Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Shortness of breath, hypoxia. Evaluate for improvement of opacities. Mild decrease in patchy airspace opacities within the right midlung and interval increase in left perihilar opacity with air bronchograms. Unchanged opacity within the right lung base. No pneumothorax. The heart size is stable..

Output: Decreased right and increasing left pulmonary opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: pleural effusions, COPD, hypoxia History: as above Severe cardiomegaly with worsening pulmonary opacities suggestive of edema, pleural effusions and consolidation.Left jugular catheter, tip in SVC.

Output: Worsening pulmonary opacities suggestive of CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: Is there infiltrate? History: Sickle cell with chest pain. Afebrile. Streaky left basilar opacity likely atelectasis. No specific evidence of infection or edema. Stable appearance of single lumen chest port with tip in projection of right atrium. No pleural effusion. No pneumothorax.

Output: Streaky left basilar opacity likely atelectasis. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: ? SOB History: ? SOB Mild cardiomegaly.Moderately sized hiatal hernia is noted.Lung volumes in the upper limits of normal. No abnormal focal lung parenchymal opacities.The pleural spaces and visualized bones are within normal limits.

Output: Moderately sized hiatal hernia. No additional abnormal radiographic findings.


Instruction: Generate impression based on medical findings.

Input: 88-year-old female with colon mass CHEST:LUNGS AND PLEURA: Right upper lobe. Micronodular is unchanged, measuring 4-mm in diameter. Other 1 -- 2-mm micronodules unchanged.Unchanged peripheral scarlike abnormality. The left lower lobe contiguous with the lateral pleural surface.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter hypodensities in the liver are unchanged. Cholelithiasis is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged. Punctate calcifications in the right kidney, likely representing stones. Lack of IV contrast limits the evaluation of some of the hypodense lesions in the kidneys.They are grossly stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant wall thickening involving the distal transverse colon image number 100, series number 4 and is consistent with patient's known history of colon cancer. Associated borderline enlarged lymph nodes in the mesentery surrounding the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Distal transverse colon carcinoma associated with small lymph nodes in the colonic mesentery.No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old. Reason: shortness of breath and hemoptysis. History: As above. Questionable enlargement of the heart with a globular contour which is partially related to magnification from AP lordotic technique. Low lung volumes with diffuse acute airspace opacities. No large pleural effusion or pneumothorax.

Output: 1. Diffuse acute airspace opacities which are nonspecific, however, given the history of hemoptysis this may be secondary to pulmonary hemorrhage. Vasculitis such as the Goodpasture's disease should be considered. Differential considerations include edema and less likely atypical infection. 2. Questionable cardiomegaly. Findings discussed with the emergency department physician, Dr. Mulenga, at 11:50 AM on 5/10/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: chest pain History: chest pain Small lung volumes.No acute abnormality.Heart size upper normal.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: widened mediastinum? chest pain radiating to back with different BPs in both arms History: as above No significant cardiopulmonary abnormality.Unremarkable mediastinal contours.Left jugular catheter tip at SVC/RA junction level.

Output: No significant abnormality. If dissection is strongly suspected, thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Stable cardiomediastinal silhouette. Calcified aortic arch.Lungs are clear. No focal consolidation, pleural effusion or pneumothorax.

Output: Stable appearance of the chest with no evidence of acute cardiopulmonary process or gross evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: Signs of fluid overload/aspiration History: Hypoxia requiring BiPAP Slight increase in interstitial markings suggestive of edema with underlying emphysema.Moderate cardiomegaly.Small left pleural effusion and basilar atelectasis.

Output: Mild interstitial edema with underlying emphysema.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT remains within 2 cm of the carina. NG and bilateral jugular catheters are also similar in positionDiffuse persistent mixed interstitial and patchy airspace opacities in all 4 quadrants with moderate nonspecific cardiomegaly and small effusions are again observed, representing overall moderate improvement in increased aeration.

Output: ETT unchanged and overall improving aeration


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: intubated, swan in place, IABP in place History: intubated, swan in place, IABP in place IABP marker in proximal descending thoracic aorta. Left venous catheter tip in SVC. Right jugular Swan-Ganz catheter tip in interlobar pulmonary artery. NG tube has been advanced, the tip is in the stomach. ET tube tip 3-4 cm above carina. Persistent pulmonary edema. Fractured sternotomy wires as on prior.

Output: IABP marker in proximal descending thoracic aorta. Right jugular Swan-Ganz catheter tip in interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with throat pain and swallowed foreign body. Evaluate for foreign body or pneumonia. Cardiomediastinal silhouette is unremarkable.No focal lung opacity or pleural effusion. Flattening of the diaphragms which may suggest early COPD. No radiographic evidence of foreign body.

Output: No evidence of pneumonia or foreign body.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p PICC History: verify picc placement (needs to be central for TPN) No significant cardiopulmonary abnormality.Right PICC, tip in the SVC.

Output: Right PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: r/o PNA History: weakness, dizziness Normal heart size. Interval resolution of pneumomediastinum and subcutaneous emphysema seen on prior exam.No focal opacity or pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: r/p infection History: productive cough Median sternotomy, heart size normal.Mild deviation of the trachea to the right is consistent with a goiter.No specific evidence of infection or edema.

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


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old. No unexpected radiopaque foreign body. Support devices are present including Swan-Ganz catheter, endotracheal tube and multiple chest tubes. Median sternotomy hardware is intact.

Output: No radiopaque foreign object identified. Stable support devices. Remaining findings are unchanged.


Instruction: Generate impression based on medical findings.

Input: Aortic valve replacement Unchanged Swan-Ganz projected in the right pulmonary outflow tract. Mediastinal chest tubes also similar, however ETT has been removedUnderlying cardiopulmonary appearance also similar with moderate basilar changes suggesting CHF with layered effusions and cardiomegaly

Output: ETT removed


Instruction: Generate impression based on medical findings.

Input: Hypoxia Persistent small right pneumothorax with minimal interval continued resolution. Unchanged right chest tube projects towards the midline at the level of the aortic arch. The underlying cardiopulmonary appearance is otherwise similar without new abnormality.Dobbhoff coiled within the gastric lumen. Left jugular catheter terminates in the innominate. ETT extends to within 2 cm of the carina

Output: ETT in unchanged and continued resolution of what is now a small right pneumothorax


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Evaluate balloon pump placement. Swan-Ganz catheter tip in the right proximal descending pulmonary artery.Distal IABP marker is in the mid descending thoracic aorta.Stable cardiomegaly with unchanged pacemaker leads.Lower zone opacities suggestive of pleural effusions and edema with retrocardiac atelectasis, not significantly changed.

Output: Distal IABP marker is in the mid descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: s/p PICC placement for IV antibiotics History: please eval PICC positioning Left PICC, barely entering the subclavian region.No significant pulmonary or pleural abnormality.Radiodense object projected over the gastric fundus could be ingested or external to the patient.

Output: Left PICC, tip just entering the subclavian region.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old. Scoliosis Evaluation of the spine is slightly limited due to inability to optimally position the patient. There is approximately 25 degrees dextroscoliosis of the thoracolumbar spine as measured from the superior endplate of T6 to the inferior endplate of L4. Please note that there is also a pelvic tilt with elevation of the left iliac wing, but the right iliac wing is not included in its entirety in the field of view of this study.There is 2-3 cm of negative coronal balance. There is approximately 4 cm of positive sagittal balance.A neurostimulator device is again seen in similar position to that seen on prior chest radiograph.

Output: Scoliosis and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Cough, dyspnea. Concern for Varicella pneumonia. Streaky opacity in right lower lobe, improved from previous study.Unremarkable cardiac and mediastinal silhouette.

Output: Improvement of right lower lobe opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Stable cardiomediastinal silhouette with tortuosity of the aorta.Lungs are clear.No pleural effusions.Redemonstration of moderate-sized hiatal hernia.Degenerative changes noted in thoracic spine.

