Instruction: Generate impression based on medical findings.

Input: Angiosarcoma CHEST:LUNGS AND PLEURA: New bilateral pleural effusions. Cardiomegaly is unchanged.MEDIASTINUM AND HILA: Index mediastinal lymph node is unchanged measuring 1.6 by 1.1 cm on image number 27, series number 7.CHEST WALL: Index left axillary lymph node is slightly smaller measuring 1.1 x 0.8 cm on image number 9, series number 7.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: 2.7 x 2.4 cm hypervascular lesion in the spleen is unchanged and best seen on arterial phase images.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left upper pole nephrolithiasis is unchanged. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes involving the posterior elements of the vertebral bodies at the thoracic level. These findings are better characterized on the spine MRI dated 5/25/2011.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: Postsurgical changes involving the thoracic spine. Splenic lesion is unchanged.New bilateral small pleural effusions and cardiomegaly. No significant change in the size of the index mediastinal and left axillary lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Chest pain workup. Normal cardiomediastinal silhouette. No focal airspace opacities, pleural fluid or pneumothorax. Right upper quadrant surgical clips.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: swan History: hf Moderate cardiomegaly.Mild interstitial edema is noted without pleural effusions or infection.IVC Swan-Ganz catheter, tip in proximal left descending pulmonary artery.

Output: Unchanged Swan-Ganz catheter and mild edema.


Instruction: Generate impression based on medical findings.

Input: Head and neck cancer, fever and risk of aspiration Again no acute cardiopulmonary abnormality other than mild COPD changes. Mildly tortuous aorta and unchanged right jugular dual port.

Output: Mild COPD without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Post device placement in EP lab question pneumothorax. Left subclavian ICD leads are unchanged in position and appear intact. No significant pneumothorax.No focal airspace opacities. Trace pleural fluid on the right.

Output: No significant sized pneumothorax. Trace volume of pleural fluid on the right.


Instruction: Generate impression based on medical findings.

Input: 84 year old male with right flank bruising, low platelets, status-post biliary placement of a drain on 9/3/09. Please evaluate for retroperitoneal, hepatic bleeding. CHEST:LUNGS AND PLEURA: New bilateral pleural effusion. Multiple areas of patchy groundglass opacities noted in bilateral upper lobes, lingular lobe, on bilateral lower lobe. Differential includes infection, hemorrhage. Massive cardiomegaly. MEDIASTINUM AND HILA: Incidental note is made of a aberrant right subclavian artery.Diffuse coronary calcifications are seen. The left atrium is enlarged. Calcific densities are seen at the atriocaval junction. A few calcified subcarinal lymph nodes are noted (image 37, series 3)..CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver demonstrates fissural prominence, nodular surface and enlargement of left lobe, consistent with cirrhotic morphology. A IR placed biliary drain is noted in appropriate location with the tip of the pig tail catheter in the second part of duodenum. Cholecystectomy clips identified. Exact measurement of the right anterior segment mass involving segment 8 and segment 4 A is difficult. It is best seen on image 67, series 3, and measures 5.6 x 5.6 cm, unchanged in comparison with prior study. The mass at appears to extend inferiorly and medially towards the hilum. Subcapsular retraction is identified about the inferior to it best seen on image 72 of series 3. Another subtle ill-defined low-attenuation lesion is identified in segment 7 of right lobe of liver (image 71, series 3, that appears unchanged in comparison with prior study. No obvious new lesions identified. Small esophageal varices are noted . Interval increase in ascites noted.SPLEEN: The spleen is enlarged, 16.4 cm without any obvious focal lesions. Vascular calcifications noted in the splenic hilum.. Many varices noted at the splenic hilum.PANCREAS: The pancreas is somewhat atrophicADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic. A small simple cyst is identified in the midpole of the left kidney. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Significant increase in ascites. Minimal high density fluid layering in the pelvis along the dependent portion that measures up to 30 Hounsfield units (hematocrit effect), can represent hemorrhage.  Generalized anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter noted within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Severe atherosclerotic disease. Degenerative changes noted throughout the spine.

Output: Limited study due to lack of IV contrast.1. Bilateral new pleural effusions with multiple bilateral age is patchy groundglass opacities rule out infective process, hemorrhage, is another possibility. 2. Interval increase in ascites with few areas of high attenuation layering in the pelvis representing hemorrhage.3. Cirrhotic morphology of liver with stable liver masses as described above. Appropriate location of biliary drain.4. Moderate splenomegaly with signs of portal hypertension as described above. 5. Bilateral atrophic kidneys.


Instruction: Generate impression based on medical findings.

Input: ET tube check ETT remains 4 cm above the carina. Jugular catheter terminates in the upper SVCCardiopulmonary appearance again demonstrates mild decreased lung volumes, mild cardiomegaly and a predominantly moderate left pleural effusion with underlying basilar/asymmetric edema.

Output: ET tube unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: cough, crackles rule out CHF History: as above No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with history metastatic renal cell carcinoma and treatment. Reevaluate. CHEST:LUNGS AND PLEURA: Scattered lung nodules. Next mass abutting the left hilum measures 2.9 x 2.5 cm series 6 image 42 previously 2.6 x 2.5 cm. Some micronodules are more prominent for example cluster in the left apex series 6 image 20 is compared to prior exam series 5 image 18.MEDIASTINUM AND HILA: Reference AP window node 1.1 x 0.6 in series 4 image 41. Previously 1.4 x 0.7 cm.Previously measured prevascular nodes seen on series 4 image 39 measures 1.1 x 1 cm. Previously 0.9 x 0.7 cm.CHEST WALL: Subcutaneous lesion right back, may not be fully imaged as it is seen only on the first cut where it measures 1.8 x 1.5 cm series 4 image #1. On the 8/7/10 study it measured 1.7 x 1.6 cm. There is also minuscule cutaneous lesion in the left skin is annotated on series 4 image 23, unchanged.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given that limitation, the following observations as are made:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left kidney surgically absent. Right kidney normal contour.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Index lung and mediastinal lesions as measured above. Some lung nodules are subjectively more prominent. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Index precarinal lymph node measures 2.4 by 1.5 cm on image number 38, series number 3, increased in size compared to previous CT. reference paraesophageal lymph node Measures 1.9 x 1.6 cm on image number 52, series number 3.This lymph node is also slightly increased compared to previous studyCHEST WALL: Left axillary reference node measures 8mm in diameter on image number 34, slightly increased in size. Index right axillary lymph node measures 1.3 x 1.2 cm on image number 30, series number 3, slightly increased in size.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: Left para-aortic index node measures 2.8 x 1.2 cm in image number 122, series number 3. This is slightly increased in size compared to previous CT. Other lymph nodes have also moderately increased in size compared to previous study.BOWEL, MESENTERY: Mesenteric adenopathy is increased in size compared to previous study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Extensive Pelvic adenopathy which has significantly increased in size compared to previous study.BOWEL, MESENTERY: UnremarkableBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: See.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: assess for pna History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: eval for volume overload. History: missed HD here with chest pain, flu like symptoms Moderate cardiomegaly with mild interstitial edema consistent with CHF or hypervolemia.No specific evidence of infection.

Output: CHF/hypervolemia. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: s/p cardiac surgery History: s/p cardiac surgeryAcute systolic heart failure. Support devices unchanged.Very low lung volumes.Basilar edema, small effusions, and atelectasis not substantially changed.Moderate cardiomegaly.

Output: Edema and effusions not substantially changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: 56yo F s/p cardiac arrest. History: s/p cardiac arrest Significant worsening of air space opacities right-sided predominant with pleural effusions.Mild cardiomegaly.Tracheostomy tube tip approximately 5 cm above the carina.

