Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: ILD, PNA, URI, ACS History: SOB The cardiac silhouette is normal. Bilateral hilar prominence is stable.There are no focal pulmonary opacities or pleural effusions.

Output: Hilar lymphadenopathy without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: Intubated ICU patient w/ ARDS, multifocal pneumonia History: Intubated ICU patient w/ ARDS, multifocal pneumonia Right IJ tip terminates in the SVC. Tracheostomy cannula in place. Enteric feeding tube tip terminates out of the field of view inferiorly. Left IJ tip terminates in the left brachiocephalic vein.Patchy multifocal airspace opacities increased in the right lower lobe, and not significantly changed elsewhere, consistent with multifocal pneumonia. There is no pneumothorax. The cardiac and mediastinal contours are within normal limits for size

Output: Patchy multifocal airspace opacities, increased in the right lower lobe and unchanged elsewhere in the lung, suggestive of multifocal pneumonia or ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: evaluate for new consolidation, lung collapse History: hypoxia Large lung volumes consistent with COPD.Focal scarring right mid and left lower lung zone.No specific evidence of infection or edema.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: 64 y/o lady w/ a cough History: 64 y/o lady w/ a cough No acute cardiopulmonary abnormality. No evidence of pneumonia.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: r/o obstruction and free air History: s/p cystectomy w/ neobladder no w/ distention and pain Normal cardiomediastinal silhouette. No focal pulmonary or pleural abnormality. No pleural effusion or pneumothorax. Posttraumatic deformity of the right mid clavicle.Bilateral internal ureteral stents extending to a right lower quadrant neobladder/ileostomy pouch. Low midline surgical skin staples and bilateral pelvic surgical clips.Moderate gaseous distention of multiple loops of small bowel measuring up to 3.4 cm in diameter. There remains air within the colon, however the colon is less distended when compared to the small bowel. No gross intraperitoneal free air.

Output: Gaseous distention of the small bowel out of proportion to the large bowel. This most likely represents a postoperative ileus. A CT of the abdomen and pelvis has already been performed for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Increased bilateral wheezing and cough Clear lungs. Focal convexity along the medial left hemidiaphragm is unchanged compared to 2013. Long-term stability is reassuring. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild atherosclerosis in the aortic arch.

Output: Clear lungs. Mild atherosclerosis.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.History: Diastolic heart failure (EF of 55%). Transferred from OSH with GI bleed (was on anticoagulation for left atrial appendage clot), found to be septic secondary to presumed pneumonia. Developed Afib and AKI secondary to septic shock. Right PICC line unchanged in position.Persistent decreased lung volumes and cardiomegaly, with basilar opacities, compatible with atelectasis.No new focal pulmonary consolidation.Air-filled dilated loops of bowel in the upper abdomen.

Output: No significant interval change in decreased lung volumes, cardiomegaly, and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Persistent mildly decreased lung volumes with interstitial changes in basilar atelectasis greater on the right. No definite distinct new superimposed focal abnormalityVertebroplasties and borderline cardiomegaly with marked tortuosity of the aorta, all appear similar

Output: Atelectasis without interval change


Instruction: Generate impression based on medical findings.

Input: 50-year-old male with shortness of breath and fevers, assess for progression of pneumonia, edema. Mild interstitial thickening with septal lines. Blunting of left hemidiaphragm consistent with atelectasis and possible small pleural effusion.Stable moderate cardiomegaly. Status post median sternotomy with intact sternal fixation devices. Small calcified nodular opacities related to right first and second rib deformities that are unchanged.

Output: Mild interstitial thickening with septal lines and probable small left pleural effusion, suggestive of mild CHF. No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: chf History: chf Stable heart size. Low lung volumes but no evidence of pulmonary edema.

Output: No significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: confirm RIJ placement History: RIJ Right jugular catheter tip in the area of the SVC with no pneumothorax.ET tube tip approximately 3 cm above the carina.NG tube tip in the gastric fundus. Basilar opacity, greater on the left, compatible with effusion and atelectasis.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Tuberculosis No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: FemaleReason for Study: Reason: s/p 11 mo after a L upper lobectomy for mgmt of a T2aN0M0 stage IB adenocarcinoma. History: 3 mo f/u Stable cardiac mediastinal silhouette.Volume loss in the left lung with left pleural lesion/thickening unchanged.No new pulmonary opacities identified.Median sternotomy intact.

Output: Stable cardiopulmonary appearance without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: trached, ronchi History: as above Tracheostomy tube and NG tube unchanged.Cardiomegaly with bilateral perihilar and lower zone opacity compatible with atelectasis and aspirated secretions, slightly increased in the left lower lobe.No new findings.

Output: Slightly increased left lower lobe opacity suggestive of aspirated secretions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Dyspnea. Hypotension. Increased bilateral pleural effusions, now large. Lower lung volumes, with increasing bibasilar opacities representing edema and atelectasis.The cardiac silhouette is obscured.Right jugular venous catheter tip in the SVC.

Output: Worsening CHF, now with large pleural effusions


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Pt has T1N2cM0 SCC of the left piriform sinus, s/p CRT reporting new cough with mildly elevated WBC. Please evaluate for pneumonia or any other abnormality. History: as above No significant cardiopulmonary abnormality.Healed right rib fractures.Right jugular catheter, tip in SVC.Gastrostomy tube.

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


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: sob and new leukocytosis History: sob and new leukocytosis Increasing cardiac size as well as interval increase in perihilar/basilar interstitial opacities suggestive of edema.Bilateral pleural effusions probably increased from the prior exam.No focal areas of consolidation.Partially visualized right mandibular resection.

Output: Increasing cardiomegaly, pulmonary edema, pleural effusions, and basilar atelectasis suggestive of CHF/volume overload. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: intubated, pea arrest Lines and tubes are unchanged. No substantial change in diffuse pulmonary opacities given differences in inspiration. Right lower lobe collapse, as before. Marked cardiomegaly, as before. No large pleural effusion or pneumothorax.

Output: No substantial change in diffuse pulmonary opacities given differences in inspiration. Marked cardiomegaly, as before.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.With endocarditis. No pleural effusion or pneumothorax. Cardiomegaly. Upper lobe predominant perihilar airspace opacities compatible with consolidation or aspiration. Interval removal of right central venous catheter.

Output: Upper lobe predominant perihilar airspace opacities compatible with consolidation or aspiration.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with history of tonsil cancer status post chemo and radiotherapy. CHEST:LUNGS AND PLEURA: Stable post inflammatory granuloma. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: No evidence of metastatic disease


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: new O2 requirement History: new O2 requirement Basilar subsegmental atelectasis and scarring. No evidence of edema or pneumothorax. The heart size remains normal.

Output: Basilar scarring and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: chest wall mass biopsy History: asymptomatic Left chest wall mass. No evidence of pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: DKA, abd pain History: dka Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Mild left basilar scarring or atelectasis.Heart size normal.Left subclavian ICD, leads unchanged in position.

Output: Mild left basilar scarring or subsegmental atelectasis. No pneumothorax following left subclavian dual chamber ICD.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: intubated History: intubated Small lung volumes with basilar atelectasis increased on the right, port resolution of prior right upper lobe atelectasis.ET tube tip approximately 4 cm above the carina.Left jugular catheter, tip in SVC.Two NG tubes unchanged.

Output: Reexpansion right upper lobe with increased atelectasis right lung base. Findings are consistent with mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.History: Status post pacemaker Interval placement of left chest wall ICD with leads in the right atrium and ventricle. No significant pneumothorax.Right jugular central venous introducer and mediastinal drains unchanged.Stable cardiomediastinal silhouette.Mild bibasilar abnormality, compatible with subsegmental atelectasis, possibly from recent aspiration of secretions.

Output: Interval placement of left chest wall pacemaker with no significant pneumothorax.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Status post chest tube. Pneumothorax. Left chest tube unchanged in position. The chest tube sidehole is outside of the bony thorax and may be advanced.Left pneumothorax at the apex and laterally near the diaphragm about the same.Basal and dependent atelectasis bilaterally. Minimal subcutaneous emphysema.

