Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval for infiltrate History: cough w/ prod sputum sob Mild left basilar subsegmental atelectasis or scar. No large pleural effusion or pneumothorax. Normal heart size. Mildly tortuous aorta.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: s/p lvad History: same Cardiomegaly with pulmonary opacities suggestive of edema and retrocardiac atelectasis, unchanged.IABP catheter proximal marker 3 cm below the top of the aortic arch.Left jugular Swan-Ganz catheter removed leaving the introducer.Left subclavian ICD partially visualized but unchanged.LVAD not visualized, lying below the lower margin of the image.Right jugular catheter, one limb cannulating the SVC and the other retrograde in the left brachiocephalic vein unchanged.

Output: No change in cardiomegaly and pulmonary opacities consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: TB positive No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Progressing dyspnea Persistent mixed interstitial and patchy airspace opacities in all 4 quadrants with decreased lung volumes. Changes are mildly greater in both bases without new effusions. Borderline cardiomegalyLeft PICC line extends into the proximal SVC. Mild retraction improves position.

Output: PICC line repositioned


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with thyroid cancer on sorafenib, assess response CHEST:LUNGS AND PLEURA: Scattered micronodules are similar to prior study. Reference subpleural left lower lobe nodule is stable at 6 mm (series 5, image 72).Extensive pleural thickening is again seen in the right, consistent with stable metastatic disease. Residual loculated fluid also appears stable. Pleural drain remains in stable position with tip located within this fluid collection.No new suspicious nodules are identified.MEDIASTINUM AND HILA: Stable metastatic disease thyroid bed but reference pretracheal lymph nodes measuring 10 x 9 mm (series 4, image 13) and 12 x 9 mm (series 4, image 14); both are stable accounting for difference in technique.Significant coronary calcifications reidentified.Stable metastases involving the right cardiophrenic space (series 4, image 63) and paracaval fat at the right inferior cavoatrial junction (series 4, image 62).CHEST WALL: Right pleural drain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable subcentimeter left adrenal nodule.KIDNEYS, URETERS: Stable renal cysts bilaterally.RETROPERITONEUM, LYMPH NODES: Stable retrocrural lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable exam


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: SOB w/o Sickle Cell and Acute Chest History: above Low lung volumes with basilar atelectasis.No focal areas of consolidation.No large effusions.Heart size normal.No pneumothorax.

Output: Low lung volumes with basilar atelectasis. Otherwise no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: s/p pleurx History: s/p pleurx Interval placement of right Pleurx catheter without significant pneumothorax. Moderate right pleural effusion, unchanged. Interstitial opacities and septal lines. Adjacent compressive atelectasis. The cardiomediastinal silhouette is stable.

Output: Interval placement of a Pleurx catheter. Unchanged right pleural effusion and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: enlarged cardiac silhouette History: Chest pain; SOB Cardiomegaly, with a right aortic arch.Mild interstitial edema and perhaps small pleural effusions.

Output: CHF with pulmonary edema. Incidental note, right aortic arch.


Instruction: Generate impression based on medical findings.

Input: 26 years, Female. With history of inflammatory bowel disease and multiple surgeries here with vomiting and diarrhea. Evaluate for bowel obstruction. Chest: A right jugular central venous catheter has its tip in the SVC. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.Abdomen: Cholecystectomy clips are in place. Suture material projects over the right upper outer and pelvis. Nonobstructive bowel gas pattern. No intra-abdominal free air.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrates History: fever Unremarkable cardiac and mediastinal silhouette.Right subclavian catheter tip in the right atrium.Splenomegaly.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Pt is a 64 yo male; potential stem cell donor History: evaluate Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: 62 year old female with history of 4-cm retroperitoneal mass CHEST:LUNGS AND PLEURA: Right basilar atelectasis, unchanged.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. An index prevascular node measures 18 by 7-mm on image number 26, series number 3.CHEST WALL: Severe scoliosis.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined small hypodensity in the inferior aspect of the right lobe of the liver best seen on image number 104, series number 3, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Patient's known left para-aortic mass measures 4.2 x 3 cm on image number 94, series number 3, not significantly changed in size. This mass is separate from left adrenal gland.Ill-defined soft tissue density around the common hepatic artery is unchanged from previous study. Its etiology is unknown.Multiple collaterals in the right retroperitoneum and anterior abdominal wall consistent with thrombosis of the IVC, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracolumbar levoscoliosis. Significant degenerative disease. Compression to the spinal canal is present.OTHER: No significant abnormality noted.PELVIS:Evaluation of pelvic structures is very limited due to artifacts from the right hip prosthesis.UTERUS, ADNEXA: Uterus has lobulated contours. Bilateral adnexa cannot be well seen. Further evaluation with pelvic ultrasound may be helpful.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right hip prosthesis.OTHER: No significant abnormality noted.

Output: No significant change in the size of the left retroperitoneal mass. Its etiology is unknown and may represent chest, metastatic adenopathy or less likely pheochromocytoma. Clinical correlation is recommended. Ill-defined soft tissue density around the hepatic arteries also unchanged.Pelvic ultrasound is recommended for further evaluation of the lobulated uterus and left adnexa.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: hx of bladder cancer History: surveillance Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Azygos pseudolobe, normal variant.No sign of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval dobhoff tube History: pt s/p dobhoff tube placement Status post extubation and NG tube removal.Dobbhoff tube placed, the tip in the distal esophagus.No specific evidence of infection or edema.

Output: Dobbhoff tube tip in distal esophagus.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with right lower quadrant abdominal pain starting today at 9 a.m. Evaluate for right lower quadrant pathology. CHEST:LUNG BASES: Bibasilar left greater than right atelectasis is noted.ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesion in the right hepatic lobe near the ligament teres likely represents a perfusion defect or focal fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: A heterogeneously enhancing soft tissue mass in the expected location of the left adrenal gland is is present. It measures 1.8 cm x 2.5 cm (image 41, series 4). While most of these lesions represent benign adrenal adenomas, but a dedicated CT or MRI examination is recommended if clinically warranted in setting of potential metastasis.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is distended to the approximate diameter of 1.3 cm. Fine high density punctate densities are seen within the lumen of the appendix may represent a forming concretion. Periappendiceal inflammatory changes are noted. No periappendiceal air or fluid collections are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerosis of the aorta and its branches are noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: The appendix is distended to the approximate diameter of 1.3 cm. Fine calcifications within the lumen of the appendix may represent a forming concretion. Periappendiceal inflammatory changes are noted. No periappendiceal air or fluid collections are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.Findings consistent with acute appendicitis.2.Indeterminate left adrenal nodule as described above. While this likely represents a benign adrenal adenoma, a dedicated CT or MRI is recommended for further evaluation if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: R/o pneumothorax History: S/p thoracentesis At least moderate cardiomegaly is present as well as a right pleural effusion.No pneumothorax following thoracentesis.Mild right basilar predominant edema.

Output: Persistent right pleural effusion but no pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with lymphadenopathy in the abdomen. Follow up examination. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary micronodules are unchanged and nonspecific.MEDIASTINUM AND HILA: Borderline enlarged prevascular, pretracheal, subcarinal and hilar lymph nodes are unchanged. A reference pretracheal node measures 1.6 x 1.0 cm on image 38, series 4.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter cyst in the dome of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small retroperitoneal and mesenteric nodes are unchanged. A reference precaval node measures 2.3 x 0.8 cm on axial image 101, series 4.BOWEL, MESENTERY: Scattered colonic diverticula, no diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Pulmonary micronodules and borderline lymphadenopathy are unchanged. Although a definite etiology is uncertain, these findings likely reflect a benign process.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: Please eval pulm edema History: SOB Left lower lobe consolidation and left effusion, with suggestion of right basilar edema.Heart size normal.Right jugular catheter, tip in SVC.

