Instruction: Generate impression based on medical findings.

Input: 28-year-old male with melanoma involving the right thigh. Please evaluate for distant metastases. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Multiple new hypoattenuating lesions scattered throughout the liver are compatible with metastases. The largest lesion in segment 7 (series 3, image 99) measures 1.2 x 1.1 cm.The portal and hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Right external iliac lymphadenopathy with reference node measuring 3.2 x 2.2 cm; which is relatively stable accounting for differences in technique.Right inguinal lymph node (series 3, image 190) is slightly more prominent on current study, measuring 2.5 x 1.9 cm; previously measuring 2.4 x 1.5 cm.Ill-defined increased density in the right inguinal region (series 3, image two only) is unchanged from prior study. This again may represent postsurgical changes versus tumoral involvement.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter sclerotic focus in the anterior acetabulum on the right (series 3, image 197) likely represents a bone island.LOWER EXTREMITIES: Elongated, nodular soft tissue mass in the subcutaneous fat along the medial aspect of the right upper thigh (series 5, image 45; series 80476, coronal image 72) may patient's index lesion. For reference, in the axial plane it measures approximately 2.6 x 1.2 cmMore tubular masses seen in the subcutaneous fat along the medial aspect of the distal right thigh (series 80476, coronal image 50) likely represent venous structures.

Output: 1. Elongated, nodular soft tissue mass in the subcutaneous fat along the medial aspect of the right thigh may represent patient's index lesion. Increased soft tissue density in the right inguinal region is also noted, considerations for which would include postsurgical changes in the proper clinical context versus tumoral involvement. Right inguinal and pelvic lymphadenopathy as detailed above.2. Multiple new lesions in the liver compatible with metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? acute chest? History: Sickle cell disease, chest pain Very mild cardiomegaly with basilar scarring and skeletal findings consistent with sickle cell disease.Port catheter with its tip in the SVC.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: postop History: postop Interval sternal closure with hardware well aligned. The patient remains intubated with the cuff immediately below the cords. Repositioning of the endotracheal tube is recommended. The additional support devices are unchanged in positionPersistent right mid zone opacities with left lower lobe atelectasis unchanged. Small right apical pneumothorax.

Output: Small right apical pneumothorax. Repositioning of endotracheal tube recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval for pulm edema History: syncope Cardiomediastinal silhouette is unremarkable. No evidence of infection or edema. No pneumothorax.

Output: No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: chest pain, elevated WBC; eval for infection or fluid overload History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure Multiple cannula, tracheostomy tube and ICD are all unchanged. No interval hardware changeDecreased lung volumes with moderate nonspecific cardiomegaly, however previously appreciated and suspected loculated left pneumothorax is currently not well appreciated due to rotation and ICD generator. Consider serial imaging

Output: No acute change in pulmonary appearance and moderate CHF persists


Instruction: Generate impression based on medical findings.

Input: Chest tube placementVIEW: Chest AP 1/30/15 Right chest tube in place. There is a small right apical pneumothorax. The right subcutaneous emphysema is not significantly changed. Cardiothymic silhouette normal. Patchy opacities in the right lung not significantly changed.

Output: Right apical pneumothorax with minimal subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: post ET tube and PEA arrest History: see above ET tube is in place with its tip one to 2 cm above the carina.The current mediastinal solos unremarkable.Diffuse airspace and interstitial pulmonary opacities similar in appearance to the prior exam.Abdominal calcifications suggestive of chronic pancreatitis.

Output: Interval intubation with ET tube in satisfactory position. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old. Reason: swan position History: swan placed Swan-Ganz catheter tip in the right main pulmonary artery.Right central venous catheter with tip in the SVC.Heart size is normal with very large pulmonary arteries consistent with pulmonary arterial hypertension. No focal airspace opacity, large pleural effusion, or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female 27 years old Reason: r/o infection History: cough with pna exposure Heart size at the upper limit of normal.No focal air space opacity or pleural effusion.Nonspecific bronchial wall thickening.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Shortness of breath and chest pain. The cardiomediastinal silhouette is unremarkable. No focal pulmonary opacity. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.PICC Left PICC tip projects at the level of the axillary vein. Swan-Ganz catheter tip projects at the level of the main pulmonary artery. Mediastinal drains, surgical drain, sternotomy wires and plates, and surgical staples in place, unchanged in position.Low lung volumes. No significant interval change in bibasilar opacities, small bilateral pleural effusions and cardiomegaly. No evidence of pneumothorax.

Output: Left PICC tip projects at the level of the left axillary vein. Persistent pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with gastric cancer CHEST:LUNGS AND PLEURA: 4 mm lingular nodule (series 4; image 74), unchanged. Small diaphragmatic hernia containing fat on the left, posterior in location, not significantly changed. Hazy 4-mm nodule in the left upper lobe (series 4; image 44), unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: The right sided port terminates in the SVC. No contrast is identified within the right internal jugular or brachiocephalic veins, though this could be due to contralateral injection. However, hypodensity is seen within the lumen of the right brachiocephalic vein (series 3; image 23), possibly related to streak artifact. Fat stranding is also now visualized in the right axilla, which can be seen with vascular obstruction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Mild bilateral adrenal thickening, stable. No focal nodules are identified.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: 12 x 8mm gastrohepatic lymph node (series 3, image 93) , mildly decreased in sizeBOWEL, MESENTERY: Thickening of the gastric fundus through the distal body has greatly improved. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged and indents the urinary bladderBLADDER: Thickening of the wall the urinary bladder can be due to outlet obstruction versus incomplete distentionLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Greatly improved gastric thickening (mild residual), likely representing known tumor. Mild decrease in the regional adenopathy.Question of upper thoracic venous thrombosis on the right, despite contralateral injection. Clinical correlation and/or sonography may be beneficial. This finding was reported to and acknowledged by Natalie, RN.Stable, nonspecific pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: post procedural thoracentesis History: shortness of breath Moderate left-sided pleural effusion without evidence of pneumothorax. Small right pleural effusion. Mild rightward mediastinal shift. Heart size difficult to assess but likely enlarged. Port catheter terminates near the cavoatrial junction.

Output: Moderate left-sided pleural effusion without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Acute shortness of breath evaluate for pulmonary edema. Unchanged cardiomegaly. Mild basal atelectasis on the right. Thickening of the central airways and fissures may indicate mild residual axial interstitial edema, though the previously seen airspace opacities and septal thickening have resolved. No pleural fluid.

Output: Near complete resolution of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with history of +PPD. Evaluate for active TB. Cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity. No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: pna? History: asthma/SOB homeless Minimal basilar edema or atelectasis but no evidence of pneumonia.

Output: Minimal basilar edema or atelectasis but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: assess for changes in pulm opacities History: SOB Nonspecific basilar opacities suggestive of aspiration and/or edema.A Dobbhoff tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary opacities. Dobbhoff tube placement.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: 61yo M w/ hypoxia, eval for interval change History: as above Lower lung zone interstitial markings and a right pleural effusion suggestive of edema, with cardiomegaly status post sternotomy.No significant change.

Output: Stable CHF with edema and a right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with biopsy-proven metastasis at right hip. Restage breast cancer. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Fluid collection in the left breast (series 3, image 32) measures 2.3 x 3 cm and is compatible with known seroma.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: Prominence of the right renal collecting system with apparent narrowing of the proximal ureter (series 80280, coronal image 48) may be congenital in etiology.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta.BOWEL, MESENTERY: Left-sided colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The endometrial cavity is expanded, likely secondary to tamoxifen therapy.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Expansile, lytic lesion in the right ischium (series 3, image 187) with cortical breakthrough (series 3, image 184), compatible with a pathologic fracture.