Output: Left chest tube sidehole is outside of the bony thorax, suggest advancement. No significant change in left pneumothorax. BUIE, VANESSA at 1387 notified via text page at 8:59 AM on 5/18/2016


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Dyspnea, tx from OSH w/ NSTEMI History: dyspnea Coarse reticular opacities of fibrosis have increased since 2014. Blunting of the costophrenic angles from scarring or possible small pleural effusions. Mild cardiomegaly not significantly changed. No specific evidence of infection or edema.

Output: Coarse reticular opacities of fibrosis, increased from 2014. Mild cardiomegaly. No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: neutropenic fever, tachycardia History: neutropenic fever, tachycardia The cardiomediastinal silhouette is obscured.New left lower lobe atelectasis. Streaky right lower lobe opacities likely reflect subsegmental atelectasis, similar to prior. Increased interstitial opacities, septal lines and small pleural effusions are consistent with edema. No pneumothorax. Patchy superimposed airspace opacities are nonspecific.Right chest port tip is in the distal SVC.

Output: 1. Moderate pulmonary edema. 2. New left lower lobe atelectasis, possibly secondary to mucous plugging.3. Patchy superimposed airspace opacities are nonspecific; infection is not excluded.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: ETT check Motion degrades sensitivityEssentially unchanged cardiopulmonary appearance with suspected moderate edema, cardiomegaly and layered moderate effusions with diminished lung volumes. Superimposed atelectasis and/or additional abnormality difficult to entirely exclude. Serial imaging will be needed.ETT terminates 5 cm above the carina, mildly retracted. Right jugular catheter extends into the proximal SVC.

Output: ETT mildly repositioned


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for pulmonary infection, pateint with borderline MGUS/myeloma History: Cough, yellow sputum Severe upper lobe bolus emphysema, greater on the right, and chronic appearing interstitial opacities in the lower lung zones.No sign of pneumonia.Normal heart size and mediastinal contours with a large retrocardiac hiatal hernia.

Output: Severe emphysema and no acute findings.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: fevers Marked volume loss in the right hemithorax with apical opacity compatible with scarring and radiation reaction.Focal opacity at the left cardiac apex compatible with scarring, better shown on the recent CT scan.No evidence of pneumonia or other acute process.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: s/p intubation History: eval ETT position Right mainstem intubation. Other lines and tubes, unchanged. Diffuse pulmonary opacities, most consistent with pulmonary edema. Left greater than right pleural effusions. No large pneumothorax.

Output: Right mainstem intubation. This has been pulled back in the interim. Increase in diffuse pulmonary opacities most consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: r/o infection History: seizures Right Port-A-Cath with its tip in the RA.There are decreased lung volumes with mild basilar atelectasis.Ill-defined left perihilar opacity may represent infection or aspiration.The current mediastinal silhouette is unremarkable.No large pleural effusions.Biliary drain and cholecystectomy clips in right upper abdomen.

Output: Basilar atelectasis. Questionable left perihilar opacity may represent aspiration or or infection.


Instruction: Generate impression based on medical findings.

Input: Esophageal cancer CHEST:LUNGS AND PLEURA: Centrilobular emphysema with mild persistent bronchial wall thickening. The previously described parenchymal opacities which are irregular in shape have nearly resolved, with minimal opacity in the middle lobe and lingula (series 3, images 84; 90). MEDIASTINUM AND HILA: The previously described mediastinal lymph nodes which were borderline in size have mildly decreased in size. Calcified left hilar nodes are present. Mild coronary artery and aortic calcifications are seen.The esophageal lesion is not well demonstrated on the current exam.CHEST WALL: A right-sided port terminates in the SVC.ABDOMEN:STOMACH: The PEG tube is in place.LIVER, BILIARY TRACT: No definite hepatic lesions are identified. Stones are noted within the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: Multiple cystic lesions scattered throughout the pancreas are stable.ADRENAL GLANDS: The multinodular appearance of the left adrenal gland is stable. The previously noted minimal right adrenal thickening is unchangedKIDNEYS, URETERS: Stable bilateral renal cysts, large on the left.RETROPERITONEUM, LYMPH NODES: No frank retroperitoneal adenopathy is identified.BOWEL, MESENTERY: No significant abnormality.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Multiple radiation seeds for prostate cancer are identified. Small metallic density is noted at the base of the penis on the left.BLADDER: The urinary bladder wall is thickened anteriorly likely on the basis of incomplete distention.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Subcentimeter sclerotic focus in the left ilium (series 3, image 157) is unchanged.OTHER: No significant abnormality noted

Output: 1.Near resolution of the previously described irregular pulmonary opacities, likely inflammatory/infectious in etiology. 2.No significant change in the multiple nodules in the left adrenal gland.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Tube placement. Altered mental status. ETT tip 3 cm above carina.Large lung volumes with flattening of the diaphragm consistent with COPD/emphysema.No signs of aspiration or focal airspace opacity.

Output: ETT 3 cm above carina. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old Reason: Severe sepsis; h/o aspiration; rule out pneumonia History: see above Bilateral chest wall neurostimulator devices in place.Prominent upper thoracic skinfold, but no pneumothorax.The cardiac and mediastinal contours appear unchanged.Mild streaky right basilar opacity suggests atelectasis or scarring.

Output: Mild streaky right basilar atelectasis or scarring, perhaps related to aspiration.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with history of non-lymphoma. CHEST:LUNGS AND PLEURA: Mild emphysema. Bilateral small pleural plaques are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal lower pole simple cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Mild ectasia of the infrarenal abdominal aorta is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: s/p picc placement History: s/p picc placement Small lung volumes with pulmonary fibrosis.No specific evidence of infection or edema.Heart size normal following sternotomy.Left PICC, tip in left subclavian.

Output: Left PICC placement. Unchanged pulmonary fibrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: post thoracentesis History: post thoracentesis Right pleural effusion has decreased in size following thoracentesis, and there is no pneumothorax.No new abnormalities.

Output: No pneumothorax following successful right thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: SOB, missed dialysis History: as above Increased interstitial opacity at the bases likely due to mild edema. Other findings stable.

Output: Increased interstitial opacity at the bases likely due to mild edema. Other findings stable.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: r/o infection hx of hiv History: cough-spitting up blood Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No obvious source of hemoptysis.

Output: No significant abnormality. If hemoptysis continues a thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: History of squamous cell cancer right posterior tongue. Status post chemo and RT. CHEST:LUNGS AND PLEURA: Right lower lobe micronodule image 68/124 has not changed since a least 3/10/2008 and unlikely to represent a metastasis. No sign of pulmonary metastases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of metastatic disease or change.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval lung fields History: s/p CABG Left chest tube with postoperative left basilar atelectasis, and no pneumothorax. ET tube tip approximately 3 cm above the carina.Left jugular introducer.Left axillary vascular stent.

Output: Left chest tube with no pneumothorax. Postop left basilar atelectasis noted.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: hx of testicular cancer, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No sign of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.ETT on vent. Endotracheal tube tip 4 cm above the level of the carina. Other cardiopulmonary monitoring and support devices appear similar in position, though some are incompletely visualized. No focal pulmonary opacities. Blunting of the costophrenic angles unchanged.

Output: Endotracheal tube 4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pneumonia History: pain under right breast Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: cardiopulmonary process History: CP The heart is normal in size.Moderate thoracolumbar scoliosis.Lung volumes are normal. No abnormal focal lung opacities.The pleural spaces are within normal limits.

Output: No abnormal radiographic findings.Moderate thoracolumbar scoliosis noted.


Instruction: Generate impression based on medical findings.

Input: Reason: respiratory failure in CTICU s/p AVR wifh CABG History: same ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery.Right perihilar airspace opacity, slightly improved over the past 2 days, compatible with aspiration and/or infection.Interstitial opacity elsewhere and small effusions, not significantly changed.

Output: Slightly improved right perihilar airspace opacity suggestive of aspiration and/or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: eval swan placement History: swan Cardiomegaly, without edema or pneumonia.No substantial pleural effusions.Marked azygos vein distention.Right jugular Swan-Ganz catheter now looped in the right atrium before terminating in the right main pulmonary artery.

