Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: Eval for ring, reflux History: dysphagia/GERD Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces. Evaluation of the pharynx and hypopharynx was unremarkable. Fluoroscopic loops of swallowing were of loaded to PACS and stored at series 12 and 13. Note was made of an approximately 4.4 x 2.7 cm sliding type hiatal hernia, with the fundus of the stomach within the chest. Evaluation of reflux was limited by the patient's inability to tolerate the supine position. Esophageal peristalsis was normal.TOTAL FLUOROSCOPY TIME: 3:29 minutes

Output: 1.Moderate-sized sliding-type hiatal hernia as detailed above.2.No evidence of stricture, web or fixed narrowing.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: cough History: screening Status post median sternotomy, heart size normal.No specific evidence of infection or edema.No significant pulmonary or pleural abnormality.

Output: Median sternotomy, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: s/p left lung wedge resection, chest tube History: chest tube Unchanged. Mediastinal silhouette and mediastinal clips.Unchanged position of left chest tube with tip near the aortic arch.Persistent left pneumothorax which is minimally enlarged, currently measuring 19 mm, previously 16 mm.Persistent and not significantly changed dense opacities in the left lung, suggestive of pulmonary hemorrhage.Unchanged bronchiectasis on the right.

Output: Minimally enlarged left pneumothorax. Other findings are not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: MaleReason for Study: Reason: r/o infection History: fever tachycadia There are decreased lung volumes.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.VP shunt tubing identified bilaterally.

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


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: evaluate evolving pulm process History: SOB The cardiac and mediastinal contours are partially obscured by extensive right perihilar and basilar consolidative opacities, consistent with known mediastinal lymphadenopathy and adjacent and consolidation in the setting of metastatic adenocarcinoma, recently diagnosed.Small right pleural effusion is again noted. No pneumothorax.The right IJ venous catheter overlies the distal SVC.

Output: No interval change in appearance of mediastinal lymphadenopathy and right lung multilobar consolidation, in keeping with history of recently diagnosed metastatic adenocarcinoma in the setting of HIV infection.Small right pleural effusion is unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, Chest pain, r/o pneumonia or other abnormalities History: SOB Moderate size bilateral upper normal.Linear scarring or atelectasis at the right base, unchanged.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Fever, infiltrates, shortness of breath. No pneumothorax or pleural fluid. Unchanged cardiomegaly. Bioprosthetic aortic valve. Mitral annulus calcifications. Left subclavian dual-chamber pacemaker similar in position.Diffuse interstitial and airspace opacities about the same. Mass in the right upper lobe difficult to visualize, partially obscured by the mediastinum.

Output: Multifocal airspace opacities, increased from earlier film of 6/22/2015 but unchanged from 8/17/2015. The patient was noted to have a mosaic attenuation pattern on a recent PET/CT which could indicate hypersensitivity pneumonitis, this may be considered in addition to infection in the appropriate clinical context.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: r/o infiltrate History: productive cough Median sternotomy and small lung volumes.Heart size normal.No specific evidence of infection or edema.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Esophageal tear History: Hematemesis Cardiomegaly with increasing left lower lobe consolidation and persistent small pleural effusions.ET tube tip approximately 2 cm above the carina.Left jugular catheter appears to enter a persistent left-sided SVC.

Output: Increasing left lower lobe consolidation. ET tube tip approximately 2 cm above the carina. Left jugular catheter likely in a persistent left SVC, less likely arterial.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: pulm edema History: SOB; PNA Slightly improved left lower lobe airspace opacity. Lungs hypoinflated.

Output: Slightly improved left lower lobe airspace opacity. Lungs hypoinflated.


Instruction: Generate impression based on medical findings.

Input: 89-year-old male status post left thoracentesis. The cardiomediastinal silhouette remains obscured.Further increase in the left pleural effusion and worsening aeration of the left lung. Right pleural effusion has also increased. Worsening right basilar airspace and interstitial opacities. No clear mediastinal shift however exam is limited secondary to patient rotation. Interval removal of enteric feeding tube. Metallic stents in the right upper quadrant are unchanged.

Output: Further increase in the left pleural effusion and worsening aeration of the left lung. Right pleural effusion has also increased. Worsening right basilar airspace and interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Evaluate for acute cardiopulmonary process History: chest pain No significant cardiopulmonary abnormality.Right subclavian pacemaker, leads unchanged in position. The right atrial lead remains slightly frayed at the junction of the first rib and clavicle, but is unchanged.

Output: Unchanged right subclavian dual chamber pacemaker leads, one slightly frayed no worse than before.


Instruction: Generate impression based on medical findings.

Input: Enteric tube repositioning Further advancing of Dobbhoff tube with tip now seen overlying expected area of pylorus. Partially imaged sternotomy wires and additional presumed overlying artifact and lines/catheters noted. Remainder of exam without significant change.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Aphasia Repositioning of the right PICC line is observed with retraction and currently the tip projects in terminates in the proximal subclavian vein.Underlying cardiopulmonary appearance is otherwise similar with mildly improved overall aeration lung volumes remain decreased minimally. Elevation of the right minor fissure with associated partial collapse and volume loss of the right upper lobe appears similar to prior studies.The cardiac and mediastinal contours are otherwise within limits.

Output: Right PICC line repositioned


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: assess for infection History: assess for 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, 61 years old.Reason: s/p aortic mass excision History: s/p aortic mass excision Left subclavian dual-chamber pacemaker remains unchanged. Status post median sternotomy, tricuspid and mitral valve surgery. Left atrial appendage closure device again in place. Stable cardiac silhouette.Right basilar and left midlung linear atelectasis/scarring with element of right-sided pleural and fissural thickening again seen. Interval resolution of tiny right apical pneumothorax and right-sided chest wall subcutaneous edema.

Output: Improvement in postoperative changes as described above.


Instruction: Generate impression based on medical findings.

Input: Residual pneumothorax after chest tube removal. Empyema.VIEW: Chest AP (one view) 03/01/15, 1556 Left upper extremity PICC tip is in superior vena cava. Line is now coiled in right brachiocephalic vein.Left pneumothorax is slightly decreased in size and now is small to moderate. Subcutaneous left chest wall and left neck emphysema continues.Focal opacity in left lower lobe and streaky opacities in the right lower lobe are unchanged. Cardiac silhouette size is upper limits of normal.

Output: Decrease in size of left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: placement of R IJ CVC History: see above Small lung volumes.Heart size normal.No specific evidence of infection or failure.Right jugular catheter, tip in RA level.

Output: No pneumothorax following right jugular catheter placement, whose tip is low, in the right atrium.


Instruction: Generate impression based on medical findings.

Input: 53 years old Male. Reason: shortness of breath History: shortness of breath. Cardiac silhouette is normal. There is no evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: Unremarkable examination.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: hypoxemia, sepsis History: hypoxemia, sepsis Patchy left mid and lower lung zone opacity unchanged consistent with infection or aspiration.Heart size normal.Gastrostomy tube.

Output: Left mid and lower lung zone opacities suggestive of infection or aspiration, unchanged.


Instruction: Generate impression based on medical findings.

Input: 51 years old Male. Reason: 51yoM alcoholic cirrhosis with subjective SOB s/p albumin and pRBC admin History: as above. Hypoinflated lungs with bibasilar atelectasis. Cardiac silhouette cannot be evaluated. There is a questionable small left pleural effusion. The right central line is stable in position. No evidence of pneumothorax.

Output: Questionable left small pleural effusion. Hypoinflated lungs with bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: line placement History: line placement New left neck catheter may be malpositioned. Clinical correlation and possibly correlation with blood gases may be considered.Left subclavian port catheter tip at superior cavoatrial junction.Increasing left pleural fluid after line placement raises possibility of hemothorax.No definite pneumothorax.Right basilar opacities are suggestive of atelectasis and/or aspiration.Cardiac silhouette not well evaluated.

