic appearing scarring without additional acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: Evaluate for acute chest syndrome History: Known sickle cell disease, presenting with chest pain and SOB Moderate cardiomegaly.No significant pulmonary or pleural abnormality.

Output: Moderate cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with history of urothelial carcinoma status post cystoprostatectomy and chemotherapy CHEST:LUNGS AND PLEURA: Scattered micronodules are stable. No new nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver lesions are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hydronephrosis and hydroureter greater on the left with some atrophy on the left are unchanged. No bladder is significantly distended and this may account for some of the hydronephrosis.RETROPERITONEUM, LYMPH NODES: Previously described lymph nodes predominantly in the left para-aortic region best on image number 114 -- 116, series number 4 are unchanged. Previously described mesenteric adenopathy is also unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The patient is post cystoprostatectomyBLADDER: Neobladder is again significantly distended.LYMPH NODES: Mesenteric adenopathy adjacent to the neobladder on image 71 is unchanged measuring 17 x 9 mm image number 145, series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT. Neobladder is again distended. Bilateral hydronephrosis with parenchymal loss on the left side is unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Dyspnea status post MVA rule out pneumothorax. A vascular stent projects over the left axilla.No pneumothorax.Lung volumes are low normal. No focal pulmonary opacities or pleural fluid.Normal heart size. A coronary stent is seen just below the level of the left hilum.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended.

Output: No pneumothorax or acute pulmonary abnormality. Please note that although no obvious skeletal abnormalities are appreciated, fracture or dislocation may not be visible by this technique.


Instruction: Generate impression based on medical findings.

Input: Please evaluate for septic emboli. Patient with MSSA bacteremia of unknown source LUNGS AND PLEURA: Multifocal peripheral air space opacities are noted bilaterally, one of which in the right upper lobe (image number 34, series number 5) has possible early cavitation. Findings are consistent with septic emboli. Bilateral pleural effusions with consolidation/atelectasis in the left lower lobe.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes. Largest lymph node in the AP window measures 10 mm in diameter. ICD leads tips in the right ventricle and right atrium. Small amount of pericardial effusion. Hypodense blood pool, consistent with anemia. CHEST WALL: ICD in the left chest wall.UPPER ABDOMEN: No significant abnormality noted.OTHERS: Focal sclerotic area in the right scapula near the glenoid (image number 35, series number 80224) without cortical disruption, associated soft tissue mass, or periosteal reaction, which may represent bone island versus bone infarct.

Output: 1. Findings in both lungs consistent with septic emboli.2. Moderate amount of bilateral pleural effusions, with consolidation/atelectasis of the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: sob History: sob The cardiac and mediastinal silhouette is unchanged. Calcified aortic arch. Calcified hilar lymph nodes are unchanged. No specific evidence of infection, edema, or effusions. Left basilar scar. Degenerative changes of the thoracic spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: ett History: intubation Very low lung volumes. Left basilar subsegmental atelectasis.ET tube overlying the mid trachea, in appropriate position. The enteric tube courses below the diaphragm.Limited assessment for pleural effusions. No supine evidence of pneumothorax.

Output: Very low lung volumes. Assessment of the lungs is very limited.Appropriate position of enteric and ET tubes.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: cough History: cough Mild cardiomegaly with a tortuous aorta.No specific evidence of infection or edema.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: eval pneumothorax, s/p CT guided biopsy History: eval pneumothorax Stable small to moderate left pneumothorax following biopsy.Minimal left base atelectasis.

Output: Stable left small to moderate pneumothorax following biopsy.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: r/o PTX History: chest pain, SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: pneumonia vs edema History: shortness of breath In addition to low lung volumes, there is cardiomegaly, bilateral pleural effusions as well as pulmonary edema. Findings most compatible with congestive heart failure with basilar atelectasis. Superimposed aspiration cannot be excluded.No pneumothorax.

Output: Findings most compatible with pulmonary edema and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: ? Metastatic disease History: chest pain in breast CA Cardiomegaly without acute edema or pneumonia.Spinal fixation hardware overlies the thoracolumbar spine.

Output: Cardiomegaly without acute edema or pneumonia. No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: on ECMO, intuabted, now with increased bloody ETT secretions, eval for DAH History: as above Support devices unchanged.Stable cardiomediastinal silhouette.Increasing airspace opacities and pleural effusions compared to the prior exam.More focal area of consolidation in the right apex more prominent than on the prior exams.Left retrocardiac consolidation/atelectasis redemonstrated.

Output: Increasing pleural effusions and perihilar/basilar opacities suggestive of edema. Developing right apical consolidation may represent infection, infarction, or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: recent pneumonia, eval for infection to explain COPD exacerbation History: as above Basilar linear opacities likely representing atelectasis. The cardiomediastinal silhouette and vasculature are normal. No airspace opacities. No pleural effusion or pneumothorax.

Output: Basilar opacities likely representing atelectasis. No specific site of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: Intubated, Hypoxia, Resp Failure History: Intubated, Hypoxia, Resp Failure Basilar opacities consistent with atelectasis and small pleural effusions are slightly worse.Moderate cardiomegaly.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Slight worsening of basilar opacities suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Sarcoid and asthma with flare, recently hospitalized. Rule out pneumonia. Normal heart size. Mildly prominent central pulmonary vasculature. Lung volumes are low normal.Diffuse mild bronchiectasis, peribronchial thickening and nodularity, consistent with provided history of sarcoidosis. No visible pleural fluid or signs of pulmonary edema.

Output: No visible signs of pneumonia. Parenchymal lung abnormalities consistent with known sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Gunshot wound to left buttock and thigh. No pneumothorax or visible pleural fluid. No focal pulmonary opacities.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: eval infection, edema, effusion History: chest pain, sob, cough Stable nonspecific marked cardiomegaly. No large pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: Stable marked cardiomegaly without additional acute pulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: Rule out pneumonia? History: sirs without source, fever Vascular crowding and bronchial wall thickening. Small bilateral pleural effusions. No pneumothorax. Port catheter tip projects over the atriocaval junction. The heart size is normal. No pneumothorax. Surgical clips are seen in the left upper quadrant.

