Instruction: Generate impression based on medical findings.

Input: 63-year-old female status post R IJ Interval placement of right IJ central venous catheter with tip at confluence of brachiocephalic veins. Endotracheal tube tip 4 cm above the carina. Left chest tube unchanged. Enteric tube tip extends beyond the inferior margin of the image.Left lower lobe consolidation/atelectasis unchanged. Right basilar atelectasis. No pneumothorax.

Output: Interval placement of right IJ central venous catheter with tip at confluence of brachiocephalic veins.


Instruction: Generate impression based on medical findings.

Input: ET tube repositioned ETT repositioned, tip currently now projects 4 cm above the carina. NG remains coiled in the proximal stomach. Left jugular catheter extends into the SVC just beyond the confluenceUnderlying cardiopulmonary appearance is similar without new abnormality. Basilar atelectasis with questionable retrocardiac consolidation with low lung volumes

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: eval for edema History: h/o CHF with lower leg swelling and SOB The cardiomediastinal silhouette is within normal limits. Mild pulmonary vascular engorgement.No focal consolidation, significant pleural effusion or pneumothorax.

Output: Mild prominence of the pulmonary arteries without significant evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Fever, somnolent. Unchanged appearance of the cardiomediastinal silhouette. No pleural fluid or pneumothorax.Soft tissue artifact from skin folds bilaterally limiting assessment for pulmonary pathology in these areas.Asymmetric density of the left apex inconclusive but most likely the result of skeletal summation artifact.Chronic calcified pulmonary nodules, mediastinal and hilar lymph nodes.

Output: No visible signs of pneumonia however image interpretation is limited by bone and soft tissue artifacts. Suggest follow-up PA and lateral chest radiographs when feasible to exclude underlying pathology.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: ? pneumonia History: fever Right-sided pacemaker and left PICC line unchanged.Stable cardiomediastinal silhouette with extensive atherosclerotic changes of the aorta.Interval improvement in basilar atelectasis.No new focal areas of consolidation.

Output: Interval improvement in basilar atelectasis. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: please eval for worsening pulm edema History: tachycardia, tachypnea Cardiomegaly with small lung volumes.Previously seen pulmonary opacities may have slightly improved with the findings.Right jugular catheter, tip in SVC.

Output: Cardiomegaly, with a slight improvement in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval for infxn, device History: fevers Cardiomegaly without edema.Left subclavian pacemaker leads unchanged, with new right subclavian ICD leads and generator upgrade.Right jugular catheter tip in SVC.

Output: No specific evidence of infection. ICD upgrade since the prior study. Cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Swan-Ganz catheter Swan-Ganz catheter terminate within the right pulmonary artery. Superior margin of the intra-aortic balloon pump terminates approximately 4 cm from the top the aortic arch. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No pneumothorax. Percutaneous gastrostomy tube again noted.

Output: No substantial change in bibasilar pleural-parenchymal opacities. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: tachycardia, eval for pathology History: tachycardia 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, 79 years old with history of mitral valve disorder presenting with crackles concerning for pulmonary edema. Interval resolution of pulmonary edema is noted. No pleural effusions are present.Moderate cardiomegaly is noted. ICD leads are in place and appear unchanged.

Output: Interval resolution of pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: lung field eval History: sob Unchanged mediastinal widening.Persistent left pleural effusion with left lower lobe consolidation. Right lung unremarkable.

Output: Change mediastinal widening consistent with known mediastinal hematoma seen on recent CT.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Bilateral pleural effusion status post VATS partial decortication. Right chest tube and right jugular chest port unchanged in position. Small residual right subpulmonic pneumothorax. Bilateral loculated pleural fluid collections, left greater than right, unchanged. Patchy airspace opacities such as in the left upper lobe should be monitored to exclude developing infection. Partially visualized tubing projects over the left quadrant.

Output: Small right hydropneumothorax. Loculated pleural fluid unchanged. Patchy airspace opacities could be the result of aspirated secretions but should continue to be monitored to exclude development of aspiration pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval for PTX/contusion History: fall to L ribs, pain with inspiration Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No pneumothorax or displaced rib fracture.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pneumothorax s/p intercostal nerve block History: eval for pneumothorax s/p intercostal nerve block No sign of pneumothorax or other acute change.Pleural and pulmonary scarring at the right base with associated volume loss, unchanged.No new findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 89 yearsGender: MaleReason for Study: Reason: F/u pleural effusion History: As above Right IJ venous catheter unchanged.Stable cardiomediastinal silhouette.Pleural effusions, interstitial opacities, and left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Stable cardiopulmonary appearance with cardiomegaly, pulmonary edema, pleural effusions, and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval lung fields History: s/p BiVADs Cardiomegaly with increasing basilar opacities suggestive of edema and/or aspiration.Unchanged ECMO cannulae.IVC and LVAD, the latter only partially imaged, unchanged.A Dobbhoff tube extends below the lower margin of the image.

Output: Unchanged support devices with increasing pulmonary opacities suggestive of edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: DHT repositioning Suboptimal study secondary to motion artifact. Interval advancement of enteric tube with tip seen at level of gastric antrum. Remainder of exam without significant change including what appears to be diffuse ileus. Please refer to same day chest radiography for additional findings.

Output: Satisfactory positioning of enteric tube.


Instruction: Generate impression based on medical findings.

Input: Male 14 years old Reason: 14-year-old male with chest tube, evaluate pneumothorax. Hx of stab wound to chest. History: Chest tube has been on water seal for 24 hrs, evaluate pneumothorax.VIEW: Chest AP (one view) 1/23/2015, 14:41 Left chest tube position unchanged. Midline abdominal surgical staples are again noted.Left apical pneumothorax similar to the prior examination when accounting for differences in positioning. The cardiothymic silhouette is normal. No pleural effusion is seen.

Output: Persistent small left apical pneumothorax, unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: pt with near syncope, distant hx of arrhythmia, eval cardiomegaly History: near syncope as above 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: Male, 69 years old.Evaluate for lines, ICU patient LVAD unchanged. Left ICD leads and generator in place. Patient is status post sternotomy with chest tube. Swan-Ganz catheter tip in the right interlobar pulmonary artery. Left IJ catheter tip in the brachiocephalic vein. Aortic valve prosthesis in place.Cardiomegaly unchanged. Stable low lung volumes. Mild interstitial opacity compatible with mild edema. Probable left pleural effusion.

Output: Small lung volumes with suggestion of edema. Unchanged support devices.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: 4-year-old male with history of ALL status post chemotherapy. Pre-transplant workup to evaluate for infection. CHEST:LUNGS AND PLEURA: Bilateral dependent ground glass opacities. No additional abnormalities are noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted. A left subclavian central venous catheter is identified with its tip in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver is reidentified.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. The inferior aspect of the right kidney was not included in the examination.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Fatty liver. No additional significant abnormalities are noted.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: r/o infiltrate History: chest pain Mild cardiomegaly and a tortuous aorta.Nonspecific patchy opacity left lung base, consistent with subsegmental atelectasis or aspiration although infection is in the differential diagnosis.

Output: Nonspecific left basilar opacity, equivocal evidence for pneumonia but likely at least atelectasis or aspiration.


Instruction: Generate impression based on medical findings.

Input: 61 year old female with history of metastatic breast carcinoma. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Stable left apical scarring. Stable subcentimeter nodules in right middle lobe. MEDIASTINUM AND HILA: Reference precarinal lymph node measures 1.3 cm x 1.6 cm and has not changed substantially since prior exam.CHEST WALL: Status post left mastectomy. Fluid collection in left axilla remains unchanged.Right-sided Port-A-Cath.ABDOMEN:LIVER, BILIARY TRACT: Fatty liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts. Nonobstructing right renal stone.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 significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Stable CT examination as described above without evidence of disease recurrence.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: cough History: cough There is a basilar predominant reticular nodular interstitial abnormality within the lungs. No large pleural effusion or pneumothorax. The heart size is normal.

