Instruction: Generate impression based on medical findings.

Input: 80 year-old female with right lower quadrant pain, lactic 10.6 and acidotic with an IM gap. Concern for bowel catastrophe. CHEST:LUNGS AND PLEURA: Moderate-sized right pleural effusion. Small left pleural effusion. Several scattered lung nodules concerning for metastases. None are calcified. Largest nodule is in the right middle lobe series 5 image 49 measuring 4.3 x 3.7 mm.bilateral ground glass opacities and atelectasis.MEDIASTINUM AND HILA: Multiple foci of subcutaneous gas in the right and left chest wall. Some gas is seen in the mediastinum. Some of the gas appears to be nonspecific soft tissue some AP pericardial. I am uncertain if any is intravascular This finding was discussed with the clinical service by the resident on call at the time of examination.CHEST WALL: Scattered soft tissue gas. No fluid collections. Generalized anasarca with paucity of subcutaneous fat.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast and is also limited the bowel since the oral contrast is only in the stomach and jejunum with little dilute contrast seen more distally.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta no evidence of aneurysm. Small retroperitoneal nodes with calcification.BOWEL, MESENTERY: Small amount of ascites.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Focally markedly dilated loop of small bowel in the pelvis up to 3.7 cm as seen on coronal image 50/65 the with no discrete transition zone. Collapsed colon. No intramural air or free air. Moderate amount of ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focally dilated loop of small bowel in the pelvis with no discrete transition zone of obstruction. Correlate with any surgical history signs of ischemia or infection. Ascites. Anasarca. Bilateral pleural effusions. Scattered noncalcified lung nodules concerning for metastatic disease. Pneumomediastinum and gas in the subcutaneous tissues of the anterior chest wall of uncertain etiology. This was discussed with the clinical service (pager #2545) by the radiology resident on call (Rony Kampalath) the time of the examination.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: r/o mets History: none Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Pneumothorax. Moderate right subpulmonic hydropneumothorax, better seen on today's study. Right chest tube unchanged in position projecting over the mid thorax.Multiple pulmonary nodules and masses.

Output: Moderate subpulmonic right hydropneumothorax, consider repositioning chest tube to this location.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.SOB question lung infiltrate. Low lung volumes with basal scarring or atelectasis. The posterior costophrenic angles are not visualized due to overlying diaphragm elevation. Right upper quadrant surgical clips. SVC distention may be due to patient positioning.

Output: Low lung volumes with basal atelectasis. No visible signs of pneumonia. Consider PA and lateral chest radiographs if clinical suspicion persists as the posterior costophrenic angle regions are not well visualized.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lungs History: eval lungs ET tube tip approximately 2 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery.Bilateral basilar opacity, greater on the left, compatible with atelectasis and effusion.No pneumothorax or other acute change.

Output: Atelectasis and effusion with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old. Shortness of breath. Moderate cardiomegaly. ICD leads with right atrial lead directed inferiorly, possibly dislodged, unchanged from 2011.Diffuse interstitial and airspace opacities, increased in the upper lung zones. Probable very small pleural effusions.

Output: Increasing pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: assess for pna, signs acute chest History: cough Right Port-A-Cath with its tip in the RA.Stable cardiomediastinal silhouette.Right pleural thickening/effusion similar to the prior exam.No new pulmonary opacities.

Output: No real change without acute abnormalities. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Chest tube placementVIEW: Chest AP Left upper extremity PICC with tip in the right atrium. Right chest tube in place with sidehole in the subcutaneous tissue. There is minimal amount of subcutaneous emphysema in the right lateral chest wall but improved. Again noted scoliosis and gastrostomy tube in place. Cardiothymic silhouette normal. Patchy opacities in the right lung and left lower lobe not significantly changed. There is a small right-sided pleural effusion not significantly changed. No evidence of pneumothorax.

Output: Right lung opacities and pleural effusions not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: FemaleReason for Study: Reason: evaluate for pneumonia History: cough x 3 weeks The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 70 year old male with idiopathic pulmonary fibrosis. LUNGS AND PLEURA: Mild to moderate architectural distortion with diffuse subpleural reticular opacities, minimal honeycombing, and traction bronchiectasis, not significantly changed compared to prior. No significant air trapping on expiratory views. No significant groundglass opacities. Nonspecific subpleural sub-solid nodular opacity in the left upper lobe (series 5 image 35) new from prior. New nonspecific subsolid nodular opacity in the right lung anteriorly (series 5 image 57).Postoperative findings of the lingula, unchanged.MEDIASTINUM AND HILA: Dilated main pulmonary artery, similar to prior, compatible with pulmonary hypertension.Multiple moderately enlarged mediastinal lymph nodes, unchanged.CHEST WALL: Moderate degenerative disk disease of the thoracic spine.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant change in interstitial lung disease, most consistent with UIP. Recommend continued follow-up for new nonspecific sub-solid nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: interval change, s/p abx for suspected aspiration PNA History: see above No significant cardiopulmonary abnormality.Tracheostomy tube tip 7 cm above the carina.

Output: No significant abnormality. No obvious edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 18 yearsGender: FemaleReason for Study: Reason: Pt is an 18 yo female, potential stem cell donor evaluation History: evaluate The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: confirm R IJ and R PICC placement History: R IJ Dye jay venous catheter with its tip at the IJ SVC junction.Right PICC line with its tip in the right subclavian.Left-sided ICD unchanged.Stable cardiac enlargement with evidence of prior CABG.Chronic appearing increased interstitial opacities similar to the prior exam.No evidence of a pneumothorax.

Output: Placement of right IJ venous catheter and right PICC line. Stable cardiopulmonary appearance with chronic appearing interstitial opacities and mild cardiac enlargement.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: infiltrate, aorta outline History: chest pain No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: positive ppd history History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease, specifically no evidence of infection.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: chest tube placement History: s/p radical pleurectomy decortication 3 right chest tubes, 2 directed towards apex, one at medial base with a small right-sided pneumothorax. Mild subcutaneous emphysema on the right. Lungs hypoinflated.

Output: Small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: new ICU admission from OSH History: L subclavian line and right port-a-cath No significant cardiopulmonary abnormality.Left subclavian catheter, tip in SVC.Right jugular catheter, tip in SVC.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chf History: chf Elevated and ICD lead unchanged. Bilateral mid and lower zone pulmonary opacities, slightly improved on the right with a moderate right pleural effusion.No new findings.

Output: Findings compatible with CHF and atelectasis, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Central line placement ETT has been placed, tip projects at the carina. Pager 6229 contacted. Right jugular catheter also observed extending into the SVC at the origin junctionFocal opacities projected over the right lung base, possibly middle lobe. Serial imaging is needed to confirm clearance, however aspiration versus infection must be considered in addition to atypical focal edema given recent procedure.Cardiomegaly

Output: Right jugular catheter and ETT placement, the latter is over advanced. Service contacted


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of papillary thyroid cancer. 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 evidence of intrathoracic metastases.


Instruction: Generate impression based on medical findings.

Input: 54 years old, Female, Reason: rule out pneumonia History: short of breath COPD Emphysematous changes. Interval resolution of right middle lobe opacity. Basilar predominant opacities may reflect aspirated secretions. No new focal consolidations. No evidence of significant pleural effusion.