Output: Worsening pulmonary opacities consistent with edema, acute aspiration or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: r/o pneumonia History: SOB , CP Left-sided ICD and LVAD unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Patchy airspace opacities in both lungs suggestive of infection or aspiration.No pleural effusions.

Output: New patchy airspace passively suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Evaluate bialteral pleural effusions for re-accumulation post thora History: as above No change in basilar opacities and pleural effusions.No pneumothorax.

Output: No change in basilar opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old. Reason: NGT placement History: as above NG tube tip in the distal esophagus.Gaseous distention of the stomach and small bowel.Widespread pelvic osseous metastases again visualized.Subcutaneous emphysema involving the left chest wall, left chest tube in place.

Output: NG tube tip in the distal esophagus.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval for pathology History: chest pain No significant cardiopulmonary abnormality.A cardiac loop recorder is projected over the left side of the chest, and cholecystectomy clips are present.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: post op History: same New extra pulmonary opacities along the chest wall left greater than right which may represent loculated pleural effusions and/or extrapleural hematomas in the setting of probable anticoagulation. Lines and tubes, unchanged. Increase in diffuse pulmonary opacities. Unchanged cardiomegaly. No definite pneumothorax.

Output: New extra pulmonary opacities along the chest wall left greater than right which may represent loculated pleural effusions and/or extrapleural hematomas in the setting of probable anticoagulation.Increased diffuse pulmonary opacities, likely edema.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: CP History: Cp Chronic mild blunting of the left costophrenic angle, likely scarring. Unchanged cardiomediastinal silhouette. Scattered calcified pulmonary nodules likely reflect prior granulomatous disease. No acute pleural or pulmonary abnormalities.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: evaluate lung fields History: s/p left lower lobectomy Left-sided chest tubes remain in place. Postoperative changes in left hemithorax, unchanged. Small left apical pneumothorax, not unexpected. No new focal pleural parenchymal opacity. No new focal pleural parenchymal opacity in the right hemithorax. Unchanged heart size.

Output: Expected postoperative change.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with lymphoma CHEST:LUNGS AND PLEURA: A new focus of consolidation with adjacent ground glass opacity is identified in the left apex. The patchy peripheral ground glass opacities in the right upper lobe have improved, with mild residual. Several calcifications are identified in the left apex.MEDIASTINUM AND HILA: Heart size is enlarged. Coronary and aortic calcifications are identified.Varices surround the distal esophagus.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology is again identified. Calcification in the right lobe remains.Cholelithiasis and gallbladder wall thickening, persistent.SPLEEN: 2.3-cm splenic artery aneurysm, unchanged. Mild splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small wedge-shaped defect in the mid pole of the right kidney may represent an infarct.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Upper abdominal varices are seen.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged with calcifications.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Extensive diverticulosis of the sigmoid colonBONES, SOFT TISSUES: The left sacrum is focally demineralized, unchanged from 2007.OTHER: No significant abnormality noted

Output: Increased region of airspace opacity and groundglass opacification in the left upper lobe, with near resolution of the previously noted groundglass opacities on the right. Findings can represent drug reaction or atypical infection.Small wedge-shaped defect in the left kidney likely represents an infarction.No other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: Subclavian line History: Subclavian line Interval placement of right IJ central venous catheter with tip in the distal SVC.Additional lines are unchanged.Stable cardiomediastinal silhouette.Persistent moderate pulmonary edema with bilateral pleural effusions, right greater than left, not significantly changed.

Output: Unchanged pulmonary edema and effusions with interval placement of right IJ catheter, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: Sepsis Right PICC tip near the confluence of the brachiocephalic.Dense patchy perihilar and basilar airspace opacities suggestive of infection or aspiration. Small bilateral pleural effusions are unchanged.

Output: Unchanged bilateral pulmonary opacities suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: FemaleReason for Study: Reason: s/p robotic mitral valve repair History: NA Interval resolution of the extensive subcutaneous emphysema noted along the right lateral chest wall.The cardiomediastinal silhouette is unremarkable with evidence of a mitral valve prosthesis.The lungs are clear.No pleural effusions.No evidence of pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified. Interval clearing of pleural effusions and subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: 11 days s/p bronch, VATS LLL for T2aN0 moderately differentiated squamous cell carcinoma History: IR pigtail evaluation Left basilar pleural pigtail catheter occupies the left costophrenic angle. A trace residual left hydropneumothorax with small quantity of pleural fluid remains. Subcutaneous emphysema is again noted at the left infralateral chest wall. The right lung is fully inflated and clear. The heart size is normal.

Output: Small left hydropneumothorax in the setting of a pleural pigtail catheter occupying the left posterior costophrenic angle.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Pectus excavatum. Status post orthopedic revision. Interval revision of the thoracic orthopedic bars. The left most portion of the bar is excluded from the field-of-view. Subcutaneous right chest wall emphysema reflects recent prior procedure.Unremarkable cardiomediastinal silhouette.No focal lung opacities or pleural effusions are evident. No pneumothorax.

Output: Orthopedic hardware revision. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old. Reason: renal mass, metastatic workup History: same Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No significant cardiopulmonary abnormality, specifically no evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: cough, bloody mucus, travel recently from India, evaluate for lung infection History: as above Normal chest.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: acute hypotension and hypoxia History: see above Endotracheal tube tip approximately 3 cm from the carina.Right IJ catheter tip in the mid SVC.Pneumomediastinum and probable pneumopericardium unchanged.Diffuse bilateral pulmonary opacities compatible with ARDS unchanged.Probable bilateral effusions.Stable cardiomediastinal silhouette.

Output: Pneumomediastinum and pneumopericardium. Pulmonary opacities remain compatible with ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Question free air. Abdominal pain. Semierect portable chest radiograph. No visible free intraperitoneal air; please note that lack of fully erect patient positioning may decrease sensitivity for its detection. Mild chronic appearing basilar interstitial opacities which could be the result of emphysema without evidence of an acute process. Lumbar spine vertebroplasty noted.

Output: No visible free intraperitoneal air or acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: hypoxic, eval for PNA History: hypoxic, eval for PNA No change in severe right hemithorax volume loss with near complete opacification.Left lung unremarkable.Embolization coils and IVC filter noted.

Output: Stable near complete right hemithorax opacification. No new findings.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma. Evaluate response to treatment. CHEST:LUNGS AND PLEURA: Again noted multiple right lung nodules. Nodule in the right apex measures 8 by 8mm on image number 14. Nodule in the right lower lobe measures 19 x 17 mm image number 59, series number 3. No new nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right subpectoral lymph node is not well seen on today's study due to injection from the right arm but measures 10 by 8mm on image number 20, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Extensive hepatic metastases. Reference lesion in the right lobe measures 5.7 x 6.2 cm on image number 90, series number 3. Reference left lobe lesion measures 5 x 4.2 cm on image number 112, series number 3. These are slightly enlarged compared to previous study. Cholelithiasis without biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass measures 2.9 x 2.8 cm on image number 91.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive upper abdominal retroperitoneal adenopathy. Reference gastrohepatic lymph node measures 16 x 11 mm image number 93. More callable aortocaval lymph node measures 16 x 13 mm image number 119.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval increase in size of hepatic metastases. Lung nodules are unchanged. Upper retroperitoneal lymph nodes are slightly decreased in size.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: MaleReason for Study: Reason: evaluate CIED History: device infection Left-sided ICD with lead wires noted within the right atrial appendage, right ventricle, and coronary sinus.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Degenerative changes involving thoracic spine and glenohumeral joints.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: swan in place History: swan in place Basilar atelectasis and pleural effusions worse than on prior study suggestive of aspiration.Left subclavian IABP, marker 4 cm below the top of the aortic arch.Left jugular Swan-Ganz catheter tip in right pulmonary artery.Presternal ICD unchanged.

