Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: assess for pleural effusions/pulmonary edema History: CP and SOB Asymmetrical right paratracheal mediastinal widening. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size at the upper limit of normal.

Output: Asymmetrical right paratracheal mediastinal widening. Correlation with chest CT is suggested.Heart size at upper limit of normal.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: eval ETT, lung fields History: s/p CABG Endotracheal tube terminates 4.5 cm from the carina. Intra-aortic balloon pump is at the top of the aortic arch. Left-sided chest tubes and mediastinal drains are noted. Swan-Ganz catheter terminates within the right pulmonary artery. Left basilar pleural-parenchymal opacity. Right lung is clear. Unchanged cardiomegaly. No significant pneumothorax.

Output: Lines and tubes, as above. Left basilar pleural-parenchymal opacity, likely postoperative in nature.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: dry heaves History: retching Right -sided chest tube, right central venous catheter, and enteric tube with its tip in the distal esophagus unchanged.Stable cardiomediastinal silhouette.The lungs are clear.The large pleural effusions.Right rib fractures related to thoracotomy.

Output: No acute normality or interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for effusion, PNA History: Shortness of breath, hypoxia to 90% on RA; hx metastatic lung ca, bilateral crackles on exam Large left hilar mass compatible with known primary lung carcinoma.Basilar interstitial opacity, greater on the left, better characterized on the subsequent CT scan.Port catheter with its tip in the area of the right jugular vein.Lytic metastasis of the right fourth rib with associated soft tissue mass.Very small left pleural effusion.

Output: Findings compatible with known metastatic lung cancer. A CT scan has been performed and provides more detailed evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: preop redo MVr History: SOB Surgical changes in the chest wall and mediastinum.Marked cardiomegaly, with a somewhat globular morphology.Linear basilar atelectasis/scarring. Pulmonary vascular redistribution, without evidence of edema.No focal air space abnormality. No pleural effusions.

Output: Marked cardiomegaly, with abnormal contours, likely related to bilateral atrial enlargement. Pericardial effusion is an additional consideration. Recommend correlation with echocardiography and/or cardiac MRI.


Instruction: Generate impression based on medical findings.

Input: 65 years old Male. Reason: Evaluate Swan-Ganz placement History: Swan ganz in place. The cardiac and mediastinal silhouette is enlarged with bilateral interstitial changes and basilar opacities as well as bilateral small pleural effusions. There is no evidence of pneumothorax. The right Swan-Ganz catheter and cardiac pacemaker/defibrillator are stable in position.

Output: Cardiomegaly with bilateral interstitial changes and bibasilar opacities as well as bilateral small pleural effusions, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: check R IJ TLC placement History: check R IJ TLC placement Right IJ line terminates in the SVC. Enteric tube extends to the area of the stomach. Endotracheal tube again noted terminating approximately 5.5 cm from the carina. Bibasilar opacities and pleural effusions again noted. Mild pulmonary edema. No pneumothorax.

Output: Right IJ line without evidence of pneumothorax. Unchanged pulmonary edema, bibasilar opacities, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: pna History: unresponsive ET tube with its tip approximately 6 cm above the carina.Right Port-A-Cath with its tip in the SVC.Stable cardiomediastinal silhouette.Right pleural thickening/effusion and right basilar atelectasis similar to the prior exam.No new pulmonary opacities noted.Curvilinear metallic fragments overlying left apex and identified to be endovascular prior CT.

Output: No interval change without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: swan monitoring History: swan Bilateral costophrenic angles are excluded from the field-of-view.Right IJ central catheter terminates at the mid right clavicular head level, slightly retracted compared to prior.Severe cardiomegaly not significantly changed. Diffuse opacities of edema with small pleural effusions not significantly changed. Probable small pleural effusions remain. No pneumothorax.

Output: Severe cardiomegaly with mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: patient tachypneic and has a cough in setting of recent stroke, r/o pna History: patient tachypneic and has a cough in setting of recent stroke, r/o pna Mild cardiomegaly.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Interval evaluation for Swan placement. Heart transplant rejection. Visualized hardware and devices similar in position.The Swan-Ganz catheter from a right jugular approach is intermittently visualized due to motion, the tip can be followed to the level of the proximal right main pulmonary artery.Slight decrease in lung volumes. No specific evidence of pulmonary edema.

Output: Intracardiac portion of Swan-Ganz catheter is poorly visualized due to motion but appears to terminate at the proximal right main pulmonary artery level.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history metastatic breast carcinoma. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Stable scattered micronodules. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.Aberrant right subclavian artery.CHEST WALL: Previously noted sclerotic lesion in T11 vertebral body is less well visualized on this study. Stable nodular densities in left breast.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.Stable abdominal lymphadenopathy is seen for example on series 4, image 100/199.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable punctate hypodense foci within the kidneys.RETROPERITONEUM, LYMPH NODES: Stable, small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Overall stable CT exam on comparison to previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate effusions History: sob, known effusions Extensive bilateral pulmonary airspace opacity with cavitation in the left lung and moderate bilateral pleural effusions, not significantly changed.A more recent radiograph has been interpreted.

Output: Extensive pulmonary and pleural abnormalities, better characterized on a CT scan of the previous day, with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: evaluate for active TB History: The lungs and pleural spaces are clear. The heart size is normal.

Output: No evidence of active tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Fever and chills. Cough. Normal heart size. No focal air space opacities, pleural fluid or pneumothorax. Cholecystectomy clips.

Output: No signs of pneumonia or other acute pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: iabp placement History: see above The support devices are unchanged in position.Cardiomegaly is stable. Vascular redistribution without pulmonary edema. There is a skinfold at the right inferior hemithorax; no pneumothorax is present.

Output: Stable position of intra-aortic balloon pump.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with gist tumor CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: 3.7 x 2.5 cm enhancing mass in the superior mediastinum on image number 35, series number 3. Small amount of pericardial effusion. Calcified nodules are unchanged. Right lung base nodule measures 2 x 1.4 cm in image number 81, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multifocal mesenteric masses invading the stomach, predominantly in the left upper quadrant are again noted. Previously it measured dominant solid/mass measures 9.2 by 6.4-cm in image number 106, series number 3, not significantly changed. Referenced nodule abutting the stomach, now measures 17 x 12-mm image number 170, series number 3, not significantly changed. The mass invades the stomach, splenic hilum and abuts the body of the pancreas.Multiple enlarged lymph nodes in the small bowel mesentery are unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left ovarian cyst is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable left upper quadrant mass invading the stomach and mesenteric lymph nodes are grossly unchanged.Mediastinal mass as described above suspicious for metastatic disease..Calcified nodules and pericardial effusion are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.SOB, hypoxia, end-stage renal disease evaluate for infection versus fluid overload. Bronchial wall thickening and diffuse, somewhat clustered and nodular airspace opacities bilaterally. Increased retrocardiac opacity, obscured by the heart.Hardware and devices unchanged in position.

Output: Bronchial wall thickening with diffuse groundglass and subsolid predominantly airspace opacities may reflect a combination of hypervolemia/acute pulmonary edema and bronchopneumonia. Atypical infection such as Mycoplasma or viral pneumonia is included in the differential diagnosis. Suggest follow-up chest radiograph postdiuresis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#2 Cardiopulmonary monitoring and support devices, unchanged.Small lung volumes with lower zone opacity compatible with edema and atelectasis.No new findings.

Output: Lower zone edema and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with head and neck cancer status post chemotherapy and radiation. LUNGS AND PLEURA: Interval resolution of patchy airspace opacity. Linear scarring in the lingula, right middle lobe and lung bases. No pleural effusions.MEDIASTINUM AND HILA: Prominent precarinal nodes unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Hypodense lesion in the left hepatic lobe is unchanged.

