Instruction: Generate impression based on medical findings.

Input: History of neuroblastoma status post resection as well as chemotherapy, radiation, stem cell transplant. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Previously seen low-attenuation hepatic lesion appears slightly larger with different enhancement characteristics on comparison to prior study. While this may represent a hemangioma at a different phase of contrast enhancement, sonographic imaging may aid further evaluation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Surgical clips are seen in the right adrenal bed. The right adrenal gland is not visualized, presumably secondary to surgical removal. No evidence of recurrence is noted in this location.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Surgical clips are again seen in the retroperitoneum and right adrenal bed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously noted, multiple poorly-defined lytic lesions are again seen in the vertebral column and remain stable in comparison to prior study. Regional area of decreased bone density is noted at T9-L2 vertebral bodies and may represent post-radiation changes.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable poorly-defined lytic lesions within the vertebral column as mentioned above.

Output: 1.Previously seen liver lesion appears slightly larger with different enhancement characteristics. Sonographic evaluation may aid further characterization. 2.No evidence of disease recurrence.3.Stable bone lesions in the vertebral column as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: stem cell transplant patient with acute worsening of SOB History: SOB, crackles on exam Heart size is upper normal. New perihilar opacities, right greater than left, with septal lines compatible with pulmonary edema. No large pleural effusions. Basilar atelectasis.

Output: Perihilar opacities, right greater than left, with septal lines most compatible with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: ett eval History: as above Stable left basilar consolidation and mild lower lung zone edema.Heart size relatively normal. ET tube tip 8 cm above the carina. An NG tube terminates in the stomach, the side port at the GE junction or above.

Output: Stable pulmonary opacities. High ET tube, 8 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male status post renal transplant in 2002 recently admitted with atypical pneumonia that improved with antibiotics. Now returns with increasing shortness of breath and hemoptysis. Patient does have some underlying diastolic dysfunction. Evaluate for worsening or progression of pulmonary infiltrates. CHEST:LUNGS AND PLEURA: Interval development of patchy areas of coarse groundglass and air space opacities in peribronchovascular distribution bilaterally as well as thickened interlobular septa. New mild right pleural thickening may represent subpleural edema.Stable scattered micronodules.MEDIASTINUM AND HILA: Mild mediastinal lymphadenopathy is again seen with reference precarinal lymph node measuring 2 x 3.4 cm (series 3, image 40); previously measuring 1.5 x 3.1 cm. Mitral annular calcifications and mild cardiomegaly.Fluid density collections in the posterior mediastinum are unchanged and again likely represent dilated lymphatic channels and a dilated cisterna chyli.Heterogeneous right thyroid lobe likely due to cysts.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Limited view of the upper abdomen again shows hyperattenuating area in the medial spleen suggestive of calcification. Small low attenuation focus in right hepatic lobe (series 3, image 110) is unchanged and remains too small to characterize. Atrophic left kidney with partially visualized interpolar cystic lesion as seen previously.

Output: Interval development of patchy coarse groundglass and air space opacities in peribronchovascular distribution with thickened interlobular septa. Findings are consistent with pulmonary edema. Pulmonary hemorrhage and infection are also differential considerations.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Diffuse centrilobular emphysema, unchanged.Slight interval increase in the size of the spiculated left upper lobe nodule as seen on image number 88, series number 5, measuring 9 x 7 mm. This nodule was measuring 7 x 3 mm on image number 29, series number 5 on the previous study.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Previously described left supraclavicular lymph node now measures 18 x 10 mm image number 6, series number 4, not significantly changed.ABDOMEN:LIVER, BILIARY TRACT: Mild fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small left adrenal nodule is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 20 by 20-mm image number 119, series number 4, stable. Other para-aortic adenopathy is also stable.BOWEL, MESENTERY: Stable large parastomal hernia containing fat and nonobstructed bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post radical prostatectomy. Soft tissue between the rectum and bladder. Recurrent tumor cannot excluded.BLADDER: Focal nodular enhancement within the right lower bladder wall may represent bladder cancer or recurrent tumor. Endoscopy is recommended.LYMPH NODES: Again noted multiple enlarged lymph nodes in the pelvis. Index right obturator node now measures 7-mm in diameter image number 163, series number 4. Other larger pelvic lymph nodes are also grossly stable. Index left obturator lymph node measures 12 by 10-mm image number 157, series number 4. Left inguinal adenopathy is unchanged.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Sclerotic lesions in the pelvic bones and sacrum and lumber vertebral bodies are stable. Sclerotic lesions in the ribs are stable.OTHER: No significant abnormality noted

Output: Interval increase in the left upper lobe spiculated nodule suspicious for primary lung cancer.Metastatic left supraclavicular, abdominal pelvic adenopathy and sclerotic bone lesions are stable.Endoscopy is recommended for further evaluation of the nodular enhancement in the right inferior bladder wall which may represent bladder cancer or recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.AVR, MVR, TVR, CABG. Right jugular Swan-Ganz catheter at the main pulmonary artery/pulmonary outflow tract level. Interval extubation. Other hardware and devices unchanged.Cardiomegaly. Highly tortuous thoracic aorta.Elevation of the left hemidiaphragm with a small left pleural fluid collection and basal atelectasis. No pneumothorax.Prominence of the left paratracheal stripe and left mediastinum may be exaggerated due to patient positioning; short-term follow-up recommended to exclude possibility of a hematoma.

Output: Prominence of the left paratracheal stripe and left mediastinum may be exaggerated due to patient positioning; short-term follow-up recommended to exclude possibility of a hematoma.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: s/p TVR History: SOB Chest tubes removed with no pneumothorax but a persistent right effusion and right basilar consolidation.Right jugular introducer removed.

Output: Chest tubes removed, with no pneumothorax but persistent right pleural effusion and right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval pleural effusions History: 3915 The left port remains accessed.Persistent moderate pleural effusions with associated atelectasis and basilar edema. No interval pneumothorax. The cardiac silhouette is obscured by parenchymal opacities.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.SOB rule out for early pneumonia versus acute chest. Mild cardiomegaly for age, unchanged. Prominence of the central pulmonary vasculature consistent with history of sickle cell disease. No focal airspace opacity, pleural fluid or pneumothorax.

Output: No signs of pneumonia or radiographic findings to suggest acute chest.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Evaluate gastric distension History: Large gastric bubble on last XR Tracheostomy is in place. Unchanged PICC line. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax. Decrease in gastric distention.

Output: No acute cardiopulmonary process on radiography.Decrease in gastric distention.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: chest pain eval History: chest pain No significant pulmonary or pleural abnormality.Symmetrical hilar and mediastinal lymphadenopathy is present suggestive of sarcoidosis.

Output: Lymphadenopathy suggestive of sarcoidosis. Reference should be made to a follow-up CT and its report.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: S/P LVAD. Eval for VAD position. History: post-op Iatrogenic devices are unchanged. LVAD is in place. Cardiac leads are as expected. Mitral valve ring is as expected. Low lung volumes with question of mild pulmonary edema. Left basilar opacity again noted. No pneumothorax. Moderate cardiomegaly, as before.

Output: Iatrogenic devices, as above. Low lung volumes with question of mild pulmonary edema. Stable left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: Re-eval Left lung field History: s/p VATS Left chest tubes and venous catheter unchanged.Extensive opacity in the left hemithorax consistent with consolidation, atelectasis and effusion.Patchy airspace and interstitial opacity in the right, unchanged or slightly improved.Other findings unchanged.

Output: Chest tubes in place with no pneumothorax or other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval hemoptysis History: CH, hemoptysis Diffuse coarse interstitial opacity in a pattern consistent with severe bronchiectasis secondary to cystic fibrosis.Small chronic loculated pneumothorax at the left apex and diffuse volume loss in the left hemithorax, unchanged.Previous airspace opacity in the left lower lung has partially cleared with residual bronchiectasis and opacity compatible with mucus filled dilated bronchi.Port catheter with its tip in the SVC.

Output: Extensive bronchiectasis and chronic left loculated pneumothorax with no new findings.