Output: 1.New left neck catheter may be malpositioned. Clinical correlation and possibly correlation with blood gases may be considered.2.Increasing left pleural fluid after line placement raises possibility of hemothorax.3.Right basilar opacities are suggestive of atelectasis and/or aspiration.Findings relayed via telephone to Dr. White at 3:48 AM on 8/2/2015.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with history of aortic stenosis presenting with syncope. Assess for presence of dissection. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Aortic annulus calcifications with poststenotic dilatation of the ascending aorta, measuring approximately 3.5 cm in AP dimension (series 9, image 59). No pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesions in the liver (series 9, images 133 and 159) are nonspecific; favor benign.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.

Output: Aortic annulus calcifications with poststenotic dilatation of the ascending aorta as above without evidence of dissection


Instruction: Generate impression based on medical findings.

Input: 48 years old Male. Reason: Potential infectious sources are Post obstructive PNA in pt with lung cancer History: see above. 2 portable chest x-rays with different radiographic appearances including this examination. Repeat of the study is recommended.

Output: Technically inadequate study. Repeat of the examination is suggested.


Instruction: Generate impression based on medical findings.

Input: 73-year-old man with metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Right lower lobe pulmonary nodule measures 8mm in diameter image number 68 on series number 5, stable. Subpleural bilateral nodules have slightly increased in size. Mild subpleural fibrotic changes are unchanged.MEDIASTINUM AND HILA: Right paratracheal index node measures 3.6 by 3.8 cm in image number 30 Rocco series number 3, increased in size compared to previous study. Right hilar lesion measures 4.6 x 2.6 cm on image number 42, series number 3, slightly increased in size compared to previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Soft tissue mass dorsal to the pancreas measures 3.1 by 2.1 cm on image number 91, series number 3, slightly increased in size.ADRENAL GLANDS: Left adrenal lesion measures 10.3 by 5.8 cm in image number 93, series number 3, stable. Right adrenal lesion measures 5 .6 by 2.9 cm on image number 89, series number 3.KIDNEYS, URETERS: Status post right nephrectomy. Multiple lesions in the left kidney are grossly stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right anterior abdominal wall soft tissue mass measures 9.6 by 4.7 cm on image number 135, series number 3, slightly increased in size compared to previous study.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: Left gluteal mass measures 4.9 x 4.1 cm on image number 160, series number 3, slightly increased in size compared to previous study.OTHER: No significant abnormality noted

Output: Slight interval increase in the size of the most of the index lesions.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: chest and back pain, bronchiectasis History: above No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year old male with right pneumothorax, pigtail tube placed Right pigtail catheter tip unchanged overlying the right upper lobe. Adjacent staples unchanged. Surgical hardware, sternotomy wires and orphaned AICD leads unchanged. Small residual right apical pneumothorax. Residual pneumomediastinum and persistent extensive subcutaneous emphysema is noted. Low lung volumes with increased left basilar atelectasis. Cardiomediastinal silhouette stable.

Output: Small residual right apical pneumothorax. Residual pneumomediastinum and persistent extensive subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Weight loss question evidence of malignancy. Normal heart size. No focal airspace opacities, visible nodules or masses. No pleural fluid or pneumothorax. Scoliosis.

Output: No acute cardiopulmonary abnormality or visible signs of malignancy.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: ETT History: same Support devices unchanged.Markedly decreased lung volumes with stable cardiomediastinal silhouette.Perihilar and basilar opacities are compatible with edema/atelectasis.Left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Support devices unchanged with ET tube tip 3 cm above the carina. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval pulmonary edema History: s/p cardiac surgery Left internal jugular central venous catheter with tip in the SVC. Three chest tubes are noted. Moderate cardiomegaly. Slight interval improvement of left pleural effusion. No pneumothorax.Persistent bibasilar atelectasis.

Output: Mild pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: Evaluate IABP position History: IABP placement Left sided ICD and change.IVC Swan-Ganz with its tip in the right pulmonary artery.IABP marker in the mid descending aorta.Stable cardiac enlargement.The lungs are clear.

Output: Support devices unchanged with IABP marker in the mid descending aorta. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p ECMO History: s/p ECMO ET tube tip approximately 2 cm above the carina.Other devices unchanged.Postoperative mediastinal widening and pleural thickening over the right apex compatible with hematoma.Cardiomegaly and basilar opacities compatible with atelectasis and small effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old history shortness of breath, wheezing, evaluate for pneumonia Interval resolution of right pleural effusion. Right paramediastinal fibrosis appearing stable from prior exams. Mild bibasilar atelectasis. No cardiomegaly.

Output: Interval resolution of right pleural effusion. Stable right paramediastinal fibrosis without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality. NG tube well advanced and projects into the distal stomach unchanged

Output: Unchanged NG tube positioning


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: patient with atypical chest pain History: evaluate for cardiomegaly or infiltrate No focal pulmonary opacities, pleural effusion or pneumothorax.Normal size heart.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: assess for infiltrate / opacity History: URI Right superior lateral rib deformities appear chronic. Partially calcified left mammoplasty. Evidence of prior cholecystectomy.Streaky basilar opacities compatible with subsegmental atelectasis. External tubing projects over the left apex. No consolidation, pleural effusion or pneumothorax. The heart size is normal. Deformity with an elevated left humeral head suggestive of rotator cuff injury, possible prior fracture at the humeral neck.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: s/p paraesophageal hernia repair and Nissan fundoplication History: see above No significant cardiopulmonary abnormality.Prior opacities have resolved.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: pna History: neutropenic AMS Right IJ venous catheter with its tip in the SVC.Additional catheter tubing is noted overlying the chest.The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: effusion History: no Left-sided chest tube is identified with its tip at the apex. No significant pneumothorax noted.The cardiomediastinal silhouette is unremarkable.Mild basilar scarring/discoid atelectasis.No pleural effusions.Minimal subcutaneous emphysema along with chest wall.

Output: Left-sided chest tube in place without evidence of a pneumothorax. Minimal basilar scarring/discoid atelectasis. No pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: cordis placement History: cordis placement Dense airspace opacities suggestive of acute edema or hemorrhage, slightly denser in the upper lung zones.ET tube tip approximately 4 cm above the carina.A Dobbhoff tube terminates in the stomach.Left jugular catheter tip in left brachiocephalic vein.Right jugular catheter, tip in SVC.

Output: Worsening pulmonary opacities. New left jugular catheter placement.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: trach placement? History: see above Interval conversion of an endotracheal tube to tracheostomy tube. Nasogastric tube is looped in the stomach and is directed cranially. There is evidence of prior embolization in the abdomen.When accounting for patient positioning, increasing size of large right pleural effusion with associated atelectasis. Small left pleural effusion remains. Improved aeration of the left lower lobe. No pneumothorax.

Output: Increased size of the right pleural effusion following tracheostomy tube conversion.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate/edema History: AMS, hypoglycemia, leg swelling Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with CHF, COPD presents with altered mental status, SOB and hypercarbic respiratory failure. LUNGS AND PLEURA: Endotracheal tube tip terminates at the level of the right mainstem bronchus; service contacted. This may account for the asymmetric bilateral basilar consolidation/atelectasis. The appearance is nonspecific and although possibly due to aspiration, infection must be considered.MEDIASTINUM AND HILA: Heart size within normal limits. Small pericardial effusion.CHEST WALL: Bilateral axillary lymph nodes are not enlarged by CT criteria.UPPER ABDOMEN: NG tube tip terminates in the stomach. No other significant abnormalities noted, however evaluation of solid organ pathology is limited secondary to lack of intravenous contrast.

