Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Patient leads terminating in expected location of the right atrium and right ventricle. No new focal lung consolidation. No pleural effusion or pneumothorax. Heart size at the upper limit of normal. No acute bony abnormality.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: HTN urgency, eval for LVH / widened mediastinum History: HTN urgency No significant cardiopulmonary abnormality.Tortuous aorta, and mediastinum otherwise unremarkable.Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male; 54 years old. Reason: hydropneumothorax, assess stability History: pneumothorax Stable moderate left pleural effusion with underlying atelectasis. Stable tubes and lines.

Output: Stable left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval infiltrates History: h/o multiple myeloma, SOB, on chemo Interval removal of right jugular catheter. Unremarkable cardiac and mediastinal silhouettes. Low lung volumes but no specific evidence of infection or failure.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 30 year-old male with shortness of breath. History of sickle cell disease. Evaluate for acute chest syndrome. Cardiomegaly unchanged.Vascular redistribution consistent with chronic anemia.Unchanged prominent contour at the expected location of the pulmonary artery suggestive of pulmonary hypertension.No focal air space opacity or pleural effusion.Right port with catheter tip at the SVC/RA junction.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 17 years old Reason: eval ETT position, lung fields s/p bilateral pneumothorax History: Lemierre's, ARDs, b/l pneumothorax with 4 chest tubesVIEW: Chest AP (one view) 2/26/2016 at 0547 hours. Left-sided subcutaneous emphysema is again noted. ET tube tip is below the thoracic inlet. NG tube is present. Multiple bilateral chest tubes are unchanged. Cardiac silhouette size is top normal but stable. Multiple diffuse bilateral pneumatoceles are again noted. Small right lung base pneumothorax is present.

Output: Small right-sided basilar pneumothorax. Persistent left-sided subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Reason: fall History: as above Normal heart size with a markedly tortuous and calcified aorta.Moderate scoliosis.Mild deformity of the right 10th rib laterally suggestive of an old healed fracture.No recent fractures are visible though a chest radiograph is not sensitive in this respect.Skin fold on the left but no pneumothorax.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: cough, fever, heavy smoking, please evaluate for infection History: cough, smoking Mild cardiomegaly. Basilar subsegmental atelectasis and a large bulla projected over the lower right paratracheal region.No specific evidence of infection.

Output: Cardiomegaly, paraseptal emphysema, and basilar scarring. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: ? PTX History: chest pain and SOB Mild interstitial opacities suggestive of fibrosis, unchanged.Unremarkable mediastinal contours and cardiac silhouette.No significant pneumothorax.

Output: Unchanged interstitial fibrosis without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: ? chest pain History: ? chest pain No acute cardiopulmonary abnormality. Minimal linear scarring at the left base

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: SOB; eval for focal infection, PTX, pulm edema; hx COPD History: see above No significant cardiopulmonary abnormality.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Presurgical evaluation, dry cough Heart size is top normal in size. Mediastinal surgical clips and sternotomy wires are present.Prominence of the pulmonary vascularity with mild perihilar interstitial opacity suggestive of mild edema. Blunting of the right costophrenic angle compatible with scarring.Linear opacities at the right base could reflect retained or aspirated secretions in the small airways but are nonspecific.

Output: Signs of hypervolemia with possible mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: productive cough History: cough, fever, weakness No acute cardiopulmonary abnormality.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: History of pneumonia, cough Tracheostomy tube terminates 5 cm above the carina. Underlying cardiopulmonary appearance is otherwise unremarkable and clear. Specifically no findings to suggest pneumoniaG-tube projects over left upper quadrant

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Preoperative evaluation. Prior CABG. Rheumatic mitral valve disease. Shortness of breath. Left subclavian pacemaker with leads in the projection of the right atrial appendage, coronary sinus and cranial aspect of the right ventricle. There is an additional lead coiled overlying the pulse generator with lead tip projecting over the soft tissues of the anterior chest wall directed cranially. One of the leads is disconnected near the origin of the pulse generator but I am unable to confirm that this is the same as the retracted lead.No pneumothorax. Upper normal heart size. No pleural fluid. No signs of pulmonary edema or pneumonia.

Output: No acute pulmonary abnormality. One of the pacemaker leads has been retracted projecting over the left upper chest wall, correlate with history.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old. Dysphasia, cough, chest congestion. Evaluate for aspiration pneumonia. No evidence of infection or edema. Surgical sutures right apex.Stable cardiomediastinal silhouette.

Output: No significant acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: swan History: swan placement Right IJ Swan-Ganz catheter tip in the pulmonary outflow tract. Left subclavian AICD unchanged.The left costophrenic angle is excluded from the field-of-view.Stable basilar opacities. No new focal pulmonary opacities, pleural effusion or pneumothorax.Stable cardiomediastinal silhouette.

Output: Swan-Ganz catheter tip in the pulmonary outflow tract.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: tia History: tia Normal cardiac mediastinal silhouette.Lungs clear.No pneumothorax. No pleural effusion.Scoliotic curvature of thoracolumbar spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: tracheostomy in MICU, recurrent aspiration, LUL PNA, ?progression History: tracheostomy in MICU, recurrent aspiration, LUL PNA, ?progression Small lung volumes with interval clearing of focal left upper lobe and right lower lobe opacity.Tracheostomy tube and venous catheters unchanged.NG tube tip area of the gastric pylorus.

Output: Interval clearing of pulmonary opacities compatible with aspiration.


Instruction: Generate impression based on medical findings.

Input: 51 year old male with testicular cancer, evaluate for recurrence History: testicular cancer CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: Status post coronary vascular surgery. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status-post cholecystectomy. Stable benign appearing liver lesions, suggestive hemangiomas and cysts.SPLEEN: No significant abnormality notedPANCREAS: Fatty atrophy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged precaval lymph node (series 3 image 112) measures 1.2 x 2.5 x 3.1 cm and is slightly increased in size over recent priors, measured 1 x 1.7 x 2.7 cm on 7/19/07.Other borderline enlarged lymph nodes in the root of the mesentery are overall stable from multiple priorsBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic T11 vertebral body lesion, unchanged, likely benign.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small fat-containing left inguinal hernia. Submucosal fat deposition in the rectum suggestive of prior inflammation, unchanged. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval increase in size of precaval adenopathy. Continued surveillance is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Cough evaluate for infiltrate. Normal cardiomediastinal silhouette. No pleural fluid or pneumothorax. No focal air space opacities.

Output: No acute cardiopulmonary abnormality. Normal chest.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: concern for left clavicle fracture History: concern for left clavicle fracture No evidence of displaced left clavicular fracture. If there is high clinical suspicion for fracture, recommend dedicated, coned down views of the left clavicle.Diffuse interstitial opacities not significantly changed compared to prior. A new right lower lobe nodule is visualized. Heart size is stable.

Output: New right lower lobe pulmonary nodule. No displaced left clavicular fracture. If high clinical suspicion of fracture does exist, recommend dedicated imaging of the left clavicle.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with history of AML and neutropenic fever. Infiltrate? CHEST:LUNGS AND PLEURA: Upper lobe predominant ill-defined ground glass opacities as well as bronchial wall thickening.Bilateral small pleural effusions.Calcified granuloma in the right upper lobe.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Severe coronary artery calcifications. Low-attenuation of the blood pool is consistent with anemia.CHEST WALL: Left PICC with tip near SVC/RA junction UPPER ABDOMEN: No significant abnormality identified.

Output: Ill-defined ground glass densities in the upper lobes may be secondary. Differential considerations include atypical edema, viral infection, drug toxicity, or less likely fungal pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: Samter's triad asthma, History: poor asthma control Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 51-year-old woman with history of headache and sensorineural hearing loss, evaluate for large vessel vasculitis. Chest:GREAT VESSELS: There is common origin of the right brachiocephalic and left common carotid arteries. The aortic arch is otherwise unremarkable without wall thickening or abnormal signal.MEDIASTINUM: No significant abnormality noted.LUNGS: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted of the partially visualized liver, spleen, or kidneys.