Instruction: Generate impression based on medical findings.

Input: Reason: resp failure History: intubated ET tube tip approximately 4 cm above the carina. Catheter from the left arm extending to the SVC and port catheter looped in the area of the right jugular vein.Extensive bilateral airspace opacities and bronchiectasis consistent with known cystic fibrosis, not significantly changed allowing for position and inflation.Blunting of the left costophrenic angle consistent with small effusion or scarring.A small radiopaque object projected over the gastric fundus may represent a dental filling or crown that has been swallowed.

Output: Extensive bronchiectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: 41-day-old male with Down syndrome presenting with fever, evaluate for pneumonia and bowel dilatation.VIEWS: Chest and abdomen AP (2 views) 10/26/2016 1103 Cardiac silhouette is mildly to moderately enlarged. Pulmonary vascularity remains increased. Mild lung haziness is present. No focal airspace opacity, pleural effusion, or pneumothorax is identified.Enteric tube terminates in the proximal stomach. There is mild increase in gaseous distention of the bowel loops. No portal venous gas, pneumoperitoneum, or pneumatosis intestinalis is identified.

Output: 1.Left to right shunt pattern.2.Mildly dilated bowel loops in a disorganized pattern, with no evidence of necrotizing enterocolitis.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with vulvar Paget's disease and history of uterus cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: assess for pTX History: s/p thora No pneumothorax following left thoracentesis, with partial reexpansion of left basilar consolidation.Marked right hemithorax chronic volume loss unchanged.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Ensure PICC is central. Right upper extremity PICC tip at the SVC/RA junction. No focal pulmonary opacities.

Output: Appropriate position of right PICC with tip at the SVC/RA junction.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: pneumonia? History: tactile fever, weakness, inability to get out of bed for three days Stable cardiac enlargement.No focal airspace opacities.No large pleural effusions.

Output: Cardiomegaly without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infection, edema, effusion History: sob, wheezing, h/o asthma Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Rule out infection History: cough, fever, tachycardia Increased right upper lobe consolidation likely further atelectasis from a known obstructing right perihilar lung cancer.No reliable evidence of infection although this is possible.The lungs are unremarkable elsewhere and the heart size normal.

Output: Increased right upper lobe consolidation likely from further bronchial obstruction, without reliable evidence of superimposed infection.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Acute respiratory failure with hypoxia. ETT moved 2 cm inferiorly. ETT has been advanced, with tip now 5 cm above the level of the carina. Other tubes and lines unchanged. Large layering pleural effusions with significant associated atelectasis about the same.

Output: ETT tip 5 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Check ETT placement. ETT tip 3.5 cm above the level of the carina.Minimal basal atelectasis, possibly the result of aspirated secretions.Posterior costophrenic angle blunting may be due to scarring or trace pleural fluid.

Output: ETT tip 3 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: ptx s/p lung bx? History: none No significant pneumothorax. Minimal subcutaneous emphysema. Known nodule was better seen on CT.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Swan placement History: As above Iatrogenic devices are unchanged. Slight increase in right basilar opacity, likely atelectasis. Left basilar pleuroparenchymal opacities, not substantially changed. Unchanged cardiomegaly. No pneumothorax

Output: Left basilar pleuroparenchymal opacity, not substantially changed.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Status post MVR, SOB. Is there an effusion on the right side. Moderate right pleural fluid collection. Cardiothoracic ratio mildly enlarged, similar to previous.Basilar opacities consistent with atelectasis, mild edema and possibly postoperative contusion. Mitral ring.

Output: Moderate right pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Focal pain RIBS: Multiple minimally displaced acute fractures are observed involving the anterolateral aspects of the left eighth and ninth ribs fracture underlying patient placed markers. Remaining ribs are otherwise unremarkableChest: Minimal basilar changes suggesting atelectasis and less likely aspiration. No associated complication, specifically no pneumothorax.

Output: Acute left lower rib fractures as described


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for pulmonary edema/effusion. History: Hx of CHF Mild cardiomegaly with a slightly tortuous aorta.Small lung volumes with basilar subsegmental atelectasis. No specific evidence of CHF or pneumonia.

Output: Increased basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Pt with PTX, chest tube now clampled. Please reassess History: known PTX Interval increase in right pneumothorax, chest tube unchanged in position. Multiple lung masses.

Output: Interval increase in right pneumothorax, chest tube unchanged in position


Instruction: Generate impression based on medical findings.

Input: Cough Unchanged small right pleural effusion without significant new abnormalities. Moderate cardiomegaly with a somewhat globular shape again concerned for possible pericardial effusion. COPD changesModerate tortuosity of aorta and atherosclerotic changes

Output: Persistent small right effusion without additional new abnormality


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: Evaluate for PNA History: Abdominal pain, pt with Down's and unable to give reliable history 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, 24 years old.Reason: r/o pna History: cough, fever, tachy New nodular opacities at the lung bases. Small right pleural effusion. Normal heart size. No pneumothorax.

Output: New nodular opacities at the lung bases certainly consistent with aspiration or pneumonia..


Instruction: Generate impression based on medical findings.

Input: Tachycardia No appreciable cardiopulmonary new or acute abnormality. Borderline cardiomegaly. Left PICC line extends into the mid SVC

Output: Well-positioned left PICC line


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: COPD History: shortness of breath Status post CABG.Small lung volumes.Heart size upper normal.No significant pulmonary or pleural abnormality.Surgical clips right upper quadrant.

Output: Heart size upper normal, otherwise unremarkable. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with lung cancer status post two cycles of chemo. CHEST:LUNGS AND PLEURA: Large loculated right pleural effusion with interval increase in size. Near complete atelectasis/consolidation of the right lower lobe. Small equivocal right posterior pleural based nodule (series 3, image 102/162).MEDIASTINUM AND HILA: Nonspecific precarinal lymph node containing macroscopic fat (series 3 image 39) measuring 15 x 9 mm (previously 15 x 8 mm). No pericardial effusion.Multiple right costophrenic lymph nodes, with the largest (series 3 image 78) measuring 17 x 14 mm, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion in the left hepatic lobe adjacent to the dome, unchanged.Cholelithiasis, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple small bilateral hypodense renal lesions, majority of these are compatible with simple renal cysts and unchanged from prior. Others are too small to characterize. Cystic lesion in the inferior pole of the right kidney (series 3 image 134) is relative high density which may represent proteinaceous fluid or hemorrhage, unchanged from prior. This is incompletely evaluated on current exam.Few scattered right renal calculus, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild to moderate degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.

Output: 1) Increase in loculated right effusion. Increase in right lower lobe atelectasis.2) Stable nonspecific precarinal and right costophrenic lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Recurrent lip SCC with fever last night. Need to further characterize nodules. Right chest port catheter tip is at the SVC/right junction. Surgical clips project over the left neck. Stable cardiomediastinal silhouette. Small pulmonary nodules are incompletely characterized but appear similar. Persistent hazy bilateral basilar opacities most compatible with atelectasis. No new airspace opacities. No pneumothorax.

Output: 1.No reliable evidence of infection. 2.Small pulmonary nodules are incompletely characterized but the visualized lesions appear similar to the CT. These may be followed routinely unless the patient is neutropenic.


Instruction: Generate impression based on medical findings.

Input: Reason: Daily CXR History: Chest pain Moderate cardiomegalyWith sternal fixation devices.Mediastinal and pleural drains in place with no pneumothorax. Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female 7 years old; Reason: Assess for pulmonary edema, effusion, and opacities. History: Patient with engraftment syndrome, on broad spectrum antibiotics.VIEW: Chest AP (one view) 8/5/2016 at 0602 The right internal jugular line has its tip in the right brachiocephalic vein remains unchanged. Cardiomegaly unchanged. Right lung opacities not significantly changed.

Output: Right lung opacities not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: assess for PNA History: intubation ET tube tip just above the carina. Interval insertion of enteric tube, with side port at the gastroesophageal junction, consider advancing.Subsegmental basilar atelectasis and questionable small left effusion.Patchy right basilar opacities which may reflect aspiration.