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


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old. Reason: eval trialysis pt History: OSH transfer w trialysis line Right central venous catheter with tip in the right atrium.Cardiomediastinal silhouette is unremarkable.Low lung volumes with streaky basilar opacities likely representing subsegmental atelectasis.No focal opacity, large pleural effusion, or pneumothorax.Cervical fixation hardware and incompletely visualized IVC filter are noted.

Output: Right central venous catheter with tip in the right atrium.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female status post Whipple surgery for pancreatic ductal adenocarcinoma CHEST:LUNGS AND PLEURA: 6-mm nodule in the apical segment of the left lower lobe adjacent to the aortic arch. No other nodules in the lungs. No pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Previously described lesion in segment 4 has now increased in size and now measures 19 x 16 mm image number 101, series number 61. Second index lesion in the right lobe has also increased in size and now measures 15 x 14 mm on image number 113, series number 61. New metastatic lesions are also seen in the liver.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple surgery. Residual pancreas is unremarkable.ADRENAL GLANDS: Stable left adrenal nodule measuring 14 x 9 mm image number 87, series number 61.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small nodes in the mesentery, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size and number of hepatic metastatic lesions. Solitary nodule in the left lung.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: icu film, acute lung changes History: hypoxic respiratory failure Sternotomy sutures unchanged.There is stable cardiomegaly.Very small bilateral pleural effusions persist with stable left basilar consolidation. Bilateral pulmonary opacities continue to improve.

Output: Resolving edema pattern with persistent left basilar consolidation which could represent pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: eval for pulm edema History: dyspnea and Moderate cardiomegaly with increased upper zone blood flow but no sign of pulmonary edema or effusions.No significant pulmonary abnormalities.

Output: Moderate cardiomegaly with no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 54 years old Male. Reason: ETT History: ETT. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Minimal left retrocardiac streaky opacity is likely due to atelectasis. The ET tube has been removed. The NG tube is stable in position.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Chest pain and shortness of breath with dyspnea on exertion evaluate for signs of CHF. No focal airspace opacity, pleural fluid or pneumothorax. No signs of CHF. Normal heart size.

Output: No signs of CHF or other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrate, edema History: hypoxia Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: post-op esophagectomy, thoracotomy History: post-op esophagectomy, thoracotomy Right chest tube unchanged with no pneumothorax but persistent right chest wall soft tissue emphysema.Slight increasing basilar atelectasis with low lung volumes.An NG tube traverses a gastric pull-up. Right jugular catheter, tip in SVC.

Output: No pneumothorax, right chest tube present. Decreased lung volume with increased basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: New BIPAP requirment, aortic knob lesion seen on xray History: dyspnea Persistent small lucency adjacent to aortic arch.Lungs hypoinflated. Interval increase in consolidation on the right. Left-sided opacity unchanged.

Output: No change in lucency adjacent to aortic arch which may represent a small focus of ectopic gas such as focal pneumomediastinum.Increased right basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: f/u pleural effusion History: hypoxia, recent thora Unchanged pulmonary metastases.Stable pleural effusions with no pneumothorax.

Output: No significant pneumothorax. Stable pleural effusions and chest metastases.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with lung cancer, follow up right hilar, liver and splenic lesions, current report of fatigue CHEST:LUNGS AND PLEURA: There has been further interval reduction of the right hilar mass. It currently measures 1.4 x 2.3 cm (series 3 image 54), as compared to 1.8 x 2.6 cm. There is stable lingular subsegmental left atelectasis. The right upper lobe ground glass opacity is markedly reduced. There is interval development of cicatricial atelectasis in the right perihilar location. Centrilobular and paraseptal emphysema is again identified.MEDIASTINUM AND HILA: Reference precarinal lymph node is smaller, measuring 7 mm in short axis, as compared to 12 mm. No mediastinal or hilar lymphadenopathy is present. The heart size remains normal. There is persistent pericardial thickening or loculated fluid at the apex which is slightly increased, currently measuring 9 mm transverse (series 3 image 77). Aortic valvular and triple vessel coronary arterial calcification.CHEST WALL: Persistent degenerative changes of the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: There is mild persistent intrahepatic biliary ductal dilatation. The coned bile duct measures 8 mm transverse at the pancreatic head. In the region of the ampulla of water, there is no calcification, however there is high density which may represent sludge consider M.R.C.P. for further evaluation. The The previously described reference metastatic lesion the right hepatic lobe (series 3 image 100) measures 2.1 x 0.7 cm, slightly smaller than previous. The two peripheral lesions within segment VIII are not significantly changed.SPLEEN: The low-density lesion within the spleen measures slightly smaller, approximately 3.5 cm as compared to 3.9 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are stable. PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Increased size in the right posterior lateral abdominal wall hernia which contains fat (series 3 image 131). There is abdominal midline surgical suture without interval diastases. Diffuse atherosclerotic disease involving the thoracic and abdominal aorta, extending into the iliac arteries.

Output: 1.Interval decrease size of right hilar mass currently measuring 1.4 x 2.3 cm.2.Partial resolution of previous right upper lobe ground glass opacity from radiation reaction. Right suprahilar cicatricial atelectasis is now present.3.Persistent, mild diffuse intrahepatic biliary ductal dilatation. The central common bile duct measures 8 mm with findings as above. Consider M.R.C.P. for further evaluation.4.Decreasing size of liver and splenic metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Status post intubation confirm ETT location. ETT tip 6.5 cm above the level of the carina.Right jugular introducer, left subclavian pacemaker and Dobbhoff tube unchanged in position.Bilateral subcutaneous emphysema. No pneumothorax.Interval development of mild pulmonary edema and small pleural effusions.

Output: Mild CHF. ETT tip 6.5 cm above the carina. DHT may be advanced.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: infiltrate History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: 65F in CCU with Impella, intubated, ?device locations History: 65F in CCU with Impella, intubated, ?device locations ET tube tip is between the thoracic inlet and carina.The IABP marker overlies the proximal descending thoracic aorta.IVC Swan-Ganz catheter tip remains in the left pulmonary artery.Unchanged cardiomediastinal silhouette.Persistent perihilar and basilar opacities compatible with edema, slightly improved.

Output: Cardiopulmonary support devices as above. Minimal improvement of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Increased WOB, placed on BiPAP History: Increased WOB, placed on BiPAP Cardiomegaly.Stable position of right IJ venous catheter overlying the SVC.Persistent bilateral basilar subsegmental atelectasis associated with small bilateral pleural effusions and likely pleural thickening. No pneumothorax.

Output: No new abnormal lung parenchymal opacities.Cardiomegaly and multilobar segmental atelectasis again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: sp intubation and NGT placement History: none Basilar opacities and pleural effusions are unchanged.ET tube tip approximately 4 cm above the carina.NG tube tip in distal esophagus.Left jugular catheter, tip in SVC.

Output: ET tube tip approximately 4 cm above the carina. Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 42-year-old woman with history of pain around the left internal jugular catheter. Central venous catheter is seen without discrete fluid collection in the surrounding subcutaneous soft tissues.

Output: No evidence of abscess or hematoma.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with thyroid cancer status post two cycles of therapy. Compare to last CT. CHEST:LUNGS AND PLEURA: The nodule in the right middle lobe measures 0.8 x 0.7 Cm (image number 41, series 5). It previously measured 0.8 cm x 0.8 cm. Post surgical changes are again seen in the left lung with elevation of the left hemidiaphragm.MEDIASTINUM AND HILA: The reference left paramediastinal mass now measures 4.7cm x 4.3cm (Image 23, Series 3). It previously measured 5.2cm x 4.7cm. The right paratracheal partially calcified mass abutting the posterior wall of the SVC measures 3.4 cm x 3.4cm, unchanged. Mild pericardial thickening is again seen.CHEST WALL: Multiple lytic lesions in the midline chest wall are again seen. The reference left anterior chest wall mass measures 3.5cm x 2.9cm (Image 23, Series 3). It previously measured 4.0x 3.5cm.  Right sided diaphragmatic hernia containing fat is again noted and unchanged in appearance.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis again seen.SPLEEN: Calcifications in the spleen, likely granulomas.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left parapelvic renal cysts are again seen. The left renal vein passes posterior to the aorta. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The submucosal mass along the lesser curvature of the stomach is no longer seen. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other 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: No other significant abnormality noted.