Output: 1. Bilateral basilar consolidation/atelectasis possibly due to aspiration or infection.2. Endotracheal tube tip at the level of the right mainstem bronchus; the clinical service was notified at the time of interpretation by the radiology resident on call via stat consult.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with history of chronic lymphocytic lymphoma CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the left lower lobe, best seen image number 79, series number 6, unchanged. No other nodules.MEDIASTINUM AND HILA: Index right inferior paraesophageal lymph nodes measures 1.6 x 0.7 cm image number 45, series number 4, smaller compared to previous study.CHEST WALL: Index right chest wall/axillary lymph node is also smaller and less conspicuous and now measures 1.6 x 0.7 cm image number 18, series number 4. Other axillary lymph nodes are also smaller.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Mild splenomegaly, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts, not significantly changed.RETROPERITONEUM, LYMPH NODES: Index portacaval node measures 3.6 by 2-cm image number 111, series number 4, unchanged from previous study. Other smaller retroperitoneal lymph nodes also unchanged.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: Index right external iliac lymph node now measures 1.7 by 1 cm image number 192, series number 4, minimally smaller compared to previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Overall interval decrease in the size of the muscles the index lesions. Retroperitoneal lymph nodes are unchanged. Mild splenomegaly is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60 year old male with new cough s/p platelet transfusion History: cough s/p platelet transfusion. Unchanged position of sternotomy hardware and aortic valve prosthesis. Left upper extremity PICC overlying the cavoatrial junction.Cardiomediastinal silhouette within normal limits. No acute focal airspace opacity.No pneumothorax or pleural effusion. Right-sided pleural scarring again noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: evaluate for new source of infection; pleural effusions History: hypoxic respiratory failure Bilateral pleural effusions with basilar edema and left lower lobe consolidation not significantly changed.

Output: No change in pleural effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: s/p lobectomy History: asx Right chest tubes unchanged in position. Small right pneumothorax stable to marginally improved. Other findings stable.

Output: Small right pneumothorax stable to marginally improved.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.AMS, ? aspiration. Low lung volumes. No focal airspace opacities or signs of aspiration. Mild blunting of the left lateral costophrenic angle could indicate a very small pleural fluid collection but is nonspecific.

Output: No signs of aspiration. Questionable small left pleural fluid collection versus pleural scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Emergent intubation History: emergent intubation Low lung volumes makes detailed cardiopulmonary assessment difficult. Endotracheal tube terminates approximately 5 to 6 cm from the carina. Right-sided chest tubes again noted. Diffuse right-sided pleural parenchymal opacities with small amount of right-sided subcutaneous emphysema again noted. Left hemidiaphragm again elevated. Patchy left basilar opacities, unchanged.

Output: Endotracheal tube, as above. Stable pleural-parenchymal opacities, as above.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male with history of esophageal cancer with metastatic to the peritoneum. Complains of back pain and abdominal pain. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions unchanged from previous CT.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The amount of ascites is degrees within the interval. A reference pocket of ascites between the spleen and stomach now measures 8 x 6.6 cm. Extensive peritoneal carcinomatosis is unchanged. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral large pleural effusions, unchanged.Interval decrease in the amount of ascites. Extensive peritoneal carcinomatosis unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: 78M with postoperative pneumothorax s/p right nephrectomy History: tachycardia Decreased conspicuity of the left apical pneumothorax. Layering left pleural effusion. Mild left-sided subcutaneous emphysema again noted. Increase in right basilar atelectasis. Mild pneumoperitoneum, less apparent on this study. Unchanged heart size.

Output: Decreased conspicuity of the left apical pneumothorax. Layering left pleural effusion. Mild left-sided subcutaneous emphysema again noted. Increase in right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: post op, eval ETT, lung fields History: s/p TECAB Multiple chest tubes with no significant pneumothorax.No acute abnormality.ET tube tip approximately 4 cm above the carina.Right jugular catheter, tip in SVC.Left subclavian pacemaker, leads unchanged in position.An NG tube terminates in the stomach.

Output: No pneumothorax following surgery, and no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Hemoptysis. Hemopneumothorax with chest tube in place. Hardware and devices similar in position. The sidehole of the right chest tube again noted to be outside of the bony thorax.Minimal visible pneumothorax component on the right. The nonspecific right pleural fluid collection appears similar in volume. Pleural fluid and atelectasis on the left unchanged.

Output: No significant change in cardiopulmonary appearance. Right chest tube sidehole external to the bony thorax.


Instruction: Generate impression based on medical findings.

Input: 60 years old Male. Reason: chf; eval swan placement History: see above. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Patchy opacities are seen in the left lower lung. There are small bilateral pleural effusions. The support devices are stable in position. There is no evidence of pneumothorax.

Output: The above findings are consistent with CHF. Bilateral small pleural effusions. Superimposed infection in the left lower lung cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: sob Lines and tubes are unchanged. No substantial change in diffuse pulmonary opacities given differences in inspiration. Loculated pleural effusions, right greater than left again noted. Unchanged heart size.

Output: No substantial change in diffuse pulmonary opacities given differences in inspiration. Loculated pleural effusions, right greater than left again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval lung fields History: sob, cp Small lung volumes, with new basilar interstitial opacities consistent with edema.Small pleural effusions are present.No specific evidence of infection.Cholecystectomy clips.

Output: CHF with pulmonary edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval lung fields History: sob Large lung volumes consistent with COPD. Stable cardiomegaly. Status post sternotomy. Fractured sternal wires are unchanged.Slight interval increase in basilar interstitial opacity which may be due to mild edema. There may be small bilateral pleural effusions.

Output: Slight interval increase in basilar interstitial opacity which may be due to mild edema.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of right temporal melanoma metastases to right parotid and right neck. Evaluate for lung metastases. PET scan shows small pulmonary nodules. CHEST:LUNGS AND PLEURA: Few scattered micronodules bilaterally appear similar to comparison PET/CT. The largest nodule is in the lingula, measuring 6 mm (series 5, image 61), which was not FDG avid. No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild coronary calcifications.CHEST WALL: Mild degenerative changes of the spine. UPPER ABDOMEN: Left renal cyst.

Output: Scattered pulmonary nodules/micronodules, which are nonspecific. Metastatic disease cannot be excluded. Continued surveillance is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Evaluate for cardiopulmonary disease. History: Intubated on ventilator. Lines and tubes are unchanged. Patchy left basilar opacity again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Persistent patchy left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Chest pain, ACS. Study limited by motion artifact. Low lung volumes with bibasilar opacities likely representing atelectasis. No large pleural effusion or pneumothorax. The heart size is stable.Right chest ICD leads are unchanged in position. Median sternotomy hardware is noted.

Output: Bibasilar atelectasis. No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Abdominal pain No acute intrathoracic abnormality. Persistent abnormally dilated small bowel loops within the left upper quadrant not significantly changed from the prior study. No free air.

Output: No acute intrathoracic abnormality. Persistent abnormally dilated small bowel loops within the left upper quadrant not significantly changed from the prior study. No free air.


Instruction: Generate impression based on medical findings.

Input: 35 year old female with history of chest liver metastases from gist tumor CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma is almost replaced by numerous metastases. Index segment 8 lesion measures 6.8 by 6.2 cm on image number 84, series number 7 slightly increased compared to previous study. Enhancing component of this lesion is unchanged. Index segment 5 lesion measures 6.9 by 5.8 cm on image number 100, series number 7, again increased in size compared to previous study. Enhancing component of this lesion is also stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of perihepatic ascites, unchanged.PELVIS:Uterus: Left ovary is slightly enlarged with small cystic lesions. Further evaluation with pelvic ultrasound may be helpful.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval increase in the size of the hepatic lesions. Enhancing component of hepatic metastases is grossly stable.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old Reason: evaluate for mass or cyst in the left upper quadrant History: patient has point tenderness/pain at one specific location in left upper quadrant, small nodule vs cyst can be felt on exam in this area No masses were evident in the chest wall in the area of interest. Normal ribs and muscular planes identified.Deep to the chest and upper abdominal wall no fluid was seen. Normal splenic surface identified.