Output: Emphysematous changes with interval improvement of right middle lobe opacity. Persistent bibasilar opacities which may reflect aspiration.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male status post abdominal aortic aneurysm repair, now with increasing white cell count CHEST:LUNGS AND PLEURA: Emphysema. Biapical scarring. Ill-defined groundglass opacity in the right middle lobe, nonspecific, may represent scarring versus atelectasis. Right basilar linear atelectasis.MEDIASTINUM AND HILA: Thyroid nodules. There is an irregular shaped saccular aneurysm at the level of the arch measuring 4.9 centimeter in its greatest dimension. Diffuse atherosclerotic changes throughout the aorta.Mediastinal adenopathy. Index pretracheal lymph node measures 2.2 x 2 cm on image number 31, series number 3. Paragraph there is also focal aneurysm in the distal descending thoracic aorta measuring up to 4.4 cm on image number 57 comes inCHEST 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: Solitary right kidney. Benign left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Status post abdominal aortic graft placement and aorto right iliac graft anastomosis. There is air fro enhancing fluid collection around the aorta suspicious for infected fluid. On image number 118, series number 3, the size of the collection measures 5.5 x 2.8 cm. Collection extends along the aorta and aortoiliac graft.Retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Transplanted kidney in the right iliac fossa. Small hypodense lesions likely representing cysts but are too small to accurately characterize

Output: Large, irregular saccular aneurysm involving the aortic arch. Distal descending thoracic aortic aneurysm.Postsurgical changes secondary to AAA repair and aorto right iliac graft placement. Peripherally enhancing collection along the aorta and aortoiliac graftMediastinal and retroperitoneal adenopathy.Nonspecific ground glass opacity in the right middle lobe. Early pneumonia cannot be excluded.Dr. Singh was notified and acknowledged at the time of dictation about the above findings.


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 probable small left pleural effusion.Enteric tube with distal tip projecting inferiorly beyond the visualized field.

Output: Persistent left retrocardiac opacity and probable small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath. Rheumatic mitral valve disease No cardiopulmonary abnormality. Midline sternotomy and CABG clips

Output: Postsurgical changes without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: s/p esophagectomy History: s/p esophagectomy Right-sided chest tube, right Port-A-Cath, and NG tube unchanged.Redemonstration of pneumomediastinum.No significant pneumothorax identified.Stable cardiomediastinal silhouette.Increasing left retrocardiac atelectasis.Status post esophagectomy and gastric pull-up.

Output: Increasing left retrocardiac atelectasis. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old with history of breast cancer and new focal consolidation in setting of episode of AMS Right port with tip overlying the SVC.Poor inspiration. Diffuse subpleural and parenchymal nodules noted bilaterally, which are better characterized on CT dated 1/21/16, appearing stable from prior exam. Bilateral pleural effusions.

Output: Diffuse bilateral metastatic disease, which is better characterized on CT dated 1/21/16, appearing stable from prior exam.


Instruction: Generate impression based on medical findings.

Input: 74 years, Male. Reason: 74yo M w/sigmoid colon distention History: Distended abdomen There is marked gaseous distention of the sigmoid and descending colon and rectum measuring on the order of 17 cm in diameter. Evaluation for pneumoperitoneum Limited due to the marked degree of distention. Previously measured oral contrast is present within the large and small bowel.

Output: Marked gaseous distention of the sigmoid and descending colon concerning for volvulus or distal obstruction. No definite pneumoperitoneum, although evaluation limited due to marked degree of distention. CT is suggested for further evaluation.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: 47-year-old male intubated ET tip approximately 3 cm above the carina. Left-sided AICD with leads in appropriate position. Other support devices and lines unchanged.Stable cardiomegaly with diffuse interstitial and airspace opacities not significantly changed. Retrocardiac opacity likely atelectasis unchanged.

Output: Endotracheal tube in acceptable position. Pulmonary edema and atelectasis unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: post op avr/cabg post op avr/cabg Low lung volumes makes detailed cardiopulmonary assessment difficult. Right IJ sheath has been removed. Other lines and tubes, unchanged. No substantial change in bibasilar pleural-parenchymal opacities. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No pneumothorax. Small left pleural effusion.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: infection vs fluid in 78 year old wit COPD, newly diagnosed AML History: sob, tachypnic Small lung volumes with no specific evidence of pulmonary edema or visible effusions.Left arm catheter extending to the junction of the left axillary and subclavian veins.

Output: No acute abnormalities. .


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Right upper lobe opacity may be related to recent bronchoscopy. No significant pneumothorax.

Output: No pneumothorax following bronchoscopy.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.History of end-stage renal disease and heart failure, now with hypoxia. Bilateral venous stents are noted. There is stable cardiomegaly. Extensive calcification of the aorta noted. No focal pulmonary opacities or septal thickening. No large pleural effusion.

Output: Cardiomegaly without definite evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ET tube History: intubated ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Diffuse lateral airspace and interstitial opacity compatible with edema/RDS with moderate pleural effusions, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Overall aeration and lung volumes. Very minimal small effusions and/or scarring. No superimposed new airspace process.The cardiac and mediastinal contours are within limits

Output: Small residual effusions without new additional abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for pneumonia, volume overload History: tachypnea Increasing left lower lobe consolidation, right-sided pulmonary opacities otherwise unchanged.Small pleural effusions unchanged.Left jugular catheter tip at cavoatrial junction.

Output: Worsening left lower lobe consolidation, unchanged right-sided opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: s/p cardiac surgery. Coronary artery disease. Interval extubation.Right IJ catheter tip in the right atrium. Right PICC tip at the superior cavoatrial junction. Dobbhoff tube tip in the gastric cardia. Left subclavian pacemaker and sternotomy again noted.Large bilateral pleural effusions and extensive lower lung atelectasis unchanged.

Output: Large effusions and basilar atelectasis unchanged.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, 74 years old.Reason: Post thora History: As above Cardiomegaly.Status post left thoracentesis with no pneumothorax.

Output: Left thoracentesis with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Evaluate for cardiopulmonary disease. History: Chest Pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: IABP placement History: see above Iatrogenic devices are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild interstitial pulmonary edema again noted. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Mild interstitial pulmonary edema, as before. Iatrogenic devices are unchanged.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with history of COPD, evaluate lung fields. Mild cardiomegaly, unchanged.Stable bibasilar opacities. Probable new small left pleural effusion.

Output: Stable bibasilar opacities with new left small pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Evidence of pneumothorax or bleed following thoracentesis? Concern for puncture with thoracentesis. Large loculated right pleural fluid collection appears similar in volume; it would be difficult or impossible to assess for any blood products given its size until there was a very large amount of blood within the thoracic cavity given this pre-existing effusion. If there is any clinical concern, then an enhanced thoracic CT would be recommended.Diffuse nodules bilaterally, masslike architectural distortion in the right lung and interstitial abnormality unchanged. Right pleural drain in place.

Output: Although there is no apparent change in pleural fluid volume, active bleeding into the right pleural space would not be visible by chest radiograph given the size of pre-existing effusion until quite large. If there is continued clinical concern for traumatic hemothorax, enhanced chest CT would be recommended. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with history of chest pain shortness of breath. Evaluate for infection. There are new bibasilar fluffy air space opacities with small right pleural effusion. The cardiomediastinal silhouette is unremarkable. Moderate bronchial wall thickening.

Output: New bibasilar fluffy air space opacities with small right pleural effusion most compatible with infection such as aspiration related bronchopneumonia. Follow up PA/lateral chest radiographs suggested in 6 weeks in an adult patient to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: 58 year-old male with history of lung cancer status post two cycles of chemotherapy. Please compare with previous study and evaluate treatment response. CHEST:LUNGS AND PLEURA: Interval decrease in the size of the necrotic right hilar mass, now measuring 8.4 x 5.9 cm (series 3, image 64). Again seen is invasion into the right main bronchus as well as right middle lobe atelectasis. Additionally, there is increasing atelectasis in the superior segment of the right lower lobe from endobronchial tumor involvement.Previously referenced nodule in the right middle lobe appears relatively unchanged to minimally enlarged (series 5, image 74), measuring approximately 14 x 13 mm (previously measuring 13 x 11 mm).Scattered nodular opacities are seen bilaterally, some which likely represent new parenchymal metastatic foci (series 5, images 50, 53, and 57) while others appear to be filling previously seen cystic spaces (for example, series 5, image 43).Interstitial and nodular opacities predominantly in the right lower lobe are again suspicious for lymphangitic spread of tumor with mucous plugging.Emphysema.MEDIASTINUM AND HILA: Tumor encasement and narrowing of the right main pulmonary artery and central bronchi with medial extension into the subcarinal space without definite involvement of the carina. Tumor also extends inferiorly along the right cardiac margin as seen previously. No pericardial effusion identified. Overall, invasion of the mediastinal structures appears similar to prior study.Enlarged thyroid with heterogeneous enhancement in the left lobe appears similar to prior study.CHEST WALL: Stable sclerotic focus in right eighth rib, probable bone island. Degenerative changes of the spine.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: 9 x 13 low-attenuation focus in the uncinate process is unchanged and may represent a mucinous tumor or cyst.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. Left kidney again not visualized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Interval decrease in size of the index right hilar mass. 2. Multiple new pulmonary nodules suggesting metastatic disease as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Status post esophagectomy. Supraventricular tachycardia. Enteric tube in the projection of the neoesophagus. Left basal chest tube unchanged in position. Surgical staples overlie the left neck. Postoperative mediastinal widening and low lung volumes. Mild basal atelectasis. Patchy opacity along the chest tube tract may reflect contusion.