Output: Subsegmental atelectasis and questionable right basilar aspiration. Enteric tube side-port is at the gastroesophageal junction, consider advancing.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with leukocytosis. Evaluate for pneumonia. Stable cardiomediastinal silhouette. Ill-defined retrocardiac opacity likely represents atelectasis. No pneumothorax or large pleural effusion.Median sternotomy wires and fixation devices in place. Support devices unchanged in position.

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


Instruction: Generate impression based on medical findings.

Input: Female 19 years old Reason: r/o pna History: new onset wheezing Low lung volumes.No focal airspace opacity.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is normal.

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


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with head and neck cancer (laryngeal cancer status post tracheostomy). CHEST:LUNGS AND PLEURA:Multiple new and enlarged pulmonary nodules, consistent with metastatic disease. Previously identified nodule in the right upper lobe (series 5 image 51) now measures 13 mm (previously 5 mm). Previously identified nodule adjacent to left major fissure (series 5 image 45) now measures 11 mm (previously 5 mm). Additional nodules are less than 2-mm.Mild paraseptal emphysema, similar to prior.Right basilar scarring/atelectasis similar to prior with enlarging peripheral nodule, consistent with metastasis.MEDIASTINUM AND HILA: Tracheostomy tube in place. No significantly enlarged mediastinal or hilar adenopathy.Severe coronary artery and aortic calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: New hypodense lesion in segment 7 of the right hepatic lobe (series 3 image 68) measures 13 x 12 mm, highly suspicious for metastatic disease. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, including relative hyperattenuating exophytic left renal cyst, similar to prior.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube with balloon inflated within the gastric lumen. Nasogastric tube with tip in the second/third part of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Extensive vascular plaque of the abdominal aorta and branch vessels.

Output: Progression of metastatic disease in the lungs with new liver lesion.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: upright History: upright, AMS No acute cardiopulmonary abnormality

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Swan-Ganz catheter. Swan-Ganz catheter appears with its tip in the left upper lobe. Unchanged moderate-to-marked cardiomegaly with worsening edema. Other support devices unchanged. Mild bibasilar atelectasis. Improved aeration at the left lung base.

Output: Swan-Ganz catheter tip within the left proximal left pulmonary artery, unchanged from prior. Worsening edema.


Instruction: Generate impression based on medical findings.

Input: 71 year old with prostate cancer. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable subcentimeter left supraclavicular nodes, unchanged. Postsurgical changes of a CABG. Calcified coronary arteries.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter cyst in the midpole of the left kidney with adjacent cortical scarring, unchangedRETROPERITONEUM, LYMPH NODES: Stable, small interaortocaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: ProstatectomyBLADDER: Status post ileal diversion procedure.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sutures are seen in the sigmoid colon. Clips are seen adjacent to the rectum and obturator regions.Small ventral hernia containing sidewall of a small bowel loop without evidence of obstruction, unchanged. Bulge in the left anterior abdominal wall in the left lower quadrant, unchanged.BONES, SOFT TISSUES: Unchanged blastic metastasis involving the right iliac bone.OTHER: Atherosclerotic disease.

Output: Stable examination. Unchanged metastasis to the right iliac bone.


Instruction: Generate impression based on medical findings.

Input: Reason: interval change LLL consolidation vs effusion History: o2 requirement Persistent airspace opacity in the left lower lobe with some associated atelectasis and a moderate left effusion, slightly increased compared to previous. Small right pleural effusion, unchanged.

Output: Slightly increased opacity at the left base consistent with consolidation, atelectasis and small effusion.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old Reason: pna? History: shortness of breath No focal airspace opacity to suggest acute infection.Large lung volumes suggestive COPD.The cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.

Output: Large lung volumes suggestive of COPD, but no specific evidence of infection or significant interval change.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: assess swan ganz placement History: cardiogenic shock Line position stable.Stable cardiomegaly.No lung opacities.

Output: No interval change without evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: lung eval History: lung eval Some interval increase in fluid in right hemithorax following pneumonectomy when compared to the prior study. Otherwise no interval changes.

Output: Increased right fluid in the right hemithorax following pneumonectomy. Remaining findings are stable.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with metastatic renal cancer CHEST:LUNGS AND PLEURA: Moderate-sized partially loculated right pleural effusion is again identified. Numerous pleural-based metastatic lesions are again seen throughout the right hemithorax. Reference lesion in the right upper lung measures 4.8 x 2.8 cm image number 32, series number 3, not significantly changed in size earache however did best of the lesion is decreased. Largest lesion in the right lower lung measures 10.1 x 6 . 9 cm, slightly enlarged.Again noted bilateral colloid nodules. Reference left upper lobe pulmonary nodule is stable measuring 8 x 7 mm, image number 23, series number 5. a new, left-sided pleural-based nodule measures 7-mm image number 79, series number 5MEDIASTINUM AND HILA: Enlarged left thyroid lobe, unchanged. Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hypodense lesions arising from the left kidney are unchanged. They cannot be optimally characterized due to lack of IV contrast. High density exophytic lesion arising from the lower pole of the left kidney is unchanged measuring 22 x 20-mm image number 143, series number 3.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: Scattered punctate sclerotic regions in the pelvic bones, stable.OTHER: No significant abnormality noted

Output: Numerous pleural-based metastatic nodules predominantly on the right side of the chest. Some of these pleural-based nodules have increased in size. A new subcentimeter pleural-based nodule in the left side. Parenchymal nodules are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: evaluate for lung abnormality, injury or pneumothorax History: blunt trauma to chest 10 days ago, intermittent shortness of breath and pleuritic pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Cough and fever evaluate for pneumonia versus aortoesophageal fistula. Aortic stent graft similar in position. Cardiomediastinal silhouette appears similar to prior on this limited portable radiograph.Diffuse bronchial wall thickening appears more pronounced. No focal airspace opacities. Scarring or atelectasis in the lingula and right base. Low lung volumes. No visible pneumomediastinum.

Output: Mild bronchial wall thickening and basal atelectasis. Please refer to subsequent thoracic CT for assessment of the mediastinum.


Instruction: Generate impression based on medical findings.

Input: Status post CABG evaluate lung fields and ETT. ETT 6 cm above the level of the carina.Radiopaque density projecting over the left upper quadrant remains and could reflect a surgical clip and projects over an epicardial lead.Right jugular catheter tip at the main pulmonary artery level. Sternotomy hardware appears in alignment allowing for patient rotation. Mediastinal drains and a left basal chest tube are in place. No significant sized pneumothorax.Motion artifact with mild atelectasis but otherwise unremarkable appearance of the chest.

Output: No evidence of CHF. ETT tip 6 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old, history of thyroid cancer with paratracheal mass. CHEST:LUNGS AND PLEURA: No suspicious nodules or masses. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: The right thyroid lobe is atrophic or absent. A calcified nodule is evident within the right thyroid bed (image 10, series 4). A low attenuation right paratracheal mass with calcification inferiorly measures 3.0 x 3.9 cm on image 18, series 4.No pathologically enlarged hilar or mediastinal lymphoid tissue.The cardiac size is normal. No pericardial fluid. Aortic and coronary artery atherosclerotic calcifications are noted.CHEST WALL: Spinal degenerative disease.ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesion within the left lobe of the liver is nonspecific but may represent a benign cyst. Cholelithiasis noted.SPLEEN: Small soft tissue nodule anterior to the spleen probably represents a splenule which itself contains a small cystic lesion, likely benign.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cystic lesions, likely benign.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted

Output: Calcified paratracheal masses may represent metastases from the patient's known history of thyroid cancer. No definite evidence of metastatic disease to the lung parenchyma or the abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.CXR requested to ensure barium given at esophagram earlier today has cleared. There is some retained oral contrast within the large hiatal hernia in the lower thorax. Decreased volume of oral contrast material in the mid to distal esophageal segments. No signs of aspiration. No pneumothorax. Mild basal scarring. Scoliosis. Right neck surgical clips. Bilateral glenohumeral prostheses.