Output: No evidence of intrathoracic metastases.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with non-Hodgkin's lymphoma in remission with known pancreatic head mass. CHEST:LUNGS AND PLEURA: Few calcified granulomas. Right apical scarring similar to prior.MEDIASTINUM AND HILA: Cystic heterogeneity of the thyroid, similar prior. Calcified right paratracheal and right hilar lymph nodes, similar to prior, suggestive of prior granulomatous disease.Moderate vascular calcifications of the coronary arteries and thoracic aorta.Mild diffuse esophageal wall thickening.CHEST WALL: Left axillary reference lymph node (series 4 image 20) measures 13 x 10 mm (previously 15 x 10).ABDOMEN:LIVER, BILIARY TRACT: Status-post cholecystectomy. Mild intrahepatic and extrahepatic biliary ductal dilatation, similar to prior with common bile duct measuring 10 mm. Common bile duct dilatation tapers abruptly at pancreatic head mass.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts, similar to prior.PANCREAS: Ill-defined pancreatic head mass (series 4 image 129) measuring 12 x 11 mm, unchanged. Diffuse pancreatic ductal dilatation with abrupt change in caliber at the site of pancreatic head mass, similar to prior.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes of the thoracolumbar spineOTHER: No significant abnormality noted.

Output: Stable exam1) Nonspecific pancreatic head/ampullary mass, similar to prior.2) Left axillary lymph node stable. No new lesions.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of non-small cell lung carcinoma status post chemo and radiotherapy. Please evaluate response to treatment. CHEST:LUNGS AND PLEURA: Previously seen micronodular and left upper lobe remain stable on series 4, image 24/115, likely representing intrapulmonary lymph node. Stable calcified granuloma left upper lobe. Previously referenced subpleural nodule in left lower lobe remains stable on series 4, image 70/115. MEDIASTINUM AND HILA: Previously seen heterogeneously attenuating anterior mediastinal mass has decreased in size, measuring 3.4 cm x 3.9 cm on series 3, image 40/219.CHEST WALL: Stable, nonspecific hypoattenuating lesion in right lobe of thyroid. Multiple sites of suspected rib fractures (for example on series 4, image 34/115 and on coronal image 86/164) are observed. Correlation with bone scan is advised to exclude metastatic lesions.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.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Interval decrease in size of the anterior mediastinal mass as detailed above with stable mediastinal adenopathy.2.Multiple suspected rib fractures as described above. Correlation with bone scan is recommended to exclude pathologic fractures.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: fever, eval for PNA History: fever, eval for PNA 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, 80 years old.Reason: patient to be discharged to SNIFF, SNIFF would like an XRAY prior to placement History: none Mild left basilar subsegmental atelectasis or scarring, as before. No new focal lung opacity. No large pleural effusion or pneumothorax. Unchanged heart size. Aortic atherosclerosis.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: ICU survey; assess lung fields, lines History: s/p AVR/MVR; respirator associated pnm; h/o L iatrogenic pneumothorax Improvement in basilar edema. Basilar atelectasis left greater than right persists, unchanged. Small pleural effusions are unchanged.No significant pneumothorax.Right chest tube unchanged in position.Right jugular dialysis catheter, tip projected over the right atrium.Second right jugular catheter tip in SVC.Tracheostomy tube tip approximately 5 cm above the carina.

Output: Improvement in basilar edema with persistent pleural effusions and basilar atelectasis left greater than right. No new findings.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male enrolled in clinical research program. Heart size is normal. No focal consolidation, pleural effusion, or pneumothorax.Multiple right rib deformities are again seen, compatible with old traumatic injury.13 mm pulmonary nodule seen in the left lower lobe.No pleural effusions.

Output: Left mid lung nodule may represent metastatic disease. Correlation with same-day CT is recommended.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Heart size upper normal, the aorta tortuous.Calcified granulomata.No evidence of metastases or other significant abnormality.

Output: No sign of metastases or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: hypoxemia History: worsening dyspnea Low lung volumes.Basilar atelectasis again seen, right greater than left.Opacity near the dome of the right diaphragm may reflect worsening atelectasis however superimposed aspiration or infection is possible.Tortuous thoracic aorta, consistent with age.Stable cardiac silhouette size.Chronic elevation of right hemidiaphragm.

Output: Low lung volumes and basilar atelectasis. Opacity near the dome of the right diaphragm may reflect worsening atelectasis however superimposed aspiration or infection is possible.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: eval lung fields History: s/p LVAD ] Right PICC line repositioned with tip now in the SVC.Swan-Ganz catheter has been removed.Left-sided ICD, chest/mediastinal tubes, and LVAD unchanged.Stable cardiomediastinal silhouette.Basilar opacities compatible with atelectasis and small effusions.

Output: Interval repositioning of right PICC line. Swan-Ganz catheter has been removed. Stable cardiopulmonary appearance with basilar atelectasis and effusions.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with chest pain x 4 hours; query PE CHEST:PULMONARY VASCULATURE: Left lower lobe subsegmental pulmonary embolus (series 7, image 187). Technically adequate studyLUNGS AND PLEURA: Large right pleural effusion with right basilar compressive atelectasis. Two left lung nodules are noted a suspicious for metastatic lesions. One is seen in the superior segment of the left lower lobe laterally (series 9, image 65), measuring 6 x 4 mm. A second is seen more inferiorly in the left lower lobe medially (series 9, image 100), measuring 8 x 6 mm. A questionable third nodule seen in the left lung base on series 9, image 113.MEDIASTINUM AND HILA: Bihilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Large, heterogeneous right breast mass with overlying skin thickening/involvement. The mass contains areas of fluid density, suggesting necrosis. There is extension into the upper chest wall (series 7, image 101). Left axillary adenopathy (series 80648, coronal image 52); right axillary lymph nodes appear necrotic. Right posterior chest wall deposits (series 80648, coronal image 12; also seen on series 7, axial image 183). Additionally, there is a slightly expansile, lytic lesion in the right transverse process of the T9 vertebral body (series 7, axial image 167; series 80648, coronal image 11).Left chest Port-A-Cath with catheter tip in SVC.UPPER ABDOMEN: No significant abnormality noted

Output: 1. Left lower lobe subsegmental pulmonary embolus as above;2. Large right chest wall mass as described above with axillary and intrathoracic lymphadenopathy and left lung nodules suspicious for metastases;3. Possible metastatic lesion to right transverse process of T9 vertebral body as above.Please note that this patient may have a second MR number under which prior studies have been performed. Current MR number lists no prior workup. If the patient's metastatic lesions have not been previously evaluated, a bone scan and dedicated rib and thoracic spine imaging may be considered if further investigation is clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: intubated, assess for interval change History: see above Transplanted left lung unchanged with stable mild basilar opacities.Unchanged fibrotic right lung.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach, the side port above the GE junction. Right jugular catheter, tip in SVC.

Output: Unchanged mild left basilar opacity, stable support devices, the NG tube high.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: dyspnea, heart failure? History: dyspnea worse lying down Right IJ port tip within the SVC.No cardiomegaly.Right greater than left streaky bibasilar opacities.No significant pleural effusion or pneumothorax.

Output: Minimal bibasilar atelectasis and/or scarring. No specific evidence of infection or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Cough Bilateral nipple shadows are noted. Lungs otherwise clear without consolidation, effusion, or edema. Heart size normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Displaced rib fractures status post fall, rib pain. Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Within this limitation, no significantly displaced fractures of the visualized ribs are appreciated.Normal heart size. No pneumothorax or pleural fluid. No focal pulmonary opacities.

Output: No pneumothorax or acute pulmonary abnormality. Although no displaced fractures are appreciated please note that this technique is suboptimal for evaluation and dedicated rib series should be considered if there is continued clinical suspicion for fracture.


Instruction: Generate impression based on medical findings.

Input: Reason: interval change, intubated History: ett Diffuse airspace opacity with multiple septal lines compatible with pulmonary edema, increased compared to previous.Increased bilateral pleural effusions.Right jugular catheter, ET tube and NG tube, without significant change.