Output: 1. Lytic metastasis in the right ischium with pathologic fracture. No other sites of metastasis identified.2. Left breast fluid collection compatible with known seroma.3. Expansion of the endometrial cavity, maybe secondary to therapy such as tamoxifen.4. Prominence of the right renal collecting system with apparent narrowing of the proximal ureter may be congenital in etiology. However, this finding may be followed up on subsequent studies.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Reason: 66M with hypoxia and dyspnea. History: fever, dyspnea Cardiomegaly with small lung volumes.Diffuse bilateral interstitial opacity with multiple septal lines, increased from previous, consistent with pulmonary edema.Moderate bilateral pleural effusions.

Output: Findings consistent with increasing CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.History of Crohn's for ileocolectomy, preoperative evaluation. No focal airspace opacity, pleural fluid or pneumothorax. Cervical spine stabilization hardware incompletely visualized. Normal heart size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: LVAD History: hypervolemia Stable cardiomediastinal silhouette.Scattered areas of scarring/discoid atelectasis similar to prior exam.No new pulmonary opacities identified.LVAD and abandoned left-sided ICD leads unchanged.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Evaluate for infection. Normal cardiac and mediastinal contours.Significant blunting right posterior costophrenic angle, compatible with either small effusion or focal consolidation of uncertain chronicity, but possibly due to infection.Low lung volumes.Surgical clips are present in the left axilla.

Output: Right posterior costophrenic angle blunting may be due to a small effusion, scarring or focal consolidation.These findings were communicated to Dr. Havlin at 11:07 am.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: intubation History: intubation ET tube with its tip at the thoracic inlet.Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

Output: High position of ET tube with its tip at the thoracic inlet.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with chest pain and elevated d-dimer. PULMONARY ARTERIES: Exam is diagnostic quality. No evidence of pulmonary embolus.LUNGS AND PLEURA: Lungs are clear no focal air space opacity, pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of pulmonary embolus. No specific findings to explain patient's symptoms


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: chf History: chf Worsening basilar opacities suggestive of edema with pleural effusions right larger than left.Moderate cardiomegaly.

Output: CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: patient CHF/Asthma/COPD recently admitted for COPD exacerbation now with worsening cough/dyspnea/chills following discharge - evaluate for acute processes Low lung volumes with chronically elevated right hemidiaphragm. A focal opacity in the left peripheral mid lung is nonspecific but may be due to infection. No pneumothorax or large pleural effusion. Mild cardiomegaly.

Output: Focal opacity in the left peripheral mid lung is nonspecific, however may be due to infection in the appropriate clinical context.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female patient with thyroid cancer status post surgical resection and ablation, assess for thyroid uptake. There is expected I-131 activity in the nose, salivary glands, stomach, and urinary bladder. No increased activity consistent with functioning thyroid tissue is seen.Probe uptake of the neck is 0.032%.

Output: No functioning thyroid tissue.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: assess for pneumonia History: intermittent hemoptysis Chronically elevated right hemidiaphragm with crowding of lung markings above it but no reliable evidence of infection or edema.Severe scoliosis.Tracheostomy tube, the tip at the level of the thoracic inlet.

Output: No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: increased O2 requirement s/p thora History: see above. Bilateral basilar airspace opacities suggestive of edema and atelectasis.Pleural effusions, right greater than left.Heart size upper limits of normal.Right IJ catheter tip in right atrium.

Output: Increased edema, atelectasis, and bilateral effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Malignant neoplasm of upper lobe of right lung History: Malignant neoplasm of upper lobe of right lung Elevation of the right hemidiaphragm be due to prior right upper lobectomy.Normal postsurgical cardiac and mediastinal contours.No pleural or parenchymal abnormalities.No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: r/o acute process History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Prominent epicardial fat pad or pericardial cyst in the right cardiophrenic angle, not clinically significant.

Output: No acute cardiopulmonary abnormality or interval change


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Left renal mass Bullet fragments are projected over the lower cervical spine and lower thoracic spine.Cardiac mediastinal silhouette is normal.Streaky basilar airspace opacities compatible with subsegmental atelectasis/scarring. No new focal airspace opacity.No pneumothorax or pleural effusion.

Output: Mild basilar atelectasis/scarring. No specific evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with large B cell non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Apical scarring is unchanged. Several calcified balloons are stable.MEDIASTINUM AND HILA: Index subcarinal lymph node measures 16 x 6 minute image number 37, series number 3, unchanged. Calcified thoracic aorta, stable. No evidence of aneurysm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Mild splenomegaly, unchanged.SPLEEN: Accessory spleen is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate stones in both kidneys. No evidence of hydronephrosis. Right renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered, ill-defined areas of sclerotic lesions in the vertebral bodies and the pelvis are stable.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesions in both kidneys are unchanged.OTHER: No significant abnormality noted

Output: Stable examination without new lymphadenopathy. Sclerotic bone lesions are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: lung eval post-op History: post-op Status post median sternotomy with chest tubes but no pneumothorax.Mild basilar subsegmental atelectasis is present postoperatively.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter, tip in right pulmonary artery.

Output: Mild postop atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: evaluate lung fields History: intubated, ecmo Lines and tubes are unchanged. Mild pulmonary edema pattern, unchanged. Small pleural effusions. Small right apical pneumothorax again noted.. Unchanged cardiomegaly.

Output: Mild pulmonary edema pattern, unchanged. Small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Chest pain, shortness of breath. Evaluate for pneumothorax. Left greater than right basilar atelectasis. Blunting of the left costophrenic angle, likely small pleural effusion versus scarring. No evidence of pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: Left greater than right basilar atelectasis of uncertain chronicity with a small left pleural effusion. The differential diagnosis includes pulmonary embolism and aspiration.Findings/differential diagnosis discussed with ED/Dr. Chottiner on 9/13/16 at 10:15 am.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Need for hemodialysis status post left IJ line placement. Acute pancreatitis and acute kidney failure. Jugular catheter tip is appear well mediastinum and may be in the left IJ and ORIF E. left brachiocephalic vein and; mediastinal widening appears unchanged however confirmation of venous blood return from the line is suggested.ETT, enteric tube and right jugular catheter are unchanged in position.No pneumothorax.Moderate layering left pleural effusion with associated atelectasis; the left lower lobe remains collapsed. Mild compressive atelectasis right lung base.

Output: Left jugular catheter is positioned over the left mediastinum, most likely at the left jugular/left brachiocephalic confluence. Although mediastinal widening is unchanged and was present prior to line placement, confirmation of venous return from the line is suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: evaluate for lung infection History: wheezing and shortness of breath The heart, mediastinum, lungs, pleural spaces and visualized bones are within normal limits.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with a history of orthotopic heart transplant (2008) and protein S deficiency presents with chest pain and upper extremity swelling. Evaluate for pulmonary embolism. The comparison chest radiograph performed on 12/29/16 demonstrates no focal pulmonary opacities or pleural fluid. The ventilation images demonstrate decreased ventilation left lower lobe which eventually infiltrates. No abnormal xenon-133 retention during the washout phase.The perfusion images show matched decreased perfusion of the left lower lobe. Otherwise, the lungs are normally perfused.

Output: Low probability for pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: post op cardiac surgery History: post op cardiac surgery 2 left-sided chest tubes in place, positions unchanged.Swan-Ganz catheter tip terminates in the main pulmonary artery.IABP tip marker noted in the mid descending thoracic aorta.Median sternotomy hardware intact.Retrocardiac opacities suggestive of atelectasis/consolidation.Cardiomegaly unchanged.No pneumothorax.