Output: Worsening basilar opacities. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: eval interval change of pleural effusions History: see above Hazy opacity on the right consistent with a layered out pleural effusion and underlying atelectasis.Mild retrocardiac atelectasis on the left, improved compared to previous.No new findings.

Output: Pleural effusions and atelectasis, slightly improved compared to previous.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: chest pain, sob, hx CHF History: above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly, as before. Patient is status post sternotomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Status post left thoracotomy Status post recent left lower lobectomy. There are 2 left chest tubes in place and a small residual left apical pneumothorax.No right pneumothorax.The heart is normal in size.Right basilar discoid atelectasis.Right IJ port catheter overlying the superior cavoatrial junction.Minimal left chest wall subcutaneous emphysema.

Output: Trace residual left apical pneumothorax after recent left lower lobectomy. Adequate position of 2 left chest tubes.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p esophageal stent History: - New esophageal stent extending from the level of the aortic arch to T11. Right lower zone opacity compatible with effusion and atelectasis. Right pleural drain in place with its tip at the level of the right hilum. A more recent radiograph has been interpreted.

Output: New esophageal stent and other findings as described.


Instruction: Generate impression based on medical findings.

Input: Reason: interval changes History: as above ET tube tip approximately 4 cm above the carina. NG tube tip in the stomach.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: Increased basilar opacity which may be related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Persistent moderate to marked nonspecific cardiomegaly with associated patchy airspace abnormalities most pronounced in a perihilar, left lower and right upper lobe distribution. Small effusionsThe NG and ICD are unchanged

Output: Persistent and relatively unchanged CHF appearance with superimposed more focal right upper and left lower lobe opacities, nonspecific


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: hx of lung CA, s/p thoracentesis History: sob Bilateral paratracheal and aortopulmonary window nodularity compatible with lymphadenopathy. Left upper lobe opacification with perihilar opacities and left lower lobe consolidation unchanged. Left-sided volume loss is unchanged. Left pleural effusion is small.Right lung is fully inflated with resolving right costophrenic opacities suspicious for aspiration. Loss of height of several midthoracic vertebral bodies are stable since 7/10/2015.

Output: No evidence of pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: NG tube placement NG tube placed, the side-port is not visualized and presumed beyond the inferior edge of the image.Underlying cardiopulmonary appearance significant for suspected mild CHF including cardiomegaly, edema and small effusions greater on the right

Output: NG tube placed


Instruction: Generate impression based on medical findings.

Input: Reason: 54yo F surveillance CXR needed by employer for latent TB History: h/o latent TB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: IABP History: see above Heart size upper normal with mild interstitial opacities suggestive of edema.Coronary stent, and left subclavian ICD unchanged.Right jugular catheter, tip in SVC.The proximal IABP marker is high, projected over the right brachiocephalic artery about 2 cm cranial to the aortic arch.

Output: High IABP catheter. Mild interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Reason: CTICU History: Systolic heart failure. Swan-Ganz catheter tip in the area of the pulmonary valve or main pulmonary artery. ICD leads unchanged. Cardiomegaly with perihilar opacity compatible with edema and basilar atelectasis.

Output: Interval advancement of Swan-Ganz catheter and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: daily am cxr History: daily am cxr History of cardiomyopathy Status post heart transplant with orphaned ICD. Chest tubes and venous catheter unchanged. No evidence of pneumothorax. Streaky retrocardiac opacity likely aspirate or atelectasis.

Output: Streaky retrocardiac opacity likely aspirate or atelectasis.


Instruction: Generate impression based on medical findings.

Input: 59 years old Female. Reason: assess for possible RML infiltrate History: assess for possible RML infiltrate. Right apical pneumothorax obscured by overlying devices. Stable consolidation in the right upper lobe.Tracheostomy tube tip approximately 7 cm above the carina.

Output: No definite evidence of pneumothorax. Tracheostomy tube tip approximately 7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Cough with sputum and crackles on exam question pneumonia. Thoracic aortic aneurysm with irregular aortic border similar to recent prior studies, please refer to detailed CTA report dated 8/18/2016. This finding is incompletely assessed by plain film technique. No visible signs of mediastinal hematoma.Mild elevation of the left hemidiaphragm, present previously. Faint hazy peripheral opacities in the lung bases may have been present previously and are suggestive of either early fibrosis or scarring, possibly as a result of chronic microaspiration based on distribution. This may be slowly worsening in the posterior right lower lobe but is probably chronic.

Output: Slight increase in opacity in the right lower lobe with a chronic interstitial abnormality in the lung bases. This is favored to represent sequela of chronic microaspiration with evolving fibrosis or scarring. If patient remains symptomatic, short-term PA and lateral chest radiograph follow-up can be obtained to exclude acute worsening.


Instruction: Generate impression based on medical findings.

Input: Reason: hematoma in right upper chest region? History: tunneled catheter fell out this morning Markedly under inflated lungs with no gross cardiopulmonary abnormalities.No visible hematoma, although a chest wall hematoma would not likely be visible on a chest radiograph.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: change in status of pulmonary edema History: increasing hypoxia overnight after lasix was stopped Small lung volumes with bilateral symmetrical airspace opacity compatible with ARDS and edema.PICC line tip in left subclavian vein.No significant interval change.

Output: Pulmonary opacities compatible with ARDS/edema without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: sob History: sob No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: swan ganz History: pulmonary HTN Swan-Ganz catheter removed leaving the right jugular introducer unchanged.Left PICC, tip in the SVC.No significant pulmonary or pleural abnormality.

Output: Right jugular Swan-Ganz catheter removed.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: resp distress Endotracheal tube terminates 4 cm from the carina. Diffuse pulmonary opacities again noted, slightly increased in the right lung. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Endotracheal tube terminates 4 cm from the carina. Slight increase in diffuse pulmonary opacities most consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: FemaleReason for Study: Reason: F/u ARDS History: ARDS Support devices unchanged.No significant pneumothorax.Stable cardiomediastinal silhouette.Extensive interstitial/airspace opacities in both lungs similar in appearance to prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with extensive pulmonary opacities compatible with ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: CHF exacerbation? History: SOB Heart size upper normal, allowing for magnification artifact.No specific evidence of infection or edema.There may be a very small right pleural effusion.

Output: Heart size upper normal and possible small right pleural effusion. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: please evaluate for pna, cough, with aspiration risk History: cough Right upper lobe scarring and volume loss possibly from radiation, unchanged.Large lung volumes are consistent with COPD.No specific evidence of infection or edema.Heart size normal.

Output: Chronic right upper lobe volume loss, without acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Cardiac arrest. ETT position. ETT tip 3 cm above the carina.Enteric tube tip off the caudal margin of the film.Spinal hardware incompletely evaluated.Moderate pleural effusions with basal atelectasis, the latter has slightly increased.Mild to moderate dependent edema and atelectasis in the posterior lung fields.

Output: ETT tip 3 cm above carina. Slight worsening of basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: pan? History: ams, vomiting Mild patchy right perihilar airspace opacities compatible with infection and/or aspiration.Mild new opacity medially in the left lower lobe compatible with subsegmental atelectasis, also possibly related to aspiration.Unremarkable cardiac and mediastinal silhouette.

Output: Right upper and lower lobe airspace opacities compatible with infection, possibly secondary to aspiration.Findings were discussed with Dr. Spiegel in the ED at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old. History of sickle cell anemia, sob. Mild cardiomegaly unchanged. No significant pulmonary opacities. Osseous changes of sickle cell anemia. Cholecystectomy clips.

Output: No acute abnormalities or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: evaluate for source of fever History: fever Pleural effusions and basilar atelectasis unchanged.Left jugular catheter tip at right atrial level.Right jugular catheter in SVC.