Output: Non-specific reticulonodular opacity within the lungs; this could represent infection including disseminated tb/fungal etiologies. CT of the chest is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o free air History: abd pain, bleeding Heart size upper normal.Small lung volumes.No pneumoperitoneum.Cholecystectomy clips.

Output: Heart size upper normal, otherwise unremarkable. No pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: History leiomyosarcoma with palpable lesion 0.4 x 0.5 x 0.3 cm hypoechoic subcutaneous focus corresponding to the palpable lesion within the left superior chest. This lesion demonstrates no increased vascularity.

Output: Subcentimeter hypoechoic subcutaneous focus corresponding to the palpable lesion within the left superior chest. This lesion is nonvascular but is best considered indeterminate in etiology. If a neoplastic etiology is clinically suspected, this lesion would be amenable to ultrasound-guided FNA biopsy.


Instruction: Generate impression based on medical findings.

Input: Reason: ett distance? History: ett Tracheostomy tube in place with its tip about 6 cm above the carina.Feeding tube traversing the esophagus.Right lower lobe airspace opacity compatible with aspirated secretions and atelectasis.

Output: Tracheostomy tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: r/o pna History: sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: sob, cough History: sob, cough Lower lobe airspace opacity consistent with known severe cystic bronchiectasis and adjacent consolidation unchanged for at least the last two years.Chronic blunting right costophrenic angle.No new findings.Unremarkable mediastinal contours and cardiac silhouette.

Output: Chronic left basilar opacity consistent with known cystic bronchiectasis, with likely indolent infection or inflammation.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with a shunt mucous plugging in outside CT, airway obstruction on pulmonary function tests, and chronic cough LUNGS AND PLEURA: There is demonstration of a well marginated 2.3 cm x 1.7 cm nodule within the right lower lobe (image 62, series 5). Smaller nodules are identified within the lingular segment left upper lobe (image 62 series 5) as well scattered micronodules in both lungs.There is demonstration peribronchial thickening with probable areas of mucous plugging within the right upper and right lower lobes.MEDIASTINUM AND HILA: Calcification coronary arteries and aorta. No evidence of pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative changes and scoliosis of the thoracolumbar spineUPPER ABDOMEN: No significant abnormality noted.

Output: 1. Bronchial wall thickening and areas of mucous plugging consistent with chronic obstructive pulmonary disease.2. 2-cm nodule in the right lower lobe. The retrieval of previous exams to document stability is recommended. If not possible , either histologic correlation or a PET scan is recommended.3. Nodular densities in the lingular segment as well as scattered micronodules may be inflammatory in origin or related to mucous plugging.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with history of muscular lymphoma CHEST:LUNGS AND PLEURA: Stable intrapulmonary lymph node along the right major fissure. No new nodules.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Clusters of small retroperitoneal lymph nodes are not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: New bilateral inguinal adenopathy. Reference right inguinal lymph node measures 2.1 x 1.7 cm image number 207, series number 3. Previously it was measuring 11 by 8mm image number 208/217BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New bilateral enlarged inguinal lymph nodes, otherwise no significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz placement Interval placement of a Swan-Ganz, tip projects just beyond the bifurcation of the left and right pulmonary artery. Otherwise no additional cardiopulmonary changes. See subsequent report

Output: Swan-Ganz placed


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: CP History: CP No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough Interval removal of the right PICC line. No underlying cardiopulmonary new abnormalities

Output: PICC line removed


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Staging workup for muscle invasive bladder cancer History: bladder cancer Orthopedic hardware projects over the cervical spine.The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax. Osteophyte of the vertebral body of T8.

Output: No acute cardiopulmonary disease. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Shortness of breath. Nonspecific right basilar interstitial opacity and septal thickening. No pleural effusion or pneumothorax.The cardiomediastinal silhouette is within normal limits.

Output: Nonspecific right basilar interstitial opacity. This could be due to mild edema, aspirate or infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Fever postop Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. Left basilar pleural-parenchymal opacities again noted. Unchanged cardiomegaly. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: crackles at bases bilaterally History: see above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 66 years old Male. Reason: Evaluate positions of AICD and PM History: complete heart block, VT. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is a small right pleural effusion. Bilateral lungs are hypoinflated. The cardiac pacemakers/defibrillators are stable in position. There is no evidence of pneumothorax.

Output: The above findings are consistent with mild congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: 46 year old female with ARDS of unknown etiology CHEST:LUNGS AND PLEURA: Patchy opacities throughout both lungs with dense consolidation and air bronchograms in the dependent lungs. Moderate to large right pneumothorax with right apical chest tube, which contains intraluminal debris.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: A left renal cyst measures water density and is likely benign.

Output: 1. Patchy opacities in both lungs with dense consolidation in dependent lungs compatible with ARDS and aspiration pneumonia2. Moderate to large right pneumothorax with left mediastinal shift. Chest tube contains a significant amount of intraluminal debris and may not be functioning optimally.Findings discussed with Dr. Nelson of the ICU at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: thoracoplasty History: - Moderately large right pleural effusion with underlying atelectasis, not significantly changed.Postsurgical defect in the right lower chest wall with surgical drains in place.No new findings.

Output: Pleural effusion and surgical drains with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: SOB eval for PNA History: see above No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: asthma History: surgical clearance screening Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: TLC adjustment History: TLC adjustment Right IJ venous catheter again demonstrating extension retrograde into the right subclavian vein.Dobbhoff tube and additional right central venous catheter unchanged.Stable cardiomediastinal silhouette.Perihilar interstitial opacity similar to the prior exam.No new pulmonary opacities identified.

Output: Minimal retraction of a right IJ venous catheter with its tip still in the right subclavian vein.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: s/p lvad, pneumonia, assess for improvement History: sob Support devices are unchanged. Extensive right-sided interstitial and air space opacities mildly improved in the right lower lobe. Partially loculated moderate right pleural effusion which obscures previous opacity noted on 3/11/15. Continued evaluation of the right lower lobe following diuresis is recommended. Stable cardiomegaly.

Output: Mild improved aeration of the right sided interstitial and airspace opacities. Moderate right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: right pleural effusion. s.p esophagectomy. fevers History: fever Left PICC line has been removed.Decreased lung findings is stable cardiac enlargement.Basilar opacities are compatible with pleural effusions and atelectasis.No new pulmonary opacities identified.

Output: Cardiomegaly with pleural effusions and improving left retrocardiac consolidation/atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: CABG Marked nonspecific cardiomegaly with patchy basilar opacities again likely atelectasis, however partial consolidation and/or small effusions with edema can't be excluded.Mediastinal and basilar chest tubes, right jugular sheath are all otherwise unchanged

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated. Sepsis. Likely ARDS History: see above ET tube tip approximately 4 cm above the carina.NG tube tip in the stomach. Diffuse nonspecific airspace opacity, slightly improved compared to previous, compatible with edema with moderate pleural effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: Shortness of breath History: Shortness of breath, wheeze Mild diffuse interstitial opacities are chronic. No superimposed consolidation. Pleural spaces are clear. The heart size is normal.

Output: No evidence of acute pneumonia. Chronic opacities are stable in the setting of disseminated histoplasmosis.


Instruction: Generate impression based on medical findings.

Input: History of arteritis. Chest pain. Rule-out aortic dissection. LUNGS AND PLEURA: Minimal right lung base dependent atelectasis and pleural thickening.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of aortic dissection.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reevaluate Dobbhoff tube placement Enteric tube terminates in the proximal gastric body. Tracheostomy tube is noted. Surgical drain in neck.Increased left basilar/retrocardiac atelectasis/consolidation. Small bilateral pleural effusions. No pneumothorax. The heart size is stable.