Output: Vascular crowding and small bilateral effusions without focal airspace opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Evaluate for support devices ET tube approximately 4.0 cm from the carina. Enteric tube is looped with tip in the stomach. Temperature probe device is high within the neck, possibly the hypopharynx. Please check the back of the mouth to make sure this probe is not coiled.Cardiomediastinal silhouette is unchanged. Worsening diffuse pulmonary opacities.

Output: Unchanged support devices. Worsening diffuse pulmonary opacities.Temperature probe device is high within the neck, possibly the hypopharynx. Please check the back of the mouth to make sure this probe is not coiled.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: Age: 64 yearsGender: MaleReason for Study: Reason: ETT History: ETT ET tube with its tip 5 cm above the carina. Cardiomediastinal silhouette is unremarkable.Lungs are clear. No pleural effusions.

Output: No acute cardiopulmonary abnormalities. ET tube unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: evaluate for cause of shortness of breath History: SOB Increasing basilar opacities suggestive of edema, with with atelectasis.Heart size normal.Left PICC, tip in SVC/RA junction level.

Output: Increasing or new basilar opacities suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: evaluate cardiopulmonary system History: dyspnea s/p OHT Median sternotomy, heart size normal.No specific evidence of infection or edema.Chronic appearing opacity left lung base.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: ?reaccumulation of L. effusion History: known left effusion s/p thora on 5/27 No significant reaccumulation of pleural fluid. Mild left greater the right basilar linear opacities which may represent scarring and/or atelectasis. Question mild interstitial pulmonary edema. Mild cardiomegaly. No pneumothorax.

Output: Basilar opacities likely representing scarring and/or atelectasis with no specific evidence of infection. Overall findings are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Postprocedural pneumothorax. Chest tube clamped. History of breast cancer. 4 mm residual right apical pneumothorax component. Residual loculated air component, likely cavitation, within the anterior right upper lobe mass. Bilateral pulmonary nodules and masses and extensive lymphadenopathy about the same. Right chest wall subcutaneous emphysema. Left chest port tip at the SVC. Right chest wall clips.

Output: 4 mm residual right apical pneumothorax. No acute change in pulmonary nodules or masses.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: sepsi History: AMS Lungs clear.Mild cardiac enlargement.No pleural effusion. No pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: eval pnx History: as above Mid and lower lung zone interstitial and airspace opacities worsened since the prior study accompanied by bilateral pleural effusions.Heart size likely normal. A small right apical pneumothorax unchanged.Gastrostomy tube noted.

Output: Worsening pulmonary opacities and pleural effusions suggestive of CHF/hypervolemia, with possible superimposed aspiration or infection. Very small right apical pneumothorax unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA, pneumo History: new O2 requirement, hyperresonnace in RLL, AMS New or increased patchy bilateral airspace opacity, suggestive of aspiration and/or infection.Unremarkable cardiac and mediastinal silhouette. No sign of pneumothorax or visible pleural effusion.

Output: Increased bilateral patchy airspace opacities suggestive of aspiration and infection.


Instruction: Generate impression based on medical findings.

Input: Scleroderma and pulmonary fibrosis. Early matter cause. Check for PE. No symptoms however increased RU and PA pressures. PULMONARY ARTERIES: No significant abnormality noted.LUNGS AND PLEURA: Reidentified is the mild intra-and interlobar septal thickening predominantly seen in both bases. Mild stable apical scarring. No pulmonary nodules or masses identified.Scattered calcified granulomas in the right base, unchanged MEDIASTINUM AND HILA: Small scattered mediastinal nodes are similar in appearance.Heart and pericardium are normal. Mild atherosclerotic changes in the aorta. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Persistent small hiatal hernia. These small cyst is noted in the right lobe of the liver which is stable. Small accessory spleen.

Output: 1. No interval change and reidentified is the mild fibrotic pattern seen consistent with patient's given diagnosis of scleroderma. 2. No evidence of a PE


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: s/p right IJ central venous catheter History: as above Pulmonary edema and pleural effusions with left basilar consolidation, unchanged.NG tube placed, the side port at or above the hemidiaphragm level.Right jugular catheter, tip in SVC.ET tube tip approximately 5 cm above the carina.

Output: No change in pulmonary opacities and pleural effusions. NG tube placed, the side port at or above the GE junction.


Instruction: Generate impression based on medical findings.

Input: Left-sided chest pain No cardiopulmonary abnormality.

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: assess for pneumothorax, pneumonia History: cough No significant cardiopulmonary abnormality.Healed clavicular fractures.Cervicothoracic spine stabilization hardware.Right jugular catheter, tip in SVC.A Dobbhoff tube extends below the lower margin of the image.

Output: No significant cardiopulmonary abnormality. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: eval for pneumonia History: ams The cardiomediastinal silhouette is unchanged.Low lung volumes without evidence of infection or edema.No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: evaluate for pneumothorax History: s/p failed line placement Cardiomegaly, with lower lung zone opacities and large right pleural effusion not significantly changed.No pneumothorax following line placement attempt.ET tube tip 4 cm above the carina.Right jugular Swan-Ganz catheter replaced with one terminating at the SVC/RA junction level.Left subclavian ICD unchanged.NG tube still doubled back in the esophagus.Impella unchanged in position.