Output: Pulmonary edema with worsening left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: assess for acute process History: assess for acute process Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with metastatic cyano sarcoma CHEST:LUNGS AND PLEURA: Stable bilateral multiple pulmonary nodules. Index right middle lobe nodule measures 2.6 by 1.7-cm image number 67, series number 4. Additional right middle lobe index nodule measures 3-mm in diameter image number 73, series number 4. Other nodules are also unchanged.MEDIASTINUM AND HILA: Mildly dilated aortic root is unchanged.CHEST WALL: Lytic lesion involving the sternum and first right tube is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in the left lobe of the liver likely representing a small cyst is stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable left iliac bone metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Central line placement. History of CHF. Right jugular catheter tip in the right atrium. Left subclavian ICD leads are unchanged in position, the ventricular lead tip is high in the right ventricle, not in the apex.Laterally loculated fluid in the pleural space on the right probably similar in volume though it has shifted in position somewhat. Patchy opacities in the dependent aspect of the right lung nonspecific and could reflect aspiration.

Output: Right jugular catheter tip in the right atrium. Persistent unilateral pleural fluid or pleural thickening on the right. Patchy opacities in the right lung are nonspecific and may be the result of aspiration with atelectasis, correlate for signs of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: patient with airspace opacities, has improved, want to evaluate History: SOB Persistent decreased lung volumes. Multifocal airspace opacities have not significantly changed. The heart size is magnified but does appear slightly increased since April 2015, consider pericardial effusion. No pneumothorax.

Output: Multifocal airspace opacities have not significantly changed. Heart size enlarged, consider pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: interval exam, pt intubated History: interval exam, pt intubated ET tube tip about 8 cm above the carina.Venous catheter and NG tube unchanged.Bilateral nonspecific lower zone opacity compatible with atelectasis likely related to aspirated secretions, increased on the right.No new findings.

Output: Slightly increased basilar opacity compatible with atelectasis and aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: 63 year old female with abdominal pain. Evaluate for free air. No focal airspace opacities. Bilateral volume loss and basilar atelectasis. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable. No free air.

Output: 1. No free air. 2. Bilateral volume loss and basilar atelectasis. Recommend upright PA/Lateral views for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer status post surgery and I-131 ablation therapy There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. No increased activity consistent with functioning thyroid tissue is seen.Probe uptake of the neck is 0.04%.

Output: No functioning thyroid tissue.


Instruction: Generate impression based on medical findings.

Input: Reason: after PICC line History: Double lumen place PICC line PICC line tip in the SVC.Mild blunting of the right costophrenic angle compatible with scarring, unchanged.No significant cardiopulmonary abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: rule out pneumo History: rule out pneumo Interval post-procedural extubation and enteric tube removal. Support devices otherwise unchanged in position.Low lung volumes.Upper tracheal narrowing suggestive of post-intubation tracheal stenosis.Stable cardiomediastinal silhouette and improving right pleural effusion.No new focal airspace opacities

Output: Interval improvement in right pleural effusion. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: assess for PA catheter and interval CP changes History: as above Swan-Ganz catheter tip terminates in the right interlobar artery. Mild streaky left basilar atelectasis and small right pleural effusion. No focal consolidation pneumothorax. Unchanged cardiomegaly.

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


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: follow up left pleural effusion; s/p thoracentesis on 6/30; known NSCLC, evaluate for recurrence of fluid History: none Unchanged left hemithorax volume loss with residual pleural fluid, stable volume.No significant pneumothorax.Right lung unremarkable.

Output: No change in residual left pleural effusion and left hemithorax posttreatment volume loss.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: h/o renal cancer History: see above Mild to moderate cardiomegaly.No significant pulmonary or pleural abnormality.No metastases identified.

Output: Mild to moderate cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: pt with ams, hyperglycemia. History: hyperglycemia Patchy left basilar opacity suggestive of aspiration or infection.Elsewhere, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Left basilar opacity, possible infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old, with chest pain and shortness of breath. PULMONARY ARTERIES: No evidence of pulmonary embolus to the segmental level. Motion artifact limits evaluation of the vessels more distally.LUNGS AND PLEURA: Predominantly basilar and peripheral groundglass opacities with septal thickening and bronchiectasis are again observed. Although the groundglass opacities are more intense, this finding may reflect motion artifact rather than true disease progression. Mild interval change, however, cannot be excluded. No evidence of honeycombing. No pleural fluid. Right lower lobe suture line again seen.MEDIASTINUM AND HILA: Cardiomegaly. No pericardial effusion. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Cholelithiasis. Small hiatal hernia.

Output: 1.No PE to the segmental level.2.Interstitial abnormalities compatible with NSIP (nonspecific interstitial pneumonia) with no definite interval change given limitations due to motion.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with dysphagia, weight loss, history of H. pylori and significant smoking history. Scout radiograph of the chest reveal no acute cardiopulmonary abnormalities.Double contrast evaluation of the esophagus reveal no mucosal or mural abnormalities. No hiatal hernia was identified. AP and lateral series of the neck (series 12 and series 13) reveal a small volume of silent aspiration which was cleared by asking the patient to cough. There was mild impression posteriorly related to anterior osteophyte of the cervical spine.Fluoroscopic examination of esophageal motility revealed proximal escape compatible with mild esophageal dysmotility.No gastroesophageal reflux was identified.Swallowed barium tablet passed spontaneously without delay.

Output: 1. Mild esophageal dysmotility. 2. Small volume of silent aspiration was noted. Fluoroscopy Time: 6:26Air Kerma: 84.1 mGy


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with mesothelioma status post 4 cycles of chemotherapy. Reevaluate disease status. CHEST:LUNGS AND PLEURA: Continued partial resolution of a previously noted right upper lobe wedge shaped opacity on axial image 36.Minimal residual loculated pleural fluid at the medial right base with minimal adjacent pleural thickening, unchanged.Subcentimeter pleural-based nodule on the right at axial image 54. Right lower lobe micro-nodule on axial image 58 is unchanged. Scattered additional bilateral micronodules are unchanged.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.The reference right hilar lesion measures 26 x 9 mm on image 41 (not significantly changed measuring 28 x 9 mm on prior).The cardiac size is normal. No pericardial fluid.CHEST WALL: Healing right rib fracture. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedADRENAL GLANDS: Low-density right adrenal nodule measures 28 x 18 mm on image 81 (previously 26 x 17 mm).KIDNEYS, URETERS: Small hypodense right renal lesion, unchanged and likely benign.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Improving right lung opacities and focal pleural thickening. No evidence of new pleural or parenchymal disease.2.Stable right hilar lymphadenopathy.3.Multiple additional findings, as above, are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: ETT History: SDH Endotracheal tube terminates 2 cm above the carina. An enteric tube terminates inferior to the caudal margin of the image.Right infrahilar opacities suspicious for aspiration. Subsegmental atelectasis in the retrocardiac location, unchanged. No interval pneumothorax.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: 27-year-old male status post PICC placement. There has been interval repositioning of the right PICC, with tip now in the superior vena cava.Persistent low lung volumes with minimal bibasilar scarring and/or mild atelectasis.

Output: Interval repositioning of right PICC, with tip now in the superior vena cava.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with pulmonary hypertension LUNGS AND PLEURA: Septal thickening and subpleural reticulation is identified more prominent at the lung bases. There is mild upper lobe centrilobular emphysema. No significant mosaic perfusion abnormality or air trapping.Mild groundglass opacities are noted at the bases. No evidence of honeycombing.Scattered nonspecific micronodules. No evidence of pleural effusion..MEDIASTINUM AND HILA: Enlargement of the pulmonary artery measuring 33.5 mm in its maximum axial dimension.There is cardiac enlargement with right atrial enlargement. Marked calcification of the coronary arteries. No evidence of a pericardial effusion. Atherosclerotic changes of the aorta.Prominent paratracheal lymph node (image 25, series 3) measures 19 mm x 16 mm. Multiple mildly prominent prevascular lymph nodes.CHEST WALL: Degenerative changes within the thoracic spineUPPER ABDOMEN: No significant abnormality noted.