Output: Within limitations of a noncontrast exam, no evidence of vasculitis involving the aortic arch or the great vessels.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Tachycardia, desaturation. Interval slight retraction of left PICC with the distal tip in the left brachiocephalic vein. Interval placement of nasogastric tube with the sidehole positioned above the GE junction in the distal tip in the epigastrium.The cardiomediastinal silhouette is within normal limits. No airspace opacity, pleural effusion, or pneumothorax. Findings of small bowel obstruction in the visualized upper abdomen.

Output: No acute cardiopulmonary process. Advancement of nasogastric tube advised.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: Cough History: Cough Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: r/o acs History: VOC, fever Cardiomegaly.No specific evidence of infection or edema.No evidence of infection or infarction.Skeletal abnormalities of sickle cell disease identified.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: bladder cancer surveillance History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Coughing Mild motion degrades sensitivity. Persistent decreased lung volumes with mild COPD changes are otherwise observed without interval change or new superimposed focal airspace abnormalityCholecystectomy clips and pronounced scoliosis

Output: Mild emphysematous changes without discrete new superimposed focal acute abnormality


Instruction: Generate impression based on medical findings.

Input: Reason: r/o clots - xray need for V/Q History: shortness of breath Normal heart size with prominent main pulmonary arteries, which are confirmed to be enlarged on a previous CT scan, suggestive of pulmonary hypertension. No significant pulmonary abnormalities.

Output: Possible pulmonary hypertension and no significant pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: 54F s/p trach for neck mass, now with shortness of breath History: SOB Underinflated lungs with no gross abnormalities.The apical areas are obscured by the patient's chin however.Dobbhoff tube with its tip in the gastric fundus.

Output: Small lung volumes with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain Mild cardiomegaly with a mildly tortuous aorta.Bilateral mainly basilar interstitial opacity with multiple septal lines compatible with edema.Small pleural effusions.A CT scan has been performed and provides more detailed evaluation.

Output: Findings compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Recent thora for R pleural effusion History: sob Small pleural effusions. Mild bibasilar atelectasis. No pneumothorax. Normal heart size. Mild disc degeneration.

Output: Small pleural effusions without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: new onset seizure, eval for infection History: seizure No focal consolidation, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with breast cancer CHEST:LUNGS AND PLEURA: Moderate left-sided pleural effusion which has increased minimally compared to previous CT. By apical pleural/parenchymal thickening worse at the left apex is unchanged. Reticulations in the right upper lobe anteriorly are unchanged. Subpleural densities in the right middle lobe are unchanged.MEDIASTINUM AND HILA: Previously described multiple enlarged mediastinal lymph nodes are again noted. Index precarinal lymph node measuresCHEST 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 notedKIDNEYS, 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, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant Moderate elevation of the right hemidiaphragm. Small left-sided pleural effusion. Mild basilar atelectasis particularly at the right lung base. Normal heart size. Aortic atherosclerosis.

Output: Moderate elevation of the right hemidiaphragm suggestive of right-sided hemidiaphragmatic and/or phrenic nerve dysfunction.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Post bronchoscopy with risk for perforation. Evaluate for pneumothorax. Redemonstration of cardiomegaly and chronic interstitial opacities. There is no significant evidence of infection or edema. No large pleural effusion or pneumothorax.

Output: No pneumothorax or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with history of ovarian cancer. Receiving chemotherapy. Evaluate disease. CHEST:LUNGS AND PLEURA: New, nonspecific subcentimeter nodule is present in the right lower lobe.Few other micronodules and calcified nodules bilaterally as seen previously. No suspicious masses or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Right chest port catheter with catheter tip in near SVC/RA junction. ABDOMEN: LIVER, BILIARY TRACT: Fatty infiltration of the liver. Layering material in the gallbladder likely represents sludge. No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Uterus absent.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Wall thickening of several loops of distal ileum likely represent sequela of radiation therapy. More focal nodular thickening is seen on series 3, image 165.Focal soft tissue thickening involving the rectum (series 3, image 182) is also noted. While this may represent postoperative changes, tumor implant is also a possibility.No evidence of bowel obstruction. No ascites.BONES, SOFT TISSUES: Nodular soft tissues focus along the anterior/inferior abdominal scar projecting posterior into the peritoneum appears similar to prior study with the index lesion (series 3, image 187) measures 2.2 x 2.7 (stable).

Output: 1. New subcentimeter pulmonary nodule in the superior segment of the right lower lobe. While it may be postinflammatory in etiology, continued surveillance is recommended.2. Stable postoperative changes and scarring in the lower abdomen extending to the ventral surface of the bladder.3. Wall thickening of distal ileum, possibly sequela of radiation therapy. Nodular areas of thickening in a loop of distal ileum as well as of the rectum may represent posttreatment changes. However, tumor implant is also a possibility.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: New fever s/p mandibular free flap History: Febrile, Trach on PS/CPAP Tracheostomy unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Nonspecific basilar opacities compatible with atelectasis.No focal areas of consolidation.No large pleural effusions.

Output: No interval change without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Female, 58 years old. Reason: pleural effusion, edema, infiltrate. History: back pain, dyspnea Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.No evidence of osseous abnormality.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with sinonasal cancer status post chemotherapy. LUNGS AND PLEURA: Previously identified right upper lobe subpleural opacity adjacent to the vertebral column (image 37, series 5) is unchanged since 3/2005 and unlikely to represent a metastasis. Stable appearing nodule in the superior segment of the right lower lobe, 6 mm x 6 mm (image 59, series 5) likely represents an intrapulmonary lymph node.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Multiple well-defined hypodense lesions scattered throughout the liver compatible with simple cysts, unchanged.

Output: No new findings. No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with nausea and vomiting. Movement of NG tube. Again noted is contrast-containing dilated loop of bowel in the right lower quadrant. Free intraperitoneal gas cannot be excluded. NG tube no longer identified. Clips overlie the pelvis and right chest.

Output: NG tube retracted and not visualized.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: SICU patient intubated History: SICU patient intubated The endotracheal tube projects approximately 3.5 cm above the carina. A right internal jugular catheter has its tip at the junction of the brachiocephalic veins and superior vena cava. An enteric tube extends below the field-of-view. The left internal jugular venous catheter has its tip at the cavoatrial junction. Surgical clips project over the left neck.The cardiomediastinal silhouette is unchanged. Streaky bibasilar, right greater than left, opacities likely atelectasis and/or scarring. Small to moderate bilateral pleural effusions may have increased in size, although it is difficult to discern size given portable technique and patient positioning. No pneumothorax.