Output: No acute change in low lung volumes with basal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: acute pathology History: chest pain, h/o HTN Unremarkable cardiac and mediastinal silhouette with a mildly tortuous aorta, unchanged.Mild lower zone scarring, unchanged.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/p CABG with CT Removal History: SOB Interval removal of lines and tubes. No significant pneumothorax. Left basilar pleuroparenchymal opacity, not substantially changed. No new focal pleural parenchymal opacity. Resolved and were easily length is very high. I cannot be negative.Evaluate for positive Unchanged cardiomegaly.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: chest pain History: above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: assess for bronchitis History: shortness of breath Chronic loculated right pleural effusion with associated right perihilar fibrosis and bronchiectasis appearing similar to the prior examination. Mild peribronchial thickening at the left lung base. There is no new focal consolidation, pleural effusion or pneumothorax. Cardiac and mediastinal contours are within normal limits for size.

Output: 1.Mild left basilar peribronchial cuffing may represent element of aspiration. No discrete consolidation. 2.Chronic right pleural effusion with associated paramediastinal fibrosis appearing similar to the prior.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. The patient has been extubated.Right IJ Cordis catheters remain in place; the lateral catheter is kinked at the skin surface. Right chest tube unchanged in position. Prosthetic mitral valve is present.Trace residual right hydropneumothorax. Bilateral, right greater than left, basilar subsegmental atelectasis. Subcutaneous emphysema right infralateral chest wall at the chest tube entry site slightly increased.

Output: Persistent trace right hydropneumothorax with increasing subcutaneous emphysema at the chest tube entry site.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: eval for cause of SOB History: new onset AFib, hx CLL, COPD No change in hazy opacity overlying the left hemithorax with patchy left basilar pleural-parenchymal opacities. Diffuse reticular abnormality in the right lung, slightly increased from last study. Small right pleural effusion versus thickening. Unchanged heart size. Dense aortic atherosclerosis again noted. No pneumothorax.

Output: Question of mild increase in interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 87 years old Female. Reason: intubated History: intubated. Study limited due to technique. There are irregularities of the left hemidiaphragm with patchy opacities in the left lung base. The tip of the NG tube projects over the gastric cardia. The tip of the ET tube is about 3-cm above the carina. Multiple lines overlie the chest.

Output: Patchy opacities in the left lower lung, which may represent atelectasis and possibly small pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: S/P LVAD. eval for VAD position History: Post-op Support devices unchanged.Stable cardiomediastinal silhouette.Pleural effusions similar to the prior exam.Mild improved aeration in the left lower lobe.No new pulmonary opacities identified.

Output: Support devices unchanged. Mildly improved left lower lobe aeration. Persistent cardiomegaly and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old. normal

Output: downtime epic


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: small pneumothorax yesterday, now on wall suction pigtail R chest, f/u PTX History: PTX Support devices unchanged including right chest pleural catheter.Persistent right apical pneumothorax identified.Cardiomediastinal silhouette is unremarkable.Perihilar opacities and probable small pleural effusions unchanged.No new pulmonary opacities identified.

Output: Persistent small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Mild to moderate changes compatible as CHF including enlarged heart, small effusions and diffuse changes suggesting edema. No discrete superimposed focal additional process

Output: Suspected moderate CHF


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.NG tube placed earlier, needed to be advanced. Evaluate for placement. Unchanged Dobbhoff placement, tip remains at the left hemidiaphragm, not past the GE junction.Unchanged left basilar atelectasis.Cardiac silhouette is within normal limits.

Output: Unchanged Dobbhoff placement, tip not passed GE junction.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Fever evaluate for pneumonia Low lung volumes with eventration of the left hemidiaphragm. No focal airspace opacities, pleural fluid or pneumothorax. Mild cardiomegaly, about the same.

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


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Intubated. The support devices are not significantly changed. Persistent diffuse airspace opacities are unchanged.IABP distal tip high, at the top of the aortic arch.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pain Essentially perihilar mixed interstitial and airspace opacities are observed with borderline cardiomegaly. Concern for early pulmonary edema.

Output: Mild pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: 61 y/o hx of HTN with worsening DOE and lower extremity edema concern for volume overload History: SOB, lower extremity edema Mild hyperinflation of the lungs. Mild interstitial pulmonary opacities. Patchy bibasilar opacities noted. Small pleural effusions. Mild cardiomegaly. Enlarged central pulmonary arteries. No pneumothorax.

Output: Probable mild pulmonary edema with small pleural effusions. Mild hyperinflation of the lungs. Mild cardiomegaly.Query pulmonary hypertension. Correlation with echocardiography is suggested.


Instruction: Generate impression based on medical findings.

Input: Check shunt, placed 3 weeks ago Shunt: The visualized components of the shunt are completely unchanged, specifically no evidence of new discontinuation or kinking since the prior study. Proximal tip again projects in the midline over lying the sella. The shunt valve projected posterior to the occipital lobe on the left is unchanged in position and setting. Shunt tip again projects towards the left hemidiaphragmSkull: No new abnormality, burr hole projected over left posterior parietal bone similar to prior exam. Sinuses are clearC-spine: No radiographic abnormality. Soft tissues are intactChest: No cardiopulmonary abnormality

Output: No change in left-sided ventriculopleural shunt


Instruction: Generate impression based on medical findings.

Input: 78 years, Male. Reason: 78M s/p open partial nephrectomy, now with distension History: abdominal distension Normal cardiothymic silhouette. Left basilar atelectasis with trace bilateral pleural effusions. Increased lung markings diffusely. Post-surgical changes of left rotator cuff repair.Left abdominal drain, surgical staples, and soft tissue swelling consistent with recent surgery. Multiple distended loops of bowel with air-fluid levels in the erect view. No evidence of free intraperitoneal air.

Output: Multiple distended loops of bowel suggestive of post-operative ileus, however, recommend follow-up radiographs to exclude small bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: 59y/o with URI symptoms, h/o stem cell transplant and AML. Please evaluate for infiltrates History: runny nose, cough Chronic appearing elevation right hemidiaphragm.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

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


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA, interval change History: increasing lactate Moderately large layered out left pleural effusion and probable small right pleural effusion.No specific evidence of pneumonia.Unremarkable cardiac and mediastinal silhouette.

Output: New pleural effusions, greater on the left.


Instruction: Generate impression based on medical findings.

Input: ET tube placement, progression of lung processes. Bilateral patchy opacities consistent with aspiration and infection, partially obscured by the Life Vest, slightly worse and now with mild superimposed edema. Moderate pleural effusions, increased on the left. Retrocardiac atelectasis/consolidation similar to most recent prior study. ETT tip at the clavicular head level. Enteric tube tip projects over the distal stomach.

Output: ETT tip at the clavicular head level. Worsening of pulmonary opacities and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxemia History: see above Marked cardiomegaly with several septal lines in the lower lungs consistent with interstitial edema.Small right pleural effusion.Catheter tip in the upper right atrium.