Output: Stable to slight interval decrease in size of the mediastinal lymph nodes, pulmonary parenchymal nodule, and chest wall mass as described above. The gastric mass is no longer visualized.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Altered mental status. Mild elevation of the right hemidiaphragm.Hazy perihilar distribution opacities. No visible pleural fluid or pneumothorax.

Output: Hazy opacities nonspecific but suggestive of aspirated secretions. Acute edema is considered less likely.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old, history of tongue cancer. Status post chemotherapy, radiation therapy, ending 7/11/09. LUNGS AND PLEURA: Biapical scarring. Stable right middle lobe opacity likely due to prior infection. Scattered pulmonary micronodules are unchanged and likely post infectious or represent intrapulmonary lymph nodes. No suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: Bilateral thyroid cystic lesions. The cardiac size is normal. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Right chest port.UPPER ABDOMEN: Cholecystectomy clips. Gastrostomy tube in place. Stable subcentimeter splenic hypodensity, likely benign.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval for infiltrate or edema History: SOB Study is limited by large patient body habitus. No focal lung consolidation. Moderate cardiomegaly again noted. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: s/p thoracentesis History: s/p thoracentesis Slight improvement in left-sided pleural effusion. No new focal lung opacities. Unchanged heart size. Port catheter again noted terminating in the SVC. No pneumothorax.

Output: Status post left-sided thoracentesis without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: intubated History: intubated Endotracheal tube tip has been repositioned and tip now projects 4 cm above the carina.Stable cardiomediastinal silhouette with leftward mediastinal shift.Extensive interstitial and airspace opacities are not significantly changed when compared to prior examination. Unchanged volume loss of the left hemithorax with decrease in small apical pneumothorax. Small left pleural effusion/thickening, not significantly changed. Stable to slight decrease in pneumomediastinum. Near complete resolution of neck subcutaneous emphysema.Findings suggestive of pneumoretroperitoneum are less conspicuous on the current study.

Output: 1.Small left apical pneumothorax is smaller. Slight decrease in pneumomediastinum with near complete resolution of the neck subcutaneous emphysema.2.Findings suggestive of pneumoretroperitoneum are less conspicuous.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of gist tumor, status post resection CHEST:LUNGS AND PLEURA: Subcentimeter nodule in image number 69, series number 5 is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes involving the bowel segments unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study. No evidence of metastatic or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: assess for pneumonia, recently treated for aspiration History: Syncopal episode, hypotension Stable cardiomediastinal silhouette.Retrocardiac opacity suggestive aspiration or infection. No large pleural effusions or pneumothorax.

Output: Persistent retrocardiac opacity suggestive of aspiration or infection without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Presenting with shortness of breath. Please rule out edema. Stable cardiomegaly without pleural effusions. Mild left basilar atelectasis. No pneumothorax.

Output: Cardiomegaly without findings of frank pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Cardiomyopathy, CHF. Unchanged cardiomegaly and unsharpness of the central pulmonary vasculature. No visible pleural fluid. Left subclavian ICD unchanged in position. Right jugular Swan-Ganz catheter at the distal right pulmonary artery.

Output: Mild hazy opacity and vascular ensure this could indicate minimal residual edema.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Penile cancer evaluate for metastatic disease. Left subclavian dual-chamber pacemaker with leads in the projection of the right atrial appendage and directed towards the right ventricular apex.The left hilum is obscured by the pulse generator and overlying leads and cannot be assessed.The remainder of the lungs are clear. No pleural fluid.Mild degenerative changes of the spine.

Output: Left hilum cannot be assessed due to overlying hardware, but no visible pulmonary metastases are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: pna? edema? History: sob, desats Small lung volumes with nonspecific basilar opacities suggestive of edema or aspiration, and small pleural effusions.Left PICC, tip in the SVC.

Output: Basilar edema or aspiration. Findings are not specific for infection.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Evaluate for previous, h/o bilateral perihilar opacity suggestive of edema with L lower lobe retrocardiac atelectasis History: trach Cardiomegaly with left basilar atelectasis, unchanged.Tracheostomy tube, the tip at the level of the thoracic inlet.Left subclavian ICD, leads unchanged in position.

Output: Unchanged left basilar atelectasis, which may be the results of aspirated secretions. No evidence of edema.


Instruction: Generate impression based on medical findings.

Input: 37 year old female with history of ovarian cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small lymph node adjacent to cecum measures 7 mm on image number 160, series number 7, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized. Multiple small nodules within the small bowel mesentery in the pelvis are stable. Index nodule measures 1 x 1 cm on image number 174, series number 3. Ill-defined soft tissues adjacent to the vaginal cuff are also grossly stable. Their significance is indeterminate.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: wedge History: no Cardiomegaly with nonspecific basilar opacities suggestive of edema and subsegmental atelectasis, unchanged.Left chest tube, tip near apex, with no pneumothorax.

Output: No significant change in pulmonary opacities, and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: MaleReason for Study: Reason: r/o pneumonia History: cough fver 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 Faint increased opacity projected over the mid right lung, which correlates with overlapping soft tissues, presumably posterior. Lungs are otherwise clear although minimally asymmetric, likely secondary to marked scoliosis. Cardiac and mediastinal contours are within limits. No effusions.

Output: Scoliosis with overlapping asymmetric soft tissues, presumably accounts for mild asymmetry in lung volumes. Consider follow-up serial imaging if suspicion remains high on the right


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: s/p thoracentesis History: s/p thoracentesis Mild interval decrease in right pleural effusion post thoracentesis.No pneumothorax identified.Stable cardiac enlargement with perihilar opacities increased from the prior exam and compatible with edema.Mild interval increase in left pleural effusion.

Output: Mild decrease in size of right pleural effusion postthoracentesis. No pneumothorax identified. Cardiomegaly with increasing pulmonary edema and small left pleural effusion compatible with worsening CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval infection, edema, effusion, mediastinal silhouette History: chest pain Mild cardiomegaly status post median sternotomy and mitral valve repair.Mild right basilar scarring or subsegmental atelectasis unchanged.No specific evidence of infection or edema.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: LUNGS AND PLEURA: Interval increase in dense post obstructive consolidation within the left apex, likely due to mucous plug or intrabronchial tumor recurrence. Interval development of diffuse bilateral lower lobe interstitial opacities, likely due to post therapy changes.Stable residual scarlike lesion (image 57 series 5). Reference opacity medial to this lesion is unchanged, measuring 7 x 9 (image 53 series 5), previously 7 x 8 mm.Severe centrilobular emphysema. Postoperative volume loss in the left.MEDIASTINUM: Small pericardial fluid collection. Reference left paratracheal node stable, again measuring 10 x 10 mm (image 41 series 4). The adjacent left paraesophageal lymph node (image 41 series 4) stable, again measuring 11 x 13 mm.CHEST WALL:Unremarkable.UPPER ABDOMEN

Output: 1. Interval increase in left apical postobstructive consolidation, likely due to intrabronchial mucous plug or tumor recurrence. 2. Stable mediastinal adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Trach and pleural effusion. Pneumonia. Interval increase in pleural fluid volume on the right. Edema, pleural fluid and atelectasis on the left about the same. Opacification of the lower two thirds of the right hemithorax.

Output: Enlarging right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: sickle cell with VOC ? acute chest History: back pain, shoulder pain, nausea and vomiting bile, chest pain Moderate cardiomegaly with increased upper zone blood flow consistent with chronic anemia.No acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male 61 years old , assess fluid status, oxygen requirement Support devices stable in position with enteric tube projecting over area of gastric pull-up. The intrathoracic stomach appears more distended from prior examRight perihilar airspace opacities as well as streaky bibasilar opacities. Bilateral pleural effusions.