Output: Bilateral pleural effusions and bibasilar atelectasis without substantial change.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: shortness of breath Cardiomegaly with small pleural effusions and possibly mild interstitial edema.A more recent radiograph has been interpreted.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with metastatic leiomyosarcoma to the liver. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Upper mediastinal lymph node measuring 8 by 8mm image number 16, series number 3 is unchanged from previous CT.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Again noted bilobar hepatic metastatic lesions. Reference lesion in the left lobe is enlarged measuring 4.5 x 2.8 cm image number 96, series number 3. Reference lesion in the right lobe is also slightly enlarged measuring 2.7 x 2.5 cm image number 85, series number 3. Other metastatic lesions also significantly increased in size.SPLEEN: Not visualized. Round soft tissue densities in the left upper quadrant largest measuring 2.2 x 2.1 cm on image number 105, series number 3 increase in size and lack are present splenules. Given the patient's history of leiomyosarcoma peritoneal spread is a less likely possibility.PANCREAS: Status post distal pancreatectomy. Postsurgical changes in the pancreatectomy bed is unchanged. Previously measured reference ill-defined soft tissue area measures 2 x 1.4 cm image number 107, series number 3.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate stone in the right kidney without causing hydronephrosis unchanged. 5-mm stone in the right UV junction without causing significant hydronephrosis. RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged. Reference lymph node measures 9 x 9 mm image number 134, series number 3.BOWEL, MESENTERY: Significant interval increase in the size of the right current mass adjacent to the surgical anastomosis on the left side of the abdomen. The mass measures 5.9 x 5.6 cm image number 122, series number 3. On retrospect , it was measuring 4.2 x 2.9 cm number 125, series number 5 on CT dated 7/28/2009. Inferior to this mass there are also well-defined round, necrotic appearing components with peripheral rim enhancement.Right lower quadrant ileostomy is unchanged.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: Ill-defined soft tissue mass measuring 3 x 2.2 cm image number 180, series number 3 in the wall of small bowel in the pelvis is stable in size and likely represents metastatic disease.In the right lower quadrant small bowel loop adjacent to the surgical anastomosis demonstrates mild wall thickening. This appearance may also secondary to adjacent nonopacified small bowel. Evaluation of this area on follow-up imaging is recommended to exclude other metastatic disease.Mesenteric adenopathy in the left upper quadrant measuring 15 x 15 mm image number 115, series number 3 is significantly enlarged. Previously present measuring 8 by 8mm image number 115, series number 5. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval progression of disease with interval increase in the size of the recurrent mass in the surgical anastomosis on the left side and increase in the size of the hepatic metastatic lesions. Small mediastinal and retroperitoneal lymph nodes and metastatic lesion to the small bowel in the pelvis are stable.Right UV junction stone.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p picc line adjustment History: s/p picc line adjustment Right upper extremity PICC catheter tip has been slightly retracted and is now at the atriocaval junction. Other support devices are unchanged.Stable cardiomediastinal silhouette.Persistent right basilar opacities with interval improved aeration of the left lower lobe.No pneumothorax.

Output: Right upper extremity PICC tip at the atriocaval junction. Improved aeration of the left lower lobe.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, 37 years old.PICC placement for TPN. Enteric tube extends to the upper abdomen with tip overlying the gastric antrum.Right upper extremity PICC tip projects over the right atrium. This may be retracted by 5 cm.Layering pleural fluid and atelectasis about the same. Left paratracheal stripe widening may be the result of air in the esophagus; the remaining contour abnormality immediately above the level of the aortic arch is better seen on today's study given the presence of rotation and is of unclear etiology; possibly vascular summation or a lymph node.

Output: Right PICC tip at the cranial aspect of the right atrium and may be slightly retracted if desired. Left superior mediastinal contour abnormality; suggest reassessment with PA and lateral chest radiographs after management of patient's volume status.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: h/o M.S. and contractures, now with acute onset SOB History: SOB The cardiomediastinal silhouette is unremarkable.Bilateral pleural effusions similar to the prior exam.Right central venous catheter with its tip in the SVC.No new pulmonary opacities identified.

Output: Bilateral pleural effusions without interval change.


Instruction: Generate impression based on medical findings.

Input: 63 years, Male. Reason: eval NG,Jtube History: repositioned Distal esophageal stent is noted. Feeding tube is coiled multiple times in the stomach with tip overlying the descending duodenum. Pelvis is excluded from view.Bilateral chest tubes are partially visualized. Retrocardiac opacity is noted. Please see same day chest radiograph report for additional findings.

Output: Feeding tube is coiled multiple times in the stomach with tip overlying the descending duodenum.


Instruction: Generate impression based on medical findings.

Input: Reason: eval balloon pump History: see above Aortic balloon catheter tip in the proximal descending aorta.Swan-Ganz catheter and ICD leads unchanged.Cardiomegaly with no specific evidence of edema or infection.

Output: Balloon catheter marker at the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old. Interval removal of a Swan-Ganz catheter.New right jugular catheter extending to the SVC with no pneumothorax or other complications.Left jugular catheter and ECMO cannulae unchanged.Cardiomegaly with pleural effusions and pulmonary opacity compatible with edema and underlying sarcoid.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: chest pain History: chest pain No acute abnormality.No specific evidence of infection or edema.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 94 yearsGender: FemaleReason for Study: Reason: weakness, fall History: weakness Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.Moderate dextroscoliosis of the thoracolumbar junction.Severe degenerative joint disease involving the glenohumeral joints bilaterally.No acute fracture identified.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: eval lung fields, chest tubes History: s/p AVR Unchanged chest tubes with no pneumothorax.Unchanged basilar atelectasis and edema with small pleural effusions.Status post extubation.Right jugular Swan-Ganz catheter tip in right pulmonary artery.

Output: Unchanged pulmonary opacities. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: CHF, decreased breath sounds. Question effusions. Mild cardiomegaly unchanged. No pleural fluid or pneumothorax. Mild chronic interstitial abnormality without significant change. Mild basal atelectasis on the right.

Output: Mild chronic interstitial abnormality which may reflect borderline edema. No pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Reason: 22 y/o lady w/ a hx of sickle cell. ? PNA on port CXR History: None Moderate cardiomegaly and skeletal sclerosis consistent with sickle cell disease.Mild right lower lobe mainly interstitial opacities, not significantly changed from the previous exam but increased from 3/6/2016, compatible with infection.

Output: Persistent mild right lower lobe opacity compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant Moderate cardiomegaly with single lead ICD device extending to the apex of the right ventricle.No sign of CHF or active pulmonary disease.

Output: Moderate cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Hypotension st post CABG History: Hypotension st p CABG Median sternotomy for aortic valve replacement with chest tubes but no pneumothorax.Mild basilar atelectasis retrocardiac region postop.Right jugular Swan-Ganz catheter tip in main pulmonary artery.ET tube tip approximately 3 cm above the carina.No significant pneumothorax. Esophageal ultrasound probe in place.

Output: No pneumothorax. Postoperative basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Essential hypertension. Generalized pain. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Small bowel obstruction. High nasogastric tube output CHEST:LUNGS AND PLEURA: Moderate right pleural effusion, increased in size, causing partial atelectasis of the right lower lobe. A small left pleural effusion is noted, new.MEDIASTINUM AND HILA: Stable anterior diaphragmatic node.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Sludge layers within the gallbladder. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again identified is a partial small bowel obstruction, as air and fluid are noted throughout the colon. The transition point is again noted in the midline of the pelvis (series 3, image 151). Scattered surgical clips are noted along with a ventral abdominal wall incision.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild ascites, improved. Partially thrombosed right ovarian vein (series 3, image 119), unchanged.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The previously described soft tissue density adjacent to the right iliac vessels, is less well appreciated on this study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Partial small bowel obstruction, unchanged. New small left pleural effusion with increase in the right pleural effusion, now moderate.Mild ascites, mildly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: Check ET tube placement History: Et tube ET tube has been retracted and is 6-7 cm above carina. Other findings stable in short interval.

Output: ET tube has been retracted and is 6-7 cm above carina


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: air leak s/p open lobectomy History: shortness of breath One of two right chest tubes removed, and there is an air-fluid level indicative of a right hydropneumothorax.Unchanged right basilar consolidation and pleural effusion.Increased interstitial markings in the left lung base periphery could be the result of aspiration.Right subclavian catheter, tip in SVC.

Output: One of two right chest tubes removed, and there is a right hydropneumothorax as well as right basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Eval line placement History: none Moderate cardiomegaly with borderline interstitial edema.Left subclavian ICD, leads unchanged in position.Right jugular catheter, tip in SVC.