Output: Cardiomegaly with mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: intubated, eval ETT position and hardware History: as above Esophageal probe has been removed. Other lines and tubes, unchanged. Improvement in right upper lobe atelectasis. No substantial change in bibasilar pleural-parenchymal opacities. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Improvement in right upper lobe atelectasis. No substantial change in bibasilar pleural-parenchymal opacities. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female with gist tumor CHEST:LUNGS AND PLEURA: Calcified right middle lobe nodule is unchanged. Right lung base nodule with peripheral calcification is unchanged measuring 2 x 1.2-cm image number 75,series number 4.MEDIASTINUM AND HILA: Enhancing mass in the superior mediastinum is unchanged measuring 4 x 2.1 cm in image number 35, series number 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly is unchanged.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: Portacaval and paraceliac adenopathy is unchanged.BOWEL, MESENTERY: Multifocal mesenteric mass is invading the stomach, predominantly in the left upper quadrant are again noted. Previously, predominantly solid heterogeneous mass was measuring 9.2 x 6.3 cm. Today measures a 8.9 x 6.4 cm in image number 99, series number 4, not significantly changed from previous study. The mass measures stomach, splenic hilum and abuts the body of the pancreas and superiorly extends to the level of the diaphragm. Multiple soft tissue nodules around the stomach are unchanged. One of the reference nodules, which was previously are referenced measures 19 x 15 mm image number 130, series number 4, not significantly changed.The enlarged lymph nodes in the small bowel mesentery are unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left ovarian cystic lesion is unchanged.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: Small amount of free fluid in pelvis.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: s/p intubation and failed RIJ cortis placement History: s/p intubation and failed RIJ cortis placement Endotracheal tube tip is in the right mainstem bronchus. Increasing bibasilar opacities representing combination of edema and atelectasis. Increasing left basilar atelectasis. Small bilateral pleural effusions.

Output: Endotracheal tube tip in the right mainstem bronchus.


Instruction: Generate impression based on medical findings.

Input: Reason: 65M with ICM s/p LVAD. Confirm diuresis History: as above Cardiopulmonary monitoring and support devices, unchanged.New PIC line with its tip in the right axillary vein.Cardiomegaly with layered out large pleural effusions and underlying opacity compatible with atelectasis.No pneumothorax or other acute change.

Output: A large effusions and atelectasis with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.ETT positioning. Low endotracheal tube with tip near the right mainstem bronchus orifice.No acute change in extensive interstitial and airspace opacities, loculated left pleural fluid collection and fibrotic appearing native right lung. Other tubes and lines unchanged.

Output: Low endotracheal tube. No acute change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: ? Infiltrate History: cough Cardiac silhouette is normal in size.There is mild elevation of the right hemidiaphragm with blunting of the costophrenic angle suggesting pleural thickening. Right lower lobe calcified granuloma. No focal consolidation, sizable effusion or pneumothorax.

Output: Blunting of the right lateral costophrenic angle suggesting pleural thickening. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64 M w. ECMO cannulas History: The IABP marker is no longer visualized. Remaining support devices are stable.The cardiac silhouette is enlarged and stable.Bilateral airspace opacities appear stable. There is a persistent small left pneumothorax. Small bilateral pleural effusions stable.

Output: IABP marker not visualized, likely removed. Otherwise stable support devices, cardiomegaly, pulmonary opacities, and left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: swan location History: as above Swan-Ganz catheter terminates in the main PA. Moderate cardiomegaly again noted. No new focal lung consolidation.No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Pt with hypoxia, ARDS, eval for worsening infiltrates History: Hypoxia, ARDS Feeding tube terminates over the superior mediastinum. Low lung volumes makes detailed cardiopulmonary assessment difficult. Diffuse pulmonary opacities, unchanged. Unchanged heart size.

Output: Feeding tube terminates over the superior mediastinum. Low lung volumes makes detailed cardiopulmonary assessment difficult. Diffuse pulmonary opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval lung fields, ETT History: s/p transfer from OSH Endotracheal tube terminates approximately 4 cm from the carina. Enteric tube terminus within the body of the stomach. Right IJ line terminates in the superior aspect of the RA. Low lung volumes. Probable mild pulmonary edema. Patchy bibasilar pleural-parenchymal opacities. Plate and screws in the left clavicle, incompletely visualized. Large patient body habitus. Normal heart size.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable mild pulmonary edema. Patchy bibasilar pleural-parenchymal opacities. Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: s/p lung resection History: see above Interval removal of right apical chest tube.Stably enlarged but now partially obscured cardiac silhouette.New small to moderate right basilar pleural effusion with associated atelectasis. No pneumothorax.

Output: New small to moderate right basilar pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Dizziness and giddiness question pneumonia Left upper lobe spiculated mass with lymphadenopathy in the left hilum.Upper normal heart size. Tortuous thoracic aorta with ectasia of the ascending segment.

Output: Left upper lobe mass with hilar lymphadenopathy compatible with primary pulmonary malignancy.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Fever assess for infiltrate. The abdomen was shielded.Normal heart size. No focal airspace opacity, pleural fluid or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Weakness. Intubated. ETT tip 3.5 cm above the level of the carina. Enteric tube and right PICC unchanged.Lung volumes remain low with basal atelectasis and hazy diffuse airspace opacity, right greater than left, that may be chronic and exaggerated due to underinflation artifact. Blunting of the left costophrenic angle unchanged compared to recent films this admission and could be the result of scarring or loculated fluid.

Output: Nonspecific blunting of the left costophrenic angle with ipsilateral retrocardiac/basal atelectasis; infection in the left lung base cannot be entirely excluded. Diffuse lung abnormality could be the result of chronic CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Pre-op cardiac surg History: N/A No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: POD 2 LVAD History: POD 2 LVAD Right IJ Swan-Ganz catheter likely coiled in the right atrium. Repeat radiograph is recommended for confirmation.Mediastinal drain unchanged.Interval extubation.LVAD again noted.Low lung volumes.Bilateral basilar atelectasis.Stable cardiomegaly.

Output: Right IJ Swan-Ganz catheter likely coiled in the right atrium. Repeat radiograph is recommended for confirmation, preferably PA/lateral if feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: lung infiltrate History: cough Interval removal of left internal jugular central venous catheter.Cardiomediastinal silhouette is normal. Small left mediastinal calcified lymph nodes are noted. No focal airspace opacities, pleural effusion, or pneumothorax identified.

Output: No acute cardiopulmonary abnormalities without evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Evaluate left basilar/retrocardiac opacity seen on AXR. History: As above Stable appearance of the chronic elevation left hemidiaphragm with associated compressive left basilar atelectasis.Lungs otherwise appear clear.Cardiomediastinal silhouette appears normal.Interval placement of Dobbhoff tube which is below the diaphragm and the tip is beyond the lower border of the film.

Output: 1. Stable appearance of chronic elevation of left hemidiaphragmInterval placement of a Dobbhoff tube below the diaphragm the tip of which is not visualized.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pna History: cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.History of liver transplant, follow-up pneumothorax Stable to mildly improved right pneumothorax, now measuring approximately 10 mm. No significant interval change in small left pneumothorax. No significant change in basilar opacities and effusions.Cardiac silhouette stable in size.NG tube, endotracheal tube central venous catheter, and Swan-Ganz catheter unchanged in position.

Output: Stable to mildly improved small right pneumothorax. Stable small left pneumothorax.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: cough questions sarcoid Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: LVAD placement History: LVAD Moderate cardiomegaly status post sternotomy and valve repair.Unchanged pulmonary opacities suggestive of edema with a small left pleural effusion.Disconnected ICD leads and LVAD unchanged.Right jugular Swan-Ganz catheter tip in right pulmonary artery.Left jugular catheter, tip in SVC.