Output: Retrocardiac atelectasis/consolidation without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for focal infiltrate; concern for sepsis History: see above Moderate cardiomegaly.Mild streaky basilar opacities consistent with subsegmental atelectasis. A new small nodular opacity in the right lung is suggestive of a small amount of pleural fluid loculated in the minor fissure.Catheter tip in the SVC.

Output: Atelectasis and pleural effusion but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: Evaluate for infiltrate, R lung opacity History: Hypoxia and decreased air movement of R lung and desaturations NG tube in the stomach. Right upper extremity PICC tip in the right subclavian vein. Shunt catheters overlie the chest and upper abdomen.Stable cardiac silhouette. Slightly improved aeration in the right upper lobe, with interval development of diffuse opacities in the left lung, likely atelectasis.

Output: Slightly improved right upper lobe atelectasis with interval worsening of left opacities, likely atelectasis as well.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: sob, pna or acute pathology History: sob Stable cardiomegaly. Bibasilar interstitial abnormality likely due to edema. Probable small pleural effusions. No focal opacity to suggest pneumonia.

Output: Stable cardiomegaly. Bibasilar interstitial abnormality likely due to edema. Probable small pleural effusions. No focal opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: 24yo male with history of Crohn's disease on Cimzia History: Positive TB. Positive exposure to known TB contacts in the army. R/o active TB infection The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: evaluate for infection History: cough Small lung volumes.Nonspecific increased interstitial markings consistent with fibrosis is stable.No specific evidence of infection or edema.Stable vertebral compression fractures.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: r/o pneumonia History: cough, fever COPD/emphysema. Unchanged basilar scarring.No specific evidence of infection or edema.

Output: COPD/emphysema, but no evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: r/o infiltrate History: altered mental status with possible sepsis Moderate to severe cardiomegaly with a tortuous aorta.Basilar interstitial opacities could be edema or scarring.No specific evidence of infection.Cholecystectomy clips.

Output: Cardiomegaly, and possible edema, but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Acute onset and tachycardia and SOB. C/F pulmonary edema. Worsening left basal atelectasis and pleural fluid. Subsegmental atelectasis at the right base, also likely associated with at least a small volume of pleural fluid. Lung volumes appear decreased compared to the prior study. No pneumothorax.Although the cardiothoracic ratio appears increased, this could be exaggerated by decrease in lung volume since the prior study. Pericardial fluid cannot be excluded.No specific evidence of pulmonary edema.

Output: No convincing evidence of pulmonary edema however there are moderate pleural fluid collections and new basal atelectasis on the left. Cardiothoracic ratio appears increased, pericardial fluid cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: MaleReason for Study: Reason: ? SOB History: ? volume The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Intubation. Interval repositioning of the ET tube, now with tip at the carina. NG tube tip in the distal stomach. Vascular coils and pigtail catheter project over the left upper abdominal quadrant.Layering large left pleural effusion with underlying left basilar atelectasis, not significant changed.Cardiomegaly.

Output: ET tube tip at the carina.


Instruction: Generate impression based on medical findings.

Input: Evaluate pleural effusionVIEW: Chest AP 1/13/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. There are two chest tubes on the right unchanged. The left PICC is unchanged. Recurrence of a large right pneumothorax with mediastinal shift from right-to-left. There is opacification of the left lung unchanged. Metabolic bone disease of prematurity again noted.

Output: Recurrence of the large right pneumothorax with mediastinal shift from right to left.


Instruction: Generate impression based on medical findings.

Input: Reason: ett History: ett ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Small lung volumes with nonspecific basilar opacities compatible with consolidation and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 59-year-old using female with stage III uterine endometrial cancer. Status post surgery and 5 weeks of radiotherapy. Evaluate disease status. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left lower lobe on image number 47/139 is stable.MEDIASTINUM AND HILA: Retrosternal goiter.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without biliary dilatation. No evidence of focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass measuring 2.5 by 3-cm. Right adrenal gland is normal. Left adrenal gland findings represent a benign adenoma. Otherwise normal abdominal MRI on 2/19/2008. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple nonenlarged, small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: Markedly distended, but otherwise unremarkable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right obturator lymphocele has resolved. Left obturator adenopathy measuring 16 x 12-mm on the prior examination is now less than 1 cm in dimension, after radiotherapy. The small left-sided collection anterior to the left external iliac vessels has resolved.

Output: 1.Left adrenal mass is benign adenoma. Cholelithiasis.2.Pelvic right-sided lymphocele and small fluid collections seen on the prior examination have resolved..3.Left-sided pelvic adenopathy has resolved with radiotherapy.4.Subcentimeter left lower lobe nodule seen on the prior examination is stable.5.Goiter with retrosternal extension.:


Instruction: Generate impression based on medical findings.

Input: Reason: cause of increased oxygen requirement History: increased oxygen requirement Normal heart size and mediastinal contours.Small lung volumes with mild basilar opacity suggestive of atelectasis. No other specific evidence of CHF or infection.

Output: Mild basilar atelectasis of uncertain etiology. Differential diagnosis includes aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: cough, congestion, asthma, eval for PNA History: cough, congestion, asthma, eval for PNA 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, 25 years old.Reason: SVC History: As above Increasing right pleural fluid, conceivably a hematoma, significantly compressing the right lung.Patchy consolidation throughout the left lung is consistent with aspiration or pneumonia.Left pleural effusion.Embolization coils are unchanged over the midline.ET tube tip approximately 4 cm above the carina.

Output: Increased right pleural fluid significantly compressing the right lung. An underlying hematoma is possible. Increased opacity throughout the left lung is consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male 94 years old Reason: 94 M s/p lap chole w N/V/ diarrhea, eval bowel gas pattern History: N/V/diarrhea No focal pulmonary consolidation. Pleural spaces are clear. Bowel gas pattern is nonobstructive. No definite free intraperitoneal air.Postsurgical changes with multiple clips in the right upper abdomen.Degenerative changes affects the lumbar spine.

Output: Nonobstructive bowel gas pattern


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: PNA, aspirations History: SOB, increased crackles 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: Chest tube check Left basilar mediastinal chest tubes are unchanged. Swan-Ganz continues to extend into the right pulmonary pleural tract. ETT removed. Left jugular catheter terminates in the proximal SVC. LVAD unchangedMild cardiomegaly with retrocardiac partial consolidation and/or atelectasis. Small left effusion

Output: Left chest and mediastinal chest tubes are unchanged


Instruction: Generate impression based on medical findings.

Input: 59 years old Male. Reason: change to infiltrate, effusion History: lung txp. Bilateral basilar atelectasis and moderate pleural effusions, not significantlychanged.Tracheostomy tube and venous catheter also unchanged.No new findings.

Output: Atelectasis and pleural effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval for ptx, ett position History: ett position, ptx Cardiomegaly with new left lower lobe consolidation and a left pleural effusion.No significant pneumothorax.ET tube tip approximately 2 cm above the carina.

Output: New left pleural effusion and left lower lobe consolidation, but no pneumothorax. ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: pna History: pna Moderate cardiomegaly with diffuse interstitial and airspace opacities worse than on the prior study.Tracheostomy tube tip 6 cm above the carina.Right jugular or subclavian catheter tip at right atrial level.

Output: Worsening pulmonary opacities consistent with edema or aspiration, versus infection.


Instruction: Generate impression based on medical findings.

Input: 29-year-old male with diffuse large B-cell non-Hodgkin's lymphoma status post stem cell transplant. CHEST:LUNGS AND PLEURA: New left lower lobe air space disease could represent infection or aspiration. Stable scattered micronodules. No suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion. No pathologically enlarged hilar or mediastinal lymph nodes. Anterior mediastinal soft tissue measures 1.9 x 1.7 cm on axial image 28/211, is unchanged, and may represent residual thymus.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: sob History: sob. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. The support devices are stable in position.

