Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab AICD electrodes unchanged in position.Stable cardiomegaly.No focal airspace opacities.No significant pleural effusions or pneumothorax.

Output: No evidence of pneumothorax. No interval changes from prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Abdominal pain. Lung volumes remain low, similar to prior. Basilar scarring and atelectasis bilaterally. The lung bases, especially the posterior costophrenic angle regions are obscured and cannot be assessed accurately. The upper lung zones are without acute abnormality.Right upper quadrant surgical clips.Unable to assess for the presence of pneumoperitoneum as the patient is not fully erect.

Output: No visible acute abnormalities. Please refer to subsequent CT abdomen reported separately which will include imaging of the lung bases.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: eval for rib fracture History: rib pain s/p fall The lungs and pleural spaces are clear. Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality. No displaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: sob, evalaute History: SOB Increasing right lower lung opacity. Left lower lobe slightly better aerated.Stable cardiac and mediastinal silhouette.Dextroscoliosis of the thoracolumbar spine.

Output: Aspiration pneumonia, worsening on the right.


Instruction: Generate impression based on medical findings.

Input: Reason: hemothorax/mucous plug? History: acute hypoxia Large right pleural effusion, increased compared to previous now, possibly due to hemothorax, with mediastinal shift to the left.Moderately large left effusion with underlying atelectasis.Catheter tip in the SVC.

Output: Increasing right pleural effusion, possible hemo-thorax.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: POD2 from central ECMO placement History: s/p central ECMO placement ECMO cannulae and left chest tube unchanged. Swan-Ganz catheter tip in right pulmonary artery.Pulmonary edema and pleural effusions unchanged though the lungs are slightly better aerated. Interval extubation.

Output: Pulmonary edema and pleural effusions unchanged though the lungs are slightly better aerated.


Instruction: Generate impression based on medical findings.

Input: Reason: aspiration pna History: cough Normal heart size with evidence of previous median sternotomy. No sign of aspiration or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: eval lungs and mediastinum History: SOB in pt with CHF and COPD Left-sided pleural and parenchymal scarring unchanged.No reliable evidence of acute edema or pneumonia.Heart size near upper normal, the mediastinum otherwise unremarkable.

Output: Chronic pleural and parenchymal scarring, but no reliable evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: line placed History: line placed Interval placement right IJ central catheter that terminates at the roof of the right atrium. Sternotomy hardware remains well aligned. A metallic valve occupies the mitral position.Cardiomegaly is unchanged. Stable cardiomegaly and basal predominant interstitial opacities suggestive of edema. No pneumothorax.

Output: Cardiomegaly with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: There is been marked enlargement of several of the prior noted micronodules, the largest of which now measures 1.6 x 1.5 cm (series 12, image 25) -- this previously measured approximately 4 mm in diameter. Other new or enlarging masses are seen in the left apex (series 12, image 18) measuring 1.1 x 1.3 cm and numerous nodules in the right lung base greater than 1 cm in size.MEDIASTINUM AND HILA: Again seen is coronary artery calcification. Superiorly, mildly prominent lymph nodes are unchanged in the pretracheal space. However, inferiorly in the paraesophageal region there is a new lymph node mass (series 10, image 75) measuring 2.4 x 1.8 cm). Prominent right cardiophrenic angle lymph node (series 10 and image 80) is unchanged. 58-year-old male with hep C. cirrhosis, HCC status post hemispheres 11/11. Evaluate interval change in triple phase liver.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology to liver again seen with multiple lesions throughout both lobes, some of which are calcified.Previously reported reference lesions are as follows:Right dome reference enhancing lesion measures 0.9 x 0.7 cm (series 9 and image 10) unchanged. This is immediately posterior to a larger hypovascular lesion measuring 2.7 x 2 .4 cm, previously measuring 2.3 x 2.2 cm. Right lobe segment 6 enhancing lesion is more difficult to visualize today but appears to measure 1.8 x 1.3 cm (series 9, image 34) compared with 1.6 x 1.3 cm previously.Right lobe segment 5/6 lesion (series 10 come image 104) measures 3.1 x 4 .4 cm, previously 3.6 x 3.6.Poor enhancement seen in the portal veins and its branches, however they appear unchanged from prior examinations and no definite tumor thrombus is seen. Hepatic veins are similarly poorly visualized and no assessment can be made.No change seen in appearance of the gallbladder with mildly thickened wall and high density material contained within representing other stones or sludge debris. No intrahepatic or extrahepatic biliary duct dilatation is seen to suggest obstruction. SPLEEN: Splenomegaly unchanged. No change in the calcification and mural thrombus seen in the peri-splenic collateral.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Marked increase in the prior noted reference hepatoduodenal ligament lymph node is seen. Reference lymph node now measures 6.2 x 4.9 cm (series 10, image 111) compared with 3.5 x 2.9 cm previously.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Minimal change in appearance of the reference liver lesions in the liver as measured above. No new lesions are identified. 2. Multiple new pulmonary masses most consistent with metastases. 3. New areas of mediastinal lymphadenopathy and paraesophageal region. 4. Marked increase in hepatoduodenal ligament lymph node metastasis.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with metastatic pancreatic cancer. Please evaluate for study enrollment. CHEST:LUNGS AND PLEURA: 3-mm right lower lobe nodule (series 12; image 55).MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormalityABDOMEN:LIVER, BILIARY TRACT: A few arterially enhancing foci are seen in the periphery of the liver, possibly related to transient hepatic attenuation differences and/or flash filling hemangiomas. Approximately 4 subcentimeter subtle hypodensities are seen in the liver, more conspicuous on this examination.SPLEEN: No significant abnormality notedPANCREAS: A hypovascular mass is seen obliterating the pancreatic body and tail with extension to the gastric fundus and body. The mass measures approximately 9.0 x 7.7cm, not significantly changed. The mass encases portions of the splenic artery and occludes the splenic vein, with resultant venous collaterals (including gastric varices). Tumor surrounds approximately less than 90 degrees of the SMV at the confluence. The SMA and celiac axis perivascular fat is maintained.ADRENAL GLANDS: The left adrenal gland is involved by a soft tissue mass (series 13; image 96), which likely represents extension of conglomerate adenopathy.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Para-aortic adenopathy are seenBOWEL, MESENTERY: Innumerable metastatic implants are seen throughout the omentum, increased. For reference purposes, one of these in the right side measures 3.6 x 2.9 cm (series 10; image 92), previously 3.1 x 2.5 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild ascitesPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: 15 x 9 mm filling defect is seen in the dependent aspect of the bladder (series 13; image 179)LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: An addendum will be made to include the JOG perfusion.Mass involving the pancreatic tail with invasion of the stomach. Diffuse peritoneal carcinomatosis has increased.Metastatic adenopathy which surrounds the left renal artery and involves the left adrenal gland.Splenic vein thrombosis with encasement of portions of the splenic artery.Few subcentimeter hepatic hypodensities not be definitively characterize but could represent metastases.3-mm right lower lobe nodule, nonspecific.Filling defect in the urinary bladder, nonspecific. The findings could represent a blood clot, tumor or noncalcified stone.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: chest pain History: above Tortuous thoracic aorta, correlate for systemic hypertension. No pleural effusions or pneumothorax. No specific radiographic evidence of edema or infection.

Output: Tortuous thoracic aorta, correlate for systemic hypertension.


Instruction: Generate impression based on medical findings.

Input: Persistent fever; pancreatitis with pseudocyst CHEST: Tracheostomy tube.LUNGS AND PLEURA: Right upper lobe calcified granuloma. Small bilateral pleural effusions are seen, decreased, with minimal associated atelectasis.MEDIASTINUM AND HILA: The heart size is enlarged. The suprahepatic IVC remains dilated.CHEST WALL: A right IJ catheter terminates at the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: Sludge is noted within the gallbladderSPLEEN: No significant abnormality notedPANCREAS: Mild peripancreatic inflammation is seen, decreased from the prior study. The previously described fluid collection adjacent to the stomach has resolved. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral hernia repairOTHER: A large fluid collection is seen in the right lower quadrant, measuring 10.7 x 9.5 cm in greatest transverse by AP dimension. Some high density material is seen within this collection secondary to hemorrhage versus oral contrast. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Large fluid collection in the right lower quadrant. Hyperdense material within the collection may be due to hemorrhage or oral contrast (this would indicate a fistula with the adjacent bowel, though no potential site is definitely visualized).Decreased pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Fatigue and shortness of breath. Left basal retrocardiac mass is compatible with known fat-containing diaphragmatic hernia.No focal airspace opacities, pleural fluid or pneumothorax. Normal heart size. Vascular stent projects over the left subclavian region.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Wheezing question evidence of COPD. Normal lung volumes. Mild central bronchial wall thickening. Faint subcentimeter clustered nodular opacities in the right midlung too small to characterize by plain film but may be postinflammatory such as from mild bronchiolitis. These can be conservatively monitored with conventional PA and lateral chest radiographs in 3-4 months to exclude worsening.