Output: Bibasilar opacities suggestive of atelectasis/aspiration appearing similar to prior exam. Stable appearing bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Weakness evaluate for infection, pulmonary edema. Chronic right pleural thickening and loculated fluid, scarring at the lung base and mild elevation of the right hemidiaphragm. Compressive atelectasis in the right lower lobe adjacent to the loculated pleural fluid collection.Airspace opacities and nodules seen on the prior chest radiograph are not readily visible however as significant abnormalities were identified on the prior CT, a follow-up CT scan is recommended when feasible to exclude possibility of any residual/recurrent lesions or malignancy.No signs of pulmonary edema. No focal air space opacities to suggest pneumonia.

Output: Chronic loculated right pleural fluid and pleural thickening may be from prior empyema (including a chronic, indolent tuberculous empyema). Although no signs of pneumonia are evident, portable technique has a limited sensitivity for detection of pulmonary nodules which were identified on the prior PA chest radiographs. Follow-up thoracic CT (preferably with contrast) is recommended when feasible to assess for complete resolution of previously identified nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Eval position of balloon pump History: Sudden loss of balloon pump augmentation, c/f malposition PICC tip at RA/SVC junction. Left lower lobe scarring or atelectasis. No new opacity to suggest pneumonia.Balloon pump marker unchanged in the proximal descending thoracic aorta.

Output: Balloon pump marker unchanged in the proximal descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Type for RF, ETT adjustment. ETT 3 cm above the level of the carina. Other tubes and lines unchanged. No acute change in airspace opacities near the left base consistent with aspirated secretions. Right hemithorax volume loss from lobar collapse.

Output: ETT 3 cm above the carina. No acute change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/p atrial shunt placement History: s/p atrial shunt placement Right IJ central catheter terminates at the superior cavoatrial junction.Tortuosity of the descending thoracic aorta. Heart size is stable. No edema, pneumothorax or evidence of infection.

Output: No evidence edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: trached pt, with new fever History: trached pt, with new fever Unchanged right apical pleural thickening and decreased volume of the right lung after prior partial resection. The right apical loculated air is partially obscured.Diffuse bilateral coarse reticular opacities again noted. Interval partial resolution of left lower lobe collapse.No left pneumothorax.Weighted tip enteric tube overlying the left upper quadrant of the abdomen. Tracheostomy cannula in place.

Output: Partial resolution of left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: monitor ETT History: advanced HF, pneumonia Swan-Ganz catheter has been pulled back slightly now terminating within the right pulmonary artery. Intra-aortic balloon pump is slightly lower than expected terminating just below the left mainstem bronchus, as before. Side port of the enteric tube again terminates near the gastroesophageal junction. Diffuse pulmonary opacities, unchanged. Small pleural effusions. Unchanged heart size.

Output: Lines and tubes, as above. No substantial change in diffuse pulmonary opacities most consistent with pulmonary edema. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: dysphagia, s/p kidney transplant Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: History of immature teratoma CHEST:LUNGS AND PLEURA: Small area of pleural based thickening and scarring in the right upper lobe is unchanged. Tiny nodule at the right lung base is stable and has been present as far back as an exam of 5/7/05 (image 69; series 4). This could be an intrapulmonary lymph node.MEDIASTINUM AND HILA: Borderline enlarged 11 x 13 mm right hilar lymph node (image 45; series 3) is roughly stable compared to previous.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged retroperitoneal lymph nodes have increased in number compared to previous CT.BOWEL, MESENTERY: Numerous borderline enlarged mesenteric lymph nodes have increased in number and size compared to previous CT. The reference node is stable and measures 11 x 9 mm on image number 139/227. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Right ovarian cyst decreased in size measuring 2.1 x 3.0 cm. The previously described cystic lesion on the right superolateral aspect of the bladder has a different configuration on today's examination possibly secondary to differences in bladder distention. It measures approximately 2.2 x 5.6 cm on coronal images (image 50/112; series 80232).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Decrease in size of right ovarian cystic lesion. Cystic lesion versus fluid collection on the superior aspect of the bladder roughly stable given differences in bladder distention. Other findings are stable with measurements given above.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: eval subq emphysema History: crepitus Stable cardiomegaly is silhouette.Persistent bilateral low lung volumes with coarse diffuse interstitial opacities in keeping with chronic interstitial fibrotic changes.Interval improvement in subcutaneous emphysema and pneumomediastinum no longer confidently seen.

Output: Interval improvement in subcutaneous emphysema and pneumomediastinum no longer confidently seen.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Increased white count and fever. An intra-abdominal drain or catheter projects over the right hepatic dome. Surgical staples project over the midline of the upper abdomen. Cholecystectomy clips.Low lung volumes. Normal heart size. No pleural fluid. No specific signs of pulmonary edema no focal air space opacities. Minimal atelectasis in the retrocardiac region.

Output: Mild basal opacity, more suggestive of atelectasis than pneumonia. Short-term follow-up may be obtained if the patient remains symptomatic.


Instruction: Generate impression based on medical findings.

Input: Chest tube placement for pneumothorax.VIEW: Chest AP (one view) 10/20/16, 0927 A left chest tube has been placed. No residual pneumothorax is seen.Endotracheal tube tip is below thoracic inlet. Mediastinal surgical clips are noted. There is a PDA stent. Right chest tube remains in place. Two right atrial lines are identified. Epicardial pacer leads are seen. Enteric tube tip is in stomach.Cardiothymic silhouette is mildly enlarged and unchanged. A small amount of fluid is seen in the minor fissure. No focal lung opacity is present.

Output: Placement of left chest tube and resolved left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: CHF exacerbation? History: SOB Cardiomegaly with time interstitial edema pattern, and right pleural and parenchymal scarring.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly and edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: evaluate NG tube placement. Pt pulled it out after first CXR this AM History: as above Nasogastric tube is within the proximal aspect of stomach. Right IJ line is unchanged terminating near the cavoatrial junction. Worsening diffuse/multifocal pulmonary opacities. Small pleural effusions again noted. No pneumothorax.

Output: Worsening of diffuse/multifocal pulmonary opacities consistent with pulmonary edema, pneumonia, diffuse alveolar damage, and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: Eval for PNA. History: Flu-like symptoms Lungs and pleural spaces are clear. Cardiomediastinal silhouette is unremarkable.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 37 years old Male. Reason: eval for PNA, volume overload History: SOB. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse mild bilateral interstitial edema. No evidence of pneumothorax. No focal infiltrate to suggest pneumonia.

Output: The above findings are consistent with CHF or volume overload.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: eval for PNA History: fever Basilar opacities suggestive of edema and atelectasis from aspiration or infection.Heart size upper normal at most.A Dobbhoff tube extends below the lower margin of the image.

Output: Basilar opacities suggestive of infection and aspiration or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: please perform a chest x-ray and assess for any infectious process, fluid, or abnormality History: ESRD on HD, SOB Moderate cardiomegaly status post sternotomy with a tortuous calcified aorta.Subtle interstitial opacities and a very small right pleural effusion may indicate CHF/edema.No specific evidence of infection.

Output: Cardiomegaly, small right pleural effusion and subtle edema consistent with CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: L VATS robotic apical posterior and anterior segmentectomy for management of lung nodule. Path reveals necrotizing and non-necrotizing granuloma History: none Previous left pneumothorax no longer visualized; accumulation of pleural fluid on the left has slightly increased. Nodular opacity posterior left seventh/eighth rib interspace at site of previous abnormality on CT. On nodular opacity on the right represent one of the pulmonary nodules also on prior CT. Heart size remains stable.

Output: Accumulation of left pleural fluid; left pneumothorax is no longer visualized.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval sternal wires History: pt coughed, felt popping sensation over sternum Moderate cardiomegaly status post sternotomy and valve replacement.Moderate lower lung zone opacities suggestive of edema and atelectasis with pleural effusions, slightly worse.Sternotomy sutures remain aligned.Right jugular introducer.