Output: The above findings are consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: status of pneumothorax History: SOB, CP Slight worsening left lower lobe pneumonia. Small right apical pneumothorax, not substantially different. Small left pleural effusion.

Output: Slight worsening left lower lobe pneumonia. Stable small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Intubated, assess infiltrates. Hypoxemia. Endotracheal tube tip 3.5-cm above the level of the carina. Nasogastric tube sidehole straddles GE junction and the tube may be advanced if desired.Right jugular catheter tip overlies the right atrium.Moderate right pleural fluid collection.Diffuse groundglass opacities bilaterally, with superimposed compressive atelectasis and consolidation on the left, similar to previous.

Output: No acute change in pulmonary opacities


Instruction: Generate impression based on medical findings.

Input: Shortness of breath, check for infection versus CHF Motion degrade sensitivity.Mild nonspecific cardiomegaly is partially observed. Poorly confirmed on the lateral projection. Vascular redistribution and extensive mixed interstitial and airspace opacities are observed, nonspecific. Possible moderate right effusion.A bullet projects over the lower thoracic spine, just anterior to the spinal cord.

Output: Nonspecific mixed interstitial airspace opacities and probable CHF and edema, however hemorrhage or even infection cannot entirely be excluded.


Instruction: Generate impression based on medical findings.

Input: Respiratory failure, ETT placement ETT minimally repositioned, tip projects 3 cm above the carina. NG has also remained the same as side port at the GE junction. Right jugular dialysis catheter extends into the RA at the junction.Increased retrocardiac opacity concerning for atelectasis and/or possibly increasing edema given small effusions. Serial imaging will be needed to exclude

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: eval for pneumo on R History: diminished breath sounds, decreased BP Partial right upper lobe atelectasis possibly from mucous plugging or even a central mass.Small lung volumes.Unchanged tubes and devices.No significant pneumothorax.

Output: No pneumothorax. Increased right upper lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of diffuse large B-cell lymphoma CHEST:LUNGS AND PLEURA: Right middle lobe nodule measures 13 x 12 mm on image number 117, series number 5, not significantly changed from previous study. No pleural effusions. No other lung nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left upper pole intermediate mass is unchanged measuring 2.8 x 2.3 cm other intermediate density masses arising from the left kidney are also unchanged. The mid pole lesion measures 3 x 2.2 cm image number 100, series number 3. These may represent hemorrhagic cyst, however, solid masses cannot be excluded.Small cyst arising from the right kidney are unchanged.RETROPERITONEUM, LYMPH NODES: Mesenteric and retroperitoneal lymph nodes are unchanged. Reference left para-aortic lymph node measures 17 x 16 mm image number 113, series number 3.Reference mesenteric lymph nodes are slightly smaller measuring 15 x 12 mm image number 120, series number 3. Second preference mesentery lymph node is also slightly smaller measuring 16 x 12-mm on image number 131, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple small internal and external iliac lymph nodes unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal interval decrease in/stable and mesenteric lymph nodes throughout other adenopathy in the hilum of mediastinum and lung nodules unchanged.Stable left intermediate density lesions which may represent hemorrhagic cyst, however, solid lesions cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male presents with chest pain and shortness of breath. Right chest port has its tip in the superior right atrium. Surgical skin staples superimpose the mid abdomen. An abdominal drain is seen in the left upper quadrant.Low lung volumes makes detailed cardiopulmonary assessment difficult. The cardiomediastinal silhouette is unremarkable. Right lower pulmonary opacity most consistent progressive atelectasis. No large pleural effusion or pneumothorax.Please see separately dictated same-day abdominal radiograph for abdominal findings.

Output: Progressive right basilar atelectasis. Assessment for superimposed infection is limited.


Instruction: Generate impression based on medical findings.

Input: Reason: ? fluid overload History: pedal edema Unremarkable cardiac and mediastinal silhouette. Small lung volumes with mild basilar opacity compatible with atelectasis but no reliably evidence of edema or infection.

Output: Small lung volumes with no gross abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: r/o cough,pnemonia. History: cough. No significant interval change in basilar edema and pleural effusions.Stable cardiomediastinal silhouette.Pacemaker unchanged.Status post TAVR.

Output: No significant interval change in basilar edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Improved quality of exam, however again overall appearance is similar with moderate cardiomegaly, diminished lung volumes and basilar changes representing largely atelectasis. Partial consolidation of the left lower lobe cannot entirely be excluded. Scattered nodules are again suggested, consider continued serial imaging and/or dedicated axial imaging if further characterization is needed.

Output: Persistent yet partially improved superimposes previously observed edema-like changes and atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Status post left thoracentesis Tracheostomy tube is midline. Interval removal of NG tube. Remaining enteric tube courses below the field of view. A left subclavian central venous catheter tip is in the SVC. A pigtail catheter is in the right hemithorax. Vertebral stabilization rods and surgical clips are noted in the midline. Unchanged right upper quadrant catheter/drain.Cardiomediastinal silhouette is unchanged.A left pleural effusion has decreased in size.No pneumothorax.Interstitial septal thickening is noted. Perihilar airspace opacities are noted bilaterally, increased on the right.Retrocardiac atelectasis/consolidation is unchanged.

Output: 1.Decrease in size of left pleural effusion status post thoracentesis without evidence of pneumothorax.2.Pulmonary edema pattern with perihilar airspace opacities. Retrocardiac atelectasis/consolidation is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male; 72 years. Reason: met crc History: restaging chemo CHEST:LUNGS AND PLEURA: Overall stable appearance of multiple lung lesions. Reference right upper lobe lesion (series 5 image 37) measures 2.6 x 3.3 cm (previously 3.6 x 2.5 cm). Left upper lobe lesion (series 5 image 39) measures 2.5 x 2.4 cm, unchanged. Left basilar lesion (series 5, image 81) measures 2.8 x 2.2 cm (previously 2.7 x 2.5 centers). Other non-referenced lesions are similar in size. No new lesions identified.MEDIASTINUM AND HILA: Patulous esophagus with fluid. Moderate-sized hiatal hernia. Coronary calcifications. CHEST WALL: The right central venous catheter tip at the SVC/right atrium. Symmetric. Rest tissue bilaterally.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration.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: Multiple small bowel loops in close proximity to the rectus musculature anteriorly, likely represents nonobstructive adhesive disease.  BONES, SOFT TISSUES: Post operative appearance of the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Nodular enlargement of the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Post surgical changes of the anus/rectum, similar to prior. Prevertebral soft tissues are within normal postoperative limits.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable pulmonary metastases. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval for fluid collection History: s/p vats/decort with drainage from wound sites Heart size is normal. Interval improvement of postoperative appearance of the right hemithorax with small volume right pleural fluid which tracks along the major and minor fissures. Right basilar subsegmental atelectasis/consolidation, similar to the prior exam. Interval removal of chest tubes without significant residual pneumothorax. Minimal left basilar atelectasis.

Output: Interval improvement of the postoperative changes


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Evaluate for PNA, signs of ACS History: SS Dz, pain crisis, chest pain, OSH XR showing small L mid lung opacity Patchy left lower lung zone opacities are nonspecific, some of which may be scarring although developing infection is possible.Heart size normal.Right jugular catheter, tip at cavoatrial junction level.

Output: Patchy left lower lung zone opacities suggestive of infection, with underlying scarring.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p extubation History: s/p extubation Interval extubation. Cardiopulmonary monitoring and support devices otherwise unchanged.Cardiomegaly with pleural effusions and basilar atelectasis.No new findings.

Output: Interval extubation and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: r/o chf or infiltrate History: cough in setting of CHF Large lung volumes.Heart size upper normal.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.