Output: Mild central bronchial wall thickening is present however the lung volumes appear normal. Faint clustered nodular densities in the right lung is too small to characterize but could potentially reflect bronchiolitis; short-term 3-4 month PA and lateral chest radiograph follow-up suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: lung inflitrate History: cough No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Placement of central line. Kidney transplant and hypotension. Right jugular introducer tip at the level of the right brachiocephalic vein, no visible pneumothorax. Dobbhoff tube unchanged in position terminating at the gastric body level.Small lung volumes with basilar compressive atelectasis and improving diffuse interstitial opacities suggestive of edema. Diffuse osseous abnormality may be the result of medical renal disease.

Output: Improving pulmonary edema. Right jugular introducer terminates at the right brachiocephalic vein level. No visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: eval swan placement History: cardiogenic shock Patient is status post sternotomy. Right-sided biventricular ICD generator and leads in place. Right Swan-Ganz catheter tip is in the right main pulmonary artery.Mild cardiomegaly. Small bilateral pleural effusions. No pneumothorax. Mild bibasilar streaky opacities compatible with atelectasis.

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


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: sob, copd History: sob Large lung volumes, otherwise unremarkable.Left subclavian pacemaker, leads unchanged in position.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: overload History: cough Minimal interstitial opacities and thickening of the fissures are suggestive of edema.Mild cardiomegaly.Flat diaphragms are suggestive of COPD.

Output: Findings suggestive of early edema with underlying COPD.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: MaleReason for Study: Reason: T2N0 lung adenocarcinoma s/p RUL'ectomy May 2015 with diffuse ground glass opacities for routine surveillance History: none No focal areas of consolidation.No pleural effusions.Right apical pleural thickening and right upper lobe volume loss compatible with prior lobectomy.Degenerative changes of the thoracic spine with mild compression deformities of several mid and lower thoracic vertebrae.

Output: Right apical pleural thickening and right upper lobe volume loss compatible with a previous right upper lobectomy. No acute cardiopulmonary abnormality is identified.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: lung transplant History: followup Bibasilar and biapical pleural parenchymal scarring again noted. No focal lung consolidation. Heart size, unchanged. Sternotomy wires again noted. No pneumothorax or large pleural effusion.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with proteinuria and anasarca. History of kidney stones, hematuria. Right pleural effusion. Patient is a smoker with clubbing. Evaluate for lung and abdominal pathology. CHEST:LUNGS AND PLEURA: Right greater than left pleural effusions. Calcified granuloma in the right lower lobe. No suspicious nodules or masses.Central bronchial wall thickening bilaterally.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: Gallstones without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal stones. No hydronephrosis. No abnormal perinephric collections.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aortic arch, descending aorta, and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine. Generalized anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the spine. Generalized anasarca.

Output: 1. Pleural effusions and central bronchial wall thickening.2. No renal stones or hydronephrosis.3. Generalized anasarca.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: r/o infection History: cough with chest pain New right middle lobe opacity consistent with aspiration or pneumonia. Rightward deviation in the superior aspect of trachea again noted, consistent with large thyroid nodule/mass as noted on previous MRI neck studies. This is not substantially different compared to 9/13. Normal heart size. Aortic atherosclerosis again noted. No large pleural effusion or pneumothorax.

Output: New right middle lobe opacity consistent with aspiration or pneumonia. Chest radiograph follow-up in 8 weeks is suggested. Findings discussed with Dr. Helland at 822am at time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: et tube placement History: et tube advanced ET tube tip approximately 3 cm above the carina. Catheter tip in the right atrium.NG tube tip in the stomach.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Metastatic sarcoma. New left thigh numbness and right thoracic pain. Noncontrast study. CHEST: The following observations are made given limitations of an unenhanced study.LUNGS AND PLEURA: Increasing number of innumerable bilateral pulmonary nodules. Reference left lower lobe peripheral nodule (image 60; series 4) is stable and measures 1.1 x 1.2 cm.MEDIASTINUM AND HILA: Reference subcarinal lymph node, (image 41; series 3) measures 2.0 x 1.7 cm. Right internal jugular vein central venous catheter terminates in the right atrium.CHEST WALL: New right (approximately T8) thoracic rib fracture (image 60; series 3).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: New bony metastases in the spinal column.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval decrease in size of lobulated right ischiorectal fossa mass lesion, (image 208; series 3) which now measures 9.7 x 8.2 cm. New bony metastases throughout the pelvis. There is new destruction of the inferior aspect of the left sacrum (image 190; series 3). Correlate with clinical symptoms. Additionally, the left portion of the mid sacrum is been destroyed by tumor. This could be better evaluated using MRI exam as clinically indicated. Multiple flat bone metastases also noted.OTHER: No significant abnormality noted

Output: With regard to the clinical query:1. New right (approximate T8) lateral rib fracture.2. Innumerable bony metastases throughout the vertebral bodies and pelvis. In particular, there are destructive lesions of the mid and inferior left sacrum.Other findings and measurements as above.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Chest pain question pneumonia. Unchanged appearance of the cardiomediastinal silhouette.Eventration of the right hemidiaphragm is new from the last chest radiograph but unchanged compared to a recent abdominal CT dated 1/22/2016.No focal pulmonary opacities, pleural fluid or pneumothorax.

Output: No signs of pneumonia or acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: MaleReason for Study: Reason: chest pain History: cough Stable cardiac enlargement. Extensive bilateral air space and interstitial opacities compatible with edema.No focal areas of consolidation.No pleural effusions.No evidence of a pneumothorax.

Output: Cardiomegaly with extensive bilateral air space and interstitial opacities compatible with edema increased from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Age: 38 yearsGender: FemaleReason for Study: Reason: 38 y/o female with agitation, dyspnea, temp rising r/o pneumonia History: dyspnea Tracheostomy tube and right central venous catheter unchanged.Right basilar consolidation/atelectasis new from the prior exam.Mild increase in left basilar subsegmental atelectasis.Stable cardiomediastinal silhouette.G-tube in place.

Output: Increasing right basilar consolidation compatible compatible with aspiration pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: ICU survey History: endocarditis New right IJ venous catheter with its tip in the SVC. Tracheostomy tube unchanged.Enteric tube with its tip in the margin of the image.Stable cardiac enlargement.Perihilar and basilar opacities mildly improved .Pleural effusions similar to prior exam.No evidence of a pneumothorax.

Output: Interval placement of a second right IJ venous catheter without complication. Mild interval improvement in the pulmonary edema. Persistent basilar atelectasis and pleural effusions..


Instruction: Generate impression based on medical findings.

Input: Radical thymectomy and shortness of breath Improving or recurrent patchy opacities largely a perihilar distribution without effusions. Possible edema. Interval removal of the right chest tube. Unchanged right jugular port. No new superimposed additional cardiopulmonary abnormality

Output: Decreasing suspected pulmonary edema and chest tube removed


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval for lung infiltrate/source of infection History: eval for lung infiltrate/source of infection. Endotracheal tube tip 3 cm from the carina. Right IJ catheter tip in the mid SVC. Enteric tube tip in the stomach.Persistent left pleural effusion. Left basilar atelectasis. No new focal pulmonary opacity. Stable mild to moderate cardiomegaly.

Output: Persistent left pleural effusion. No new focal pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: chf exacerb History: chf Left-sided ICD in LVAD unchanged.Right PICC line with its tip in the right subclavian vein.Stable marked cardiac enlargement with pulmonary vascular redistribution.No new pulmonary opacities noted.Median sternotomy is intact.