Output: Unchanged basilar atelectasis and pleural effusions without evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#2 Interval removal of the 2 apical chest tubes with small bilateral pneumothoraces measuring 1.7 cm on the right and 1.9 cm on the left. Other lines and tubes, unchanged. No new focal lung consolidation. Unchanged heart size.

Output: Interval removal of the 2 apical chest tubes with small bilateral pneumothoraces measuring 1.7 cm on the right and 1.9 cm on the left.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Pleuritic pain over the right lower lobe and purulent cough. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: elevated BP, sob History: elevated BP Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: pleural effusions History: as above Mild lower lung zone edema with small pleural effusions unchanged since earlier today but improved compared to yesterday.Mild cardiomegaly noted.

Output: Improving CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with chest pain. Evaluate cardiac silhouette. Cardiomediastinal silhouette is unremarkable, specifically no mediastinal widening. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: infection? History: neutropenic fever Heart size upper normal.Small pleural effusions and basilar opacities could be represent edema from hypervolemia.Atypical infection is also in the differential diagnosis, although the basilar findings are nonspecific Right jugular catheter, tip at cavoatrial junction.

Output: Gradually increasing basilar opacities and pleural effusions, nonspecific, not typical for infection.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male. Metastatic renal cell carcinoma. Evaluate disease status. CHEST:LUNGS AND PLEURA: New bilateral small pleural effusions and bibasilar atelectasis. Punctate right middle lobe nodule is unchanged.MEDIASTINUM AND HILA: Previously described mild paratracheal adenopathy has almost completely resolved. Previously measured referenced lymph node now measures 9 x 6 mm on axial image number 35/222 of series 3. Subcarinal adenopathy is decreased in size. Extensive coronary artery calcification. Mild cardiomegaly. CHEST WALL: No change in the expansile right anterolateral rib lesion measuring 4.2 x 2.3-cm at axial image 59/222 of series 3.ABDOMEN:LIVER, BILIARY TRACT: Numerous diffuse hepatic metastases replacing the liver parenchyma are stable. Previously mentioned reference metastases in the right lobe measures 5.8 x 4.4 cm on image number 93/222 of series 3. The second reference mass in the left lobe measures 8.2 x 5.4 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Vertebral body hemangioma at axial image 80/222. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged, but otherwise unremarkable. BLADDER: The bladder wall is thickened, but otherwise unremarkable. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the bilateral pleural effusions and stable to decreased mediastinal adenopathy. Extensive liver metastases and the expansile rib lesions are grossly unchanged.


Instruction: Generate impression based on medical findings.

Input: Cough Faint mixed interstitial and airspace opacity in the left lung base, likely lingular and possibly the left lower lobe. Additional focal amount in the right lung base and along the minor fissure in the right upper lobe.Cardiac and mediastinal contours are within limits.

Output: Nonspecific patchy opacities concerning for multifocal infection and early pneumonia and less likely an alternate abnormality such as infarcts.


Instruction: Generate impression based on medical findings.

Input: Status post right thoracotomy and decortication for mesothelioma. Right chest tubes unchanged in position.Moderate circumferential right hydropneumothorax unchanged.Right chest wall subcutaneous emphysema.

Output: No significant change in postoperative right hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: rule out chest metastasis History: hx of renal cell carcinoma Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Moderate to severe thoracolumbar scoliosis.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: lung eval History: lung eval Cardiomegaly with aortic balloon catheter and ICD leads unchanged.Mild basilar atelectasis but no evidence of pulmonary edema or infection.PICC line tip at the right axilla.

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


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with history of neutropenia and fever, rule out infection Thoracic spine fixation hardware noted.Right IJ catheter tip within the SVC.Decreased lung volumes.No new lung or pleural abnormalities.Stable cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormalities. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of ovarian cancer CHEST:LUNGS AND PLEURA: Micronodule in the rightminor fissure is smaller, measuring 2-mm image number 42, series number 4. Left-sided pleural effusion has resolved.MEDIASTINUM AND HILA: Duplicated IVC is unchanged. Reference anterior diaphragmatic lymph node is smaller, measuring 21 x 9 mm image number 65, series number 3. Left-sided preference lymph node is also smaller measuring 6 x 8 mm number 67, series number 3.Asymmetrically enlarged right thyroid lobe is unchanged.CHEST WALL: Stable left axillary lymph nodes.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: Reference left para-aortic lymph node measures 21 x 15 mm image number 87, series number 3, minimally decreased in size. Reference lymph node adjacent to the portal vein measures 29 x 24 mm image number 85, series number 3, not significantly changed.BOWEL, MESENTERY: Bowel containing ventral hernias are unchanged. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Reference is right iliac lymph node is smaller, measuring 24 x 12 mm, image number 150, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the diaphragmatic, pelvic adenopathy, right micronodule. Retroperitoneal lymph nodes are unchanged to slightly decreased is size.Interval resolution of the small left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with history of pancreas cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right thyroid nodule is unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Biliary stent with expected pneumobilia, stable. There is moderate amount of intrahepatic biliary dilatation, stable.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic body and tail with dilated duct. There is some soft tissue fullness in the region of the pancreatic head measuring 1.8 x 1 .1 cm image number one the 12th series number 3. This is unchanged from previous study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Artifacts from the left the prosthesis limits also evaluation of the pelvis.

Output: No significant change from the previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: swan placement History: CHF with swan placement Mild cardiomegaly.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.Right subclavian ICD unchanged.

Output: No change in support devices, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: IJ placement. PTX? Other complication? History: line placement Cardiomegaly with pulmonary opacities becoming more confluent, increased left lower lobe consolidation and worsening pleural effusions.Right jugular catheter tip at cavoatrial junction level.An NG tube remains coiled in a large hiatal hernia.ET tube tip approximately 5 cm above the carina.

Output: Right jugular catheter, tip in SVC. Worsening pulmonary opacities and enlarging pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: fever, cough Bilateral lower lobe airspace opacities and atelectasis, increased from previous, compatible with aspiration and infection.Increased bilateral pleural effusions.PICC tip in the right atrium.

Output: Increased basilar opacities compatible with consolidation, atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: 65yoF s/p intubation for PEA arrest History: as above ET tube tip approximately 4 cm above the carina.Small lung volumes with a left Bochdalek hernia as previously described.No acute pulmonary abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: swan, ett History: swan, ett Cardiopulmonary monitoring and support devices, unchanged.Diffuse interstitial opacities suggestive of edema and focal consolidation in the left lower lobe, not significantly changed.Probable small bilateral pleural effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices Interval removal of a right chest tube and left chest wall drain. Tracheostomy tube and right chest wall drain unchanged.Cardiomegaly with diffuse nonspecific airspace opacity and pleural thickening or pleural effusions, not significantly changed allowing for position and inflation.

Output: Interval removal of right chest tube with no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 19 yearsGender: MaleReason for Study: Reason: ? PTX History: car accident and chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: accidental CT removal; s/p TECABG History: CT removal s/pTECABG Left chest tube removed with a small left pneumothorax and severe left chest wall soft tissue emphysema.There may be a small right apical pneumothorax.Pulmonary opacities are suggestive of edema left-sided predominant.

Output: Left pneumothorax and left chest wall soft tissue emphysema following chest tube removal. Small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: 54F pmh htn p/w SOB and DOE History: SOB, DOE Moderate cardiomegaly with basilar interstitial opacities suggestive of mild edema or aspiration.Minimal pleural effusions may be present.

Output: Cardiomegaly with minimal edema and small effusions suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: What is lung expansion History: On HFOVVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. The umbilical venous catheter tip in the right atrium. Right chest tube in place. Cardiothymic silhouette normal. Diffuse lung haziness with lucency at the right lung base which may represent small pneumothorax. No evidence of pleural effusion.