Output: Heart size upper normal, with large lung volumes. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with known metastatic colon cancer. Abdominal pain and distention. ABDOMEN:LUNG BASES: There are small bilateral pleural effusions, left greater than right. Stable mediastinal and hilar lymphadenopathy. Cardiomegaly with transvenous pacemaker leads. Status post median sternotomy. Left lower lobe consolidation and volume loss. Compressive atelectasis of the right lower lobe.LIVER, BILIARY TRACT: Stable size of the previously seen bilobar metastatic lesions; for reference, the segment 5 lesion on series 3, image 74 measures 3.8 x 3.6 cm.The portal vasculature remains patent, and there is no evidence of biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable appearing left renal cystRETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcification and mural thrombus formation throughout the abdominal aorta is stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate remains enlarged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen soft tissue nodule is again seen on series 3, image 105 and measures 1.5 x 0.9 cm (stable).Stable SI joint ankylosis. Small amount of free fluid in the pelvis

Output: 1. Stable bilobar hepatic metastases.2. New bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Status post thoracentesis LVAD, ICD are all unchanged. Increasing mild basilar edema with small layered effusions with mild nonspecific cardiomegaly; suggesting CHF.No immediate postprocedural complication, specifically no pneumothorax

Output: Mild new CHF


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: positive ppd History: positive ppd Clear lungs. Unexpected convexity in the AP window. No large pleural effusion or pneumothorax. Normal heart size.

Output: The lungs are clear. However, there is unexpected convexity in the AP window which may represent localized lymphadenopathy. Consider correlation with contrast-enhanced chest CT for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: fever, r/o pna History: fever Low lung volumes. Left basilar subsegmental atelectasis or scarring. Mild cardiomegaly given lower lung volumes. No pneumothorax. Question small left pleural effusion.

Output: Left basilar subsegmental atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with history of shortness of breath. Cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax. Mild bronchial wall thickening.

Output: Mild bronchial wall thickening which can be seen in reactive airways disease or bronchitis.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: MaleReason for Study: Reason: resolving pneumonia History: fever Left Port-A-Cath and left PICC line unchanged.Stable cardiomediastinal silhouette with right paratracheal lymphadenopathy.Interstitial and multifocal nodular opacities similar to the prior exam.No new pulmonary opacities identified.No pleural effusions.

Output: Stable cardiopulmonary appearance with right paratracheal lymphadenopathy and multifocal nodular and interstitial opacities compatible with known metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: 70M intubated in ICU, aspiration pneumonia, persistent hypoxia History: 70M intubated in ICU, aspiration pneumonia, persistent hypoxia Patchy air space opacities unchanged consistent with atypical edema or infection.ET tube tip approximately 5 cm above the carina. ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right PICC, tip in axillary region.

Output: Stable pulmonary opacities, tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old. Shortness of breath, pleuritic chest pain since 9pm yesterday. Cardiomediastinal silhouette is within normal limits.Streaky left basilar opacity. No pleural effusions or pneumothorax.

Output: Left basilar atelectasis or possible infarct. See follow-up chest CT for additional details.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: sob - pleural effusions? History: sob on occasion An ICD is noted with its tips unchanged. Changes of a prior median sternotomy are noted. The remainder of the hardware is stable. LVAD device again noted.The cardiac mediastinal silhouette is unchanged. No focal pulmonary opacity suggestive of pneumonia. No pleural effusion or pneumothorax. Blunting of the left costophrenic angle appears chronic.

Output: The appearance of the chest is stable without superimposed acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Septicemia Motion heavily degrades sensitivity.Persistent lung lower zone opacities suggesting progressive edema with moderate pleural effusions and atelectasis again observed. Mild cardiomegaly. Aspiration again cannot be excludedTracheostomy tube, Dobbhoff and bilateral jugular catheters unchanged

Output: Persistent lower zone edema in both bases with pleural effusions


Instruction: Generate impression based on medical findings.

Input: Female 47 years old Reason: post CRT placement History: none There is no focal consolidation, pleural effusion or pneumothorax.The cardiomediastinal contours are within normal limits for size. Biventricular pacemaker lead positions unchanged.The imaged skeleton and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: Evaluate for effusion, aspiration, opacity History: altered mental status, stroke - R sided weakness Small lung volumes with pulmonary vascular redistribution.Moderate cardiomegaly is present.Mild interstitial opacities are suggestive of edema, but no evidence of infection.Small pleural effusions are likely.Hilar fullness most likely is vascular.

Output: CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Large masslike area in the right paratracheal region which appears flocculated likely calcified. Probable calcified lymph nodes also noted within the left mediastinal and hilar regions. Lungs are clear. No pleural effusion or pneumothorax. Normal heart size.

Output: Probable stigmata of previous granulomatous disease, most severe in the right paratracheal region. Comparison to previous studies is suggested. If these are not available, consider further evaluation with chest radiography in 6 months.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old. Reason: eval pna History: cough, malaise Large patient body habitus.Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 96 years old.Reason: evaluate for pna, chf History: productive cough Stable cardiomediastinal silhouette with calcified aortic arch. Subcarinal and left hilar calcified granulomas again seen.Low lung volumes with worsening bibasilar aeration likely atelectasis and small pleural effusions. Left lung base calcified granuloma.Right proximal humerus remote fracture deformity.

Output: Low lung volumes with worsening bibasilar aeration likely atelectasis and small pleural effusions. Recommend continue clinical followup and consider further imaging as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: icu History: icu Tracheostomy tube, right IJ venous cathetesr, and bilateral chest tubes unchanged.Stable cardiac mediastinal silhouette.Perihilar and basilar airspace/interstitial opacities similar in appearance to the prior exam.Right pleural effusion/thickening redemonstrated.No new pulmonary opacities identified.No pneumothorax.

Output: Support devices unchanged. Stable cardiopulmonary appearance with extensive pulmonary opacities and right pleural effusion/thickening.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: edema History: edema Cardiomegaly with mild basilar interstitial edema pattern, consistent with CHF.Small pleural effusions are present.Right jugular catheter, tip at the RA level.

Output: Cardiomegaly with mild interstitial edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval infection, edema, effusion History: RUQ abd pain \T\ R sided CP worse w/ inspiration The heart is normal in size. Mild tortuosity of the thoracic aorta.Lung volumes are normal. No abnormal focal parenchymal opacities to suggest pneumonia, as clinically questioned.The pleural spaces are within normal limits.No osseous lesions are present.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: shortness of breath History: shortness of breath Large lungs consistent with COPD.Apical paraseptal emphysema.No specific evidence of infection or edema.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of esophageal carcinoma status post radiotherapy. CHEST:LUNGS AND PLEURA: Interval resolution of previously seen ground glass air space opacities. No suspicious nodules or masses. Paramediastinal/paraspinal radiation fibrosis.MEDIASTINUM AND HILA: Small pericardial fluid. Unenlarged mediastinal lymph nodes. Distal esophageal mass is less distinct, but measures 21 x 19 mm (series 3, image 65); on study from 12/3/2008 it measured approximately 21 x 19 mm.CHEST WALL: Right Port-A-Cath with central line tip in SVC. Bilateral thyroid nodules. Stable degenerative changes of the spine.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hepatic cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged renal cysts bilaterally.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Jejunostomy tube in left midabdomen.BONES, SOFT TISSUES: Stable degenerative changes of the spine.

Output: Stable appearing distal esophageal mass.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: r/o pneumo - follow effusion History: s/p pleurex Unchanged pulmonary opacities with right pleural thickening and fluid, and right hemithorax volume loss.Unchanged left Pleurx catheter.No significant pneumothorax.Left jugular catheter tip at cavoatrial junction.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: s/p lap assisted Ivor-Lewis esophagectomy 6/17/15 History: none Right lung opacities and loculated pleural fluid with air-fluid levels, unchanged. Very small left pleural effusion noted.Heart size normal.Right jugular catheter, tip in SVC.