Output: Cardiomegaly, with borderline edema. Right jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: 20 yo M with subcutaneous ICD placement, ?position change History: ICD placement Presternal ICD lead, unchanged allowing for differences in projection and position.Generator device in the left chest wall with a small amount of subcutaneous emphysema.Moderate cardiomegaly with increased upper zone blood flow and mild basilar scarring, unchanged.Filter device and embolization coils in the IVC.

Output: Presternal ICD device in place with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male 44 years old Reason: preop for islet cell transplant History: as above The left extremity PICC has been removed. No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. Embolization coils again noted in the right upper quadrant.

Output: No acute cardiopulmonary abnormality. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: s/p esophagectomy History: - Tubes, drains, and lines unchanged.Stable cardiomediastinal silhouette.Persistent small left apical pneumothorax.Basilar opacities are compatible with atelectasis/edema

Output: Stable cardiopulmonary appearance with persistent left apical pneumothorax. Support devices unchanged.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Left apical scarring is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Evaluate cardiopulmonary pathology History: pleuritic chest pain The cardiac silhouette appears enlarged. Low lung volumes. Bibasilar streaky opacities are present subsegmental atelectasis/consolidation. No pleural effusion or pneumothorax.

Output: Enlarged cardiac silhouette and bibasilar atelectasis. Please see CT of the chest from the same date for further findings.


Instruction: Generate impression based on medical findings.

Input: Reason: lung fields History: sob Bilateral pulmonary opacities suggestive of edema with pleural effusions, larger on the left.Tracheostomy tube and venous catheters unchanged.No new findings.

Output: Findings suggestive of pulmonary edema and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: Daily CXR History: Daily CXR Cardiomegaly status post sternotomy.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter tip in right pulmonary artery, looped in the right atrium. The service was contacted regarding this yesterday.Left subclavian ICD, leads unchanged in position.LVAD unchanged.Left PICC, tip in the SVC.

Output: Swan-Ganz catheter still looped in the right atrium. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: s/p Bronch with biopsy History: Fu CXR post-op Status post clamshell sternotomy for bilateral lung transplant.Left bronchial stent unchanged.Mild left upper lobe scarring, the lungs otherwise unremarkable and stable.

Output: No pneumothorax following bronchoscopy and biopsy.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: post trach History: post trach cxr Interval placement of tracheostomy tube.Interval removal of nasogastric tube.Pacemaker leads unchanged in position.Interval development of retrocardiac opacity which may represent atelectasis however infectious etiology cannot be excluded.No pneumothorax.

Output: 1. Tracheostomy tube placement2. Interval development of retrocardiac opacity, likely atelectasis. Infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: ARDS History: dyspnea, hypercapnia Moderate cardiomegaly with unchanged lower lung zone edema and left lower lobe consolidation.Persistent pleural effusions left larger than right.Left central line still terminates at the cavoatrial junction.

Output: No change in pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Prematurity. Esophageal and duodenal atresia.VIEW: Abdomen and chest AP (2 views) 10/30/2016 at 1708 hours. Esophageal tube tip terminates at T4. Mediastinal clips and TEF ligature are again noted. Gastrostomy tube is in place. Right lower extremity PICC terminates in the iliac vein.Cardiac silhouette size is normal. Persistent diffuse lung haziness with no focal opacities, effusions or pneumothorax.Paucity of abdominal gas

Output: Diffuse lung haziness with no focal opacities.Paucity of abdominal gas.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of colon cancer, stage III, resected in 6/06. Evaluate for recurrent disease. CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. A few scattered pulmonary micronodules, some of which are calcified, are nonspecific.MEDIASTINUM AND HILA: Small mediastinal lymph nodes, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the dome of the liver, too small to characterize, is unchanged.SPLEEN: Calcified granulomas in the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cystic lesion is unchanged and likely benign.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postoperative change status post partial rectal resection with mild thickening of the residual rectal wall. Presacral soft tissue density and foci of air, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant interval change and, specifically, no evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for change in opacities History: bilateral pulmonary opacities, now intubated with ARDSVIEW: Chest AP (one view) 06/24/15 at 04:53 Unchanged lines and support devices with left chest pigtail catheter again noted. Interval enlargement of bilateral pleural effusions with interval worsening of multifocal patchy airspace opacities, in a pattern suggestive of ARDS. Low lung volumes. No pneumothorax is identified. Cardiothymic silhouette normal.

Output: Interval worsening of bilateral pleural effusions and airspace opacities suggestive of ARDS.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: Cough and 20 pack-year history Prominent central pulmonary vessels, concern for pulmonary hypertension. No distinct superimposed focal air space abnormality or hilar finding to support malignancy, however consider serial imaging and/or CT evaluation given patient history; given greater sensitivity.Cardiac and mediastinal contours significant for mild tortuosity of the aorta

Output: Possible pulmonary retention without superimposed acute interval change


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: FemaleReason for Study: Reason: Pre-Eclampsia, concern for pulm edema History: respiratory distress / increasing work of breathing There is mild cardiac enlargement.Perihilar interstitial opacities are suggestive of edema and atelectasis.No focal areas of consolidation.No large pleural effusions.

Output: Mild cardiomegaly with probable interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: asses for pneumonia History: sepsis Ill-defined left lower lobe opacity suspicious for developing pneumonia. Remaining lungs clear. Heart size normal. No other interval change

Output: Developing left lower lobe opacity suspicious for pneumonia


Instruction: Generate impression based on medical findings.

Input: Fever Unchanged cardiopulmonary appearance with a borderline cardiac appearance exaggerated by scoliosis. Midline sternotomy and ICD unchanged. Interval right jugular catheter placed tip extends into the proximal SVC. Specifically lungs are clear other than basilar scarring and/or atelectasis

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old with shortness of breath, rule out pneumonia. Persistently low volumes and bibasilar atelectasis is not significantly changed although is again worse on the right compared to the left. There are multilevel vertebroplasties. Tortuosity of the aorta is unchanged.

Output: No significant change in bibasilar atelectasis or persistently low lung volumes.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: swan catheter placement History: none Right IJ Swan-Ganz catheter tip terminates in the right interlobar pulmonary artery.Mild streaky left basilar opacities suggest minimal atelectasis. Possible small right pleural effusion. No pneumothorax. Cardiomegaly unchanged.

Output: Swan-Ganz catheter tip in the right interlobar pulmonary artery. Otherwise no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: Rule out pneumonia. History: neutropenic fever Right central venous catheter with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Minimal basilar scarring.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: Volume overload vs worsening septic emboli History: Increased 02 requirement Feeding tube terminates in the gastric antrum. Low lung volumes. Small bilateral pleural effusions. Bibasilar opacity. No specific evidence of edema. Scattered nodular opacities are less conspicuous on this exam. Moderate cardiomegaly, unchanged.

Output: No significant change from prior examination. Right basilar opacity most consistent with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: check pulmonary status History: check pulmonary status ET tube tip approximately 7 cm above the carina.Feeding tube tip in the area of the gastric pylorus.Moderately elevated right hemidiaphragm with subsegmental atelectasis at the right base and no other significant pulmonary abnormalities.Chest tubes on the left but no pneumothorax.Catheter in the left arm extending to the axilla.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: history of left sided pleural effusion History: dyspnea Known cystic fibrosis with scar like opacities and areas of bronchiectasis, improved compared to the prior study especially in the left lower lobe.No pleural effusions identified.Unremarkable mediastinal contours and cardiac silhouette.

Output: Chronic opacities related to known cystic fibrosis, improved in the left lower lung zone with no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: r/o pulmonary edema History: sob Moderate cardiomegaly.No specific evidence of infection or edema.

Output: Cardiomegaly without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest tube removal Right chest tubes removed without postprocedural immediate complication. Underlying cardiopulmonary appearance is grossly similar given marked motion limiting sensitivity. Persistent right jugular sheath

Output: Right chest tubes have been removed


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.New tracheostomy placement. Mild right basilar atelectasis, not significantly changed. No pleural abnormalities.Cardiomediastinal silhouette is within normal limits.Interval placement of tracheostomy tube, with tip approximately 3 cm above the carina.