Output: Cardiomegaly with increasing opacity suggestive of edema and atelectasis with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: Eval spetic emboli to lungs History: endocarditis Decreased lung volumes with mild cardiac enlargement.Nonspecific widening of the mediastinum.Mild basilar scarring/discoid atelectasis.No focal areas of consolidation.No large pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. Nonspecific widening of the mediastinum may represent tortuous vessels or mediastinal lipomatosis. CT of the chest can be performed if there is a clinical concern.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Concern for infection The overall enlargement of the cardiac contours. There is enlargement of the central pulmonary arteries, suggestive of pulmonary arterial hypertension.Low lung volumes. Signs of interstitial pulmonary edema. Assessment of the left lower lobe is limited and focal heterogeneous opacities may represent atelectasis or pneumonia in the appropriate clinical setting.Small left larger than right pleural effusions. No pneumothorax.

Output: Signs of interstitial pulmonary edema associated with small bilateral pleural effusions.Assessment for superimposed pneumonia, specifically in the left lower lobe is very limited. Correlate with physical exam and clinical presentation.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient s/p intubation and R IJ central line placement; please eval placement of central line History: As above ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC. NG tube tip in the stomach.Patchy nonspecific bilateral opacities compatible with aspiration and/or infection.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 29 year-old female with Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Stable minimal bibasilar patchy opacities.MEDIASTINUM AND HILA: The anterior mediastinal mass has greatly decreased in size, measuring 5.6 x 3.1 cm, previously 11.0 x 6.0 cm. Only minimal mass effect is now seen affecting the left brachiocephalic vein.Bilateral supraclavicular, subpectoral, left axillary and mediastinal adenopathy persists but have also significantly improved.CHEST WALL: The right-sided port terminates at the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hypodense 1.8 x 1.4 cm lesion in the body of the uterus may represent a degenerating fibroid.Both ovaries are identified and are unchanged in appearance.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant improvement in the supraclavicular and thoracic adenopathy.


Instruction: Generate impression based on medical findings.

Input: 33 year old female with history of MS and asthma who p/w URI Sx r/o PNA History: Congestion, cough, SOB. Normal cardiac silhouette. No focal airspace opacity, pleural effusion, or pneumothorax. No displaced rib fractures.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: elevated wbcs History: As above. Small right pleural effusion and right perihilar subsegmental atelectasis.Calcified granuloma in the right upper lobe.Surgical drain in the right upper quadrant of the abdomen and multiple surgical clips and staples.

Output: Right pleural effusion and subsegmental atelectasis. No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: arrest, assess for ptx History: arrest for ptx Diffuse interstitial and air space opacities consistent with edema are unchanged.No significant pneumothorax.Unchanged tubes and devices.

Output: Stable pulmonary opacities. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: R lower chest pain, no trauma History: R lower chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild disc degeneration osteopenia.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: chest pain, stroke? History: aphasia, global weakness Small lung volumes with basilar subsegmental atelectasis.Heart size near upper normal with a tortuous aorta.No specific evidence of infection or edema.

Output: Basilar subsegmental atelectasis, probably from mild mucous plugging or aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Shortness of breath Low lung volumes.Persistent elevation of the left hemidiaphragm with basilar opacities consistent with atelectasis.Marked cardiomegaly is unchanged. Streaky bibasilar opacities.

Output: Low lung volumes; basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with history of lung cancer. Status post chemotherapy. Restaging examination. CHEST:LUNGS AND PLEURA: Stable mild emphysema. The entire right upper lobe is replaced by soft tissue density, partially containing air bronchograms which may represent recurrent neoplasm versus progression of the fibrosis secondary to radiation. Previous described spiculated right upper lobe lesion is no longer visualized due to dense soft tissue density surrounding it.Focal irregular areas of groundglass opacity and interstitial thickening in the left and right lower lobes likely represents radiation changes. No new nodules suspicious for metastatic disease.No acute infiltrates or effusions.MEDIASTINUM AND HILA: Right hilar irregular soft tissue density with ill-defined borders and containing calcification and appears to have increased in size and may be causing postobstructive changes in the right upper lobe. Subcentimeter cyst upper mediastinal right-sided lymph nodes are also seen. This ill-defined right hilar soft tissue density extending into the right upper lobe cannot be differentiated from the surrounding radiation fibrosis and consolidation. Nodular right thyroid is stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Increased size of large mass in the right lobe of the liver dome measuring 8.8 x 7.7 cm at image number 76 on series number 3, consistent with metastatic disease. This mass cannot be separated from a presumed right adrenal mass measuring 11.8 x 8.4 cm at image number 99, series number 3 which invades the liver and IVC as well as the right kidney.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal mass as described above. Left adrenal gland has developed a centimeter size nodule which is best seen at coronal image 38/69.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Increased size of the retroperitoneal lymphadenopathy as axial image 112/201 where the left-sided periaortic lymph node mass measures 3 x 3.7 cm, significantly increased in size since the prior exam. There is diffuse confluent retroperitoneal lymphadenopathy to the iliac bifurcation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval stable right hilar soft tissue mass causing right upper lobe consolidation.Increased size of of hepatic/right adrenal and retroperitoneal metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p swan placement History: s/p swan placement Swan-Ganz catheter tip in the right descending pulmonary artery.ICD leads unchanged.Moderate cardiomegaly with mild basilar interstitial opacity which appears to be at least partly chronic though there may be component of interstitial edema.

Output: Swan-Ganz catheter in the right descending pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: s/p drain right fluid collection. eval for possible hemorrhage. History: as above Right pleural drain and right Port-A-Cath unchanged.Increasing airspace opacity in the right upper lobe .Scattered foci of right pleural air and fluid.Small left pleural effusion unchanged and bibasilar opacities similar to the prior exam..Stable cardiac mediastinal silhouette with postsurgical changes related to prior esophagectomy and gastric pull up.

Output: Increasing right upper lobe opacity representing known empyema and possible superimposed hemorrhage. Right loculated pleural air and fluid as well as nonspecific basilar opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Neutropenic, fever, eval for PNA Port catheter terminates just above the cavoatrial junction. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Sepsis ETT and NG both removed without apparent complication. Right jugular catheter and incompletely visualized catheters overlying the upper abdomen grossly unchangedCardiopulmonary appearance otherwise remains similar with moderate right effusion and basilar atelectasis with borderline cardiomegaly

Output: ETT and NG removed


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.CHF dyspnea, evaluate for pneumonia." 4279". Cardiothoracic ratio appears enlarged however this may be exaggerated due to magnification from portable technique.Layering pleural effusions, large on the right and moderate on the left. Significant dependent atelectasis in addition to dependent air space opacities bilaterally. Nonspecific retrocardiac opacity which may be in part the result of compressive atelectasis.

Output: Pleural effusions and atelectasis. Additionally, there is dependent lung field air space opacity which may reflect atypical edema, aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.SOB and fever. Low lung volumes. Tortuous thoracic aorta with mediastinal widening may be exaggerated by the degree of underinflation, incompletely evaluated.Basal atelectasis obscures the previously noted nodular opacities on the left.

Output: Low lung volumes with basal atelectasis. Nodular opacities in the left costophrenic angle are of indeterminate etiology and could potentially represent atypical infection if patient is immunocompromised and if PTLD has been excluded as the etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: patient with abnormal portable cxr History: chest pain and sob Heart size upper normal, and the suggestion of interstitial opacities more likely chronic than edema, with bronchial wall thickening.Diaphragmatic contours are unremarkable.No specific evidence of infection.

Output: Heart size upper normal, with nonspecific interstitial opacities and bronchial wall thickening.


Instruction: Generate impression based on medical findings.