Output: Stable loculated right hydropneumothorax with air-fluid levels.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: eval line placement History: TV pacing wire, IJ, s/p tavr Patient status post TAPVR. Cardiac lead terminates over the expected location of the RV. Right internal jugular line/sheath terminates within the superior aspect of the SVC. No focal lung consolidation. Mild patchy bibasilar opacities. No pleural effusion or pneumothorax. Large hiatal hernia noted.

Output: Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: postop - redo washout History: postop Right chest tubes are unchanged with no pneumothorax.Mild basilar atelectasis is present particularly on the right.Moderate cardiomegaly.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter tip directed towards the left main pulmonary artery.

Output: No significant pneumothorax. Right basilar atelectasis gradually improving.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for active TB History: Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: evidence of pneumonia History: cough productive of yellow sputum, fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: r/o PNA History: New fever Interval increase in the right effusion with progression of right middle lobe airspace consolidation.Stable left basilar opacity.Line stable. No pneumothorax.

Output: 1. Progression of right effusion and right middle lobe consolidation2. Remaining cardiopulmonary findings are unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: FemaleReason for Study: Reason: ETT History: ETT ET tube with its tip 4 cm above the carina.Stable cardiac enlargement with perihilar/basilar opacities compatible with edema and atelectasis.Bilateral pleural effusions unchanged.

Output: ET tube in satisfactory position. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: assess lung fields, concern for pneumonia History: copd, asthma, on bipap Severe emphysema.No specific evidence of infection or edema.Heart size normal.

Output: Severe emphysema, but no sign of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Pulmonary edema assess ETT placement. Endotracheal tube terminates in the cervical trachea, 11 cm above the level of the carina.Cardiomegaly unchanged. Layering pleural fluid and atelectasis on the right, slightly worse. Improving interstitial edema.

Output: ETT terminates in the cervical portion of the trachea and may be advanced. Enlarging right pleural fluid collection but improvement in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: FemaleReason for Study: Reason: R/o pneumonia History: Chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: sob History: above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Azygos pseudolobe, normal variant.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Shunt placement SHUNT DEVICE: An intracranial shunt exists the skull via a right frontal burr hole and courses down the scalp, neck and anterior chest wall before entering the abdomen and terminating in the right lower quadrant. Portions of the shunt overlying the skull are radiolucent which limits evaluation but otherwise there is no shunt kinking or discontinuity identified. The notch position projects posterior and inferior along the course of the shunt.SKULL: There are surgical changes relating to left parietal craniotomy.CERVICAL SPINE: There is degenerative disc disease of the lower cervical spine.CHEST: There is volume loss of the left lung with additional findings previously described on recent chest CT.ABDOMEN: The bowel gas pattern is nonobstructive.

Output: VP shunt placement and other findings described above.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: pre- procedure (TEE) History: 59F p/w ICD infection Left subclavian ICD lead and generator in place. Cardiomediastinal silhouette is unremarkable. Left coronary stent in place. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No specific evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: to eval post B/T procedure History: chest pain, refractory asthma Patchy opacity left infrahilar region on the frontal view could be aspirated secretions related to bronchoscopy.Previous right lower lung zone opacity has resolved.No other acute abnormality.

Output: Patchy left infrahilar opacity possibly related to the recent procedure.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Cough and SOB evaluate pneumonia. Large lung volumes suggestive of COPD/emphysema. Improving basal atelectasis. Right lower lobe anterior and medial basilar opacity has improved, consistent with atelectasis rather than infection.

Output: Interval improvement in basal atelectasis. No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated History: Intubated ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC. ICD leads unchanged.Cardiomegaly with basilar streaky opacities compatible with subsegmental atelectasis.

Output: Cardiomegaly and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: Placed central line, wnat to confirm placement. History: line placement needs Port catheter tip in the lower right atrium, unchanged.Right jugular catheter tip in the SVC. Feeding tube tip in the stomach.Small lung volumes with bilateral nonspecific opacities suggestive of subsegmental atelectasis and possibly metastatic disease.No new findings.

Output: Catheter tip in the SVC with no complications.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Reference ureters are lymph nodes are significantly smaller. Superior mediastinal lymph node now measures 18 x 11 mm image number 18, series number 3.CHEST WALL: Postsurgical changes in the right axilla again noted. Right axillary lymph nodes are significantly smaller. Reference lymph nodes now measures 6 by 8mm image number 31, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypodense area around the falciform ligament has developed within the interval. The shape angiographic appearance is very atypical for metastatic disease. This may represent focal fat infiltration. However, metastatic disease cannot be entirely excluded. For reference it measures 2.6 x 2.2 cm image number 92, series number 3. No other new hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node is smaller now measures 10 x 10 mm image number 117, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small fibroids in the uterus are unchanged.BLADDER: Small pelvic lymph nodes are unchanged.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The appearance of the right iliac bone lesion is unchanged. OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the mediastinal and axillary lymph nodes.Interval development of a large hypodense lesion in the liver. Its shape angiographic pattern is very atypical for metastatic disease. This may represent focal fatty infiltration versus metastatic disease. MRI is recommended for further evaluation.Right iliac lesion is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Dorsalgia. Side/mid back pain with deep breath on certain movement. Pleuritic pain. No pleural fluid or pneumothorax. No focal airspace opacities. No visible pleural lesions. Degenerative changes of the thoracic spine with mild scoliosis.

Output: No acute pulmonary or pleural abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old. New right jugular catheter with its tip in the SVC.No pneumothorax or other complications.Cardiomegaly and mild basilar interstitial edema and atelectasis, unchanged.No new findings.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Status post paravertebral nerve block question evidence of pneumothorax. No visible pneumothorax.No focal airspace opacity. Mild left basal compressive atelectasis.Old, healed granulomatous disease with calcified lymph nodes and granulomas.

Output: No pneumothorax or acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: AM CXR after chest tube placement History: AM CXR after chest tube placement Stable life support devices including enteric tube overlying the mid aspect of the gastric conduit status post esophagectomy and gastric pull-through.Stable cardiomediastinal silhouette.Slight worsening left retrocardiac consolidative opacity likely representing atelectasis with question trace effusion. No pneumothorax.

Output: Slight worsening in left retrocardiac atelectasis with question trace effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p LVAD, trach, eval lung fields History: s/p LVAD, trach, eval lung fields Cardiopulmonary monitoring and support devices, unchanged.Marked cardiomegaly with bilateral pulmonary opacity compatible with edema, atelectasis and nonspecific consolidation, slightly increased in the left upper lobe area.Moderately large d pleural effusion on the left and are smaller effusion on the right.

Output: CHF and nonspecific air space opacity slightly increased in the left upper lobe.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate lungs and mediastinum History: left sided chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: pna? History: cough, focal exam Single lead ICD device unchanged in position.Calcified granulomas. No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 60 year old female with history of colorectal cancer. Evaluate disease status. CHEST CT

Output: The previously described pelvic fluid collection anterior and superior to the bladder persists without interval change, and this may represent a postoperative lymphocele. No measurable metastatic disease. No acute abnormality was found.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: Evaluate for infiltrate History: shortness of breath ] IJ venous catheter and left-sided ICD unchanged.Markedly decreased lung volumes with stable cardiac enlargement.Perihilar/basilar opacities are similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiac enlargement and perihilar/basilar opacities compatible with edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: sob Moderately severe cardiomegaly, not significantly changed.Motion artifact and morbid obesity degrades image quality. However there is no reliable evidence of pulmonary edema or pneumonia.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Fever and aortic embolism Chronic appearing diffuse mild interstitial changes representing old disease without a distinct superimposed process. Specifically no findings to suggest pneumonia. Scattered calcified granuloma.The cardiac and mediastinal contours are within limits.