Output: Cardiomegaly with pulmonary edema unchanged. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT History: ETT ET tube tip 1 cm above the carina.Nonspecific bilateral airspace and interstitial opacity, slightly improved since the previous day.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Device placement 2-lead left subclavian ICD appears similar without evidence of interval change or new complication.Moderate cardiomegaly with underlying effusions and edema appears mildly improved infiltrate large and suspected loculated component along the posterior left lung base persists, best evaluated on the lateral projection

Output: Improving effusions, however moderate fluid collections persist with loculation


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: post op History: post op Repositioning of the left chest tube. Interval increase in left basilar opacity and small effusion. No change in right lung opacity.

Output: Repositioning of left-sided chest tube with associated interval increase in the basilar opacity and effusion.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female. Lung nodule noted on chest x-ray. History of interstitial fibrosing lung disease, abdominal mass 50-pound weight loss over two years. CHEST:LUNGS AND PLEURA: Increased bronchiectasis and fibrotic changes in both lung bases. Some mild fibrotic changes in the periphery of the upper lobes with small irregular opacity in the right upper lobe appears to be fibrosis rather than a nodule. No definite lung masses are seen. No effusions.MEDIASTINUM AND HILA: Heavy calcifications in the aorta and coronary arteries. Clusters of nodes in the pretracheal and AP window. For baseline purposes cluster of nodes in the precarinal area series 3 image 36 measure 1.7 x 2.2 cm.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the bowel a solid organs due to lack of oral or intravenous contrast. Given those limitations, the following observations are made.LIVER, BILIARY TRACT: Normal variant small right lobe liver with retrohepatic gallbladder unchanged and 2007.SPLEEN: No significant abnormality noted.PANCREAS: Atrophy with mild pancreatic ductal dilatation unchanged and 2007.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic calcifications aorta and branch vessels. Note evidence of aneurysm. Splenic artery calcification but no evidence of aneurysm.BOWEL, MESENTERY: Partial intrathoracic stomach. This is unchanged and 2007.BONES, SOFT TISSUES: Scoliosis and degenerative changes.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: Scoliosis and degenerative changes. Nonobstructive mild bulging lower pelvic wall near the right groin represent early mild hernia formation since image 161.OTHER: No significant abnormality noted.

Output: No definite evidence of malignancy. Fibrotic changes in lungs. Right upper lobe focal fibrotic change favored. Clusters of mediastinal nodes. Atherosclerotic disease. Intrathoracic stomach. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 23-year-old female with tachycardia. Enlarged pulmonary artery chest x-ray. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: Central bronchial wall thickening as well as upper lobe predominant septal thickening with few subtle areas of groundglass opacities in both lungs.Mild basilar atelectasis. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Left jugular central venous catheter with tip in the right atrium. UPPER ABDOMEN: No significant abnormality noted.

Output: Findings compatible with mild pulmonary edema. No pleural effusions. No PE.


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary abnormality and a right jugular triple Hickman appears well positioned, tip projects into the mid SVC

Output: Right Hickman placement


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Intubated. ET tube tip is about 3 to 4 cm above the carina. Enteric tube with tip in the gastric body. Left IJ tip likely at the confluence of the jugular and brachiocephalic veins. Layered right pleural effusion and adjacent atelectasis and mild left-to-right mediastinal shift.

Output: ET tube tip about 2 to 3 cm above the carina. Unchanged right pleural effusion with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: infection History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough Persistent mild nonspecific artery magnified with decreased lung volumes with atelectasis yet no specific findings to suggest edema or superimposed acute abnormality.Note however is made of a new catheter projected over the upper lumbar spine and cardiac silhouette of uncertain path. May represent an anterior chest wall catheter but appearance and layer out does not conform to known vascular patterns.

Output: No new pulmonary acute abnormality, however new superimposed catheter of uncertain position is described; please correlate.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female status post left lower lobe lobectomy for non-small cell lung cancer. Evaluate for interval change. CHEST:LUNGS AND PLEURA: Postoperative change and volume loss on the left status post left upper lobe resection are redemonstrated. No suspicious nodules or masses to suggest disease recurrence. Right lower lobe micro-nodule on axial image 51/95 is unchanged. Small scarlike opacity in the right middle lobe (axial image 44/95) is unchanged. No pleural fluid. Mild upper lung emphysema is noted.MEDIASTINUM AND HILA: The cardiac size is normal. No pericardial fluid. Mild aortic atherosclerotic calcifications. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Right axillary skin thickening and prominent lymph nodes are unchanged. A reference node measures 1.7 x 0.8 cm on axial image 18/143.ABDOMEN: Within the limitations of a noncontrast examination, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Low density lesion off the superior pole of the left kidney is unchanged and probably represents a benign cyst.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination with no evidence of recurrent or metastatic disease in the chest or abdomen.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: small L ptx post bx History: small L ptx post bx Trace left apex pneumothorax. Multiple metastases were better seen on CT.

Output: Trace left apex pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: post op History: SOB Cardiomegaly, with linear scarring or subsegmental atelectasis, gradually improving.Left subclavian single chamber ICD unchanged.

Output: Improving atelectasis with no new findings and stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with history of atypical vascular disease. Evaluate for paraneoplastic syndrome CHEST:LUNGS AND PLEURA: Mild bilateral bronchiectasis in the lung bases, unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Bilobar multiple cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Left upper pole cyst measures 1.7 x 1.7 cm diameter. No obvious solid component. However there is enhancement of thin septations within the lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.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: Leiomyomatous uterus. Bilateral renal cysts. The cyst in the upper pole of the left kidney is minimally complex with enhancing thin internal septations. A follow-up CT in one year is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: acute chest Port catheter terminates near the cavoatrial junction, as before. Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild bibasilar subsegmental atelectasis or scarring. No large pleural effusion or pneumothorax. Normal heart size. Previously demonstrated partially imaged left humeral prosthesis has been removed.1 Please see shoulder radiograph interpretation from same day for other details.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval IABP History: serial eval Iatrogenic devices are unchanged. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: check for ptx s/p biopsy on right History: rll nodule Small right lower lobe nodule with mild perilesional hemorrhage and edema. No significant pneumothorax. Emphysema.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Interval placement of a right IJ central catheter that terminates at the superior aspect of the azygos vein.Interval decreased lung volumes. Retrocardiac opacity suggestive of subsegmental atelectasis. No pneumothorax. Cardiac silhouette is magnified.

Output: No pneumothorax following central line placement.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Mild COPD with minimal basilar changes likely atelectasis and/or scarring. Midline sternotomy with multiple broken wires. No acute cardiopulmonary findings

Output: COPD with suspected minimal scarring. Serial imaging however will be helpful if suspicion remains high


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: eval ETT History: intubation Endotracheal tube terminates 2 cm above the carina. Nasogastric tube has been advanced the sidehole immediately inferior to the GE junction.Right-sided opacities with multifocal consolidation stable. Left mid zone consolidation is new. Small bilateral pleural effusions slightly increased. No pneumothorax.

Output: Increasing size of bilateral pleural effusions and left nodular consolidation. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for thoracic aneurysm, abnormalities History: Hx of thoracic AAA (4.5x4.3cm), renal mass Tortuous and ectatic aortic arch consistent with a history of thoracic aortic aneurysm.Calcification in the area of the aortic valve.Normal heart size and no significant pulmonary abnormalities.