Output: Stable marked cardiac enlargement with pulmonary vascular redistribution. No acute abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Weakness Motion degrades sensitivity.Overall gross stability of chronic extensive changes in the upper lungs again correlate with patient's known tuberculosis. See subsequent report

Output: Extensive scarring without discrete superimposed acute airspace ulnarly abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval for infiltrate/edema History: sob Low lung volumes. Stigmata of previous granulomatous disease. Mild cardiomegaly again noted. No large pleural effusion or pneumothorax. No focal lung consolidation or evidence of overt left-sided heart failure.

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


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.PICC placement Left jugular catheter tip at the confluence of the brachiocephalic veins with the SVC. Left PICC extends into the mid right atrium.Mild elevation of the right hemidiaphragm. Improving basal opacities, suspicious for aspirated secretions and atelectasis. Gastrostomy tube retention device projects over the left upper quadrant.

Output: Left PICC tip projects over the mid right atrium and may be retracted by 4-5 cm.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Fever Spinal fixation hardware.Mild cardiomegaly.Bibasilar subsegmental atelectasis and possible small right pleural effusion. No specific evidence of infection.

Output: No specific evidence of infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: NICM with LVAD, s/p recent RVAD decannulation History: NICM Interval extubation and removal of nasogastric tube.Support devices otherwise stable.No change in basilar opacities.No pneumothorax.

Output: Interval removal of the ET tube and NG tube.Basilar opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Eval for infection or effusion History: SOB, tachypnea Moderate cardiomegaly.Small lung volumes.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.CHF with Swan-Ganz catheter. Right jugular Swan-Ganz catheter projects over the proximal right upper lobe pulmonary artery.Left subclavian ICD unchanged in position.Unchanged cardiomegaly with persistent mild superior mediastinal widening. No visible pleural fluid or pneumothorax.Slightly coarse interstitial lung markings improved from previous, consistent with near complete resolution of pulmonary edema.

Output: Near complete resolution of pulmonary edema. Swan-Ganz catheter tip projects over the proximal right upper lobe pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: post heart transplant, routine screening History: none Cardiomegaly with left ventricular enlargement, similar to prior.Low lung volumes with flattened diaphragms. No consolidation, pleural effusion, or pneumothorax.Status post median sternotomy.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Right-sided crackles evaluate for pneumonia Normal heart size. No pleural fluid or signs of pulmonary edema. Soft tissue opacity in the projection of the prevascular space between the manubrium and ascending aorta. No signs of pneumonia.

Output: No signs of pneumonia or pulmonary edema. Masslike retromanubrial soft tissue. Recommend correlation with thoracic CT when feasible.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate lung fields, lines History: mechanical ventilation ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Small lung volumes with focal consolidation in the posterior basal segment of left lower lobe compatible with aspiration and possibly infection. Sharply marginated peripheral left upper lobe nodule measuring approximately 12 mm, and punctate central calcification, visible in retrospect on recent radiographs and most likely benign, but reevaluation with a right PA and lateral radiographs is recommended when feasible.

Output: 1. Focal left lower lobe consolidation compatible with aspiration and possibly infection.2. Sharply marginated left upper lobe nodule with probable central calcification and likely benign but follow-up with standard radiographs is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: desaturation, hypoxia History: see above Tubes and lines are unchanged.Stable cardiomediastinal silhouette with aortic graft stable.The cardiac mediastinal silhouette is unremarkable.Basilar predominant air space and interstitial opacities are compatible with edema and/or aspiration.

Output: Support devices unchanged. Lower zone opacities compatible with edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: 38 year old male with unknown exudative pleural effusion. No focal airspace opacities. Left moderate pleural effusion with adjacent atelectasis unchanged. No right pleural effusion. No pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: Moderate left pleural effusion with adjacent atelectasis unchanged.


Instruction: Generate impression based on medical findings.

Input: Male 10 years old Reason: Is VP shunt in place and well connected History: seizuresVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 9/23/2015 Redemonstration of right suboccipital ventriculostomy catheter descending along the right neck, right chest and entering the abdomen in the right upper quadrant. No kinking or discontinuity of the radiopaque portions of the shunt catheter identified. Multiple orphaned catheters are again noted. Cardiac apex is right-sided. Cardiac silhouette size is normal. No focal lung opacity. Bilateral coxa valga deformity is again. Thoracolumbar scoliosis is again present.

Output: No kinking or discontinuity of the radiopaque portions of the shunt catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: Medical clearance to work in Hong Kong. H/o seronegative arthropathy, +PPD s/p TB vaccine in China History: See above Small calcified right hilar lymph nodes compatible with prior healed infection. No focal consolidation, effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No acute abnormalities. No radiographic findings to suggest active intrathoracic tuberculosis.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, 57 years old.Cough and chills, dyspnea. Normal heart size. Patchy basilar opacities suggestive of atelectasis and mucoid plugging, however early infection cannot be excluded. No large focal airspace opacities.Cholecystectomy clips. Sternotomy hardware and midline.

Output: No conclusive evidence of pneumonia; faint basilar opacities could potentially reflect very early infection however are most suggestive of mucoid plugging and atelectasis. If the patient remains symptomatic, follow-up PA and lateral chest radiographs suggested in 7-10 days to exclude development of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Hypoxemia evaluate trach. Tracheostomy tube tip at the level of the clavicular heads. Left jugular catheter unchanged in position. Lung volumes remain low with diffuse airspace opacities similar to recent previous, suggestive of ARDS.

Output: Tracheostomy tube unchanged in position with tip 4-cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old Reason: Evaluate for new infiltrate History: productive cough, fatigue, bibasilar crackles h/o ILD The cardiomediastinal silhouette is normal.Bibasilar subsegmental atelectasis or scarring is unchanged. No evidence of superimposed infection.No pleural effusion or pneumothorax.

Output: No evidence of pneumonia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval for wide mediastinum History: hypotension Unchanged right upper lobe fibrosis and right hemithorax volume loss.Apparent progression of widened mediastinum when compared to recent prior.No focal consolidation or pleural effusion.Calcified left upper lobe nodules are unchanged.

Output: Apparent increase in width of the mediastinum for which CTA is recommended for further catheterization.


Instruction: Generate impression based on medical findings.

Input: Reason: patient with IABP, eval placement History: IABP, heart failure Aortic balloon catheter and ICD lead in place with the balloon catheter marker about 2 cm below the top of the aortic arch.Cardiomegaly with mild basilar atelectasis and small pleural effusions

Output: CHF and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o diastolic heart failure, increasing O2 demand, eval for fluid status History: hypoxia Small lung volumes with heart size without apparent normal and a tortuous aorta.Lower zone linear opacities consistent with subsegmental atelectasis.No evidence of pulmonary edema or infection.

Output: Basilar atelectasis but no specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 103 years old.Reason: eval for CHF Interval decrease in bilateral pleural effusions. Coarse interstitial opacities suggestive of edema, not significantly changed. Unchanged mild cardiomegaly.

Output: Findings compatible with CHF with decreased pleural effusions.


Instruction: Generate impression based on medical findings.

Input: SOB. Mild cardiomegaly, unchanged. Thickening of the bronchovascular bundles and fissures suggests hypervolemia. Minimal posterior loculated pleural fluid or thickening on the lateral. Mild septal thickening consistent with edema.

Output: Mild CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: SOB with exercise; patient has h/o Hodgkin lymphoma with mediastinal mass, S/P XRT; allotransplant for therapy-related MDS--> now years later with SOB on exercise. ? recurrent mass vs coronary artery disease History: as above Increased calcification of the large right hilar lymph nodes. Chronic elevation right hemidiaphragm.No specific evidence of infection or edema.Heart size normal.

Output: Interval increase in calcification of the right hilar enlarged hilar lymph nodes however no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: placement of pLeural catheter L History: cough Catheter looped in the pleural space at the left base. Marked interval decrease in the left pleural effusion.Moderate right effusion unchanged.Basilar nonspecific opacity compatible with atelectasis.

