Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.SOB question CHF. Upper normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.Lung volumes are low normal.No signs of CHF.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: TB patient from residual. Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 63 Male NSCLC status post one cycle of treatment. Please review and compare. CHEST:LUNGS AND PLEURA: Lingula mass series 4 image 55, 4.8 x 2.2 cm. few scattered nodules elsewhere, unchanged.MEDIASTINUM AND HILA: Left hilar node series image 41, 3 x 2.8 cm.AP window node, series 2 image 40, 3 x 1.5 cm. Right hilar node, series image 44, 1.5 x 1.4 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multifocal lesions redemonstrated increased in size.Reference lesion segment 4, series image 85, measures 2.7 x 2.6 cm.All of the lesions are also increased lesion in particular abutting the gallbladder fossa is markedly larger as seen on series 3 image 109.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic foci in thoracic and lumbar vertebral bodies multifocal, unchanged. No new sites of disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Progression of disease of particular increase in size of mediastinal nodes and liver lesions.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old Reason: r/o PNA History: cough and SOB Cardiomegaly. Diffuse interstitial opacities likely representing scarring in a patient with known sickle cell disease.Superimposed basilar edema.No significant pleural effusion. Right apical nodular lesions may reflect scarring but are nonspecific.Right upper quadrant surgical clips.

Output: 1. Moderate CHF on a background of chronic appearing opacities most consistent with scarring.2. Small nodular opacities in the right lung apex most likely represent scarring. Follow-up PA/lateral chest radiographs may be obtained in 6 to 12 months to confirm stability.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: interval change History: interval change Right IJ Swan-Ganz and chest/mediastinal tubes unchanged.Stable cardiac mediastinal silhouette.Mild perihilar edema similar to the prior exam.No evidence of a pneumothorax.

Output: Support devices unchanged. Stable cardiopulmonary appearance with mild edema.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Encounter for screening for respiratory tuberculosis. Normal cardiomediastinal silhouette. The lungs are well-inflated and clear. No signs of active intrathoracic tuberculosis. Mild thoracic scoliosis.

Output: No signs of active intrathoracic tuberculosis or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: PICC adjusted, eval reposition History: as above Cardiomegaly status post sternotomy, with moderate-sized bilateral pleural effusions and stable basilar opacities.Right PICC pulled back, the tip still retrograde in the left brachiocephalic vein at the midline.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: PICC repositioned, but still retrograde in the left brachiocephalic vein.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60yr old male with history of MM; pre-auto sct evaluation History: evaluate Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.History of intubation. Endotracheal tube, NG tube, and right internal jugular central venous catheter unchanged in position.Cardiac silhouette stable in size.Extensive pulmonary opacities consistent with edema/ARDS without acute interval change. No pneumothorax.

Output: No significant interval change since the prior study.


Instruction: Generate impression based on medical findings.

Input: 73 old male with metastatic rectal cancer CHEST:LUNGS AND PLEURA: Referenced left upper lobe cavitary lesion has not increased in size and now measures 44 by 25-mm image number 41, series number 4. There are multiple new metastatic lung nodules. Index right lower lobe lesion measures 25 x 23 mm image number 84, series number 4. Index lingular lesion measures 40 by 32 mm on image number 53, series number 4. These lesions are also increased in size compared to previous study.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Right hepatectomy. No focal lesions in the residual liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter cyst in the upper pole of the right kidney.RETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Presacral soft tissue changes are stable. The represent postsurgical changes.

Output: Interval increase in the size and number of lung metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Heart transplant status. Evaluate fluid. Sternotomy wires and mediastinal clips are present.Heart size remains normal.Interstitial lung disease without signs of superimposed pneumonia or pulmonary edema.Apparent filling defect in the distal left main and proximal left lower lobe airway without atelectasis, statistically most likely aspirated or retained secretions, though nonspecific by plain film. There is probably an additional site of debris in the proximal dependent left main bronchus.

Output: 1. No specific signs of pulmonary edema.2. Apparent filling defects in the left main bronchus and proximal left lower lobe airways nonspecific but statistically most likely represent aspirated or retained secretions/nonocclusive bronchial mucous plug. This can be conservatively followed by plain films to assess for resolution and is not associated with lobar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: post biopsy rule out pneumothorax History: none Left perihilar opacity noted. Mild diffuse lung reticulation, slightly increased from last study. No significant pneumothorax. No pleural effusion. Unchanged heart size.

Output: No convincing evidence of significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: s/p chest tube placement History: s/p transbronchial biopsy Large left pneumothorax, with tension component as there is a deep sulcus sign, despite a left chest tube subsequently repositioned.Chronic right hemithorax volume loss.Moderate basilar atelectasis.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: Large left tension pneumothorax, subsequent corrected.


Instruction: Generate impression based on medical findings.

Input: Reason: congested History: dyspnea Cardiomegaly with aortic valve prosthesis.Bilateral pleural effusions with underlying atelectasis.No significant interval change.

Output: Findings compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: sob, hx of CHF History: sob Cardiomegaly with septal lines suggestive of edema.No large pleural effusions. No specific evidence of infection.Median sternotomy for aortic valve replacement.

Output: Cardiomegaly with mild edema suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: 5-month-old male with right empyema status post right chest tube placement. Evaluate for pneumothorax or if lungs have reexpanded. VIEW: Chest AP (one view) 12/9/2015, 0544. Right chest tube remains in place. Cardiothymic silhouette is normal. Improved aeration of the right lung with mild diffuse hazy opacities. Moderate right pleural effusion. No pneumothorax. No focal opacity, pleural effusion, or pneumothorax of the left lung. Gaseous distention of the stomach.

Output: Improved aeration of the right lung with diffuse hazy opacities and moderate right pleural effusion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: cough x months, History: reduced air entry right chest No significant cardiopulmonary abnormality.More kyphosis with a stable lower thoracic spine compression or developmental abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: pna? History: ams No focal consolidation, pleural effusion or pneumothorax.The cardiac and mediastinal contours are within normal limits for size.The bones and soft tissues are normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: yes History: coughing blood A lobulated 2 x 1 cm opacity suspicious for a mass is seen projecting in the superior segment of the left lower lobe. CT correlation is required. Surrounding interstitial opacity noted as well.Hyperexpanded lung fields with flattening of the diaphragm would suggest chronic obstructive airway disease.Cardia mediastinal silhouette is within normal limits.No pneumothorax. No pleural effusion.

Output: 1. A lobulated 2 x 1 cm opacity suspicious for masses seen in this appears segment the left lower lobe. CT correlation is required.2. Chronic obstructive airway disease


Instruction: Generate impression based on medical findings.

Input: Concern for free air on chest radiography Markedly limited exam secondary to body habitus and patient positioning. Pneumoperitoneum noted, better visualized on prior chest films.

Output: Markedly limited exam, pneumoperitoneum better visualized on prior chest radiography. Please refer to same day CT study for additional findings.