Output: 1.Predominantly upper lobe centrilobular emphysema.2.Enlargement of pulmonary artery, compatible with pulmonary arterial hypertension. Pulmonary vascular occlusive disease and pulmonary embolism cannot be assessed without intravenous contrast material.3. Non-specific predominantly basilar interstitial abnormalities which may represent early interstitial pneumonia. Other entities in the differential diagnosis would include pulmonary capillary hemangiomatosis, as well as pulmonary venoocclusive disease.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ett position History: above Motion artifact. ET tube tip 4 cm from the carina. Enteric tube tip is inferior to the margin of image. Right IJ central venous line with tip in the mid SVC, but appears to have been slightly retracted from prior position. Stable cardiomediastinal silhouette. Unchanged appearance of diffuse interstitial and airspace opacities and likely small pleural effusions.

Output: ET tube tip 4cm from the carina. Unchanged cardiopulmonary appearance with diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.History of fever, evaluate lungs Left-sided chest port tip in innominate confluence. Interval removal of right pigtail chest tube. Cardiomediastinal silhouette is normal. Stable minimal blunting of the right costophrenic angle likely represents scarring. No pleural effusions or pneumothorax.

Output: No definite evidence of pneumonia.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: Female, 51 years old.Reason: 51 F s/p PICC placement for IV antibiotics please eval positioning History: PICC placement Left PICC tip in the axillary vein.The cardiomediastinal silhouette is normal and stable.No focal pulmonary opacities or large pleural effusions.

Output: Left PICC tip in the axillary vein.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: rule out infection History: fever, cough Right chest wall port catheter tip at the superior cavoatrial junction.New mild pulmonary edema.No pneumothorax or large pleural effusion.Unremarkable cardiomediastinal silhouette.Metallic density overlies the right midlung, likely external to patient.

Output: New mild pulmonary edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: ETT History: as above Basilar opacities representing atelectasis.Line position stable.No new findings.

Output: Basilar opacities representing atelectasis. Line position stable.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: eval fluid overload History: sob Small lung volumes with cardiomegaly and interstitial/airspace edema pattern.

Output: Cardiomegaly with pulmonary edema unchanged.


Instruction: Generate impression based on medical findings.

Input: Bacteremia. No cardiopulmonary acute airspace abnormality other than minimal atelectasis and a small right effusion

Output: Small right effusion


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: central line placement History: as above Pleural effusions right larger than left and retrocardiac consolidation are unchanged.An NG tube terminates in the stomach.ET tube tip approximately 4 cm above the carina.Right subclavian catheter, tip in SVC.

Output: Unchanged pleural effusions and retrocardiac consolidation. New right subclavian catheter placement.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old. Cough. Mild cardiomegaly.Probable small pleural effusions with overlying atelectasis. No specific evidence of infection.

Output: Small pleural effusions with overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: evaluate ETT History: intubated Basilar atelectasis unchanged since yesterday but worse compared to the day before suggestive of mucous plugging or aspirated secretions.ET tube at the carina, directed towards the right main bronchus.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: ET tube still low, with basilar atelectasis. The service was text paged (1219) regarding its placement.


Instruction: Generate impression based on medical findings.

Input: Reevaluation of pulmonary nodules for resolution. LUNGS AND PLEURA: Interval resolution of multiple bilateral pulmonary nodules, with small residual scar like opacities.MEDIASTINUM AND HILA: Enlarged heterogeneous thyroid gland, compatible with a goiter, unchanged.No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Resolution of multiple pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Reason: et tube, wide mediastinum History: et tube adjusted ET tube tip approximately 2 cm above the carina.NG tube tip in the stomach.Tortuous aorta accentuated by rotation, not significantly changed allowing for projection.Mild basilar opacity compatible with atelectasis.

Output: ET tube in acceptable position. Tortuous aorta, accentuated by rotation.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.ETT, pneumonia, unspecified pleural effusion. Markedly low lung volumes. ETT at the thoracic inlet level. Retrocardiac opacity, most likely atelectasis from aspirated secretions. ASD occluder device partially obscured by spinal rods. Left jugular central venous catheters terminate at the SVC level. Trace pleural effusions.

Output: Improving retrocardiac atelectasis, though there are persistent signs of aspiration on the left.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old. Swan-Ganz catheter has been withdrawn with the tip in the main pulmonary artery. Line position otherwise unchanged. Lungs remain clear. No pneumothorax.

Output: Repositioning of Swan-Ganz catheter. No other interval changes.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: hx of NSCLC with necrotizing PNA s/p JP drain in cavitary lesion, JP drain inflated, eval for pneumothorax History: JP drain inflated Pigtail drain within cavitary lesion in left upper chest. No significant change in cardiopulmonary appearance with no evidence of pneumothorax. Left PICC tip in left subclavian vein.

Output: Pigtail drain within cavitary lesion in left upper chest. No significant change in cardiopulmonary appearance with no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: evaluate for pneumothorax History: acute mid back pain Large lung volumes, related to a deep inspiratory effort.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: assess for pna History: sob ET tube has been removed.Dobbhoff tube with its tip beyond the margin of the image. Stable cardiomediastinal silhouette.Mildly improved aeration at the right lung base.No new pulmonary opacities identified.

Output: Interval extubation. Mildly improved aeration at the right lung base.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Aspiration pneumonia Tracheostomy tube is in place.Cardiac mediastinal silhouette is normal. No pneumothorax or pleural effusion.Patchy bibasilar airspace opacities may reflect aspiration.Pneumoperitoneum. Findings relayed to pager 2772 (Kennedy, Aimee). Patient had recent surgical gastrostomy tube insertion.

Output: Patchy bibasilar airspace opacities may reflect aspiration. Pneumoperitoneum, expected in view of recent surgical gastrostomy tube insertion.


Instruction: Generate impression based on medical findings.

Input: Age: 99 yearsGender: FemaleReason for Study: Reason: eval lung fields History: palpitations Stable mild cardiac enlargement with pulmonary vascular redistribution.Basilar interstitial opacities most likely are chronic in origin.No focal areas of consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male history of shortness of status post lung transplant. Right IJ catheter with tips in the right atrium. Status post right lung transplant. Severe fibrosis in the native left lung appearing similar to prior. Stable cardiomediastinal silhouette. No specific evidence of infection or edema.

Output: Severe fibrosis in the native left lung, but otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Presenting with shortness of breath and a history of COPD.1 Small left pleural effusion. No pneumothorax. Bibasilar right greater than left streaky opacity is consistent with aspiration/infection. The cardiomediastinal silhouette is normal.

Output: Bibasilar right greater than left radiopacity consistent with aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusion History: decreased bs over right base Complete opacification of the right hemithorax with increased volume, consistent with a large pleural effusion and underlying atelectasis. Perihilar and lower zone interstitial opacity on the left with septal lines suggestive of edema but nonspecific. Possible small left effusion in the posterior costophrenic angle.

Output: Complete opacification of the right hemithorax by a large pleural effusion with probable pulmonary edema in the left lung.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with locally advanced breast cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: 554 cm fluid density lesion in the left breast. Postsurgical changes in the left axilla.ABDOMEN:LIVER, BILIARY TRACT: Small hypodense lesions in the liver are nonspecific and unchanged from previous study. Cholelithiasis is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 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: Fluid density lesion in the left breast and postsurgical changes in the left axilla. No significant change in the hepatic lesions which are nonspecific and some of the more too small to accurate characterize.


Instruction: Generate impression based on medical findings.