Output: Tracheostomy tube tip approximately 3 cm above the carina.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for aspiration History: eval for aspiration Endotracheal tube terminates 5 cm above the carina. Nasogastric tube side hole terminates at the GE junction.The lungs and pleural spaces are clear. The heart size is normal.

Output: No evidence of aspiration in this intubated patient.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for pneumothorax History: S/p IVC filter removal Unremarkable cardiac and mediastinal silhouette. Skinfold over the left lateral lung but no pneumothorax.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old. Intubated. Evaluate for interval change. ETT tip 2 cm above the carina. NGT tip in the stomach.Severe emphysema with upper lobe scarring.Large left apical cavitary lesion, unchanged.No new findings.

Output: ETT in appropriate position. Left apical cavitary lesion with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Chest tube check Tracheostomy tube is unchanged. A new pigtail catheter projects over the lateral right lower lung with interval decreased effusion. Small to moderate pleural collections are again observed bilaterally.Under expansion with basilar streaky densities suggesting probable atelectasis, however the opacities and the appearance is nonspecific. If there is concern for infection or aspiration, serial imaging will be needed

Output: Interval placement of a right chest tube


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old. History: Multiple myeloma. Symptom of fever, malaise, fatigue. Query pneumonia. Unremarkable cardiomediastinal silhouette.No focal pulmonary opacity or pleural disease.Mid thoracic vertebral body compression fracture again seen on lateral view.

Output: No acute cardiopulmonary process. Midthoracic vertebral body fracture redemonstrated.


Instruction: Generate impression based on medical findings.

Input: History 7-year-old male s/p left lung transplant with new onset hemoptysis Persistent diffuse chronic interstitial disease within the native right lung as well as mild basilar scarring of the left transplanted lung. Decreased lung volumes. No evidence of pleural effusion or pneumothorax.

Output: Chronic abnormalities of the right native lung with no signs of infection or hemorrhage. No interval changes..


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: s/p lung txp History: worsening fluid status? Severe interstitial and airspace opacities with pleural effusions are unchanged.Dobbhoff tube with tip in transverse duodenum.Two right jugular catheters, one at the right atrial level and the other in the SVC.Tracheostomy tube tip approximately 6 above the carina.

Output: Unchanged severe pulmonary opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of aortic dissection now with chest pain radiating to back. CHEST:LUNGS AND PLEURA: Mild bibasilar pleural thickening, unchanged. No suspicious nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Stable type B aortic dissection. Measurement at the level of the right main pulmonary artery is 5.8 cm (series 10, image 73), unchanged. Ascending aorta repair is intact without evidence of complication.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: Previously noted inferior pole right renal cyst is not well visualized on current study. Multiple remaining cysts appear similar prior study. Stable infarcted atrophic left kidney.RETROPERITONEUM, LYMPH NODES: Type B aortic dissection continues into the abdomen and has been stable since prior study from 2007. Two right renal arteries and mesenteric arteries are supplied by the true lumen. The left renal artery comes off the false lumen with infarction of the left kidney as above.Measurement of the aneurysm at the level of the midpole of the right kidney is 3.3 x 2.9 cm (series 9, image 189); also stable since study from 12/14/2007.The aneurysm extends into the left common iliac artery and enters the left external iliac artery. The proximal left common iliac artery is aneurysmal, measuring 2.3 x 2.6 cm (series 10, image to 30) and is also stable accounting for differences in technique.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS: Please note that the entire pelvis was not scanned; however its visualized portions show no significant abnormality.

Output: Stable type B aortic dissection. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: eval for interval change History: SOB Large right pleural effusion, minimal improvement in aeration on the right. Left side hypoinflated. Osseous metastases.

Output: Large right pleural effusion, minimal improvement in aeration on the right.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: interval exam History: interval exam s/p lvad Chest CT with no pneumothorax.Cardiomegaly and persistent minimal edema pattern.ET tube tip approximately 3 cm above the carina.Left jugular Swan-Ganz catheter tip peripherally located in a branch of the interlobar pulmonary artery.Unchanged LVAD and ICD.

Output: Swan-Ganz catheter tip quite peripheral in a branch of the interlobar pulmonary artery. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Cough, hypoxemia, history of pneumonia x3. Normal cardiomediastinal silhouette. No pleural fluid or pneumothorax.No focal airspace opacities or signs of pulmonary edema.

Output: No acute cardiopulmonary abnormality. Specifically, no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Neutropenic fever. Rule out signs of infection. No focal airspace opacities, pleural fluid or pneumothorax. Left jugular catheter tip at the level of the right atrium, no pneumothorax. Right chest port unchanged in position.

Output: No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 35-year-old little with metastatic melanoma CHEST:LUNGS AND PLEURA: Reference left lower lobe lesion measures 1.7 x 1.5-cm image number 62, series number 6, not significantly changed from previous study. Other smaller nodules are also unchanged. Nodular density on image number 70 on previous study has resolved and could represent atelectasis.MEDIASTINUM AND HILA: Previously described pulmonary emboli most prominent in the right lower lobe pulmonary two branches are again visualized.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity on image number 120, series number 4 is unchanged. No other hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Small right adrenal nodule likely representing an adenoma is unchanged measuring 15 by 12 mm on image number 83, series number 4.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A new IVC filter is in place. Thrombosis of the left common iliac vein and possibly internal iliac vein is unchanged. New thrombus superior to the tip of the IVC filter.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: There is new thrombus superior to the level of the IVC filter. Thrombosis of the left common iliac vein is not significantly changed thrombus also likely extensive the left internal iliac vein. Previously described pulmonary arterial branch emboli are less obvious on right upper and left lower lobe branches. Right lower lobe emboli are still present. One of the right lower lobe nodular densities have resolved in the interval. Other lung nodules are unchanged.Dr. Berhanu , resident on call for oncology, was notified and acknowledged about these findings, specifically the new thrombus superior to the level of the IVC filter, at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: 38yo M s/p intubation, assess ETT History: as above Lines and tubes are unchanged. Diffuse pulmonary opacities again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Diffuse pulmonary opacities again noted.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of cervical lymphadenopathy evaluate for change in size compared to 3/21/11. Previously noted bilateral, multi-compartmental lymph nodes in the neck, are again seen; however, are decreased in size compared to the previous examination. No new abnormal lymph nodes are noted. Reference lymph node at the angle of the left mandible previously measuring 8 mm, (series 3, image 40), now measures 5 mm, (series 3, image 49).Pharyngeal/laryngeal airway are patent. Epiglottis, vallecula, piriform sinuses, and vocal cords are unremarkable. Parotid, submandibular, and thyroid glands are unremarkable. Carotid arteries and jugular veins are patent. Limited views of the brain, and orbits are within normal limits. Mild multilevel degenerative disk disease, unchanged. The visualized lung apices are within normal limits. Partial visualization of sternotomy wires, and pacemaker generator within the left chest wall.

Output: 1. Multi-compartmental lymph nodes throughout the neck, which may be reactive in etiology, with overall interval decrease in size.2. Repeat imaging may considered if the lymphadenopathy fails to resolve clinically.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with history of anal cancer CHEST:LUNGS AND PLEURA: Emphysematous changes, stable. Linear atelectasis in lingula and mild bronchial wall thickening is stable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cavernous transformation of the main portal vein with collateral vessels in the hepatic hilum is again noted. Main portal vein is patent. Mild splenomegaly, unchanged.SPLEEN: Mild splenomegaly, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index aortocaval lymph node measures 8 mm in diameter on image number 130, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index left inguinal lymph node measures 1.2 x 0.9 cm on image number 200, series number 3, unchanged from previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.History of asthma, pulmonary exacerbation Minimal bronchial wall thickening compatible the stated history of asthma. No associated consolidation or pneumothorax. The pleural spaces are clear. The heart size is normal.