Instruction: Generate impression based on medical findings.

Input: History of bladder cancer. CHEST:LUNGS AND PLEURA: Previously described subcentimeter nodular densities in the right lung are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left chest wall lipoma is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the anterior aspect of the left lobe are unchanged. Fatty infiltration of the liver. No new focal lesions. Liver is slightly enlarged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Small left adrenal nodule is unchanged.KIDNEYS, URETERS: Again identified the linear catheter-like high density material in the fat posterior and lateral to the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: Postsurgical changes consistent with know bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter lung nodules are unchanged. No evidence of metastatic or recurrent disease


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: FemaleReason for Study: Evaluate for infection (TB) 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: Age: 86 yearsGender: MaleReason for Study: Reason: eval hypoxemia cause, hardware History: post op Chest/mediastinal tubes unchanged.Stable cardiomediastinal silhouette.Perihilar/basilar interstitial opacities, pleural effusions, and basilar atelectasis similar to the prior exam.No pulmonary opacities identified.Median sternotomy is intact.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Nodule tube right lateral chest wall. Renal transplant and shortness of breath Scattered granulomata with a discrete focal opacity in the left lung base abutting the diaphragm. Questionable satellite smaller nodules are observed towards the hilar region with possible lymphadenopathy. Although likely pneumonia given patient history, concern for an underlying malignancy must be excluded. CT evaluation and/or clear serial imaging is needed to ensure clearance given a questionable masslike appearance. No distinct osseous abnormalities or definite effusion.The remaining lungs are otherwise significant for scattered calcified granuloma is observedCardiac and mediastinal contours are otherwise grossly within limits.Dr. Druelinger contacted

Output: Left lower lobe focal consolidation, possibly infectious however mass cannot entirely be excluded. Follow-up imaging and/or possibly CT evaluation may be indicated.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: AMS, elevated BG; eval for PNA, infiltrate History: AMS, elevated bg No significant cardiopulmonary abnormality.Streaky opacity left base unchanged likely scarring.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.History of cough and chronic malignant neoplasm of the bladder. The cardiac and mediastinal contours are within normal limits.Left IJ port catheter in place terminates in the right atrium.Lung volumes are normal. No abnormal focal lung parenchymal opacities. Assessment for noncalcified small pulmonary nodules is limited.The pleural spaces are within normal limits.Moderate degenerative changes of the thoracic spine.

Output: Adequate position of port catheter. No evidence of acute cortical pulmonary process.Conventional radiography has poor sensitivity for the detection of noncalcified pulmonary nodules. If there is concern for pulmonary metastatic disease, further assessment with chest CT should be performed.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: assess for edema vs pna, increased SOB History: sob Global cardiomegaly. Tortuosity of the thoracic aorta.Scattered bilateral mid lung and basilar septal lines suggestive of chronic interstitial pulmonary edema. Signs of pulmonary venous hypertension are noted.Possible trace pleural effusions. No pneumothorax.

Output: Cardiomegaly, signs of pulmonary venous hypertension and interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: 56 yo F w ARDS eval ETT placement History: see above Stable life support devices, including ETT tip 2.5 cm above the carina.Unchanged coronary mediastinal silhouette, enlarged.Grossly stable diffuse bilateral interstitial and airspace opacities compatible with patient's history of ARDS.

Output: Stable appearance of the chest as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p intubation History: PNA ET tube tip about 7cm above the carina and NG tube tip in the stomach.Right upper lobe atelectasis with bronchiectasis and bilateral lower lobe airspace opacity with atelectasis as characterized on the CT scan of the previous day.No new findings.

Output: Slightly high position of ET tube and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: evaluate for fluid overload History: cough Heart size upper normal with an aorta tortuous but consistent with age. No significant pulmonary or pleural abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: eval for PNA, fevers on chemo History: cough The cardiomediastinal silhouette is stable.There is persistent elevation of the left hemidiaphragm with adjacent atelectasis. There are no focal airspace opacities or pleural effusions. Right-sided airspace opacities seen in August 2016 have resolved.

Output: No evidence of pneumonia or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Presenting with cough and fever, please rule out infection. The cardiomediastinal silhouette is normal. Left lower lobe atelectasis. No focal lung opacity. No pleural effusion or pneumothorax. Bronchial thickening that is advanced for age.

Output: 1.No focal lung opacity to indicate infection. 2.Bronchial thickening consistent with asthma1.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: left sided pneumonia? History: cough for 10 days with ralse on left The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: SOB. Fatigue. Question pneumonia or pleural effusions. History of Sjogren's syndrome per prior MRI report Assessment of the lung parenchyma significantly limited by low lung volumes. Coarse interstitial abnormality nonspecific but suspicious for ILD.Heart size appears upper normal to mildly enlarged, similar to prior. Central pulmonary vasculature remains prominent. Atherosclerotic calcification of the thoracic aorta at the level of the arch. No pleural fluid or pneumothorax. No convincing evidence of pulmonary edema.

Output: Low lung volumes with coarse interstitial abnormality poorly evaluated but could represent interstitial lung disease in the setting of known Sjogren syndrome, recommend correlation with ILD protocol CT chest when feasible. Faint opacities are entirely nonspecific by plain film technique, however Sjogren- associated airways disease or lymphoproliferative disease such as lymphocytic interstitial pneumonia cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: FemaleReason for Study: Reason: r/o acute chest History: CP, sickle cell There are decreased lung volumes with stable cardiac enlargement.Left pleural thickening/effusion and opacity in the region left costophrenic angle similar to the prior exam.Mild increased basilar interstitial opacities compatible with edema, however accentuated by overlying soft tissue.No new pulmonary opacities identified.Osseous changes related to sickle cell disease.

Output: No significant interval change compared to the prior exam with mild chronic basilar edema and left pleural effusion/thickening.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with atypical chest pain. Rule out infiltrate. Cardiomediastinal silhouette within normal limits.No acute focal airspace opacity.No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lungs History: eval lungs ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Balloon catheter marker in the proximal descending aorta, unchanged.Bilateral airspace and interstitial opacity compatible with edema, improved compared to the previous day.

Output: Interval improvement in pulmonary opacity compatible with edema.


Instruction: Generate impression based on medical findings.

Input: 53 year-old female with left breast T2, N1 cancer status post mastectomy plus reconstruction with progressive neck pain and point tenderness in the left superior scapula. CHEST:LUNGS AND PLEURA: There is a 5-mm right upper lobe nodule (series 6, image 24), which is unchanged from previous examination. There is a left upper lobe airspace opacity which is unchanged and is likely secondary to radiation changes.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left mastectomy. Left breast skin thickening. No enlarged axillary lymphadenopathy.Left tram flap reconstructionABDOMEN:LIVER, BILIARY TRACT: The gallbladder is absent with cholecystectomy clips in place.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post subtotal colectomy with colorectal anastomosis.BONES, SOFT TISSUES: Degenerative changes of the thoracic spine.OTHER: Harvest of left rectus for tram flapPELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 22-year-old male. History of multiple shunt revisions. Ear pain. SHUNT DEVICE: Posterior occipital approach catheter entering the foramen magnum with tip at the C2 level, unchanged. The catheter courses down the soft tissues of the right neck and into the jugular vein with tip in SVC. No kinking or discontinuity of the radiopaque portions of the shunt. Orphaned catheter tubing in the left neck, unchanged.SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: No significant abnormality noted.