Output: Right jugular Swan-Ganz catheter looped in the right atrium before terminating in right main pulmonary artery, subsequently repositioned.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: eval for etiology of SOB History: SOB Mild cardiac enlargement.No focal air space opacities identified.Small bilateral pleural effusions noted.

Output: Mild cardiac enlargement with blunting of the costophrenic angles compatible with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: chest tubes History: chest tubes Endotracheal tube terminates 5 cm above the carina. There is a radiopaque marker that appears to represent the tip of an intra-aortic balloon pump visualized at the level of T11. If this is a femorally placed intra-aortic balloon pump, advancement is recommended.Low lung volumes with mid to lower zone opacities of atelectasis with mild edema and pleural effusions.

Output: Opacity at the level of T11 favors that of an intra-aortic balloon pump tip which would require repositioning. Basilar atelectasis with effusions and mild edema.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: eval pneumonia History: SOB, cough Complete white out of the left hemithorax. Port catheter terminates near the cavoatrial junction. Stigmata of previous granulomatous disease noted in the right hemithorax. Rightward mediastinal shift.

Output: Large left-sided pleural effusion. This has been subsequently drained with development of small left-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 91 year old female with right lower extremity edema. History of cancer. Near syncope. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the level of the subsegmental pulmonary arteries.LUNGS AND PLEURA: Scattered micronodules. No suspicious nodules, masses, or pleural effusion.Basilar atelectasis/scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size mildly enlarged without pericardial effusion.Enlarged pulmonary artery as well as enlargement of the right ventricle and right atrium are compatible with pulmonary artery hypertension. The ascending aorta is ectatic.Left diaphragmatic eventration, unchanged.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: No PE. Study is diagnostic to the level of the subsegmental pulmonary arteries. Findings compatible with pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval for infiltrate History: chest pain, low grade fever Mild cardiomegaly.No significant pulmonary or pleural abnormality.

Output: Mild cardiomegaly but no evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Leukocytosis - Pneumonia? History: Leukocytosis Cardiomegaly with the suggestion of basilar edema.No specific evidence of infection.LVAD and ICD unchanged.

Output: Cardiomegaly and possible edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Sickle cell and chest pain rule out acute chest. Right humeral prosthesis incompletely included on the image. Cholecystectomy clips.Heart size appears normal. Central pulmonary vasculature at least upper normal in caliber which may indicate pulmonary hypertension.Parenchymal scarring bilaterally, but no focal airspace opacities. Osseous changes related to sickle cell disease.

Output: No radiographic signs of acute chest.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: Lethargy History: As above The lung apices are obscured by the patient's anatomy with neck in flexion.Normal cardiothoracic ratio. Heavily calcified thoracic aorta. Median sternotomy and mediastinal surgical clips. No focal airspace opacities in the visualized lung parenchyma.Lower lobe bronchial wall thickening and mild bronchial dilatation suspicious for sequela of chronic aspiration. No signs of acute aspiration on the current study however.Multiple left sided rib fracture deformities which appear chronic.Severe degenerative changes of glenohumeral joint spaces.Degenerative changes and curvature of the spine.

Output: Lung apices are not visualized and cannot be assessed. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o left pneumothorax History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: ESRD, uremia History: As above Moderate cardiomegaly with vascular redistribution but no sign of pulmonary edema or effusions.No significant pulmonary abnormalities.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: r/o pneumothorax History: chest tube removal Prior chest tubes have been removed and there is no significant pneumothorax.Left lower lobe atelectasis persists, possibly from aspirated secretions.New findings.Status post median sternotomy and aortic valve replacement.

Output: No pneumothorax following chest tube removal. Persistent left lower lobe opacity possibly aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Reason: History of Pleural effusion History: f/u Large lung volumes compatible with COPD.Poorly defined nodular opacities at the right base compatible with metastases, better defined on previous CT scans.Mild right hilar enlargement compatible with lymphadenopathy.Bilateral apical scarring.Decreased right pleural effusion with mild residual blunting of the costophrenic angle.

Output: Decreased right pleural effusion and no other significant change.


Instruction: Generate impression based on medical findings.

Input: 45 years old Male. Reason: lung infiltrate History: chest pain; SOB. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal. Linear density is seen in the right lower lung, which is consistent with a scar.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval ett History: ett Worsening central airspace opacities now present on the right side as well consistent with acute edema or aspiration.ET tube tip approximately 3 cm above the carina.

Output: ET tube tip approximately 3 cm above the carina. Worsening pulmonary opacities consistent with acute edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Moderate lower lung zone interstitial opacities consistent with known interstitial lung disease.Heart mildly enlarged with large central pulmonary arteries.No specific evidence of infection or edema.

Output: Moderate interstitial lung disease and possible pulmonary arterial hypertension.


Instruction: Generate impression based on medical findings.

Input: Reason: any re-accumulation of R PTX s/p chest tube removal, previous pleural effusion and PTX Interval removal of right chest tube.Otherwise, the cardiopulmonary monitoring and support devices are unchanged.Slight interval increase in bilateral pleural effusions, right greater than left, since removal of chest tube.No significant pneumothorax is identified.Bibasilar atelectasis/consolidation is not significantly changed.

Output: Interval removal of chest tube, with slightly increased bilateral pleural effusions, but no pneumothorax is identified.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval lung fields History: chest pain Enteric tube has been removed. Right IJ sheath remains in place. Vascular stent likely in the aorta, incompletely visualized within the lower abdomen. Iatrogenic coils are noted in a similar location. Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar pleuroparenchymal opacities, not substantially changed. 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: Female, 70 years old.Reason: eval ET tube placement History: intubated Endotracheal tube tip 4.6 cm superior to the carina. Enteric tube enters the left upper quadrant with tip not included in the study.Cardiac silhouette is magnified likely at the upper limits of normal. Mild perihilar congestion with likely component of interstitial edema. Interval worsening bibasilar aeration likely atelectatic in nature.

Output: Mild worsening in bibasilar aeration likely atelectatic in nature, but correlate with any concern for developing pneumonic consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: eval for acute chest History: sickle cell pain Mild cardiomegaly consistent with known sickle cell disease.No significant pulmonary or pleural abnormality.

Output: Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.History of A. fib, increasing O2 requirement. The enteric tube has been removed and the defibrillator appears unchanged. There are slightly low lung volumes with subsegmental basilar atelectasis but no evidence of large pleural effusions or new pulmonary opacities.

Output: Low lung volumes with basal atelectasis but no effusions or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Stroke, rule out infection. No pulmonary or pleural abnormalities.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 96 years old.Reason: eval for infiltrate or effusion History: SOB Bilateral interstitial opacities consistent with edema. Moderate to large bilateral pleural effusions with associated lower zone subsegmental atelectasis. Associated pneumonia is in the differential. No pneumothorax. Cardiac silhouette is obscured.

Output: Pulmonary edema with moderate large pleural effusions. Associated infection is a consideration.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Check pulmonary status. Malignant neoplasm of the liver. Interval removal of Dobbhoff tube. The right sided peripheral venous catheter appears to have been retracted as it can be followed only to the level of the SVC.Lung volumes remain low. Improving edema and atelectasis, moderate. Left pleural effusion appears smaller.Partially visualized pigtail catheters project over the right upper quadrant.

Output: Interval retraction of venous catheter with tip now at junction of the SVC. Improving pulmonary edema, pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: chest pain History: chest pain Severe cardiomegaly with an ICD lead in place.Right jugular catheter tip in the SVC.Basilar opacity consistent with subsegmental atelectasis.No specific evidence of pneumonia.

Output: Cardiomegaly. Nonspecific basilar opacities related to atelectasis. No acute abnormality or interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: pna? ptx? History: syncope Cardiomediastinal silhouette and vasculature normal. Lungs clear of airspace and interstitial opacities. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: pt intubated, advanced et tube History: SOB Interval advancement of ET tube now located about 4 cm above the level of carina.Redemonstration of low lung volumes and significant multi-segmental atelectasis in the lung bases, consider mucous plugging.Cardiomediastinal silhouette is stable.