Output: Diffuse lung haziness with lucency at the right lung base which may represent a small pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: IABP The lung catheter marker at the level of the aortic arch and left jugular catheter tip in the SVC.Cardiomegaly with right basilar airspace opacity suggestive of infection and moderate compressive atelectasis in the left lower lobe.

Output: Right lower lobe pneumonia, possibly secondary to aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath, wheezes and crackles diffusely History: shortness of breath Heart size about upper normal.Bilateral mainly perihilar and lower zone airspace and interstitial opacity with septal lines at the periphery, highly compatible with acute pulmonary edema.

Output: CHF with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: r/o pneumonia History: sob cough Cardiomediastinal silhouette is within normal limits.No focal air space abnormality. No pleural effusions.Calcific opacity overlying the left lateral ribs may be a bone island, exostosis, or external artifact.

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


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: s/p cardiac surgery, daily CXR History: s/p cardiac surgery, daily CXR Feeding tube extends inferiorly off the field-of-view. Unchanged basilar opacities and pleural effusions. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: follow up after PleurX placement History: dyspnea Right pleurx catheter unchanged in position. Right pleural effusion stable to marginally improved. No new opacity.

Output: Right pleural effusion stable to marginally improved.


Instruction: Generate impression based on medical findings.

Input: Atrial septal defect repair Motion degrade sensitivity. The 2 right jugular sheaths both appear kinked at skin entry point. Tips unchanged.The additional right jugular catheter is also observed projecting deep into the right atriumInterval decreased lung volumes with patchy opacities in both bases and perihilar distribution suggesting edema with probable mild cardiomegaly and small effusions.

Output: Increasing pulmonary edema


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with lightheadedness, recent pneumonia. Evaluate for worsening pneumonia, pulmonary edema. Right-sided pleural effusion with adjacent compressive atelectasis and consolidation not significantly changed. No new pulmonary opacities. No pneumothorax. Stable cardiomediastinal silhouette.

Output: No significant interval change in right-sided pleural effusion with adjacent compressive atelectasis/consolidation. No new pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Low-grade fever. Shortness of breath Mildly decreased lung volumes with nonspecific patchy opacities in both bases greater on the right with small effusions. Concern for multifocal infection over aspiration must be considered in the appropriate setting. Serial imaging will be helpfulCardiac and mediastinal contours are grossly within limits

Output: Nonspecific bilateral largely right middle and lower lobe opacities concerning for infection and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female 29 years old Reason: r/o pneumonia, rib fx History: cough x 1 wk, left lower rib pain Cardiomediastinal silhouette is unremarkable. Left lower lobe retrocardiac opacity, consistent with infection. No pleural effusion or pneumothorax.

Output: Left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Aortic valve replacement Increasing large right pleural effusion without additional cardiopulmonary change. Right jugular catheters have also been removed without apparent complication

Output: Right jugular catheters removed an enlarging right pleural effusion


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube History: chest tube Chest tube extending to the left apex with no significant pneumothorax.Cardiomegaly and bilateral pulmonary opacity compatible with edema with lower zone atelectasis and pleural effusions, greater on the right.

Output: Chest tube in place with no significant pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with lung cancer CHEST:LUNGS AND PLEURA: Postsurgical changes in the left upper lobe are redemonstrated. Left superhilar mass has not increased in size and measures 4.6 x 2.9 cm image number 40, series number 4. Left upper lobe mass with postobstructive pneumonia has also increased in size. Small left-sided pleural effusion.Bilateral emphysematous changes are unchanged. Left lower lobe round atelectasis or other atelectatic changes are also stable. New nodular dense these in both lungs suspicious for metastatic disease. In reference right lower lobe lesion measures 14 x 10 mm on image number 72, series number 4.MEDIASTINUM AND HILA: Reference subcarinal lymph node measures 25 x 10 mm image number 49, series number 4, unchanged. Left pulmonary artery and main bronchus are encased by the patient's known left hilar mass. Left supraclavicular and superior mediastinal adenopathy is unchanged.CHEST WALL: Multiple left axillary nodes are stable.ABDOMEN:LIVER, BILIARY TRACT: Segment 8 lesion is unchanged. No new lesions in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Upper abdominal adenopathy is slightly increased in size. Retroperitoneal adenopathy extends throughout the abdominal aorta. Previously measured reference left para-aortic lymph node measures 12 x 14 mm on image number 129, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left iliac lytic lesion, T11 vertebral body, lesion consistent with metastatic disease are unchanged. Right scapular metastatic lesion is new from previous study.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral external iliac adenopathy is unchanged. Right external iliac lymph node measures 19 x 14 mm image number 191, series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Previous described right psoas muscle metastatic lesion measures 3.2 x 2.6 cm, not significantly changed from previous study.OTHER: No significant abnormality noted

Output: Interval progression of disease with increase in the number of lung nodules, left hilar mass, retroperitoneal adenopathy and right scapular metastases.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with history of the cystic sarcoma status post stem cell transplant CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: Reference paratracheal lymph node on the left side measures 11 x 11 mm image number 34, series number 3. No significant change in the mediastinal lymph nodes. Right hilar aggregation of lymph nodes is also not significantly changed measuring 16 x 14 mm image number 42.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Stable splenic cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged retroperitoneal lymph nodes are unchanged. Reference left paraortic lymph node measures 13 x 11 mm image number 108.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Leiomyomatous uterus 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: No significant change in the size of the adenopathy as described above. Findings of acute pancreatitis have resolved.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: FemaleReason for Study: Reason: eval for infection History: status asthmaticus ET tube with its tip 2 cm above the carina.NG tube with its tip beyond the margin of the image.Decreased lung volumes a stable cardiac mediastinal silhouette.Left lower lobe consolidation/atelectasis which may be source of infection.

Output: ET tube in satisfactory position. Left lower lobe consolidation/atelectasis may be a source of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: infection? History: chest tightness Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax. No focal pulmonary opacity.

Output: No specific evidence for infection.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: worsening shortness of breath R/o pleural effusion History: worsening SOB Right Pleurx catheter unchanged.Mild interval increase in right pleural effusion and diffuse right-sided interstitial opacities with septal lines compatible with edema .Small left pleural effusion.Right perihilar mass and numerous pulmonary nodules similar to the prior exam.

Output: Interval increase in the right pleural effusion as well as pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Assess for evidence of volume overload in a patient with PH and cardiogenic shock 2/2 RHF History: RHF Central venous catheter tip at the RA/SVC junction. TIPS stent noted.The cardiac silhouette is enlarged but stable.Bilateral pleural effusions with increasing left basilar atelectasis. Mild interstitial opacities also persist.

Output: Stable pulmonary edema and bilateral pleural effusions with increasing left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 18 yearsGender: MaleReason for Study: Reason: syncope History: palpitations, dizziness 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, 48 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Small pleural effusions and persistent left lower lobe consolidation.Stable tubes and catheters. Stable pulmonary opacities and pleural effusions

Output: Stable pleural effusions and basilar consolidation, tubes and catheters.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: check ett placement History: intubated ET tube tip 6 cm above carina. Other support hardware appears stable though evaluation is severely limited by body habitus. Slight interval improvement in left lower lobe opacity. Other findings stable.

Output: ET tube tip 6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: PH of bil breast cancer , now w recurrence, request chest x-ray to assess for pul mets History: PH of bil breast cancer , now w recurrence, request chest x-ray to assess for pul mets No evidence of metastases or other significant abnormality.Unremarkable mediastinal contours and cardiac silhouette.Mild scarring left mid to lower lung.