Input: Metastatic neuroendocrine tumor of the pancreas CHEST:LUNGS AND PLEURA: Multiple punctate peripheral bilateral pulmonary micronodules are unchanged, nonspecific.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple peripherally enhancing masses consistent with metastatic disease are again noted. Previously reference left hepatic lobe on glomerate lesion now measures 9.6 x 6.8 cm not significantly changed. Other hepatic masses are also relatively unchanged. Reference portacaval lymph node measures 2 x 1.8 cm image number 111.SPLEEN: No significant abnormality notedPANCREAS: Postop changes of Whipple surgery.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple enlarged and enhancing mesenteric and retroperitoneal lymph nodes are again seen. Reference mesenteric lymph node measures 2.8 x 2.6 cm on image number 136. This lymph node compresses the SMV in its distal portion.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the extensive metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 57 year old female with pancreatic cancer CHEST:LUNGS AND PLEURA: Again noted are bilateral numerous nodules consistent with metastatic disease. They have increased in size compared to previous CTs.index right lower lobe nodule now measures and 26 x 21 mm image number 52, series number 11. Index left lower lobe nodule now measures 29 x 19 mm in on image number 58, series number 11.MEDIASTINUM AND HILA: Index right hilar lymph node is stable in measuring 15 x 12 mm image number 40, series number 11. Other small mediastinal lymph nodes are stable.CHEST WALL: Bilateral axillary lymph nodes and increased in size. An index right axillary lymph node measures 16 x 13 mm image number 17, series number 11. This lymph node was measuring 12 by 8mm image number 21 series number 10224 on CT dated 2/2010.ABDOMEN:LIVER, BILIARY TRACT: Again noted a metallic stent in the common bile duct. Biliary dilatation and pneumobilia in the left lobe persists.Patient's known hepatic abscess in the right lobe has almost completely resolved other than ill-defined hypodense area at the periphery of the right lobe best seen on image number 68, series number 11. Percutaneous drain has been pulled within the interval. Development of new, hypodense ill-defined area in segment 4 and 8 of the liver. This ill-defined area may represent cholangitis and organizing small abscesses.SPLEEN: No significant abnormality noted.PANCREAS: Patient's known pancreatic head mass is ill-defined and measures 3.4 x 1.9 cm image number 96, series number 11. Significant ductal dilatation the body and tail of the pancreas is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal vein is compressed by the retroperitoneal adenopathy. Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Extensive gastrohepatic, periaortic and retrocrural lymph nodes, stable.BOWEL, MESENTERY: Stomach is distended. Pancreatic head mass may be causing gastric outlet obstruction. Main portal vein is also encased by the mass and surrounding adenopathy.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: Interval increase in the right inguinal lymph node. It measures 19 x 14 mm image number 172, series number 11. Previously both measured 12 x 10 mm image number 125, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter fearful enhancing hypodense focus in the muscles anterior to the right femur. A small abscess cannot be excluded.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the bilateral lung nodules suspicious for metastatic disease. Gastric outlet obstruction caused by pancreatic head mass.Interval resolution of patient's known right liver lobe abscess. New ill-defined hypodense area in segments 4 and 8 suspicious for developing abscess.Retroperitoneal adenopathy is stable.Interval increase in the size of right inguinal lymph node with development of a possible small abscess in the muscles anterior to the right femur.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: widened mediastinum, ptx, cardiomegaly, pneumonia History: chest pain, acute onset Nonspecific left basilar opacity may represent atelectasis, consolidation, and/or pleural effusion.Right basilar subsegmental atelectasis.Stable moderate cardiomegaly.

Output: Left lower lobe lung opacity and probable effusion may represent infection in the appropriate clinical setting


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval for PNA History: SOB, cough Interval increase in right upper lobe atelectasis/consolidation with slight rightward tracheal shift.Increase in patchy right basilar opacity which may represent aspiration and/or infection. No pneumothorax or pleural effusion. Heart size is stable.

Output: Interval increase in right upper lobe atelectasis/consolidation.Interval increase in patchy right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: 89yo F s/p intubation History: assess ETT Interval extubation.Resolving left lower lobe opacity and effusion. No other interval change.

Output: Resolving left lower lobe opacity and effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: 47 y/o with myositis, ILD c/o pleuritic pain, evaluate History: pleuritic pain Mild basilar interstitial opacities which could correlate with myositis related ILD.No specific evidence of infection or edema.Heart size normal.No pleural effusions.

Output: Basilar interstitial opacities consistent with mild ILD, for which CT would provide more information.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Status post aspiration of left chest. Evaluate for pneumothorax. Interval placement of enteric tube with the tip in the stomach. The left abdominal surgical drain has been removed, the right is unchanged in location. Multiple surgical clips project over the mid abdomen. Left central venous catheter is in the right atrium.Persistent moderate right pleural effusion and subsegmental atelectasis. No pulmonary opacity. No pneumothorax.

Output: No pneumothorax status post needle aspiration.


Instruction: Generate impression based on medical findings.

Input: Check ETT NG removed. Left jugular catheter and ETT otherwise unchanged.Underlying right pleural effusion and basilar opacity appears similar again suggesting infection and/or possible aspiration.

Output: NG removed


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: intubated History: intubated Stable right chest tube with no pneumothorax.Continued improvement in basilar atelectasis with no new findings.ET tube tip approximately 4 cm above the carina. Right jugular catheter, tip in SVC.

Output: Improving basilar atelectasis with no new findings.


Instruction: Generate impression based on medical findings.

Input: Enteric tube placement Suboptimal exam secondary to technique and patient motion artifact. Enteric tube seen extending into proximal stomach, tip overlies proximal gastric body. Nonobstructive bowel gas pattern. Mildly heterogeneous appearance of right femoral head, nonspecific. Spinal degenerative disease.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Swan reposition. 1 cm right apical pneumothorax.Left jugular Swan-Ganz catheter tip is far distal, extending into a segmental branch of the right middle lower lower lobe. Other hardware and devices unchanged. Patchy atelectasis bilaterally.

Output: 1 cm right apical pneumothorax. Far distal position of left jugular Swan-Ganz catheter, consider repositioning.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old Reason: r/o PNA, edema. Hx of ESRD History: SOB Large right pleural effusion and associated compressive atelectasis/consolidation, not significantly changed when accounting for differences in pulmonary inflation.Small right pleural effusion slightly decreased from the prior examinationCardiomediastinal silhouette unchanged.

Output: Large left pleural effusion associated with associated compressive atelectasis/consolidation unchanged. Small right pleural effusion not significantly changed when accounting for differences in positioning. No specific evidence of edema or infection.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, 30 years old.Reason: ?post-procedural complication ?PTX History: post-CRT device Slight motion artifact. Left subclavian biventricular ICD terminates in the right atrial appendage, right ventricle, and coronary vein. Overlying anatomy slightly limits evaluation. Within these limitations, no large pneumothorax. No pleural effusion. No focal pulmonary abnormality. Moderate cardiomegaly.

Output: No large 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, 48 years old.Reason: dyspnea History: dyspnea Left ICD with leads, mitral valve prosthesis, and aortic valve prosthesis are unchanged. Median sternotomy wires, fracturing of the lowest mediastinal wire with 4 mm separation.Cardiomediastinal silhouette is normal.Right greater than left pleural effusion with right middle lobe and lower lobe atelectasis.No pneumothorax.

Output: Right greater than left pleural effusion with right middle lobe and lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: assess ET positioning History: intubated ET tube, right jugular catheter and right chest tube unchanged. Cardiomegaly with diffuse interstitial and airspace opacity compatible with pulmonary edema and atelectasis. Extensive subcutaneous emphysema in the right chest wall. A CT scan has been performed recently and provides more detailed evaluation.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Pleurectomy Mild interval improvement with improved aeration involving both left and right lungs, however postsurgical changes involving the left including volume loss, the elevated hemidiaphragm and streaky patchy densities in the left lung base persist. Small left effusion. The cardiac and mediastinal contours remain similar and within limits though mildly exaggerated by moderate scoliosis

Output: Postsurgical changes involving the left hemithorax without evidence of new superimposed focal abnormality. Mild improving left atelectatic changes


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: determine edema vs consolidation c/f infection History: tachycardia, hypoxia Increased lung volumes compatible COPD.The cardiomediastinal silhouette is unremarkable.The lungs are clear.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, 65 years old.Shortness of breath evaluate acute pulmonary edema. Diffuse hazy and reticular opacities with severe septal thickening bilaterally. Heart size remains normal. No visible pleural fluid.

Output: Diffuse, severe edema-like opacities may reflect atypical/noncardiogenic edema in the absence of known malignancy and/or clinical signs of infection. Follow-up to radiographic resolution recommended. If the abnormality does not resolve post diuresis, consider CT for evaluation.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube placement History: s/p left VATS wedge Chest tube extending to the left apex with no significant pneumothorax.Gastric interposition extending to the right of the mediastinum.Port catheter with its tip in the SVC.Mild basilar atelectasis.