Output: There is some retained oral contrast material within the mid to distal esophageal segment as well as within the large hiatal hernia. No specific evidence of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Pleural effusions Left chest wall ICD with leads in the right atrium, right ventricle, and coronary sinus. High placement of a inferior approach Swan-Ganz catheter with tip in the proximal left pulmonary arteryModerate-to-marked cardiomegaly.No pleural effusions. No pneumothorax.Mild retrocardiac atelectasis likely compressive. Right basilar opacity has mildly improved since the prior exam.

Output: 1.No large pleural effusion. Mild improvement of right basilar opacity.2.Swan-Ganz catheter tip of is in the proximal left pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Evaluate for evidence of worsening small bowel obstruction. Continued emesis. There are multiple dilated loops of small bowel with differential air-fluid levels measuring up to 3.4 cm. There is a small amount of gas and stool in the proximal colon. Midline surgical skin staples and surgical anastomotic material in the left hemiabdomen.

Output: 1. Findings consistent with persistent small bowel obstruction. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: Hx of PTX History: None Right sided pigtail catheter similar in position. Trace right pneumothorax at the apex, about the same. Pneumomediastinum/pneumopericardium and diffuse subcutaneous emphysema. Low lung volumes with improving basal atelectasis. IABP marker projects over the descending thoracic aorta approximately 4-cm below the top of the aortic arch in this projection.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: reasses pulmonary edema History: Oxygen requirment Right basilar chest tube unchanged.No evidence of pneumothorax.Patchy airspace pulmonary opacities unchanged from the prior exam.Stable cardiac mediastinal silhouette.

Output: Patchy airspace pulmonary opacities are unchanged from prior exam.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: MaleReason for Study: Reason: eval for acute etiology of chest pain History: chest pain Decreased lung volumes with moderate cardiac enlargement.Interval clearing of the airspace opacities noted on the prior exam.No pleural effusions.

Output: Cardiomegaly with interval clearing of the previously noted pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: new O2 requirement, fever, s/p lung transplant History: see above The heart is normal in size.Surgical clips in the left hilum again noted. Left apical capping and pleuroparenchymal opacities in the left apex represent focal areas of scarring, stable from recent studies. Left basilar retrocardiac bandlike opacities may represent discoid atelectasis or developing bronchopneumonia.The right pleural space is within normal limits.

Output: Left basilar retrocardiac bandlike opacities may represent discoid atelectasis or developing bronchopneumonia, assessment is limited in this single AP projection. Correlate with physical exam


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: size of pleural effusion History: sob Right subpulmonic effusion, and a smaller left.Innumerable pulmonary metastases.Right jugular catheter, tip at SVC/RA junction level.

Output: Right pleural effusion, larger than before with extensive metastatic disease and a small left effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Chronic dyspnea with recent cough. Evaluate for evidence of pneumonia. History: chronic dyspnea and recent cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: MaleReason for Study: Reason: s/p lung transplant, chest congestion, shortness of breath. History: as noted above Status post bilateral lung transplant.Ill-defined left upper lobe opacities compatible with scarring unchanged from the prior exams.No new pulmonary opacities identified.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: endotracheal tube position History: intubated Stable position of support devices. External blanket has been removed.No significant change in basilar opacities favoring edema with possible aspiration. Small pleural effusions Cardiomegaly unchanged. Skinfold projects at the left thoracic inlet; no pneumothorax is present

Output: Stable pulmonary edema pattern, and possible aspiration with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.ICU. Large loculated right pleural fluid collection compressing the adjacent lung similar in volume. Cardiopulmonary hardware and support devices similar in position.The left lung is clear.Cardiomegaly unchanged.

Output: Unchanged large right loculated pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval ptx History: tachy post IJ puncture The right pleural effusion has increased in the interval, now moderate and tracking along the inferior aspect of the right major fissure.No supine evidence of pneumothorax, considering limitations of technique.Very low lung volumes limit the assessment of the lungs. Passive right basilar atelectasis are noted.Surgical clips relate the abdomen.

Output: Interval increase in size of the right pleural effusion, now moderate.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath, multiple myeloma Interval new marked interstitial and largely airspace opacities greater on the left in a parahilar distribution. Suspected small to moderate effusions also greater on the left. Increased cardiac size and mild cardiomegaly although this changes partially magnification artifactOsseous structures are grossly similar, however please note difficulty in evaluating, specifically the right upper shoulder

Output: Marked interval increased suspected pulmonary edema mildly asymmetric and greater on the left likely due to patient positioning


Instruction: Generate impression based on medical findings.

Input: Chest tube placementVIEW: Chest AP ET tube and enteric tube again noted. Umbilical lines again noted. There is placement of a left chest tube with resolution of the pneumothorax. Cardiothymic silhouette normal. No focal lung opacity.

Output: Left chest tube placement with resolution of the pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: r/o infection History: coughing up blood Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pna, pulm edema History: cough Unremarkable cardiac and mediastinal silhouette. Mild focal scarring of the right costophrenic angle but no acute pulmonary findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: s/p CT removal History: s/p CT removal Incomplete mitral annuloplasty ring is in place. Epicardial pacing wires remain in place.Diffuse right-sided pulmonary opacities not significantly changed over last 24 hours. Residual right infralateral subcutaneous emphysema. Trace right pneumothorax is present.

Output: Trace pneumothorax and diffuse opacities on the right.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of squamous cell carcinoma. Cancer staging. CHEST:LUNGS AND PLEURA: Few scattered micronodules as well as calcified granulomas, unchanged. No new suspicious nodules, masses, or pleural effusion.Mild left basilar atelectasis.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease. A borderline enlarged precarinal lymph node (image 3, image 36) measures 13 mm in short axis.Heart size markedly enlarged without pericardial effusion. Severe coronary calcifications. Enlargement of the main pulmonary artery is compatible with pulmonary hypertension.Pacer leads in expected locations.CHEST WALL: Mild degenerative changes of the thoracic spine. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Scattered calcifications compatible with prior granulomatous disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta and iliac arteries. No pathologically enlarged retroperitoneal lymph nodes identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mixed sclerotic and lytic changes of the L1, L4, and inferior aspect of L3 vertebral bodies are most compatible with Paget disease.

Output: 1. No evidence of metastases.2. Probable Paget disease involving several vertebral bodies in the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extra cardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality noted.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: PNA, edena History: cough Decreased lung volumes with stable cardiomediastinal silhouette.Mild basilar subsegmental atelectasis.No new pulmonary opacities identified.No pleural effusions

Output: No acute cardiopulmonary abnormality. No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Pleural mesothelioma. Chest tube. Removal of medial right chest tube, the remaining lateral and basal right-sided chest tubes are unchanged in position. Extensive subcutaneous emphysema right chest wall and neck.Small right subpulmonic and apical pneumothorax. Persistent nodular soft tissue opacity in the right lateral costophrenic angle which could reflect hematoma, loculated fluid or residual disease.Resolution of pleural fluid and near complete resolution of atelectasis on the left.Left chest port tip at the SVC.

Output: Small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: preop History: -- The cardiomediastinal silhouette is unremarkable.Minimal scarring/discoid atelectasis at the left lung base.No focal areas of consolidation.Mild scoliosis thoracolumbar spine.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with non-Hodgkin's lymphoma. Evaluate disease status. CHEST:LUNGS AND PLEURA: Stable 13 x 7 mm partially calcified oblong opacity in the right upper lobe (series 5; image 33). Calcified right upper lobe granuloma.MEDIASTINUM AND HILA: 26 x 21 millimeter anterior mediastinal soft tissue density, not significantly changed when remeasured (series 3; image 41). Calcified mediastinal and right hilar lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in the left lobe of the liver is unchanged, too small to characterize, but likely in the periodSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodensities in the kidneys, compatible with cystsRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: cough, fever, eval for PNA or fluid overload History: cough, fever, eval for PNA or fluid overload Left subclavian dual chamber ICD remains unchanged. Status post median sternotomy and CABG surgery.Grossly stable cardiac silhouette.Low lung volumes with new right basilar airspace disease. Streaky left retrocardiac opacity likely atelectatic in nature. No sizable effusion or pneumothorax.