Output: NG tube still doubled back in the esophagus. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: sob History: sob Minimal basilar scarring or subsegmental atelectasis, the lungs otherwise unremarkable.Heart size normal, the aorta mildly tortuous but consistent with age. Surgical clips overlie the thyroid region.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: 81F s/p left wedge resection c/o SOB History: SOB, anemia Unchanged cardiac mediastinal silhouette.Stable position of chest tube near the aortic arch. Dense consolidation in the left lung and left pneumothorax are not significantly changed.Bronchiectasis is again seen on the right.

Output: No significant interval change in dense left airspace opacities and pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with metastatic cholangiocarcinoma. T CHEST:LUNGS AND PLEURA: Bilateral pleural effusions, moderate on the left and small on the right are unchanged. Mild pulmonary edema. Scattered nonspecific subcentimeter nodules, nonspecific. A new subcentimeter nodule is noted on image number 25, series number 5.Dependent atelectasis in the lung bases are unchanged.MEDIASTINUM AND HILA: Reference cardiophrenic lymph node is unchanged measuring 17 x 12 mm in image number 58, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous metastatic hepatic lesions are again noted. Index segment a metastatic focus measures 38 x 33 mm, minimally increased in size compared to previous study. Thrombosed left portal vein is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left renal cyst.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Ascites, increase in size compared to previous study.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Ascites. Right lateral inguinal hernias, larger on the left. Left inguinal hernia contains ascites and nonobstructed bowel segments. Right inguinal hernia contains fat.

Output: Bilateral pleural effusions are stable. Ascites is increased in size. Numerous new liver lesions are again noted. Minimal interval increase in the size of the index lesion.Retroperitoneal and cardiophrenic adenopathy, stable.Bilateral inguinal hernias.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: effusion, consolidation History: sob No significant pleural effusion or pneumothorax.Scarring/subsegmental atelectasis noted.Mild cardiomegaly. Thoracic aortic calcifications.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.History of bladder cancer, evaluate for metastatic disease. Biapical scarring unchanged. Large lung volumes, about the same. Normal heart size. No pulmonary nodules or masses are appreciated. No signs of metastatic disease.

Output: No signs of metastatic disease. Large lung volumes.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old. Progressive dyspnea on exertion with basilar crackles in patient with advanced dementia. Eventration of the right hemidiaphragm is not significantly changed from the prior exam. No pneumothorax. The heart size is at the upper limits of normal and the aorta is tortuous but both are unchanged. No pneumothorax.

Output: No significant acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Decreased breath sounds Marked perihilar and four-quadrant changes with moderate effusions greater on the right and cardiac megaly. Concern for moderate CHFLeft jugular dialysis catheter again extends into the mid SVC unchanged

Output: Marked increasing failure and CHF


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.EtOH abuse, chest pain, A. fib rule out aspiration pneumonia. Low lung volumes. Mild basal and dependent atelectasis, but no signs of pneumonia. Left rib fracture deformities are chronic.

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


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.COPD with acute exacerbation. Stable cardiomediastinal silhouette. No focal consolidation. Bibasilar subsegmental atelectasis/scarring. No pleural effusion or pneumothorax. Surgical clips from cholecystectomy.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Respiratory distress requiring intubation check ET tube placement. Low position of right jugular catheter which may be retracted by about 8-9 cm.Subpulmonic fluid on the right similar in volume with associated compressive atelectasis. Paramediastinal atelectasis in the left lower lung is unchanged. No pneumothorax.

Output: Right jugular catheter tip low in the right atrium, recommend repositioning. No acute change in atelectasis or pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.History of removed chest tubes. Interval removal of chest tubes and right IJ central venous catheter since the prior study.Cardiac silhouette unchanged in size.Unchanged basilar opacities compatible with atelectasis and effusions. No pneumothorax.

Output: Interval removal of chest tubes and right IJ central venous catheter without pneumothorax. Unchanged basilar opacities compatible with atelectasis and effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Vascular insufficiency of the intestine, check pulmonary status. Interval extubation. Nasogastric tube tip off the caudal margin of the film. Small pleural fluid collections seen previously are no longer visible. Minimal residual septal thickening on the left. No focal air space opacities.

Output: Near complete resolution of CHF such hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Evaluate for effusion/consolidation, eval pacemaker, evaluate for cardiomegaly History: Hx of ischemic cardiomyopathy, pacemaker in place, recent sepsis Cardiac leads terminate in the expected location of the right atrial appendage, the right ventricle, and likely a coronary vein. Left lung is clear. Right basilar pleural-parenchymal opacities noted. Mild cardiomegaly. No pneumothorax.

Output: Left lung is clear. Right basilar pleural-parenchymal opacities noted, likely postinfectious or postinflammatory scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: please assess for interval progression/resolution of hydropneumothorax History: 74M s/p nephroureterectomy with tachycardia, new o2 requirement The amount of fluid in the small left hydropneumothorax has decreased. Stable small apical air component.No right pleural effusion or right pneumothorax.Stable left lower lobe subsegmental atelectasis.The heart is normal in size. Moderate atherosclerotic calcification of the thoracic aorta.Persistent minimal left chest wall subcutaneous emphysema.

Output: Persistent small left hydropneumothorax with interval decrease in the amount of left basilar fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old. Reason: dysphagia to solids and liquids Scout radiograph of the chest demonstrated diffuse reticular interstitial opacities consistent with known history of fibrosis. No evidence of mediastinal widening or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. Fluoroscopic evaluation of the hypopharynx and upper esophagus demonstrate no evidence of aspiration. Evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.During the exam, no spontaneous or provoked gastroesophageal reflux was observed. A swallowed barium tablet was held briefly in a physiologic location and passed readily into the stomach with sips of water.TOTAL FLUOROSCOPY TIME: 9:54 minutesENTRANCE DOSE: 252.30 mGy

Output: No evidence of esophageal stenosis, mass lesion, or dysmotility.


Instruction: Generate impression based on medical findings.