Output: Interval advancement of ET tube now located 4 cm above carina. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: Pulm Edema History: cough Mild diffuse pulmonary edema and small pleural effusions again noted. Unchanged cardiomegaly. No pneumothorax. Iatrogenic devices are unchanged.

Output: Unchanged pulmonary edema, mild, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: r/o acute process, infiltrates, pneumonia, pulm edema History: increased O2 requirement, hemoptysis Support devices are unchanged in position. The right infralateral chest wall soft tissues are excluded from the field-of-view.Portable technique limits fine detail. Given this limitation, there is no significant change in the diffuse airspace and interstitial opacities with small pleural effusions as noted 7 days earlier. Heart size is magnified, appearing upper limits of normal. No interval pneumothorax.

Output: No significant change despite the technical limitations in the severe bilateral airspace and interstitial opacities with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old. Reason: Cough, congestion in patient with HIV, undetectable viral load History: As above Cardiomediastinal silhouette is unremarkable.No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.7 days status-post auto SCT, neutropenic, febrile with new wheezing and shortness of breath. Low lung volumes. Left greater than right basilar atelectasis. No evidence of pneumonia.Cardiomediastinal silhouette is within normal limits given technique.Right IJ central catheter with tip in SVC.

Output: Left greater than right basilar atelectasis. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: sepsis History: sepsis ET tube has been removed.Right central venous catheter and NG tube unchanged.Decreased lung volumes a stable cardiomediastinal silhouette.Nonspecific basilar opacities compatible with atelectasis and possible small effusions.

Output: Interval extubation. Stable cardiopulmonary appearance with basilar opacities compatible with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: cough History: cough Focal interstitial and airspace opacity in the left lower lobe, new since the previous radiograph and also new since a CT scan of 3/26/2015, compatible with pneumonia.Unremarkable cardiac and mediastinal silhouette. A text page was sent to Dr. Brukner at the time of reporting.

Output: Left lower lobe opacity compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Aortic valve replacement ETT removed. Swan-Ganz again extends into the main pulmonary flow tract. Mediastinal chest tubes are also similar positionCardiopulmonary appearance is also mildly improved with increased aeration in the left lower lobe and retrocardiac opacities, presumably resolving atelectasis. Questionable small effusions

Output: ETT removed


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: low grade fevers, r/o infection History: low grade fevers, r/o infection Right PICC line with its tip in the right atrium.Cardiomediastinal silhouette is unremarkable.Marked elevation right hemidiaphragm and probable moderate size right pleural effusion and underlying atelectasis.The left lung is clear.

Output: Right basilar opacity suggesting moderate right-sided pleural effusion and consolidation/atelectasis. Infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: f/u ptx History: f/u ptx ET tube tip approximately 3 cm above the carina.Diffuse nonspecific pulmonary opacity and loculated left pleural effusion without significant change.No new findings.

Output: Stable appearance of bilateral pulmonary opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.HIV, gastric pull-up. Concern for pneumonia and asthma. Cough. Previous history of esophagectomy, TB and aspiration pneumonia. Air and fluid in the right paramediastinal pull-up. Low lung volumes with diffuse groundglass opacities, left greater than right, without significant change from the most recent previous study but appearing progressed compared to the 3/27/2015 examination.

Output: Persistent airspace opacities, increased since the 3/27/2015 examination. CT chest recommended. Differential considerations include infectious or cellular pneumonitis in addition to the clinically suspected indolent infection such as pneumocystis and/or atypical mycobacterial pneumonia such as MAI.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: r/o abnormality History: cough x several months Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Tachypnea evaluate for atelectasis or edema. Low lung volumes about the same. Mild to moderate dependent atelectasis without significant change. Left jugular catheter remains directed peripherally in the left subclavian vein. Enteric tube incompletely visualized but extends below the GE junction.

Output: No specific evidence of pulmonary edema. Dependent atelectasis, left greater than right persists. Suggest repositioning of left jugular catheter


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pathology History: chest heaviness Catheter tip in the SVC.No significant cardiopulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: neutropenic fever History: fever 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: Check for cardiomegaly, kidney transplant Mildly decreased lung volumes, however appearance is exaggerated due to marked kyphosis and questionable partial fusion of midthoracic vertebrae. No distinct superimposed acute cardiopulmonary abnormality other than minimal basilar atelectasis. Specifically no definite cardiomegaly.Cholecystectomy clips and midline sternotomy

Output: Atelectasis without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: assess for infection History: fever, sickle cell disease, nausea/vomiting Heart size normal.Lungs clear.Blunting of right costophrenic angle likely pleural thickening however small effusion cannot be excluded. Follow-up recommended and as well as lateral.No pneumothorax.

Output: Blunting of right costophrenic angle may represent pleural thickening therefore right lateral decubitus would be helpful. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Preoperative chest x-ray. Bariatric surgery. Cardiomediastinal silhouette is within normal limits. No pulmonary opacity, pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: EKG abnormality Postsurgical changes including an ETT terminating 4 cm above the carina. IABP extends 3 to 4 cm below the aortic arch and a Swan-Ganz project into the right pulmonary outflow tract. 2 mediastinal chest tubes and left chest tube overlie the left lung base, no appreciable pneumothorax.Decreased lung volumes with nonspecific patchy streaky densities in both bases, likely atelectasis

Output: ETT and chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: Eval pulmonary edema and effusions History: S/P Aortic Dissection Repair Two of the tubes/drains have been removed. Pleural/extra pulmonary opacity in the right hemithorax, slightly increased from previous study. Patchy right basilar opacity again noted. No new focal consolidation the left lung. Extensive subcutaneous emphysema again noted. Unchanged cardiomegaly.

Output: Interval removal of 2 of the chest tubes/drains. Increased right pleural/extra pulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Cp, sob History: above Bilateral posterior seventh rib deformities and right lateral rib deformities favoring callus of prior fracture, unchanged. Multilevel degenerative changes of the thoracic spine. No interval evidence of infection or edema. The heart size is normal.

Output: No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Assess position of Swan-Ganz. Right IJ Swan-Ganz catheter, IBP marker, and left chest wall ICD unchanged. Swan-Ganz tip in the right pulmonary artery.Mildly improved left basilar atelectasis. No focal pulmonary opacities, pleural effusions, or pneumothorax.Unchanged cardiomegaly.

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


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: rule out acute History: pain, sickle cell Heart size upper normal.No specific evidence of infection or edema.Suboptimal study, but no reliable evidence of infection or infarction.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with cough and shortness of breath. Status post robotic CABG. Stable cardiomediastinal silhouette.Persistent bilateral pleural effusions with associated basilar atelectasis. Large loculated left pleural effusion is again noted.

Output: Persistent large loculated left pleural effusion with bilateral dependent pleural effusions and bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: sickle cell, cough, acute chest, history of pulmonary hypertension Moderate to severe cardiomegaly. No pleural effusion or pneumothorax. No focal pulmonary opacities. Unchanged increased reticular interstitial markings and bibasilar scarring.

Output: Unchanged bibasilar scarring and marked cardiomegaly without evidence of focal opacity or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.TAVR. Right jugular introducer and T8 the are unchanged in position.Cardiomegaly with signs of pulmonary hypertension and hypervolemia.Bilateral pleural effusions with associated atelectasis, increasing.

Output: Worsening hypervolemia/CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: Swan position History: CHF Swan-Ganz catheter is somewhat redundant in appearance over the lower aspect of the heart, likely near the RA/RV junction. Swan-Ganz catheter terminates in the RVOT/PA junction. Other devices are not substantially different. Clear lungs. Unchanged heart size.

Output: Swan-Ganz catheter is somewhat redundant in appearance over the lower aspect of the heart, likely near the RA/RV junction. Swan-Ganz catheter terminates in the RVOT/PA junction.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Productive cough, relative hypotension, chest pain, fever. Evaluate for pneumonia. No focal pulmonary opacities, pleural effusions, or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No cardiopulmonary abnormalities


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: cause of SOB History: increased work of breathing and oxygen requirement Left greater than right basilar reticular abnormality again noted, not substantially different. Mild cardiomegaly. Left perihilar mass again noted. No large pleural effusion or pneumothorax.