Output: 1. Enteric tube terminates in the proximal gastric body.2. Increased left retrocardiac opacity may reflect aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval for cardiomegaly, pericardial effusion, pulmonary edema History: ecg with beat to beat QRS variation c/f electrical alternans Lungs spaces are clear. Heart size is upper limits normal. Minimal atherosclerotic disease of the distal transverse arch is present.

Output: No acute pulmonary process. Heart size upper limits normal.


Instruction: Generate impression based on medical findings.

Input: 8-year-old male with bilious emesisVIEW: Abdomen AP (one view) 4/3/15 at 0957 Multiple surgical staple lines are seen in the lower abdomen. Residual contrast material pleural space. Central line tip in the intrahepatic IVC. Jejunostomy tube is present in the right lower quadrant.Postoperative changes are identified in the lower chest. Overall paucity of bowel gas. Hyperdensity in the right hemiabdomen represents a gallstone.

Output: Overall paucity of bowel gas.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Air leak on prior chest radiograph. Unremarkable cardiomediastinal silhouette.Emphysema with large lung volumes.The previously seen right basilar hydropneumothorax is no longer evident.

Output: Emphysema, without hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate IABP positioning. History: See above. Aortic balloon catheter in the descending aorta with its tip at the level of T6.Small lung volumes with patchy nonspecific airspace opacity and pleural effusions, larger on the right.Catheter tip in the SVC.

Output: Balloon catheter in the descending aorta and pulmonary air space opacities which may be due to edema or aspiration, without significant change.


Instruction: Generate impression based on medical findings.

Input: Anasarca and fluid overload. Heart failure Moderate COPD changes with minimal streaky densities in both bases, possibly scarring. No discrete superimposed acute airspace process or distinct evidence of failure, however early edema cannot be excluded. No effusionsBorderline cardiomegaly. Mild tortuosity of the aorta with more moderate atherosclerotic changes in the arch exaggerated by scoliosis

Output: Nonspecific basilar changes, possibly old scarring. Comparison with prior images or serial imaging will help delineateI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Chest pain Marked scoliosis with an unchanged left subclavian ICD. Lungs remain clear and without superimposed acute abnormality

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: r/o pneumonia History: short of breath, dialysis patient, diaphoretic and fevers Moderate cardiomegaly with moderate lower lung zone edema and small pleural effusions.No specific evidence of infection.Right jugular catheter, tip at the cavoatrial junction level.

Output: Cardiomegaly with moderate pulmonary edema consistent with CHF and or hypervolemia. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: 56 yo F with MCTD-ILD and increased cough. Evaluate for infiltrate History: cough, dyspnea Heart size about upper normal.Diffuse basilar predominant chronic interstitial lung disease, previously characterized by CT scan compatible with fibrosis.No specific evidence of infection or other superimposed acute findings.

Output: Severe chronic interstitial lung disease with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old. Reason: Evaluate for acute cardiopulmonary pathology. History: altered mental status, dehydration, emesis. Cardiomediastinal silhouette is unremarkable.Low lung volumes with bibasilar subsegmental atelectasis.No specific evidence of infection or edema.No large pleural effusion or pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female 2 days old Reason: what is the lung expansion History: HFOVVIEW: Chest AP (one view) 4/23/2016 at 2221 hours. ET tube tip is at the thoracic inlet. Umbilical lines unchanged. NG tube tip is at the stomach. Both right-sided chest tubes are unchanged.Cardiac silhouette size is normal. Persistent bilateral diffuse lung haziness with interval worsening in right-sided pneumothorax.

Output: Interval worsening in right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: ICD placement. Left subclavian ICD with leads in the projection of the right atrium and right ventricle, the ventricular lead tip is directed slightly cranially.Pneumothorax. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.Low lung volumes with a subtle atelectasis or scarring unchanged.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: interval change History: interval change Swan-Ganz catheter has been pulled back slightly. Lines and tubes are otherwise unchanged. Left greater than right bibasilar opacities again noted. Question of mild pulmonary edema which may be related to lower lung volumes. Probable small pleural effusions. No pneumothorax. Unchanged cardiomegaly.

Output: Question of mild pulmonary edema which may be related to lower lung volumes. Left right bibasilar atelectasis and/or consolidated lung. Small pleural effusions. Moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: interval changes History: Heart failure. Swan-Ganz catheter tip in the right main pulmonary artery.ICD lead and venous catheter unchanged.Cardiomegaly with a moderate right and smaller left pleural effusion and underlying atelectasis.No new findings.

Output: Findings compatible with CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: Respiratory distress History: History of nonrheumatic mitral valve insufficiency. The left subclavian IABP has been removed in the interval. Interval intubation with adequate position of the ET tube terminating approximately 5.2 cm above the carina.The right IJ vascular sheath overlies the proximal SVC, unchanged in position. Enteric tube coursing below the diaphragm and off the field-of-view.Intact median sternotomy wires. Pacemaker in place.The left pleural pigtail catheter is unchanged in position and there is no residual pneumothorax in the single AP projection. Trace left pleural effusion again noted.Bilateral chest wall and right supraclavicular subcutaneous emphysema is unchanged.

Output: Interval removal of left subclavian IABP.Interval intubation with adequate position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Dobbhoff tube positioning No Dobbhoff tube visualized. Large amount of residual contrast seen, mostly throughout colon. Dilated small and large bowel noted diffusely. Please see same day chest radiography for additional findings.

Output: Dobbhoff tube not visualized. Findings consistent with mild to moderate diffuse ileus. Large amount of persistent residual enteric contrast, presumably from patient's OPM performed 5/12/2016, also suggesting decreased bowel motility.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with newly diagnosed base of tongue cancer. Staging. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Punctate hypoattenuating focus in segment 6 (series 4, image 133) is too small to characterize. Cholelithiasis without evidence of acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged from prior study from 2006. Nonobstructing, 4-mm left renal stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is only partially visualized; diverticulosis of the descending colon without acute inflammation.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: evaluate for infection History: altered mental status, unresponsive Stable cardiac enlargement.Mediastinal double density likely representing large hiatal hernia which is unchanged from the prior study.Lungs clear with no evidence of infection or edema.No pleural effusion. No pneumothorax.

Output: 1. Hiatal hernia2. No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pneumonia History: cough, immune compromised host Unremarkable heart and mediastinum with intact sternal fixation hardware. No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: r/o infection History: tachycardia and elevated WBC No significant cardiopulmonary abnormality.Moderate-sized hiatal hernia.Upper abdominal cholecystectomy clips.

Output: Hiatal hernia, but no sign of infection or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath New patchy opacity at the left lung base. Endobronchial valves remain in place. Emphysema at the right lung base again noted consistent with alpha-1 antitrypsin deficiency. Normal heart size. No pneumothorax.

Output: New patchy opacities at the left lung base suggestive of aspiration or pneumonia. Endobronchial valves remain in place.


Instruction: Generate impression based on medical findings.

Input: Reason: Abdominal pain and distension, r/o obstruction History: Abdominal pain and distension, r/o obstruction Gas and stool seen throughout the colon. Nonobstructive bowel gas pattern. The cavitary lesion in the right lower lobe is better evaluated on the chest CT dated 9/2/2015.

Output: Nonobstructive bowel gas pattern. 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, 35 years old.Reason: evaluate bronchiectasis flare History: see above Stable cardiomediastinal silhouette with surgical clips overlying the right upper mediastinum.Right lung volume loss and other postoperative changes status post right upper lobectomy again seen. No new focal consolidation, sizable effusion or pneumothorax.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: swan, effusions History: swan, effusions Left-sided ICD unchanged.Right IJ Swan-Ganz with its tip in the right ventricle.Pleural effusions and extensive pulmonary opacities, right greater than left similar to the prior exam.