Output: New right basilar opacity concerning for pneumonia in the proper clinical setting.


Instruction: Generate impression based on medical findings.

Input: Non-Hodgkin lymphoma This study is severely limited to the lack of IV contrast. Particularly the mediastinal lymph nodes, solid abdominal organs are very difficult to evaluate.CHEST:LUNGS AND PLEURA: Previously described right middle lobe nodule has resolved. Smaller nodules are present in both lungs, some are new from previous study. Postobstructive changes are noted in the right middle lobe. A new lingular index nodule measures 6 x 4 mm on image number 43, series number 3.MEDIASTINUM AND HILA: Index AP window adenopathy is increased in size and now measures 2.8 x 1.8 cm on image number 34, series number 3. Right hilar adenopathy is also significantly increased in size. Other non-referenced mediastinal lymph nodes also increased in size.CHEST WALL: Bilateral axillary lymph nodes have increased in size. An index left axillary node now measures 1.5 by 0.8 cm on image number 24, series number 3. Previously, it was measuring 1 x 0.7 cm on image number 30, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node measures 1.3 x 1.3 cm on image number 105, series number 3, not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index right inguinal lymph node measures 1.6 x 1.4 cm in image number 164, series number 3. index left inguinal lymph node measures 1.3 x 1.3 cm image number 179, series number 3, slightly smaller compared to previous study. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Limited study due to lack of IV contrast. Significant interval increase in the size of the mediastinal, hilar and axillary adenopathy. New subcentimeter nodules in both lungs. Interval resolution of the previous described index nodule.Grossly stable index left para-aortic lymph node. Inguinal lymph nodes are also either slightly smaller or unchanged.


Instruction: Generate impression based on medical findings.

Input: 41 years old Female. Reason: interval changes History: as above. There is new the opacity in the right lower lung. There is no pleural effusion or pneumothorax. The cardiac silhouette is normal.The tube and lines are stable in position.

Output: Minimal patchy opacity in the right lower lung, new as compared with prior study and may represent edema.


Instruction: Generate impression based on medical findings.

Input: Endocarditis Essentially unchanged moderate cardiomegaly with patchy cardiopulmonary opacity similar to prior exams greater on the right and left lung base. Persistent CHF again suspectedTracheostomy tube and Dobbhoff unchanged

Output: Suspected CHF similar prior


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: Ett adjusted History: as above Low lung volumes with basilar subsegmental atelectasis. No pneumothorax. Cardiomediastinal silhouette within normal limits. Support lines are unchanged in position.

Output: Basilar atelectasis with no other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old. Swan-Ganz catheter tip in the right descending pulmonary artery.ICD lead tip in the area of the right ventricular apex.Cardiomegaly withLarge main pulmonary artery suggestive of pulmonary hypertension. No reliable evidence of pulmonary edema or infection.

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


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old. Right-sided ICD and right IJ venous catheter unchanged.Interval placement of a left central venous catheter with its tip in the SVC.No evidence of a pneumothorax.Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

Output: Interval placement of a left central venous catheter without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.History: Ischemic cardiomyopathy, COPD. Interval change. Persistent small lung volumes and cardiomegaly.ICD with 3 leads in place, unchanged.Interval increase in blunting of left costophrenic angle, and opacity suspicious for consolidation.

Output: Increased left basilar opacity suspicious for consolidation. Could be further evaluated with lateral radiograph.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female: Metastatic non-small cell lung cancer. CHEST:LUNGS AND PLEURA: Stable right upper lobe consolidation with volume loss, at least partially related to prior radiation. Concomitant tumor cannot be excluded. Loculated fluid at the right apex remains.Fibrotic changes at the right lung base remain. Extensive centrilobular emphysema and right pleural calcifications remain.MEDIASTINUM AND HILA: Small mediastinal nodes remain.CHEST WALL: Mild height loss of a few thoracic vertebral bodies remainsABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal metastatic disease not significantly changed, measuring 24 x 23 mm (series 2; image 91) when remeasured. The right adrenal metastasis not significantly changed when remeasured, measuring 3.1 x 2.6 cm (series 3; image 93).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia and duodenal diverticulum.Right hemicolectomy. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged right ovary,unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive sigmoid diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diffuse atherosclerotic disease.

Output: Overall stable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: PNA History: chemo pt w febrile neutropenia Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain, 60F h/o HTN p/w chest pain 2 days after lifting heavy materials at work. also with back pain. r/o acute pathology and comment on mediastinal widening please History: above Normal heart size with a tortuous aorta and moderate dextroscoliosis. No significant pulmonary or pleural abnormalities.

Output: Tortuous aorta and scoliosis but no visible acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: s/p thoracotomy History: s/p repeat thoracotomy, muscle flap Status post right thoracotomy and esophageal resection with pull-up, traversed by an NG tube.No pneumothorax, two right chest tubes with loculated pleural fluid or fluid layering posteriorly.Right jugular catheter, tip in SVC.

Output: No pneumothorax following recent esophagectomy and gastric pull-up.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No acute cardiopulmonary abnormality. Lungs remain clear. Moderate tortuosity aorta similar to prior exam given mild rotation. Cardiac silhouette within limits

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: IR drain, evaluate pleural fluid, wall suction History: htx, ptx, worsening effusion Right pleural pigtail drain again noted. Unchanged small to moderate size right pleural effusion. Left hemithorax is unchanged. Unchanged cardiomegaly. No pneumothorax.

Output: Right pleural pigtail drain again noted. Unchanged small to moderate size right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with metastatic colon cancer status post RFA of hepatic lesion on 12/11/09. Evaluate for interval change. CHEST:LUNGS AND PLEURA: Micronodules along fissure on the right series 4 image 50, unchanged from prior exam series 4 image 49 possibly an and pulmonary noted. No new lung nodules. No effusions.MEDIASTINUM AND HILA: No pathologic size nodes. Partial intrathoracic stomach (not a paraesophageal hernia). Coronary artery calcifications.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: No new sites of disease.Lesion that underwent RFA on the border of segment 5/6 as a larger near fluid density area caudally probably representing changes related to RFA. Along cephallic margin is more intermediate density seen on series 3 image 100 to measure 3.6 x 2.4-cm (also see coronal 60/110) which is less specific and concerning for residual tumor. No evidence of hepatic or portal vein thrombus. No biliary dilatation. Cholelithiasis, unchanged. Small nodes in the porta hepatis unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right hydroureter, unchanged.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal, portacaval and periportal nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder wall thickening. Foley catheter. Posterior wall of the bladder performed in infused to the presacral soft tissue unchanged from prior.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes. Left lower quadrant colostomy with parastomal hernia, nonobstructive. Parastomal hernia contains both large and small intestine. Diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Postsurgical changes and soft tissue thickening in the presacral space could represent postsurgical change. As before, the urinary bladder is tented and he is this area.

Output: Expected postsurgical changes. Changes in liver consistent with RFA and possible residual tumor should be followed. Nonobstructive parastomal hernia. Stable postsurgical changes in the presacral space. Numerous other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: pna, pleural effusion History: f/c, sob Focal opacity left lung base could represent atelectasis, more so than pneumonia.Small pleural effusions are noted.Heart size upper normal.

Output: Nonspecific left base atelectasis and small left pleural effusion, slightly pneumonia more likely atelectasis from aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.PICC. Crohn's disease. Left PICC tip at the superior vena cava.Moderate left and small right pleural fluid collections with associated atelectasis increased from previous. Lung volumes remain low. Mild dependent atelectasis. No pneumothorax.