Output: No significant abnormality. No sign of metastases or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with pancreatic cancer CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter possible intrapulmonary lymph node on image number 22, series 4, unchanged.MEDIASTINUM AND HILA: Right thyroid nodule is unchanged.CHEST WALL: Reference right axillary lymph node measures 10 x 7 minutes on image number 24, series number 3, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Index lesion in the caudate lobe is smaller and now measures 13 x 17 mm image number 68, series number 3. Right lobe lesion is unchanged measuring 9 x 8 mm on image number 65, series number 3. Narrowing of the extrahepatic main portal vein is unchanged. Cholelithiasis is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic head mass is enlarged measuring 4.3 x 4.8 cm. Metallic stent is in place. Dilated pancreatic duct is unchanged. Stomach is dilated. The mass invades the second and third portion of duodenum and likely causing gastric obstruction. This has progressed from previous CT.Venous collector is secondary to chronic invasion of the SMV is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval increase in the size of the pancreatic head mass. One of the index hepatic metastases lesions is smaller.Invasion of the duodenum by the pancreatic head mass causing gastric outlet obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: eval for effusion History: CHF The aorta is tortuous and aneurysmally dilated, without the benefit of prior studies it is difficult to determine the chronicity of this appearance. Mild cardiomegaly. No specific evidence of edema or infection. Appearance of the left hemidiaphragm suggestive of a small Morgagni hernia. 17 mm nodular opacity in the right lower lung may represent either a rib end or pulmonary nodule.

Output: 1.No evidence of edema. The aorta is tortuous and probably aneurysmally dilated, without the benefit of prior studies is difficult to determine the chronicity of this appearance. If there is clinical concern for acute aortic pathology, CTA may be obtained if required.2.17 mm nodular opacity in the right lower lung may represent either a rib end or pulmonary nodule. Recommend correlation with prior outside studies if able to be obtained and submitted by the referring clinical service. If outside exams are not available, then further characterization may be made with CT when feasible.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: assess swan positioning History: swan placement Swan-Ganz catheter terminates within the RPA. Unchanged cardiac lead. Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Reason: sp cabg, avr, mvr, tvr History: sp cabg, avr, mvr, tvr ET tube tip in the proximal right main bronchus. This has been adjusted on the subsequent radiograph.Swan-Ganz catheter directed towards a left upper lobe branch of the pulmonary artery.Balloon catheter with its tip at the level of the aortic arch.Nonspecific opacity in the left hemithorax consistent with consolidation and atelectasis.Surgical sponge markers projected over the mediastinum, presumably in an open sternotomy wound.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for septic source History: septic s/p cardiac surg ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery.The diffuse nonspecific air space and interstitial opacity suggestive of edema with small pleural effusions.No acute change.

Output: Diffuse pulmonary opacities suggestive of edema with no other specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 44-year-old man with history of seminoma. Evaluate response to therapy. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: A nonenlarged right hilar lymph node is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hepatic hemangioma in the right lobe is unchanged. No additional focal lesion. Hemangioma measures 2.5 x 1.5 cm inSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference lymph node measures 9 x 5 mm image number 132, series number 3 smaller from previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Hepatic hemangiomas unchanged. Retroperitoneal lymph node smaller


Instruction: Generate impression based on medical findings.

Input: ETT check ETT remains 4 cm above the carina. NG and right jugular catheters are also similar with an additional new dialysis catheter terminating in the proximal SVC. No definite postprocedural complication, however the right pleural effusion again is observed, possibly due to semiupright positioning however serial imaging will be needed to confirm the absence of hemorrhageMild cardiomegaly and nonspecific patchy opacities in both bases

Output: ETT unchanged and new right jugular catheter with underlying moderate right effusion. See detail provided


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Fluid in the lungs History: SOB Increasing pulmonary opacities consistent with metastases, also involving the hila, unchanged.Enlarging right pleural effusion and basilar consolidation.Mild basilar edema-like opacities.Unchanged catheters.

Output: Enlarging right pleural effusion with basilar consolidation, otherwise unchanged with intrathoracic metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o pna, edema History: hx CKD, SOB, CHF Cardiomegaly with vascular congestion . Basilar opacities and pleural effusions. Findings are compatible with congestive heart failure.

Output: Cardiomegaly, pulmonary edema ,pleural effusions compatible with congestive heart failure


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: increase sob Moderate cardiomegaly with resolving lower zone interstitial opacities compatible with atelectasis, edema and small effusions. ICD leads and venous catheter unchanged.

Output: Resolving basilar opacity and effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: r/o stroke History: as above Cardiomediastinal silhouette within normal limits. No airspace opacities. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with CLL staging CHEST:LUNGS AND PLEURA: 5 mm right upper lobe nodule best seen on image number 21, series number 5 is stable. No new nodules.MEDIASTINUM AND HILA: Extensive mediastinal and hilar adenopathy. Reference subcarinal lymph node measures 3.1 x 1.9 cm, slightly enlarged compared to previous study. Other mediastinal lymph nodes are also slightly enlarged.CHEST WALL: Bulky axillary lymphadenopathy versus. Reference left axillary lymph node measures 3.7 x 2.8 cm number 22, series number 3. All of them axillar lymph nodes increased in size.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenomegaly, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Bulky retroperitoneal adenopathy is increasing size. Reference portacaval lymph node measures 4.8 x 7-cm image number 95, series number 3.BOWEL, MESENTERY: Present thick adenopathy is also increased in size.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left external iliac lymph nodes measures 17 x 13 and image number 167, series number 3, not significantly changed. Most of the other pelvic lymph nodes have slightly increased in size.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the mediastinal, hilar, axillary, abdominal and pelvic adenopathy.Stable splenomegaly. Stable right upper lobe nodule


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Central line placement on the right. Right jugular catheter tip at the SVC. Endotracheal tube has been slightly retracted, now 3 cm above the level of the carina. Nasogastric tube tip off the caudal margin of the film.Moderate edema-like opacities with small pleural effusions and basal atelectasis. No pneumothorax.

Output: No pneumothorax. Appropriate position of right jugular catheter. No significant change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: ? pna History: weakness Unremarkable cardiac and mediastinal silhouette. Mild streaky opacity at the left base compatible scarring and atelectasis.No specific evidence of pneumonia.

Output: Left basilar scarring but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Chest pain. Normal heart size. No evidence of mediastinal widening or pneumothorax. No focal airspace opacities.Multiple tiny metallic fragments project over the left anterior chest wall external to the bony thorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: MaleReason for Study: Reason: Infiltrates History: fever 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: ETT placed ETT placed, tip projects 2 cm above the carina.Persistent decreased lung volumes without superimposed new cardiopulmonary abnormality. Relative increase in cardiac silhouette size is likely due to semiupright positioning and technique

Output: ETT placed


Instruction: Generate impression based on medical findings.

Input: Female; 46 years old. Reason: s/p esophagectomy and bilateral chest tubes History: above Postsurgical changes from esophagectomy with mediastinal and left upper quadrant surgical clips. Enteric tube tip in expected location of the distal neo-esophagus. Bilateral chest tubes in place. Right chest Port-A-Cath tip in SVC.Moderate left basilar opacity most compatible with effusion with underlying atelectasis/consolidation. Small right apical pneumothorax.Normal heart size.

Output: Postsurgical changes as described. Small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Cough and fever Persistent unchanged lower cervical and mid thoracic spine fixation with stimulation catheters projected over the lower thoracic spine.Persistent decreased lung volumes with nonspecific streaky densities in both bases again observed and remain nonspecific; possible aspiration, infection versus atelectasis

Output: Persistent nonspecific basilar changes. Given patient history, concern for aspiration or even infection must be continued to be excluded


Instruction: Generate impression based on medical findings.