Output: Swan-Ganz catheter unchanged with its tip in the right ventricle. Stable cardiopulmonary appearance with pleural effusions edema, and atelectasis greater on the right.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: CT abd with limited lung view suggestive of infection, elevated WBC, eval for pneumonia History: see above Extensive mediastinal and hilar lymphadenopathy, better seen on a prior CT, probably unchanged.Foci of subsegmental atelectasis are noted, but no specific evidence of edema or pneumonia.Small pleural effusions are present.

Output: No specific evidence of infection. Known metastatic disease with extensive lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female; 49 years old. Reason: interval change History: swan, chf Stable Swan-Ganz catheter tip in right main pulmonary artery. Stable ICD.Stable cardiomegaly. Stable patchy bilateral nonspecific air space opacities. No pneumothorax.

Output: Stable Swan-Ganz catheter and patchy nonspecific airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: sob s/p thoracentesis for left pleural effusion, history of CLL Cardiac size unchanged. Left pleural effusion is again seen with associated atelectasis. No evidence of pneumothorax.

Output: Left pleural effusion with associated atelectasis without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 43 year old female with fever, cough, chest pain. Evaluate for infiltrate No focal airspace opacities. Mild bronchial wall thickening which can be seen with asthma or bronchitis. Blunting of the left costophrenic angle likely from atelectasis. No pneumothorax.Increasing cardiomegaly since study dated 1/28/2015.Lucency below the right hemidiaphragm extending the midline is suspicious for pneumoperitoneum.Findings discussed over the phone with Dr. Sakaria on 4/16/2015 at 2:07 PM.

Output: 1. Findings are suspicious for pneumoperitoneum. Recommend dedicated upright abdominal radiograph for further evaluation.2. Mild bronchial wall thickening which can be seen with asthma or bronchitis.3. Increasing cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: ICU patient History: ICu patient ] IJ Swan-Ganz with its tip in the pulmonary artery.LVAD, left PICC line, and bilateral chest tubes unchanged.IABP marker not identified on this exam.Stable cardiac enlargement with basilar opacities compatible with atelectasis/edema and effusions.No new pulmonary opacities.No pleural effusion.

Output: Interval removal of an IABP. Remaining support devices are unchanged. Stable cardiopulmonary appearance with basilar opacities compatible with atelectasis/edema and pleural effusions..


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: cough,fever Nodular and streaky right upper lobe opacities with associated pleural thickening, suggestive of postinfectious scarring, though the chronicity is uncertain and the differential diagnosis includes TB. Mild volume loss is present in the right upper lobe with elevation of the minor fissure.Unremarkable cardiac and mediastinal silhouette. Mild blunting of the left costophrenic angle compatible with scarring.

Output: Nodular and streaky right upper lobe opacity with associated pleural thickening suggestive of postinfectious scarring, though activity and chronicity is uncertain. The differential diagnosis includes TB and other granulomatous infections. Comparison with previous radiographs and/or CT scan would be helpful to evaluate potential activity.This was conveyed to the ED via Stat Consult.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: evaluate abnormal lung sounds History: abnormal lung sounds right base Moderate cardiomegaly unchanged.No specific evidence of infection or edema. Left subclavian 3-lead ICD unchanged.

Output: Cardiomegaly without acute cardiopulmonary abnormality. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pulm edema or infectious process History: congestion, rales Heart size about upper normal but no sign of pulmonary edema or effusions.No evidence of pneumonia or other acute process.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o swan placement, eval for placement History: see above Swan-Ganz catheter tip in the main pulmonary artery.ICD leads unchanged.Mild cardiomegaly and no significant pulmonary abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with history of Goblet cell carcinoid of the appendix. CHEST:LUNGS AND PLEURA: Indeterminate 4-mm left lower lobe subpleural pulmonary nodule is unchanged when compared to 7/29/08. A bowel gas at a lumenMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion at the dome of the liver, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormalityADRENAL GLANDS: 20 x 14 mm right adrenal nodule, unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osteopenia.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: sob History: pleural effusion Partial opacification of the right hemithorax may be due to right upper lobe tumor contiguous with the right perihilar and right paratracheal regions.Lobulated right pleural thickening is present with a right pleural effusion.Left-sided lower lung zone predominant nodules appear to be metastases.

Output: Probable advanced stage lung cancer.


Instruction: Generate impression based on medical findings.

Input: Mantle cell non-Hodgkin's lymphoma. Compare to previous. CHEST:LUNGS AND PLEURA: Stable scattered micronodules and left upper lobe calcified granuloma. No suspicious nodules or masses. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Hypoattenuating lesion in the isthmus of the thyroid is grossly unchanged. No pathologically enlarged hilar or mediastinal lymph nodes. Cardiac size is normal. Stable small pericardial effusion or thickening.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesion in segment 4a of the liver is unchanged. No new lesions. No intrahepatic biliary dilatation. The portal and hepatic vasculature is patent.SPLEEN: Scattered punctate splenic calcifications probably represent prior granulomatous disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small inguinal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable exam. No evidence of recurrent or progressive disease.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Pre kidney evaluation. r/o infiltrates, r/o cardiomegaly History: pre kidney evaluation Cardiomegaly, unchanged.Elevation of the right hemidiaphragm, unchanged.No specific evidence of infection or failure.

Output: Cardiomegaly with no acute abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: SOB, dyspnea Small lung volumes with diffuse nonspecific opacity compatible with edema and small effusions.Surgical artifacts compatible with previous sternotomy and CABG surgery.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: MaleReason for Study: Reason: 29M s/p lap donor nephrectomy now with chest pain History: chest pain s/p lap donor nephrectomy The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: IABP placement History: HF Left-sided ICD and IABP marker unchanged.Stable cardiomediastinal silhouette.Lungs are clear.No new pulmonary opacities noted.

Output: Support device in change. Stable cardiopulmonary appearance without acute abnormalities .


Instruction: Generate impression based on medical findings.

Input: Reason: assess IABP placement History: IABP not functioning Balloon pump marker in the proximal descending aorta, about 3 cm below the top of the arch.Swan-Ganz catheter and ECMO cannulae unchanged.Small left apical pneumothorax, new from previous.Diffuse severe bilateral airspace opacity and pleural effusion.

Output: Balloon catheter in the proximal descending aorta. Small left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: S/P left wedge resection. Possible aspiration History: SOB Improvement in aeration of lung bases though basilar opacities remain.Line position stable.Left apical pneumothorax not well visualized.

Output: 1. Decreased right apical pneumothorax.2. Improved aeration lung bases however basilar opacities remain.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.19 days status post BMT. Also cardiac history rule out infection or fluid overload. Persistent cough and DOE. The left jugular catheter is significantly displaced by the patient's goiter, unchanged in position compared to recent radiographs but compared to the initial placement image on 6/27/2016, the catheter tip has been retracted by at least 6 cm, now projecting at or near the level of the azygos vein.Unchanged cardiomegalyMild pulmonary edema has improved. Small pleural effusions..

Output: Improving mild CHF. The patient's tunneled left IJ dialysis catheter has been significantly retracted from its original intended position with tip now at the level of the azygos. Correlate with catheter flow rate and if insufficient, consider repositioning.CARRERI, KASSANDRA (6984) verbally notified at 12:00 PM on 7/27/2016, clinical service is aware of the finding and stated that flow rate within the catheter is good.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: eval for edema History: hypertension/chest pain/sob No significant cardiopulmonary abnormality.Spinal stimulation hardware unchanged.Cholecystectomy clips noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval for mass History: wt loss and dry cough No significant cardiopulmonary abnormality.Left subclavian dual-chamber pacemaker, leads unchanged, the ventricular lead directed towards the pulmonary outflow tract.