Output: No mass or findings to correlate to the area of pain, tenderness or palpable abnormality.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with head and neck cancer. CHEST:LUNGS AND PLEURA: Multiple scattered bilateral micronodules unchanged. No new lesions.MEDIASTINUM AND HILA: Common origin of the right brachiocephalic and left common carotid arteries (normal variant). Moderate calcified and noncalcified vascular disease of the aortic arch and it's branches. Moderate coronary artery calcifications. No pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe hemangioma, similar to prior.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild to moderate vascular calcifications of the abdominal aorta.

Output: 1) No evidence of metastatic disease.2) Atherosclerotic disease .


Instruction: Generate impression based on medical findings.

Input: Reason: PNA History: hypotension Moderate left ventricular cardiomegaly with a tortuous and mildly ectatic aorta, unchanged allowing for rotation.Mild right basilar atelectasis or scarring and no sign of pulmonary edema or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusion History: as above Diffuse chronic interstitial disease as previously described and characterized by CT scan.No visible evidence of pleural effusion or other acute interval change.Mild superior mediastinal widening compatible with lymphadenopathy unchanged.

Output: Chronic interstitial disease and lymphadenopathy with no acute change.


Instruction: Generate impression based on medical findings.

Input: IPF with acute chest and back pain. Left chest wall and neck subcutaneous emphysema. Moderate pneumomediastinum. Air lucency projecting over the left apex may reflect dissection of mediastinal air into the extrapleural space versus a tiny pneumothorax collection.Small fibrotic lungs. No visible new pulmonary opacities.

Output: Moderate pneumomediastinum and left chest wall subcutaneous emphysema. Air lucency projecting over the left apex may reflect dissection of mediastinal air into the extrapleural space or less likely a tiny pneumothorax collection.


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: MaleReason for Study: Reason: pectus excavatum History: pectus excavatum s/p Nuss Bar Chest stabilization hardware unchanged.Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath. Status post pneumonia (decreased white blood cells with antibiotics). Questionable mass on chest radiograph. On Coumadin for DVT. LUNGS AND PLEURA: Increasing bilateral pleural effusions, more on the left with loculated fluid along the major fissure and peripheral left upper lobe.Multiple air space opacities with air bronchograms in the left upper lobe and lingula, likely due to infectious process.Irregularly shaped opacity in the left lower lobe (image 44/series 6), which also shows air bronchograms, is also likely from infectious process.An isolated cyst is noted in the right upper lobe. Subsegmental atelectasis/scarring in the right middle lobe. A calcified nodule in the left upper lobe, likely a granuloma.MEDIASTINUM AND HILA: Severe calcifications along coronary vasculature. Extensive aortic calcification. Cardiac enlargement with small pericardial effusion. CHEST WALL: Anasarca. Diffuse mottled appearance in the vertebral bodies, which could be due to multiple myeloma.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Multiple airspace opacities on the left, consistent with infection. 2. Cardiomegaly. Increasing bilateral pleural effusions, left greater than right.3. Diffuse mottled appearance of the bones, which could be due to multiple myeloma.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Right IJ placement. Patient rotation and motion artifact limiting evaluation. Right jugular catheter directed towards the SVC. ETT tip roughly 3 cm above the expected level of the carina. Enteric tube tip beyond the caudal margin of the film. PH probe looped in the oropharynx.Significant basal aspiration on the right. Nonspecific retrocardiac opacity on the left, probably also a combination of aspiration and atelectasis.

Output: Right jugular catheter directed towards the SVC, no significant pneumothorax. Signs of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Preop evaluation; CABG. The cardiac silhouette is at the upper limits of normal in size. The hilar and pulmonary vascular are within normal limits. No air space opacity, pleural effusion, or pneumothorax. Multiple stents noted in the left axilla. Surgical clips noted in the epigastrium.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: post op, eval ETT, Lung fields History: s/p MVR, TVR Small lung volumes with mild basilar atelectasis.ET tube tip approximately 2 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Chest tubes in place with no pneumothorax.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female 20 years old Reason: chest tube in place, high peak pressures in 80s-90s, check for pneumothorax History: high peak pressures Tracheostomy cannula in place with tip terminating 4 cm above the carina.Remaining support tubes and lines unchanged.Small right pneumothorax unchanged.Diffuse bilateral interstitial opacities compatible with provided history of ARDS.No large pleural effusions identified.The cardiomediastinal silhouette is unremarkable.

Output: 1.Diffuse bilateral interstitial opacities compatible with reported history of ARDS.2.Bilateral chest tubes, with an associated small right pneumothorax, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate tube placement, worsening infiltrates History: post arrest ET tube tip approximately 3 cm above the carina.Enteric tube traversing the esophagus.Basilar opacities, greater on the left, compatible with consolidation, atelectasis and pleural effusions, not significantly changed, some of which may be secondary to aspiration.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: s/p pleurex catheter, now with desat. CT placed to waterseal earlier. Eval for interval change History: s/p pleurex catheter, now with desat. CT placed to waterseal earlier. Eval for interval change Lines and tubes are unchanged. Stable moderate right-sided pneumothorax. Low lung volumes makes detailed cardiopulmonary assessment difficult. Increase in diffuse pulmonary opacities. Unchanged heart size. Improvement in pneumoperitoneum.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Increase in diffuse pulmonary opacities, likely pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval infection, edema, effusion History: esrd missed hd Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size again at the upper limit of normal.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: 71 yo F with combined pulmonary fibrosis and emphysema. Patient just completed antibiotics and has persistent SOB. Evaluate for infiltrate, effusion. History: SOB Small lung volumes with diffuse severe chronic interstitial disease compatible with fibrosis and elevation of the right hemidiaphragm, unchanged from previous.Port catheter with its tip in the area of the SVC.No evidence of pneumonia or pleural effusion.

Output: Severe chronic interstitial disease with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval for pneumonia or pneumonitis History: persistent cough, construction worker Mild bibasilar subsegmental atelectasis or scarring. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Smoker. Fever and desaturation Extensive reticular changes greater in both bases with small effusions and questionable patchy opacities in both bases. Early edema superimposed upon extensive interstitial chronic scarring most likely. Cardiac and mediastinal contours are grossly within limits of the mild-to-moderate atherosclerotic disease

Output: Suspected mild edema superimposed on emphysematous changes and old chronic interstitial scarring


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64 y/o m with PICC line placed. Check placement of PICC History: see above Left PICC, the tip doubled back in the SVC or azygos.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

Output: New left PICC, double back in the SVC or azygos.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Cough History: Cough 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, 80 years old.Reason: eval for aspiration pneumonia History: same Interval removal of Dobbhoff tube. Hiatal hernia. No new opacity to suggest pneumonia. Left lower lobe atelectasis.

Output: No new opacity to suggest pneumonia. Left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.History of tracheotomy with stent. There is stable appearance of support devices and tracheal stent. The tip of the Dobbhoff tube is not visualized on this study. There is no change in the cardiopulmonary appearance with left basilar effusion and atelectasis.

Output: Unchanged examination with persistent left basilar effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.ET tube placement. ET tube tip is approximate 2 cm above the carina. Enteric feeding tube tip projects over the distal stomach. Low lung volumes with left basilar and retrocardiac consolidation.