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


Instruction: Generate impression based on medical findings.

Input: Metastatic colorectal cancer. Evaluate chemotherapy response. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Left Port-A-Cath in place with distal tip in the SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple bilobar hypoattenuating lesions representing metastatic disease unchanged. A reference lesion in caudate lobe is unchanged measuring 9 x 8 mm on image number 99. Cholelithiasis unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing right renal calculus is unchanged.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: Status post proctocolectomy with left lower quadrant colostomy unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the pelvis

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: LLL crackles History: LLL crackles, chest heaviness There is moderate cardiac enlargement increased in size since the prior exam.Pulmonary vascular redistribution.Bilateral basilar scarring/discoid atelectasis.No focal areas of consolidation.Probable small right pleural effusion.

Output: Interval increase in cardiac size may represent cardiomegaly and/or pericardial effusion as noted on the recent CT abdomen and pelvis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60 yo s/p arrest with pneumonia History: pneumonia Iatrogenic devices are unchanged. Improvement in patchy right basilar opacity. Persistent left lower lobe opacity and small left pleural effusion. No pneumothorax.

Output: Improvement in patchy right basilar opacity. Otherwise no substantial change.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: 13 months s/p VATS RUL for T2aN0M0 IB squamous cell carcinoma History: none Large lung volumes reflecting COPD or chronic. Minimal residual opacity in the right lower lobe may represent scar at site of prior inflammation. There is blunting of the right costophrenic angle from small pleural effusion which appears chronic. Right inferolateral rib deformity.Rounded opacity at the right posterior eighth/ninth rib interspace which may represent a nodule. This can be further characterized with a CT thorax.

Output: Rounded opacity at the right posterior eighth/ninth rib interspace which may represent a nodule. This can be further characterized with a CT thorax.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube s/p decort History: same Interval removal of one of two left chest tubes with no significant pneumothorax.Small air collections at the left base, most likely loculated in the pleural space, new from previous.Diffuse nonspecific airspace and interstitial opacity compatible with cystic fibrosis with superimposed areas of atelectasis.

Output: Interval chest tube removal with small residual loculated air collections at the left base.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: r/o infiltrate History: confusion No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: evaluate lung fields History: s/p left vats Low lung volumes with bibasilar opacity likely reflecting atelectasis. No specific evidence of edema. No large pleural effusion or significant pneumothorax. The heart size is normal. A left-sided chest tube is directed apically. A right chest port terminates in the SVC.

Output: Left-sided chest tube without significant pneumothorax and bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for pulm edema History: hypoxia Median sternotomy, heart size normal.Aortic endograft unchanged.No significant pulmonary or pleural abnormality.

Output: Status post aortic endograft. No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: atrial fib, LE swelling, evel for ADHF History: atrial fib, LE swelling, evel for ADHF Left chest wall port catheter tip in the right atrium.Small to medium bilateral effusions and basilar atelectasis.No new focal airspace opacity.Unremarkable cardiomediastinal silhouette.

Output: Bilateral effusions without definite pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: short of breath x 1 mo with history of asthma and possible fevers History: chest pain (pleuritic), short of breath x 1 mo Normal cardiac silhouette.Lungs clear. No pneumothorax. No pleural effusion.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: evaluate treatment for pneumonia History: cough, sputum production Persistent right lower lobe airspace opacity, not significantly changed.

Output: Persistent right lower lobe airspace opacity, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: Pt spike fever--> r/o PNA History: as above Aortic stent again noted. Low lung volume. Opacity along the right minor fissure is suggestive of atelectasis or scarring. There is increased elevation of the right hemidiaphragm. Streaky opacity in the right lung base is suggestive of atelectasis, and there is a probable small right pleural effusion. Tortuous calcified aorta similar to prior. The cardiac contours are within normal limits for size.

Output: Right basilar opacity suggestive of atelectasis and small right effusion suggestive of aspiration; follow-up chest radiograph is suggested to rule out development of pneumonia if symptoms persist.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Evaluate left chest tube placement and interval decrease in pneumothorax. SOB. Right PICC with tip at the level of the right atrium. Left chest tube projects over the medial lung base.Left basal pneumothorax is not measurable, but probably slightly improved.Pleural fluid and basal atelectasis bilaterally unchanged. Lower lobe bronchiectasis noted bilaterally.There appears to be diminished lung perfusion on the right, unchanged since the patient's admission exam of 4/9/2016 and of unclear chronicity.

Output: Interval left chest tube placement which terminates medially at the base. The known left anterior and subpulmonic pneumothorax is not readily measurable in this patient position but probably slightly improved.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.TB screening. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval infection, edema, effusion History: altered mental status Moderate to severe upper lobe paraseptal emphysema.Equivocal new nodular airspace opacity on the right may be due to aspiration or atelectasis, less likely infection.Unremarkable mediastinal contours and cardiac silhouette.

Output: Moderate to severe upper lobe paraseptal emphysema. Equivocal new nodular airspace opacity on the right may be due to aspiration or atelectasis, less likely infection.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: shortness of breath, CHF Dual-lead ICD with leads in the right atrium and right ventricle.Moderate to severe cardiomegaly.Bibasilar and apical atelectasis/scarring. No specific evidence of pulmonary edema.No pleural effusion or pneumothorax.Surgical clips in the abdomen.

Output: Cardiomegaly without specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Interstitial lung disease History: Interstitial lung disease Interval removal right-sided chest tube. No pneumothorax. Mild basilar opacities again noted. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: chest tube placement History: s/p VATS resection paraspinal schwannoma, patient is status post left upper lobectomy for lung cancer. Left chest tube in place.Cardiomediastinal silhouette is unremarkable.Low lung volumes with postoperative changes of left upper lobectomy. No large pleural effusions or pneumothorax. Bilateral basilar streaky opacities compatible with atelectasis.

Output: Left chest tube in place without significant pneumothorax. Bilateral basilar streaky opacities compatible with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: fever workup History: fever Chronic right hemidiaphragm elevation.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: Chronic right hemidiaphragm elevation, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: s/p thoracentesis History: sob Unchanged near complete opacification of the left hemithorax with bilateral pleural effusions.Extensive mediastinal and supraclavicular calcified masses consistent with amyloid are unchanged.