Output: Left perihilar mass again noted. Interstitial lung disease. No definite new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Cough and SOB. Evaluate for infection. Normal heart size. Tortuous thoracic aorta. Right paratracheal opacity unchanged and may reflect goiter and/or ectatic vasculature. No focal airspace opacities, pleural fluid or pneumothorax. No signs of CHF or pneumonia. Healed rib fracture deformities on the right.

Output: No acute cardiopulmonary abnormality. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Lung transplant Questionably minimally increasing bilateral pleural effusions and edema-like pattern large in a perihilar and basilar distribution. Appearance and change may be largely due to differences in more supine positioning. Borderline cardiomegaly.Persistent moderate to more pronounced right chest wall and neck emphysema. Again no evidence of an associated recurrent pneumothorax following chest tube removalSternotomy

Output: Pulmonary edema and effusions essentially unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: eval lung fields History: cp Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Post right chest tube placement. New right apical pneumothorax measuring up to 1 cm in maximal diameter. Interval placement of apically directed right chest tube. Right internal jugular catheter tip terminates at the upper superior vena cava. Left chest wall pacer, leads unchanged. Post median sternotomy.Unchanged moderate right and small left pleural effusions with adjacent atelectasis. Persistent interstitial opacities, right greater than left.

Output: Interval placement of apically directed right chest tube with unchanged moderate right effusion and pulmonary edema. New right apical pneumothorax measuring to 1 cm maximal diameter.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, 29 years old.Empyema post-chest tube placement. The patient is status post left chest tube placement with a new proximately 12-mm left apical pneumothorax. A cutaneous emphysema is also noted along the chest tube tract. Bibasilar opacities, left greater than right with the left basilar collection containing gas are stable. Right jugular catheter with tip over the SVC/RA junction. Cardiomegaly again noted.

Output: New small left apical pneumothorax status post left chest tube placement. Gas-containing left basilar opacity is essentially stable as is a milder right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.ET tube further in. ETT tip 6 cm above the level of the carina. Spinal fixation hardware. Low lung volumes basal atelectasis.Severe degenerative change of the right glenohumeral joint and humeral head.

Output: ETT tip 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: asthma on steroids; night sweats History: asthma on steroids; night sweats Stable cardiomediastinal silhouette.Redemonstration of bronchial wall thickening.No focal areas of consolidation.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: 73 yearsGender: MaleReason for Study: Reason: eval lung fields History: s/p LVAD Support devices unchanged with right IJ Swan-Ganz catheter in the right pulmonary artery and ET tube tip approximately 6 cm above the carina.Stable cardiac enlargement.Mild basilar opacities compatible with small effusions and atelectasis similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: eval for pulm edema in setting of ADHF History: SOB Unfavorable progression of bilateral basilar opacities and pleural effusions. Mid and upper lung zones are clear. No other interval change.

Output: Unfavorable progression of bibasilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Chest tubes. Right apical chest tubes, one of which has been slightly advanced. Right apical pneumothorax with maximal pleural separation from the chest wall of 3 cm, about the same. Right hemithorax incompletely included on the image.Small right pleural effusion. Opacities in the right lung unchanged. Small left pleural fluid collection with associated atelectasis and possibly mild edema.

Output: Stable 3 cm right apical pneumothorax. One of the right-sided chest tubes has been advanced.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: r/o infection, bronchitis History: cough sob 5 days Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: evaluate hemoptysis History: hemoptysis Slight increase in left lower lobe consolidation, with a diffuse interstitial abnormality elsewhere.Tracheostomy tube tip approximately 5 cm above the carina.Right PICC, tip in the SVC.

Output: Increased left lower lobe consolidation with mild edema.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female with history of right mandible carcinoma with reconstruction. Please evaluate. CHEST:LUNGS AND PLEURA: Focal area of linear atelectasis in the inferior upper lobe. No suspicious pulmonary nodules. No pleural effusion.MEDIASTINUM AND HILA: Moderate pericardial effusion. Mildly enlarged posterior tracheal lymph node as seen on image 14. Shotty mediastinal lymph nodes.CHEST WALL: Status post left mastectomy. Surgical clips are noted in the left axilla. Mildly enlarged axillary lymph nodes which are unchanged from prior exam.ABDOMEN:LIVER, BILIARY TRACT: No parenchymal lesions are identified in the liver. The gallbladder is normal in appearance. The hepatic vasculature is widely patent.SPLEEN: Splenic artery calcifications.ADRENAL GLANDS: Adrenal nodule that arises from the left limb of the left adrenal gland which measures 11 x 10 mm as seen on image 95, unchanged in appearance from prior scan on 1/25/2005.KIDNEYS, URETERS: Multiple cysts in the right kidney with the largest cyst arising from the superior pole of the right kidney unchanged in appearance. PANCREAS: Atrophic pancreas consistent with age.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Hypoxia Patient is status post sternotomy. Femoral canula tip in the femoral cannula superior right atrium. Right pleural effusion and lower lung consolidation without significant change from prior study. Increased left paratracheal soft tissue consistent with lymphadenopathy seen on prior CT. Interval improvement of left edema.

Output: Stable appearing right pleural effusion and lung base consolidation. Interval improvement of left pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: evaluate for infection History: recent pneumonia, tachypnea, tachycardia Moderate cardiomegaly is unchanged. Widened superior mediastinum is likely from aneurysmal aorta seen on prior CT. New left basilar consolidation and small left pleural effusion.

Output: New left basilar consolidation and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PTX History: s/p thoracentesis, 1.6L removed, left side No sign of pneumothorax most decreased left effusion following thoracocentesis.Other findings including a large right effusion and metastatic nodules, unchanged.

Output: Decreased left effusion and no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: pna History: cough No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: r/o infiltrate History: chest pain Moderate to severe thoracic lumbar scoliosis.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

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


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with weakness. Evaluate for mass CHEST:LUNGS AND PLEURA: Subcentimeter left upper lobe calcified nodule is unchanged. Subpleural subcentimeter nodule in the lateral right lung base is not visualized.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: A 4 x 2.7 cm round, soft tissue density lesion exophytic from the lateral aspect also left lobe liver is unchanged. MRI is recommended for further characterization of this lesion which may represent a liver mass, splenule or a congenital variant.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: 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: MRI is recommended for further evaluation of the exophytic soft tissue density arising from the left lateral lobe of the liver.


Instruction: Generate impression based on medical findings.

Input: Male; 69 years old. Reason: Further evaluation of R basilar infiltrate c/f PNA (CAP vs. aspiration - known cough w food) as well as possible RUL infiltrate - pt has multiple large firm LN raising concern for malignancy, extensive smoking history History: altered mental status, possible aspiration, multiple prominent firm lymph nodes Unremarkable cardiac and mediastinal silhouettes.Mild nonspecific basilar opacities, greater on the left, compatible with aspiration and possibly infection and similar to prior.Probable prominent left nipple shadow.

Output: Mild nonspecific basilar opacities, greater on the left, compatible with aspiration and possibly infection.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval for causes of SOB History: as above Increasing lower lung zone opacities suggestive of edema with pleural effusions.At least moderate cardiomegaly is present.Right PICC, tip in axillary region.Prior right jugular catheter removed.

Output: Increasing lower lung zone edema with pleural effusions consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: Known pneumothorax, assess for resolution s/p vent placement. History: Known pneumothorax, assess for resolution s/p vent placement. Improvement in the left pneumothorax, with a left thoracic vent in place.No new findings.

Output: Improvement in left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infection History: recent chemo Normal heart size with a tortuous aorta. Moderately elevated left hemidiaphragm with overlying atelectasis. No specific evidence of infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Cardiogenic shock Swan-Ganz has been advanced, tip now projects into the right pulmonary blood track approximately 2 additional centimeters. ICD unchangedUnderlying cardiopulmonary appearance significant for increasing patchy opacities suggesting edema superimposed upon a collapsed left lower lobe, however partial consolidation cannot be excluded

Output: Increasing pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Pneumothorax. ET tube tip approximately 4 cm above the carina. Right chest port catheter tip in the right atrium. Enteric tube tip in the gastric body.Low lung volumes with bibasilar atelectasis and left pleural effusion.No pneumothorax.Dilated air-filled bowel loops in the upper abdomen, similar to prior.