Output: Thoracic aortic aneurysm and possible aortic valve calcification.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with recurrent ovarian cancer CHEST:LUNGS AND PLEURA: Calcified granulomata and calcified mediastinal and right hilar lymph nodes, stable. No new nodules or pleural effusionMEDIASTINUM AND HILA: Calcified mediastinal lymph nodes. Right-sided port with its tip in the right atrium. Reference subcarinal lymph node measures 2.5 by 1.7-cm in image number 45, series number 3, not significantly changed. Other mediastinal lymph nodes are also stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Previously measured reference lesion in the right lobe of the liver is increased in size and now measures 2.5 x 2 cm, image number 85, series number 3. Multiple, new, hypodense liver lesions, consistent with metastatic disease are seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference lesion on the right side of the vaginal cuff measures 2.2 by 1.5 cm, slightly enlarged compared to previous study. An additional lesion extending from the vaginal cuff anteriorly is also minimally increased in size.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable mediastinal lymph nodes.Interval increase in the size and number of hepatic metastatic lesions.Minimal Interval increase in the size of the soft tissue lesion near the vaginal cuff concerning for recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male persistently afebrile. Evaluate for source of infection. CHEST:LUNGS AND PLEURA: Patchy "bud and tree" opacities particularly throughout the right upper lobe persist. Dense consolidation has increased in volume involving the right and left lower lobes. Aspiration pneumonia cannot be excluded. No significant pleural effusions.MEDIASTINUM AND HILA: Adenopathy unchanged. ET tube NG tube in place. CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs or bowel due to lack of IV or oral contrast. Given those limitations, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Focus nephrolithiasis right kidney unchanged.RETROPERITONEUM, LYMPH NODES: Caval filter.BOWEL, MESENTERY: Generalized ileus. Small amount of intraperitoneal fluid persist. One pigtail catheter is seen in the right abdomen abutting the abdominal wall in the amount of fluid surrounding the catheter is diminished compared to the prior exam. Precise measurements cannot be made due to the lack of oral contrast a comparable image series 4 image 145 with compared to prior exam series 2 image 137.Nasoenteric tube terminates at the ligament of Treitz. No evidence of bowel obstruction. There is some distortion of bowel consistent with adhesions however. Ileostomy right lower quadrant.BONES, SOFT TISSUES: Gaping midline abdominal wound.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Jackson-Pratt drain in the pelvis. The amount of fluid surrounding the drain is diminished compared to the prior scan but some fluid persist. No evidence of bowel obstruction.BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality noted

Output: Given limitations of no oral or IV contrast the amount of free and loculated fluid in the abdomen and pelvis is diminished. Increase bibasilar atelectasis or consolidation persistent but and tree appearance in lungs. Infection cannot be excluded. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of multiple myeloma with shortness of breath. LUNGS AND PLEURA: Peripheral, reticular opacities along the lateral aspect of the right upper and right middle lobes are unchanged suggestive of scarring. Right upper lobe calcified granuloma unchanged. Small focus of nodular opacities along the right major fissure (axial image 54/121) is nonspecific but may reflect aspiration or early infection. A linear band of opacity is re-demonstrated in the right lower lobe compatible with atelectasis or scar. Linear opacities in the medial and left lower lobe likely reflect scarring or atelectasis. No pleural fluid.MEDIASTINUM AND HILA: The cardiac size is normal. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Right chest wall port catheter in place with its tip in the SVC. Orthopedic hardware is demonstrated within the lower cervical spine.UPPER ABDOMEN: No significant abnormality noted.

Output: Nonspecific small focus of nodular right upper lobe opacities. Otherwise, no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.NG placement. Nasogastric tube projects over the stomach with the sidehole just beyond the GE junction. Unchanged cardiomegaly. Coarse pulmonary opacities and bronchial wall thickening about the same, possibly related to aspirate.

Output: Appropriate position of nasogastric tube.


Instruction: Generate impression based on medical findings.

Input: Reason: assess line/tube position History: as above ET tube tip approximately 5 cm above the carina.NG tube extending below the inferior margin of the radiograph.Large lung volumes suggest COPD.No acute change.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Left lung collapsed, increased WOB Marked interval improvement with increased aeration of the left hemithorax with persistent basilar changes and moderate layered pleural effusion. Patchy opacities in a perihilar distribution persist. The right lung however otherwise remains similar with mixed interstitial and patchy opacities again project in a perihilar distribution. Small right effusion.Unchanged left PICC line, tip projects towards and possibly within the origin of the azygous.

Output: Marked interval improvement with increased aeration of the left hemithorax, possibly representing a post thoracentesis


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: evaluate pleural effusion History: pleural effusion by TTE Pericardial drain removed.No significant pneumothorax.Improved left basilar atelectasis, slightly worse on the right, with small pleural effusions.Remnants of a left subclavian ICD remain in place.

Output: Improving left basilar atelectasis and removal of pericardial drain. Small pleural effusions persist.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: rule out acute caridopulmonary processes History: chest pain The cardiomediastinal silhouette is mildly enlarged.There are no focal pulmonary opacities or pleural effusions. Mild spinal curvature.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: trach/vent, eval airspace, ? evolving opacity on 4/1 compared to 3/31 in right base? History: asx Tracheostomy tube, pacemaker lead and venous catheters unchanged. Small lung volumes with mild perihilar opacity compatible with edema or aspiration and atelectasis with small pleural effusions.No new findings.

Output: Nonspecific opacities compatible with edema and atelectasis with no significant interval change..


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Fever question infiltrates. Mild basilar scarring. No focal airspace opacities, visible pleural fluid or pneumothorax.

Output: No signs of pneumonia or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: evidence of pericardial effusion History: hypotension and tachycardia of unclear etiology Moderate right pleural effusion with basal atelectasis. Peripheral nodule on the left is unchanged. No change in heart size. Left PICC tip in left subclavian vein.

Output: Moderate right pleural effusion with basal atelectasis. Peripheral nodule on the left is unchanged. No change in heart size to suggest pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: S/p cardiac surgery History: As above ET tube has been removed.Right IJ Swan-Ganz with its tip in the pulmonary artery.Chest/mediastinal tubes unchanged.Stable cardiomediastinal silhouette with nonspecific basilar opacities compatible with atelectasis more pronounced on the right.

Output: Interval extubation. Increasing right basilar opacity compatible with atelectasis possibly secondary to aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate R PTX History: SOB Persistent small right apical pneumothorax, unchanged from recent previous radiographs.Small lung volumes with basilar opacity compatible with atelectasis.No new findings.

Output: Persistent small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with diagnosis of large B-cell lymphoma CHEST:LUNGS AND PLEURA: Trace left-sided pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, unchanged. Minimal intrahepatic biliary prominence with borderline dilatation of common bile duct is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral calcified atrophic kidneys with multiple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large pulmonary mass within the small bowel mesentery measures 17.8 x 14.4 cm on image number 114, series number 4, increased in size compared to previous study. This mass encases some of the small bowel loops in the left side of the abdomen, however, does not cause obstruction.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: Transplant kidney in the right iliac fossa. Small cyst in the upper pole is unchanged.Trace amount of free fluid in the pelvis is unchanged.

Output: Minimal interval increase in the size of the mesenteric mass.


Instruction: Generate impression based on medical findings.

Input: Check for lung nodules. Status post right upper lobe removal Postsurgical changes and volume loss of the right with status post right upper lobe resection appears unchanged. No superimposed new intrapulmonary abnormalities. Minimal additional left basilar scarring

Output: Postsurgical changes without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: BiVADs, eval L lung consolidation, trach History: as above Support devices, including biventricular assist devices, are unchanged in position.Pulmonary edema pattern with left rib and right pleural effusions stable. Left lower lobe consolidation and atelectasis. Heart size remains enlarged, stable.

Output: No significant change in pulmonary edema and retrocardiac opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Acute on chronic CHF. NuPulse. Stable pulmonary venous hypertension. No evidence of pulmonary edema. No pleural effusions or pneumothorax.Devices unchanged. Swan-Ganz with tip in the main pulmonary artery.

Output: Stable pulmonary venous hypertension. Swan-Ganz with tip in the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old. Cough. Tumor debulking. EPIC history: status post rigid bronchoscopy and removal of obstructive tumor Persistent right upper lobe atelectasis with hyperexpansion of the superior segment of the lower lobe. Small right pleural effusion.No reliable evidence of infection or edema.Stable cardiomediastinal silhouette.