Output: No significant abnormality. Left subclavian pacemaker, leads unchanged in position.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: hypoxia History: hypoxia Interval progression of airspace and interstitial opacities. Cardiomegaly again noted.Support devices are stable and unchanged.No pneumothorax.

Output: Progression of interstitial and airspace opacities. Remaining findings are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: r/o pna History: CP Cardiomediastinal silhouette is within normal limits. Slightly low lung volumes. No pleural effusions or pneumothorax. No focal pulmonary opacities.

Output: Slightly low lung volumes. Otherwise no acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: s/p chest tube placement complicated by small apical pneumothorax, eval for expansion History: as above Resolution of prior left apical pneumothorax, left chest tube stable in position.Unchanged basilar predominant pulmonary opacities and pleural effusions.Severe pulmonary arterial hypertension.Bilateral subclavian catheters terminate in the SVC.

Output: Resolution of prior pneumothorax. No new findings.


Instruction: Generate impression based on medical findings.

Input: 34 years old Male. Reason: assess swan placement History: hypotensive on pressors. The Swan-Ganz catheter and ICD lead unchanged. Small lung volume with mild left perihilar and lower lung zone opacities, consistent with atelectasis and edema unchanged.

Output: Swan-Ganz catheter is stable in position.


Instruction: Generate impression based on medical findings.

Input: 10-year-old male with history of chronic sinusitis and cough. LUNGS AND PLEURA: Subcentimeter indeterminate pleural based nodule is seen in the right lower lobe (image 52/83 series 4). No air space opacities, effusions, or pneumothoraces are present. No evidence of bronchiectasis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Indeterminate subcentimeter pleural based nodule in the right lower lobe. Otherwise normal examination.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: chronic cough History: chronic cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: Swan position History: Swan position No significant cardiopulmonary abnormality.Right jugular Swan-Ganz catheter, tip in right pulmonary artery.Right PICC, tip in axillary region.Left subclavian ICD, leads unchanged in position.

Output: Unchanged support devices, the Swan-Ganz catheter tip in the right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 66 years old Male. Reason: confirm stable Swan placement History: advanced heart failure. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. Small amount of bilateral pleural effusions are noted.Swan-Ganz catheter tip in the right main pulmonary artery

Output: The above findings are consistent with severe congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: evidence of pleural effusion History: XR hypoxemia Small bilateral pleural effusions with pulmonary edema and mild basilar atelectasis.

Output: Small bilateral pleural effusions with pulmonary edema and mild basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: r/o infection/fluid History: weakness The cardiomediastinal silhouette is at the upper limits of normal. Tortuous aorta. No focal pulmonary opacity. No large pleural effusion. An incidental azygos fissure is noted and is of no clinical significance. No pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Neutropenia fever Upper normal heart size. Moderate hiatal hernia containing a large volume of internal fluid and debris. Mild adjacent compressive atelectasis.No focal pulmonary opacities or pleural fluid.Right chest port tip at the superior cavoatrial junction.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for PTX History: previous PTX Right chest tube in place with no significant pneumothorax.Small bilateral areas of subsegmental atelectasis and mild subcutaneous emphysema on the right.A more recent radiograph has been interpreted.

Output: Chest tube in place with no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Check for pneumothorax. Liver neoplasm and status post sarcoma resection No postprocedural acute complications, specifically no pneumothorax. Surgical staples are projected over left upper quadrantRight jugular sheath extends into the proximal jugular vein

Output: Right jugular sheath well-positioned without postprocedural complication


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old. Other symptoms and signs involving cognitive functions and awarenessReason: Question cardiopulmonary process History: eval Right diaphragmatic eventration, unchanged. Moderate cardiomegaly with prominent left ventricle and tortuous aorta, unchanged. No pulmonary opacities, pleural effusions or pneumothorax.

Output: Unchanged moderate cardiomegaly. No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: evaluate for pneumonia, signs of volume overload History: cough x 2 weeks, shortness of breath, PND Stable cardiac enlargement.Increasing perihilar interstitial opacities and septal lines suggestive of edema.No focal areas of consolidation.No pleural effusions.

Output: Cardiac enlargement and perihilar interstitial opacities compatible with edema suggesting volume overload and/or CHF.


Instruction: Generate impression based on medical findings.

Input: Pleuritic chest pain. Evaluate for PE. PULMONARY ARTERY: No evidence of pulmonary embolus. Normal pulmonary artery diameter.LUNGS AND PLEURA: No significant abnormality noted. A calcified granuloma in the right lower lobe.Small pleural thickening in the left lower lobe (image 158, series 6).MEDIASTINUM AND HILA: Soft tissue in the anterior mediastinum is likely residual thymic tissue. No mediastinal or hilar lymphadenopathy.CHEST WALL: Status post right mastectomy and saline implant placement. In the left breast upper outer quadrant, there is a oval shaped 1-cm mass like density, which can represent a solid mass. Unilateral mammogram and possible sonography is recommended, if this lesion has not been evaluated.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of PE.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: chest tube removal History: none Left-sided chest tube has been removed.No pneumothorax identified.Stable cardiomediastinal silhouette.Pleural thickening/effusions and basilar atelectasis similar to the prior.Stabilization hardware noted in the thoracolumbar spine.

Output: The sided chest tube removed without evidence of a significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female status post subtotal gastrectomy for a poorly defined adenocarcinoma. Evaluate for new evidence of tumor recurrence or metastasis. CHEST:LUNGS AND PLEURA: A right lower lobe micro-nodule is nonspecific. Continued follow-up is recommended. No focal consolidation, edema or pleural fluid.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: Surgical clips are evident about the residual stomach. No evidence of local disease recurrence.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nonspecific pulmonary micronodule.2.Postsurgical changes with no definite evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: CVC placement History: CVC in place ET tube tip 5 cm above carina, right jugular catheter tip in SVC, right PICC tip in SVC, NG tube extends beyond the field-of-view of study, ICD unchanged.Cardiomegaly with patchy perihilar and basilar interstitial airspace opacity likely due to edema.

Output: Right jugular catheter tip in SVC. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old, with history of chest pain. Evaluate for PE. PULMONARY ARTERIES: Technically adequate exam. No pulmonary embolus.LUNGS AND PLEURA: Ground glass opacity in the right lower lobe with subtle adjacent nodularity (image 84, series 7) may represent aspiration or infection. Short-term CT follow up is recommended to document resolution.Scattered additional micronodules, some calcified, likely represent prior granulomatous disease. No pleural fluid.MEDIASTINUM AND HILA: The cardiac size is enlarged. Aortic and coronary artery calcifications. No pericardial effusion.Prominent precarinal and right hilar lymphoid tissue is unchanged to slightly smaller. Small hiatal hernia.CHEST WALL: Left chest wall pacemaker generator, leads in the right ventricle and coronary sinus.UPPER ABDOMEN: Splenic and hepatic calcifications likely represent prior granulomatous disease. Cholelithiasis versus calcification of the gallbladder wall. Low-attenuation left adrenal nodule, unchanged and likely benign.Bilateral renal cystic lesions are unchanged.