Output: Increased pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Pneumonia History: sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna History: AIDS has not been taking meds, SOB, hypoxic, history of NSCLC in remission Unremarkable cardiac and mediastinal silhouette. Surgical clips and focal scar like opacity in the right lower lung, unchanged.Callus formation at healing rib fractures in the anterior right fourth and fifth ribs.No evidence of pneumonia or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain, relieved by nitro History: chest pain Normal heart size with a mitral valve ring in place.Approximately 12 mm nodular opacity projected medially in the right upper lobe which is indeterminate.Mild basilar scarring.No sign of pulmonary edema or pneumonia.

Output: Small right upper lobe nodule of uncertain etiology. Comparison with any available previous chest radiographs or CT scans from elsewhere is recommended to confirm stability. Otherwise, a thoracic CT scan would be appropriate for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Right-sided pleural calcifications are 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: Index periaortic lymph node is significantly smaller and now measures 6-mm in diameter on image number 104, series number 3. Other retroperitoneal enlarged lymph nodes are significantly smaller.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: Dominant right inguinal mass is also stable measuring 7.4 x 6.3 cm image number 203, series number 3. Other right inguinal lymph nodes however have increased in size. Index right inguinal lymph node measures 2.3 by 1.7-cm image number 188, series number 3. Index right femoral lymph node measures 2.6 by 1.5 cm on image number 190, series number 3. Left inguinal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the abdominal lymph nodes.Right inguinal dominant mass size is stable, however, other right inguinal lymph nodes have increased in size within the interval.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: lung infiltrate History: SOB; chest pain No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: decreasing FiO2; r/o effusion, volume overload History: SOB Normal heart size with a tortuous aorta and evidence of a previous median sternotomy with intact sternal hardware. Basilar opacities consistent with effusions and atelectasis, not significantly changed. Retrosternal opacity most consistent with postoperative hematoma/seroma, also unchanged from previous.

Output: Pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Chronic cough Moderately increasing tortuosity of the aorta without additional cardiopulmonary new acute abnormality. Minimal unchanged scarring in early COPD changes

Output: Mild COPD without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: R/O PTX post Rt. CT pull History: None Right basilar chest tube has been removed. Other iatrogenic devices are unchanged. Unchanged pulmonary edema pattern and bibasilar opacities with small pleural effusions. No pneumothorax. Unchanged cardiomegaly.

Output: Interval removal of right basilar chest tube without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: R/o new infiltrate History: Fever Residual right upper lobe opacity gradually improving with no new findings.Multiple embolization coils identified.

Output: Gradually improving right upper lobe opacity. No new findings.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with generalized weakness and recent syncopal episode. Normal cardiomediastinal silhouette. Minimal scarring at the left lung base, without interval change. No specific evidence of pneumonia. Azygous pseudolobe is again noted, a normal variant.

Output: Minimal scarring at the left lung base, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: 56M POD5 s/p cystectomy orthotopic neobladder with fever and tachycardia History: fever Postoperative pneumoperitoneum.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

Output: Postop pneumoperitoneum. No other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.ETT pulled out by 2-cm. Respiratory arrest. Endotracheal tube tip at 2.5-cm above the level of the carina. Lung volumes remain low. Bronchial wall thickening and patchy opacities in the right lung suggestive of aspiration. Blunting of the left costophrenic angle consistent with atelectasis/scarring.Diffuse subcutaneous emphysema and pneumomediastinum. Nondisplaced left lateral sixth rib fracture, but no visible pneumothorax.

Output: Pneumomediastinum and extensive subcutaneous emphysema. ETT tip at 2.5-cm above carina. Signs of aspiration on the right. Left nondisplaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Old myocardial infarct Old calcified hilar lymph nodes mildly decreased lung volumes an elevated right hemidiaphragm, of uncertain significance and chronicity. No superimposed acute pulmonary abnormality superimposed upon what may represent minimal scarring and/or atelectasis in the right lung baseCardiac and mediastinal contours are otherwise within limits

Output: Old suspected granulomatous disease exposure without additional superimposed acute abnormality. Exam limited without prior exams


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Acute heart transplant rejection. Hardware and devices similar in position.Cardiomegaly and mediastinal widening unchanged.The lungs appear clear.

Output: Unchanged cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Bladder cancer, evaluate for metastatic disease No suspicious pulmonary nodules or masses. Cardiac and mediastinal silhouettes are within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: Patient with multiple gunshotsVIEW: Abdomen and chest AP Chest: ET tube tip below the thoracic inlet and above the carina. Pulmonary opacity in the right lower periphery suggestive of contusion. There is overlying right hemithorax subcutaneous emphysema with bullet fragments. No tension pneumothorax is evident, but small pneumothorax cannot be excluded given the overlying device in the right apex. Cardiac apex, aortic arch, and stomach are left-sided. Cardiothymic silhouette is normal.Abdomen: Multiple bullet fragments scattered in the abdomen and pelvis with distended bowel loop measuring up to 5 cm. Largest fragment is in the right lower quadrant. Pneumoperitoneum cannot be excluded on this supine radiograph.

Output: ET tube tip in appropriate location. Right pulmonary opacities suggestive of pulmonary contusion with overlying bullet fragments. Multiple bullet fragments scattered in the abdomen and pelvis. Pneumoperitoneum cannot be excluded on this supine radiograph.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out chest metastasis History: hx of renal cell carcinoma sp partial nephrectomy Unremarkable cardiac and mediastinal silhouette.Small calcified granuloma at the left base compatible with previous infection.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p Chest Tube Placement History: b/l PTX Bilateral pleural catheters are projected over the periphery of the lower lungs.Bilateral pneumothoraces have resolved.Tracheostomy tube in place with subcutaneous emphysema bilaterally and residual mediastinal emphysema.

Output: Insertion of bilateral pleural effusions with resolution of pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Age: 23 yearsGender: MaleReason for Study: Reason: eval for pathology History: chest pain 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: Female, 30 years old.Reason: r/o infiltrate/pulm edema History: orthopnea, decreased BS Cardiomediastinal silhouette is within normal limits.Mild basilar linear interstitial opacities. No focal air space abnormality. No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female; 58 years old. Reason: eval for pleural effusions or infection History: SOB Right lung pleural and parenchymal scarring, unchanged. Minimal left basilar subsegmental atelectasis. Borderline cardiac enlargement. Stable IVC filter, partially visualized.

Output: Stable cardiopulmonary appearance without new air space opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with intrahepatic cholangiocarcinoma plus questionable pancreatic cancer. CHEST:LUNGS AND PLEURA: 4-mm right lower lobe nodule (series 5; image 42)MEDIASTINUM AND HILA: No significant abnormality.CHEST WALL: The right-sided port terminates in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: A right-sided internal/external the catheter courses through the liver and coils within the third portion of the duodenum. Minimal intrahepatic biliary ductal dilatation is again identified along with expected pneumobilia.The cholangiocarcinoma is again not well visualized, best visualized on MRI 6/4/09. Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: The ill-defined lesion in the pancreatic body is more conspicuous, measuring 1.8 x 1.5 cm (series 80232; image 38), and likely increased in size, though precise measurements on the prior examinations are difficult. Mildly increased pancreatic ductal dilatation is seen upstream to this lesion. contactADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimal residual striated nephrograms effect the left kidney, improved from 8/1/09RETROPERITONEUM, LYMPH NODES: Hazy soft tissue density is seen about the origin of the SMA, extending superiorly, unchanged from 11/08.BOWEL, MESENTERY: Status post gastric surgery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral adnexal cystic structures are increasing in size, the larger on the left measuring 3.7 by 3.3 cm. Layering hyperdensity within the larger cyst suggests hemorrhage.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: Pancreatic mass, likely increased in size, with increased upstream pancreatic ductal dilatation. Hazy soft tissue density about the origin of the SMA is unchanged from 11/08 and is of uncertain significance.Right internal/external biliary drain with mild residual intrahepatic biliary ductal dilatation.Bilateral ovarian cystic lesions, increasing in size. This can be followed with pelvic ultrasound to evaluate for stability/resolution.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with a right tonsillar mass LUNGS AND PLEURA: Scattered, calcified and noncalcified granulomas. No pleural effusion can be identified.MEDIASTINUM AND HILA: Marked enlargement of the thyroid gland with multiple hypodense masses. A heterogeneous mass in the right lobe of the thyroid gland (image 7, series 3) measures 4 cm. There is subsequent narrowing of the trachea to thoracic inlet.No mediastinal or hilar lymphadenopathy. Aortic and coronary calcifications.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: The severe degenerative changes and degenerative disk disease of the thoracic spine with kyphosis. This may represent ankylosing spondylitis.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Marked enlargement of thyroid gland with multiple masses. Large, heterogeneous 4-cm mass within the right lobe of the thyroid gland. There is subsequent narrowing of the trachea at the thoracic inlet.2. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT No acute cardiopulmonary abnormality. Vascular stents are present. Status post median sternotomy.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: resp insuf History: same Tubes and lines are unchanged.Stable cardiomediastinal silhouette.Bilateral pulmonary opacities and pleural effusions without significant interval change.Right apical pneumothorax redemonstrated.No new pulmonary opacities.