Input: Tachycardia Progressing and now marked perihilar and basilar mixed interstitial patchy opacities with large pleural effusions and mild cardiomegaly. Increasing CHFTracheostomy tube and right jugular dialysis catheter are similar, the former terminates 5 cm above the carina

Output: Increasing CHF


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: s/p RIJ central line History: central line placement Small lung volumes with questionable edema but no sign of infection.Small pleural effusions.Heart size upper normal, status post descending thoracic aortic endograft.Right jugular catheter, tip in SVC.ET tube tip approximately 2 cm above the carina.

Output: Right jugular catheter placement.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: extubation, evaluate for infiltrations, fluid overload History: extubation Cardiomegaly and increasing pulmonary opacities with pleural effusions.An NG tube terminates in the stomach.Status post extubation.

Output: Worsening pulmonary opacities and pleural effusions following extubation.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: Eval for ACS. History: Sickle cell disease w/ mild chest pain. Borderline cardiomegaly unchanged.Lungs clear.No pleural effusion. No pneumothorax.Stable position of tunneled PICC line.

Output: Stable cardiomediastinal silhouette with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: r/o pneumonia History: cough Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: Please assess for active disease History: Positive TB screen, quantiferon-tb-gold. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with duodenal adenocarcinoma at outside hospital. Mass, weight loss, jaundice. CHEST:LUNGS AND PLEURA: Minimal emphysematous changes. Small right pleural effusion with adjacent airspace opacity, likely atelectasis. MEDIASTINUM AND HILA: Small pericardial effusion. Coronary artery calcificationsCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: A percutaneous biliary drain enters the right lobe of the liver and terminates in the second portion of the duodenum. A biliary stent is also noted. Mild intrahepatic biliary ductal dilatation. The portal vein is patent.Subcentimeter hypodensity in segment 7 of the liver (series 12, image 4), too small to characterize. An additional 1 cm lesion in segment 6 (series 12, image 118) is noted.Mild pericholecystic fluid is identified.SPLEEN: No significant abnormality notedPANCREAS: The pancreas is atrophic and demonstrates a dilated duct extending all the way to the ampulla.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple cysts are seen within the kidneys. A small hemorrhagic cyst is noted in the lower pole of the right kidney.RETROPERITONEUM, LYMPH NODES: Several mildly prominent portal hepatic/peripancreatic lymph nodes are visualizedBOWEL, MESENTERY: Thickening is noted affecting the second portion of the duodenum, with proximal resultant duodenal distention. Pneumatosis affects the cecum and portion of the ascending colon. A few of these scattered small pockets of air are suspected to be within small mesenteric venous branches. No evidence of portal venous gas.Small ventral hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Extensive pneumoperitoneum is identified.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The urinary bladder is decompressed by Foley catheter. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small right inguinal hernia. Diffuse degenerative changes affecting the spineOTHER: Mild vascular disease.

Output: Extensive pneumoperitoneum. The site of perforation is unknown.Thickening of the second portion of the duodenum. Dilatation of the biliary and pancreatic ducts along with proximal duodenal dilatation .Pneumatosis affecting the cecum and ascending colon, of unknown clinical significance. Lactate levels may be beneficial.Mild pericholecystic fluid adjacent to the gallbladder-correlate for signs of acute cholecystitis.Biliary drain and stent in place.The above findings were reported to the covering physician at approximately 12:15 p.m.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Effusion, hemothorax Large right pleural effusion is unchanged compared to 11/2/2015. The left lung is unremarkable.The cardiac silhouette is unchanged.

Output: Unchanged large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: PNA History: cough Lateral radiograph limited by overlying soft tissues.The cardiomediastinal silhouette is unremarkable. Right apical opacity which may represent scarring, however, neoplasm cannot be excluded. Left lower lobe hazy opacity with adjacent lucency likely represents atelectasis and emphysema. No pneumothorax or pleural effusion is identified.

Output: 1. No specific evidence of infection.2. Asymmetric nodular pleural thickening at the right apex may represent scarring, however, neoplasm cannot be entirely excluded. If the referring clinical service can obtain and submit remote outside prior studies, an addendum to this report can be provided. If unavailable, imaging follow-up may be obtained in 2-3 months to confirm stability unless there is a high level of clinical suspicion for pathology in which case a CT may be obtained.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: S/P LVAD. Eval for PICC placement History: PICC line insertion Left-sided ICD and LVAD unchanged.New right PICC line with its tip in the right atrium.Stable cardiomediastinal silhouette.Left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Right PICC line in place with its tip in the RA.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: eval for new effusion/infiltrate History: septic Interval removal of right internal jugular venous catheter.Line positions otherwise stable.Hyperexpanded lung volumes but no specific evidence of infection or edema at this time. No pneumothorax.

Output: Lines stable. No specific evidence of infection or edema at this time.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: s/p MV replacement History: chest tubes Chest tubes postop with no pneumothorax.Lower lung zone edema unchanged, but retrocardiac atelectasis has improved.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: New consolidation History: Tachypneic, tachycardic Feeding tube terminates in the proximal aspect of the stomach. Right IJ line terminates in the SVC, as. No new focal lung consolidation. No pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with dyspnea on exertion and history of enlarged artery. LUNGS AND PLEURA: Significant distortion of lung parenchyma secondary to severe scoliosis as described below.Scattered punctate micronodules, some of which are calcified, likely represent prior inflammatory disease. No suspicious nodules or masses. No focal consolidation, edema or pleural fluid. Subsegmental bibasilar atelectasis.MEDIASTINUM AND HILA: The aorta is markedly tortuous secondary to scoliosis and also demonstrates significant atherosclerotic disease. The caliber of the aorta is normal. Cardiac size is also normal. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Severe rightward thoracic scoliosis. Significant degenerative changes of the visualized spine.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Severe thoracic dextroscoliosis with resultant distortion of lung parenchyma.2.No evidence of acute or chronic lung disease.3.Severe aortic atherosclerotic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Improvement of pleural effusion after thoracentesis History: Dyspena increased WOB Near complete resolution of right pleural effusion without pneumothorax status post thoracentesis. Large loculated left pleural effusionHas markedly increased since previous study. Moderate to severe atelectasis of the left lung due to relaxation/compressive atelectasis. Heart size difficult to assess. Esophageal stent, unchanged. Port catheter unchanged.

Output: Near complete resolution of right pleural effusion without pneumothorax status post thoracentesis.Marked increase in size of loculated left pleural effusion with increasing left lung atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: PNA, COPD? History: SOB Stable cardiomediastinal silhouette in size and configuration.Interval resolution of somewhat patchy/bandlike opacities within the left lung base. An element of the peribronchial cuffing is more evident and correlate with concern for airway disease. No pneumothorax.No acute osseous abnormalities.

Output: Interval resolution of previously identified left basilar opacities likely related to atelectasis.Bilateral peribronchial cuffing is more evident and correlate with concern for airway disease/bronchitis.


Instruction: Generate impression based on medical findings.

Input: 74-year-old man with RCC with METs to lung. Evaluate for progression. The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation, the following observations are made.CHEST:LUNGS AND PLEURA: Multiple scattered lung nodules of varying sizes seen in both lungs have increased in size. Reference peripheral lung nodule in the right lower lobe previously measured 1.2 cm (image 87) now measures 1.2 x 1 cm on series 4 image 58.MEDIASTINUM AND HILA: Stable small nodes. Coronary calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule unchanged.KIDNEYS, URETERS: No interval change. Right nephrectomy. Left kidney normal contour.RETROPERITONEUM, LYMPH NODES: Stable nodes gastrohepatic ligament, portacaval, porta hepatis peripancreatic. Aorta unchanged with two areas of mild aneurysmal dilatation.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Trabeculation of bladder diverticulum redemonstrated.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Increase in size of some of the lung lesions. Other findings as above, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: Pleural effusion History: Pleural effusion Improvement of pulmonary edema, with a persistent left-sided opacity suggestive of pleural effusion and adjacent atelectasis/scarring.No new findings.Renal osteodystrophy.