Output: 1.No PE.2.Right lower lobe opacity may represent aspiration or infection. Short-term CT follow-up (one month) is recommended to document resolution.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with pneumothorax status-post chest tube with abdominal pain, elevated bilirubin, femurs, and rising lactate. Concern for abscess. CHEST:LUNGS AND PLEURA: Right pneumothorax has improved since prior exam with overall improved aeration of the right lung. However, the right lung remains partially collapsed, specifically the right lower and middle lobes. Thick-walled cystic lesions are again noted at the right lung base. These would again be compatible with pulmonary abscesses are as described on previous CT chest.Worsening subcutaneous emphysema, particularly on the right with extension into the mediastinum as well.Bilateral pleural effusions. Two right-sided chest tubes are identified with tips in the right apex.MEDIASTINUM AND HILA: No mediastinal shift. Interval development of pneumomediastinum. Right jugular central venous catheter tip near RA/SVC junction. Enteric tube enters the stomach. ET tube with tip above the carina.CHEST WALL: Worsening subcutaneous emphysema, particularly in the right. Chest tubes as above.ABDOMEN:LIVER, BILIARY TRACT: Enlarged, fatty liver. No evidence of intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left kidney is not identified.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anasarca.OTHER: Small ascites. No organized fluid collections to suggest abscess.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Bladder is collapsed around a Foley catheter.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: AnasarcaOTHER: Small ascites

Output: 1. Interval improvement in aeration of right lung with persistent partial collapse of the right middle and right lower lobes. Thick-walled cystic lesions are again seen in the right lower lobe, which are again compatible with pulmonary abscesses as described on prior CT chest.2. Worsening subcutaneous emphysema with extension into the mediastinum.3. Interval development of hepatic steatosis.4. Absent left kidney.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: fever, SIRS History: r/o atelectasis, PNA Enteric feeding tube extends below the lower margin of the image. Right subclavian line directed cephalad in the right internal jugular vein, extending above the upper margin of the image.Stable cardiomediastinal silhouette.Nonspecific basilar opacity compatible with atelectasis, similar in appearance to the prior. Probable small effusions.No pneumothorax.

Output: Right subclavian line directed cephalad in the right internal jugular vein. This has been removed on subsequent imaging. No pneumothorax. Lower lobe opacities compatible with atelectasis, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: Subcentimeter, nonspecific nodule in the left lower lobe on image number 74, series number 5.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter lesion in the right lobe of the liver likely representing a cyst on image number 103, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Nonspecific, subcentimeter left lower lobe nodule.


Instruction: Generate impression based on medical findings.

Input: Reason: CP History: above Moderate cardiomegaly with a tortuous calcified aorta and coronary artery calcification and probable coronary artery stent. No sign of pulmonary edema or pneumonia.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Pt with history of HIV, cirrhosis, CAD here with worsening SOB. Please eval for infection or edema History: SOB Left chest wall pacemaker leads unchanged in position.Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: assess for ETT position, signs of infection History: s/p intubation, sepsis ET tube tip 4 cm above carina.Patchy opacities on the left are stable though at the right base there has been interval increase which may be due to aspirate or edema. Other findings stable.

Output: ET tube tip 4 cm above carina.Patchy opacities on the left are stable though at the right base there has been interval increase which may be due to aspirate or edema. Other findings stable.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: ett distance? History: ett Support devices unchanged with ET tube tip 6 cm above the carina.Stable cardiac enlargement.Nonspecific basilar opacities compatible with atelectasis similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: PA catheter History: PA catheter Swan-Ganz catheter in a branch of the right pulmonary artery, unchanged. No significant pulmonary abnormalities.

Output: Catheter tip in a right upper lobe branch of the right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with bladder cancer status post resection now with progressive weight loss and malaise. Please evaluate for progressive disease. CHEST:LUNGS AND PLEURA: Calcific granuloma left lung image 60. Intrapulmonary lymph node on the right image 63 and small lung nodules on the right image 43 and left lower lobe image 69, unchanged from 9/11/2007. Some mild emphysematous changes. No pleural effusions. No new lung nodules.MEDIASTINUM AND HILA: Calcified nodes in the prevascular space. Small nonpathologic sized mediastinal nodes elsewhere.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation the following observations are made.LIVER, BILIARY TRACT: No definite focal lesions or biliary dilatation. Probable gravel in the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hydronephrosis and hydroureter right greater than left, unchanged with bilateral perinephric stranding, unchanged. Urine is implanted in neobladder.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes nonpathologic by size criteria.BOWEL, MESENTERY: Nonobstructive midline ventral hernia containing omentum, unchanged. No evidence of bowel wall thickening or dilatation. No ascites.BONES, SOFT TISSUES: Degenerative changes with no lytic or blastic disease.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Neobladder. Prominent ureters, unchanged.LYMPH NODES: No pathologic size lymph nodes.BOWEL, MESENTERY: No evidence of ascites. Surgical anastomosis intact right lower quadrant. Colonic diverticulosis. No evidence diverticulitis. Clips from prior surgery.BONES, SOFT TISSUES: Wound previously seen is healed. There is residual soft tissue density in the subcutaneous tissues. Image 163/239 soft tissue measures 2.7 x 2.4 cm. This is decreased compared to the prior exam. A secondary a small soft tissue prominence is seen in the midline in the inferior ventral wall on image 193.

Output: No and no interval change in small lung nodules. Granulomatous disease in the chest. Persistent and stable hydronephrosis and hydroureter, gallstones, postsurgical changes in the pelvis. Soft tissue density is measurable in anterior abdominal wall of uncertain significance. Stable nonobstructive ventral hernia containing omentum.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: shortness of breath History: 6111 No change in cardiomegaly with pulmonary edema and bilateral pleural effusions.

Output: No change in the findings of congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: pneumo? History: O2 sat 80 - 82% Mediastinal and left pleural drains with no pneumothorax.Slight improvement in basilar atelectasis which may be from mucous plugging.Right jugular Swan-Ganz catheter removed.

Output: Improving basilar atelectasis. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: pna? History: sob Diffuse edema with focal opacity in the right upper lobe and an enlarging right pleural effusion.IABP catheter pulled down, now 9 cm below the aortic arch.Chest tubes unchanged with no pneumothorax.ET tube tip approximately 3 cm above the carina.Right jugular Swan-Ganz catheter with tip in the mid interlobar pulmonary artery.

Output: Unchanged pulmonary opacities but enlarging right pleural effusion. IABP catheter now low, the tip 9 cm the level of the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: FemaleReason for Study: Reason: Eval for pneumonia vs pneumothorax vs acute aortic / esophageal pathology History: Chest pain Stable cardiomediastinal silhouette with mild cardiac enlargement.The lungs are clear.No pleural effusions.No evidence of a pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Seizures No cardiopulmonary abnormality, specifically no evidence of aspiration or infection

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Chest pain History: As above Patchy left basilar opacity, unchanged. Stable moderate cardiomegaly. Otherwise no substantial difference compared to last study without evidence of pneumothorax or definite acute bony abnormality on radiography.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure Minimal advancement of the IABP, marker currently projects into the aortic arch. No additional cardiopulmonary changes including marked nonspecific for quadrant cardiomegaly with suspected small effusions and left lower lobe compressive atelectasis.

Output: IABP minimally advanced


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p CABG History: s/p CABG IABP marker in proximal descending thoracic aorta. Swan-Ganz catheter tip in proximal right pulmonary artery. Chest tubes and ICD unchanged.No evidence of pneumothorax. Small left pleural effusion unchanged.

Output: No evidence of pneumothorax. Small left pleural effusion unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lung fields History: Intubated ET tube tip approximately 5 cm above the carina.Catheter tip in the SVC.NG tube tip in the area of the GE junction.Hazy opacity at the left base suggestive of pleural effusion and atelectasis.