Output: Support devices unchanged. Stable cardiopulmonary appearance with pleural effusions and extensive bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Post device placement in EP lab. Left subclavian pacemaker unchanged. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.No visible pneumothorax.No signs of pulmonary edema or aspiration. Minimal costophrenic angle blunting may be due to pleural fluid. Right jugular sheath unchanged in position. Subcutaneous emphysema left chest wall. Right rib healed fracture deformities are chronic.

Output: No visible pneumothorax. Trace pleural fluid. New left subclavian dual-chamber pacemaker with leads in the right atrial appendage and right ventricular outflow tract.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Cough with sputum, immunocompromised. Faint airspace opacity in the right middle lobe suspicious for pneumonia in an immunocompromised post. Basal groundglass opacity bilaterally nonspecific and could reflect additional sites of infection or underinflation artifact. Heart size is normal. Pulmonary hila appear prominent and right hilar lymph node enlargement is suspected.

Output: Right middle lobe pneumonia and probable hilar lymphadenopathy. Additional basal opacities may also reflect infection but are nonspecific.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: chest pain, s/p bronchoscopy History: chest pain 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: PNA History: Seizure with aspiration No sign of aspiration or other acute change. Pacemaker leads in expected locations, unchanged.Tortuous aorta and brachiocephalic vessels.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: confirm LVAD placement Swan-Ganz catheter terminates within the interlobar pulmonary artery. Cardiac lead is unchanged. LVAD remains in place. No new focal pleural parenchymal opacity. Right basilar pleural-parenchymal scarring, as before. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: eval s/p shunt placement SHUNT DEVICE: Right frontal burr hole with ventriculostomy catheter tip near the midline. The VP shunt tubing courses down the skull, right neck, and anterior chest wall, and enters the abdomen and terminates in the pelvis. Portions of the shunt are radiolucent and difficult to assess, but we see no specific findings of complication. The valve points inferiorly towards the shunts tubing.SKULL: Skin staples along the skull reflect recent surgery. We see no acute abnormality.CERVICAL SPINE: Multilevel degenerative disc disease of the cervical spine with grade 1 anterolisthesis of C5 over C6. No acute abnormality.CHEST: Cardiomediastinal silhouette is within normal limits. No focal pulmonary consolidation.ABDOMEN: Intraperitoneal free air is noted under the diaphragm, which may be related to recent VP shunt placement. Nonobstructive bowel gas pattern. Degenerative disc disease and facet arthropathy affect the lumbar spine.

Output: Expected postsurgical changes of VP shunt placement as above.


Instruction: Generate impression based on medical findings.

Input: Status post resection HCC -- evaluate tumor recurrence and for metastases. CHEST:LUNGS AND PLEURA: No significant change since prior examination. Apical bullae seen and by basilar fibrosis/scarring seen. No parenchymal lung nodules or masses seen..MEDIASTINUM AND HILA: Calcified lymph nodes from prior granulomatous disease seen. No other abnormal mass. Vascular calcification seen..CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Prior right lobe resection. The prior noted segment 2 small 1.5 cm foci of abnormal enhancement is again seen (axial series 13, image 21 and coronal series 81013 image 67). At this time none of the portal venous or delay phases shows washout in the lesion is isointense with adjacent liver parenchyma. Lesion is never showed washout on prior examinations. The ill-defined margins today and the shape favors more and vascular flow phenomenon and may tumoral lesion.Small fluid collection in medial margin of resection line (series 15 CAM image 91) is unchanged. No new lesions identified. No biliary dilatation intrahepatic or extrahepatic is identified. Visualized left and middle hepatic veins and left portal venous branches are all patent and normal..SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: 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.

Output: 1. Status post right hepatic lobe resection. 2. Ill-defined arterial phase enhancement seen focally only on arterial phase and most likely represents vascular flow phenomena and not tumor. 3. Stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: on ventilator, tube placement History: as above Endotracheal tube tip is approximately 3 cm above the carina. Enteric tube in stomach. Central venous catheter tip is in the SVC. Left basilar chest tube is unchanged in position.Heart borders are obscured by overlying pleural effusion.Bilateral pleural effusions, which have increased in the interim, particularly on the right. There is associated basilar atelectasis/consolidation. No pneumothorax.

Output: Increasing large bilateral pleural effusions and multifocal airspace opacities, worse on the right.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Swan, severe PH History: above Cardiomegaly and signs of severe pulmonary hypertension again noted.Stable moderate right pleural effusion. No pneumothorax.Right lower lobe subsegmental atelectasis again noted.The left IJ Swan-Ganz catheter overlies the main pulmonary artery, unchanged in position.

Output: Moderate right pleural effusion, stable from priors.Stable position of support apparatus.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: r/o dissection in pt with hypertensive emergency History: HTN, shortness of breath Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.RFO trigger: BMI over 40 Suspected RFO location: chest Name of suspected RFO: N/A Attending Surgeon name/pager: balkhy Body Mass Index (BMI): 52.95 Portion of the left hemithorax is not visualized. ET tube tip is 4 cm above the carina. Right chest tube points towards the right apex. Additional right-sided drain. Nonspecific patchy airspace opacities likely subsegmental atelectasis. Mild cardiomegaly. No expected radiopaque foreign objects.

Output: No unexpected radiopaque foreign objects.Findings were discussed with Dr. Balkhy at 1638 on 9/23/15.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: eval lung fields History: s/p CABG Endotracheal tube terminates approximately 5 to 6 cm from the carina. Right IJ sheath is in place. Chest tubes noted bilaterally. Basilar opacities, likely atelectasis. No significant pneumothorax. Normal heart size. Status post cholecystectomy, as before. Small amount of left-sided subcutaneous emphysema.

Output: No unexpected postsurgical findings.


Instruction: Generate impression based on medical findings.

Input: 57 year old female with follicular lymphoma status post Allo-SCT with Clofarabine/melphalan/Campath, day 12. Patient with shortness of breath and increased edema. LUNGS AND PLEURA: Fluffy airspace opacities with a perihilar distribution and relative sparing of the periphery, involving the right lung field more than the left. Scattered micronodules are noted in the right upper lobe which are most likely post infectious in etiology though not specific, suggest follow up. Trace right effusion.MEDIASTINUM AND HILA: Mild to moderate cardiomegaly with a small pericardial fluid collection. Central venous catheter in the SVC.CHEST WALL: Right-sided axillary lymphadenopathy and skin thickening. Subcutaneous anasarca is seen. Due to lack of IV contrast, cannot evaluate patency of subclavian and axillary veins. Several small lymph nodes noted in the right axilla, with a subcutaneous collateral vessels noted in the anterior chest wall. A small breast density also on the right is seen on image 25.UPPER ABDOMEN: No significant abnormality noted. Status post cholecystectomy.