Output: Unremarkable postoperative chest.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: s/p NG tube placement History: sedated, intubated Endotracheal tube terminates within 1 cm of the carina, repositioning is recommended. Intra-aortic balloon pump tip projects over the superior left mainstem bronchus. Advancement x 2 cm recommended. There are external defibrillator pads on the right superior and left infralateral chest wall. Nasogastric tube side hole is medially inferior to the GE junction. There is a temporary femoral pacemaker electrode terminating at the expected apex of the RV.No focal consolidation, pneumothorax or pleural effusion. The heart size is normal.

Output: Repositioning of endotracheal tube recommended. Intra-aortic balloon pump advancement by 1 to 2 cm recommended.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with known metastatic pancreatic cancer status post Whipple procedure. Patient has known metastatic lesions to the liver. Please evaluate for interval change in liver lesions. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Solitary right hilar lymph node is reidentified (series 3, image 46) and has been stable since 2007. No left hilar, mediastinal, axillary, diaphragmatic, or retrocrural nodes identified. Heart size normal without pericardial effusion.CHEST WALL: Right chest wall Port-A-Cath. Left chest wall pacemaker.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined lesion with peripheral enhancement is reidentified in the right hepatic lobe. It appears to have grown in size on comparison to prior study, now measuring 4 x 3.1 cm (series 3, image 88); it previously measured approximately 2.9 x 2.2 cm. Please note that its ill-defined margins make objective measurements difficult. No new liver lesions are identified.SPLEEN: Splenomegaly as seen previouslyPANCREAS: Changes secondary to Whipple surgery. Mild dilatation of the pancreatic duct and the remaining pancreas is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes are identified as well as subtle infiltration along the root of the celiac artery, which seems to have increased slightly on comparison to multiple prior studies. This may represent tumor infiltration, and continued surveillance is recommended.BOWEL, MESENTERY: Reference mesenteric lymph node (series 3, image 121) measures 15 x 9 mm and is slightly more prominent on comparison to prior study; previously measuring 14 x 7 mm.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Slight interval enlargement of ill-defined right hepatic metastasis as described above as well as subtle increase in soft tissue infiltration around the root of the celiac artery, raising the possibility of tumor infiltration at this location. Reference mesenteric lymph node is also slightly more prominent on comparison to prior study.2. Prominent right perihilar lymph node stable since 2007.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: sp minimally invasive esophagectomy History: asx Gastric pull-up unchanged. Stable mild basilar atelectasis.Right jugular catheter, tip in SVC.

Output: Unchanged basilar atelectasis following gastric pull-up.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Chest pain and SOB. Subsegmental atelectasis or scarring at the lung bases. No focal airspace opacities. No pleural fluid or pneumothorax. Unchanged appearance of the cardiomediastinal silhouette.

Output: Linear atelectasis at the lung bases.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess effusions History: SOB Small lung volumes with bilateral pleural effusions and underlying nonspecific consolidation and atelectasis.Venous catheter and NG tube unchanged.

Output: Unchanged effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: hx of urethral cancer, evaluate for metastatic disease History: see above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: pre-op History: hip fx Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old with delirium/dementia. Left chest port catheter tip is over the right atrium.The cardiomediastinal silhouette is unremarkable when allowing for patient rotation.Right basilar atelectasis. Left retrocardiac subsegmental atelectasis.No pneumothorax.Moderate right pleural effusion.

Output: Moderate right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Dialysis patient, worsening renal function Persistent mild cardiomegaly without discrete new superimposed focal air space abnormality. A persistent chronic appearing interstitial changes observed greater both bases. No effusions.Extensive and incompletely visualized degenerative changes in both shoulders. Mild scoliosis

Output: Cardiomegaly without superimposed discrete new pulmonary disease


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: pls eval for intrathoracic changes related to bleeding or shunt History: tachycardia Tracheostomy tube has been removed. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: balloon pump History: balloonpump Left-sided ICD and right IJ Swan-Ganz unchanged.IABP marker in the aortic arch.Decreased lung volumes with stable cardiomediastinal silhouette.No new pulmonary opacities noted.

Output: Support devices unchanged IVP marker in the aortic arch. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Swan-Ganz catheter placement. Interval placement of Swan-Ganz catheter with tip in a right pulmonary artery branch. Intra-aortic balloon pump approximately 5 cm from the top of the aortic arch. Additional support devices are unchanged.Stable cardiomegaly and mild interstitial opacities. No pneumothorax or large pleural effusion.

Output: Interval placement of right Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: Reason: congestion, left sided pleuritic pain History: congestion Heart size within normal limits with an aortic valve prosthesis in place.Diffuse interstitial opacity with multiple septal lines compatible with pulmonary edema, with small pleural effusions.

Output: CHF with pulmonary edema and pleural effusions, without significant change.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of malignant mesothelioma CHEST:LUNGS AND PLEURA: Large right sided pleural effusion, unchanged. Scattered micronodules are unchanged. Calcified nodules in the lingula are unchanged.MEDIASTINUM AND HILA: Reference cardiophrenic nodule measures 19 x 9 mm in image number 60, series number 3 not significantly changed. Other small mediastinal lymph nodes are also unchanged.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 nodule is unchanged measuring 13 x 13 mm image number 19, series number 3.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph nodes is unchanged measuring 9 x 10 mm image number 113, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of ascites is unchanged. Reference right upper quadrant soft tissue density is grossly unchanged measuring 24 x 17 mm image number 88, series number 3. Maximal thickness of the collection at the left hemidiaphragm on coronal images is 13 mm in image number 43.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: Peritoneal wall thickening and ascites is unchanged.

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: confirm stable IABP placement History: advanced heart failure Cardiomegaly without edema or pneumonia.Right PICC, tip in axillary region.IABP proximal marker projects over the aortic arch.Stable single lead ICD terminate in the RV apex.

Output: Cardiomegaly without acute edema, pneumonia or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: CVC in place History: CVC in place New left internal jugular central venous catheter crosses the midline with the tip terminating in the right brachiocephalic vein.Low lung volumes. There are nonspecific patchy perihilar opacities, which may reflect atypical infection possibly noncardiogenic edema. There is no pneumothorax or pleural effusion. Moderate cardiomegaly unchanged.

Output: New left IJ tip in the right brachiocephalic vein. No pneumothorax. New patchy perihilar opacities may represent aspiration, atypical infection or possibly noncardiogenic edema.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: cp History: cp Moderate to severe cardiomegaly, worse than on the prior study raising the question of pericardial effusion. New basilar interstitial opacities consistent with edema versus aspiration.Left subclavian ICD, leads unchanged in position.

Output: Severe cardiomegaly with increased basilar opacities possibly edema although aspiration is a consideration as well.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: FemaleReason for Study: Reason: R/O infectious process History: dyspnea and wheezing The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: patient with swan catheter, want to look at placement History: swan ganz catheter Right IJ Swan-Ganz with its tip in the right pulmonary arteryLeft-sided ICD unchanged.Stable marked cardiac enlargement.Basilar interstitial opacities similar to the prior exam.No new pulmonary opacities.No large pleural effusions.

Output: Right IJ Swan-Ganz with its tip in the right pulmonary artery. Stable cardiopulmonary appearance with cardiomegaly and probable edema.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of hypoxic event after resuscitation. Evaluate for pulmonary edema. Stable cardiomediastinal silhouette. Interval improvement of right-sided patchy air space opacities. Small right pleural effusion. Mild pulmonary edema

Output: Resolving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 33 years, Female. Reason: N/V, ? TOA, please evaluate for obstruction versus ileus History: N/V, leukocytosis Patient is status post sternotomy. No significant pleural or pulmonary abnormality is noted.Nonobstructive bowel gas pattern. No evidence of free air.