Output: ET tube in acceptable position. Proximal location of NG tube.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with pancreatic cancer CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous metastatic lesions in the liver are again seen. Reference lesion in the dome measures 7.5 by 7.7 cm, image number 72, series number 71, increased from previous study. SPLEEN: No significant abnormality notedPANCREAS: Resection of the pancake head. Visualized body and tail again demonstrates marked dilatation of the pancreatic duct. There is some enhancing soft tissue near the pancreatic anastomosis which represent recurrent tumor.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference lymph nodes in the portacaval space measures 13 by 12-mm image number 102, series number 7 to one, not significantly changed. Other retroperitoneal lymph nodes , most prominently along the SMA, are also both 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: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the hepatic metastatic lesions. Retroperitoneal adenopathy is grossly unchanged.Ill-defined soft tissue in the region of the pancreatic anastomosis may represent recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: CHF, on bipap History: CHF, on BIPAP Severe cardiomegaly with vascular congestion. Pericardial effusion cannot be excluded.Moderate size left and small right effusion. Bilateral opacities more confluent on the left. Findings are most compatible with congestive heart failure and pulmonary edema however superimposed left lower lobe infection cannot be excluded

Output: Severe cardiomegaly with vascular congestion, bilateral effusions likely likely representing congestive heart failure and pulmonary edema however superimposed left lower lobe infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: cp, sob History: cp, sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: SOB, hx of CHF, eval for fluid overload History: SOB, hx of CHF, eval for fluid overload Cardiomediastinal silhouette within normal limits, unchanged. Mild right basilar subsegmental atelectasis. No significant pulmonary or pleural abnormalities.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: ? AICD placement History: chest pain over AICD site Left ICD pulse generator again seen in the inferolateral chest wall. Midline subcutaneous electrode.No focal pulmonary opacity, pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: Grossly unchanged ICD generator and midline subcutaneous electrode.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 31 years old Reason: r/o pneumonia History: cough Cardiomediastinal silhouette is unremarkable.No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: ? SOB History: ?SOB Mild interstitial opacities suggestive of edema or atypical infection.Heart size normal and there are no pleural effusions.

Output: Mild interstitial opacities which could represent edema or atypical infection such as a viral etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.ADHF, recurrent TV, endotracheal intubation. Endotracheal tube has been retracted with tip now 7 cm above the level of the carina. Other hardware and devices unchanged.Lung volumes remain low.Interval clearing of retrocardiac opacity on the left. Moderate left pleural fluid collection about the same.

Output: Interval retraction of endotracheal tube with tip now 7 cm above the level of the carina. Interval clearing of retrocardiac opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: ADHF History: as above Large lung volumes consistent with severe emphysema. Normal heart size with ICD leads in place, unchanged from previous. Right upper lobe nodular opacity, previously characterized by CT scan. No new findings.

Output: Severe emphysema with no acute change.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with shortness of breath, anuria. Evaluate lungs and evaluate for ureteral obstruction including hydronephrosis/kidney stone CHEST:LUNGS AND PLEURA: Collapse of the left lower lobe is noted without evidence of a central, obstructing mass. This may be due to chronic aspiration or multiple prior infections at this location. Left pleural effusion is also seen.Significant, predominantly upper lobe paraseptal emphysema. Few scattered micronodules are also identified bilaterally. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Small, homogenous left adrenal nodule, probable adenoma. Normal right adrenal gland.KIDNEYS, URETERS: No evidence of nephrolithiasis or ureteral stones. No hydronephrosis. Lobulated contour to the kidneys may represent scarring.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Submucosal fat deposition is seen in the ascending colon which likely represents old, inactive inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Complete left lower lobe atelectasis, possibly from chronic aspiration versus multiple prior infections at this location. Significant, predominantly upper lobe paraseptal emphysema.2. No evidence of hydronephrosis or nephrolithiasis as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: ETT placement after 3 cm advanced. ETT tip 3.5 cm level of the carina. Swan-Ganz catheter, left jugular introducer and improvement place similar in position. Right chest tube takes an unusual course, looped near the apex before descending and terminating in the projection of the right lower thorax. There is a trace, 3 mm right pneumothorax. No evidence of pulmonary edema. No pneumothorax on the left. Interval resolution of left lower lobe opacity seen on the prior study.

Output: ETT tip 3.5 cm above the level of the carina. Interval resolution of left basal opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: cough/wheezing History: productive cough/chills Decreased lung volumes.Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Pneumothorax.VIEW: Chest AP (one view) 04/12/16, 1504 A right chest tube has been placed. A very small right apical pneumothorax is seen. Hazy opacities are present in the right lung. The left lung is normal in appearance. Cardiothymic silhouette is normal.

Output: Right pneumothorax is almost completely resolved after chest tube placement.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Rule out infection, AMS History: As above Stable cardiomediastinal silhouette.Basilar atelectasis/scarring, unchanged. No new focal air space abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Device placement Motion degrades sensitivity Mild overall improved aeration, however bilateral chronic abnormalities greater in the right upper lobe and left lower lung appears similar to prior exam. No superimposed acute abnormality. Suspected small right effusionICD unchanged

Output: No new superimposed acute abnormalities upon chronic changes previously described


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: pna? History: seizure Left central catheter with its tip in the SVC.Peripheral air space opacity in the right upper lobe compatible with infection or infarction.Blunting of the right costophrenic angle compatible with effusion and/or pleural thickening.The left lung is clear.

Output: Peripheral right upper lobe airspace opacity compatible with infection or possibly infarction in an acute setting.


Instruction: Generate impression based on medical findings.

Input: Reason: eval IABP placement History: IABP in place Swan-Ganz catheter tip in the right main pulmonary artery and balloon catheter marker near the top of the aortic arch.Cardiomegaly with nonspecific basilar opacities, not significantly changed.

Output: Aortic balloon catheter and Swan-Ganz catheter unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64 y/o M s/p exlap, colon resection now with SOB History: as above New moderate lower lung zone pulmonary edema with septal lines, pleural effusions and retrocardiac atelectasis.Right jugular catheter and right PICC terminates at the cavoatrial junction.

Output: New pulmonary edema with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: infection? History: productive cough, shortness of breath No acute cardiopulmonary abnormality.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: Intubated History: Intubated ET tube tip 5 cm above carina. NG tube tip in stomach. Patchy bilateral airspace and interstitial opacities unchanged.

Output: ET tube tip 5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: cat P History: cough, fever, sob Right suprahilar opacity of increasing conspicuity especially compared to studies as far back as 2008.The lungs themselves appear unremarkable.Heart size normal.

Output: Possible right suprahilar opacity, thoracic CT recommended for follow-up. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: Swan moved History: Swan, IABP Aortic balloon catheter proximal marker projected at the level of the top of the aortic arch with the distal marker at the level of L1.Swan-Ganz catheter tip in left descending pulmonary artery. ICD leads unchanged.Cardiomegaly with no evidence of pulmonary edema or infection.

Output: Swan-Ganz catheter position unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Etiology of cough History: Cough in ILD-polymyositis on immunosuppression Chronic interstitial abnormality in the lung bases, compatible with known fibrotic lung disease.No specific evidence of acute infection.Tortuous thoracic aorta.Normal cardiac silhouette size.Spinal fixation hardware noted.

Output: Findings of known chronic fibrotic lung disease. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old. Catheter from the left arm extending to the area of the left axillary vein.No significant cardiopulmonary abnormalities.

Output: Catheter tip in the left axillary vein.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.PICC placement. Left PICC tip projects over the axillary vein. Interval increase in size of right pneumothorax now with maximal pleural separation from the chest wall of about 1.5 cm laterally. Two right-sided chest tubes are in place. Postsurgical changes of the right lung. Lung volumes remain low. Subcutaneous emphysema extending into the right neck.

Output: Left PICC tip projects over the left axillary vein. Slight enlargement of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Evaluate for pneumothorax. Right chest port and spinal fusion hardware unchanged. Chronic rib deformities.Cardiac silhouette is unchanged in size.Interval improvement in right pleural effusion since the prior study. No pulmonary airspace opacities or pneumothorax.