Output: Persistent right upper lobe atelectasis. Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with history of renal cell carcinoma status post nephrectomy. Please evaluate for disease recurrence. CHEST:LUNGS AND PLEURA: Stable right upper lobe micro-nodule. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Clear left nephrectomy site.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Stable negative exam without acute or metastatic process.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: rule out pneumonia History: SOB Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable bibasilar subsegmental atelectasis or scarring. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for cardiomegaly, CHF, or cause of her CP History: chest pain -- "pressure" with mild SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities. No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 50 years old Reason: Patient has a VP and LP shunt, please do all views , and make sure both valves are visible on the xrays for setting determination. History: headache. SHUNT DEVICE: Again seen is an intracranial shunt that exits the skull via a left parietal burr hole and courses down the scalp, neck, enters the left internal jugular pain, and terminates at the level of the right cavoatrial junction. Portions of the catheter device are relatively radiolucent limiting evaluation. Within this limitation, we see no specific features of shunt discontinuity. The notch on the pressure valve points towards the 3 o'clock position, approximately 40 to 50 mL water.There is also a shunt within the spinal canal. We estimate its tip to be at the level of T10. It then courses inferiorly and exits the spinal canal at the level of L1/L2, continues coursing along the right back and flank, off the field of view of the image. It then extends anteriorly such that its tip lies anteriorly within the pelvis. The notch on the pressure valve is not clearly evident on this study. Portions of the shunt anteriorly are relatively radiolucent and hence difficult to evaluate.SKULL: Two views of the skull show the aforementioned shunt and no acute abnormalities.CERVICAL SPINE: There is a slight kyphosis of the cervical spine with degenerative disk disease at the lower cervical spine appearing similar to the prior study. There is deformity of the posterior arch of C1 that is presumably postoperative in etiology.CHEST: The lungs are underinflated and underexposed. There is increased density of the left hemithorax that may represent a persistent left pleural effusion as suggested on prior reports.ABDOMEN: Nonobstructive bowel gas pattern. Note is made of surgical clips and multiple radiopaque pills.

Output: Shunt device is as described above with no specific radiographic evidence of complication. However, portions of the LP shunt including the notch on its pressure valve are not well seen.Per discussion with radiology technologist, the clinical service is satisfied with the images, and will not require the patient to be recalled for additional images.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with history of papillary carcinoma of the uterus and history of lung metastases CHEST:LUNGS AND PLEURA: Index left upper lobe nodule now measures 8 x 9 mm on image number 33, series number 4. Postsurgical changes of right upper lobectomy is again noted.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are stable. Index lymph node measures 9 by 7-mm image number 38, series number 3.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: Punctate left nephrolithiasis, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: tachycardia, agitation History: see above Extensive bilateral bronchiectasis and mucous plugging.Focal opacity at the right apex compatible with a history of abscesses, not appreciably changed allowing for differences in projection.PICC tip in the left axillary vein.No new findings.

Output: Extensive bronchiectasis in right upper lobe abscess with no appreciable change.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: eval ETT, lung fields History: s/p AVR Dense right breast implant overlies the chest, although the underlying lung is likely unremarkable.Large lung volumes consistent with COPD.Status post sternotomy for valve replacement with no pneumothorax.ET tube tip too low, directed towards the left main bronchus.Right jugular Swan-Ganz catheter tip far in the right descending pulmonary artery.

Output: Low ET tube. Swan-Ganz catheter tip far in the right interlobar pulmonary artery. Findings were text paged to pager 6666 of the time of dictation, forwarded to Elizabeth Martin.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: ETT placement, aspiration History: aspiration, r/o infection Endotracheal tube is unchanged. Enteric tube tip in gastric body. Increasing bilateral diffuse pulmonary opacities. Opacities on the left are more confluent than the prior exam. There are new right upper and right lower lobe fluffy airspace opacities which may represent edema, hemorrhage, or aspiration.

Output: Increasing bilateral diffuse pulmonary opacities. New pulmonary opacities on the right may represent edema, hemorrhage, or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: eval line placement, has been pulled back 2cm History: cardiogenic shock Interval partial withdrawal of right jugular catheter with its tip now in the SVC.ET tube and in the device unchanged.Perihilar nonspecific airspace and interstitial opacities suggestive of aspirated secretions and nonspecific consolidation.

Output: Interval adjustment of right jugular catheter.


Instruction: Generate impression based on medical findings.

Input: Check tracheostomy tube Interval exchange of the ETT for a tracheostomy tube, tip terminates 4 cm is above the carina. NG tube well positioned and unchanged.Mildly decreased lung volumes with an elevated right hemidiaphragm. No superimposed acute focal airspace process.Cardiac and mediastinal contours are within limits given technique and semiupright positioning

Output: Tracheostomy tube placed and ETT removed


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Status post bronchus, evaluate for postprocedure pneumothorax, worsening TRALI versus LLL worsening where saline injected. Radiopaque sheeting or clothing external to the patient projects over the left upper thorax, making it difficult to exclude a pneumothorax medially and a follow-up examination is recommended.Bilateral patchy groundglass opacities, with increase in opacity in the right upper lobe abutting the fissure as well as throughout the left lower lobe as compared to the preprocedural film of 10/25/2015.Sternotomy wires. Extrapleural fat deposition laterally on the right with very small pleural fluid collections bilaterally unchanged.

Output: No conclusive pneumothorax however a follow-up film is suggested. Opacities in the dependent right upper lobe appear worse and may be due to progression of pre-existing process. Opacities in the left lower lobe are worse but appear less well-defined and are probably at least in part related to saline injection.


Instruction: Generate impression based on medical findings.

Input: 35 year old male with shortness of breath. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the level of the subsegmental pulmonary arteries.LUNGS AND PLEURA: Bilateral interstitial abnormalities with intralobular reticulation appearing similar to prior study accounting for difference in phase of respiration. No evidence of bronchiectasis or honeycombing.Right upper lobe calcified granuloma and left upper lobe foci of calcification as seen previously.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild coronary artery calcifications. Mediastinal lipomatosis.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No PE. Study is diagnostic to the level of the subsegmental pulmonary arteries.2. Chronic interstitial abnormalities appearing similar to prior study.


Instruction: Generate impression based on medical findings.

Input: History of PE, left lower extremity edema no shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: malignant thymoma History: none Left central venous catheter with this tip in the SVC.Stable cardiomediastinal silhouette.Mild basilar scarring.Nodular opacity in left midlung as noted on prior CT.Old rib fracture deformities in the right hemithorax.Clamshell sternotomy with evidence of prior mediastinal surgery.

Output: Mild right basilar scarring. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female; 61 years old. Reason: Hypoxia, bacteremia History: bacteremia, hypoxia Mild increase in nonspecific right basilar opacity, which could be due to pneumonia. Stable mild nonspecific left basilar opacity, most likely due to atelectasis. Normal heart size.

Output: Increased right basilar opacity could be due to pneumonia.


Instruction: Generate impression based on medical findings.

Input: 89 years, Male. Reason: 89 y/o M w/ Hx of Prostate Cancer and constipation who p/w abdominal pain History: Abdominal pain Right mediastinal silhouette is normal. No pleural effusion or pneumothorax. No focal air space opacities. Scattered granulomas are noted.No pneumoperitoneum. Diffuse gaseous distention of small and large bowel compatible with mild ileus type bowel gas pattern.

Output: Mild ileus type bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: et tube History: et tube Unchanged pulmonary airspace opacities with pleural effusions.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 5 cm above the carina. Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: sp minimally invasive esophagectomy History: esophagectomy Two right chest tubes unchanged with no pneumothorax.Unchanged mild basilar atelectasis.Previously seen NG tube removed.

Output: No significant pneumothorax. Unchanged basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: icu History: Congenital insufficiency of the aortic valve. Cardiomegaly with markedly under inflated lungs.Swan-Ganz catheter from the right jugular extending at least to the right ventricle though the tip is not visible, likely due to motion artifact.Nonspecific bilateral basilar opacity compatible with atelectasis and consolidation.