Input: 29 year old female, preoperative exam for bariatric surgery to assess degree of reflux. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Single contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. A small hiatal hernia was noted. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.TOTAL FLUOROSCOPY TIME: 4:05 mm:ss

Output: 1.No esophageal structural abnormality or evidence of GE reflux. 2.Small hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with dyspnea. Evaluate for pulmonary edema. Perihilar interstitial opacities with septal lines with probable pleural effusions. No pneumothorax. Normal cardiomediastinal silhouette.

Output: Findings compatible with pulmonary edema which may be secondary to CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: ? SOB History: ? volume Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 69 y/o male with dysphagia. EGD today shoulder severe erosive esophagitis, concern for malignancy. Multiple biopsies were taken. Lateral out perforation. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. The right and left costophrenic angles were excluded from the field-of-view.Limited evaluation of the esophagus with water soluble contrast to evaluate for leak. There was no evidence of esophageal leak. There was an abrupt change in contour in the distal esophagus approximately 3.5 cm in length. The esophageal mucosa was irregular in the area of narrowing. This abnormality was incompletely evaluated on this limited exam and correlation with findings from the same day endoscopy is recommended.Fluoroscopy Time: 1 minutes 38 seconds

Output: 1.No evidence of esophageal leak.2.Narrowing in the distal esophagus with irregular mucosal surface may reflect an inflammatory or neoplastic process. This exam was limited and correlation with the same day endoscopy and biopsy is recommended.Findings discussed by phone with Dr. Kavitt on 2/24/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.SOB and chills evaluate for infiltrate Unchanged position of right bronchial stent. Complete opacification of the right upper lobe due to underlying hilar mass, with slight increase in mass effect upon the minor fissure. Fullness in the right hilum and adjacent airspace opacity progressively increasing over the last 2 films, though likely exaggerated by differences in rotation. No visible focal opacities on the left. No pleural fluid.

Output: Right lower and middle lobe opacity most compatible with infection. Interval progression of lymphadenopathy, which may be due to infection rather than tumor progression in the acute setting. Postobstructive consolidation in the right upper lobe also increasing, most consistent with infection.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Chest pain. Normal heart size. Tortuous thoracic aorta, unchanged. No focal airspace opacities, pleural fluid or pneumothorax.Mild apical scarring unchanged.

Output: No findings to account for the patient's chest pain. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with a right pulmonary nodule, follow up exam LUNGS AND PLEURA: Moderate to severe centrilobular and paraseptal emphysema unchanged.Bilateral pleural thickening scarlike opacities at the bases are stable.No suspicious pulmonary nodules can be identified.MEDIASTINUM AND HILA: Large mediastinal lymph nodes are stable.Coronary artery and aortic calcifications.Evidence of previous CABG.CHEST WALL: Median sternotomy. Soft tissue thickening in the subcutaneous tissues and around the sternum consistent with a the previous abscess.UPPER ABDOMEN: No significant abnormality noted.

Output: No suspicious pulmonary nodules or evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Kidney cancer Scattered calcified lymph nodes and large left upper lung granuloma without additional acute or new cardiopulmonary abnormality. Persistent mild cardiomegaly, left ventricular

Output: Mild cardiomegaly with out new acute pulmonary disease


Instruction: Generate impression based on medical findings.

Input: Reason: Pt is a 38 yo female; potential stem cell donor History: evaluate Normal heart size with a dextroscoliosis.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: swan in place, eval placement and for any interval change. Patient being diuresed. History: CHF, DOE, swan in place Tip of Swan-Ganz catheter remains in the right pulmonary artery.Stable cardiomegaly. Mild basilar edema.No focal lung opacities.No pneumothorax.

Output: No change in position of Swan-Ganz catheter.No change in cardiomegaly and mild basilar edema.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: PNA, edema? History: SOB, CP Large lung volumes compatible with COPD. Air space opacity right middle lobe suspicious for aspiration or infection. Mild cardiomegaly, unchanged. No associated pulmonary edema or pneumothorax. Chronic blunting right cardiophrenic angle likely from scar. Small hiatal hernia.

Output: Right middle lobe opacity suspicious for aspiration or infection. Mild cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with metastatic squamous cell carcinoma CHEST:LUNGS AND PLEURA: Emphysema, unchanged. Scattered micronodules unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Index left axillary lymph node measures 2.3 by 1.5-cm image number 16, series number 3, minimally increased in size compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: Multiple cysts in the liver are unchanged. Cholelithiasis, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm with small intramural thrombus is unchanged measuring 3.5 x 3.2 cm in its largest axial dimensions.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.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: Minimal interval increase in the size of the left axillary lymph node otherwise no other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Status post cardiac surgery. Interval placement of right central venous catheter with tip in the atriocaval junction. Low lung volumes. Unchanged bibasilar predominant streaky opacities. Stable cardiomediastinal silhouette.

Output: Interval placement of right central venous catheter with tip in the atriocaval junction. Otherwise no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: 44 yo female with history of ALL; pre-allo SCT evaluation History: evaluate Calcified granuloma left lower lobe, otherwise unremarkable.No specific evidence of infection.Unremarkable mediastinal contours and cardiac silhouette.Left jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Chest pain. Upper normal heart size. Low normal lung volumes. No pneumothorax or visible pleural fluid. Mild scarring or atelectasis in the bases. Unable to exclude pneumomediastinum on the lateral radiograph, though none is visible on the frontal film. Mild nonspecific thickening of the left paratracheal stripe.

Output: Unable to exclude pneumomediastinum, consider follow-up PA and lateral chest radiographs if clinically warranted. Mild thickening of the left paratracheal stripe could be due to ectatic vasculature, but is incompletely assessed by plain film technique. No acute findings in the lung parenchyma.


Instruction: Generate impression based on medical findings.