Input: Lymphadenopathy check, concern for*cord. History of cardiomyopathy Interval improving cardiac silhouette size, currently borderline in overall dimensions nonspecifically. Mild tortuosity aorta similar.Lungs remain clear

Output: Decreasing and now borderline cardiomegaly. No findings to suggest CHF


Instruction: Generate impression based on medical findings.

Input: Male; 70 years old. Reason: interval change? History: iabp, chf Left-sided ICD is unchanged. The IABP marker is not visualized.The cardiomediastinal silhouette is stable. A calcified subcarinal lymph node is redemonstrated.No new pulmonary opacities. No pneumothorax.

Output: The IABP marker is not visualized on this study. There is otherwise no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: pneumonia History: altered mental status Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Mild bronchial wall thickening possible.

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


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval lung fields History: eval lung fields, s/p cardiac transplant Median sternotomy with chest tubes but no pneumothorax.Stable basilar opacities suggestive of atelectasis.Right jugular Swan-Ganz catheter tip now in main pulmonary artery.Left subclavian ICD remnants remain in the chest wall.

Output: No significant pneumothorax. Stable basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: eval for ptx vs PNA History: cough, pleurisy Right middle lobe subsegmental atelectasis with small right pleural effusion. Likely trace left pleural effusion with opacities at the left costophrenic angle, also suspicious for subsegmental atelectasis. The cardia mediastinal silhouette is unremarkable. There is no pneumothorax.

Output: Right middle lobe subsegmental atelectasis with small and possibly trace left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT, lung fields History: s/p BiVAD ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.The lung catheter in the descending aorta.Multiple surgical sponge markers projected over the upper mediastinum and left lower hemithorax, presumably in an open wound.Cardiomegaly with diffuse bilateral opacity compatible with edema.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Pulmonary edema History: SOB, LE edema Poor inspiratory effort. Right basilar subsegmental atelectasis with no reliable evidence of infection. Cardiomediastinal silhouette is normal.No pneumothorax or pleural effusion.

Output: Bibasalar subsegmental atelectasis


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with metastatic leiomyosarcoma. CHEST:LUNGS AND PLEURA: Innumerable bilateral pulmonary nodules are unchanged. Reference right upper lobe nodules measure 6 mm and 6 x 6 mm (series 4; images 18-19), unchanged. Reference is left upper lobe nodule measures 7 x 7 mm, unchanged (series 4; image 28)MEDIASTINUM AND HILA: Small mediastinal nodes have minimally increased in size but are not pathologically enlarged by CT criteriaCHEST WALL: Stable expansile lytic lesion centered over the left T4 transverse process (series 3; image 23, unchanged from 6/3/09), suggestive of metastatic disease. Nonspecific subcentimeter lytic foci are seen in the left fourth rib, also unchanged.ABDOMEN:LIVER, BILIARY TRACT: Numerous hypodense lesions are seen throughout the liver, grossly unchanged. The reference lesion which extends to the hepatic dome is ill-defined and difficult to measure, but grossly unchanged in size, measuring approximately 8.5 x 8.1 cm (series 3; image 77), previously 8.3 x 8.2 cm. The second index lesion at the anterior aspect of the left lobe measures approximate 3.5 x 2.4 cm (series 3; image 90), unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy.RETROPERITONEUM, LYMPH NODES: Numerous retroperitoneal surgical clipsBOWEL, MESENTERY: Diffuse small bowel wall/fold thickening is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small fat-containing inguinal hernias, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the pulmonary, hepatic and osseous metastases.


Instruction: Generate impression based on medical findings.

Input: 67-year-old man with history of prostate cancer and bilateral lower abdominal pain for 4 weeks. CHEST:LUNGS AND PLEURA: No pulmonary nodules or effusion.MEDIASTINUM AND HILA: Mild enlarged mediastinal nodes of uncertain etiology with reference paratracheal node measuring 1.9 x 1 cm as seen on image 25/221 of series 4. There is mild to moderate cardiomegaly.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No parenchymal lesions are identified in the liver. The gallbladder is normal in appearance. There is no evidence of intrahepatic or extrahepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is an indeterminate cystic lesion in the superior pole of the left kidney which does not fulfill the criteria for simple cyst. A dedicated renal CT with noncontrast images is recommended for further follow-up of this lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in caliber with no evidence of dilatation or wall thickening.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There is bilateral external inguinal lymphadenopathy of uncertain etiology.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Indeterminate cystic lesion in the superior pole of the left kidney. Recommend dedicated renal CT with noncontrast images for further evaluation of this lesion.2. Enlarged lymph nodes of uncertain etiology in the mediastinum and bilateral external inguinal region.


Instruction: Generate impression based on medical findings.

Input: 23 years old Female. Reason: altered mental status History: altered mental status. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Streaky opacities in the lower lungs especially in the right lower lobe, which may represent atelectasis or early infection.

Output: Streaky opacities in the lower lungs, which may represent atelectasis or early infection. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: 39 yo male; potential stem cell donor History: evaluate Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: hx of esophageal leak, thoracotomy History: febrile Enteric tube has been removed. Esophageal stent traverses the distal esophagus into the stomach. Skin staples at the left infralateral chest wall and left PICC remain in stable position.Basilar opacities of subsegmental atelectasis. Heart size normal. No pneumothorax.

Output: Stable size and mediastinum. Interval removal of enteric tube.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: iabp placement History: see above Interval removal of external defibrillator pads. The remaining support devices are unchanged in position.Cardiomegaly is unchanged. No interval edema or pneumothorax.

Output: Removal of external defibrillator pads. Stable cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: PNA, edema History: 2620 Coarse basilar interstitial opacities with bronchial wall thickening noted. No pleural effusions.Unremarkable mediastinal contours and cardiac silhouette.

Output: Basilar interstitial opacities with bronchial wall thickening consistent with acute edema but also with the suggestion of aspiration or bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: Volume overload? History: History of CHF Left chest wall port terminates in the right atrium.Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities with no evidence of edema and no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: sp cardiac arrest History: - Unchanged pulmonary opacities suggestive of edema with pleural effusions and retrocardiac consolidation.ET tube tip approximately 2 cm above the carina.Right jugular catheter, tip at cavoatrial junction.Chest wall surgical drains.IVC filter.

Output: Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: swan History: as above Cardiomegaly status post sternotomy for LVAD placement without edema or pleural effusion.Left subclavian ICD unchanged.Right jugular Swan-Ganz catheter, tip in right interlobar pulmonary artery.

Output: Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: eval infection, edema, effusion History: ESRD Cardiac silhouette is normal in size.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.Calcified loose bodies again overlying the left subcoracoid region.

Output: No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: evaluate for pneumothorax after R thoracentesis History: s/p thoracentesis Support devices are unchanged in position.Decreased size of right pleural effusion following thoracentesis. The quantity of fluid is moderate, bilaterally. Additional mid to lower zone opacities suspicious for compressive atelectasis. No interval pneumothorax. Cardiomegaly persists.

Output: Decreased size of right pleural effusion following thoracentesis without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: ARDS and ETT monitoring History: hypoxia Right chest tubes are unchanged in position. NG tube in the stomach. Endotracheal tube tip 4 cm above the carina. Venous catheter unchanged.Right apical pneumothorax has slightly increased. Stable cardiac silhouette. Diffuse pulmonary opacities are unchanged. No large effusions.Relatively gasless upper abdomen.

Output: Stable appearance of diffuse pulmonary opacities. Right apical pneumothorax has slightly increased.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Eval interval change History: 49 yo M with NICM and DOE Mild cardiomegaly.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter, tip very far peripherally in the right lower lung zone.Unchanged ICD.