Output: Cardiomegaly and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p bil lung tx History: s/p bil lung tx Interval removal of one of 2 left pigtail catheters with a small residual pneumothorax.Bilateral nonspecific airspace and interstitial opacity, not significantly changed allowing for position and lung inflation.NG tube doubled back in the stomach.

Output: Small residual left pneumothorax, slightly decreased from previous.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old. ET tube tip approximately 5 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Left jugular catheter tip in SVC.Nonspecific perihilar and basilar opacities consistent with consolidation and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see 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: Reason: Hx of OHT presented w/ SOB and CP History: dyspnea, chest pain Unremarkable cardiac and mediastinal silhouette. Status post median sternotomy with intact fixation devices. Small lung volumes with mild basilar atelectasis or scarring.No specific evidence of pulmonary edema or pneumonia.

Output: Mild basilar atelectasis and no other acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: s/p CIED upgrade to CRT-D --> evaluate lead positions and r/o pneumothorax History: as above No significant cardiopulmonary abnormality.Left subclavian ICD upgraded, now biventricular dual-chamber.No significant pneumothorax.

Output: ICD upgrade without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Lung transplant. Tubes, lines and devices similar in position. Low lung volumes with basal atelectasis. Mild septal thickening and linear opacities in the left lung appear unchanged. Pleural fluid on the right about the same. Trace (2 mm) pneumothorax on the right.

Output: No acute change in atelectasis, mild pulmonary edema and left lower lung zone peribronchial opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: New tracheostomy placed History: New tracheostomy placed Tracheostomy is in place. No pneumothorax. Mild pulmonary edema pattern again noted. Patchy left basilar pleural parenchymal opacities, increased from last study. Unchanged cardiomegaly.

Output: Tracheostomy is in place. Mild pulmonary edema again noted. Increased left basilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: 68yo F w/ new hypotension, eval for cause History: as above Limited study due to patient's size.Low lung volumes.Cardiomegaly.Good position of single lead ICD.Lungs grossly clear. No evidence of effusion or pneumothorax.Right chest port with tip to severe vena cava

Output: Cardiomegaly. Limited study but no evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: pna? History: respiratory distress Stable cardiomediastinal silhouette.Basilar scarring unchanged.No focal airspace opacities.No pleural effusions.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old, with Sjogren's, dyspnea on exertion. LUNGS AND PLEURA: Mild to moderate centrilobular emphysema. Apical scarring. Scattered subsegmental atelectasis. No suspicious nodules or masses. No focal consolidation, edema or pleural fluid. Mosaic attenuation on the expiration views indicates air trapping, possibly secondary to small airways disease. No evidence of an interstitial abnormality is seen.MEDIASTINUM AND HILA: The cardiac size is normal. No pericardial effusion. No suspicious hilar or mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Small bilateral fat containing Bochdalek hernias.Multiple low attenuation lesions within the liver, the largest of which are in segment II showing near water density compatible with benign cysts.

Output: 1.No specific evidence of interstitial lung disease. No acute pulmonary abnormality.2.Other benign findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Shortness of breath. Evaluate for pneumonia. Right IJ central catheter terminates in SVC.Basilar interstitial opacities appear similar to the prior study. Probable small left pleural effusion. No pneumothorax. Large lung volumes suggestive of COPD. Cardiomegaly is stable.Chronic compression deformity of a lower thoracic vertebral body.

Output: Mild CHF without evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: re-evaluated for worsening pulmonary edema History: SOB, accessory muscle use, crackles Cardiomegaly with markedly increased bilateral diffuse airspace opacity, compatible with pulmonary edema. Nonspecific superior mediastinal widening compatible with lipomatosis and lymphadenopathy, unchanged.Skeletal findings compatible with renal osteodystrophy.

Output: Increasing pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: s/p MVR History: SOB Stable cardiac enlargement.Right pleural effusion and nonspecific right basilar opacities improved from the prior exam.No new pulmonary opacities identified.Median sternotomy intact.Mild degenerative changes in the thoracic spine.

Output: Stable cardiac enlargement with interval improvement in the small right pleural effusion and right basilar atelectasis. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: 63M with dyspnea and h/o pleural effusion. History: dyspnea, wheezing No change in pulmonary opacities and pleural effusions with basilar consolidation.Right jugular catheter tip at SVC/artery junction level.Dobbhoff tube removed. Status post TIPS. Biliary drain unchanged.

Output: Dobbhoff tube removed. Stable pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: 30F with ESRD c/f fluid overload History: SOB, CP Right IJ catheter tip in the right atrium.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: SOB r/o PNA vs volume overload History: SOB in setting of cirrhosis s/p TIPS Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Status post TIPS.

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


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of colon cancer status post resection and chemotherapy. Presenting with epigastric pain and vomiting. CHEST:LUNGS AND PLEURA: Stable Mark or nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar subcentimeter low-attenuation foci. No ductal dilatation. Hepatic vessels patent. .SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable bilateral adrenal low density lesions most likely representing adenomas.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Ill-defined fluid density surrounds the IVC adjacent to the caudate lobe. This is new from previous CT. The etiology is not certain. Peripancreatic, periceliac adenopathy is unchanged.BOWEL, MESENTERY: There are mildly dilated small bowel loops in the right upper and right lower quadrant measuring up to 3.5 cm. In the right upper quadrant there is focal area of increased density in the small bowel mesentery surrounding the mild with thick walled bowel loops. More distal small bowel loops are decompressed. These findings are compatible with a partial mid small bowel obstruction. No free air to suggest perforation. Small amount of free fluid in the pelvis. No evidence of abscess. IVC is very small suggestive of dehydration.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Uterus is not visualized. Left ovary is unremarkable. Right ovary is not well seen.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: Small amount of free fluid in the pelvis.

Output: Partial small bowel obstruction at mid small bowel level. Mildly dilated small bowel loops in the right upper and right lower quadrant with associated right upper quadrant localized increased density in the small bowel mesentery. These changes most likely represent edema and fluid secondary to obstruction/ischemia in the small bowel loops and mesentery, rather than peritoneal disease of the patient's known colon cancer. Some of the small bowel loops in that location demonstrate mild wall thickening again may be secondary to obstruction or ischemia.Retroperitoneal adenopathy, unchanged. New ill-defined soft tissue density around the IVC near the caudate lobe. The etiology is not certain but this may also represent some inflammatory changes.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.History of pulmonary fibrosis evaluate for pneumonia or effusion. Asymmetric, low lung volumes, right greater than left. Nodule along the fissure in the right midlung. Diffuse bronchiectasis, left greater than right. Patent pulmonary arteries are enlarged, consistent with pulmonary hypertension.

Output: No specific signs of pneumonia or superimposed CHF. Severe pulmonary fibrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: ETT placement History: ETT Mild cardiomegaly with unchanged pleural effusions and left lower lobe consolidation.ET tube tip approximately 2 cm above the carina.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 2 cm above the carina. Unchanged pleural effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old Reason: Chest tube placement Interval placement of a left sided basilar chest tube. Interval placement of a nasogastric tube with the tip terminating just proximal to the esophageal hiatus. Right superior vena cava central venous catheter tip terminates in the SVC. Interval placement of an endotracheal tube, with the tip terminates approximately 3 cm above the carina.Large well-circumscribed air collection in the left hemithorax not significantly changed and not representative of a hydropneumothorax. Bibasilar opacities suggest atelectasis. Small volume basilar pneumothorax.

Output: Large well-circumscribed air collection in the left hemithorax not significantly changed s/p tube placement.


Instruction: Generate impression based on medical findings.

Input: AV canal repair. Trisomy 21.VIEW: Chest AP (one view) 11/14/15, 0507 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in gastric body. Right internal jugular line tip is in superior vena cava. There is a right chest tube. A right atrial line is present. Epicardial pacer leads are seen. There is a mediastinal surgical clip.Focal opacity is present in the right perihilar region and in left lower lobe. Cardiac silhouette size is normal. No pneumothorax is identified.

Output: Continued lung opacities.