Output: 1. Alveolar pattern with a perihilar distribution, greater on the right than the left, which is suggestive of edema given the presence of pleural fluid. Alveolar hemorrhage or drug reaction cannot be excluded.2. Secondary findings of the right breast and chest wall are suggestive of venous stasis, correlation with right upper extremity ultrasound or venogram to exclude venous thrombosis may be of use if indicated clinically. Dr. Szmulewitz was text paged regarding this suggestion at the time of final interpretation.3. Nonspecific density right breast, suggest mammographic correlation.4. Punctate micronodules as above.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: assault, pain History: above Cardiomediastinal silhouette is unremarkable. No focal airspace opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.SOB, asthma exacerbation. Lung volumes remain low. Chronic basal scarring with improvement in previously seen superimposed bronchial wall thickening, atelectasis and peribronchial opacities. Minimal residual scarlike opacity remaining in the right middle lobe, nonspecific, but improved from some of the earlier films. No pneumothorax or visible pneumomediastinum.

Output: No new opacities to suggest acute infection. Chronic lower lung zone abnormalities with slight improvement in appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: sternal, rib fx? History: CP, back pain s/p MVA The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax. No displaced rib or sternal fracture.

Output: No acute cardiopulmonary disease. No displaced rib or sternal fracture.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval worsening hypoxemia, eval for progression of infiltrates and increased effusion size History: hypoxemia, coarse BS, culture confirmed PNA, decompensated heart failure Cardiomegaly with chest tubes but no pneumothorax.Overall, little change in basilar opacities suggestive of edema and aspiration.A Dobbhoff tube extends below the lower margin of the image.Right jugular Swan-Ganz catheter, tip in main pulmonary artery.Left subclavian ICD, leads unchanged in position.Stable LVAD.

Output: Little change in basilar opacities. No new findings.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with mantle cell lymphoma CHEST:LUNGS AND PLEURA: The previously described subcentimeter nodular opacities have overall improved. The reference lesion in the left lower lobe (series 4, image 66) now measures 4 x 2 mm; previously 6 x 6 mm.MEDIASTINUM AND HILA: The reference right hilar lymph node (series 4, image 39) measures 16 x 12 mm (previously 28 x 11 mm). The reference subcarinal lymph node measures 14 x 5 mm, previously 15 x 10 mm (series 4, image 43). The left hilar and mediastinal nodal prominence has resolved.CHEST WALL: The reference left axillary node measures 7 x 6 mm, previously 13 x 8 mm (series 4; image 17).Healing right lateral seventh rib fracture, new.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: The reference peripancreatic lymph node is stable, measuring 14 x 7 mm (series 3, image 93)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: 8 x 7 mm reference right common iliac lymph node (series 3, image 154), mildly decreased in size (previously 12 x 9 mm). The reference right external iliac lymph node now measures 12 x 4 mm (series 3, image 170), previously 14 x 7. The reference of right inguinal lymph node (series 3 comminuted 197) is mildly decreased in size, now measuring 10 x 10 mm (previously 12 x 10)BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Decrease in size of virtually all of the reference pulmonary nodules and lymph nodes.New healing right seventh rib fracture.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: evaluate for worsening pleural effusion or increasing lung metastatic dx, hx of MBC History: sob Left hemithorax volume loss and a layering effusion likely, unchanged.Healed granulomatous disease.No specific evidence of infection.

Output: Layering left pleural effusion unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath No pneumothorax following biopsy.Left lower lung zone opacities and nodules are present. Right lung unremarkable

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: central line in-NSVT-look for position of tunneled cath History: as above Unchanged pleural effusions and basilar opacities allowing for distribution of fluid.Right jugular catheter low in the right atrium.

Output: Right jugular catheter low in the right atrium. Unchanged pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Pneumonia History: fever Tracheostomy. Intact sternotomy fixation hardware. Left PICC tip at the level of the SVC. Cardiomediastinal silhouette similar to prior.Numerous pulmonary nodules compatible with metastatic disease.Persistent nonspecific basilar opacity likely reflecting a combination of effusions and atelectasis/consolidation, not significantly changed.

Output: No significant interval change in nonspecific basilar opacities; underlying infection would be difficult to exclude.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: pna History: sob No significant cardiopulmonary abnormality.No specific evidence of infection.Prior left base opacity has resolved.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: increased DOE over past 1-2 months History: as above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography. If symptoms continue, consider correlation with HRCT.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval ETT, lung fields History: s/p AVR, MVR Lines and tubes are unchanged. Mild pulmonary edema with patchy bibasilar opacities and pleural effusions and cardiomegaly again noted. No pneumothorax.

Output: Unchanged pulmonary edema, bibasilar opacities, and pleural effusions with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male 71 years old Reason: possible aspiration History: seizure Right chest wall Port-A-Cath tip terminates the cavoatrial junction.Unchanged streaky retrocardiac opacity with associated small pleural effusion suggestive of atelectasis/aspiration.The cardiomediastinal silhouette is normal.

Output: Left basilar atelectasis/aspiration and small pleural effusion not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: shortness of breath History: SOB Low lung volumes makes detailed cardiopulmonary assessment difficult. Right basilar pleural-parenchymal opacity, unchanged. Unchanged heart size. No pneumothorax.

Output: Unchanged right basilar pleural-parenchymal opacity. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: sob History: sob Decreased lung volumes with stable cardiac enlargement.No focal airspace opacities.No large pleural effusions.

Output: Cardiomegaly without acute abnormalities. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for PNA History: CP and SOB Stable cardiomediastinal silhouette.Nonspecific basilar linear interstitial opacities, compatible with atelectasis/scarring, unchanged. No new focal air space abnormality.

Output: Basilar atelectasis/scarring, unchanged, without acute abnormality. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: r/o infection History: rigors, tachy Lower lung volumes. Clear lungs. Mild bronchial wall thickening. No pleural effusion or pneumothorax. Increase in moderate cardiomegaly.

Output: Query bronchitis. Increase in moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: Intubated History: Intubated ET tube about 7 cm above the carina and feeding tube tip in the stomach.Mediastinal widening and enlarged cardiac silhouette consistent with pericardial effusion.Left chest tube in place with no significant pneumothorax. Lower zone opacity compatible with edema, atelectasis and small effusions.

Output: Stable pulmonary opacities and line position.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60M with history of ICM s/p LVAD here with ADHF. History: heart failure, vad Median sternotomy with moderate to severe cardiomegaly.Persistent lower lung zone edema and left basilar consolidation are unchanged.LVAD only partially imaged.Left subclavian ICD, leads unchanged in position.Right jugular catheter, tip in SVC. Diffuse tracheal narrowing may be from prior intubation, unchanged.

Output: Unchanged CHF with edema and basilar consolidation. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval lines and tubes History: as above Intra-aortic balloon pump again terminates at the level of the aortic arch. Swan-Ganz catheter terminates within the proximal aspect the left pulmonary artery. Other lines and tubes, unchanged and as expected. Diffuse pulmonary opacities with more confluent left lower lobe opacity and small pleural effusions again noted. Unchanged cardiomegaly.

Output: Diffuse pulmonary opacities with more confluent left lower lobe opacity and small pleural effusions again noted. Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: atelectasis History: hypoxemia Cardiomediastinal silhouette is unremarkable. Left basilar subsegmental atelectasis is noted. No pleural effusion or pneumothorax. Left shoulder fixation device is again identified.

Output: Left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: cough, ams History: above, vss No new opacity to suggest pneumonia. Atherosclerosis of the aortic arch.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 97 years old.Cough Mild cardiomegaly. Low lung volumes. No specific evidence of infection or edema. No pleural effusions.

Output: Mild cardiomegaly without specific evidence of infection or edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: persistent cough History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: cough, r/o pneumonia History: cough The heart is normal in size.Lung volumes are normal. No abnormal lung opacities. Specifically, no radiographic evidence of pneumonia.Surgical clips within the upper abdomen again noted.No pleural effusion or pneumothorax.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: widened mediastinum, effusion, pna, cardiomegaly History: chest pain, palpitations daily x 2-3 episodes over the last month. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Cough, history of malignant neoplasm of esophagus. Post chemotherapy, RT, esophagectomy. Follow previously measured basilar interstitial opacities and pleural thickening. Right chest port unchanged in position. Small pleural effusions. Opacity in the inferior paramediastinal regions is most consistent with compressive atelectasis, though it is incompletely assessed by plain film. Stable blunting of the right costophrenic angle region. No pneumothorax or suspicious pulmonary nodules are appreciated.