Output: Improvement in pulmonary edema with persistent left-sided pleural and parenchymal abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: sob, tachycardia History: sob, tachycardia Heart size about upper normal or mildly enlarged.Mild nonspecific basilar opacity, mainly on the right, may be related to aspiration, and/or infection.

Output: Mild nonspecific basilar opacity possibly related to aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with right breast cancer and increase in the axillary nodes CHEST:LUNGS AND PLEURA: Right apical scarring and bronchiectasis. Bilateral lung nodules, more prominent on the right side. These are suspicious for metastatic disease. An index nodule in the right middle lobe measures 10 by 7-mm image number 50, series number 4. There are also multiple pleural based masses in the right lower lobe.MEDIASTINUM AND HILA: Extensive mediastinal adenopathy. An index right tracheal necrotic lymph node measures 2.1 x 2 cm on image number 21, series number 3.CHEST WALL: Large right breast mass. Numerous enlarged right axillary lymph nodes. An index right axillary lymph node measures 1.9 x 1.7 cm on image number 45, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: 1.4-cm hypodense lesion in the inferior pole of the spleen are to representing a simple cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions involving thoracic and lumber vertebral bodies consistent with metastatic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions in the pelvic bones compatible with metastatic disease.OTHER: No significant abnormality noted.

Output: Pulmonary, pleural, mediastinal and osseous metastatic disease.Right breast mass and right axillary metastatic adenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: is there an infiltrate History: chest pain sob history gastric cancer on chemo Unremarkable cardiac and mediastinal silhouette. Port catheter with its tip in the SVC.No sign of pneumonia or other acute process.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.SOB question CHF. Left jugular catheter tip at the confluence of the brachiocephalic veins with the SVC. No pneumothorax. Large right pleural fluid collection with associated compressive atelectasis of the majority of the right middle and lower lobes. Left basal scarring and minimal pleural fluid on the left. Patchy opacities in the dependent aspects of the left lung are more suggestive of aspirated secretions than edema.

Output: No specific evidence of edema. Large right pleural fluid collection. Mild hypervolemia, but no convincing evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: 77 y/o f with COPD and CHF, with bibasilar crackles, eval for mass/pulm edema History: see above Large lung volumes consistent with COPD.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Tachypnea. Evaluate for flash pulmonary edema. Low lung volumes with basilar atelectasis, left greater than right. Small left pleural effusion. No specific evidence of pulmonary edema. Cardiomediastinal silhouette is unchanged.Interval placement of percutaneous cholecystostomy tube.

Output: Lung volumes with atelectasis and small left pleural effusion without specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.History of HIV, now with chest pain. The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.SOB. CHF versus infection. Cardiomegaly with enlargement of the central pulmonary vasculature.No signs of pulmonary edema or pneumonia. No pleural fluid. No pneumothorax.

Output: Cardiomegaly and signs of pulmonary hypertension but no evidence of CHF or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusion History: bradycardia, chest pain Mild blunting of the left costophrenic angle compatible with scarring.Right jugular catheter with its tip in the right atrium.Filter device in the IVC.

Output: Mild blunting of the left costophrenic angle compatible with scarring. No specific evidence of pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: Evaluate for position of vent, eval for effusion/consolidation History: Intubated for long spinal surgery ET tube with its tip approximately 4 cm above the carina.Left pleural effusion and underlying pulmonary opacity increased from the prior exam.The right lung is clear.

Output: ET tube in satisfactory position. Increasing left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Chest congestion, status epilepticus. Low lung volumes. Basal opacity in the right most likely atelectasis however pneumonia cannot be excluded. The right hemidiaphragm obscures this region.Diffuse nodular opacities bilaterally suspicious for aspiration bronchiolitis given patient's history.

Output: Diffuse bronchiolitis, likely related to aspiration. Right lung base is not well delineated given compressive atelectasis and obscuration by the liver and an underlying infection cannot be excluded. Serial chest radiographic follow-up suggested if there is clinical concern for infection.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.New requirement S.O.B. and tachycardia. PE versus atelectasis versus volume overload. Low lung volumes unchanged, with basal scarring and atelectasis. Small pleural effusions. Soft tissue swelling overlying the chest wall and bilateral chest wall drains are noted.

Output: Atelectasis/scarring in the lung bases and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.History of dyspnea. Right port catheter with tip in the right atrial/SVC junction. Cholecystectomy clips noted.The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: eval for infil or effusion History: intermittent CP for weeks Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: PTX on 4am CXR. Tube fixed History: asx Chest tube extending to the right apex with interval resolution of a right pneumothorax.ET tube tip approximately 5 cm above the carina. Basilar pulmonary opacities compatible with atelectasis. Subcutaneous emphysema, mainly on the right.

Output: Interval resolution of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with history of cough and shortness of breath and fibrosis seen on outside CT. LUNGS AND PLEURA: Irregular, linear, and reticular opacities with microcystic honeycombing, and micronodules. Extensive traction bronchiectasis. This pattern is more pronounced in the subpleural region with the lower lobes more diffusely involved. Given a mixture of findings, this may represent a combined process with acute NSIP over chronic lung fibrosis. Serial imaging as indicated for further evaluation. MEDIASTINUM AND HILA: Tracheobronchomegaly. Cardiomegaly with enlarged main pulmonary artery which raises the question of pulmonary hypertension. Enlarged mediastinal lymph nodes with reference precarinal node measuring 21 x 14 mm as seen on image 32. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Diffuse pulmonary fibrosis with acute components of NSIP. Serial imaging as indicated for further evaluation.2. Tracheobronchomegaly3. Enlarged pulmonary artery which raises the question of pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with history of left IJ placement. The left costophrenic angle is excluded from the field of view. Left IJ catheter with tip projecting over the left brachiocephalic vein. Left-sided AICD with leads in expected location. Bilateral right central venous catheters with tip at the cavoatrial junction. Left basilar chest tubes, unchanged. ET tube 5 cm above the carina. Stable cardiomegaly. Decreased lung volumes with basilar edema, effusions, and atelectasis/consolidation.

Output: Left IJ catheter with tip projecting over the left brachiocephalic vein. Otherwise, stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male status post hemiarthroplasty with sustained tachycardia. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic the level of the lobar pulmonary arteries.LUNGS AND PLEURA: Mild centrilobular emphysema. Bibasilar atelectasis.Scattered micronodules. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: No PE. Study is diagnostic the level of the lobar pulmonary arteries.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: baselien eval pre kidney transplant Left ICD is again seen in place. Right central venous catheter has been removed. Incidental note is made of an azygos pseudo-lobe.No focal air space opacity, pleural effusion, or pneumothorax is identified.The cardiomediastinal silhouette is normal.

Output: No evidence of cardiomegaly or infection.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old Reason: lung infiltrate History: fever. cough Cardiomediastinal silhouette is unremarkable.Stable emphysematous changes without superimposed focal air space opacity.No pleural effusion. Biapical scarring unchanged.

Output: No acute cardiopulmonary abnormality. Emphysema without infection.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Fevers and hypotension. No focal airspace opacity or visible pleural fluid. Elevation of the right hemidiaphragm unchanged. Normal heart size. Right upper quadrant surgical clips.

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


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with metastatic bladder cancer CHEST:LUNGS AND PLEURA: Previously measured right middle lobe mass cannot be accurately measured on today's study due to new envelope surrounding consolidation in the right upper lobe. This mass cannot be differentiated from the surrounding consolidation.Index lesion in the left upper lobe now measures 2.7 by 1.5-cm image number 27, series number 4, stable. Another index lesion in the right lower lobe now measures 2.3 by 1.5-cm on image number 88, series number 4. This is also stable. Additional right lower lobe mass now measures 3.4 by 2.1-cm in image number 69, series number 4. This lesion is also stable.Previously described large ill-defined air space opacity with air bronchograms in the right lower lobe is unchanged. New air space opacity with air bronchograms has developed involving the right upper lobe.Interval development of small amount of right-sided pleural effusion.MEDIASTINUM AND HILA: Subcarinal lymph node measures 22 x 14 mm on image number 51, series number 3, stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy. Neobladder is unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Fat-containing bilateral inguinal hernia.