Output: Low lung volumes and left pleural effusion, without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Cough and crackles on exam rule out pneumonia. Extensive pleural calcifications bilaterally limit visualization of the lung parenchyma, this may be the result of old, treated pleural tuberculosis. No pleural fluid. Lower lobes appear clear on the lateral radiograph. No visible airspace opacities.

Output: Extensive pleural calcifications bilaterally obscure the lung parenchyma. Within this limitation, no visible signs of pneumonia or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 60 year old female with chest pain, r/o ptx s/p bx. Left chest port catheter with tip in the SVC. Enlarged lung volumes compatible with COPD. Right lower lobe mass again noted compatible with known cancer. No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: No pneumothorax. No interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Cystectomy with dyspnea. Tachycardia. Trace pneumoperitoneum, presumably postoperative.Normal heart size. Small right pleural effusion. No focal airspace opacities or signs of pulmonary edema.

Output: Trace pneumoperitoneum, presumably postoperative. Small right pleural effusion. No signs of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.PICC placement and hypotension. Large lung volumes consistent with emphysema/COPD. Mild pulmonary edema. Small pleural effusions. Left PICC tip projects over the left brachiocephalic vein to the left of midline and may be advanced. Heart size is upper normal.

Output: Left PICC tip projects over the left brachiocephalic vein. Signs of COPD/emphysema and mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: eval ETT tube History: intubated An endotracheal tube projects approximately 3 cm above the carina. An enteric tube extends below the field-of-view. Surgical clips project over the left breast shadow and right axilla.Large lung volumes. The cardiomediastinal silhouette is unremarkable. Atherosclerotic calcifications of the aorta. Reticular nodular opacities are unchanged. Left basilar streaky opacities more apparent. Left-sided rib crowding may be due to patient positioning or due to volume loss of the left hemithorax such as in the case of atelectasis. Right apical pleural thickening slightly more evident than on prior radiographs but this is likely due to patient positioning. No pneumothorax.

Output: Endotracheal tube approximately 3 cm above the carina. Streaky left basilar opacities likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Shortness of breath evaluate for pneumonia. Large left pleural fluid collection associated atelectasis. Small pleural effusion on the right is new. Cardiomegaly with prominence of the central pulmonary vasculature unchanged.

Output: Increased pleural fluid and atelectasis, especially on the left. Underlying infection on the left cannot be excluded as the parenchyma is not visible.


Instruction: Generate impression based on medical findings.

Input: ALL with chest painVIEWS: Chest AP/lateral Right chest port tip at the SVC. Cardiothymic silhouette normal. No focal lung opacity. No pleural effusion or pneumothorax.

Output: No focal lung opacity.


Instruction: Generate impression based on medical findings.

Input: NJ tube placement Nasojejunal tube seen extending beyond level of ligament of Treitz, tip located in lateral left mid abdomen. Residual contrast seen, including in appendix. Incompletely imaged bilateral hip hardware. Please refer to concomitant chest radiography from same day for additional findings.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: eval for ptx History: eval for otx Low lung volumes. Mild bibasilar subsegmental atelectasis or scarring. Question mild pulmonary edema. Mild cardiomegaly given the low lung volumes. No large pleural effusion or pneumothorax. Spinal hardware noted overlying the lumbar spine. Status post cervical spinal fusion.

Output: Probable mild pulmonary edema. Mild cardiomegaly. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: post thoracentesis History: sob Loculated left hydropneumothorax has left some of the air component than on the prior study although there is still left pleural fluid or pleural thickening and volume loss.Right lung unremarkable.No significant pneumothorax.

Output: Improvement in size of the air component of the left hydropneumothorax, with no new findings.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: DOE since yesterday, on coumadin, recent R hip replacement History: DOE Borderline cardiac enlargement.The lungs are clear.Blunting of the costophrenic angles compatible small effusions.

Output: Borderline cardiac enlargement with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: infiltrate History: AMS No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Status post thoracentesis ET tube tip is 3.0 cm above the carina. Right internal jugular central venous catheter tip is in the right atrium.Moderate cardiomegaly.Large lung volumes suggest COPD. Bibasilar opacities compatible with pleural edema, pleural effusions and adjacent atelectasis. Interval improvement in bilateral upper lung airspace opacities.No pneumothorax.

Output: No pneumothorax status post thoracentesis. Resolving edema with atelectasis and effusions.


Instruction: Generate impression based on medical findings.

Input: Cough Interval decreasing and now small right pleural effusion essentially loculated largely against the posterior wall and along the major fissure. Minimal atelectasis without additional pulmonary abnormality. Cardiac and mediastinal contours are within limits for technique.Clamshell sternotomy and bilateral hilar surgical clips unchanged

Output: Decreasing and now small to moderate loculated right effusion


Instruction: Generate impression based on medical findings.

Input: Male, 94 years old.Reason: eval for pneumonia History: fever Cardiomediastinal silhouette is unchanged.Focal air space opacity in the left lower lobe, compatible with pneumonia. No significant pleural effusion.

Output: Left lower lobe pneumonia.Findings discussed with ED physician at 1:30 PM


Instruction: Generate impression based on medical findings.

Input: Age: 92 yearsGender: FemaleReason for Study: Reason: 92F with diastolic dysfunction, worsened SOB. Assess for infection vs edema History: SOB There are decreased lung lines with stable cardiac enlargement.Perihilar interstitial opacities increased from the prior exam.Right pleural effusion and basilar atelectasis/edema also increased from the prior exam.No focal areas of consolidation.

Output: Interval worsening of CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: pneumomediastinum History: abnormal prior cxr Cardiomegaly with mild basilar opacities possibly edema.Distended azygos vein.Right chest wall soft tissue emphysema extends to the supraclavicular region without evidence of underlying pneumothorax.A small pneumomediastinum may be present.ET tube tip approximately 3 cm above the carina.

Output: Nonspecific basilar opacities and cardiomegaly. Soft tissue emphysema with a possible small pneumomediastinum but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: R/o pulm edema in transplant patient with c/f rejection History: LE edema Increase in bibasilar opacities which may represent atelectasis, aspiration, or edema. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Increase in bibasilar opacities which may represent atelectasis, aspiration, or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: Swan in place, assess positioning; also w/ recent fevers to 38.2 and mild cough, eval for interval change c/f infection History: see above Right sided ICD and right IJ Swan-Ganz unchanged.Stable cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: MaleReason for Study: Reason: IABP placement History: see above Right IJ Swan-Ganz with its tip in the right pulmonary artery slightly retracted from the prior exam.IABP has been placed with the marker in the distal aortic arch.Stable cardiac enlargement.Small right pleural effusion unchanged.No new pulmonary opacities identified.

Output: Swan-Ganz catheter minimally retracted with its tip in the right pulmonary artery. IABP marker in the distal aortic arch. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old, with prior history of non-small cell lung cancer. Need staging. CHEST:LUNGS AND PLEURA: Spiculated left upper lobe mass measures 4.2 x 3.5 cm on axial image 27, series 5, unchanged to minimally smaller when compared to 4.1 x 3.8 cm on the prior exam. The superior portion of this mass is calcified. A small focus of lucency laterally within this mass is similar to the prior exam and may reflect cavitation or retraction. The mass spans the hemithorax from the aortic arch to the thoracic wall. No definite evidence of vascular or chest wall invasion is seen.Subtle right-sided ground glass opacities are unchanged (images 29 to 38, series 5).Scattered additional micronodules are unchanged.Mild centrilobular emphysema. No pleural fluid.MEDIASTINUM AND HILA: The cardiac size is normal. No pericardial fluid. Aortic and coronary artery atherosclerotic calcifications. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: Bilateral adrenal masses have not significantly changed. The right mass measures 1.1 x 1.6 cm and the left measures 1.6 x 2.4 cm, both on image 75, series 3.KIDNEYS, URETERS: Heterogeneous fat and soft tissue density exophytic lesion off the mid pole of the left kidney is unchanged and may reflect an angiomyolipoma.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic atherosclerotic calcifications. Mild ectasia of the aorta superior to the bifurcation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant interval change and specifically no evidence of disease progression.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: PRE Lung or Heart-Lung Transplant Evaluation History: PRE Lung or Heart-Lung Transplant Unchanged moderate interstitial lung disease previously characterized by CT.No superimposed edema or pneumonia.