Output: ET tube tip 2 cm above the carina. Left basilar and retrocardiac consolidation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 66 year old male. History of uroepithelial cancer. Evaluate for recurrence. This examination is limited by the absence of intravenous contrast.CHEST:LUNGS AND PLEURA: Calcific granulomas are unchanged. No acute infiltrates or effusions.MEDIASTINUM AND HILA: Stable mild pericardial thickening since the prior examination.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small left adrenal nodule is unchanged. This is hypodense and compatible with a benign adenoma.KIDNEYS, URETERS: Moderate hydronephrosis and hydroureter on the left side has resolved. Previously described moderate right hydronephrosis has resolved. The percutaneous nephrostomy catheter and double J stent in the left ureter has been removed.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes are unchanged. The reference lymph nodes measures 8 by 8 mm on image number 117/216. No new nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Orthotopic neobladder. Surgical anastomosis identified.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pna History: pleuritic R chest pain, R-sided crackles Mild cardiomegaly with a mitral valve ring in place. Small lung volumes with linear scarring at the right lung base. No specific evidence of pulmonary edema or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: screen for active TB in patient with hx of exposure and treatment History: screen for active TB in patient with hx of exposure and treatment No new focal lung consolidation. Calcified granuloma again noted at the right lung base. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: central line insertion History: none Endotracheal tube tip approximately 2 cm above the carina. New right IJ central venous catheter with tip projecting or the mid SVC. Left IJ central venous catheter remains oriented laterally likely in the left subclavian veinPartially obscured cardiac silhouette is grossly unchanged.Low lung volumes with mild bibasilar atelectasis, right greater than left.Feeding tube tip overlying the epigastric region pointing cephalad.

Output: New right IJ central venous catheter with tip overlying the mid SVC.Feeding tube tip overlying the epigastric region pointing cephalad.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: IABP Placement History: IABP placement Moderate cardiomegaly with small lung volumes.No specific evidence of infection or edema.IABP catheter proximal marker 3 cm below the top of the aortic arch.Left jugular Swan-Ganz catheter tip in main pulmonary artery slightly pulled back.Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter slightly pulled back, otherwise stable support devices. Cardiomegaly without acute edema.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Hemothorax. Bilateral pleural effusions, with underlying atelectasis, not significantly changed. Mild to moderate vascular congestion, unchanged.Dialysis catheter tip in the SVC. Right pleural pigtail catheter is unchanged in position.No new findings.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male status post bilateral lung transplant, bronch, BAL with transbronchial biopsy. Rule out pneumothorax. Postsurgical changes of bilateral lung transplant. Bibasilar opacities likely scarring or atelectasis. No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Assess atrial lead placement Left chest wall dual-lead ICD with leads in RA and RV, unchanged compared to 7/7/2015. The cardiac silhouette is unchanged. Mild basilar interstitial opacity without evidence of infection or edema. No pleural effusions.

Output: ICD leads in the RA and RV, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Central venous catheter Patient has been extubated. Other lines and tubes, unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar pleuroparenchymal opacities, not substantially changed. Unchanged cardiomegaly. No pneumothorax.

Output: Basilar pleuroparenchymal opacities, not substantially changed.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and history of asthma No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with history of paravesicular endothelial carcinoma CHEST:LUNGS AND PLEURA: Increasing right pleural effusion. Decreasing left pleural effusion. Micronodules unchanged.MEDIASTINUM AND HILA: Index on the right the lymph nodes at the level of the great vessels measures 2.1 x 1.6cm (image 11; series 4), equivocally decreased in size. Other extensive cardiophrenic and posterior paramediastinal lymph nodes roughly stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic metastases. For reference purposes, there is a 3.4 x 2.9 cm index lesion in the right lobe (image 78; series 4).SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic or peripancreatic lesion measures 5.4 x 4 .1 cm, slightly enlarged (image 91; series 4).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephrostomy catheters catheters. Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: Index hepatogastric lymph nodes has increased in size and measures 2.6 x 2.0 cm (image 82; series 4). Reference left para-aortic lymph nodes measures 5.2 x 4.4 cm (image 132; series 4), slightly enlarged..BOWEL, MESENTERY: Significant interval worsening of the peritoneal carcinomatosis and increasing ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Increasing ascites as noted above.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.BLADDER: Bladder compressed by tumor.LYMPH NODES: Index right internal iliac node cannot be well differentiated from the surrounding soft tissues but it has increased in size and measures 8.5 x 5.3 cm (image 173; series 4).BOWEL, MESENTERY: Interval worsening of the peritoneal carcinomatosis. Previously measured mesenteric mass has increased in size and now measures 11.4 x 5.4 cm (image 163; series 4).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anasarca

Output: Overall worsening of disease with measurements given above.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Assess for metastasis, recurrence, known BHD syndrome, history of right partial nephrectomy that revealed chromophobe RCC History: see above No significant cardiopulmonary abnormality.No evidence of metastases.Known cystic lung disease not visualized by conventional radiography.

Output: No significant abnormality by conventional radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: assess chest tube placement, right sided effusion History: chest tube The cardiomediastinal silhouette is unremarkable.Moderate size right pleural effusion and underlying right basilar atelectasis.Mild left perihilar interstitial opacities suggestive of edema.Catheter is identified with its tip in the right lower hemithorax.Moderate size right apical pneumothorax.

Output: Right hydropneumothorax and underlying basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Cardiac arrest, cause unspecified. ETT tip 2 cm above the level of the carina. Nasogastric tube projects over the left upper quadrant.No pneumothorax. Biapical and left basal scarring. Pleural plaque at the left base. No specific signs of pulmonary edema. Volume loss in the lung bases appears unchanged. Small focal opacity along the left hemidiaphragm medially nonspecific and could be a focus of aspiration. Interval removal of surgical staples in the abdomen. Surgical clips near the midline abdomen unchanged.

Output: New left basal focal opacity suspicious for aspiration. ETT tip 2 cm above the level of the carina, consider repositioning.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with a history of Non-Hodgkin's lymphoma. Status post chemotherapy and auto CT 8/5/09. Evaluate for disease response to transplant. Compare to prior. CHEST:LUNGS AND PLEURA: There is bibasilar atelectasis with patchy infiltration of the bases bilaterally and the lingula, correlate clinically for signs of infection. The previously seen left lower lobe lobe nodule is unchanged. There are no new pulmonary nodules.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: A port is seen in the soft tissues of the right chest wall. A triple lumen catheter overlies the left chest wall. LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable calcifications along the dome of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Bibasilar atelectasis with patchy infiltration of the bases bilaterally and the lingula, correlate clinically for signs of infection.2. Stable lower lobe lung nodule


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: infection History: weakness No significant cardiopulmonary abnormality.No specific evidence of infection or edema.Cholecystectomy clips and IVC filter noted.Prior right jugular catheter removed.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: s/p attempted IVCF removal History: dyspnea Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: FemaleReason for Study: Reason: pneumonia s/p azithromycin with continued symptoms History: cough, fever, chest pain The cardiac mediastinal silhouette is unremarkable.Interval improvement in the left basilar opacity noted on the prior exam.Minimal residual scarring/discoid atelectasis in this region.No new pulmonary opacities identified.No pleural effusions.

Output: Interval improvement in the left basilar opacity noted on the prior exam. No new pulmonary opacities identified.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: 71M s/p cardiac surgery History: s/p cardiac surgery Status post sternotomy. Cardiopulmonary monitoring and support devices are unchanged. Small right pleural effusion. No pneumothorax. Basilar atelectasis and low lung volumes.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of aggressive delta alpha T cell lymphoma developed anaplastic large cell lymphoma. Status post chemoembolization with ifos/etoposide/Rituxan. Complains of abdominal pain and fevers. Firm tender right abdominal nodule and left popliteal fossa nodule. Concern for disease progression. Please evaluate for increased lymphadenopathy. CHEST:LUNGS AND PLEURA: Scattered 2- to 3-mm micronodules which probably represent prior infection/inflammation. Right lower lobe calcified granuloma is unchanged. No acute infiltrates or effusions.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion. No significant hilar or mediastinal lymphadenopathy.CHEST WALL: Thrombosis of the right subclavian vein is noted on axial image 16/216. This has been present on prior exams. Bulky bilateral axillary lymphadenopathy is improved. A right axillary index lesion measures 1.8 x 2.2 cm on axial image 27/216 and is smaller when compared to the prior exam. An index left axillary lymph node measures 1.5 x 1.6 cm on axial image 28/216 and is smaller.ABDOMEN:LIVER, BILIARY TRACT: The liver remains enlarged measuring approximately 22 cm on coronal images. No focal liver lesions. Calcified gallstones are unchanged. No evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical defect in the right kidney is unchanged on axial image 96/216. Stable cystic lesions bilaterally.RETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes are generally smaller when compared to the prior exam. A left para-aortic index lesion measures 1.1 x 1.5 cm on axial image 108/216 and is smaller when compared to the prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative disease affects the spine. There is diffusely asymmetric right greater than left lateral pelvic musculature involving the gluteus which was present previously. No discrete lesions were found. The possibility of infiltrative changes cannot be excluded.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The uterus is enlarged with multiple heterogeneous masses, some of which are calcified, most likely representing fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: Bulky bilateral inguinal lymphadenopathy again noted. Prior index lesions are not included within the region of the scan. For comparison, however, a left external iliac node measures 1.6 x 2.3 cm on axial image 165/216. When compared to the prior exam of 4/27/08, this lesion is smaller.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is diffusely asymmetric right greater than left lateral pelvic musculature involving the gluteus which was present previously. No discrete lesions were found. The possibility of infiltrative changes cannot be excluded. These findings are seen best at axial image 20/216 on the present examination and axial image 27/212 the prior examination. If indicated, MRI examination may be helpful for further evaluation.OTHER: No significant abnormality noted.