Output: Scattered chronic appearing changes and suspected scarring without superimposed distinct acute disease.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: PNA History: SOB with trach Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Prior pleural effusions have resolved.Tracheostomy tube tip 7 cm above the carina.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: 71 yod with AML on clinical trial had cough and fever at home over the weekend, had sick contact History: cough, fever Mild left base scarring, otherwise unremarkable.No significant abnormality.Unremarkable mediastinal contours and cardiac silhouette.

Output: Mild left base scarring, but no evidence of pneumonia or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: History of hemoptysis 9/07 with multiple micronodules to evaluate for interval change LUNGS AND PLEURA: New right pleural effusion and increased size of left pleural effusion from 9/24/07 at left effusion somewhat smaller from 11/28/07.Multiple micronodules again seen about the same. Small granulomatous type calcifications also again seenPreviously seen air space opacity in left lung on 11/28/07 much improved. Patchy groundglass opacity is now seen at both bases.MEDIASTINUM AND HILA: No new significant abnormality noted. Poststernotomy findings and ICD device again seen at about the sameCHEST WALL: No new significant abnormality noted, and as aboveUPPER ABDOMEN: Incomplete and less than adequate evaluation. Multiple small calcified gallstones versus thick milk of calcium seen in gallbladder

Output: Changing pleural effusions and airspace opacities as above.Multiple micronodules unchanged. Continued follow-up in September 2008, recommended if patient is high risk for lung cancer, and if still unchanged no further follow-up needed. If patient is not high risk for lung cancer no further follow-up needed.


Instruction: Generate impression based on medical findings.

Input: Left pneumothorax Unchanged left chest tube, tip again projects into the apex with a less significant apical residual pneumothorax. Overlying chest wall and neck emphysemaCardiopulmonary appearance is also otherwise unchanged

Output: Left chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Tachypnea Lungs remain clear. Cardiomegaly and hilar fullness is unchanged. Dobbhoff tube below the diaphragm.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate lung fields History: tachypnea Cardiopulmonary monitoring and support devices, unchanged.Moderately large bilateral pleural effusions and underlying nonspecific airspace opacity and atelectasis, not significantly changed from previous.No new findings.

Output: Large pleural effusions and underlying pulmonary opacity without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab New left subclavian dual-chamber pacemaker, leads in appropriate position with no pneumothorax.

Output: Uncomplicated pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: IABP check The IABP marker projects 3 cm from the aortic arch. Mild cardiomegaly with otherwise clear lungs

Output: IABP marker well positioned


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p transhiatal esophagectomy with left chest tube. Please eval lungs and neck incision. Please include neck in image History: as above Persistent basilar atelectasis and pleural effusions.An NG tube traverses a pull-up.Left chest tube with no significant pneumothorax.Right jugular catheter tip at cavoatrial junction.Left upper quadrant enterostomy tube.

Output: Basilar atelectasis and pleural effusions unchanged. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval for pna vs chf History: crackles in left lower lobe, cough Cardiomegaly with mild/moderate interstitial opacities suggestive of edema similar to the prior study.Small left pleural effusion.No reliable evidence of infection.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly with interstitial edema but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Post ICD. Interval placement of a left subclavian ICD, the proximal lead projects over the right atrium directed medially, and the distal lead projects over the right ventricle. No pneumothorax. Valvular prosthesis.Low lung volumes with significant basal atelectasis and dependent consolidation.Mild pulmonary edema and pleural effusions unchanged.

Output: No pneumothorax post ICD placement. Decreased lung volumes with worsening basal atelectasis and dependent lung nonspecific consolidation. CHF, about the same.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Status post TECAB Stable cardiomediastinal silhouette.Bibasilar subsegmental atelectasis and possible small pleural effusions, slightly improved.No pneumothorax.

Output: Bibasilar subsegmental atelectasis, similar to prior.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Cough. Evaluate for cardiopulmonary abnormality, pneumonia. Interval resolution in bibasilar opacities. Unchanged focal scarring. No pulmonary opacities to suggest infection. No evidence of pulmonary edema. No pleural effusions or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out infection History: rule out infection Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: 82 F with DLBCL on chemo now with cough. please evaluate for PNA History: cough No acute abnormality.No specific evidence of infection or edema.Previously seen pleural thickening and underlying bone destruction no longer visible.Right jugular catheter tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: post op, eval lung fields History: s/p ASD repair Right IJ sheath terminates at the level of T3, right of midline. Right chest tube terminates at the right cardiophrenic angle.The patient is rotated to the left, accentuating the mediastinal contour. Opacities in the right perihilar location may represent aspirated secretions or atelectasis. Lucency over the thoracic midline suspicious for pneumomediastinum. Small right pleural effusion. Subcutaneous air noted in the right lateral chest wall No significant pneumothorax.

Output: Right perihilar opacities of aspirated secretions and/or atelectasis. Small right pleural effusion. Suspected minimal pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: r/o ptx History: sob No pneumothorax. Bilateral pulmonary nodules and masses again noted.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.History of productive cough and fever. Please evaluate for pneumonia. No pleural effusion or pneumothorax is visualized. Cardiomediastinal silhouette is within normal limits. No focal lung opacities visualized.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with fever, unspecified. Concern for infection. No focal airspace opacity, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p superior RLL nodule bx History: s/p superior RLL nodule bx No pneumothorax following lung biopsy.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Sustained VT, evaluate LVAD position, pulmonary edema. Right jugular catheter tip at the superior cavoatrial junction. LVAD appears similar in position. Left subclavian ICD unchanged. No focal pulmonary opacities, large volume of pleural fluid or pneumothorax. No signs of pulmonary edema.Sternotomy hardware appears in alignment.

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


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: rales History: see above Right IJ central catheter terminates at the level of the azygos vein.Cardiomegaly with mitral annular calcification. Mild bilateral edema. Trace pleural effusions.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with history of colon cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of right hemicolectomy. Fat containing peri-incisional hernia is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Weakness with multiple falls at home. Mild interstitial basilar edema pattern is new from previous. Sclerotic osseous metastases are again seen involving ribs and vertebra.

Output: Mild basilar edema pattern, new. Multiple osseous metastases again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: weight loss History: as above The cardiomediastinal silhouette is normal.There are patchy reticular interstitial opacities in the left lower lobe without dense, focal area of consolidation or pleural effusion. Within this area, there is a nodular opacity in the lateral left lung base.

Output: Nodular opacity within an area of probable chronic scarring, further evaluation with CT can be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.NJ placed yesterday at outside hospital. Enteric tube marker projects above the GE junction.No focal pulmonary opacities or pleural fluid. Normal heart size.

Output: Nasojejunal tube tip projects over the distal esophagus, above the GE junction.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: Cough with green expectoration History: Cough with green expectoration Mild cardiomegaly.No evidence of infection or infarction, or other acute abnormality.

Output: Mild cardiomegaly, but no acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: r/o infiltrate or pulmonary edema History: CC of CP No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Check LV lead placement Unchanged 3-lead left subclavian ICD with lead tips in expected locations. No postprocedural complicationsCardiopulmonary appearance is otherwise well visualized and free of complication. Scattered calcified granuloma and lymph nodes are otherwise observed

Output: ICD unchanged without postprocedural complications


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Post tracheostomy. Left lower lobe consolidation. Groundglass opacities and bronchial wall thickening elsewhere about the same. Interval placement of tracheostomy with tube tip at the level of the clavicular heads. Other tubes and lines unchanged in position.