Output: Interval development of right upper lobe consolidation and small amount of right-sided pleural effusion. Index lesions in the chest are stable.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with history of lung cancer status post chemotherapy and radiation treatment. Compare to prior scan. CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema with scarring in the right lung apex is reidentified. The previously identified spiculated, heterogeneous mass in the posterior segment of the left upper lobe has decreased in size and now measures 23.6 x 9.4 mm as seen on image 28/104 (previously 32.2 x 23.2 mm). Interval decrease in size of the nodule previously demonstrated in the left major fissure. Scattered 1 mm micronodules are reidentified and are stable in appearance from prior scan. MEDIASTINUM AND HILA: Decrease in size of mediastinal and hilar lymph nodes with reference left prevascular lymph node measuring 8.6 x 4.7 mm as seen on image 32/145 (previously 19.5 x 14.7 mm).Increase in size of mural thrombus in the descending thoracic aorta which extends inferiorly to the origin of the celiac trunk with contrast defining a free edge as seen on image 84/145. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver appears less dense likely from fatty infiltration. The previously noted hypodense lesion in segment 5 of the right lobe liver is less discrete, however, increased in size from prior scan.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hypodense lesions in the kidneys are unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Interval decrease in size of spiculated mass in the left upper lobe of the lung and prevascular lymph node, however, increase in size of hypodense liver lesion.2. Increase in size of mural thrombus/atheroma in the descending thoracic aorta with contrast defining a free edge, which could embolize distally.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: Eval for cardiopulmonary disease. History: Cough x 1 month Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Healed left fracture.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: MaleReason for Study: Reason: Assess lung fields History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: 69M in CCU, h/o OHT, c/o abdominal/chest burning, ?volume overload, ?free air History: 69M in CCU, h/o OHT, c/o abdominal/chest burning, ?volume overload, ?free air Normal heart size and evidence of previous median sternotomy. Small lung volumes with no sign of CHF or infection.Focal lucency medially below the left hemidiaphragm could represent free intraperitoneal air. Either a standing erect chest radiograph, cross table lateral view or an abdominal CT scan is recommended for further evaluation.The findings were discussed with the CCU resident at the time of reporting.

Output: Possible free air in the abdomen. Further evaluation is recommended as described above.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male presents with tachycardia. Evaluate for pneumonia. The cardiomediastinal silhouette is stable. Mixed streaky and patchy retrocardiac opacities favored to be sequelae of aspiration. No focal pulmonary opacity suggestive of pneumonia. Blunting of the costophrenic angle appears chronic. Small hiatal hernia. No pneumothorax..

Output: 1.Retrocardiac opacities favored to represent sequelae of aspiration.2.Small hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: s/p liver surgery with diaphragm involvement History: assess for post operative injury or effusion. Central venous catheter terminates just below the cavoatrial junction. No focal lung consolidation. Probable mild basilar atelectasis. No large pleural effusion or pneumothorax. Heart size within normal limits. Surgical staples overlie the upper abdomen.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old. New right IJ venous catheter extending retrograde into the right subclavian vein.Right chest tube, NG tube and feeding tube unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Basilar opacities compatible with atelectasis and pleural effusions.

Output: New right IJ venous catheter extending retrograde into the subclavian vein.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: is there a pneumonia? History: cough, fever, crackles on exam The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with metastatic carcinoid tumor. History of colon cancer LUNGS AND PLEURA: There is demonstration of an 8mm nodule in the superior segment of the right lower lobe (image 55, series 5) and may represent a pulmonary metastasis. A small micronodule identified adjacent to the minor fissure may represent an intrapulmonary lymph node. Upper lobe predominant centrilobular emphysema . Scattered areas of scarring within the upper lobes. No evidence of pleural effusionsMEDIASTINUM AND HILA: Multiple mediastinal lymph nodes are identified with the largest in the precarinal region measuring 26.5 mm x 19.9 mm (image 41, series 3).Extensive coronary artery calcification as well as calcification of the aorta is noted. There is a mild pericardial effusion and/or pericardial thickeningCHEST WALL: There is lymphadenopathy within the right axilla (image 20, series 3).Extensive degenerative changes within the thoracic spineUPPER ABDOMEN: Multiple hypodense lesions within the liver, consistent with hepatic metastases. Partially visualized right renal cyst

Output: 1. Right axillary and mediastinal lymphadenopathy and multiple hepatic masses consistent with metastatic disease. A solitary 8mm nodule within the superior segment of the right lower lobe may represent a solitary pulmonary metastasis.2. Underlying centrilobular emphysema.3. Cardiac enlargement with a small pericardial effusion or thickening, CAD, and atherosclerotic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p R IJ TLC History: Previously reported history of prostate cancer Interval placement right IJ central catheter terminating at the level of the azygos vein.The patient is rotated to the left. Increasing opacification inferior right hemithorax favoring effusion and atelectasis. Multifocal pulmonary nodules and diffuse osseous sclerosis of widespread osseous metastases not significantly changed. Progressive left lower lobe consolidation. Lucency at the right apex may be artifactual; however, a small pneumothorax cannot be entirely excluded.

Output: Increasing right pleural effusion and consolidation left lower lobe. Possible trace right apical pneumothorax following central catheter placement.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Chest pain evaluate pneumonia. Postsurgical and post therapeutic changes related to left breast reconstruction and chest wall irradiation with mild pulmonary fibrosis.Diffuse groundglass opacity bilaterally could represent pulmonary edema however as this appearance has progressively worsened over time, interstitial lung disease cannot be excluded.Moderate to severe multichamber cardiomegaly, increased from 1/6/2015.

Output: Worsening cardiomegaly and groundglass opacities could reflect atypical pulmonary edema. However, given lack of documented resolution this raises suspicion for interstitial lung disease. Follow-up PA and lateral chest radiographs recommended to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: PNA History: AMS No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Refractory AML with cough. Left chest port unchanged in position. Normal heart size. No focal airspace opacities to suggest pneumonia. No pleural fluid or pneumothorax. Chronic apical pleural thickening unchanged.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 72 year old female with history of squamous cell carcinoma of the larynx treated with radiation and chemotherapy. Previous abnormal CT LUNGS AND PLEURA: Residual scarring is identified in the right upper lobe and both lower lobes without interval change. There is no interval change in the left upper lobe reference nodule (image 24, series 7). No new pulmonary nodules can be identified. There is no evidence of a pleural effusion MEDIASTINUM AND HILA: Reference mediastinal lymph node (image number 35, series 5) measures 20 mm x 7.2 mm without significant interval change. . There is evidence of previous coronary artery bypass surgery.CHEST WALL: Median sternotomy otherwise, unremarkable.UPPER ABDOMEN: No significant abnormality noted..

Output: Without interval change since the prior examination. There is no evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Biapical scarring and calcified granulomas are stable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Stable axillary lymph nodes. Reference right axillary lymph node measures 8 x 5 mm in image number 31, series number 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: 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: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: interval change History: respiratory failure 2/2 pulmonary edema Slight increase in the appearance of interstitial and air space opacities but this could be due to decreased lung volume since the prior study. Heart size normal.An NG tube extends into gas distended stomach. ET tube tip is 8 cm above the carina.

Output: Slight worsening of pulmonary opacities consistent with edema or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: balloon pump placement History: balloon pump Severe cardiomegaly.No specific evidence of infection or edema.IABP catheter proximal marker 2 cm below the top of the aortic arch.Left subclavian ICD, leads unchanged in position.Right jugular catheter, tip in SVC.

Output: Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: cough 4+ months History: cough The cardiomediastinal silhouette is normal.There are no focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old. New left jugular catheter extending across the midline with its tip directed cephalad in the area of the right brachiocephalic vein. This has been adjusted on the subsequent radiograph.Additional findings including pulmonary edema and pleural effusions, not significantly changed.

Output: Abnormal location of left jugular catheter.