Output: Unchanged moderate interstitial lung disease already characterized by CT.


Instruction: Generate impression based on medical findings.

Input: Altered mental status Marked limitation due to orientation and rotation with extensive calcified costochondral cartilageLungs are mildly decreased in volume, greater on the right likely due to patient leaning and positioning. No discrete superimposed focal air space abnormality.Borderline cardiomegaly with suspected tortuosity of the aorta heavily exaggerated. Pronounced atherosclerotic changesIncompletely visualized extensive degenerative changes of the left shoulder, right shoulders cut off

Output: Cardiomegaly without discrete superimposed acute pulmonary abnormality. See extensive limitations described above


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: chest eval History: chest eval Support hardware unchanged in position. Previously described mediastinal widening is slightly improved, likely due to technique and increased pulmonary aeration. Mild basilar edema with small pleural effusions unchanged.

Output: Previously described mediastinal widening is slightly improved, likely due to technique and increased pulmonary aeration. Mild basilar edema with small pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: s/p nuss bar removal History: pain Interval removal of Nuss bar. No pneumothorax. Focal nodular lesion overlying the left hilum likely represents a vessel on end. Consider correlation with PA and lateral radiograph. Normal heart size.

Output: Interval removal of Nuss bar. No pneumothorax. Focal nodular lesion overlying the left hilum likely represents a vessel on end. Consider correlation with PA and lateral radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Sob, rule out PNA History: SOB No significant cardiopulmonary abnormality.Lower thoracic spine degeneration and deformity with angulation.

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


Instruction: Generate impression based on medical findings.

Input: Male, 93 years old.Evaluate for etiology of pulmonary crackles, aspiration in a.m. Submitted for worsening back pain. Left pleural thickening unchanged. Cardiomegaly increased from exam of 2014. New subsegmental atelectasis at the left lung base as well as patchy small opacities consistent with aspiration related bronchiolitis. Signs of hypervolemia, but only minimal septal thickening. Left subclavian ICD.

Output: Signs of hypervolemia with cardiomegaly but no conclusive pulmonary edema. Signs of aspiration in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: 21-day-old male with increased work of breathing. Is there pulmonary edema?VIEW: Chest and abdomen AP (2 views) 2/15/2016 9:35 Feeding tube is coiled within the gastric body. Left PICC with tip in the left innominate vein. The cardiothymic silhouette is within normal limits. Diffuse lung haziness. No large pleural effusion. Nonspecific disorganized bowel gas pattern. No evidence of free intraperitoneal air, pneumatosis or portal venous gas. Left-sided bowel-containing inguinal hernia.

Output: Hyperreactive airway/bronchiolitis pattern. Disorganized bowel gas pattern. Left-sided bowel containing inguinal hernia.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Right lower lobe opacity. Endotracheal tube. ET tube tip at the carina.Spinal fusion hardware, surgical clips, skin staples, and G-tube again noted.Small to moderate right pleural effusion. Unchanged bilateral lower lobe opacities, right greater than left, compatible with aspiration as seen on the prior CT.

Output: Unchanged right lower lobe opacity compatible with aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: please assess for recurrent disease History: s/p cystectomy Unremarkable cardiac and mediastinal silhouette. Large lung volumes suggest COPD.Healed right rib fracture.No sign of metastases.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o worsening pleural effusion, line placement History: line placement Right jugular catheter with its tip in the SVC.ET tube tip approximately 5 cm above the carina.Large bilateral pleural effusions and underlying opacity compatible with atelectasis.New right apical and paramediastinal opacity may represent hematoma secondary to catheter placement.

Output: New right jugular catheter with a possible mediastinal and apical hematoma.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: 55 yo post op with chest heaviness, r/o acute pathology History: heaviness/chest tightness Right Port-A-Cath with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Lungs are clear.Haziness overlying the right lower hemithorax may represent small effusion.Surgical drain over the right upper abdomen.

Output: Probable small right pleural effusion. No focal air space opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna History: wheeze Unremarkable cardiac and mediastinal silhouette. Small lung volumes with a calcified granuloma in the left base but no sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: chest pain History: dyspnea No focal pulmonary opacity, pleural effusion, or pneumothorax.Unremarkable cardiac mediastinal silhouette.

Output: No evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: intubated History: intubated Support devices unchanged with ET tube tip approximately 4 cm above the carina.Stable cardiac enlargement.Perihilar opacities suggestive of edema and left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, pulmonary edema, and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Chest tube removal evaluate for effusion, atelectasis and pneumothorax. Interval removal of mediastinal drains and a right chest tube. Aortic valve prosthesis. Normal heart size. Patchy atelectasis in the lung bases about the same. Minimal pleural fluid in the posterior costophrenic angles. No evidence of pulmonary edema.Trace amounts of air seen anteriorly on the lateral radiograph at the site of the subxiphoid mediastinal drain tracts, but no significant sized pneumothorax. Minimal subcutaneous emphysema.

Output: Mild basal atelectasis. Small pleural effusions. No significant sized pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Status post upgrade to biventricular ICD Biventricular ICD with leads in the right atrial appendage, right ventricle, and coronary sinus.Mild cardiomegaly.No pleural effusion or pneumothorax.Diffuse interstitial and airspace opacities compatible with minimal interstitial edema.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: chest tube, clamped, please assess for interval changes History: Chest tube Left subpulmonic chest tube unchanged with a possible subpulmonic pneumothorax, more likely gas in the gastric fundus.Right hemithorax chronic volume loss.

Output: Small left pneumothorax versus air in the gastric fundus projected over the diaphragm, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: SOB, cough History: as above Stable line position. Persistent left basilar opacity. Atelectasis or scarring. No specific evidence of infection or edema. No pneumothorax.

Output: Persistent left basilar opacity but no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: s/p R VATS wedge History: lung nodule, post-op Exam limited by low lung volumes. Right basilar opacity consistent with edema and atelectasis. No pneumothorax.Chest tube projects over right hemithorax terminating near the apex. Surgical clips again visualized in region of left hilum. Subcutaneous emphysema over right chest wall.

Output: Postoperative right basilar opacity with no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: Line exchange History: Line exchange Study limited by motion artifact. Endotracheal tube again terminates at the thoracic inlet and could be advanced. Enteric tube extends inferiorly off the field of view. Left IJ line terminates in the SVC. Slight worsening diffuse pleural parenchymal opacities. Unchanged cardiomegaly. No pneumothorax.

Output: Study limited by motion artifact. Endotracheal tube again terminates at the thoracic inlet and could be advanced.Slight worsening diffuse pleural parenchymal opacities


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Rule out pna, cardiomegaly History: Chest pain Stable cardiomediastinal silhouette. Basilar subsegmental atelectasis/scarring. No new focal airspace abnormality. No pleural effusions.Thoracic scoliosis.

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


Instruction: Generate impression based on medical findings.

Input: 74 year-old male with hypoxemia, diagnosis unclear. No history of tobacco, worked on auto line assembly. LUNGS AND PLEURA: Lungs are hyperinflated. Severe centrilobular and paraseptal emphysema, greatest in right upper lobe. Panlobular emphysema could be considered if the patient underlying metabolic disorder. No definite honeycombing, ground glass opacity, or diffuse interlobular septal thickening. No significant air trapping on expiratory views.Linear opacity in the right lower lobe radiating from the hilum to the pleura, likely scarring/atelectasis. Small dependent right pleural effusion.Multiple calcified granulomas.MEDIASTINUM AND HILA: 53 x 18mm left anterior mediastinal smoothly marginated soft tissue structure with fluid attenuation (series 3 image 28), likely represents prominent pericardial recess or pericardial cyst, less likely bronchogenic cyst, even less likely thymoma.Multiple calcified hilar and mediastinal lymph nodes, suggestive of prior granulomatous disease. Moderate coronary artery calcifications. Heart size within normal limits.CHEST WALL: Sclerotic focus in the T3 vertebral body adjacent to the pedicle, likely represents benign bone island in the absence of known primary malignancy.UPPER ABDOMEN: Subcapsular calcification in the right posterior hepatic lobe, likely post traumatic.Prominent right adrenal.Hiatal hernia. Diverticulosis.