Output: Swan-Ganz catheter tip very far peripherally in the right lower lung zone.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure, check lead placement Motion again degrades sensitivity.The right subclavian 2-lead ICD again demonstrate lead tips in grossly similar positions, however follow-up imaging is needed to confirm the more proximal lead overlying the right atrium. Difference in position is likely due to patient rotation observed on prior study and overall appearance similar to the immediate postplacement.Cardiopulmonary appearance is otherwise grossly similar with markedly decreased lung volumes similar to prior with marked cardiomegaly. Small to moderate effusions cannot be excluded, specifically on the left.

Output: Cardiomegaly without apparent ICD lead position change


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: check pulmonary status History: check pulmonary status Unchanged pulmonary opacities and pleural effusions.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.Bilateral jugular catheters are unchanged in position.Right ureteral stent.

Output: Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: post op, eval ETT, lung fields History: s/p CABG Swan-Ganz catheter tip in proximal right pulmonary artery. Bilateral chest tubes directed towards bases. Mediastinal drain. ET tube tip 3 cm above carina.Lungs hypoinflated with no evidence of pneumothorax. Bibasilar opacities likely atelectasis or aspirate.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: FemaleReason for Study: Reason: 29F w/ sickle cell crisis, now with wheezing and cough, SOB History: cough, SOB Right Port-A-Cath with tip in the SVC.Stable cardiac enlargement with pulmonary vascular redistribution.Perihilar/basilar increased interstitial opacities are suggestive of edema.No large pleural effusions.

Output: Cardiomegaly with increased perihilar and basilar interstitial opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Age: 37 yearsGender: MaleReason for Study: Reason: Consolidation 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, 29 years old.Reason: fever, cough, had pneumonia a month ago, had CXR outside facility with bilateral patchy infiltrates History: fever, cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: evaluate ICD History: ICD infection No significant cardiopulmonary abnormality.Left subclavian ICD, leads unchanged in position.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval tube position History: ARDS ET tube tip approximately 6 cm above the carina.Diffuse bilateral nonspecific airspace opacity, increased compared to previous.Right jugular catheter with its tip in the area of the SVC.Possible small right subpulmonic pneumothorax for which further follow-up is recommended.

Output: 1.ET tube in acceptable position.2. Possible small right subpulmonic pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Shortness of breath and wheezing. Evaluate LVAD and left-sided ICD with leads unchanged in position. Marked cardiomegaly with no significant interval change in the mediastinal silhouette. Unchanged basilar interstitial opacities, which are likely partially chronic. No pneumothorax.

Output: Unchanged marked cardiomegaly and basilar interstitial opacities, which are likely partially chronic.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Please re-evaluate lung fields for volume overload History: Intubated, CHF Left lower lobe consolidation and small left pleural effusion, worse than on the prior study and consistent with aspiration or pneumonia.Mild to moderate cardiomegaly unchanged.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: Worsening left lower lobe consolidation with a left pleural effusion, suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: PNA? History: increased o2 requirement Unchanged basilar opacities and small pleural effusions with mild cardiomegaly.No reliable evidence of pneumonia.Right jugular catheter tip at cavoatrial junction.Prior left jugular catheter removed.

Output: Small pleural effusions and nonspecific basilar opacities likely atelectasis, but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: eval ETT, lung fields History: s/p pericardial stripping, pericardial window Left basilar chest tube is coiled at the left cardiophrenic angle. Sternal hardware remains well aligned.Interval decreased lung volumes with mid to lower zone subsegmental atelectasis. No significant pneumothorax or pleural effusion. Mild subcutaneous emphysema left infralateral chest wall.

Output: Low lung volumes with basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: mass History: new onset dysphagia Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.A and a positive, chronic sinusitis, skin nodules. Evaluate for vasculitis, sarcoidosis, etc. Normal heart size. No visible pulmonary nodules or masses. Linear scarlike opacity left midlung. No pleural fluid or pneumothorax. No convincing evidence of lymphadenopathy or obvious signs of interstitial lung disease. Right upper quadrant surgical clips.

Output: No specific evidence of either sarcoidosis or vasculitis by plain film technique. If there is a high level of clinical suspicion, consider chest CT.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: evaluate tube position History: respiratory failure Endotracheal tube, unchanged. Enteric tube terminates within the distal aspect of the stomach.Newly apparent clustered nodular opacities overlying the mid aspect of the right lung. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Newly apparent clustered nodular opacities overlying the mid aspect of the right lung. This can be reevaluated on close imaging follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: AM CXR History: AM CXR Left chest tube terminating near the left lung apex. Stable small left apical pneumothorax.Stable left basilar-predominant interstitial opacities. The right lung remains essentially clear.Stable cardiomediastinal silhouette.Right chest port, tip near the cavoatrial junction. Left-sided endobronchial valves in unchanged position.

Output: Stable small left pneumothorax. No other interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Evaluate for pneumonia. ET tube tip is approximately 6 cm above the carina. Enteric feeding tube tip extends down the inferior margin of the image. Cardiomediastinal silhouette is unchanged. Low lung volumes. Patchy opacity in the right perihilar region likely represents atelectasis secondary to low lung volumes. No pleural effusion or pneumothorax.

Output: Patchy right perihilar opacity is favored to represent atelectasis. No pleural effusion or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Diaphoresis and increased work of breathing. Evaluate for infection. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: rule out infection History: fever, cough No focal pulmonary opacity, pleural effusion, or pneumothorax.Mild cardiomegaly redemonstrated.Chronic elevation of left hemidiaphragm.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: check pulmonary status History: check pulmonary status Small lung volumes, but no acute abnormality.ET tube tip approximately 5 cm above the carina.Left jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.

Output: Small lung volumes, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Lung transplant dyspnea on exertion. Bronchoscopy yesterday Persistent bilateral moderate pleural effusions greater on the right with underlying decreased volume extensive streaky densities suggesting at least partially atelectasis over a acute process such as aspiration or infection.Right jugular catheter unchanged, tip projects into the proximal SVC.Midline sternotomy

Output: Unchanged right central line without new postprocedural complication


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: FemaleReason for Study: Reason: 74 yo F w HF p/w sx of volume overload, assess for pulmonary edema History: DOE, abdominal distension There is mild cardiac enlargement with atherosclerotic changes of the aorta.No focal areas of consolidation or pleural effusions.

Output: Mild cardiac enlargement without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: abd pain s/p EGD - assess for any potential signs of esophageal perforation History: abd pain Unremarkable mediastinum with no sign of mediastinal emphysema or other signs of esophageal perforation.Elevated left hemidiaphragm with overlying subsegmental atelectasis, unchanged from previous.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Postoperative 6 after cystectomy evaluate for airspace process. Shortness of breath and anemia. Small left pleural effusion with persistent ipsilateral basal opacities, one of which is now wedge-shaped. Retrocardiac atelectasis on the left is slightly improved. Basal groundglass opacity on the right also appears to be slightly improving. Partially visualized catheter is in the upper abdomen.

Output: Pleural fluid and persistent basal opacities on the left could be the result of aspirated or retained secretions however the wedge-shaped appearance in one area raises the possibility of an infarct. This could alternatively reflect fluid partially extending into the fissure. If feasible, suggest correlation with right-side-down lateral decubitus view of the chest to see if the abnormality clears.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: intubated, daily interval change History: intubated, daily interval change Enteric tube terminates within the proximal aspect of stomach and could be advanced if clinically indicated. Multifocal diffuse pulmonary opacities again noted. Unchanged cardiomegaly. No pneumothorax. Lines and tubes are unchanged otherwise.

Output: Enteric tube terminates within the proximal aspect of stomach and could be advanced if clinically indicated. No substantial change in the diffuse multifocal pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: post op History: Interval extubation. Line positions are stable. Increase in small effusions with no other interval change.

Output: Increase in small effusion. Interval extubation with lines otherwise stable.