Output: Minimal bronchial wall thickening compatible with stated history of asthma. No evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: widened mediastum History: Chest pain 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: Female, 54 years old.Reason: please do early am to eval apical pneumothorax History: apical pneumo Improved left pneumothorax with a left chest tube, and unchanged pleural effusions with left basilar consolidation.Right sided venous catheter overlies the right atrium.

Output: Improvement in left apical pneumothorax


Instruction: Generate impression based on medical findings.

Input: 72-year-old female, follow-up for colon cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Enlarged heterogeneous thyroid gland with mass effect on trachea causing some airway compromise appear similar to prior study.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Small gallstone without evidence of cholecystitis or biliary dilatation. Subcentimeter lesion in the right lobe is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple hernias containing nonobstructing bowel segments are unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Pt is a 30 yo female w/ hx of DLBCL s/p chemo; pre-asct Left-sided PICC terminates near the cavoatrial junction. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Normal heart size.

Output: No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Reason: please eval while intubated History: intubated Cardiopulmonary monitoring and support devices, unchanged.Bilateral opacity compatible with edema, atelectasis and effusions, greater on the left. Small amount of residual intraperitoneal air, decreased from previous.No new findings.

Output: CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: infection vs edema History: sob, tahcypnea, wbc Moderately underinflated lungs with streaky basilar opacities compatible with atelectasis. Bilateral venous catheters unchanged and feeding tube in the body of the stomach.

Output: Basilar atelectasis with no specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Clinical information LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No metastatic disease


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Rule out foreign body Interval removal of left pacemaker pulse generator and electrode. Interval placement of a bioprosthetic mitral valve. The endotracheal tube terminates 5 cm superior to the carina. Right central catheter terminates within the mid right atrium. Left subclavian Swan-Ganz catheter terminates in the main pulmonary artery. Several subxiphoid mediastinal drains and a right basilar chest tube are present. External defibrillator pads are in place.MID to lower zone postoperative edema and atelectasis. No significant pneumothorax. Interval widening of the mediastinum likely related to postoperative hematoma and/or fluid.No evidence of radiopaque foreign body. These findings were discussed by telephone with Dr. Ota, the attending surgeon, on 3/13/15 at 1242 hrs.

Output: No evidence of radiopaque foreign body.


Instruction: Generate impression based on medical findings.

Input: 78 years old Female. Reason: Eval ET placement. History: See above.. Stable retrocardiac opacity, which can be due to pneumonia. New groundglass opacity in the right upper lobe. The cardiac silhouette is stable. There is no evidence of pneumothorax. There is a questionable left small pleural effusion. The ET tube and NG tube are stable in position.

Output: Stable retrocardiac opacity, which can be due to atelectasis or pneumonia. New groundglass opacity in the right upper lobe, which can be due to edema or infection. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old. ET tube tip approximately 3 cm above the carina.Catheter tip in the right atrium. An NG tube terminates in the stomach.Small lung volumes with interstitial opacities suggestive of edema and atelectasis.Unchanged right chest wall mass involving the lateral aspect of the right third rib.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: ACS, overload History: CP in ESRD Stable global cardiomegaly.The tip of the right IJ HD catheter terminates in the superior cavoatrial junction.Persistent signs of pulmonary venous hypertension. Minimal bilateral lower lobe septal lines represent interstitial pulmonary edema.No pleural effusion or pneumothorax.

Output: Persistent signs of interstitial pulmonary edema associated with cardiomegaly and pulmonary venous hypertension.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with history of aggressive non-Hodgkin's lymphoma. CT after two cycles with little to no change. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Pretracheal adenopathy is unchanged measuring 19 x 9 mm image number 44, series number 4. Other scattered small mediastinal lymph nodes are not significantly changed. Aortic valve calcifications and mitral valve replacement are noted.CHEST WALL: Sternal wires unchanged. No other significant abnormality.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right renal stone and mild right-sided caliectasis are unchanged. Left double J stent is placed within the left renal collecting system.RETROPERITONEUM, LYMPH NODES: Nonspecific subcentimeter retroperitoneal lymph nodesBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Pelvic lymphadenopathy is not significantly changed since the prior exam. Reference right obturator adenopathy measures 1.9 x 1.6 cm on image 200, series 4. Left obturator adenopathy measures 2.7 x 3.3 cm on image number 191, series number 4. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Large pelvic mass is not significantly changed, now measuring 12.1 x 7.5 cm image number 194, series number 4 invading the bladder, prostate and the seminal vesicles.

Output: Stable large pelvic mass, pelvic adenopathy and other findings.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Postop CABG. Unchanged mediastinal drains. Interval removal of endotracheal tube and Swan-Ganz catheter. Opacity and volume loss in the left lower lobe.

Output: Interval removal of endotracheal tube and Swan-Ganz catheter without significant interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Fever. Nodular and linear retrocardiac opacity, which appears similar to prior exam and is better evaluated on CT chest, abdomen, and pelvis performed the same day. There is increased right pleural effusion with overlying atelectasis. Cardiomediastinal silhouette is unchanged. No new focal airspace opacity or pneumothorax. Interval removal of right sided chest port.

Output: Nodular and linear retrocardiac opacity appears similar to prior examination. Increasing right pleural effusion with overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Chest pain in patient with sickle cell disease, prior PE, ACS. Cardiothoracic ratio appears improved compared to the prior study, now within normal limits. Diffuse osseous stigmata of sickle cell disease.Basilar scarring bilaterally. No focal airspace opacities.

Output: Chronic pulmonary and skeletal findings consistent with sickle cell disease. No acute pulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: evaluate for pulmonary edema, infiltrate History: shortness of breath, chest pain, mild volume overload, afib Moderate cardiomegaly. Pleural effusions and pulmonary edema have improved. No focal lung consolidation. No pneumothorax.

Output: Improving pleural effusions and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Known cystic lung disease of unknown etiology versus emphysema.Heart size normal.No reliable evidence of superimposed edema or pneumonia.

Output: Interstitial lung disease, prior CTs revealing emphysema or numerous cysts.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Subarachnoid hemorrhage. Ventilated patient. Mild diffuse interstitial abnormalities are stable. Cardiomegaly is slightly progressed. Left PICC tip over the SVC. ET tube is 4 cm above the carina. NG tube in the stomach. No pneumothorax.

Output: Mild interstitial edema pattern is stable. Cardiomegaly slightly progressed.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and cough. Chest pain Persistent moderate nonspecific cardiomegaly with decreased lung volumes essentially unchanged. No specific superimposed acute cardiopulmonary abnormality. Lungs are clear

Output: Cardiomegaly without acute pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Heart disease. Stable. Preop. Severe interstitial lung abnormality with emphysema, coarse reticulonodular opacities and mild volume loss. Normal heart size. Main pulmonary arteries are may be enlarged, pulmonary hypertension cannot be ruled out. Atherosclerotic calcification of the thoracic aorta. No specific signs of edema or other acute abnormality.

Output: No acute pulmonary abnormality however the patient has a severe interstitial lung disease pattern consistent with pulmonary fibrosis and correlation with ILD protocol thoracic CT is recommended when feasible to further characterize.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Fever and cough rule out acute process. Bronchial wall thickening and bilateral basal peribronchial opacity, which appears to have cleared on a subsequent CT, likely reflecting aspiration. No pleural fluid. Normal heart size.

Output: Probable mild aspiration of secretions which appears to have cleared on a subsequent CT through the area.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: cp History: above No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: evaluate pneumonia History: pneumonia Amputated left-sided ICD electrodes unchanged from prior. Sternotomy hardware well aligned.Left mid to lower zone reticular opacities of pneumonia. No associated edema. Heart size stable.