Output: Unchanged near complete opacification of the left hemithorax with bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Check for cardiomegaly. End-stage renal disease Persistent mild borderline cardiomegaly, nonspecific. Appearance is improved since 2014. Prominent pulmonary arteries suggest hypertensionRight jugular dialysis catheter well positioned.Lungs are clear

Output: Borderline mild cardiomegaly without acute pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Reason: Placement of ET tube History: Tubed ET tube tip approximately 4 cm above the carina.Heart size but upper normal with no significant pulmonary abnormalities.NG tube tip in the stomach.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent basilar consolidation and pleural effusions again suggests infection and/or aspiration. Small lung volumes. Mild cardiomegaly.

Output: Unchanged bilateral nonspecific basilar opacities, consistent with and concerning for infection over aspiration


Instruction: Generate impression based on medical findings.

Input: Fever and cough Ill-defined airspace and interstitial abnormality observed in the right lower lung, predominantly right middle lobe. Streaky changes in the right lower lung appears more like atelectasis. Upper lungs and left lung are clearCardiac and mediastinal contours are within limits

Output: Right middle lobe pneumonia given patient's history


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: ? Fluid overload History: SOB Right pleural effusion extending into the fissure versus an external skin fold.Chronic elevation left hemidiaphragm.No specific evidence of edema, and no sign of pneumonia.Left jugular catheter, tip in SVC.

Output: Possible right pleural effusion, but no sign of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Bodyaches and cough is there an infiltrate. 2 cm irregularly marginated nodule of the right upper lobe is barely visible on the lateral radiograph, even with direct comparison to sagittal images of CT. It is not visible on the frontal radiograph.Cervical spine hardware and loop recorder again seen. Chronic mild elevation of the right hemidiaphragm. Mild blunting of the right posterior costophrenic angle may be due to trace amount of pleural fluid. No specific signs of pulmonary edema. No new focal airspace opacities to suggest pneumonia.

Output: Irregularly marginated nodule in the anterior right upper lobe is barely visible by this technique and is most compatible with a primary lung malignancy. This lesion previously demonstrated growth on CT. Small right pleural effusion without evidence of CHF or pneumonia, a malignant effusion cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: ett placement History: ett placement Small lung volumes with interstitial and airspace opacities unchanged, accompanied by small pleural effusions.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.Calcified gallstones.

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


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: balloon pump History: balloon pump Lines and tubes are unchanged. Low lung volumes with mild pulmonary edema. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No change in degree of pulmonary edema. Line position stable.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated in SICU; please compare to prior image History: Intubated in SICU ET tube tip approximately 2 cm above the carina.New NG tube extending to stomach.Catheter tip in the SVC.Mild basilar and perihilar opacity in the right transplanted lung consistent with edema and atelectasis with a small effusion. Severe chronic interstitial disease in the left native lung consistent with fibrosis.

Output: Mild edema and pleural effusion with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No appreciable cardiopulmonary abnormality given semiupright portable technique and suspected decreased inspiration effort.Marked carotid calcifications bilaterally

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: End-stage renal disease. Chest pain. Moderate partially loculated right pleural fluid collection. Chronic basal opacities previously documented to represent metastatic calcification related to ESRD. Right subclavian ICD leads unchanged. Severe cardiomegaly, about the same.

Output: Moderate partially loculated right pleural fluid collection. No convincing evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: evaluate for placement of swan History: as above Cardiomegaly, small lung volumes and foci of subsegmental atelectasis are unchanged.Right jugular Swan-Ganz catheter pulled back to the right pulmonary artery.Second right jugular catheter tip in SVC.ICD and LVAD unchanged.

Output: Swan-Ganz catheter repositioned, slightly pulled back.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: assess ET tube placement History: cardiogenic shock Endotracheal tube has been advanced terminating approximately 3.5 cm from the carina. Other lines and tubes are not substantially changed. Patchy bibasilar opacities and pleural effusions again noted. Mild pulmonary edema again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Lines and tubes, as above. Mild pulmonary edema with bibasilar opacities and pleural effusions again noted. Opacity at the right lung base is mildly improved.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.History: Worsening pleural effusion or evidence of pulmonary congestion. Left pleural effusion is worsened from prior examination after thoracentesis with adjacent atelectasis. Right basilar opacity. Low lung volumes. No pneumothorax. The cardiomediastinal silhouette is obscured by left pleural effusion and atelectasis.

Output: Worsening left pleural effusion. Right basilar opacity may represent aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Eval for chest pain. History: Chest pain The heart is normal in size.Small chronic right pleural effusion associated with right basilar pleural thickening is unchanged from prior studies.Right middle lobe bandlike opacities represent scarring, also unchanged.The heart is normal in size.Diffuse osteopenia and mild degenerative changes of the thoracic spine.

Output: Right basilar scarring and pleural thickening are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: eval for infiltrate History: hypoxia The cardiomediastinal silhouette is normal in size.Large lung volumes with flattened diaphragms suggestive of COPD. Minimal bibasilar scarring. No focal pulmonary opacity, pleural effusion or pneumothorax.Metallic density in the left chest may represent an old bullet fragment.

Output: Large lung volumes with flattened diaphragms suggestive of COPD. Chronic bronchial wall thickening at the lung bases, particularly on the right may be the result of recurrent aspiration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Status post LVAD. ICU survey. Cardiomyopathy. ETT tip 4 cm above the level of the carina. Other tubes and lines similar in position. No pneumothorax.Diffuse opacities predominantly in the right lung suggestive of recurrent aspiration. Previously seen opacities have partially cleared. Small pleural effusions.

Output: Recurrent aspiration.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with AML status post stem cell transplant. Follow-up pneumonia. CHEST:LUNGS AND PLEURA: Slight interval decrease in patient's large pleural effusions with persistent left greater than right basilar atelectasis. There is very mild residual interstitial opacities in the upper lobes with near complete interval resolution of previously seen ground glass opacities. Stable bibasilar scarring.Unchanged scattered micronodules. No suspicious nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Stable heterogeneity of the thyroid gland.CHEST WALL: Right lateral chest wall nodule appear similar to prior study; likely sebaceous cyst.Right upper extremity PICC tip in the right subclavian vein. 2-lead pacemaker in expected location.UPPER ABDOMEN: Ascites and atherosclerotic disease of the aorta as seen previously.

Output: Near complete interval resolution of previously seen ground glass opacities with slight interval decrease in patient's large pleural effusions. There is persistent basilar atelectasis, left greater than right, which appears similar to the study from 2/1/2010.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: r/o pheumothorax / hemothorax / fluid collection History: SOB Post-PROCEDURE Pleuroscopy / Thorascopy Interval decrease in right pleural effusion, small right apex pneumothorax. Left basilar atelectasis.

Output: Interval decrease in right pleural effusion, small right apex pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.ET tube. ET tube 3 cm above the level of the carina. PH probe projects over the proximal esophagus. NGT tip off the caudal margin of the film. Peripheral catheter from the left terminates at the confluence of the brachiocephalic veins with the SVC.Interstitial and airspace opacities bilaterally with some improvement in aeration on the left. Retrocardiac opacity likely representing atelectasis, nonspecific.