Output: Pleural catheter at the left base with decreased effusion and no visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: chest pain History: chest pain The cardiac mediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.Healing left ninth rib fracture deformity.Median sternotomy with evidence of a prior CABG.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: s/p chest tube removal x 3 History: as above Chest tubes have been removed. There is no evidence of a pneumothorax.Right central venous catheter with its tip at the RA/SVC junction.Stable cardiac enlargement.Chronic nonspecific interstitial opacities unchanged.No new pulmonary opacities identified.Median sternotomy is intact.

Output: Interval removal of chest tubes without evidence of a pneumothorax. Stable cardiac enlargement without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with a history renal cell carcinoma. Evaluate for chest metastasis. Cardiomediastinal silhouette is unremarkable. No significant pulmonary or pleural abnormalities

Output: No acute cardiopulmonary abnormality without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: esophageal CA s/p stent with new severe hiccups History: hiccups Right chest wall port terminates in the cavoatrial junction. Esophageal stent is unchanged.Cardiomediastinal silhouette is unremarkable. Right pleural effusion and right lower lobe consolidation appear increased as compared to prior exam. The right lower lobe consolidation appears more dense, with questionable cavitation. No pneumothorax. Dilated loops of bowel are partially visualized in the upper abdomen.

Output: Interval increase in right pleural effusion and right lower lobe consolidation. The right lower lobe consolidation appears more dense, with questionable cavitation. This is suggestive of worsening pneumonia, but an underlying malignancy cannot be ruled out. Contrast enhanced CT of the chest is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval ETT, lung fields History: s/p MVR Lines and tubes are unchanged. Improvement in right basilar atelectasis. Persistent left basilar pleural-parenchymal opacity. No new focal pleural parenchymal opacity. No significant pneumothorax. Unchanged cardiomegaly.

Output: Improvement in right basilar atelectasis. Persistent left basilar pleural-parenchymal opacity. No new focal pleural parenchymal opacity


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.SOB and chest pain. Unchanged cardiomegaly. Mild vascular redistribution suggesting hypervolemia, no signs of overt pulmonary edema. Mid and lower lung scarring bilaterally. No focal airspace opacities.The left humeral infarct is chronic.Mild scoliosis and skeletal changes consistent with sickle cell disease.

Output: Signs of mild hypervolemia, but no specific radiographic findings to suggest acute chest.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with lethargy, fever, or edema. CHEST:LUNGS AND PLEURA: Left-sided chest tube and within the right apex. No pneumothorax. Small amount of left-sided and moderate amount of right-sided pleural effusion. Right sided pleural effusion has slightly increased in the interval. Bibasilar atelectasis.MEDIASTINUM AND HILA: Stable mediastinal adenopathy.CHEST WALL: Open wound left chest wall. Tracheostomy in place.ABDOMEN:LIVER, BILIARY TRACT: 11-mm hypodensity in the left lobe of the liver is unchanged. Previous described hyperdense lesion in the left lobe is not well seen on today's study due to the phase of enhancement.SPLEEN: Status post splenectomy.PANCREAS: Peripancreatic fluid near the tail of the pancreas is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Small amount of fluid in the left nephrectomy bed and a small collection is unchanged.RETROPERITONEUM, LYMPH NODES: Again noted small amount of hyperdense material adjacent to the left psoas muscle and tracking superiorly which may represent extravasated oral contrast material. No definite drainable abscess. Fat stranding in the left upper quadrant and left side of the abdomen compatible with inflammation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large tissue defect in the midline a left-sided the abdomen, unchanged.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: Small amount of free fluid.

Output: A no significant change from previous study. High density material along the left sauce muscle likely represents extravasated oral contrast material. Bilateral pleural effusions, small retroperitoneal collections are unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: 56 y/o F with PMHx of head and neck cancer with hypotension, eval for infection History: hypotension Tracheostomy tube in place with its tip 5 cm above the carina.Left Port-A-Cath with its tip in the SVC.G-tube in place.Cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormality is identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: r/o mets; h/o RCC History: none Unchanged cardiomediastinal silhouette, including left atrial enlargement.Stable small effusions/scarring.No metastatic disease.

Output: No acute cardiopulmonary process is identified. No metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old, status post two cycles of Carbo/Taxol. Evaluate for non-small cell lung cancer and compare with prior CT scans. CHEST:LUNGS AND PLEURA: Biapical scarring, unchanged. 7-mm right upper lobe micronodule on axial image 34, series 5, is new, as is a 5 mm scarlike right upper lobe nodule on axial image 40, series 5. Additional micronodules are unchanged, including one within the minor fissure which probably represents an intrapulmonary lymph node. Pleural thickening at the base of the right middle lobe is unchanged. No pleural fluid.MEDIASTINUM AND HILA: Surgical clips in the superior mediastinum. Minimal prevascular stranding and fluid are unchanged. No pathologically enlarged hilar or mediastinal lymph nodes.The cardiac size is normal. No pericardial effusion.CHEST WALL: Status post median sternotomy.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in segment 8 is unchanged and probably benign.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted

Output: 1.Scattered pulmonary micronodules, two of which are new in the right upper lobe, are nonspecific but not necessarily indicative of metastatic disease.2.Postoperative change in the superior mediastinum.3.No evidence of metastatic disease in the abdomen.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old Reason: Tachypnea, febrile History: Tachypnea, febrile Cardiomegaly with pleural effusions and basilar atelectasis.Low lung volumes.Catheter tip in the SVC, unchanged. NG tube with tip extending beyond the inferior portion of the image.

Output: Pleural effusions and atelectasis without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: ETT placement ET tube tip approximately 4 cm above the carina.Small lung volumes with no gross abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: Evaluate known malignancy History: hemoptysis x 3 days There is a large opacity in the apicoposterior left upper lobe with surrounding parenchymal distortion likely representing the patient's known malignancy. Contrast enhanced CT of the chest should be obtained for confirmation. Multiple scattered noncalcified tiny pulmonary nodules are identified as well.No pleural effusion. No pneumothorax.

Output: There is a large posterior left upper lobe mass. While likely representing the known malignancy, prior studies are not available. Contrast-enhanced CT can be taken for complete evaluation. Multiple noncalcified bilateral small pulmonary nodules are identified as well.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: r/o mets History: none Linear atelectasis or scarring both lung bases, improved.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: Basilar scarring. No evidence of metastases or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: FemaleReason for Study: Reason: eval for PTX History: rib pain The cardiomediastinal silhouette is unremarkable.Amplatz interatrial occluder identified.The lungs are clear.There are no pleural effusions.No pneumothorax.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval possible intracardiac foreign body History: hypotension, incidental ?foreign body on 6/10 KUB Unchanged basilar opacities suggestive of atelectasis or infection.Tracheostomy tube tip approximately 4 cm above the carina.Bilateral jugular catheters still terminate in the SVC and cavoatrial junction levels.

Output: Unchanged basilar opacities. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male; 20 years old. Reason: intubated History: intubated Stable tubes and lines.Stable cardiomediastinal silhouette.Stable bibasilar nonspecific atelectasis/consolidation, right greater than left.

Output: Stable bibasilar nonspecific atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: EmpyemaVIEW: Chest AP 2/22/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Bilateral chest tubes and left PICC again noted. Cardiothymic silhouette normal. Bilateral lung opacities in the right middle lobe, right lower lobe and left lower lobe not significantly changed. Bilateral small pleural effusions unchanged.

Output: Bilateral lung opacities and small pleural effusions not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval for interval change History: sob Persistent bibasilar edema and atelectasis with small bilateral pleural effusions. Interval removal of endotracheal tube and one enteric tube. Other support hardware unchanged.

Output: Persistent bibasilar edema and atelectasis with small bilateral pleural effusions


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: baseline exam as part of heart transplant evaluation History: none Cardiomegaly status post LVAD placement and sternotomy.Improved retrocardiac atelectasis.Elsewhere, the lungs are unremarkable.LVAD and ICD unchanged.

Output: Improving retrocardiac atelectasis with cardiomegaly but no acute edema.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: 84 yo female with copd, weight loss, please eval for mass. patient unable to afford CT scan. History: weight loss, sob Severe emphysema.Moderate to severe cardiomegaly.A very large goiter deviates the trachea to the right at the thoracic inlet level.No sign of a mass, or other abnormality.