Output: Stable right subclavian vein thrombosis.Stable hepatomegaly.Interval decrease in lymphadenopathy as described above.No new lesions. Asymmetric gluteal musculature, right greater than left may represent infiltrative change or other etiology. If indicated, MRI examination may be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Reason: 62 y/o M with head and neck cancer here for chemotherapy. reports mild cough. please evaluate for a pulmonary process History: cough Unremarkable cardiac and mediastinal silhouette. Port catheter with its tip in the SVC.Large lung volumes consistent with COPD.No sign of pneumonia or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: infection? volume status? cough and fever on peritoneal dialysis History: as above Postop change right shoulder. Interval removal of venous catheter.No acute cardiopulmonary abnormality. Calcified granulomas.

Output: No evidence of significant pulmonary edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old, smoker with cough and weight loss. Questionable density in the left upper lobe on chest x-ray. LUNGS AND PLEURA: Severe centrilobular emphysema. Biapical scarring. Although no specific finding is seen to account for the abnormality noted on the recent chest film, scattered bilateral micronodules are evident, the largest of which measures 6 mm in the right upper lobe (axial image 21/106). CT follow-up is recommended within 3 to 6 months.MEDIASTINUM AND HILA: The cardiac size is normal. No pericardial fluid. Aortic and coronary artery atherosclerotic calcifications.No pathologically enlarged hilar or mediastinal lymph nodes.Small hiatal hernia.CHEST WALL: Status post mastectomy on the right.UPPER ABDOMEN: Hypoattenuating lesion in segment 8 is incompletely evaluated but probably represents a benign cyst.The left adrenal gland is mildly thickened.

Output: Severe emphysema and scattered pulmonary micronodules. In a high-risk patient, short term CT follow-up in 3 to 6 months is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval et tube placement History: tubed Large right pleural effusion with increasing right basilar opacification.Hyper expanded but clear left lung.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip in SVC.

Output: Enlarging right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval for PNA History: L sided weakness Mild cardiomegaly. No focal lung opacity. No pulmonary edema. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male 30 years old Reason: ? Infiltrate History: Cough and LLL aching Cardiomediastinal silhouette is unremarkable. No focal opacity or pleural effusion. Nonspecific mild bronchial wall thickening.

Output: Nonspecific mild bronchial wall thickening. No specific evidence of pneumonia..


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with fever. Evaluate for infection. Moderate cardiomegaly with increased upper zone blood flow, consistent with sickle cell disease.Chronic left basilar streaky opacities, consistent with scarring.No focal pulmonary consolidation or pleural effusion.Components of bilateral shoulder hemiarthroplasties are visualized.Right upper quadrant surgical clips are noted.

Output: Moderate cardiomegaly without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: ET tube position History: parapneumonic effusion Mild left base subsegmental atelectasis, the lungs otherwise unremarkable.ET tube tip approximately 2 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with dysphagia. Evaluate for extrinsic esophageal compression. CHEST:LUNGS AND PLEURA: Scattered nonspecific micronodules. No suspicious nodules, masses, or pleural effusion.Left greater than right basilar scarring. Mild to moderate upper-lobe predominant centrilobular emphysema. Mild subpleural reticulation and fibrosis also noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Ectatic descending aorta impresses on the posterior aspect of the esophagus without upstream esophageal dilatation. No abnormal mass causing extrinsic compression of the esophagus identified.Heart size normal without pericardial effusion. Severe calcifications of the left circumflex artery.Left thyroid nodules.Multiple surgical clips are seen near the GE junction.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Multiple small retroperitoneal lymph nodes are partially visualized. Atherosclerotic disease of the descending aorta with partial visualization of an endovascular stent.Approximately 50% collapse of the L1 vertebral body.

Output: 1. No evidence of extrinsic esophageal compression. If further evaluation for dysphagia is clinically warranted, consider a fluoroscopic esophagram.2. Mild subpleural fibrotic changes in the lungs.3. L1 vertebral body compression fracture of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p esophagectomy History: same Basilar opacities unchanged possibly from aspiration, unchanged.Small post op pneumoperitoneum.An NG tube extends below the lower margin of the image.Left subclavian ICD, leads unchanged in position.

Output: Unchanged basilar opacities possibly from aspiration.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: worsening hypoxemia History: see above New endotracheal tube tip 3 cm above the carina.NG tube tip terminates in the fundus of the stomach.Patchy bibasilar and perihilar interstitial and airspace opacities and small bilateral pleural effusions not significantly changed.Mild cardiomegaly unchanged.Gaseous distention of the colon and stomach better appreciated on subsequent CT examination.

Output: Pulmonary edema secondary to CHF not significantly changed. Interval intubation with ETT tip 3 cm above the carina.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: R/o pneumonia History: SOB, wheezing Large lung volumes with patchy bilateral mainly upper zone opacity is consistent with scarring, bronchiectasis and bronchiolitis, not significantly changed from previous. The findings are consistent with a history of sarcoidosis.Unremarkable cardiac and mediastinal silhouette.

Output: Chronic pulmonary abnormalities consistent with sarcoidosis and bronchiectasis but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female newly diagnosed high grade leiomyosarcoma of the vulva. status post surgical [illegible]. Outside CT 10/07 pulmonary nodules right lung. Evaluate pulmonary nodules or evidence metastatic disease CHEST:LUNGS AND PLEURA: Few nodules seen throughout the right lung there is largest nodule is probably in the right middle lobe seen on image 30 34/90 and measures 8.7 x 8.7 mm. Examples of other nodules seen in the right lobe include two other nodules seen on image 34, two nodules seen on image 43, a nodule on image 45 in the right base. Punctate nodule left CP angle image 65. Many of these were annotated with circles for identification.There are no pleural effusions.MEDIASTINUM AND HILA: Scattered small mediastinal nodes none are pathologic by size criteria. There is also a small right cardiophrenic node.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There are two clusters of lesions in the liver. There are a few scattered punctate nonspecific hypodensities. There are also other lesions that are hypoattenuating with peripheral nodular hyper attenuating areas suggestive of hemangioma. The largest is in the medial segment of the left lobe image 84 measuring 2.3 x 1.8 cm. A second probable hemangiomas seen in segment 7 image 69 measuring 1.3 x 0.9 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.KIDNEYS, URETERS: Parapelvic cysts on the left. Kidneys otherwise normal.ADRENAL GLANDS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small shotty nodes none significant by size criteria. Some distortion to a rotatory dextroscoliosis of the lumbar spine. Surgical clips left retroperitoneum infrarenal.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. Specifically, no lytic or blastic disease.OTHER: Full extent of the vulvar lesion seen on MR is not included in the CT. Note that the issue rectal fossa fat perirectal fat are normal. No evidence of ascites.