Output: Tracheostomy tube tip at the clavicular head level. Unchanged pulmonary edema, aspirated secretions and left lower lobe consolidation most consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Somnolence and heart failure history Motion degrades sensitivity. Grossly persistent unchanged moderate nonspecific cardiomegaly with left lower lobe lung consolidation and/or atelectasis. Small effusions again cannot entirely be excluded.Decreased lung volumes with otherwise grossly clear upper lobes.Unchanged left subclavian two lead ICD

Output: Cardiomegaly with persistent lower lobe partial consolidation


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: evaluate Swan Ganz History: see above Moderate cardiomegaly.No reliable evidence of edema or pneumonia.Right jugular Swan-Ganz catheter tip directed towards the right interlobar pulmonary artery. Left subclavian ICD, leads unchanged in position.

Output: Right jugular Swan-Ganz catheter tip directed towards the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o pulm edema, febrile, eval pna or edema History: see above Heart size about upper normal or mildly enlarged.Small lung volumes with diffuse mainly interstitial opacity, compatible with pulmonary edema.Basilar opacity compatible with small pleural effusions and atelectasis, greater on the left.Interval removal of right jugular catheter.

Output: Mild pulmonary edema with atelectasis and small effusions. No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: r/o infection History: AMS, cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Swan, central line. Cardiogenic shock. Swan-Ganz catheter tip at the level of the distal right interlobar pulmonary artery/proximal right descending pulmonary artery level. Right jugular catheter tip at the right atrium. Peripheral catheter from the left projects over the SVC. Dobbhoff tube overlies the distal stomach to the right of midline. IABP marker blurred due to motion but is probably the square density projecting 2 cm below the top of the aortic arch.Diffuse interstitial and airspace opacities, left greater than right with retrocardiac atelectasis/consolidation about the same.

Output: Unchanged cardiopulmonary appearance. Swan-Ganz catheter may been slightly advanced.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with metastatic renal cell carcinoma. Restage. CHEST:LUNGS AND PLEURA: Previously noted pleural-based and parenchymal bilateral metastatic nodules again noted. Reference medially-located, right lower lobe pleural-based lesion measures 1.3 x 2.0 cm (image 77; series 3), equivocally enlarged compared to previous. Loculated fluid at the right lung base. MEDIASTINUM AND HILAAgain noted mediastinal and bilateral hilar metastatic lymph nodes. Previously referenced subcarinal lymph node (image 53; series 3) appears to have enlarged slightly compared to previous and measures 4.3 x 2.9 cm. Small supraclavicular nodes are stable.CHEST WALL: No significant abnormality noted..ABDOMEN:LIVER, BILIARY TRACTStable bilobar hypoattenuating foci, likely representing benign hepatic cysts.. Hydropic appearing gallbladder.SPLEEN: No significant abnormality noted..PANCREAS: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: Stable right renal lesion (image 111), measuring 2.3 cm x 1.5 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No other significant abnormality noted..PELVIS: Evaluation of the pelvis is limited by streak artifact from patient's bilateral hip arthroplasties.PROSTATE, SEMINAL VESICLES: No significant abnormality noted..BLADDER: No significant abnormality noted..LYMPH NODES: No significant pelvic lymphadenopathy..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No other significant abnormality noted..

Output: Equivocal interval disease progression with measurements given above. Hydropic appearing gallbladder is new compared to prior.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval post thoracentesis History: s/p thora No change in interstitial opacities and pleural effusions.Heart size normal. No pneumothorax following thoracentesis.Left-sided port catheter terminates at the cavoatrial junction.

Output: No pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: 73 y/o male with crackles at bases, r/o pneumonia History: congestion Left lower lobe opacity presumably atelectasis adjacent to a large hiatal hernia.No specific evidence of infection or edema.Heart size normal.Right jugular catheter, tip in SVC.

Output: Retrocardiac atelectasis adjacent to a hiatal hernia, but no reliable evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: effusion? History: sob? No change in degree of cardiomegaly with vascular congestion, left basilar opacity and small effusion.Removal of Swan-Ganz catheter.No pneumothorax.

Output: Essentially unchanged cardiopulmonary findings. Interval removal of Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.LVAD Hardware and devices unchanged in position. Moderate pleural effusions with basal/dependent atelectasis.

Output: No acute change in pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: 47 year old female with nodular pneumonia and questionable mass. LUNGS AND PLEURA: Focal area of scarring in the right middle lobe likely secondary from prior pneumonia. Multiple calcifications in the right lower lobe which are suggestive of prior granulomatous infection. Focal area of emphysema in the right lower lobe which may be related to scarring from prior infection. Focally dilated vein in the right middle lobe of uncertain etiology that is likely chronic in nature. No evidence of arteriovenous malformation. In the absence of hemoptysis, this likely represents a stable finding.MEDIASTINUM AND HILA: Mildly enlarged nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Focal area of scarring in the right middle lobe and emphysema in the right lower lobe. 2. Focally dilated vein in the right middle lobe which likely represents a stable finding. In the absence of hemoptysis, suggest follow-up chest x-ray in 6 months.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: 47 yo M with legionella PNA intubated, eval for interval change and ETT placement History: see above Endotracheal tube tip now projects 6.7 cm superior to the carina. Life-support devices remain unchanged.Stable cardiac silhouette.Stable appearance of bilateral mid and lower lung zones predominant airspace disease with likely small effusions. No pneumothorax.Redemonstration of osseous changes consistent with history of multiple myeloma.

Output: Endotracheal tube tip now projects 6.7 cm superior to the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Evaluate IABP placement. IABP marker is 1.5 cm below the top of the aortic arch.Stable cardiomegaly with unchanged ICD leads.No evidence of infection or edema.

Output: IABP marker is 1.5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Left VATS, talc pleurodesis status post chest tube. Left chest tube has been retracted, no visible pneumothorax. Small volume of pleural fluid and pleural thickening bilaterally similar to previous. Left jugular catheter unchanged in position. Peripheral opacities in the right middle and lower lung about the same and have an appearance suggestive of rounded atelectasis post pleurodesis.

Output: Retraction of left chest tube without significant change in pleural fluid. Nonspecific opacities may be related to recent procedures.


Instruction: Generate impression based on medical findings.

Input: Reason: S/p single-chamber ICD History: None Single lead ICD device with the tip of the lead projected in the area of the apex of right ventricle.No pneumothorax or other complications.

Output: New ICD device with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Chest pain. Evaluate for pneumothorax. Unchanged right pleural thickening along the minor fissure and left basilar scarring. No acute pulmonary or pleural abnormalities.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: Patient with pleural effusion now with leukocytosis and hypotension, please evaluate for interval change History: As above Right central catheter is unchanged in position.Right-sided, probably airspace opacities, have become more patchy and confluent. Small right pleural effusion. Left lower lobe atelectasis consolidation is stable. The findings are suspicious for infection. Heart size is within limits of normal.

Output: Patchy airspace opacities have become more confluent on the right, suspicious for infection. Left lower lobe consolidation is stable.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: r/o PNA in HIV History: fatigue, myalgias, headache, nausea/vomiting, just restarted HAART 3 wks ago after 2.5 months off Normal cardiac and mediastinal contours.Distended azygos vein, similar to prior and probably not clinically significant.No pleural or parenchymal abnormalities.

Output: No evidence of pneumonia; no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Cough rule out infection. No pleural fluid or pneumothorax. Normal heart size. No focal air space opacities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: hemothorax History: s/p cardiac surgery with increased chest tube output Unfavorable progression of opacification of the right hemithorax representing increased effusion. Lines are otherwise stable. No other interval changes.

Output: Increasing right pleural effusion.