Output: Severe emphysema and a very large goiter with cardiomegaly. No evidence of a lung mass.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: r/o infectious etiology History: shortness of breath Stable cardiac enlargement with prominence of the pulmonary artery.The lungs are clear.No pleural effusions. Degenerative changes in the thoracic spine.

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


Instruction: Generate impression based on medical findings.

Input: Mitral valve insufficiency Motion degrades sensitivity, however mildly increased indistinctness to the mixed interstitial and airspace opacities suggesting increasing edema. Cardiomegaly along with effusions and possible partial consolidation of left lower lobe versus atelectasis are otherwise observedSwan-Ganz unchanged

Output: Mildly interval increasing moderate CHF


Instruction: Generate impression based on medical findings.

Input: Reason: fever, cough History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Venous catheters extending to the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: intubated History: as above Unchanged left basal predominant pulmonary opacities with a left pleural effusion.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 3 cm above the carina. Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: chest pain, hx of heart transplant History: above Median sternotomy for heart transplant, heart size normal.No significant pulmonary or pleural abnormality.Retained fragment of an ICD.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Heart failure and Swan placement. IABP marker projects 2 cm below the top of the aortic arch.Left jugular Swan-Ganz catheter tip at the distal right main pulmonary artery level. Right jugular introducer projects over the SVC. Endotracheal tube tip 3 cm above the level of the carina. Enteric tube looped in the stomach.Moderate pleural fluid bilaterally.Mild to moderate dependent edema, atelectasis and aspiration of secretions.Significant retrocardiac atelectasis; opacity in the left infrahilar region is most likely atelectasis and edema but should be monitored on serial radiographs to exclude possibility of infection.

Output: Right jugular Swan-Ganz catheter tip at the distal right main pulmonary artery level. No pneumothorax. Moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: r/o recurrent pleural effusions, opacity History: febrile, h/o Leukemia (ALL) with pleuritis 2/2 dasatinib No change in elevation right hemidiaphragm with streaky basilar opacities.Lungs otherwise remain clear.PICC line stable in position.Heart size normal.No pneumothorax.

Output: No change in elevation of right hemidiaphragm and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: chest pain History: smoke cocaine, pleuritic chest pain Moderate cardiomegaly.Bronchial wall thickening noted.No specific evidence of infection or edema.Azygos pseudolobe, normal variant.

Output: Moderate cardiomegaly and bronchial wall thickening, but no reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.With history of sickle cell disease presenting with pain. Please evaluate for acute chest syndrome. Unchanged cardiomegaly. Low lung volumes with subsegmental atelectasis. Mild bilateral perihilar opacity appears worsened in comparison to prior examination. Skeletal abnormalities consistent with given history of sickle cell disease, including ill-defined sclerosis of the left humeral head and H-shaped vertebral bodies.

Output: Cardiomegaly. Low lung volumes limit evaluation for pulmonary opacities. Perihilar opacities appear similar in comparison to 4/16/2016 and may represent sequelae of current symptomology.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: s/p cystectomy ileal conduit for bladder cancer, metastases ? History: none 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: 64-year-old male with history of mantle cell lymphoma CHEST:LUNGS AND PLEURA: Bibasilar dependent atelectasis.MEDIASTINUM AND HILA: The tip of the port catheter is at the junction of the SVC and right atrium.Index right paratracheal node measures 7 by 8mm image number 12, series number 3, smaller compared to previous study. Right hilar nodal conglomerate is unchanged measuring 7 x 8 mm on image number 47, series number 3. Stable ectasia of the ascending thoracic aorta.CHEST WALL: Enlarged right axillary lymph node is unchanged measuring 18 by 11-mm image number 20, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the liver is unchanged. No new lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index left external iliac node measures 19 by 9-mm image number 189, series number 3. Stable from previous study. Reference right inguinal lymph node measures 19 by 5-mm image number 208, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: preop CABG History: angina Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Status post bilateral shoulder repairs probably for rotator cuff injury.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: please check PICC placement History: new PICC New left arm PICC, tip low in the right atrium. Right chest tube unchanged in position.Interval increase in the right pleural effusion, with a small residual component of subpulmonic pneumothorax.Diffuse nodular interstitial opacities compatible with metastatic disease are unchanged.

Output: Left arm PICC, tip in the low right atrium. Increase in right effusion with small residual right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male; 55 years old. Reason: pna? ptx? acute process? suggestion of pe? History: pleuritic chest pain, acute onset Interval resolution of mild patchy opacity in the right upper lobe. Stable minimal left basilar scarring. No new abnormal airspace opacities. No pleural effusions. Normal heart size.

Output: No acute cardiopulmonary abnormality is evident on these radiographs, but please see subsequent CT chest report regarding mild left lower lobe opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Cardiomediastinal silhouette within normal limits.No acute focal airspace opacity.No suspicious pulmonary nodule identified.No pneumothorax or pleural effusion.

Output: No evidence of pulmonary metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: ECMO decannulation History: ECMO decannulation. ECMO cannulae repositioned with right IJ and femoral approach with tips overlying the SVC. Left IJ central venous catheter tip overlies the right atrium. Unchanged position of ET tube which is approximately 3 cm above the carina. Enteric tube terminates in the gastric antrum or first portion of the duodenum.Stable cardiopulmonary appearance with multifocal lower lobe predominant hazy opacities and consolidation as well as persistent moderate pleural effusions compatible with ongoing ARDS.

Output: ECMO cannulae repositioned with right IJ and femoral approach with tips overlying the SVC. Stable multifocal opacities and consolidation compatible with ongoing ARDS.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with hypoxemia, left lower lobe atelectasis, on high flow nasal cannula. Aortic stent in place with stable widening of the mediastinum. Enteric tube tip in the stomach.Increasing perihilar/retrocardiac consolidation and pleural effusion with decreased aeration of the left lung. Persistent perihilar glass opacities in the right lung. Moderate cardiomegaly. No pneumothorax.

Output: Increasing opacification of the left lung with enlarging pleural effusion and underlying atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Concern for pulmonary etiology of persistent tachypnea, and cough, despite 100% oxygenation History: persistent tachypnea, faint breath sounds, Borderline cardiomegaly with bilateral hazy opacities in the mid and lower lung zones which likely represents mild edema. Superimposed left basilar infection cannot be excluded.No pneumothorax.

Output: Borderline cardia megaly with hazy opacities likely edema. Superimposed left lower lobe infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: r/o ptx History: chest pain, pleuritic Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: ETT History: see above Lower lung zone subsegmental atelectasis unchanged.Heart size upper normal.No specific evidence of infection or edema.Swan-Ganz catheter removed. ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: ET tube tip approximately 5 cm above the carina. Swan-Ganz catheter removed. Unchanged lower lung zone subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.IABP. IABP marker projects about 2 cm below the top of the aortic arch.No acute change in dependent atelectasis. Left subclavian ICD unchanged.

Output: IABP marker projects over the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old. Shortness of breath. Right chest port catheter tip in SVC, unchanged.Previously seen radiopaque marker projecting over the right descending pulmonary artery has been removed.Small lung volumes with basilar subsegmental atelectasis, unchanged.

Output: Interval removal of catheter that had a small radiopaque marker. Basilar atelectasis, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: eval position of NG tube History: NG tube placement, hypoxia Examination is severely limited by portable technique, lordotic projection and patient's large body habitus. Due to these factors, the enteric tube is not visualized along the distal aspect of its course, and placement cannot be assessed. Right-sided central venous catheter tip projects over the right atrium. Left IJ central venous line tip projects over the acute cephalic vein.The cardiac silhouette remains enlarged, although is incompletely evaluated. Slight interval increase in pleural effusions with adjacent atelectasis and pulmonary opacities compatible with pulmonary edema. No evidence of pneumothorax.

Output: 1. Limited evaluation of the course of the enteric tube due to technical and patient factors as listed above.2. Slight interval increase in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: NGT placement History: nausea, vomiting NG tube extends beyond the field-of-view of study. Borderline cardiomegaly with minimal subsegmental basilar atelectasis. Atherosclerotic calcification of the aorta.

Output: NG tube extends beyond the field-of-view of study.


Instruction: Generate impression based on medical findings.