Output: Two clusters of lesions in the liver several hemangiomas and other small nonspecific hypodensity that can be followed. Multifocal lung lesion suspicious for metastatic disease. Small mediastinal nodes can be followed on a pathologic size criteria. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Possible pneumonia in left lung base History: Cough for 1 week The heart is normal in size.Left upper lobe focal irregularly-shaped opacity with a pleural tag, not seen on prior studies and concerning for a pulmonary nodule.No radiographic findings to suggest pneumonia, as clinically questioned.The pleural spaces are within normal limits.No osseous lesions are present.

Output: Findings suspicious for left upper lobe irregularly-shaped pulmonary nodule. In the setting of smoking history, further characterization with nonemergent chest CT is recommended.No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest pain Interval resolution of previously observed failure and persistent diminished lung volumes and mild nonspecific cardiomegaly. Minimal atelectasis and/or chronic interstitial changes/scarringNo discrete effusions. Midline sternotomy

Output: Cardiomegaly without discrete additional superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral small ovarian cysts, not significant changed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT eval History: intubated in MICU ET tube tip approximately 2 cm above the carina. Bilateral mainly perihilar and lower zone airspace and interstitial opacity compatible with edema or aspiration, increased since the previous day.Severe upper zone emphysema.Small bilateral pleural effusions.NG tube tip in the stomach.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with history of cough and shortness of breath. Fibrosis seen on outside CT. LUNGS AND PLEURA: Asymmetric lung volumes slightly decreased on the left. Bilateral, predominantly peripheral areas of chronic coarse interstitial markings with a reticulonodular pattern greater at the lung bases. Mild paraseptal emphysematous changes most pronounced in the right lower lobe. Compressive atelectasis in the left lower lung. No frank evidence of superimposed acute process given background of pulmonary fibrosis.MEDIASTINUM AND HILA: Extensive coronary artery calcifications are noted. Mild to moderate cardiomegaly with enlarged left ventricle. Enlarged mediastinal lymph nodes with reference precarinal lymph node measuring 1.7 x 1.4 cm as seen on image 43/101 and para-aortic lymph node measuring 1.3 cm in short axis. Ectatic, tortuous descending aorta with extensive atherosclerotic disease.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Chronic underlying pulmonary fibrosis.


Instruction: Generate impression based on medical findings.

Input: 83 years old Female. Reason: eval for infiltrate/edema History: sob. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There are stable basilar interstitial changes. There is a new nodular opacity in the right the low lobe abutting right hemidiaphragm. The Port-A-Cath is stable in position.

Output: Cardiomegaly. New nodular density in the right lower lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: pna, edema, effusion, hardware History: sob Median sternotomy with basilar edema and retrocardiac atelectasis with small pleural effusions, slightly worse.Left PICC, looped near its tip probably in the azygos vein.Left jugular catheter tip in left brachiocephalic vein.

Output: Slight worsening of basilar edema and atelectasis. PICC tip still looped in the azygos.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: fever, looking for source of infection History: fever Heart size upper normal.Previously seen edema like opacities have nearly resolved, with a residual small left pleural effusion.No specific evidence of infection.

Output: No specific evidence of infection. Improvement of prior pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: cough, chest congestion, HbSS. Evidence of PNA? Acute chest? History: cough Right chest port terminates in the right atrium. Low lung volumes. Unchanged scarring. No focal pulmonary opacities. The cardiomediastinal silhouette is stable. Skeletal deformities consistent with sickle cell, unchanged.

Output: No focal pulmonary opacity to suggest infection.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old. Crackles at the bases. Mild perihilar and basilar streaky atelectasis. No pleural effusion.Gastrostomy tube. Right chest port tip at the cavoatrial junction.

Output: Mild perihilar and bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: MaleReason for Study: Reason: eval lung opacities History: intubated Motion limits sensitivity.Inferior portion of the chest is not included on the image. Tracheostomy tube and bilateral central venous catheters unchanged.Stable cardiac enlargement with perihilar opacities compatible with edema.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p diaphragm resection History: diaphragm resection Unremarkable cardiac and mediastinal silhouette. Port catheter with its tip in the SVC.Streaky basilar opacities compatible with atelectasis and probable small right effusion.

Output: Mild basilar atelectasis and probable small right effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Status post CABG evaluate ETT and lung fields. Interval placement of mediastinal and pericardial drains as well as a left basal chest tube. Right jugular Swan-Ganz catheter tip at the right main pulmonary artery level.No pneumothorax.Basal atelectasis and small pleural effusions.

Output: Mild basal atelectasis and small pleural effusions. No endotracheal tube is identified.


Instruction: Generate impression based on medical findings.

Input: Jaw pain, shortness of breath diaphoresis cough and malaise Mild bilateral basilar interstitial changes, presumed likely chronic without a definite superimposed new airspace abnormality. Old scarring along the minor fissure.Mild tortuosity of the aorta without definite cardiac focal abnormality.Extensive cholelithiasis

Output: Residual chronic scarring without acute superimposed disease


Instruction: Generate impression based on medical findings.

Input: Reason: eval for intrapulmonary process History: acute onset chest pain and dyspnea Unremarkable cardiac and mediastinal silhouette.Healed right rib fracture.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Assess for leak, pneumonia post esophagectomy History: Bilateral chest tubes Nasogastric tube terminates at the level of the carina, occupying gastric interposition. Bilateral apically directed chest tubes, sternal wires and skin staples at the left thoracic inlet are in stable position.Diffuse opacities throughout the left lung. Small pleural effusions. Mediastinal width is stable. Lucency in the left upper abdominal quadrant may represent pneumoperitoneum. This can be assessed with upright abdominal radiograph when the patient can tolerate.

Output: Mildly widened mediastinum which is unchanged compared to prior following esophagectomy. Possible pneumoperitoneum which can be confirmed with upright abdominal radiograph when the patient can tolerate.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Scattered bilateral metastatic nodules are again seen. Referenced nodule on image number 64, series number 4 is enlarged measuring 15 x 14 mm in the right lower lobe. Number all of the metastatic nodules have also increased in the interval.MEDIASTINUM AND HILA: Reference right retrocrural lymph node measures 15 x 12 minutes on image number 85, series number 4. Other small mediastinal lymph nodes are also unchanged.CHEST WALL: Chest wall metastases on the right measures 14.5 by 10.2 cm, significantly enlarged in size. Axillary adenopathy and other chest will metastases have also increased in size.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal mass measures 3.5 x 3.3-cm image number 96, series number 4, not significantly changed from previous study. Prominent right adrenal gland is unchanged.KIDNEYS, URETERS: Status post right nephrectomy. Interval minimal increase in the size of the posterior mass in the upper pole of the left kidney measuring 15-mm on image number 104, series number 4. Simple appearing cyst in the upper pole and lower pole left kidney are unchanged.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy. Referenced precaval lymph node measures 2.6 x 2 cm image number 132, series number 4. Other lymph nodes are also minimally increased in size.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: Subtle lytic lesions in the pelvic bones are unchanged. New enhancing soft tissue nodule in the right gluteal region measuring 14 x 12 minutes on image number 160, series number 4.OTHER: minimal left hydrocele.