Output: 1)Severe emphysematous changes without evidence of interstitial lung disease. Panlobular emphysema could be considered if the patient underlying metabolic disorder such as alpha 1 anti-trypsin deficiency. 2) Prominent pericardial recess or pericardial cyst, less likely bronchogenic cyst, even less likely thymoma


Instruction: Generate impression based on medical findings.

Input: Cough with bloody streaks No cardiopulmonary acute abnormalities. Mild tortuosity aorta and mild scoliosis.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval cause of hypoxemia, progression of atelectasis History: atelectasis, hypoxemia Nasogastric tube and skin staples are unchanged in position.Progressive low lung volumes. Nonspecific mid to lower zone opacities slightly increased on the right. No pneumothorax.

Output: Progressive volume loss with increasing right basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Recurrent malignant pleural effusion status post right thoracentesis rule out pneumothorax. Left Pleurx catheter unchanged in position with tip near the apex. A new small caliber catheter projects over the right lung base. Interval decrease in right pleural fluid collection volume, now moderate. No pneumothorax. Moderate volume of pleural fluid on the left is unchanged.Slight worsening of edema and atelectasis.Bilateral lower lobe airspace opacities increased from prior.

Output: No pneumothorax. Moderate pleural fluid collections, decreased on the right. Slight interval worsening of edema and atelectasis. Basal airspace opacities indeterminate and could be the result of edema, infection or malignancy.


Instruction: Generate impression based on medical findings.

Input: Reason: rpt opacity vs soft tissue History: chest pain Previously described opacity in the periphery of the right hemithorax was apparently artifactual and is no longer evident.Mild focal nodular scar like opacity in the left upper lobe is unchanged from previous radiographs and likely benign.Perihilar bronchial thickening compatible with asthma.Unremarkable cardiac and mediastinal silhouette.

Output: Chronic bronchial thickening compatible with asthma and no acute change.Previously described soft tissue opacity on the right was apparently artifactual.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: swan History: swan Swan-Ganz catheter tip in proximal right pulmonary artery. Other support hardware stable.No change in cardiomegaly and retrocardiac opacity.

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


Instruction: Generate impression based on medical findings.

Input: 22 year old male with history of Stage 3 Melanoma status post interferon therapy. Please evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Several subcentimeter pulmonary nodules noted throughout right lung. These are unchanged from prior study in 2009.MEDIASTINUM AND HILA: Small amount of thymic tissue noted in anterior mediastinum. No other significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered, subcentimeter, mesenteric lymph nodes again identified. These appear unchanged when compared to prior study.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: Tiny sclerotic focus in posterior aspect of right acetabulum likely represents benign bone island. Stable when compared to prior study.OTHER: No significant abnormality noted

Output: Unremarkable exam.


Instruction: Generate impression based on medical findings.

Input: Male 25 years old Reason: r/o obstruction. RLQ pain with hx Crohn's, typical of Crohn's exacerbation The lungs are clear except for linear atelectasis in the right midlung. Heart size is normal.Small bowel gas pattern is nonobstructive. Average stool scattered throughout the colon in a nonobstructive pattern. No free intra-abdominal air.

Output: Nonobstructive bowel gas pattern.Linear opacity in the right mid lung likely reflecting atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: line PICC palcement. pulled back 3 cm History: as above Left-sided PICC terminates in the right atrium approximately 3 cm from the cavoatrial junction. No new focal lung consolidation. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: PICC terminates in the RA approximately 3 cm from the cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old Reason: Check Pulmonary status History: Check Pulmonary status Support devices unchanged in position.Interval partial left lung reexpansion with atelectasis and effusion in the left mid and lower lung. Right hemithorax remains clear.

Output: Interval partial left lung reexpansion with atelectasis and effusion in the left mid and lower lung.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: r/o acute cardiopulmonary source of chest pain and left shoulder pain History: CP and L shoulder pain Mild basilar subsegmental atelectasis with a left pleural effusion, unchanged.Mild cardiomegaly.Right jugular catheter, tip in SVC.

Output: Unchanged mild left basilar atelectasis and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: r/o edema History: SOB, hx HF, not taking Lasix No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: chronic cough- occasionally productive History: chronic cough- occasionally productive Mild cardiomegaly status post sternotomy.Small pleural effusions are present but no edema or pneumonia.Left subclavian pacemaker, leads unchanged in position.

Output: New small pleural effusions without obvious edema or infection.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: pneumonia, cardiomegaly effusion History: hx of throat cancer presenting with neutropenic fever, productive cough Right Port-A-Cath with its tip in the SVC.Stable cardiomediastinal silhouette.Interval increase in diffuse interstitial opacities which may represent edema.No focal areas of consolidation.No large pleural effusions.

Output: Diffuse increased interstitial opacities compared to the prior exam suggestive of edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: ards ET tube tip approximately 4 cm above the carina.Left jugular catheter extending to the area of the left innominate vein.Diffuse nonspecific pulmonary opacity, not significantly changed allowing for marked differences in projection.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old, with long smoking history, weight loss, suspicious finding on chest x-ray. Chronic shortness of breath with mild exertion. LUNGS AND PLEURA: A dense opacity in the superior segment of the left lower lobe (image 34, series 5) measures 2.5 x 1.9 cm. Central cavitation with an air-fluid level is evident.Numerous scattered pulmonary micronodules are identified, many of which are calcified and likely reflect prior granulomatous disease.No pleural effusion.MEDIASTINUM AND HILA: The cardiac size is normal. No pericardial effusion. Coronary artery and aortic atherosclerotic calcifications are noted.Calcified right hilar lymphoid tissue likely reflects prior granulomatous disease.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Left lower lobe lung cancer, less likely necrotizing infection.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: lung infiltrate History: chest heaviness Mild cardiomegaly.No specific evidence of infection or failure.

Output: Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: assess for pulmonary edema History: increased 02 requirement Heart size normal.Large hiatal hernia.No reliable evidence of edema or pneumonia.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Swan-Ganz catheter placement. Right jugular Swan-Ganz catheter tip at the level of the pulmonary outflow tract / main pulmonary artery.No pneumothorax.Left subclavian ICD and an LVAD in place.No signs of pulmonary edema.

Output: Right jugular SGC tip at the level of the pulmonary outflow tract/main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: assess heart size, lung abnormalities History: SOB, urinary retention Cardiomegaly.Small lung volumes.No specific evidence of infection or failure.

Output: Cardiomegaly, but no reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: s/p thoracentesis, eval for pneumothorax History: s/p thoracentesis Slight decrease in right pleural effusion with no evidence of significant pneumothorax. Left-sided venous catheter is been removed. Other findings stable.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: infection History: as above Heart size upper normal with a tortuous aorta.No specific evidence of infection or edema.Left subclavian pacemaker, leads unchanged in position.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: evaluate for infection History: germ cell tumor, fever, recent grand mal seizure Right chest port tip in the SVC.Low lung volumes with asymmetric elevation of the left hemidiaphragm. Left basilar opacities, likely atelectasis.Gas-filled stomach is noted.

Output: Left basilar atelectasis, without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of bladder cancer, status post cystectomy, ileal conduit. Assess for recurrence This study is limited due to lack ofCHEST:LUNGS AND PLEURA: Stable bilateral micronodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left breast lesion measures 2.4 x 2 cm on image number 40, series number 4, slightly smaller.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney with moderate hydronephrosis and moderate left-sided hydronephrosis are stable.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not seen.BLADDER: Status post cystectomy, ileal conduit is again noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing periumbilical hernia.OTHER: No significant abnormality noted.

Output: No significant change from previous study. Bilateral moderate hydronephrosis with atrophic right kidney and retroperitoneal adenopathy are unchanged