Output: No significant change from the prior examination. Basal opacities and pleural fluid unchanged.


Instruction: Generate impression based on medical findings.

Input: Colon cancer status post chemotherapy CHEST:LUNGS AND PLEURA: Reference right lower lobe nodule measures 6 x 6 mm image number 68, series number 6, unchanged. Other subcentimeter nodules in both lungs are also unchanged.MEDIASTINUM AND HILA: Borderline enlarged right hilar lymph node is also unchanged measuring 13 x 10 mm image number 46, series number 5.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: A few round subcentimeter hypodense lesions scattered in the liver are stable.SPLEEN: Splenic cyst and calcifications are unchanged.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, ADNEXAE: Small fibroid is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter lung nodules and right hilar lymph node are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: pneumonia? History: fever with severe cough and vomiting Lungs hypoinflated though there is no focal opacity to suggest pneumonia.

Output: Hypoinflation but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.General weakness question pneumonia Upper normal heart size and tortuous thoracic aorta unchanged. No focal airspace opacities, pleural fluid or pneumothorax. Heavily calcified aorta. Surgical clips in the upper abdomen. Bony erosion in the lower cervical spine poorly visualized but unchanged.

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


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with postmenopausal bleeding and anterior cervical mass 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Cervix is enlarged and contains air and hyperdense material. Evaluation of the cervix and uterus is extremely limited fetal echo of IV contrast. Left ovarian mass measuring 5.8 x 2.9 cm image number 151, series number 3, new compared to previous study.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion in the left acetabulum is unchanged.OTHER: No significant abnormality noted.

Output: Enlarged uterus and cervix, suspicious for endometrial or cervical carcinoma.New large cystic ovarian mass on the left side.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: eval pna History: as above Pleural effusions and basilar consolidation suggestive of infection or aspiration.Median sternotomy, heart size upper normal.Left subclavian dual chamber pacemaker noted.

Output: Pleural effusions and basilar opacities suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate or effusion, known hx renal ca with lung mets History: cough Multiple bilateral pulmonary chills, compatible with metastases.Partial atelectasis of the right upper lobe consistent with bronchial obstruction by tumor.No sign of pneumonia or significant pleural effusion.A CT scan has been performed and provides more detailed evaluation.

Output: Multiple pulmonary metastases with endobronchial involvement and partial right upper lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of renal cell carcinoma CHEST:LUNGS AND PLEURA: Bilateral lung masses consistent with metastatic disease. Large, lobulated mass in the right lower lobe measures 5.2 by 4.9 cm on image number 51, series number 10278. Left lower lobe atelectasis. Small bilateral pleural effusions. Right-sided pleural calcification.MEDIASTINUM AND HILA: Mediastinal adenopathy measuring 1.3 by 1.7-cm in image number 32. Other mediastinal adenopathy is also present.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: 1.9 x 1.6 cm hypodense lesion in the right lower liver. Etiology is unknown.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Erosive changes affecting the endplates of L3 and L4 vertebral bodies with enhancing soft tissue lesion centered on the disk space. These findings are suspicious for spondylo-diskitis. Further evaluation with MRI of the lumber spine is recommended.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral lung metastases. Mediastinal likely metastatic adenopathy.Indeterminate liver lesion. MRI may be helpful for further evaluation.Possible swallowed diskitis affecting the lower lumber spine. MRI is recommended for further evaluation and time to exclude metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 85 yearsGender: MaleReason for Study: Reason: Rule out pulm edema History: SOB Left-sided ICD unchanged.Decrease lung volumes with stable cardiac enlargement.Nonspecific basilar opacities are compatible with atelectasis.No focal or is a consolidation identified.No large pleural effusions.

Output: Basilar atelectasis without specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: 22 year-old male with history of PICC placement. Right upper extremity PICC tip deep in the right atrium.Low lung volumes. Unchanged cardiomediastinal silhouette. No focal air space opacities, pleural effusions, or pneumothorax.

Output: Right upper extremity PICC tip deep in the right atrium.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with increased bilateral leg swelling and increased shortness of breath x1 week. Evaluate for pulmonary edema. No focal airspace opacities. No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Lupus. Shortness of breath. Normal cardiomediastinal silhouette.No specific evidence of infection or edema.No pleural effusions.No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Dehydration and elevated white count Motion degrade sensitivity.Decreased lung volumes with minimal basilar changes suggesting atelectasis with a possible small right effusion. Follow-up serial imaging will be helpful. No definite significant focal airspace processCardiac and mediastinal contours are grossly within limitsLarge hiatal hernia

Output: Large hiatal hernia with questionable small right effusion. No definite distinct acute cardiopulmonary abnormalities. Limited exam


Instruction: Generate impression based on medical findings.

Input: Reason: s/p Aortic Dissection repair History: Aortic Dissection repair Swan-Ganz catheter tip in the right main pulmonary artery. Moderate cardiomegaly with basilar subsegmental atelectasis.No pneumothorax or other acute change.

Output: Cardiomegaly and mild atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: s/p right thoracentesis and pleurx placement History: ? pneumo Right Pleurx catheter placement with no pneumothorax and improvement in right pleural effusion.The lungs are better inflated with improving edema and persistent left lower lobe consolidation, as well as moderate to severe cardiomegaly.New right jugular catheter, tip at SVC/RA junction level. Other tubes and catheters are stable.

Output: Right Pleurx catheter placement, with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: SOB, atelectasis? History: SOB Lungs hypoinflated. Venous catheter tip at RA/SVC junction. Minimal basilar edema or atelectasis. Abdominal surgical clips; equivocal pneumoperitoneum is presumably postoperative.

Output: Minimal basilar edema or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old Reason: eval for infection History: CP and coughing No focal airspace opacity.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is normal.

Output: No specific evidence of infection or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: ams History: ams Leftward patient rotation makes detailed pulmonary evaluation difficult. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Retrocardiac opacity is slightly more conspicuous than previous study, possibly related to leftward patient rotation. Monitoring presence is reassuring, however.

Output: No focal lung consolidation or evidence of overt left-sided heart failure. Retrocardiac opacity is more conspicuous than previous study which may be related to leftward patient rotation though the fact that it has been present since 2005 is reassuring. Consider correlation with PA and lateral radiograph.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old with Hx of right thoracotomy upper lobe resection and chylothorax Right chest tubes stable in position with subcutaneous emphysema along the right chest wall. Right apical pneumothorax is better visualized on this exam.Right lung volume loss consistent with history of lobectomy. Persistent right airspace and interstitial opacities. No significant pleural effusions.

Output: Right lung post-operative changes with persistent airspace/interstitial opacities. Right apical pneumothorax is better visualized on this exam.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with history of squamous cell cancer of the base of tongue, had lung lobectomy on the left. LUNGS AND PLEURA: The left upper lobe mass has been resected with adjacent postoperative changes and extensive soft tissue thickening along the suture line. Though this is likely post surgical scarring, disease recurrence cannot be excluded and continued follow-up is recommended.Right upper lobe (axial image 35/102) and left upper lobe (axial image 38/102) nodules are new and likely post inflammatory, though continued follow-up is recommended.No pleural effusion.MEDIASTINUM AND HILA: Tracheostomy in place. Bronchogenic versus esophageal duplication cyst in the right infrahilar region is unchanged. A calcified right hilar lymph node likely reflects prior granulomatous disease. Cardiac size is normal with no pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: A G-tube is present. Splenic and liver calcifications are unchanged. The pancreatic duct is mildly dilated, unchanged.

Output: Interval left upper lobe nodule resection with soft tissue surrounding the suture line. Though this likely represents post operative scarring, continued follow up is recommended.Two new subcentimeter pulmonary nodules are seen and are likely postinfectious, but continued follow-up is recommended to exclude additional metastases at this location.


Instruction: Generate impression based on medical findings.