Output: Left PICC tip at the SVC level. Enlarging pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: r/o pna History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with pancreatic cancer status post Whipple and chemotherapy. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post Whipple procedure.SPLEEN: No significant abnormality notedPANCREAS: Status post Whipple procedure. Ill-defined soft tissue in the portacaval region is unchanged in size and configuration.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post Whipple procedureBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlargedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable small soft tissue density in the portacaval region, most likely postoperative.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate ICD History: ICD shock, unknown ICD device Unremarkable cardiac and mediastinal silhouette. ICD lead tip projected in the area of the apex and right ventricle.No acute pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with cough and shortness of breath No focal airspace opacity is evident.The cardiomediastinal silhouette is normal.No pneumothorax or pleural effusion seen.

Output: No acute cardiopulmonary abnormality. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: am cxr History: pericarditis Small lung volumes with probable mild cardiomegaly.Tortuous aorta with fullness in the AP window area, unchanged as previously described.Mild interstitial opacity, suggestive of edema and possible small pleural effusions.

Output: Probable mild interstitial edema.


Instruction: Generate impression based on medical findings.

Input: 69-year-old man with bladder cancer status post 4 cycles of chemo. Please evaluate disease status and compared to 2/18/2008 scans. CHEST:LUNGS AND PLEURA: Calcified granuloma in the right upper lobe. No pulmonary nodules or effusions appreciated.MEDIASTINUM AND HILA: Stable pretracheal lymphadenopathy. Coronary artery calcifications are appreciated.CHEST WALL: Chest port in the right anterior chest wall with catheter tip in the SVC and RA Junction.ABDOMEN:LIVER, BILIARY TRACT: Several hypodensities with imperceptible walls and no contrast enhancement are redemonstrated. These lesions likely represent simple cysts. The gallbladder appears normal in appearance. There is no intrahepatic or extrahepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy is redemonstrated with reference pre-aortic lymph node seen on image 129/232 on series 4, measuring 1.4 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Widespread metastatic sclerotic bony lesions, some of which appear more conspicuous. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy with neobladder.LYMPH NODES: Confluent lymphadenopathy at the bifurcation of the aorta encasing the common and external iliac arteries. This appears stable from prior exam.BOWEL, MESENTERY: No abnormal dilatation of small or large bowel.BONES, SOFT TISSUES: Widespread metastatic sclerotic bony lesions, some of which appear more conspicuous. Reservoir for penile prosthesis is seen in the left abdominal wall.OTHER: No significant abnormality noted

Output: 1. Stable regional and retroperitoneal adenopathy.2. Widespread metastatic sclerotic bony lesions which appear more conspicuous than prior exam. 3. Status post left nephrectomy and prostatocystectomy with neobladder.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: fall, weakness Normal heart size and mediastinal contours. Retrocardiac midline opacity consistent with a hiatal hernia, unchanged. Diffuse fine reticular interstitial disease, increased from previous with decreased lung volumes, suggestive of a chronic process. This could be better evaluated by CT scan.No acute findings.

Output: Diffuse fine interstitial opacity, likely chronic but increased over the past 4 years. This could be further evaluated by CT scan if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: evaluate lung fields History: s/p thoracotomy Left-sided chest tube noted. Question of small left-sided pneumothorax. Unchanged cardiomegaly. Mild left-sided subcutaneous emphysema. Small amount of pneumoperitoneum, not unexpected given hernia repair.

Output: Expected postoperative changes status post hernia repair.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: SOB, new renal mass, look for mets History: SOB Single lateral decubitus film demonstrates small left effusion. No obvious pneumoperitoneum. Lungs otherwise grossly clear.

Output: Small left effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: chest pain History: CP to back, eval mediastinum. Hyperinflation of the lungs compatible with COPD. No focal air space opacity.No pneumothorax, pulmonary edema, or significant pleural effusion.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Dobbhoff placement NG tube is been removed and replaced with a Dobbhoff projects into the mid gastric lumen. Right jugular catheter terminates in the mid SVCUnderlying cardiopulmonary appearance is grossly similar with suspected bilateral pleural effusions greater on the left, possibly larger. Serial imaging is needed to confirm. Overall decrease in lung volumes and patchy opacities in a perihilar and basilar distribution again most concerning for edema.

Output: Dobbhoff tube placement


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Cough x 2 months, evaluate for infectious process. Very mild bronchial wall thickening. No evidence of pneumonia.

Output: Very mild bronchial wall thickening which is nonspecific but most commonly seen in asthma or bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.SOB rule out pneumonia Emphysema. Lower lobe crowding of bronchovascular structures with linear and reticular opacities suggesting fibrosis, likely chronic. Diaphragmatic eventration. Normal heart size. No specific evidence of pulmonary edema.

Output: Chronic appearing basilar opacities associated with volume loss suspicious for pulmonary fibrosis, unlikely to be an acute pulmonary abnormality. Consider follow-up PA and lateral chest radiographs and if this abnormality persists, then ILD protocol thoracic CT.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with history of lung cancer with brain metastases. CHEST:LUNGS AND PLEURA: Right upper lobe mass has changed shape and measures approximately 16 x 20 mm on axial image 15/96 which is smaller than on the prior exam. A separate, more inferiorly located mass which may represent an intrapulmonary lymph node has increased in size and now measures approximately 18 x 12 mm on axial image 23/96.Referenced right upper lobe micronodule (axial image 20/96) as well as other scattered micronodules are unchanged.MEDIASTINUM AND HILA: Multiple thyroid hypodense lesions are unchanged.Right pretracheal lymph node has increased in size and now measures approximately 33 mm on axial image 33/147. A right hilar lymph node has also increased in size. Small precarinal lymph nodes unchanged.Cardiac size is normal with no pericardial effusion.CHEST WALL: Lytic lesion within a left lateral rib (axial image 44/147) likely represents a metastatic focus.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions within both lobes of the liver are new and likely represent metastatic disease. The largest of these in segment 4a measures approximately 14 mm in diameter. Gallbladder polyp unchanged.SPLEEN: No significant abnormality notedADRENAL GLANDS: A new right adrenal mass measures 22 x 13 mm on axial image 96/147. The left adrenal mass has increased in size and now measures 30 x 19 mm on axial image 96/147.KIDNEYS, URETERS: Multiple small hypoattenuating lesions in the kidneys are new.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple lytic lesions noted within the vertebral bodies of L1 through L4 likely representing metastatic disease.OTHER: No significant abnormality noted

Output: 1.Right upper lobe mass has changed shape and measures smaller than on the prior exam.2.Additional right upper lobe mass has increased in size.3.Progression of mediastinal and hilar lymphadenopathy.4.Multiple bony metastatic lesions.5.Multiple liver metastases.6.New right adrenal mass with progression of the left adrenal mass.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: cancer? pna? History: weakness, wt loss, dyspnea on exertion Rightward deviation of the trachea with fullness of the upper mediastinum on the lateral view, which may represent a thyroid goiter or lymphadenopathy.No focal airspace opacity to suggest infection.Old healed rib fractures noted on the left.

Output: Rightward deviation of trachea with fullness of the upper mediastinum suggestive of thyroid goiter or lymphadenopathy. CT of the chest with contrast is recommended for further evaluation. Comparison with prior imaging if made available may also be of benefit.


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with a history of a right middle lobe micronodule, for reevaluation LUNGS AND PLEURA: A small 3-mm micronodule is noted in the right middle lobe (image 67 series 4). This was present on the prior examinations and demonstrates no interval change. Several small intrapulmonary lymph nodes are noted . An isolated small cyst is identified in the right lower lobe. No other pulmonary or pleural abnormalities can be identified.. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy identified. There is no evidence of pericardial effusion or cardiac enlargement.CHEST WALL: Degenerative changes in the cervical and visualized thoracic spine. Mild anterior listhesis of C7 on T1. Degenerative changes of the left glenohumeral jointUPPER ABDOMEN: Cholelithiasis

Output: Stable benign 3-mm micronodule in the right middle lobe. No further follow-up is needed.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: intubated History: intubated The enteric tube extends inferiorly off the field-of-view. Other lines and tubes, unchanged. Diffuse and basilar opacities again noted. Small pleural effusions, increased from last study. Unchanged heart size. No pneumothorax.