Output: Persistent left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: r/o pneumonia History: increased inhaler use Heart size normal. Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.AMS and sepsis. Secondary malignant neoplasm of right lung. Pneumomediastinum with subcutaneous emphysema in the neck. Decreased opacity along the suture line in the left upper lobe.Right lower lobectomy.Right middle lobe masslike opacity about the same.No signs of pulmonary edema or pneumonia.

Output: Interval development of pneumomediastinum of unclear etiology. Improved density of mass surrounding the left upper lobe resection site. Please note that this mass previously demonstrated communication with the tracheobronchial tree and breakdown of the tracheobronchial tree with or without secondary infection of the mass could be a potential cause of pneumomediastinum.Case discussed with the ED at 12:58 PM on 8/16/2016.


Instruction: Generate impression based on medical findings.

Input: Reason: resp distress History: as above Interval clearing of perihilar and lower zone opacity compatible with atelectasis and consolidation.Residual small pleural effusions.Right jugular catheter tip in the area of the junction of the jugular and brachiocephalic veins.

Output: Improvement in lower lobe opacities with residual small effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: eval for failure History: CP and SOB No significant cardiopulmonary abnormality.Right subclavian biventricular ICD unchanged.Ureterostomy tubes incompletely visualized.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with medullary thyroid cancer status post 19 cycles of therapy. CHEST:LUNGS AND PLEURA: Multiple pulmonary metastases have increased in number and prominence on comparison to prior study. Reference left upper lobe nodule measures 7 x 8 mm (series 4, image 23); previously measuring 6 x 8 mm. A right lower lobe nodule (series 4, image 58) measures 6 mm, previously measuring approximately 3 mm.Scarring and suture line in right middle lobe is again seen, compatible with previous biopsy.MEDIASTINUM AND HILA: New necrotic lymph nodes are seen in the prevascular space (series 3 images 11 and 20). Heart size normal without pericardial effusion.CHEST WALL: Very small sclerotic foci in the head of the right clavicle and in the posterior right sixth rib have not changed. ABDOMEN:LIVER, BILIARY TRACT: Irregular thickening and enhancement of the gallbladder wall as described previously. No evidence of intrahepatic metastases.Prominence of the common bile duct, measuring 8.5 mm. Subtle layering density within the gallbladder may represent noncalcified gallstones.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: Diffuse colon wall thickening without evidence of obstruction or free air.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: Diffuse colon wall thickening without evidence of obstruction or free air.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Progression of pulmonary metastases.2. Diffuse colon wall thickening without evidence of obstruction; compatible with colitis.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia, pneumothorax History: chest pain Bilateral basilar streaky airspace and interstitial opacity, greater on the right, suggestive of aspiration, possibly recurrent.This was conveyed to the ED via STAT consult. (No response was obtained from the ED telephones despite multiple attempts).Dilated loops of bowel with air-fluid levels in the abdomen.No pneumothorax.

Output: Extensive basilar airspace opacity, greater on the right, suggestive of aspiration and infection, possibly chronic.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: 7days s/p MUD SCT, Neutropenic with new SOB History: SOB, coarse lung sounds Focal subsegmental atelectasis right perihilar region, elsewhere the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.Left jugular catheter tip at cavoatrial junction level.

Output: Focal subsegmental atelectasis, but no reliable evidence of pneumonia. If index of suspicion of infection is high, a thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: VOC; eval for acute chest signs History: see above Mild basilar interstitial opacities are suggestive of scarring.Heart size normal.No evidence of infection or infarction.Left jugular catheter, tip at SVC/artery junction level.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: FemaleReason for Study: Reason: intubated, checking for interval changes History: intubated, aspiration pna ET tube and left PICC line unchanged.NG tube placed with its tip in the stomach.Interval increase in perihilar/basilar opacities compatible with edema and atelectasis.Pleural effusions, right greater than left, increased from the prior exam.

Output: Interval increase perihilar/basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Cervical cancer, status post 4 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: The tip of the port and left-sided central venous catheter are in the right atrium.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Focal infarcts are unchanged.KIDNEYS, URETERS: Right nephrectomy. Atrophic left kidney with multiple cysts that have remained stable. Punctate stone in the left kidney.ADRENAL GLANDS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Previously mentioned left retroperitoneal adenopathy no measured 2 x 2.1-cm in image number 97/181, increased in size. Retrocaval adenopathy is also increased in size now measures 20 x 13 mm on image number 97/181. Previously it was measuring 13 x 9 mm on image number 104/200.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy and bilateral oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Interval increase in the size of the pelvic adenopathy. Previously measured left external iliac adenopathy now measures 2.8 x 1.9 cm image number 148/181.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral severe sacroiliitis.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the retroperitoneal and pelvic adenopathy.The tip of the central venous catheter and port catheter are in the right atrium.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female large B-cell lymphoma, mediastinal adenopathy, lung fungal disease. LUNGS AND PLEURA: Chest tubes have been removed in the interval. No residual pneumothorax. Predominantly upper lobe ground glass opacities are less prominent. Interstitial thickening and bronchiectasis are noted suggesting fibrosis. Basilar dense air space opacity has improved, although a subtle interstitial abnormality persists.Right suprahilar mass with central necrosis has increased in size measuring 9.4 x 8.8 cm in maximum 29/90 compared to 0.4 x 5.2 cm on the prior examination. Trace right basal pleural effusion.MEDIASTINUM AND HILA: Small residual pneumomediastinum evident. Tracheostomy tube in place. Right paratracheal reference node measures 8 x 8 mm on axial image 21/90 and is smaller when compared to the prior exam where it measured 10 x 11 mm. Reference subcarinal lymph node measures 1.7 x 1.0 cm a next image 33/90 which is slightly smaller when compared to the prior examination where it measured 1.2 x 2.3 cm. Previously noted mass in the prevertebral soft tissues is not clearly evident on the current examination. Retrocrural adenopathy is grossly unchanged. No new mediastinal or hilar nodes.CHEST WALL: Left breast nodule has not significantly changed from the most recent prior examination, although it is smaller when compared to more distant exams. Interval increase in the size of a right internal mammary lymph node is noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Significant interval increase size of right hilar mass.2.Interval decrease in several reference lesions as described above. Mixed response in previously noted lymphadenopathy.3.Interval improvement in basilar dense air space disease, presumably improved fungal pneumonia. Diffuse groundglass opacities persist but are less prominent with an element of fibrosis. The latter could represent drug reaction but is nonspecific.


Instruction: Generate impression based on medical findings.

Input: Male, 16 years old, with a tibial mass. Evaluate for metastases. LUNGS AND PLEURA: Two nonspecific micronodules are evident adjacent to the major and minor fissures on the right (axial images 38 and 54, series 4). No additional suspicious nodules or masses are identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Two nonspecific micronodules in the right lung. 2.No definite evidence of metastatic disease to the chest.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate stool burden History: abdominal pain, constipation Normal heart size. No pneumothorax, pleural effusion. Above average stool burden. Nonobstructive gas pattern. Scattered surgical clips.Sclerosis and flattening of the left femoral head which may be degenerative or related to avascular necrosis, and was visualized to some degree on CT from 4/29/2014 and a lesser extent on CT from 2010.

Output: Above average stool burden. Flattening and sclerosis of the left femoral head may be related to chronic degenerative changes or even avascular necrosis. Correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: s/p lvad, assess for pneumonia, edema or effusions History: cough No significant cardiopulmonary abnormality.Status post LVAD placement. Left subclavian ICD, leads unchanged in position.

Output: No specific evidence of infection. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate volume History: tachypnea Small lung volumes with streaky opacity at the right base compatible with subsegmental atelectasis.No specific evidence of pulmonary edema. Normal heart size with a tortuous and ectatic aorta, unchanged.