Output: ETT tip 3 cm above carina. Waxing and waning pulmonary opacities may be the result of aspirated secretions, atelectasis and edema.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Eval for causes of hemoptysis History: Hx of H\T\N ca, hemoptysis Large lung volumes consistent with COPD.Left upper lobe scarring.No specific evidence of infection or edema.Healed right rib fractures.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: atypical PNA s/p ett History: ett, PNA Cardiopulmonary monitoring and support devices, unchanged.NG tube tip in the area of the GE junction.Diffuse mainly interstitial pulmonary opacity, without significant interval change.

Output: ET tube in acceptable position. Proximal location of NG tube.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: hx of chf here with sob, decreased exercise tolerance and LE edema History: see above Moderate cardiomegaly with small pleural effusions.No reliable evidence of edema or pneumonia.Left subclavian single chamber ICD, lead tip in the expected location of the RV apex.

Output: Cardiomegaly with small effusions, suggestive of CHF but without edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: ett position History: ett Small lung volumes with persistent lower lung zone atelectasis.ET tube tip approximately 2 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval for pna and check ETT depth History: asthma, sob, intubated No significant cardiopulmonary abnormality.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Sarcoid. Bilateral lung transplant now complicated by persistent effusions. Hardware and devices unchanged in position.Partially loculated pleural fluid collections bilaterally, right greater than left, not significantly changed.Lung volumes remain low.Groundglass opacities and consolidation bilaterally, becoming more confluent in the right lung.

Output: Diffuse opacities in the right lung are becoming more confluent. No significant change elsewhere.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: CM s/p OHT, annual eval History: CM s/p OHT, annual eval Orphaned cardiac leads. Status post sternotomy/OHT. No new pulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: post-op cardiac surgery History: post-op cardiac surgery Moderate cardiomegaly with nonspecific basilar opacity consistent with atelectasis and small effusions, slightly improved.Interval removal of a Swan-Ganz catheter.Catheter sheath with its tip in the area of the right innominate vein.No pneumothorax.

Output: Basilar opacity compatible with atelectasis and small effusions, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Post thoracentesis. Hardware and devices similar in position. No significant pneumothorax. Decreased volume of loculated pleural fluid on the left. Basal atelectasis, left greater than right. Small volume of pleural fluid on the right also appears decreased, but this may be positional.

Output: No significant pneumothorax post thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Dobbhoff tube placement. Dobbhoff tube tip has been slightly advanced with tip projecting over the gastric body. PICC tip at the cavoatrial junction. Stable basilar opacities and layering pleural effusions.

Output: Dobbhoff tube tip projects over the gastric body. Stable basilar opacities and layering pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: assess reasons for hypoxemic respiratory failure History: on 100% fiO2 while intubated ET tube tip approximately 5 cm above the carina.ICD leads in expected locations, with a right ventricular lead superior to the right ventricular apex. NG tube tip in the stomach.Small lung volumes with diffuse severe reticulonodular interstitial opacity compatible with fibrosis.

Output: Severe chronic interstitial disease suggestive of fibrosis. A CT scan would be appropriate for further evaluation if one has not been performed recently elsewhere.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: right internal jugular placement History: shortness of breath The heart size is normal. The cardiomediastinal silhouette is stable. Interval placement of right internal jugular catheter with tip in the SVC. Endotracheal tube tip is high, 12 cm above the carina. Enteric tube tip projects over the region of the gastric pull-up above the diaphragm. Chest tube tips project over the right apex. There is no significant residual pneumothorax.Small bilateral pleural effusions. Stable bibasilar and perihilar pulmonary airspace opacities.

Output: 1. High endotracheal tube, 12 cm above the carina.2. Interval placement of right IJ catheter with tip at the region of the SVC.3. Stable pleural effusions and pulmonary airspace opacities as detailed above.


Instruction: Generate impression based on medical findings.

Input: 68 years old Male. Reason: copd ro pna History: copd ro pna. The apical fibrosis appears similar to prior. The left upper lobe cavities similar to the prior. Streaky left basilar opacities suggestive of atelectasis. The cardiac silhouette is normal.

Output: Cavitary lesions in the left upper lobe with biapical fibrosis, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: s/p lvad, assess for pna or effusions History: sob Patient is status post sternotomy. LVAD in place. Presternal ICD lead and generator in place. Left upper extremity PICC tip in the brachiocephalic/SVC junction.Marked cardiomegaly again noted.No pneumothorax.Persistent nonspecific opacity in the left base unchanged and partially obscured by cardiomegaly.Minimal pleural fluid.

Output: Persistent left basal opacity may reflect pneumonia. Please refer to same day CT.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: eval for CP History: L sided CP x 1 day No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.Multiple bilateral healed rib fractures.

Output: No evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: evaluate for pneumonia History: cough, fever Heart size normal. Lungs clear.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and hypoxia Chronic appearing interstitial opacities in all 4 quadrants with mild volume loss and mediastinal shift previously observed and unchanged. No focal areas of consolidation or definite effusions. Please note cutoff of the left chest wall and costophrenic angle.Mild cardiomegaly

Output: Cardiomegaly without superimposed new acute pulmonary abnormality. Underlying chronic appearing and suspected fibrotic changes


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with colon cancer CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules are again identified, some of these have decreased and others have slightly increased in size. Reference left posterior upper lobe nodule measures 6 x 6 mm, previously 10 x 9 mm. A few these nodules demonstrate cavitation/pseudo-cavitation. MEDIASTINUM AND HILA: Mildly enlarged supraclavicular and mediastinal lymph nodes remain.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: Moderately severe bilateral hydroureteronephrosis, slightly increased. Bilateral renal hypodensities persist.RETROPERITONEUM, LYMPH NODES: Several mildly prominent retroperitoneal lymph nodes are identified, slightly increased in size. For reference purposes, one of these measures 15 x 10 mm (series 3; image 123), previously 12 x 11 mm. Soft tissue infiltration at the root of the mesentery which encases the SMA and SMV has significantly increased and causes narrowing of the SMVBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: The urinary bladder is greatly distended and demonstrates a thickened wall, not significantly changedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Progression of a metastatic disease involving the mesenteric root, causing narrowing of the SMV. Mild increase of retroperitoneal adenopathy.Fluctuation in size of bilateral pulmonary metastases with stable supraclavicular and thoracic adenopathy.Slightly increased moderately severe bilateral hydroureteronephrosis. The prostate gland remains enlarged-please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Eval for cardiopulmonary disease. History: Abd pain Minimal streaky linear basilar opacity likely due to atelectasis. No evidence of pneumonia.

Output: Minimal streaky linear basilar opacity likely due to atelectasis. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: FemaleReason for Study: Reason: concern for pna History: sob Persistent complete opacification of the left hemithorax.Nonspecific perihilar opacities in right lung unchanged.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with complete opacification of the left hemithorax.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA or other acute cardiopulm process History: L sided chest pain, cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute cardiopulm process History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities. :


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: resp insuf History: same Interval removal of Swan-Ganz catheter. No change position of mediastinal drain.Stable appearance of low lung volumes with basilar atelectasis and small effusions.No significant pneumothorax.