Output: Nonobstructive bowel gas pattern. No evidence of free air.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old Reason: chest pain, hx of SLE History: chest pain, hx of SLE No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. Surgical clips again noted in the left axilla. The bones and upper abdomen unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: eval for enlarging effusion History: tachycardia, hypoxemia, fevers Left pleural effusion and retrocardiac consolidation/atelectasis without significant interval change.Right middle lobe subsegmental atelectasis mildly improved.Right PICC line with its tip in the SVC.Stable cardiomediastinal silhouette.Embolization coils are identified in the left upper abdomen.

Output: Left pleural effusion and left basilar consolidation/atelectasis similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: sob doe evaluate for abnormality History: sob doe evaluate for abnormality Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: eval for esophogeal perforation History: s/p endoscopy with severe pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Surgical clips in the upper abdomen.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: cp History: above Cardiac silhouette is normal in size.Slight hyperlucent lungs with mild linear retrosternal linear scarring. No focal consolidation, sizable effusion or pneumothorax.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Lemierre syndrome eval pneumonia History: sepsis Improved lung inflation with scattered septal lines, but no new findings.Right jugular catheter, tip in SVC.

Output: No reliable evidence of pneumonia. Scattered septal lines but no other significant findings.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female on VV ECMO. Evaluate lung fields, ECMO placement. Right internal jugular ECMO cannula unchanged with sideholes projecting above the right atrium. Tracheostomy tube tip 3 cm above the carina. Upper extremity PICC tip in SVC. Enteric tube tip in the antral/pyloric region. Right upper quadrant surgical clips.Diffuse bilateral airspace opacities not significantly change from prior study. Cardiomediastinal silhouette remains obscured. Note is made of increased gastric distention from prior study.

Output: 1. Right internal jugular ECMO cannula unchanged. 2. Diffuse bilateral airspace opacities not significantly changed.3. Note is made of increased gastric distention from prior study.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male with gastric cancer CHEST:LUNGS AND PLEURA: Stable right middle lobe noncalcified nodule, best seen on image number 63, series number 5, measuring 6-mm in diameter.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Mild stranding around the celiac axis is unchanged.BOWEL, MESENTERY: Changes secondary to a total gastrectomy. Previously measured soft tissue density near the splenic hilum is smaller now measuring 1.2 x 0.9 cm number 93, series number 3.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: Nonspecific small soft tissue focus near the splenic hilum is slightly smaller. Other findings are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Chest pain, tachycardia Cardiac silhouette is normal. No focal pulmonary opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: rule out pneumonia vs foreign body History: cough, short of breath 2 months Linear opacity in the right mid zone favors scar. There is no consolidation, pleural effusion or pneumothorax. Heart size is normal. No evidence of radiopaque foreign body. Minimal bronchial wall thickening which can be seen in the presence of asthma or bronchitis.

Output: Minimal bronchial wall thickening which can be seen presence of asthma or bronchitis. No radiopaque foreign body.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: eval subcutaneous emphysema, ptx? History: crepitus extending to neck/face,chest tubes removed Right-sided chest tube has been removed.Small residual right pneumothorax.Severe subcutaneous emphysema overlying the entire chest as well as visualized neck increased from the prior exam particularly in the left chest.No new pulmonary opacities identified. Increased

Output: Interval removal of right-sided chest tube. Small residual right pneumothorax. Increasing severe subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: CT NON-INFUSED CHEST 4/30/2008 11:51 AM LUNGS AND PLEURA: Linear area of increased density in the lateral subpleural region of the right middle lobe is noted and appears slightly improved from prior study. It most likely represents peripheral scarring from previous infectious or inflammatory process.MEDIASTINUM AND HILA: Right lobe of the thyroid gland is asymmetrically enlarged. Minimal pericardial effusion. Shotty mediastinal lymph nodes are noted and are stable in size from prior exam. Coronary artery calcifications are noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Peripheral scarring in the right middle lobe, likely secondary to infectious or inflammatory process. Unless the patient is at increased risk for lung cancer, no further follow-up is indicated for this lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p Right lung wedge resection History: asx Right chest tube with no pneumothorax following wedge biopsy.Emphysema.Status post median sternotomy for CABG.

Output: No pneumothorax, right chest tube in place.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Shortness of breath. Normal heart size. No focal airspace opacity, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality other than minimal basilar atelectasis and/or scarring

Output: Minimal scarring without superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary abnormality. Postsurgical changes of the right breast and axillary clips appear unchangedThe left jugular catheter again terminates in mid SVC

Output: Unchanged postsurgical changes


Instruction: Generate impression based on medical findings.

Input: Intubation ETT remains 5 cm from the carina. Right jugular Swan-Ganz projects into the right atrium. Incomplete visualization of a new or newly appreciated IVC filter.Cardiopulmonary appearance is significant for mild persistent yet resolving changes suggesting pulmonary edema and mild cardiomegaly with small effusions.

Output: ETT and Swan-Ganz are both unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: evaluate for changes ; worsening SOB/ lower saturations History: worsening SOB worsening saturations Normal heart size. Tortuous thoracic aorta. Basilar predominant chronic interstitial opacities as seen on recent CT. No superimposed focal airspace opacity.

Output: Chronic interstitial lung disease without evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female history of breast cancer CHEST:LUNGS AND PLEURA: Right upper lobe nodule on image number 36, series number 5 has slightly increased in size now measuring 6 mm. Before it was measuring 3 mm on image number 82, series number 5. There is a new subcentimeter lesion on image number 46, series number 5 in the right middle lobe.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Index right axillary lymph node measures 2 x 1 cm on image number 41, series number 3.Left axillary adenopathy has also significantly increased with in the interval. Postsurgical changes involving the right breast.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver, increased in size consistent with metastatic disease. An index lesion in the right lobe measures 1 x 1.1 cm on image number 91, series number 3. Previously closed measuring 8 x 8 mm on image number 81, series number 4. There are also some benign cysts in the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Endometrial stripe is slightly thickened. Correlation with pelvic ultrasound is recommended.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the bilateral axillary lymph nodes, lung nodule and hepatic metastases. New subcentimeter lung nodule in the right side.


Instruction: Generate impression based on medical findings.

Input: Fever No definite cardiopulmonary abnormality, however small effusions cannot be excluded . Unchanged postsurgical staples projected over the mid right lung and chest wall

Output: Small nonspecific effusions without definite superimposed additional airspace abnormalities. Serial imaging may be needed in light of the provided history


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.History of fever and elevated lactate, evaluate for pneumonia. Enteric tube with tip in the stomach. Right IJ central catheter with tip at SVC atrial junction.Stable cardiomediastinal silhouette.Low lung volumes with persistent basilar opacities comprised of small effusions and atelectasis/consolidation, not significantly changed. No pneumothorax.

Output: Stable cardiopulmonary appearance including small effusions and basilar atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: SOB and productive cough. Left subclavian dual chamber pacemaker. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.Normal heart size. Low normal lung volumes. No pleural fluid. Coarse interstitial opacities, most pronounced in the dependent lung fields, possibly the result of atypical edema and superimposed bronchitis.

Output: Indeterminate interstitial abnormality which may be the result of bronchitis and mild edema but is nonspecific. Suggest follow-up PA and lateral chest radiographs after symptoms have resolved assess for clearance.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old Reason: pna? History: cough, asthma, sob Normal heart size with tortuous aorta.Emphysema without specific evidence of infection or edema. Calcified granulomas on the right.

Output: No specific evidence of pneumonia. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Shortness of breath and BiPAP. Evaluate for edema or signs of infection. Normal heart size. Coarse airspace opacities with mild vascular redistribution. Moderate left pleural fluid collection. Retrocardiac atelectasis.

Output: Signs of hypervolemia. Coarse pulmonary opacities somewhat atypical in appearance for acute edema and in the appropriate clinical context, diffuse bronchiolitis from aspiration or infection may be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: Pulm Edema History: SOB Swan-Ganz catheter tip in right pulmonary artery. ICD unchanged.No significant pulmonary edema or pleural effusions. Heart size stable.