Input: Reason: eval iabp placement History: heart failure Cardiomegaly with an ICD lead an aortic balloon pump in place, unchanged.Small lung volumes with no reliable evidence of edema on the current radiograph.No new findings.

Output: Balloon catheter in the descending aorta and no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: ?pneumonia History: cough, yellow, green sputum Mild to moderate cardiomegaly.No significant pulmonary or pleural abnormality.No specific evidence of infection.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: r/o acute, hyper coag History: cp Worsening right basilar airspace opacity suggestive of infection. Small focal opacity along left heart border probably of similar etiology.Heart size normal.

Output: Worsening airspace opacities suggestive of infection although pulmonary embolism is in the differential diagnosis especially given the history of hypercoagulability.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Left-sided stabbing chest pain, atypical, history of SLE. Symptoms for 3 to 4 days. Normal heart size. Central pulmonary vasculature appears upper normal in size. No pneumothorax or visible pleural fluid. No focal airspace opacities.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 18 months evaluate lung volumes s/p extubationVIEW: Chest AP (one view) 9/4/2015 at 05:11 and sonogram of the chest wall 9/3/2015 The endotracheal and enteric tubes have been removed. The cardiothymic silhouette and lung volumes are normal. The streaky opacities at both lung bases and in the left upper lobe have slightly improved. No pleural effusion or pneumothorax.There is a soft tissue mass in the right lateral chest wall which was also seen on the recent chest wall sonogram.

Output: Status post extubation. Slight improvement in multifocal pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 83 years, Male, Reason: surg History: Mild cardiomegaly is unchanged.Bibasilar atelectasis and small bilateral effusions are unchanged.Swan-Ganz catheter is unchanged. Interval removal of IABP. Removal of enteric tube. Median sternotomy wires are intact.

Output: Interval removal of enteric tube, otherwise stable exam.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: mass near sternal notch?, edema, pna History: sob Heart size normal.Lungs clear.Left subclavian central venous line with tip in right atrium.No pleural effusion. No pneumothorax.Incidental note made of air-fluid levels in loops of what appears to be both colon and small bowel therefore likely ileus. If clinically indicated, follow-up abdomen film for further evaluation.No evidence of mass near sternal notch as clinically questioned.

Output: 1. No radiographic evidence of mass near sternal notch as clinically questioned2. No evidence of infection or edema3. Air-fluid levels in loops of bowel. If indicated, follow-up with single view abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: assess progression/resolution of pulmonary edema History: oxygen requirement, clinical symptoms of volume overload Cardiomegaly, unchanged. Airspace opacities throughout the right lung, slightly improved compared to the prior exam. No new airspace opacity, large pleural effusion, or pneumothorax. IVC filter again noted.

Output: Continued interval improvement in right lung consolidation.


Instruction: Generate impression based on medical findings.

Input: 75 year old female with history of bladder cancer CHEST:LUNGS AND PLEURA: Left upper lobe pulmonary nodule measures 5 mm number 30, series number 6, stable. Right lower lobe nodule is increased in size and now measures 10 x 11 mm image number 67, series number 6. Left lower lobe nodule in image number 70, series number 6 has also significantly enlarged. Other scattered micronodules are relatively unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate hypodense foci in the liver and simple cyst in the right lobe are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileal conduit and ileostomy is again noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Uterus, adnexa: No significant abnormality notedBLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Artifact from a left hip prosthesis limits optimal evaluation of the pelvis.OTHER: No significant abnormality noted

Output: Interval increase in the right and left lower lobe nodule suspicious for metastatic disease. No other significant change.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with recurrent salivary gland cancer. Evaluate extent of disease. LUNGS AND PLEURA: Diffuse areas of centrilobular emphysema with one well-defined cyst in the right upper lobe. Scattered calcified micronodules most likely reflect prior granulomatous disease. A left upper lobe nodule (axial image 39/29) is very dense and most likely also benign. No suspicious pulmonary nodules or masses. No focal consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: Small pretracheal lymph nodes. The cardiac size is normal with a small pericardial effusion. The aorta is markedly tortuous.CHEST WALL: Degenerative changes affect the spine.UPPER ABDOMEN: Paracaval fat, possibly a lipoma lipoma noted (axial image 79/109).Scattered hypoattenuating lesions within the liver are incompletely evaluated but probably represent cysts. The largest hepatic lesion on axial image 83/109 is not well circumscribed, nonspecific. An isolated hepatic metastasis would be uncommon.Large left renal hypoattenuating lesion is incompletely evaluated but probably represents a cyst.

Output: 1.No conclusive findings of metastatic disease in the chest.2.Centrilobular emphysema.3.Cystlike liver and renal lesions as above.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: SOB, asthma exacerbation History: see above Cardiomediastinal silhouette is unremarkable. Streaky right basilar opacity which may represent atelectasis or scarring.No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Urothelial cancer Persistent moderate right pleural effusion with interval resolution of the small pneumothorax. Decreased lung volumes without definite new focal airspace process, however ill-defined patchy opacity in the left upper and lower lungs are otherwise again observed and correlate with prior recent CT.Cardiac and mediastinal contours remain within normal limits

Output: Interval resolution of small right pneumothorax with residual moderate effusion


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: eval ETT, lung fields History: s/p MVR Endotracheal tube terminates over 10 cm from the carina. Patient has been extubated in the interim. Swan-Ganz catheter terminates in the RPA. Mediastinal drains noted. Low lung volumes makes detailed cardiopulmonary assessment difficult. Probable mild pneumopericardium. Mild basilar opacities, likely atelectasis. Unchanged cardiomegaly. No significant pneumothorax.

Output: Expected appearance status post MVR except for high endotracheal tube which has been subsequently removed.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: SOB; increased WOB; evaluate for PNA History: as above Stable position left univentricular pacing wire. Stable cardiomegaly. Persistent low lung volumes with basilar opacities of atelectasis and pleural effusions. Progressive retrocardiac consolidation suspicious for infection. Follow-up to resolution recommended. The left infralateral chest wall is excluded from the field of view. No interval pneumothorax.

Output: Progressive retrocardiac consolidation with low lung volumes basilar atelectasis. Follow-up to resolution recommended.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with left rib pain status post fall. Rule out pneumothorax. Evaluate for rib fracture. Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.Equivocal posterolateral nondisplaced left 5-6 rib fractures (see annotated image).

Output: Equivocal posterolateral nondisplaced left 5-6 rib fractures (see annotated image) bu no evidence of pneumothorax. Correlate with site of pain and tenderness.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: r/o lung path History: dry cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Shortness of breath and hypoxia. Dyspnea. Bronchial wall thickening and associated atelectasis/scarring. Groundglass opacity suspicious for pneumonitis. No signs of pulmonary edema or pneumonia.

Output: Bronchial wall thickening and ground glass opacity suggestive of aspiration pneumonitis.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: chest tube placement History: s/p right thoracotomy, repair entero-tracheal fistula, latissimus muscle flap Right chest tubes following chest wall resection with right upper lung zone opacification.New tracheal stent.An NG tube traverses a gastric pull-up.

Output: New tracheal stent. Right chest wall resection, with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Cough and SOB evaluate for infiltrate. Mild bronchial wall thickening. Hazy perihilar opacities in the right lung suspicious for pneumonia.

Output: Bronchial wall thickening and hazy parenchymal opacity in the right lung suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: cp History: cp No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: 36M w/ disseminated cryptococcus, new L sided pleuritic posterior rib pain, eval for effusion, intrapulm process History: l sided pleuritic rib pain Lungs are clear airspace and interstitial opacities.The cardiac silhouette and vasculature are normal. A double lumen central line is seen with the tip in the projection of the right atrium. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Subclavian balloon pump History: As above Cardiomegaly, with lower lung zone opacities suggestive of edema, with pleural effusions, unchanged. Right jugular introducer unchanged.Right PICC, tip in SVC.IABP proximal marker within 2 cm of the top of the aortic arch.

Output: Mary edema with pleural effusions, and stable devices.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: Rule of PNA History: 29 y/o M with HIV on HAART presenting with fever and tachycardia No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: repositioning of picc line History: none Increasing basilar opacities suggestive of edema and atelectasis with small pleural effusions.Postoperative pneumoperitoneum.Right PICC, tip in SVC, no longer looped.The NG tube is been removed.