Output: Interval improvement in right pleural effusion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Optic neuritis. Check for sarcoid or Wegener's No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.ET tube placement. Minimal interstitial edema pattern, stable. The ET tube is 3 cm above the carina. No pneumothorax.

Output: Minimal interstitial edema pattern, stable.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: h/o laryngeal cancer now s/p trach, "p/w SOB in setting of cleaning supplies" (bleach fumes), ?atelectasis suggesting mucus plug, ?new infiltrate Normal cardiac and mediastinal contours.Tracheostomy tube tip is approximately 5.5 cm above the carina.Gastrostomy tube projects over the stomach.No pleural effusions, pneumothorax, or focal opacities.No visible bronchial wall thickening.

Output: No acute cardiopulmonary abnormality. No visible signs of inhalational injury.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: History of tongue cancer status post resection. CHEST:LUNGS AND PLEURA: 2 to 3-mm micronodules unchanged. No evidence of pulmonary metastases.MEDIASTINUM AND HILA: Coronary artery calcifications. No significantly enlarged mediastinal or hilar lymph nodes.CHEST WALL: Neck mass, described separately on the neck CT.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: infection History: chronic SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: IABP Balloon catheter marker projected about 3 cm below the top of the aortic arch.Venous catheter and ICD lead unchanged.Mild cardiomegaly with no evidence of CHF or other acute change.

Output: Catheter in the descending aorta, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: SOB History: SOB No interval change in appropriate position of support apparatusThe appearance of the right hilum after radiation with no residual mass is unchanged. Left basilar discoid atelectasis again noted.Right basilar pleural thickening. No pneumothorax.

Output: Stable adequate position of support apparatus.Residual right hilar mass and adjacent radiation fibrosis again noted.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: pulmonary edema History: acute decompensated heart failure Stable cardiac enlargement..Interval improvement in pulmonary edema and and pleural effusions.No focal areas of consolidation.Underlying chronic appearing interstitial opacities unchanged.Bullet fragment identified in the left upper abdomen.

Output: Cardiomegaly with interval improvement in the pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old.Reason: PNA? Pulmonary edema? effusion? History: AMS? difficulty breathing New patchy airspace opacities left greater than right, consistent with infection and/or aspiration.Small left pleural effusion.Heart size upper normal.

Output: Multifocal pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: chest pain, history of dm and htn History: above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right subclavian catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.History of pneumonia, evaluate ET tube placement. ET tube tip approximately 3 cm above the carina, right central venous catheter, and enteric tube unchanged.Cardiomediastinal silhouette is unchanged.Right lower lobe opacity with adjacent pleural effusion also unchanged. Mild left perihilar opacities also unchanged. Small left pleural effusion.

Output: Overall stable examination with bilateral pleural effusions and airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: eval for acute cardiopulmonary abnormality History: CP Heart size upper normal.No specific evidence of infection or failure.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: P w/ Hx of OHT (12/2013) presenting from OSH w/ c/f PNA History: SOB, productive cough Status post median sternotomy for heart transplant.New basilar opacities suggestive of infection or aspiration.Left subclavian pacemaker, leads unchanged in position.

Output: Left basilar pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: ETT History: ETT ICD with leads unchanged. Enteric tube tip courses below the field-of-view. ET tube tip is approximately 7.5 cm above the carina, unchanged, consider advancement.Bibasilar atelectasis and airspace opacities suspicious for aspiration.

Output: ET tube tip is 7.5 cm above the carina, consider advancement.Bibasilar atelectasis and airspace opacities suspicious for aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Pacemaker leads projected in the area of the right atrium and right ventricle with the ventricular lead directed superiorly and laterally, above the apex.Mild blunting of the left posterior costophrenic angle compatible with a very small effusion.No pneumothorax or other complications.

Output: New pacemaker device with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: Positioning of triple lumen after exchanging History: Exchanged cordis for triple lumen New right IJ venous catheter with its tip in the RA.Chest/mediastinal tubes unchanged.No evidence of a pneumothorax.Median sternotomy is intact.Stable cardiac enlargement with basilar atelectasis slightly improved on the left.

Output: New right IJ venous catheter with its tip in the right atrium. Interval improvement in left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: pre-op bariatric surgery History: none Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Large patient body habitus. Right AC joint widening again noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: 81 yo F with new increased O2 requirement and bilateral opacities, ?change in opacities History: hypoxia The cardiac contours are partially obscured. Signs of emphysema with superimposed pulmonary edema, slightly improved within the right hemithorax as compared to the 11/20/2016 prior examination. A left retrocardiac opacity may reflect a combination of atelectasis and a left pleural effusion. A small right pleural effusion with fluid within the right minor fissure has decreased in size. There is no evidence of pneumothorax. Median sternotomy wires appear intact.

Output: Pulmonary edema, slightly improved within the right hemithorax as compared to the 11/20/2016 prior examination.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: CF, cough, congestion, fever, eval for PNA History: CF, cough, congestion, fever, eval for PNA Chronic bilateral bronchiectasis and chronic left apical loculated pneumothorax is again demonstrated. There is however an interval increase in airspace opacity within the left lower lung which may represent aspiration and/or infection.Volume loss of left hemithorax again noted.Stable appearance of single lumen chest port.

Output: Evidence of superimposed infection in the left lower lobe, superimposed upon the chronic bilateral bronchiectasis


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: effusion? History: SOB No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 74 year-old male with history of NG tube placement. Dobbhoff tube tip at the level of the distal esophagus. Diffuse severe interstitial opacities are unchanged. Probable small bilateral pleural effusions. Stable cardiomediastinal silhouette.

Output: Dobbhoff tube tip at the level of the distal esophagus, otherwise stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 60 year-old man status post esophagectomy for esophageal adenocarcinoma. History of petit mal seizures. VP shunt. Increasing WBC and seizure frequency. Evaluate for abscess pneumonia or source of increase white count. CHEST:LUNGS AND PLEURA: Multifocal air-fluid collections in the right pleural space consistent with empyema. For baseline purposes on axial image 26 collection measures 6.4 x 5 cm.Postsurgical changes. Multifocal collapsed lung on the right. Gastric pull up. Small amount of pleural fluid bilaterally. Some atelectasis at the left base.MEDIASTINUM AND HILA: Gastric pull up.Catheter material in the pulmonary arteries crossing from right to left. This appears to be an isolated piece of catheter.CHEST WALL: Gas throughout the right chest wall consistent with recent surgery. Loculated air fluid collection in the lateral right chest wall measured on series 3 image 63 as 8.2 x 3.5-cm. surgical staples in the skin along the right chest wall.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Small areas of hypodensity in and surrounding the pancreatic body and neck. This could represent small areas of pancreatic necrosis or peripancreatic fluid. No evidence of pancreatic ductal dilatation. Surrounding vessels show no evidence of thrombus.ADRENAL 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: Postsurgical changes anterior abdominal wall. Fat stranding in the omentum consistent with recent surgery.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: Fat stranding in the subcutaneous tissues consistent with mild anasarca postsurgical changes.

Output: Multiloculated collections in the right pleural cavity. Loculated air fluid collection in the right chest wall. Bilateral pleural effusions. Catheter material in the pulmonary artery. Pancreatic and peripancreatic fluid consistent with pancreatitis and small areas of necrosis. Postsurgical changes in the omentum on the abdominal wall.Discussed with surgical team.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: MaleReason for Study: Reason: hypoxia History: o2 at 84% There are decreased lung volumes with stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: IVC filter placement Right subclavian catheters and stimulation wires unchanged. New IVC filter incompletely visualized projected over the inferior edge of the image.No postprocedural pulmonary abnormalities. Persistent mild cardiomegaly

Output: IVC filter placed