Input: Possible stroke. Facial weakness Moderate COPD changes without superimposed acute cardiopulmonary abnormality. Moderate scoliosis with what appears to be a subacute left clavicle fracture. In addition incomplete visualization of a sclerotic irregularity overlying and/or involving the left humeral neck, consider dedicated imaging

Output: No acute cardiopulmonary abnormalities, however underlying multiple osseous changes questionable requiring additional imaging or consideration.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with history of cervical cancer. Possible stent displacement versus urinary retention. Wound with bladder metastases. Severe abdominal pain and urinary retention. This examination is limited by absence of IV contrast. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Mass located anterior to left hepatic lobe is stable in size on image number 81, series number 3.SPLEEN: Peritoneal mass invading the splenic hilum is stable and measures 6.7 x 4.4-cm image number 35, series number 3.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left-sided hydronephrosis and dilated left ureter were resolved by interval placement of a nephroureterostomy.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Right pericolonic mass measures 6.6 x 7.5 cm image number 57, series number 3, not significantly changed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right ovarian cystic lesion is stable . Left adnexal mass is stable . Cervix is ill-defined and heterogeneous.BLADDER: Left wall of the bladder is asymmetrically thickened likely secondary to invasion by patient's known cervical cancer. Bladder is minimally distended. LYMPH NODES: Left inguinal lymph node is borderline enlarged and not significant changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The left-sided hydronephrosis is resolved with a nephroureterostomy. No other significant change from previous study. Cervical mass invading the left bladder wall and left ureter, peritoneal implants are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: 76 yo M w h/o portal venous thormbosis and portal hypertension transfer for GI bleed, altered mental status History: altered mental status, upper GI bleed Bilateral pleural effusions, larger on the right, with underlying opacity compatible with atelectasis.ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: resp failure History: as above Pulmonary opacities suggestive of edema and aspiration or atelectasis from mucous plugging.Tracheostomy tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.A Dobbhoff tube extends below the lower margin of the image.Left subclavian catheter, tip in SVC.Right pleural drain with a small residual 3 mm pneumothorax.

Output: Unchanged support devices. Minimal right pneumothorax, and unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pneumonia or pulmonary edema History: chest pain Interval removal of Swan-Ganz catheter.Right jugular catheter coiled within the supraclavicular region with its tip projected in the area of the jugular vein.Other findings unchanged.

Output: Abnormal location of right jugular catheter, the tip of which may be extraluminal.


Instruction: Generate impression based on medical findings.

Input: Surgery for Tetralogy of Fallot.VIEW: Chest AP (one view) 09/11/16, 0440 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in gastric body. Right internal jugular line has its tip in right atrium. Right atrial line tip is in superior vena cava. A chest tube is present in right hemithorax. Epicardial pacer leads are seen.Soft tissue edema is noted.Cardiothymic silhouette is normal. Hazy opacity in the left medial and lateral base is present. There is no pneumothorax.

Output: Continued left base hazy opacity.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of shortness of breath and chest pain Left port catheter tip located within the SVC.Increased lung volumes.Redemonstration of bilateral lower lobe predominant pulmonary nodules and masses, including three cavitary left lower lobe masses, unchanged from prior exam.Left pleural effusion and/or scarring.No evidence pneumothorax.

Output: Bilateral lower lobe predominant nodules and masses not significantly changed from prior exam.Please refer to CT chest (8/4/2015) for further characterization.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male rule out hydronephrosis. History of prostate cancer and melanoma. Acute leukemia. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left upper lobe on image number 34, series number 5. Another subcentimeter nodule in the right middle lobe is on image number 46, series number 5. Subpleural nodules on the right on the left on image number 53, series number 5. Bilateral dependent atelectasis.MEDIASTINUM AND HILA: 1.7-cm nodule in the left thyroid lobe.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 noted. Specifically, 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: Status post radical prostatectomy and lymph node dissection. No evidence of recurrence.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis with mild wall thickening and peri-clonic fat stranding around the sigmoid colon suggestive of mild acute diverticulitis. No evidence of peridiverticular abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Nonspecific subcentimeter lung nodules as described above.No evidence of hydronephrosis.Acute diverticulitis.Clinical team was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old. Intra-aortic balloon pump tip terminates in the proximal descending thoracic aorta. Remaining support devices unchanged.Cardiomegaly stable. No interval edema or pneumothorax.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Mesothelioma status post pleurectomy/decortication S./PE chemo, now on observation. CHEST:LUNGS AND PLEURA: Right hemithorax pleural thickening and volume loss compatible with provided history of mesothelioma has progressed. New anterior diaphragmatic lesion measures 5.3 -cm in thickness on image 53 at the 12 o'clock position. Multiple new pleural lesions are seen at the right lung base, including a lesion in the azygoesophageal recess which abuts the esophagus. Tumor also extends deep into the right costophrenic sulcus but does not extend through the prevertebral fat. Continued improvement of a previously noted right upper lobe wedge shaped opacity on axial image 37.Subcentimeter pleural-based nodule on the right previously reference has increased in size, 14 -mm in thickness (image 57), previously 7-mm at the 9 o'clock position. At this same level (the level of the right inferior pulmonary vein), pleural tumor at the 10 o'clock position measures 13-mm in thickness, previously 0 mm. Right lower lung nodule is now a evident within the the fissure rather than in the lung parenchyma and has progressed.Postoperative change at the right posterior hemidiaphragm with graft material in place. MEDIASTINUM AND HILA: Surgical clips in the thyroid bed. The thyroid is not visualized. Several borderline to small mediastinal lymph nodes on the right are unchanged. Small mediastinal lymph nodes in the subcarinal region are similar in appearance as are right subhilar lymph nodes.The reference right hilar lymphatic tissue measures 27 x 14 mm (image 42), previously 26 x 9 mm.Coronary artery calcifications.CHEST WALL: Chronic right rib fracture. No evidence of extension through the chest wall.UPPER ABDOMEN: Limited images. Status post cholecystectomy. Compression on the dome of the liver by diaphragmatic mass. No definite evidence of direct invasion of the liver.Low-density right adrenal nodule grossly unchanged and 28 x 18 mm on image 82. A small retrodiaphragmatic lymph node on image 74 is new.