Input: Male 14 years old; Acute onset of headache for 5 days in patient with vp shunt, dandy walker syndrome.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 8/24/2016, 0639 hours Ventriculostomy tube tip is just adjacent to midline in the middle cranial fossa. A right-sided burr hole is present in the posterior parietal region with the valve reservoir mechanism in the parietal soft tissue. There is a radiolucent area of catheter just after exiting the skull that is unchanged in position. Distal shunt tubing courses along the neck chest and enters the peritoneal space in the right upper quadrant. The caudal tip of the catheter terminates in the left lower abdominal quadrant. No shunt discontinuity seen. Bowel loops are not displaced from the tip of the catheter.The cardiothymic silhouette is within normal limits. No focal lung opacities are seen.There is average stool burden.

Output: No evidence of extracranial shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Severe emphysema and scattered regions of fibrosis similar to a recent CT.No evidence of superimposed edema or pneumonia.Unremarkable mediastinal contours and cardiac silhouette.

Output: Severe emphysema. No superimposed abnormality.


Instruction: Generate impression based on medical findings.

Input: 66 year old female with chronic cough. Evaluate for sarcoidosis, baseline filrm. Bilateral perihilar lymphadenopathy compatible with known sarcoidosis. No focal airspace opacities. Right basilar streaky opacities likely scarring or atelectasis. No pleural effusion or pneumothorax.

Output: Perihilar lymphadenopathy unchanged from 2003 compatible with known sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT History: eval ETT ET tube tip approximately 5 cm above the carina.Right jugular catheter unchanged.No significant pulmonary abnormalities.

Output: Interval advancement of ET tube.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Right central venous catheter with its tip in the SVC.Cardiac size cannot be adequately evaluated due to bilateral pleural effusions.Basilar atelectasis without focal areas of consolidation.Median sternotomy and CABG with several of the sternal wires to fractured.

Output: Mild/moderate bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: r/o infection, edema, effusion History: chest pain, shortness of breath The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.IVC filter in expected location.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Reason: 69 y/o lady w/ a ? empyema History: 69 y/o lady w/ a ? empyema Large left loculated hydropneumothorax with a chest tube in place, not significantly changed.Adjacent partial atelectasis of the left upper lobe.Moderate right pleural effusion.

Output: Left hydropneumothorax, which may represent an empyema, and right pleural effusion without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Lung Cancer Unchanged cardiomegaly. Elevation of the right hemidiaphragm is secondary to postoperative volume loss. Pulmonary nodules and calcified right right hilar lymph nodes are unchanged with diffuse coarse peripheral and basilar predominant fibrotic interstitial abnormality. No specific evidence of superimposed infection.

Output: Pulmonary nodular fibrosis is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: eval ET tube History: ET tube Moderate cardiomegaly with left lower lobe consolidation and left pleural effusion noted, unchanged.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Right subclavian catheter tip at right atrial level.

Output: Unchanged cardiomegaly and left basilar opacity with a left pleural effusion. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Chest pain question acute chest Right chest port unchanged in position. Upper normal heart size. No pleural fluid or pneumothorax. Faint opacities at the left base may reflect infection.

Output: Faint left basal opacities suspicious for infection.


Instruction: Generate impression based on medical findings.

Input: Reason: sepsis History: sepsis Elevated left hemidiaphragm with basilar atelectasis or scarring, unchanged.Blunting of the right costophrenic angle compatible with a small effusion or scarring.Catheter tip in the upper right atrium.Hiatal hernia and adjacent atelectasis contributing to right retrocardiac opacity.

Output: No sign of pneumonia or other acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: pneumonia, cardiomegaly, effusion History: hx of lupus, here with abd pain, n/v/d, fever, infectious workup No pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement, History: ETT placement ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC.Nonspecific diffuse pulmonary opacities, at least partially chronic, with probable pleural effusions.Normal heart size with enlarged central pulmonary arteries consistent with pulmonary hypertension.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with history of carcinoid, status post resection CHEST:LUNGS AND PLEURA: Calcified right micronodular in the right upper lobe unchanged. No new nodules.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple liver cysts are unchanged. Index lesion in the right lobe of the liver measures 4.3 by 3.4 cm on image number 100, series number 7, minimally increased in size. There is a new hypodense lesion in the left lobe, best seen on image number 93, series number 7 measuring 2 x 1.6 cm.SPLEEN: No significant abnormality notedPANCREAS: There is a new hypodense lesion in the body of the pancreas measuring 2.1 x 2 cm image number 105, series number 7. Upstream pancreatic duct is mildly dilated and distal body and tail of the pancreas enhances less. This lesion may represent a primary pancreatic adenocarcinoma versus a metastatic lesion.ADRENAL GLANDS: Nodular adrenal glands unchanged.KIDNEYS, URETERS: Bilateral renal cysts are stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Partially calcified mesenteric soft tissue mass measures 2.9 x 2.3 cm on image number 139, series number 7, not significantly changed. Other mesentery nodes are also stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval development of a pancreatic mass causing upstream ductal dilatation. This may represent a primary pancreatic adenocarcinoma versus metastatic lesion.Minimal interval increase in the size of the right lobe metastatic lesion. A new possible metastatic lesion in the left lobe.Mesenteric mass is stable.


Instruction: Generate impression based on medical findings.

Input: Age: 86 yearsGender: FemaleReason for Study: Reason: r/o cat p History: cough for 1 week- post tussive emesis Left-sided ICD unchanged.Stable cardiac enlargement.Interval improvement in the right basilar atelectasis.Small bilateral pleural effusions identified.No new pulmonary opacities noted.

Output: Stable cardiac enlargement with small bilateral pleural effusions and interval improvement in right basilar atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: eval ETT, lung fields History: s/p AVR, MVR Status post sternotomy and AVR/MVR Endotracheal tube terminates approximately 5.5 cm from the carina. Swan-Ganz catheter remains within the pulmonary artery. Mediastinal drains are noted. Mild pulmonary edema. New small left pleural effusion and patchy left basilar opacity. No pneumothorax.

Output: Expected postoperative appearance status post AVR and MVR.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: eval for PNA History: fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: 26-year-old male with shortness of breath, evaluate for parenchymal disease LUNGS AND PLEURA: Redemonstration of diffuse bronchial wall thickening.Inspissated bronchus and bronchocele within the left upper lobe slightly more prominent than on prior exam and again consistent with allergic bronchopulmonary aspergillosis.No evidence of interstitial lung disease.No evidence of air trapping.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Airway thickening, compatible with asthma. Left upper lobe inspissated bronchus and bronchocele more prominent than prior exam and compatible with allergic bronchopulmonary aspergillosis.2.No evidence of interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: evaluate for pneumothorax History: chest pain and dyspnea after smoking crack New right basilar opacity and small lung volumes.Small right pleural effusion.Small lung volumes.Heart size normal.

Output: New right basilar opacity and small pleural effusion more suggestive of infection or aspiration than crack lung.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: FemaleReason for Study: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left-sided ICD is identified with lead wires in the right atrial appendage, right ventricle, and coronary sinus.Stable cardiac enlargement.The lungs are clear.No pleural effusions.No pneumothorax.

Output: . Placement of a left-sided ICD without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: 63yo M w/ recent hypercarbic respiratory failure, now intubated, check for ETT placement History: as above ET tube tip 4 cm above the carina. NG tube is coiled in the upper esophagusSmall bilateral pleural effusions with basilar edema and atelectasis. Cardiomegaly.

Output: ET tube tip 4 cm above the carina. NG tube is coiled in the upper esophagus


Instruction: Generate impression based on medical findings.