Output: Interval line removal. No change in basilar atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: cancer follow-up s/p cystectomy for bladder cancer. History: none The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old. Cough/SOB. Evaluate for pneumonia versus COPD. Large lung volumes suggestive of COPD or asthma. No evidence of infection or edema.Normal cardiomediastinal silhouette.

Output: Large lung volumes suggestive of COPD or asthma. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Preop EVAR, abdominal aortic aneurysm. Left subclavian ICD with leads in the right atrium, right ventricle and a coronary sinus branch. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed. Sternal hardware in alignment.No pneumothorax or pleural fluid. Basal scarring. Increased subsegmental atelectasis in the lower lungs. No focal airspace opacities or signs of CHF. Tortuous thoracic aorta.

Output: Increased subsegmental atelectasis but otherwise no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with history of fever. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Syncope The cardiac and mediastinal contours are within normal limits.Low lung volumes. No abnormal focal lung parenchymal opacities, considering the of technique.No pleural effusion or pneumothorax.No osseous lesions are noted.

Output: No abnormal radiographic findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Productive cough rule out pneumonia. Normal cardiomediastinal silhouette. Mild bronchial wall thickening nonspecific but may indicate bronchitis. No focal airspace opacities or pleural fluid. No pneumothorax. Apical lucencies suggestive of emphysema.

Output: Bronchial wall thickening suggestive of bronchitis. No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: intubated patient - wprsening hypoxia History: hypoxia, altered mental status ET tube tip 4 cm above carina. NG tube extends beyond the field-of-view of study. PICC tip in right atrium.Lungs hypoinflated with persistent basilar edema, atelectasis, and effusions.

Output: Lungs hypoinflated with persistent basilar edema, atelectasis, and effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: daily am cxr History: secondary malignant neoplasm of bone. Interval extubation.Bilateral small pneumothoraces with the lung margins a few millimeters from the chest wall.Esophageal stent in place and multiple chest tubes.Nonspecific pulmonary opacity compatible with edema and atelectasis.Elevation of the left hemidiaphragm.

Output: Small bilateral pneumothoraces, new or increased from previous, with chest tubes in place. A text page was sent to Dr. Martin at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Rule out pneumonia History: Rule out pneumonia Left basilar subsegmental atelectasis and small left effusion.Heart size upper normal.Right PICC, tip in the SVC.NG tube removed.

Output: Nonspecific left basilar opacity likely atelectasis with a small left pleural effusion. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Chest congestion and cough for 3 weeks Clear lungs. No pleural effusion or pneumothorax. Mild cardiomegaly. Tortuous aorta. No acute bony abnormality. Mild disc degeneration. Large patient body habitus. Mild degenerative changes of the shoulders.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: elevated white count, malaise, r/o infection History: above Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: pneumonia History: sob Cardiomegaly with mild interstitial edema including septal lines. No evidence of infection or significant sized pleural effusions.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach, the side port above the GE junction.

Output: Pulmonary edema likely from CHF. High NG tube.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval swan History: none Cardiomegaly with mild interstitial edema slightly improved. Unchanged support devices.Swan-Ganz catheter still peripherally in the right interlobar pulmonary artery.

Output: Right jugular Swan-Ganz catheter still peripherally located in the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 23 year-old female with history of shortness of breath. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. No focal air space opacities, pleural effusions, or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: pna? pacer problem? lightheaded? History: lightheaded Left pacemaker device with leads in stable position, with leads in the right atrium and the second lead directed superoposteriorly.Borderline cardiomegaly. Calcified thoracic aorta.Large lung volumes. Stable bibasilar scarring/atelectasis.Interval resolution of interstitial pulmonary edema, with persistent pulmonary vascular redistribution. No focal pulmonary opacities.No pleural effusion or pneumothorax.

Output: Improved interstitial pulmonary edema. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: eval for acute process History: abdominal pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 91 year-old female with history of colon cancer CHEST:LUNGS AND PLEURA: Bilateral pleural effusions, unchanged from previous study. Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Heart size is increased within the interval.CHEST WALL: No significant abnormality noted.ABDOMEN:Evaluation of the visceral organs is limited due to poor enhancement.LIVER, BILIARY TRACT: Diffuse biliary dilatation involving both intra-and extrahepatic biliary tract is unchanged.SPLEEN: Focal lesions in the spleen are not well seen due to poor opacification.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Generalized anasarca.OTHER: Small amount of ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Generalized anasarca.OTHER: Small amount of ascites.

Output: Limited study due to poor opacification of the visceral organs likely secondary to heart failure. Within this limitation, no significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with history of Burkitt lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: An enlarged left lobe of the thyroid extending into the mediastinum.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: 7-mm hypodense lesion anterior to the pancreatic body on image number 106, series number 3. Further elevation of this lesion with M.R.C.P. is recommended.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate stone in the lower pole the right kidney.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: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Enlarged left lobe of the thyroid.Right nephrolithiasis.Subcentimeter hypodense, exophytic lesion anterior to the pancreas. Further evaluation of this lesion with M.R.C.P. is recommended.


Instruction: Generate impression based on medical findings.

Input: 21-year-old female status post bilateral thoracoscopy and sympathotomy. Cardiomediastinal normal limits.No focal consolidation, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: intuabted History: intubated Endotracheal tube terminates 3 cm above the carina. Remaining support devices are unchanged.Streaky basilar opacities of subsegmental atelectasis or retained secretions. Otherwise no change.

Output: Appropriate position of endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p MVR Interval removal of right chest tube and jugular catheter with no residual pneumothorax.Small lung volumes with nonspecific basilar consolidation and atelectasis with probable small pleural effusions.

Output: Increased basilar consolidation and atelectasis. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p 3/2/15 Malignant pleural mesothelioma of the right pleural space, status post partial pleurectomy, video-assisted thoracoscopy. History: follow up Right chest tube in place with a moderate pleural effusion but no pneumothorax.Right basilar opacity consistent with atelectasis.No new findings.

Output: Postoperative findings with pleural effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.History of cough. The cardiomediastinal silhouette is mildly enlarged but stable.Nodular right lower lobe airspace opacities are noted, possibly related to aspiration or early pneumonia. No pleural effusion.