Output: Interval progression of disease with multiple new pleural masses on the right.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Peripheral nerve block. Low lung volumes. Leftward patient rotation. Mild diffuse interstitial pulmonary edema. Patchy bibasilar opacities. No pleural effusion or pneumothorax. No acute bony abnormality.Apparent cardiomegaly, likely related to low lung volumes and AP projection.

Output: Mild interstitial pulmonary edema. Low lung volumes.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: s/p chest surgery History: see above Pleural effusions, right greater than left, decreased from the prior exam.Volume loss in the right lung related to prior surgery.Stable cardiomediastinal silhouette.Moderate size hiatal hernia redemonstrated.

Output: Mild interval decrease in the pleural effusions, right greater than left.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: shortness of breath History: shortness of breath No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval for pneumonia History: fever Mild cardiomegaly.No significant pulmonary or pleural abnormality.Right jugular catheter, tip in SVC.Gastrostomy tube noted.

Output: Mild cardiomegaly, without edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated, eval ET position and hardware History: none ET tube tip approximately 3 cm above the carina.Right jugular catheter tip at the SVC/RA junction.Perihilar bronchial thickening but no specific evidence of pulmonary edema or pneumonia.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with metastatic rectal cancer to the lungs, on chemotherapy. CHEST:LUNGS AND PLEURA: Interval development of subpleural consolidation at the right base which may represent resolving pulmonary infarct. No significant change in previous noted bilateral subcentimeter nodules. Reference right lower lobe nodule (image 68 series 5) again measures 3 mm.MEDIASTINUM AND HILA: Focal hypodensity within the distal SVC and right atrium may represent thrombosis.CHEST WALL: Right chest port distal tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable mildly enlarged mesenteric lymph nodes. No significant free fluid/air. Stable left lower quadrant colostomy. Filling defect within the splenic vein (image 53 coronal series) is consistent with thrombosis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Resolution of previously described presacral abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No significant change in reference measurements.2. Splenic vein thrombosis.3. Superior vena cava, right atrial thrombosis. 4. Right lower lobe pulmonary consolidation which may be due to resolving infarction.These findings were discussed with Dr. M. Sharma at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: fever History: fever Endotracheal tube terminates 3 cm above the carina. Right PICC terminates in the mid right atrium. Enteric tube terminates inferior to the caudal margin of the image. Curvilinear opacity favoring stent or tube in the common duct. A short pigtail catheter and metallic devices project over the left upper abdomen.No significant change in the left greater than right pulmonary opacities and pleural effusions. No significant pneumothorax. Retrocardiac atelectasis unchanged.

Output: No change in the left greater than right pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: Cough and rales; Baseline for chest PT History: Cough and rales The cardiomediastinal mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: removal of left chest tube History: removal of left chest tube Stable left basilar consolidation and small bilateral pleural effusions. No pneumothorax.Intact sternotomy wires.Stable cardiomegaly.

Output: No change in left basilar consolidation and small effusions.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab AICD unchanged in position.Stable cardiomegaly.No focal air space opacities. Stable mild basilar reticulation.No significant pleural effusions or pneumothorax.

Output: Stable AICD placement. No specific evidence of infection or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Improved overall aeration with clear lungs other than scattered calcified granuloma and hilar lymph nodes greater on the left. This letter finding consistent with old healed granulomatous disease exposure.Cardiac and mediastinal contours significant for moderate atherosclerotic changes most pronounced involving the aortic arch

Output: Old healed granulomatous disease exposure without superimposed acute new abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: Evaluate for pulmonary edema History: Shortness of breath Persistent, slightly increased diffuse airspace opacities consistent with edema. Stable cardiomegaly.

Output: Persistent, slightly increased diffuse airspace opacities consistent with edema.


Instruction: Generate impression based on medical findings.

Input: Hemoptysis and asthma.VIEWS: Chest PA/lateral (two views) 04/21/15 No focal lung opacity is present. Lung volumes are slightly increased; the AP diameter of the chest is increased. Cardiothymic silhouette is normal.

Output: Marked improvement in appearance of the chest with no focal residual opacity. Slightly increased lung volumes.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: please evaluate for pneumothorax s/p left sided pacemaker placed in RVOT History: left sided pacemaker placed in RVOT New left subclavian pacemaker, the tip in the pulmonary outflow tract.Heart size near upper normal.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: No pneumothorax following pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: s/p Aortic valve/sternotomy. sternal/back pain History: pain No significant pulmonary or pleural abnormality.Unremarkable cardiomediastinal silhouette. Unchanged median sternotomy wires and aortic valve prosthesis noted. Hiatus hernia.Surgical clips in right upper abdomen and superior to right lung apex. Screws noted in right humeral head.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 52 years old Female. Reason: evaluate ETT position History: transport to and from OR. There is interval improvement of the cardiomegaly and left pleural effusion. Patchy opacities in the right lung appears smaller as compared with prior study. The ET tube and NG tube are stable in position. The right IJ catheter has been removed. The new Swan-Ganz catheter is noted. The tip of the Swan-Ganz catheter projects over the main pulmonary artery.

Output: Interval improvement of the cardiomegaly, left pleural effusion and patchy opacities in the right lung described above.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval for acute process, interval change since most recent x-ray History: hemoptysis, recent pe diagnosis Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. Findings secondary to known recent pulmonary emboli.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: ett position History: reintubated ET tube tip is 2 cm above the carina. Left internal jugular central venous catheter tip is in the SVC.Unchanged healed rib fractures bilaterally. Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax. No focal pulmonary opacities.