Output: Right PICC reposition. Increased basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Increased sputum production, cough, rule out pneumonia Dual lead ICD with appropriate lead positioning. No specific evidence of infection or edema. The cardiac silhouette is normal.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 14-week-old female with placement of new chest tube.VIEW: Chest AP (one view) 3/3/2015 17:02 Left chest tube with tip overlying right upper hemithorax. Feeding tube tip coursing below the left hemidiaphragm and extending beyond the inferior margin of the image. Right central line tip in the right atrium.Mediastinal shift to the right. Bilateral coarse pulmonary opacities are noted. Probable small left pleural effusion. Moderate left-sided pneumothorax. No pneumothorax on the right.

Output: Left chest tube tip in the right upper hemithorax. Moderate left sided pneumothorax. Bilateral coarse pulmonary opacities and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: impella, eval interval change History: see above Interval removal of femoral Swan-Ganz catheter and external defibrillator pads. Dobbhoff tube and impella device remain in place.Mild basilar edema and small pleural effusions. No pneumothorax.

Output: Mild edema and small pleural effusions with empella device in place.


Instruction: Generate impression based on medical findings.

Input: 47 years, Female. Reason: rule out obstruction History: abdominal pain Paucity of bowel gas limits sensitivity for obstruction although no definite evidence of obstruction seen. No free air Ostomy right lower quadrant.Lungs clear. Mediastinal osseous and soft tissue structures normal.

Output: Paucity of bowel gas limits sensitivity but no obvious obstruction. Chest normal.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female diagnosed this leak 4-cm Mass in esophageal and esophagus biopsy shows adenocarcinoma staging CT. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Extensive calcified mediastinal nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There are a few scattered masses in the right left lobe of the liver are heterogeneous enhancement and central more profound hypoattenuation consistent with metastases. For baseline purposes largest lesion in the lateral segment of left lobe as measured on series 2 image 86, 5.1 x 4 cm.Lesion in segment 7 is measured on series 3 image 90, 2,2 x 2 cm.SPLEEN: No significant abnormality noted.PANCREAS: The mass in the body of the pancreas is causing mild ductal dilatation. At the level of the celiac axis and measure the pancreatic mass on series 3 image 96 is 4.2 x 3.8 cm. This pattern of involvement extrinsically by esophageal or gastric cancer would be unusual in the should raise the question of a second primary are pancreatic primary with metastasis to the GI tract.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few foci of calcification the left kidney consistent with nephrolithiasis. Two hypodensities bilaterally likely renal cysts.RETROPERITONEUM, LYMPH NODES: A scattered retroperitoneal nodes. The baseline purposes left periaortic node just caudal to the renal artery as measured on series 3 image 105, 2.2 x 1.8 cm.BOWEL, MESENTERY: There is soft tissue mass confluently involving the cardia of the stomach gastrohepatic ligament area, proximal body of the pancreas with encasement of the celiac axis and its branch vessels. The soft tissue density extends dorsal to the pancreas to abut the left renal vein as well.Few mesenteric lymph nodes for example series image 123.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the dependent portion of the pelvis. No definite evidence of carcinomatosis. The bowel is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal hepatic metastases. Confluent tumor involving EG junction cardiac, gastrohepatic ligament, pancreas and retroperitoneum. Small amount of free fluid in the pelvis. The pattern raises the question of pancreatic primary neoplasm.Nephrolithiasis. Mediastinal granulomata.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: Chest pain The lungs are underinflated. The cardiac silhouette is at the upper limit of normal. No gross abnormality is seen.

Output: No gross abnormality seen.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Weakness and shortness of breath. Elevation left hemidiaphragm with basilar scarring. Lungs otherwise clear. Bullet fragment in the posterior midline chest wall. No pneumothorax.

Output: No acute-appearing cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Distal thoracic aortic aneurysm with mural thrombus. Evaluate size. Also has infrainguinal aortic aneurysm (stable) with patent stent grafts. No evidence of endoleak. CHEST:LUNGS AND PLEURA: Bilateral emphysema. Scarring at both lung bases. Subcentimeter nodule along the right major fissure (image 57; series 4). No effusions.MEDIASTINUM AND HILA: Substernal thyroid. Small mediastinal lymph nodes are not enlarged using CT size criteria. Ascending aorta measures 4.5 cm in diameter. Proximal descending thoracic aorta measures 4.0 cm in diameter (image 52; series 10). At the level of the diaphragm, the aorta measures 6.1 x 6.6 cm (image 92; series 10).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: Large bilateral renal cysts as seen previously (stable)RETROPERITONEUM, LYMPH NODES: The supraceliac portion of the abdominal aortic aneurysm appears to have increased in size minimally. On direct side to side comparison, it measured 6.5 x 5.9 cm (image 35; series 9; 10/13/2009 study) previously and currently measures 6.7 x 6.3 cm at the same level (image 97; series 9).Status post endovascular aortic stent placement. The stent, aortic sac, and residual patent lumen are all stable compared to prior. The sac again measures 5.1 cm in diameter (image 136; series 9). Delayed images show no evidence of endoleak. TheThe celiac, superior mesenteric, and renal arteries are patent.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left common iliac artery stent graft is also patent with no evidence of endoleak. Right femoral graft is patent.

Output: 1. Slight increase in size of supraceliac portion of aortic aneurysm as above (approximately 3 to 4 mm in growth since the prior exam).2. Infrarenal aortic aneurysm is stable in size with patent vascular stent grafts and no evidence of endoleak or stent migration.


Instruction: Generate impression based on medical findings.

Input: SOB. Left pleural fluid and persistent lower lobe consolidation and atelectasis suspicious for underlying pneumonia. Moderate volume of pleural fluid on the right unchanged. Diffuse edema-like interstitial opacities, about the same. Patchy airspace opacities on the right, with a new right infrahilar opacity suspicious for pneumonia.

Output: Worsening multifocal opacities suspicious for pneumonia. Moderate pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: shortness of breath History: SOB Unchanged basilar opacities and pleural effusions right greater than left.Tubes and catheters are unchanged.

Output: No change in pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: assess edema and PNA History: fluid overload, positive sputum cx Endotracheal tube terminates 2 cm above the carina, successfully repositioned.Retrocardiac consolidation with right-sided opacities not significantly changed. Findings suggestive of aspiration pneumonia. No pneumothorax.

Output: No significant change in left greater than right basilar opacities, left pleural effusion, following endotracheal tube repositioning.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: eval for edema History: sob with chf. Sternotomy fixation present. Streaky bibasilar opacities suggestive of subsegmental atelectasis.Vague left basilar opacity may represent very mild pulmonary edema.No pneumothorax or significant pleural effusion.Stable mild cardiomegaly.

Output: Possible mild left basilar edema with stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old. Reason: evaluate for active TB History: hx of positive PPD or positive Quantiferon Cardiomediastinal silhouette is unremarkable.No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No significant cardiopulmonary abnormality. No evidence of active tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Status post right extended pleurectomy and the cortication. Chest tube in place x2 Small right apical pneumothorax, appearing similar to the prior study. Postsurgical changes compatible with the stated history of right-sided pleurectomy and decortication. There is a small right pleural effusion with underlying atelectasis/consolidation. Right-sided nodular opacities, unchanged. 2 right-sided chest tubes in place, unchanged in position. Subcutaneous emphysema along the lateral aspect of the right hemithorax.

Output: No significant interval change in size of the small right apical 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: pna? History: sob, tachycardia, productive cough New large right pleural effusion occupying at least three fourth of the right hemithorax volume, obscuring a previously seen right lung base mass.Small left effusion.Patchy opacities on the left may be atelectasis.

Output: New large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male intubated. Evaluate endotracheal tube. Endotracheal tube tip 2 cm above the carina. Enteric tube sidehole in the stomach. Right subclavian venous catheter tip in the cavoatrial junction.No significant interval change in bibasilar consolidation, atelectasis and pleural effusions as seen on previous CT. No pneumothorax. Mild cardiomegaly.