Output: Right lower lobe airspace opacities possibly aspiration or early pneumonia.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with history of metastatic colorectal cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Index lesion in the left lobe of the liver is slightly enlarged measuring 2.5 x 2.2 cm on image number 17 of series #. Other two lesions have also slightly increased in size.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: New moderate left-sided hydronephrosis caused by enlarged left para-aortic adenopathy.RETROPERITONEUM, LYMPH NODES: Reference para-aortic node has significantly increased in size and now causes left-sided hydronephrosis. Now it Measures 2.2 x 2 cm on image number 116 consummate number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Enhancing mass in the bladder has increased in size and now measures 3.8 by 2.8 cm on image number 166 , series number 3.LYMPH NODES: Multiple enhancing irregularly contoured soft tissue mass is are again identified in the midline pelvis and most like to represent adenopathy. A reference lymph node measures 3.4 x 2.8 cm on image number 153, series number 3, slightly increased in size. Bilateral internal iliac and operator adenopathy have also increased in size.BOWEL, MESENTERY: Diffuse long segment circumferential thickening of the rectosigmoid colon is again noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval progression of disease with interval enlargement of the hepatic lesions, retroperitoneal and pelvic adenopathy or, bladder mass with newly developed left-sided moderate hydro-nephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: Volume overload History: As above Persistent pulmonary edema with bilateral pleural effusions. Venous catheter unchanged.

Output: Persistent pulmonary edema with bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Altered mental status. History of aspiration pneumonitis. PULMONARY ARTERY: No embolus is noted in pulmonary arteries.LUNGS AND PLEURA: New small bilateral pleural effusions. Small lung volumes. Nonspecific opacities in the dependent portions of bilateral lower lobes, which likely represent atelectasis.MEDIASTINUM AND HILA: Left sided subclavian central line tip appears to be in the SVC.CHEST WALL: Stable contrast or calcification within the the thecal sac of the thoracic spine, possibly due to prior intrathecal contrast administration.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No evidence of pulmonary embolism.2. Small amount of pleural effusions. Lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Shortness breath, evaluate pneumothorax and chest tube placement. Left costophrenic angle excluded from field-of-view.Right-sided chest tube is now directed more medially with tip projected near right superior mediastinum. Right IJ catheter with tip at SVC atrial junction.Right-sided pneumothorax is no longer visible. Low lung volumes with nonspecific basilar opacities unchanged.

Output: Right-sided pneumothorax no longer visible. Unchanged basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: complaints of chest pain, R/O pleural effusion History: chest pain The heart is normal in size. Limited assessment of the mediastinum and hila.No abnormal focal lung opacities. Lung volumes are normal.No signs of pleural effusion or pneumothorax in this single AP projection.

Output: No abnormal radiographic findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: surveillance History: sob Right hydropneumothorax smaller than before with some aeration now of the right upper lobe.Stable left pleural effusion. Right jugular catheter, tip in SVC.

Output: Right hydropneumothorax improved, with some reexpansion of the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: eval IABP placement History: CHF s/p SC IABP placement Left-sided ICD and IABP marker unchanged.Stable cardiac enlargement.Mild basilar interstitial opacities compatible with edema/atelectasis.No large pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.History of AIDS, now with chest pain and cough. The cardiac silhouette is stable.Thoracolumbar scoliosis noted.Perihilar bronchial wall thickening noted, however there is no focal pulmonary opacity or pleural effusion.

Output: Bronchial wall thickening similar to prior exams suggestive of bronchitis. No evidence of pneumonia or pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Shunt placement SHUNT DEVICE: A right-sided VP shunt exits a right frontal burr hole. The shunt courses within the soft tissues of the right neck, anterior right chest, right anterior abdomen, and terminates within the central pelvis. A portion of the calvarial course of the shunt is radiolucent which limits evaluation however the remaining shunt demonstrates no evidence of kinking or discontinuity.SKULL: No significant abnormality noted.CERVICAL SPINE: Moderate to severe degenerative disc disease of the cervical spine.CHEST: A prosthetic mitral valve is noted. The patient is status post median sternotomy. Prominent interstitial markings may reflect vascular congestion. The cardiomediastinal silhouette is enlarged and there is calcification of the aortic arch.ABDOMEN: The bowel gas pattern is nonobstructive. Multiple clips are noted within the pelvis. Moderate degenerative disc disease of the lower lumbar spine noted.

Output: Right-sided VP shunt without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: s/p L thoracent, routine r/o PTX History: none Resolution of prior left basilar consolidation and effusion.Persistent right pleural effusion with overlying atelectasis.No pneumothorax following thoracentesis.

Output: Resolution of prior left basilar opacity and effusion with no pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: intubation, dr cart History: intubation, dr cart New patchy airspace and interstitial opacities consistent with edema and aspiration.Tracheostomy tube, the tip at the level of the thoracic inlet.Right jugular catheter, tip in SVC.

Output: New pulmonary opacities consistent with edema and aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: s/p LVAD History: Removed left chest tube. Line position stable. No pneumothorax following removal of chest tube.Stable cardiomegaly. Left basilar opacity unchanged.

Output: No pneumothorax. Support devices stable. No change in left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: assess lines and tubes History: as above ET tube and venous catheters unchanged.Moderately large bilateral pleural effusions with underlying opacity compatible with atelectasis and consolidation.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: S/p bronch. History: Prior bronchial bleed Continued opacification and volume loss in the left hemithorax consistent with atelectasis and effusion.Perihilar and upper lobe airspace opacity on the right possibly related to hemorrhage and aspirated blood.Subcarinal mass impinging on the carina and right main bronchus.Interval extubation.

Output: Interval extubation. Extensive bilateral abnormalities without acute change.


Instruction: Generate impression based on medical findings.

Input: Rule out pneumonia, check tracheostomy tube Persistent yet shifting nonspecific basilar opacities, most suggestive of atelectasis and less likely aspiration. Small effusions again cannot be excluded superimposed upon decreased lung volumes.Tracheostomy tube remains 4 cm above the carina. Right jugular catheter extends into the proximal SVC

Output: Nonspecific basilar changes with suspected effusions and atelectasis. Serial imaging will be needed to confirm clearance and continued shifting of these changes indicating probable atelectasis


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: r/o underlying inf History: productive cough Cardia mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Again noted is cervical stabilization hardware and mediastinal surgical clips.

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


Instruction: Generate impression based on medical findings.

Input: Reason: 72 yo F w/ sepsis screen positive, eval for pulm infiltrates History: see above Persistent left basilar opacity consistent with pleural scarring and atelectasis as shown on the recent CT scan.No specific evidence of pneumonia or other acute change.

Output: Left pleural scarring with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Status post recent VATS procedure. Status post right upper lobe wedge resection. There is a right chest tube in place and a small residual right apical pneumothorax.Asymmetric interstitial fibrosis and subpleural heterogeneous opacities, characterized on recent chest CT .No left pneumothorax.Moderate right supraclavicular and cervical subcutaneous emphysema.

Output: Small residual right apical pneumothorax after recent right VATS procedure. Adequate position of right chest tube.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess for pulm edema vs PNA History: cough, sob, h/o heart transplant Mild improvement in the right basilar opacity. No change in mild elevation of left hemidiaphragm with basilar atelectasis. Mid and upper lung zones remain clear.Normal cardiomediastinal silhouette.No pneumothorax.