Output: Lines and tubes, as above. Mild pulmonary edema with small pleural effusions and increase in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with history of metastatic colon cancer, considering for radioembolization. Large amount of radiotracer activity is identified within the right hepatic lobe compatible with the patient's known neoplasm. No abnormal extrahepatic abdominal foci are evident. There is a small amount of activity in the lungs (lung fraction = 1.9%).

Output: 1. Radiotracer uptake in the right hepatic lobe compatible with the patient's known neoplasm.2. Minimal lung shunting fraction as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: 58 y/o F s/p central line placement History: central line placement Left jugular catheter extending to the area of the SVC with no pneumothorax or other complications.ICD leads unchanged.Cardiomegaly with airspace and interstitial opacity compatible with edema and chronic interstitial disease, not significantly changed.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Eval for pulmonary edema/ effusion, h/o lung cancer History: SOB, Tachypnea Left hydropneumothorax, lung completely opacified and the left main bronchus cutoff.Right basilar soft tissue mass and right pleural effusion.

Output: Presumed lung cancer, see above. A more recent CT has been scheduled.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: Evaluate position of ETT History: Intubated and sedated Retrocardiac opacity suggestive of atelectasis from aspirated secretions or mucous plugging, with volume loss.ET tube tip cannulates the right main bronchus, likely responsible for left basilar atelectasis.

Output: Right bronchial intubation, with mild left base atelectasis, already corrected as seen on subsequent radiographs.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: 55yoM with Swan Ganz check placement History: see above Cardiomegaly without edema.Right jugular Swan-Ganz catheter tip in pulmonary outflow tract. Left subclavian ICD, leads unchanged in position.Right PICC, tip in axillary region.

Output: Cardiomegaly without edema. Swan-Ganz slightly pulled back.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Evaluate for lung nodule, previous history of nodule. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No nodule identified.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: IABP History: Preop for VAD Cardiomegaly.Mild pulmonary edema unchanged with no pneumonia.IABP catheter proximal marker within 1 cm the top of the aortic arch.Right PICC, tip in the SVC.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly with mild edema. Unchanged support devices.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: r/o PNA History: productive cough, rhonchi on exam The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Moderate-sized hiatal hernia.

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


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Fever and cough, evaluate for pneumonia. Left upper lobe mass not significantly changed from the prior exam now measures approximately 6 cm in greatest dimension.Fullness of the hilum seen on the lateral view suggests hilar/mediastinal lymphadenopathy.Streaky retrocardiac opacity suggests atelectasis. Bibasilar scarring unchanged.Small left pleural effusion and subtle right septal lines may reflect fluid status.Cardiomediastinal silhouette unchanged.

Output: 1.New small left pleural effusion and subtle septal lines may reflect fluid status. 2.New left basilar atelectasis, but no specific evidence of infection. 3.Left upper lobe mass and suggestion of hilar/mediastinal lymphadenopathy unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval infection, edema, effusion History: ESRD, coarse BS in R lung field Right internal jugular central venous catheter tip in the SVC.Cardiomegaly with an extremely tortuous thoracic aorta.Perihilar airspace opacities and peripheral interstitial opacities at the lung bases are consistent with interstitial pulmonary edema, mildly improved compared to the prior exam.Interval decrease in small bilateral pleural effusions with underlying bibasilar atelectasis.No pneumothorax.Aortic stent graft.

Output: Pulmonary edema and bilateral pleural effusions, mildly improved since the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: 80 y/o lady w/ a new leukocytosis History: 80 y/o lady w/ a new leukocytosis Increase in patchy right basilar opacity and right pleural effusion. Scar like opacities again noted at the left lung base. Elevation of the right hemidiaphragm, unchanged. Unchanged cardiomegaly. No pneumothorax. Aortic atherosclerosis again noted. Cardiac leads, unchanged.

Output: Increase in patchy right basilar opacity and right pleural effusion, certainly consistent with aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: assess sternal hardware History: pt felt pulling in chest with movement and now has increased pain Chest tube, venous catheter, sternotomy hardware, and skin staples are unchanged. As noted on prior multiple screws are not centered over the sideplate holes. Lungs hypoinflated with nonspecific basilar opacity

Output: Chest tube, venous catheter, sternotomy hardware, and skin staples are unchanged. As noted on prior multiple screws are not centered over the sideplate holes.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? fluid overload? History: dyspnea Small lung volumes with increased basilar atelectasis of uncertain etiology.Probable moderate cardiomegaly with a tortuous aorta.Filter device in the IVC.

Output: Decreased lung volumes with increased basilar atelectasis of uncertain etiology. The differential diagnosis includes intra-abdominal disease, pulmonary embolism, and aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: evaluating for pna History: productive cough, low grade temp \T\ fatigue x 1.5 weeks, failing course of Augmentin. Ill-defined opacity in the periphery of the left lung base, possibly in the lingula, suggestive of pneumonia.Elsewhere, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Left basilar opacity consistent with infection/pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath No pneumothorax. Patchy bibasilar opacities, slightly increased. Small pleural effusions, improved. Unchanged heart size.

Output: No pneumothorax. Improvement in pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with castrate resistant prostate cancer and rising PSA, back pain. CHEST:LUNGS AND PLEURA: No significant abnormality noted. Eventration of the left leaf of the diaphragm. See sagittal image 89/110MEDIASTINUM AND HILA: Atherosclerotic calcifications coronaries and aorta.CHEST WALL: Mild gynecomastia. Few scattered sclerotic foci in the vertebral bodies consistent with metastasis.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Several high density areas likely representing high density cysts particularly in the right kidney. No calcifications. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: In the axial plane S3 image 125, the aorta measures 4.9cm AP x 3.6cm transverse and in the coronal plane the maximal transverse diameter of aorta is 3.7-cm on image 40/84. This is in the mid to distal abdominal aorta well below the origin of the renal arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered new sclerotic foci consistent with metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Left femoral and distal external iliac lymph nodes. Largest lymph node in the left external iliac distribution series 3 image 170 measures 3.3 x 3 cm. T he adjacent left femoral node measures 2.5 x 2.1 cm series 3 image 177. These lymph nodes are new compared to the 2006 study.BOWEL, MESENTERY: Postsurgical changes possibly related to lymph node dissection..BONES, SOFT TISSUES: . Sclerotic focus L5 and posterior inferior margin L2 concerning for metastases. Small nonspecific sclerotic focus left iliac wing coronal image 64/84.OTHER: No significant abnormality noted

Output: New, scattered sclerotic foci in the osseous tract structures concerning for metastases. New pelvic adenopathy. Abdominal aortic aneurysm. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain, lower GI bleed Similar to appearance on prior CT imaging from March 11, 2016 is mildly distended and thickened small bowel, gas noted distally in colon. No evidence of bowel obstruction. Metallic artifact seen in left upper quadrant, present on prior CT study. Spinal degenerative disease. Pessary device visualized.Please see same day chest radiography for additional findings.

Output: No evidence of bowel obstruction. Similar to appearance on prior CT imaging from March 11, 2016 is mildly distended and thickened small bowel.


Instruction: Generate impression based on medical findings.

Input: Reason: 79 yo M known MRSA PNA/empyema + E. coli empyema s/p multiple chest tubes. Mediastinal hematoma vs pleural fluid connection on CT Chest WO 5/3/15. Not a surgical candidate. Daily CXR for mediastinal monitoring. History: see above Tracheostomy tube, left pleural drain and feeding tube unchanged.Drainage catheter in the area of the left axilla, also unchanged.Enlarged cardiac silhouette and diffuse nonspecific bilateral opacities compatible with a history of pneumonia and empyema.No new findings.

Output: Bilateral pulmonary opacities and pleural effusion with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old with new fever. Severe cardiomegaly with pulmonary vascular redistribution, unchanged from the prior. Bilateral airspace and interstitial opacities are also stable. Small bilateral pleural effusions. No new focal consolidations. No pneumothorax.