Output: Increased right basilar atelectasis which could be related to aspirated secretions. No specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: cardiogenic shock s/p IABP insertion, has open chest History: as above ET tube, Swan-Ganz catheter, mediastinal drains, and IABP marker unchanged.IJ venous catheter removed.Stable cardiomediastinal silhouette.Left retrocardiac consolidation/atelectasis similar to the prior exam.Interval improvement of perihilar edema.

Output: IABP marker in the proximal descending aorta. Improvement in perihilar edema.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: correct ETT positioning History: intubation Interval retraction of endotracheal tube with tip now located approximately 4 cm above the carina.Right IJ catheter stable position.Stable cardiomegaly.Right pleural effusion with underlying atelectasis not significantly changed from prior exam.Persistent interstitial and airspace opacities on the right and streaky left basilar opacities unchanged.

Output: Interval retraction of endotracheal tube with tip located 4 cm above the carina. Otherwise, no interval change from prior exam.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, 79 years old.Reason: 79 yo F with chest tube and effusion, evaluate for interval change History: as above Right chest tube is in place. Surgical clips overlie mediastinum.Interval increase in loculated right pneumothorax with slight reexpansion of the right lung. Left basilar opacity appears improved. Residual contrast is noted within the bowels.

Output: Interval increase in loculated right pneumothorax with slight reexpansion of the right lung. Left basilar opacity is improved.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Right upper lobectomy for lung cancer. Follow-up. Interval removal of right-sided chest tubes without pneumothorax. Postoperative volume loss on the right compatible with history of upper lobectomy. Suture lines in the right middle and left upper lobes consistent with areas of wedge resection. No pleural fluid or visible pulmonary nodules or masses.

Output: No pneumothorax post chest tube removal. No signs of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: FemaleReason for Study: Reason: leukocytosis and chest pain History: leukocytosis and chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#2 Lines and tubes are unchanged. Low lung volumes. Moderate pulmonary edema and small pleural effusions again noted. Unchanged heart size.

Output: No substantial difference compared to last study.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: s/p NSTEMI, with know MAC/bronchiectasis History: as above Right central venous catheter with its tip in the RA. Mild cardiac enlargement with atherosclerotic changes of the aorta.Basilar predominant bronchiectasis without focal areas of consolidationNo pleural effusions.

Output: Brochiectasis. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT has been minimally retracted yet well positioned, NG coiled in the proximal stomachUnderlying cardiopulmonary appearance is otherwise similar with mixed interstitial and airspace changes largely in both bases with a questionable small right effusion. Atelectasis versus possible aspiration remains and overall mild progression since 9/21/2015.Borderline cardiomegaly with moderate aortic tortuosity similar to prior exams

Output: ETT minimally retracted yet remains well-positioned


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Pleural effusion History: Pleural effusion Removal of right-sided chest tubes. No significant pneumothorax. No large pleural effusion. No substantial change in bibasilar pleural-parenchymal opacities, right greater than left. Unchanged heart size.

Output: Removal of right-sided chest tubes. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p 5/27 Resection of right upper lobe lung nodule as a wedge, Mediastinal lymphadenectomy History: none Right hemithorax postsurgical volume loss with apical pleural thickening, unchanged.COPD with flat diaphragms.No complication of recent surgery identified.

Output: Recent right apical resection. COPD.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Eval R PTX History: eval R ptx Right chest tube directed towards the apex with no pneumothorax although there is mild right chest wall soft tissue emphysema.Increased basilar atelectasis which may be the result of aspirated secretions and mucus plugging.

Output: Increasing basilar atelectasis which may be the result of aspirated secretions and mucus plugging. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: eval for pulm edema vs. infection and also check dobhoff placement History: eval for pulm edema vs. infection (continues to be hypoxic) and also check dobhoff placement Left pleural effusion and adjacent consolidation unchanged.Heart size upper normal.Left jugular catheter, tip in SVC.A Dobbhoff tube terminates in the stomach.

Output: Unchanged left pleural effusion and adjacent consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: s/p LUL for suspicious LUL nodule History: Suspicious nodule Two left chest tubes following recent left upper lobectomy.No significant pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: lung cancer History: s/p RUL lobectomy for Stage I NSLC Right upper lobe volume loss.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No evidence of recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male for with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Left apical scarring is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: 75-year-old man status post 4 cycles chemotherapy evaluate disease CHEST:LUNGS AND PLEURA: No nodules or effusions. Elevated left hemidiaphragm.MEDIASTINUM AND HILA: Small mediastinal nodes are unchanged. Index precarinal node seen in image 46/221 to measure 1.8 x 0.9 cm, unchanged. No new nodes.CHEST WALL: Sclerotic osseous metastasis to rib bulges into the right chest cavity, unchanged. Sclerotic metastases thoracic vertebral bodies also unchanged. No new sites of disease.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Fatty replaced.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Some cortical thinning left lower pole, unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Shotty nodes nonpathologic by size criteria. Atherosclerotic changes. Caval filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered blastic metastases end partial collapse and scoliosis lumbar spine redemonstrated, unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: Postsurgical changes and radiation implants.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: A scattered blastic metastases unchanged in size and extent.

Output: Stable osseous metastases. Stable scattered small lymph nodes. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 8-day-old former 26 week gestational age patient with pneumoperitoneum. Is there improvement in bowel dilation?VIEWS: Abdomen AP/cross table lateral (two views) 06/14/16, 1645 and 1647 Feeding tube tip is in stomach. Umbilical venous line has its tip at level of hepatic vein. Right lower quadrant drain tip is in left upper quadrant.No pneumoperitoneum is seen. Mildly to moderately dilated bowel loops are present in a disorganized pattern. There are very few air-fluid levels. There appears to be a left inguinal hernia.Hazy opacity is seen in the lung bases.

Output: Dilated bowel in a disorganized pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: follow up s/p intubation, hypoxia History: follow up s/p intubation, hypoxia Stable pulmonary opacities right upper lobe predominant where there is mild volume loss.ET tube low, cannulating the right main bronchus.A Dobbhoff tube extends below the lower margin of the image.

Output: Six The service was notified of this by text page at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: Tachycardia History: Tachycardia, O2 requirement Bilateral chest tubes with a 1.7 cm left apical pneumothorax that extends around the periphery of the left base.Right chest wall soft tissue emphysema noted.Extensive cystic lung disease unchanged.

Output: Recurrent left pneumothorax despite bilateral chest tubes.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: FemaleReason for Study: Reason: intubated, interval change History: intubated ET tube, left sided chest tube, NG tube, and right central venous catheter unchanged.Stable cardiomediastinal silhouette. Redemonstration of left retrocardiac consolidation and small left pleural effusion.Focal air space opacities in the right upper and lower lobes may be secondary to aspiration and similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance with left retrocardiac consolidation/atelectasis and air space opacities in the right lung suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with neutropenic fever. History of head and neck cancer. Evaluate for source of fever. Persistent low lung volumes with mild unchanged subsegmental atelectasis or scarring at the lung bases.No focal lung opacity.Right chest port unchanged in position. Gastrostomy tube projects over the left upper quadrant.

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


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: FemaleReason for Study: Reason: wEGENERS/ SOB sUB GLOTTIC STENOSIS History: SOB 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: Female, 66 years old. History: Necrotizing pancreatitis. Symptoms: Dyspnea and desaturation. Decreased lung volumes and cardiomediastinal silhouette unchanged.Persistent left retrocardiac opacity compatible with atelectasis/consolidation with left pleural effusion.Enteric tube projecting inferiorly beyond the visualized field.

Output: Persistent left retrocardiac opacity and left pleural effusion. No significant interval change from prior radiograph.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.