Output: No significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: s/p R Thoracotomy History: nausea, vomiting Two right apical chest tubes remain unchanged.Stable cardiomediastinal silhouette.Postsurgical right lung volume loss with likely small right pleural effusion. There is slight increase in interstitial marking prominence with hazy opacities in the right lung probably related to shallow inspiration.

Output: Right lung postsurgical changes with slight increase in interstitial marking prominence and hazy opacification probably related to shallow inspiration. Attention on followup imaging recommended as an element of early aspiration cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.History of new fevers with hypoxia. Left central venous catheter with tip in the SVC.The cardiomediastinal silhouette is stable.Mild bilateral interstitial opacities with small bilateral pleural effusions are unchanged.

Output: No significant interval change in edema or effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval PNA History: productive cough Cardiomediastinal silhouette is within normal limits. No focal air space abnormality. No pleural effusions.Severe S-shaped scoliosis of the thoracic spine.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.ET tube in place. Kidney transplant status. ETT tip 3 cm above carina. Right jugular Swan-Ganz catheter at the main pulmonary artery level, the tip is probably overlapping and within the proximal left descending pulmonary artery.No significant changes left greater than right pleural effusions, atelectasis and consolidation as well as diffuse groundglass and patchy nodular opacities bilaterally.

Output: No acute change in pleural fluid or pulmonary opacities. Swan-Ganz catheter tip likely in the proximal left descending pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Newborn 25 week gestational age patient with right pneumothorax. Repositioning of lines.VIEWS: Chest and abdomen AP (two views) 03/12/16, 1335 Endotracheal tube tip is between thoracic inlet and carina. Two right chest tubes are in place. Umbilical venous line tip is in right atrium. Umbilical arterial line has its tip at T5.Cardiothymic silhouette is normal. Granular lung opacities are present bilaterally. Lung volumes are large with hemidiaphragms between ninth and 10th posterior ribs. No pneumothorax is seen. Cardiothymic silhouette is normal.Less bowel gas is present. Bowel gas pattern is disorganized.

Output: Resolved pneumothorax. Granular lung opacities related to surfactant deficiency/surfactant administration. Less bowel gas.


Instruction: Generate impression based on medical findings.

Input: Hemoptysis rule out infiltrate. Slight decrease in lung volumes compared to the prior study. No focal airspace opacities, visible pleural fluid or pneumothorax. Mild retrocardiac atelectasis. Incompletely visualized spinal fixation hardware.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Concern for pneumonia The cardiac and mediastinal contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities.Blunting of the right costophrenic angle suggestive of pleural thickening. No pneumothorax.

Output: No radiographic findings to suggest pneumonia


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: r/o pneumonia, pleural effusion History: sob Cardiomegaly appearing similar to prior study.Left basilar scarring and small chronic left pleural effusion unchanged.Posterior pleural thickening unchanged.ICD and LVAD position unchanged from prior study.

Output: No acute interval change. ICD and LVAD position unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: as above Swan-Ganz catheter tip in the main pulmonary artery.Cardiomegaly with basilar opacities compatible with pleural effusions and atelectasis.No pneumothorax or other acute change.

Output: Pleural effusions and basilar atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.PICC in place. Right PICC tip projects over the lateral aspect of the right subclavian region.Right jugular Swan-Ganz catheter projects over the right descending pulmonary artery. Left subclavian ICD unchanged in position.No focal pulmonary opacities.

Output: Right PICC tip in the lateral aspect of the right subclavian vein projection.


Instruction: Generate impression based on medical findings.

Input: Male 37 years old Reason: Pneumothorax; Post device placement in EP Lab Right chest wall subcutaneous AICD device position unchanged.No focal airspace opacity or pneumothorax.Nonspecific minimal blunting of left costophrenic angle.Mild cardiomegaly unchanged.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: s/p intubation History: intubated Endotracheal tube terminates approximately 3 cm from the carina. Diffuse opacities again noted. Unchanged cardiomegaly. No large pleural effusion or pneumothorax. Prominence of bowel loops within the abdomen.

Output: Prominence of bowel loops within the abdomen. Correlation with abdominal radiograph is suggested.Endotracheal tube terminus approximately 3 cm from the carina.No substantial change in diffuse pulmonary opacities given differences in inspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: intubated, assess ETT History: intubated, assess ETT Endotracheal tube is at the carina and could be old back slightly if clinically indicated. Enteric tube, unchanged. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Endotracheal tube is at the carina and could be old back slightly if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: 65M w CHF, CAD p/w CP SOB. C/f cardiac etiology History: sudden SOB, CP relieved with nitro The cardiomediastinal silhouette is unremarkable.Mild elevation left hemidiaphragm with minimal basilar atelectasis.No focal areas of consolidation.No pleural effusions.

Output: Mild left basilar atelectasis. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: rule out infection History: rule out infection No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: 59F w/ cardiogenic shock s/p VAV ECMO decannulation History: - ET tube tip approximately 6 cm above the carina. Swan-Ganz catheter tip in the main pulmonary artery.Feeding tube coiled in the stomach.Pulmonary edema and small pleural effusions, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: ? PNA Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: eval ETT, lung fields History: s/p MVR Endotracheal tube terminates 6 cm above the carina. Right IJ Swan-Ganz catheter is angulated toward the right pulmonary artery. External defibrillator pads are in place. 2 mediastinal drains are present. ICD electrodes are unchanged in position. Interval placement of sternotomy hardware.Cardiomegaly is unchanged. Increasing, right greater than left, mid to lower zone opacities of atelectasis and mild edema. No pneumothorax.

Output: Postoperative atelectasis and mild edema. Stable cardiomegaly. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with cough and shortness of breath. Evaluate for pneumonia. Stable mild cardiomegaly with left atrial enlargement.Moderately sized hiatal hernia again noted.No acute focal airspace opacity.Right costophrenic angle subsegmental atelectasis versus scarring.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Confirm stable tube placement, reassess lung fields. Respiratory failure status post lung transplant. History of ILD. Low endotracheal tube with tip 1.5 cm above the level of the carina.Right jugular catheter and enteric tube unchanged in position.Loculated pleural fluid on the left unchanged. Diffuse interstitial and airspace opacities in the left lung without significant change. Basal atelectasis/consolidation on the left about the sameElevation of the right hemidiaphragm and right hemithorax volume loss in the presumably fibrotic native right lung.

Output: No acute change in pleural fluid or extensive parenchymal opacities. Low endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: quant gold +, eval for cavitary/other lesions suspicious for pulmonary tb History: see above The cardiomediastinal silhouette is unchanged. Atherosclerotic calcifications affect the aortic arch.Postoperative volume loss in the left lung. Streaky opacities at the right lung base likely reflect atelectasis. Small left pleural effusion.Surgical clip overlies the left upper quadrant.

Output: Small left pleural effusion. No cavitary lesion as clinically questioned. However, CT would be more sensitive.


Instruction: Generate impression based on medical findings.

Input: Reason: 74F with NSTEMI and new heart failure symptoms. History: NSTEMI, dyspnea Low lung volumes and near complete opacification of the right hemithorax likely secondary to large pleural effusion and associated compressive atelectasis.Streaky left basilar opacity is also seen consistent with atelectasis.

Output: Large right pleural effusion and bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Check for aspiration. Elevated white count Diffuse mild interstitial changes appear similar without evidence of interval new superimposed acute cardiopulmonary abnormality. Marked tortuosity of the aorta exaggerated due to rotation and semiupright technique. No new hardware

Output: Underlying chronic changes without superimposed new acute abnormality, specifically previously observed questionable edema has resolved


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: reassess pleural effusions History: bilateral pleural effusions, pulmonary edema, SOB Moderate cardiomegaly with lower lung zone opacities suggestive of edema.No specific evidence of infection.

Output: CHF with cardiomegaly and mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: ET tube History: intubated ET tube tip 3 cm above carina. NG tube tip in stomach. Venous catheter tip at RA/SVC junction.No change in pleural effusions and basilar atelectasis. No new opacity.