Input: Metastatic pancreatic cancer. CHEST:LUNGS AND PLEURA: Micronodules in the right upper lobe are unchanged. Hazy air space opacities seen in the right lower lobe and in the right middle lobe have increased. Similar air space densities are also seen in the left lower lobe. These focal areas are not suspicious for metastatic disease however drug toxicity or infection cannot be excluded.MEDIASTINUM AND HILA: Enlarged lymph nodes in the pericardial recess a smaller now measuring 15 x 10 mm on image number 55/211.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver. Multiple metastases in the liver, increasing number. The lesion in segment 8 has increased in size now measuring 5.9 x 5.1 cm image number 64/211. Second lesion in segment two measures 3.9 x 2.8 cm on image number 67/211.SPLEEN: Ill-defined 1 cm subtle hypodense lesion, unchanged from previous CT.PANCREAS: Air is noted within the soft tissue mass in the head of the pancreas. This may be secondary to an abscess or neck glottic/infected tumor. Soft tissue mass measures 2.4 x 2.2 cm and encases the acentric vessels.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left para-aortic lymph node now measures 2.2 x 1.3 cm on image number 86. Multiple other enlarged lymph nodes are seen in the retroperitoneum. BOWEL, MESENTERY: Postop changes.BONES, SOFT TISSUES: Mostly air-containing collection in the subcutaneous tissues in the midline fistulas into the skin. No communication with the abdomen is noted.OTHER: Small amount of ascites.PELVIS:UTERUS, ADNEXAE: 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: Small amount of ascites.

Output: Possible abscess in the region of the pancreatic head. Interval progression of disease with increase in the number and size of the hepatic metastases. Interval increase in the size of ascites.Interval increase in the irregular airway opacities in the lungs which may be secondary to drug toxicity.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: Cough x2 weeks, febrile, rales on exam History: respiratory distress / increasing work of breathing Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Small amount of right-sided pneumoperitoneum.

Output: Small amounts of pneumoperitoneum underneath the right hemidiaphragm, likely related to recent C-section. No focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Fever, elevated CRP rule out pneumonia. NuPulse counterpulsation device unchanged in position. Interval placement of a left sided peripheral catheter which terminates over the left axillary vein region.Small to moderate right pleural fluid collection similar in volume. Minimal pleural fluid on the left blunting the cardiophrenic angle. Left lower lobe basal opacity posteriorly more suggestive of atelectasis than infection, though he latter is not entirely excluded.Unchanged cardiomegaly.

Output: No conclusive evidence of pneumonia; left basal opacity near the costophrenic angle is most suggestive of atelectatic lung however serial plain film follow-up is suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: sob History: sob 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, 45 years old.Increasing shortness of breath. Left chest wall port, with tip terminating at the cavoatrial junction, unchanged. Left hydropneumothorax, with new moderate to large effusion. Small to moderate right pleural effusion with adjacent atelectasis, unchanged.

Output: Left hydropneumothorax, with new moderate to large effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: fever History: fever Left PICC line with its tip in the SVC.Decreased lung volumes.The cardiac mediastinal silhouette is unremarkable.Left retrocardiac consolidation/atelectasis may be source of infection.Small left pleural effusion.

Output: Left retrocardiac consolidation/atelectasis and small left pleural effusion may be a source of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: eval for pneumonia History: cough, sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: chest pain and SOB History: chest Pain and SOB Minimal left basilar subsegmental atelectasis or scar. Clear lungs otherwise. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Fever Unremarkable cardiac silhouette.Streaky left mid and lower lung opacity likely representing subsegmental atelectasis.No specific evidence of infection or edema.

Output: Left lower lobe subsegmental atelectasis, without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT terminates 4 cm above the carina. Mild nonspecific cardiac megaly basilar patchy changes and moderate layered effusions with decreased lung volumes suggests mild edema.

Output: ETT well-positioned


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: eval for acute cardiopulmonary abnormality History: sob, cough Moderate cardiomegaly. Small lung volumes but no specific evidence of edema or pneumonia.Marked degenerative or erosive abnormalities affect both shoulders.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain The heart size at about upper normal with intact sternal fixation devices.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: STEMI History: STEMI The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Mitral valve replacement. ET tube approximately 5 cm above the carina.Sternotomy hardware, right chest tube, two mediastinal drains, and Swan-Ganz catheter in the right pulmonary artery noted.The previously seen radiopaque prosthetic mitral valve is no longer visualized.Cardiomegaly, similar to prior.Low lung volumes with bibasilar subsegmental atelectasis. No specific evidence of infection or edema.

Output: Postsurgical changes with low lung volumes and bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain unspecified Persistent and essentially unchanged edema with effusion and atelectasis. Small and volumes with moderate nonspecific cardiomegaly again observed.Mediastinal chest tubes removedSwan-Ganz extending into the right pulmonary outflow track appears similar position, extending from the left jugular sheath.

Output: Unchanged subclavian and mediastinal chest tubes removed


Instruction: Generate impression based on medical findings.

Input: Reason: 27F pmh AICD, CHF History: CP, SOB Marked cardiomegaly with ICD leads in place, unchanged.No evidence of pulmonary edema or visible effusions.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Age: 38 yearsGender: MaleReason for Study: Reason: 38yo M s/p proning, eval for ETT and infiltrates History: as above Support devices unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Basilar and peripheral interstitial and groundglass opacities similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged the ET tube approximately 5 to 6 cm above the carina. Stable cardiopulmonary appearance with diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 67 year old female with history of cervical cancer. Evaluate disease. CHEST:LUNGS AND PLEURA: Postsurgical changes in the right lung. Right apical scarring is unchanged. Possible intrapleural lymph node on the right is unchanged (image 44, series 5).MEDIASTINUM AND HILA: Reference right carinal lymph node measures 0.8 cm by 0.7 cm (image 44, series 3), previously measuring 0.8 cm x 0.8 cm.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Homogeneously hypodense lesions predominantly in the left hepatic lobe are not significantly. The largest lesion measures 2.2 cm x 2.6 cm (image 110, series 3), previously measuring 1.8 cm x 2.5 cm.Cholecystectomy clips in place.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodularity of the left adrenal gland is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A soft tissue prominence in the location of the prior surgical scar in the anterior abdomen (image 174, series 3) appears slightly decreased in size.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Right vulvar mass measures 2.8 cm x 2.3 cm (image 197, series 3), previously measuring 2.8 cm x 2.5 cm.Nodular prominence exerting mass effect on the posterior bladder is unchanged dating back to 2005. This may represent a prominent skene gland. 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 examination with no significant interval change of the reference lesions as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: pt with leukemia with port needed picc for chemo/abx History: none PICC line from the left arm extending to the SVC. Port catheter also extending to the SVC.No significant cardiopulmonary abnormalities.

Output: PICC line tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Chylothorax Unchanged pigtail right catheter into surgical chest tubes on the left. No evidence of new superimposed cardiopulmonary abdomen the oral recurrent pneumothoraces.

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Stage IV colon cancer. Baseline needed prior to starting study. Left jugular chest port tip in the right atrium.Normal heart size.New 18 mm nodule in the right upper lobe, consistent with metastasis. No focal airspace opacities, pleural fluid or pneumothorax.Degenerative changes of the spine with osteophyte formation.Subcarinal lymphadenopathy not well visualized, please refer to recent CT.

Output: New 18 mm right upper lobe nodule consistent with a metastasis. Subcarinal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Exam limited with cut off of the left chest wall and lung baseOld healing rib fractures on the right without additional new cardiopulmonary abnormality. Scoliosis.

Output: No new acute disease yet see limitations described


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: r/o pneumonia History: sepsis A right single lumen port is currently accessed. The catheter terminates in the central superior vena cava.There are small bilateral pleural effusions with mid to lower zone subsegmental atelectasis. Heart size is within limits of normal. The right hilum appears enlarged, possibly accentuated by rightward rotation. Focal opacities at the right suprahilar location warrant further follow-up with PA and lateral imaging.

Output: Small pleural effusions with mid to lower zone subsegmental atelectasis. Opacities in the right suprahilar location warrants further evaluation with a PA and lateral radiograph.


Instruction: Generate impression based on medical findings.

Input: 41 years old Female. Reason: ETT change, assess position History: ETT change, assess position. There is a questionable patchy opacity in the right lower lung. There is no evidence for pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Questionable patchy opacity in the right than the lung. Subsequent chest x-ray has been reported.