Output: Unchanged severe cardiomegaly and diffuse opacities in both lungs. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 63 years old Male. Reason: post op CABG History: post op CABG and MVR. Cardiac silhouette is normal. There is no definite evidence of infiltrate or pneumothorax. There is a blunting of the left costophrenic angle, suggesting small left pleural effusion. The Swan-Ganz catheter, the mediastinal drain and left chest tube are stable in position.

Output: Small left pleural effusion. No definite evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cardiac arrest History: as above ET tube tip approximately 2 cm above the carina.Chest tubes on the right with no pneumothorax.Venous catheters unchanged.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.

Output: Basilar atelectasis and effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: s/p exlap, HIPEC ET tube tip approximately 1 cm above the carina. Catheter tip in the SVC.Basilar opacity consistent with atelectasis.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: assess for PNA History: fever Low lung volumes. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart is at the upper limit of normal, as before.

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


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Intubated History: None Cardiomegaly with the suggestion of basilar edema like opacities.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Right subclavian and left jugular catheters terminate in the SVC.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for progression in infiltrate, pulmonary edema History: hypxia Nonspecific basilar opacity suggestive of atelectasis and interstitial edema with possibly a small left effusion.Marked patient rotation towards the left side producing distortion of the mediastinal silhouette.Feeding tube tip in the body of the stomach.

Output: Basilar atelectasis and probably interstitial edema, without significant change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and COPD exacerbation Persistent no acute cardiopulmonary new abnormalities. Persistent focal scarring and surgical staples projected in the mid right lung along with large lung volumes and COPD changes. Questionable small right effusionRight jugular catheter again extends into the mid SVC

Output: No acute cardiopulmonary abnormality. Postsurgical changes and suspected scarring in the mid right lung remains unchanged


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: s/p thyroidectomy History: s/p thyroidectomy There are decreased lung volumes with mild cardiac enlargement.Widening superior mediastinum most may be related to recent thyroid surgery.The lungs are clear.No large pleural effusions.Contrast material is identified in the transverse colon.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: pulm edema? History: sob Right PICC is again seen with tip near the cavoatrial junction.Mild cardiomegaly. There are worsening bilateral interstitial opacities, worse at the bilateral bases consistent with edema. There are bilateral pleural effusions, right greater than left, worse than the prior study. Cephalization of the pulmonary vasculature.

Output: Worsening interstitial opacities consistent with edema and worsening bilateral pleural effusions. Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 66 years old Male. Reason: balloon pump position. History: above. Cardiomegaly. The tip of the intra-aortic balloon pump catheter is 8.1 cm below the top margin of aortic arch and unchanged. ICD lead position are unchanged. Stable basilar atelectasis.

Output: The intra-aortic balloon pump tip is about 8 cm below the top margin of aortic arch. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement History: ETT placement ET tube tip approximately 3 cm above the carina.NG tube tip in the stomach.Severe cardiomegaly and diffuse pulmonary opacity compatible with edema.Large layered out right pleural effusion.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Tetralogy of Fallot and Fontan procedure. Is there pleural effusion?VIEWS: Chest AP/lateral (two views) 02/08/16 Mediastinal surgical clips and embolization coils are again seen. Surgical clips in right lower lateral chest are again noted. Epicardial pacer leads are again seen.Cardiothymic silhouette is upper limits of normal to mildly enlarged. Aortic arch is right-sided. Pulmonary vascularity is slightly asymmetric with less blood vessels on the left. No pleural effusion is identified.

Output: No pleural effusion. Asymmetric pulmonary blood flow.


Instruction: Generate impression based on medical findings.

Input: Patient with intracranial hemorrhage and hemodynamically unstable please evaluate further, unable to receive contrast due to elevated BUN and creatinine LUNGS AND PLEURA:None there is a large consolidating lesion involving the left lower and lingular lobe is a new small lung and right lower lobe without significant pleural effusion on either side..MEDIASTINUM AND HILA: An endotracheal tube and a nasogastric tube are noted . Small amount of mucous and lungs endotracheal tube.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Large consolidating lesion on the left and a smaller one on the right without pleural effusion. Small amount of mucus is surrounding the endotracheal tube. Nature of consolidation is uncertain. Considerations are retained secretions and atelectasis versus pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: sp neck dissection, tracheostomy History: - Feeding tube with its tip in the right lower lobe bronchus. This has been placed in the stomach as shown on a subsequent abdominal radiograph.Tracheostomy tube in place.No acute pulmonary abnormalities.

Output: Feeding tube in the right lower lobe basal bronchus. This is been corrected on a subsequent abdominal radiograph.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: Right apical scarring is unchanged. Scarlike opacities in the anterior aspect of the right lung likely representing postradiation changes are stable.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined, geographic hypodensity anterior to the main portal vein on image number 83, series number 3 is new from previous CT and may represent focal fatty infiltration. However, possibility of metastatic disease cannot be entirely excluded.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Presumed left renal parapelvic cysts versus less likely mild caliectasis.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: Left inguinal borderline enlarged lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Possible focal fat infiltration anterior to the main portal vein. Correlation with MRI of the liver is recommended


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: assess for pneumonia, free air History: left sided chest, neck pain s/p robotic surgery Small lung volumes with basilar opacities and pleural effusions.Heart size normal.

Output: Specific basilar opacities consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female, febrile status post open incisional hernia repair with separation of components Small lung volumes with bibasilar atelectasis. Small left pleural effusion. No pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: No evidence of infection. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Fever Unchanged shunt catheter tubing projected and looped over the right lower lung without additional underlying cardiopulmonary new abnormalities. Changes include mild nonspecific interstitial changes presuming chronic without superimposed focal air space abnormalities. No findings to support aspiration or infection.Old healed rib deformity involving the posterior lateral aspect of the left sixth rib

Output: No definite focal intra-pulmonary change to support source for possible pneumonia. Old shunt tubing observed again described. See detail provided


Instruction: Generate impression based on medical findings.

Input: 51 years old Male. Reason: Eval for effusion History: S/P LVAD with persistent L sided Drainage. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. Small amount of bilateral pleural effusions are noted. The Swan-Ganz catheter has been removed. The cardiac assist device is stable in position.The tip of the right PICC line projects over the right axilla.

Output: The above findings are consistent with congestive heart fail lure.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: evaluate ETT placement History: recent intubation ET tube tip approximately 3 cm above the carina. Increased right perihilar airspace opacity, compatible with aspiration.A more recent radiograph has been interpreted.

Output: Increased right lung opacity compatible with aspiration.


Instruction: Generate impression based on medical findings.

Input: 29 years old Male. Reason: r/o aspiration History: aspiration. Cardiomegaly. Lower lung volumes. Patchy opacities are noted in the retrocardiac area in the left lower lung, worse as compared with the prior study. There is no evidence of pneumothorax.

Output: Interval worsening of the consolidation in the left lower lobe, which can be due to aspiration or pneumonia. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Left chest tube Left chest tube again noted without significant pneumothorax. Left basilar opacity stable. Right lung is clear.

Output: No acute change. No measurable pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with right apical pulmonary nodule for follow-up. LUNGS AND PLEURA: Noted ground glass nodule in the right apex is not identified on current examination most likely was inflammatory in origin.Mild bronchial wall thickening has improved in comparison to the prior exam.MEDIASTINUM AND HILA: Moderate coronary artery and aortic calcifications.There is mild cardiac enlargement without evidence of pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Interval clearing of the ground glass nodule in the right apex which most likely was inflammatory in origin.2.Mild bronchial wall thickening, demonstrating interval improvement.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Presenting with dizziness. No pleural effusion or pneumothorax. Heart size is upper limits of normal. Subsegmental atelectasis/scarring is visualized in the right greater than left basilar lung zones. Status post median sternotomy. No specific evidence of pneumonia or CHF.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: cough, fever, evidence of pneumonia? History: cough, fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: ET tube position History: s/p intubation Lines and tubes are unchanged. No new focal lung opacity. No evidence of pulmonary edema. Unchanged heart size. No large pleural effusion or pneumothorax. Healed rib fractures bilaterally again noted.

Output: No acute cardiopulmonary process on radiography.