Output: ET tube tip 3 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: F/u CXR s/p subclavian IABP placement History: F/u CXR s/p subclavian IABP placement Interval exchange of IABP catheter, now with the proximal marker in the descending aorta.Catheter tip in SVC.Cardiomegaly with grossly stable appearance of bilateral pleural effusions and pulmonary edema.

Output: Interval exchange of IABP, marker in the descending aorta. Allowing for differences in projection and position, no appreciable change to bilateral pleural effusions and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: 42yoF, CP, eval for infiltrate History: chest pain At least moderate cardiomegaly with mild basilar edema consistent with CHF.Unchanged proximal descending aortic stent. Mediastinal contours are stable.

Output: Cardiomegaly with mild edema consistent with CHF. No change mediastinal contours.


Instruction: Generate impression based on medical findings.

Input: Fever Interval Dobbhoff placement with tip projected into the proximal stomach. Additionally new interstitial and patchy mixed opacities have progressed and now involves both lungs greater in both bases. Concern for progressing atypical infection such as viral pneumonia or aspiration again remains high

Output: Increasing changes suggesting atypical infection such as viral pneumonia or aspiration. Dobbhoff tube placement


Instruction: Generate impression based on medical findings.

Input: Chest port not drawing backVIEWS: Chest AP and lateral Left chest port with tip at the SVC. Again noted septal occluder device and GJ tube. There is a small amount of barium within the peritoneal cavity. Cardiothymic silhouette normal. No focal lung opacity. No pleural effusion or pneumothorax.

Output: Left chest port with tip at the SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: aspiration History: coughing, emesis Tracheostomy tube and left jugular catheter unchanged.Dilated trachea, unchanged from previous radiographs.Interstitial and airspace opacities in the right transplanted lung suggestive of edema, possibly with aspiration, with pleural thickening or organized effusion.Chronic interstitial disease in the left native lung.

Output: Perihilar opacity on the right, suggestive of edema and possibly aspiration, not significantly changed from previous.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate recent PNA History: cough Mild residual opacity of the right costophrenic angle compatible with scarring and atelectasis.No other significant findings.

Output: Mild residual scarring and/or atelectasis at the right costophrenic angle.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male back pain. Evaluate for pneumonia versus perinephric abscess or abdominal abscess. Patient on hemodialysis. CHEST:LUNGS AND PLEURA: The large left pleural effusion has increased in size with associated collapse of the left lower lobe. Small right pleural effusion is stable or minimally increased. Scattered bilateral lung nodules redemonstrated. Index nodule in the right lower lobe seen on series 5 image 37 and is slightly increased in size now measuring 1.1 x 1 cm.MEDIASTINUM AND HILA: A scattered small mediastinal lymph nodes are again seen. Subcarinal lymph node is slightly larger now measuring about 2.5 x 1.2 cm, series 2 image 38. Calcific granulomata right hilum.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast and in the bowel due to the lack of oral contrast. Given those limitations, the following observations are made.LIVER, BILIARY TRACT: The mass in the medial segment of the left lobe as seen on narrow window levels is larger, measuring 3.3 x 2.7 cm, series 3 image 76. No new lesions are seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left kidney particularly the upper pole is slightly larger (and in coronal plane, rounder) on today's study. Comparing to the contrast-enhanced and delayed images from the May 19, 2009 there is a distinct change with enlargement of the kidney compression of some of the upper pole cyst and loss of renal sinus fat. I strongly suspect an expansile process in the left kidney be infectious or neoplastic cannot exclude transitional cell carcinoma.There is small amount of perinephric fat stranding and fluid bilaterally but this is unchanged. The varied renal cysts and renal calcifications are unchanged.RETROPERITONEUM, LYMPH NODES: Scattered large left periaortic nodes and periaortic nodes proximally stable.BOWEL, MESENTERY: Minimal amount of free intraperitoneal fluid. No evidence of intraperitoneal abscess. The bowel is normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small right and left common iliac nodes unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mass previously described in the left psoas muscle is not well seen without IV contrast but probably unchanged. Degenerative changes and mild sclerosis probably related to renal disease. No definite lytic or blastic disease.OTHER: No significant abnormality noted

Output: Increase in size of liver and lung lesions. Increase in size of left pleural effusion and collapse left lower lobe. Stable adenopathy.Exam is not sensitive for renal or solid organ infection but there is suggestion of expansion of the left upper pole concerning for tumor or infection. No evidence of perinephric abscess however.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: eval for acute chest History: pain crisis Stable cardiomediastinal silhouette.Decreased lung volumes with basilar interstitial opacities suggestive of atelectasis and/or scarring.No focal areas of consolidation.No large pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change. No specific evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: monitor impella History: s/p impella Interval extubation.Impella device projected in area of left ventricle.Stable cardiomegaly with an ICD.Swan-Ganz catheter tip in the right main pulmonary artery.Bibasilar opacities, greater on the left, suggestive of atelectasis, unchanged. No new focal pulmonary opacity.

Output: Impella device projected in area of left ventricle. Basilar atelectasis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: TB screening, hx of positive PPD History: none The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax. Left basilar atelectasis. No radiographic evidence of tuberculosis.

Output: No acute cardiopulmonary disease. No radiographic evidence of tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female 88 years old; Reason: r/o pna History: cough The cardiomediastinal silhouette is unchanged. The aorta appears ectatic is probably aneurysmally dilated, however, unchanged. No pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate ETT placement and adjustment History: ETT high on previous CXR ET tube tip approximately 5 cm above the carina.Mild basilar opacity consistent with subsegmental atelectasis and aspirated secretions.Upper lobe predominant bullous emphysema.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Knee 59-year-old using female with newly diagnosed as stage III uterine cancer. Status post surgery. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left lower lobe on image number 82/112MEDIASTINUM AND HILA: Retrosternal goiter.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without biliary dilatation. No evidence of focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass measuring 2.5 by 3-cm. Right adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple nonenlarged, small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: Unremarkable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right obturator hypodensity measuring 4.2 x 2.3 cm likely representing postop changes or a lymphocele. Left obturator adenopathy measuring 16 x 12-mm. small left-sided collection anterior to the left external iliac vessels measuring 2.2 x 2.3 cm. small amount of free fluid in pelvis likely secondary to recent surgery.

Output: Left adrenal mass of indeterminate etiology. MRI of the adrenals the helpful for further evaluation.Pelvic right-sided lymphocele and small fluid collections likely postsurgical.Left-sided pelvic adenopathy.Subcentimeter left lower lobe noduleGoiter with retrosternal extension.


Instruction: Generate impression based on medical findings.

Input: Sepsis. Line placement. Low lung volumes. Diffuse bronchial wall thickening and no specific evidence of pulmonary edema and no focal airspace opacities. A partially visualized left PICC terminates over the left axilla and is not in a central vein.

Output: Left PICC terminates in the region of the left axillary vein. Interval development of diffuse bronchial wall thickening, but no specific signs of pulmonary edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: Evaluation of bilateral PTX History: Dyspnea Bilateral chest tubes with a recurrent left pneumothorax and small residual right.Upper lobe predominant cystic lung disease.

Output: Recurrent left and residual right pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: intubated History: intubated Near complete resolution of a left-sided pneumothorax. Stable cardiopulmonary appearance.LVAD, lines, and tube positions are not significantly changed. Endotracheal tube tip is approximately 5 cm above the carina.

Output: Near complete resolution of left-sided pneumothorax with otherwise stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female evaluate DHT. Dobbhoff tube tip in the stomach with tip directed retrograde in the region of the gastric fundus. Tracheostomy tube tip 4.0 cm above the carina. Left subclavian catheter tip in the right atrium.No interval change in bilateral pulmonary opacities and pleural effusions, including dense right apical opacity in a pattern suggestive of radiation fibrosis as seen on prior CT study in 2015. No pneumothorax. Cardiomediastinal silhouette partially obscured by overlying pulmonary opacities but grossly unchanged.Deformities of multiple right-sided ribs compatible with known metastases also seen on prior CT in 2015.

Output: Dobbhoff tube tip directed retrograde in the gastric fundus.