Output: ET tube is in appropriate position.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Shortness of breath Lines and tubes are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in diffuse pulmonary opacities given differences in inspiration. Small pleural effusions again noted. No significant pneumothorax. Unchanged cardiomegaly.

Output: No substantial change in diffuse pulmonary opacities given differences in inspiration. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with chest pain and shortness of breath. Cardiomediastinal silhouette within normal limits.Left retrocardiac opacity suspicious for pneumonia versus atelectasis. Additional left basilar atelectasis present.Small left pleural effusion. Right lung and pleural space within normal limits.

Output: Left retrocardiac opacity suspicious for pneumonia versus atelectasis with small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: End-stage renal disease. Check for cardiomegaly Borderline cardiomegaly without additional cardiopulmonary abnormality

Output: Borderline cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.VAD, SOB. A right PICC terminates in the projection of the right axillary vein.Interval removal of left jugular introducer without pneumothorax. Other hardware and devices similar in position. No focal pulmonary opacities or signs of edema.

Output: No acute pulmonary abnormality. Right PICC projects over the axillary vein region and is not central in location


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: wheezing, with h/o CHF, assess for edema/effusions History: as above Cardiomegaly, with basilar edema-like opacities and small pleural effusions, consistent with CHF.No specific evidence of infection.

Output: CHF with cardiomegaly, basilar edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: pneumothorax History: follow up COPD with multiple foci of scarring.No pneumothorax.No specific evidence of infection or edema.Moderate size hiatal hernia.

Output: COPD, with no pneumothorax or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: chest pain History: above Cardiomediastinal silhouette is stable in size and configuration with a calcified aortic arch.Relatively low lung volumes with no focal consolidation, sizable effusion or pneumothorax.No acute osseous abnormalities.

Output: Stable appearance of the chest with no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: chest pain, recent incarceration History: above The lungs and pleural spaces are clear. No specific evidence of infection. The cardiomediastinal silhouette is unremarkable. There is partial fusion of two lower thoracic anterior vertebral bodies, noted on the lateral view.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: r/o ptx History: patient coughing acutely, SOB Left-sided chest tubes unchanged.Minimal subcutaneous emphysema along left lateral chest wall.No significant pneumothorax.Decreased lung volumes a stable cardiomediastinal silhouette.No new pulmonary opacities noted.

Output: No interval change. 2 left-sided chest tubes in place. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male presents for evaluation of the subclavian IABP. ETT tube 4cm from carina. Swan-Ganz catheter tip slightly changed position and now overlies the proximal right main pulmonary artery. Left upper extremity PICC has its tip at the cavoatrial junction. Enteric tube is coiled over the stomach with tip at overlying the gastric body. Previously noted intra-aortic balloon pump may have moved slightly distally approximately 2 cm.Diffuse bilateral consolidative opacities are not significantly changed. Bilateral small pleural effusions. No pneumothoraces. Cardiomediastinal silhouette is unchanged.

Output: Swan-Ganz catheter now overlies the proximal right main pulmonary artery. Intra-aortic balloon pump may have moved distally approximately 2 cm.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: eval tube placement History: as above Worsening basilar opacities suggestive of edema and atelectasis.Slight increase in size of right pleural effusion, stable left.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip at cavoatrial junction level.

Output: ET tube tip approximately 5 cm above the carina. Slight increase in basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: edema? History: sob Apparent increase in heart size, may be secondary to difference in technique.Interval improvement of diffuse interstitial opacities is suggestive of improving pulmonary edema.Increased patchy opacities in the right upper lung zone suggests shifting fluid/edema.

Output: Moderate interval improvement of pulmonary edema. Apparent increase in heart size may be secondary to technique.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Swan position. Right jugular Swan-Ganz catheter looped in the right atrium before extending into the right upper lobe pulmonary artery where it is probably situated in a proximal segmental branch.No pneumothorax or acute pulmonary abnormality.Mild basal scarring.Left subclavian ICD unchanged.

Output: Recommend repositioning of Swan-Ganz catheter has its proximal portion is looped in the right atrium and the distal tip extends into a proximal segmental branch of the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: post pneumo tube clamp History: post chest tube removal No significant change in small right apex pneumothorax s/p chest tube removal. Other findings stable.

Output: No significant change in small right apex pneumothorax


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old. No change in the bilateral pulmonary opacities.Line position stable.Heart size normal.No pneumothorax. No pleural effusion

Output: No change in bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 51 years old Male. Reason: eval lines, positioning of swan History: A fib. Multiple chest tubes with no evidence of pneumothorax. Status post sternotomy and cardiac size normal. The tubes and lines are stable in position. Basilar linear densities are noted.

Output: The tip of the Swan-Ganz catheter projects over the right ventricular out flow tract, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: r/o pneumonia History: cough Subtle basilar interstitial opacities, particularly on the left with associated bronchial wall thickening suggestive of mild bronchiolitis. There is no pleural effusion or pneumothorax. There is new fullness of the hilum concerning for development of lymphadenopathy. The heart size is normal.

Output: 1.Findings suggestive of mild basilar bronchitis.2.New hilar fullness concerning for lymphadenopathy and possibly recurrent disease (CLL). Correlation with CT chest is suggested when feasible.


Instruction: Generate impression based on medical findings.