Output: Interval progression of disease with increase in size and number of lung nodules, chest wall metastases, and size of left renal mass.Retroperitoneal and left adrenal metastatic disease and mediastinal adenopathy are unchanged.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of renal cell carcinoma CHEST:LUNGS AND PLEURA: Bilateral lung masses consistent with metastatic disease. Large, lobulated mass in the right lower lobe measures 5.2 by 4.9 cm on image number 51, series number 10278. Left lower lobe atelectasis. Small bilateral pleural effusions. Right-sided pleural calcification.MEDIASTINUM AND HILA: Mediastinal adenopathy measuring 1.3 by 1.7-cm in image number 32. Other mediastinal adenopathy is also present.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: 1.9 x 1.6 cm hypodense lesion in the right lower liver. Etiology is unknown.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Erosive changes affecting the endplates of L3 and L4 vertebral bodies with enhancing soft tissue lesion centered on the disk space. These findings are suspicious for spondylo-diskitis. Further evaluation with MRI of the lumber spine is recommended.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral lung metastases. Mediastinal likely metastatic adenopathy.Indeterminate liver lesion. MRI may be helpful for further evaluation.Possible swallowed diskitis affecting the lower lumber spine. MRI is recommended for further evaluation and time to exclude metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: R-sided chest pain x1 day; eval for infiltrate, edema History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Acute respiratory failure Interval removal of the NG tube and ETT with otherwise associated progressing mixed interstitial and airspace opacities demonstrating increased confluence, greater in both bases and on the right. . No definite interval change in the borderline cardiomegaly and mediastinal contours.

Output: Increasing nonspecific patchy opacities, concerning for increasing edema versus infection, as described


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: pre-op eval History: down syndrome Small lung volumes with increased interstitial markings, unchanged.Mild cardiomegaly noted.No specific evidence of infection.

Output: Small lung volumes with mild cardiomegaly, unchanged.


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed colon cancer post colectomy. CHEST:LUNGS AND PLEURA: A hazy 6 -mm nodule is seen in the left lung base (series 4, image 61). Calcified granulomas are seen in the left upper lobe.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes are identified. No mediastinal adenopathy is visualized. A borderline enlarged 1.4 x 1.0 cm left axilla lymph node is seen (series 3, image 25).CHEST WALL: No significant abnormality noted.1.4 x 1.3 cm hypodense nodule in the right lobe of the thyroid glandABDOMEN:LIVER, BILIARY TRACT: The liver is mildly enlarged. Numerous stones are seen within the gallbladder.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: A partial colectomy has been performed with a double barrel ostomy in the left mid abdomen.BONES, SOFT TISSUES: A midline surgical defect is seen in the anterior abdominal soft tissues.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Distortion of the uterus and is compatible with fibroids. A 2.8 x 1.6 cm cystic lesion is seen in the right adnexa.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A ring-enhancing fluid collection is seen in the perirectal region, measuring 3.1 x 1.6 cm. Adjacent surgical clips are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The left common femoral vein is dilated when compared to the right: evaluation of thrombus is not possible due to the phase of the study.

Output: Partial colectomy.Ring enhancing fluid collection in the pelvis, likely postsurgical (seroma versus abscess. Cystic right adnexal lesion. This could arise from the right ovary versus being a postsurgical fluid collection. Follow-up transvaginal ultrasound may beneficial.Nonspecific subcentimeter pulmonary nodule and borderline enlarged left axillary lymph node: Follow-up in 6 months may be beneficial


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: pna? History: cough, wheezing, sob No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: r/o PNA, pleural effusion History: hx met colon CA, tachycardic, hypoxic, SOB Right mid and lower lung zone opacity with a right pleural effusion.Small left pleural effusion.Heart size is likely normal.Right jugular catheter, tip in SVC.

Output: Right mid and lower lung zone opacity possibly infection although underlying tumor is possible and a thoracic CT is recommended for follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: interval change, right lower lobe opacity, bilateral effusions History: as above Catheter tip in the SVC. Bilateral airspace and interstitial opacities with moderately large pleural effusions, slightly increased compared to previous, suggestive of CHF.

Output: Increasing pleural effusions with pulmonary edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: assess change in consolidation, now febrile History: as above Right perihilar airspace opacity, unchanged or slightly improved, suggestive of aspiration pneumonia.Small bilateral pleural effusions.Catheter tip in the SVC.

Output: Right perihilar airspace opacity suggestive of aspiration, unchanged or slightly improved compared to previous.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of right breast cancer status post mastectomies with recurrence in the right chest wall status post chemotherapy. Evaluate response for surgical planning. A targeted right ultrasound was performed in the location of the known right chest wall recurrence. A biopsy clip has been placed since the prior examination which is visualized sonographically. Surrounding the biopsy clip is a subtle elongated area of mildly decreased echogenicity measuring approximately 2.4 x 0.2 cm in transverse dimension and 1.1 cm in longitudinal dimension, appearing less conspicuous compared with the prior ultrasound examination. This area does not demonstrate vascularity on color Doppler imaging.

Output: The patient's known chest wall recurrent neoplasm appears slightly decreased in size and conspicuity sonographically. Please see MRI performed the same day for further characterization. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Weight loss, brain lesion CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Small amount of fluid and inflammatory changes in the right axilla, right chest wall and right supraclavicular region. The etiology is unknown.ABDOMEN:LIVER, BILIARY TRACT: Simple cyst in the left lobe liver. Punctate hypodensities in the liver, too small to accurate characterize but are most like a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Block midthoracic vertebral bodyOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.Small amount of fluid/inflammatory changes in the right axilla, supraclavicular region and chest wall, the etiology is unknown.


Instruction: Generate impression based on medical findings.

Input: 66 yo female with shortness of breath. Evaluate for pneumothorax. Scattered areas of subsegmental atelectasis. No focal airspace opacity, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette. Note that the previously visualized right middle lobe opacity is not well-seen on the current exam.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: sob History: sob Right chest port catheter terminates at the superior atriocaval junction.Basilar predominant interstitial opacities appear similar to the prior examination. Unchanged bilateral pleural effusions. No pneumothorax. Heart size is normal.Partially imaged abdominal catheter and stent. Gaseous distention of stomach.

Output: No significant change in bibasilar opacities likely reflecting atelectasis with superimposed edema and aspiration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: Swan positioning History: Swan positioning Support devices unchanged with right IJ Swan-Ganz tip in the pulmonary artery.Stable cardiac enlargement.No focal areas of consolidation. No new pulmonary opacities noted.Mild blunting the right costophrenic angle.

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


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval OG tube History: see above Marked distention of the stomach increased from last study. Enteric tube terminates within the stomach. Endotracheal tube, unchanged. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax. Small amount of pneumoperitoneum, likely postoperative.

Output: Marked distention of the stomach increased from last study. Enteric tube terminates within the stomach.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: SOB, probably CHF< fluid overload History: SOB Left-sided pacemaker with lead wires in the right atrial appendage and right ventricle.The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Cardiomegaly with mild-to-moderate pulmonary edema, unchanged.IABP catheter tipAt the top of the aortic arch. IVC Swan-Ganz catheter tip in main pulmonary artery.Tracheostomy tube tip approximately 6 above the carina.Right jugular catheter tip in SVC and a left jugular in the left innominate vein at the midline.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Cardiogenic shock, IABP placement. IABP marker projects more inferiorly, now at the level of T7/T8.Right jugular Swan-Ganz catheter unchanged in position. Left subclavian single lead ICD unchanged.Cardiomegaly.Slight vascular unsharpness suggestive of hypervolemia, but no signs of pulmonary edema.

Output: IABP now projects at the level of T7/T8.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with history of tobacco use and 8mm left upper lobe nodule. CHEST:LUNGS AND PLEURA: Minimal upper lobe centrilobular emphysema. No suspicious nodules, masses, or pleural effusion.Previously seen 8mm nodular density in the left upper lobe likely represented summation artifact from superimposed structures.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: Minimal upper lobe centrilobular emphysema. Otherwise, no significant abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Status post cardiac surgery. Mitral insufficiency history. Right jugular introducer appears kinked at the skin insertion site.Right chest tube extends over the lung apex to terminate medially in the cardiophrenic angle region. Mitral prosthesis noted.Paramediastinal opacity in the right lung likely atelectasis or postoperative contusion, but there is no conclusive pneumothorax. The left lung is clear.

Output: No conclusive pneumothorax. Mild opacity in the right cardiophrenic angle region likely a combination of atelectasis and postoperative contusion.