Output: Bibasilar consolidation, atelectasis and pleural effusions not significantly changed. No superimposed acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with chest pain, shortness of breath. Evaluate for pneumonia, pneumothorax, dissection. Mild bronchial wall thickening. No focal airspace opacity, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: Findings suggestive of reactive airway disease.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Stable left ventricular enlargement. Single lead ICD terminates in the apex of the right ventricle.Lung volumes are normal. No signs of pulmonary edema.No pleural effusion or pneumothorax.

Output: Stable adequate position of single lead ICD. No postprocedural pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: Evaluate for acute cardiopulmonary process History: severe SOB, hx asthma Patchy perihilar opacity and nonspecific bronchial wall thickening as can be seen with asthma or bronchitis.

Output: Patchy perihilar opacity and nonspecific bronchial wall thickening as can be seen with asthma or bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: hx of bladder ca sp cystectomy No pleural effusion. The cardiomediastinal silhouette is within normal limits. Scattered calcified granulomata. Calcified atherosclerosis of the aortic arch. No focal pulmonary opacity. No pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Status post CABG evaluate lung fields Tubes and lines unchanged in position. Interval enlargement of left pleural fluid collection, now moderate, with new basal atelectasis. Volume of pleural fluid and degree of atelectasis on the right is similar to prior.

Output: Enlarging left pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: post thoracentesis History: as above Marked reduction in right-sided pleural effusion status post thoracentesis. No significant pneumothorax. Unchanged left basilar pleural-parenchymal opacity. Likely normal heart size.

Output: Status post right-sided thoracentesis with reduction in right-sided pleural effusion without evidence of significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: 71 y/o CHF, PNA? interval change History: sob Right pleural scarring and calcification unchanged.Coarse basilar interstitial opacities are suggestive of edema, unchanged, with mild cardiomegaly.No specific evidence of infection.

Output: No reliable evidence of infection although there is the suggestion of edema. Healed empyema probably tuberculous.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: intubated History: as above ET tube with its tip 3 cm above the carina.NG tube with its tip beyond the margin of the image.The cardiomediastinal silhouette is unremarkable.The lungs are clear.

Output: Support devices unchanged with ET tube tip in satisfactory position. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval infection, edema, effusion History: fever, sob, cough Small right pleural effusion or pleural scarring, unchanged. No specific evidence of infection or edema.

Output: Stable small right pleural effusion or pleural scarring, probably the latter.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: devices, pulmonary edema History: central access x 2, no other known hardware, on 3L O2 by NC Mild cardiomegaly.Small lung volumes.No specific evidence of infection or failure.Two right jugular catheters terminate at the SVC/RA level.Left axillary to subclavian vascular stent.

Output: Cardiomegaly with small lung volumes, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: rule out pneumonia History: possible pneumonia 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: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 85 yearsGender: MaleReason for Study: Reason: new onset afib, eval for cardiolmegaly History: tachycardia Mild cardiac enlargement.Decreased lung volumes with chronic appearing basilar interstitial opacities suggestive of fibrosis/scarring.No focal air space opacities.No large pleural effusions.Multiple surgical clips in the epigastric region.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Does the pt have infiltrates or Pulmonary edema? History: CP Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? edema? History: chest pain, shorntess of breath, decreased exercise tolerance, history of CHF Moderately severe cardiomegaly.Diffuse bilateral interstitial and airspace opacity, increased compared to previous, compatible with edema.Pleural scarring at the right base and probable pleural effusions.Radiopaque object, probably a bullet projected over the lower thoracic spine.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: Shortness of breath - sudden onset while driving + cough History: SOB Cardiac silhouette is normal in size.Lungs are clear.No acute osseous abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: evaluate for changes s/p URI History: worsening cough, soboe, ILD Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.Degenerative changes throughout the thoracic spine.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with history of angiosarcoma (of the scalp). Please evaluate chest for metastatic disease. CHEST:LUNGS AND PLEURA: Nodule in the left lower lobe (series 4, image 57) has increased in size. It currently measures 6 mm; previously measuring approximately 3 mm in greatest axial dimension. It can be seen on prior study from 10/10/2009, where it is unmeasurable. Minimal increase in previous the seen left lower lobe nodule (series 4, image 53) is seen as well, which is of uncertain clinical significance.Otherwise, previously seen scattered nodules bilaterally appearing similar to prior study. Reference nodule in the left upper lobe (series 4, image 39) measures 4 mm and is stable. No new nodules identified.Very mild subpleural reticulation and cyst formation is compatible with mild interstitial lung disease. New right pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Right adrenal nodule, grossly unchanged. Nonobstructing right renal calculi.

Output: 1. Scattered nodules as seen previously. While reference nodule in the left upper lobe remains stable, two previously seen left lower lobe nodules are slightly increased in size, both of which have increased in size since study from 10/10/2009.2. New small right pleural effusion of indeterminate etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old. Pre-kidney evaluation. End stage renal disease. Evaluate for cardiomegaly and infiltrates. No significant pleural or parenchymal abnormality.Unremarkable cardiac and mediastinal silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: pna? acute pathology? History: general malaise, abdominal pain, poor historian Low lung volumes. No focal lung consolidation. Heart size again at the upper limit of normal. No large pleural effusion or pneumothorax.

Output: Severely limited study by low lung volumes. No focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: s/p PICC line placment, eval for central placement History: s/p PICC Left upper extremity PICC tip near the confluence of the brachiocephalic veins. No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: Left upper extremity PICC tip near the confluence of the brachiocephalic veins.


Instruction: Generate impression based on medical findings.

Input: Line placement No radiopaque catheter is observed nor subsequent postprocedural complication, specifically no pneumothorax.Mild bilateral basilar interstitial changes consistent with old chronic change and scarring. Lungs otherwise clear. Cardiac and mediastinal contours significant for moderate atherosclerotic disease and mild tortuosity, unchanged.

Output: Bilateral basilar scarring without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Emesis x1 while wearing BiPAP this a.m., rule out new infiltrate. No signs of aspiration. Cardiomediastinal silhouette unchanged with tortuosity of the thoracic aorta. Nasogastric tube is looped in the stomach.

Output: No signs of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male 83 years old Reason: Check ET tube in mech vent patient History: PEA Arrest ET tube tip approximately 2 cm above the carina. Central venous catheter unchanged in position. Enteric tube tip in the stomach.Decrease in lung volumes with bibasilar atelectasis. No new focal opacity.

Output: Basilar atelectasis with no new focal opacity.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: ho cardiogenic and septic shock History: - Cardiomegaly with pleural effusions, left lower lobe consolidation and probable basilar edema, unchanged allowing for differences pleural fluid distribution.The left ventricular ECMO cannula is still in place although the IVC cannula appears to have been removed.A right axillary ECMO cannula is unchanged in position.Right jugular catheter, tip in SVC.Left jugular Swan-Ganz catheter, tip still in the left descending pulmonary artery are one of its branches.ET tube tip approximately 5 cm above the carina.IABP catheter tip projected over the aortic arch. Left subclavian ICD, leads unchanged in position.

Output: Apparent removal of an IVC ECMO cannula, otherwise unchanged with pleural effusions, cardiomegaly and left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: cough Mild cardiomegaly, unchanged.New mild airspace opacity in the right upper lobe, compatible with pneumonia in the appropriate clinical setting.

Output: Right upper lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old, with history of pulmonary infarct, AIDS, presenting with shortness of breath and cough. Evaluate for infiltrate and pulmonary infarct. PULMONARY ARTERIES: Technically adequate exam. No evidence of pulmonary embolus.LUNGS AND PLEURA: Mild centrilobular emphysema. The previously noted left upper lobe wedge-shaped opacity is no longer evident. No new focal opacity, edema or pleural fluid. A right upper lobe micronodule is unchanged (axial image 59/132).MEDIASTINUM AND HILA: The cardiac size is normal. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Mildly prominent axillary lymph nodes demonstrate benign morphology and are unchanged.Punctate calcifications are noted in the right breast.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of pulmonary embolus or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Foreign body in the respiratory tree unspecified history of pneumonia evaluate progression. Lower lobe consolidation and a moderate left pleural fluid collection are unchanged. Reticulonodular opacities at the right lung base, stable to improving. Mild septal thickening.

Output: Left lower lobe consolidation and diffuse pulmonary opacities elsewhere are unchanged.