Input: 78-year-old female with history of non-small cell lung cancer status post lobectomy, aspergilloma; worsening pleural effusions seen on chest x-ray. CHEST:LUNGS AND PLEURA: Thick-walled left apical cavity communicating with left mainstem bronchus appears similar to prior study. Patient is status post left upper lobectomy. Size of the left pleural effusion has increased with new loculated component. 5 mm pulmonary nodule in right middle lobe (series 5, image 37) is stable as far back as 2/15/07 CT compatible with benign etiology. Stable sub 2-mm nodules are again noted in the right lung.MEDIASTINUM AND HILA: No mediastinal or hilar enlarged lymph nodes. Heart size normal without pericardial effusion.Aortic valve and coronary artery calcifications are again noted. Atherosclerotic disease of the aorta is unchanged.Mild esophageal dilatation with fluid and debris from the mid esophagus to the GE junction is not appreciably changed. Stable small hiatal hernia.CHEST WALL: Previously referenced left supraclavicular lymph node measures 13 x 9 mm (series 3, image 11) in the axial plane; previously measuring 15 x 12 mm. However, in the coronal plane (series 80260, coronal image 35) it measures 22 x 13 mm and appears minimally minimally increased in size when compared to study from 2/15/2007 when it measured 19 x 13 mm in the coronal plane (series 553134, coronal, image 26).UPPER ABDOMEN: Fat-containing mass in left anterolateral chest wall appears relatively unchanged when comparing with CT 2/15/2007, measuring 4.4 x 2.6 cm on series 3, image 89. Reference retrocrural lymph node is stable as far back as 2007, measuring 17 x 12 mm (series 3, image 72).Stable left upper pole renal cyst is again seen .

Output: 1. Increased left pleural effusion with loculation.2. Stable left apical cavity with bronchopulmonary fistula and no internal contents to suggest aspergilloma. 3. Stable right middle lobe pulmonary nodule as far back as 2007 consistent with benign etiology. 4. Stable fat-containing lesion in left anterolateral chest wall and stable debris-filled esophagus.5. Left supraclavicular lymph node is minimally more prominent in the coronal dimension when compared to prior study from 2007. Measurements as above.


Instruction: Generate impression based on medical findings.

Input: Follow-up CT right upper lobe nodule. CHEST:LUNGS AND PLEURA: Scattered well-defined micronodules up to 5 mm have not significantly changed over the series of examinations. No new pulmonary abnormalities are seen.MEDIASTINUM AND HILA: Status post CABG.CHEST WALL: Median sternotomy.UPPER ABDOMEN: No significant abnormality noted.

Output: Stable micronodules for which no further CT follow up is recommended at this time.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with COPD and COPD exacerbation. LUNGS AND PLEURA: Moderate centrilobular emphysema. No pleural effusions.MEDIASTINUM AND HILA: Coronary arterial calcifications. No pericardial effusion or significant mediastinal lymphadenopathy. Layering debris in the dependent portion of the trachea likely secondary to mucous.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Moderate emphysema without acute cardiac or pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male with shortness of breath, evaluate for parenchymal disease LUNGS AND PLEURA: Redemonstration of diffuse bronchial wall thickening.Inspissated bronchus and bronchocele within the left upper lobe slightly more prominent than on prior exam and again consistent with allergic bronchopulmonary aspergillosis.No evidence of interstitial lung disease.No evidence of air trapping.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Airway thickening, compatible with asthma. Left upper lobe inspissated bronchus and bronchocele more prominent than prior exam and compatible with allergic bronchopulmonary aspergillosis.2.No evidence of interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Eval for cause of shortness of breath History: shortness of breath, wheezy No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Productive cough. Minimal localized bronchial wall thickening and peribronchial opacity in the left lung base, nonspecific for pneumonia as there is bronchial wall thickening seen in the right lower lobe as well raising question of prior aspiration. No large airspace opacities or pleural fluid collections. Normal heart size.

Output: Basal bronchial wall thickening may indicate aspiration. Left basal peribronchial opacity not specific for infection and could be postinflammatory. If the patient remains symptomatic, follow-up PA and lateral chest radiographs may be obtained in a few days. If the patient is a smoker, follow-up is suggested to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female, evaluate for aspiration NG tube tip in the distal esophagus with side-port at the midesophagus.No focal airspace opacities. No large pleural effusion. No pneumothorax.Cardiomediastinal silhouette is unremarkable.Surgical clips in the mid abdomen.

Output: No evidence of infection, edema or aspiration. NG tube tip in the distal esophagus.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: copd exacerbation, evaluate for pna History: see above Left basilar opacity increased consistent with bronchiectasis with mucus impaction or infection.Elsewhere, the lungs are unremarkable.Heart size normal.

Output: Left basilar bronchiectasis with superimposed infection or mucoid impaction.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: location of RIJ triple-lumen History: s/p sheath -> TLC exchange Right IJ line terminates in the SVC. No pneumothorax. No substantial change in bibasilar pleural-parenchymal opacities. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: Right IJ line terminates in the SVC without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: small pneumothorax after left lung biopsy. Assess for resolution. No significant pneumothorax.Unchanged pulmonary opacities, with left greater than right.Unchanged cardiomediastinal contours.Left-sided chest port with tip in the SVC.

Output: No significant 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: Male, 85 years old.Reason: 85M CHF here w SOB; eval for fluid overload Increased patchy basilar opacities. Increase in small right pleural effusion. Unchanged cardiomegaly. No pneumothorax. Cardiac leads terminate within the expected location of the right atrial appendage and right ventricle.

Output: Probable mild pulmonary edema given history.


Instruction: Generate impression based on medical findings.

Input: 4 days old male. Respiratory failure. Evaluate bowel gas pattern. VIEW: Chest and abdomen AP (two views) 10/10/2016 ET tube tip between the thoracic inlet and carina. Enteric tube tip in the stomach. Umbilical venous catheter tip in the right atrium. Removal of an esophageal temperature probe.Cardiothymic silhouette is mildly enlarged. Mild diffuse lung haziness with left lower lobe opacity which obscures the left hemidiaphragm. Right pleural effusion. No pneumothorax.Paucity of bowel gas without evidence of pneumatosis, portal venous gas or intraperitoneal free air.

Output: 1. Mild diffuse lung haziness with left lower lobe opacity and right pleural effusion. 2. Paucity of bowel gas without evidence of pneumatosis or intraperitoneal free air.