Output: Mild improvement in right basilar atelectasis. No other change.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval for pneumonia History: cough, body aches, chills, sob Worsening multifocal pulmonary opacities consistent with infection or aspiration.Mild to moderate cardiomegaly unchanged.No large pleural effusions.

Output: Worsening pulmonary opacities consistent with infection, or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Chest pain. No focal airspace opacity, pleural fluid or pneumothorax. No specific signs of pulmonary edema.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumothorax / hemothorax / fluid collection History: SOB Post-PROCEDURE Pleuroscopy / Thorascopy Interval insertion of a right chest tube with drainage of a right pleural effusion but development of a moderate size right basilar pneumothorax.Persistent moderate left pleural effusion.

Output: Decreased right pleural effusion with a new right basilar pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Cough Small bilateral effusions with basilar atelectasis. Decreased lung volumes without discrete focal additional airspace abnormality.Right jugular dual port placed since prior study, tip extends into the proximal SVC.Cholecystectomy clips

Output: Small effusions with suspected basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of right hemicolectomy due to colonic perforation secondary to Ogilvie's syndrome status post recent takedown of ileostomy and mucous fistula with ileocolonic anastomosis. CHEST:LUNG BASES: Small bilateral effusions.Also noted is a hiatal hernia with dilatation of the esophagus.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Scattered splenic calcifications stable on comparison to previous exam.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: Dilatation of the transverse colon as well is diffusely dilated distal small bowel without obvious distal obstructive lesion.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Drain is noted within the subcutaneous tissue of the midabdomen around surgical incision site.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: Dilated distal small bowel as described above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Diffusely dilated distal small bowel as well as dilatation of the transverse colon without evidence of obvious distal obstruction, favoring the diagnosis of ileus.Also noted is a hiatal hernia with esophageal dilatation.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.History of kidney cancer status post nephrectomy. Assess for metastatic disease. Clear lungs. Moderate cardiomegaly again noted. Mild left-sided pleural thickening/scarring. No pleural effusion or pneumothorax. No acute bony abnormality. Second-most superior sternotomy wire is fractured, unchanged. Mild disc degeneration.

Output: No convincing evidence of metastatic disease on chest radiography. However, radiography is less sensitive than CT in this assessment.Moderate cardiomegaly again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Reason: Evaluate ETT placement History: s/p cardiac arrest Cardiomegaly.No specific evidence of infection or edema.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.Esophageal probe noted.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Routine screening post heart transplant. Chronic elevation of the right hemidiaphragm. Lung volumes similar to previous. Mild atelectasis or scarring at the left base. No focal airspace opacities, pleural fluid or pneumothorax. Cardiothoracic ratio similar to previous. Sternotomy hardware unchanged.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Intubated. Persistent perihilar and retrocardiac opacities suggestive of mild pulmonary edema. No large pleural effusion or pneumothorax. NG tube and enteric tube tip projecting at the level of the antrum of the stomach. ET tube tip terminates at the level of the carina. Right jugular introducer in place. Interval removal of Swan-Ganz catheter. Sternotomy wires and plates and aVR in place, unchanged. Cardiomegaly, unchanged.

Output: Persistent findings suggestive of mild pulmonary edema. ET tube tip terminates at the level of the carina.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, 85 years old.Reason: assess ET tube History: s/p T lami New ET tube is 5 cm above the carina. Cardiomegaly and mild to moderate interstitial pattern suggesting edema is stable with a small left pleural effusion which is slightly larger. No pneumothorax. New drain overlies the midline.

Output: Status post ET tube placed 5 cm above the carina. Slight increase in left effusion with edema pattern otherwise stable.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Right middle lobe nodule measuring 13 by 8mm image number 64, series number 5, unchanged. Two other adjacent small nodules are also stable. No new nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Intermediate density left upper pole renal mass measures 24 by 23-mm image number 92, series number 3, stable. Other bilateral smaller hypodense lesions are also stable. Another intermediate density lesion in the mid left kidney is also unchanged measuring 25 by 20-mm image number 105, series number 3. A dedicated renal mass protocol CT may be helpful for further evaluation of these lesions.RETROPERITONEUM, LYMPH NODES: Index para-aortic lymph node measures 17 by 16 mm on image number 117, series number 3, minimal increase in size from previous study . Index mesenteric lymph node measures 15 by 16mm on image number 125, series number 3. This lymph node has also minimally increased in size. Second mesentery index lymph node measures 50 by 11-mm image number 137, series number 3.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 to minimally increased retroperitoneal and mesentery lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old. Unremarkable cardiac and mediastinal silhouette. Catheter tip in the SVC.Bilateral airspace and interstitial opacity, greater on the left, compatible with pneumonia, not significantly changed from the previous day.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 51 year old female with sigmoid colon cancer. Evaluate response. CHEST:LUNGS AND PLEURA: Right middle lobe scarlike opacities are unchanged. A lingular micro-nodule is also unchanged. Right basilar subsegmental atelectasis/scarring. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: Right chest wall port catheter in place.ABDOMEN:LIVER, BILIARY TRACT: Punctate segment 7 hypodense lesion is too small to characterize. No suspicious mass lesions. No intrahepatic biliary dilatation. The portal and hepatic vasculature is patent. The gallbladder is unremarkable.SPLEEN: A splenic hypodensity is unchanged, probably benign.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severe left hydronephrosis and hydroureter is grossly unchanged. The cause of this finding is presumed to be a mass in the left lower pelvis as described below. The right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A previously referenced mass in the left lower pelvis measures 5.1 x 3.6 cm on axial image 162/215 which is slightly smaller when compared to the prior exam where it measured 5.9 x 3.6 cm. The previously noted soft tissue density at the rectal stump suture line is not clearly visualized on today's exam. Right lower quadrant ostomy is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Tubular cystic structure in the left adnexa is unchanged and probably represents hydrosalpinx.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval decrease in the size of a left lower quadrant mass.2.Stable left hydronephrosis and hydroureter.3.Stable left hydrosalpinx.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p VSD partial repair, w/ pulmonary edema on ecmo History: -- No change in airspace predominant opacities suggestive of edema or ARDS.Unchanged support devices.

Output: Stable support devices and pulmonary opacities, with no new findings.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with a history of base of the tongue cancer, status post chemo/RT, evaluate for disease and compare to previous LUNGS AND PLEURA: Stable scattered micronodules. No new suspicious nodules or masses can be identified.MEDIASTINUM AND HILA: Previously noted left thyroid lobe hypodensity significantly decreased in size and most likely represented a small cyst.No mediastinal or hilar lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Right chest port has been removed.Left lateral wall fat containing mass is unchanged and most likely represents a lipoma.Stable sclerotic focus posteriorly in the left eighth rib.UPPER ABDOMEN: NG tube in place.Cholelithiasis.Splenic artery aneurysm, unchanged.

Output: No evidence of metastatic disease. Decreased size of the left thyroid lobe hypoattenuating lesion. Stable left chest wall fat containing mass. Stable splenic artery aneurysm.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Hypertension Cardiac mediastinal silhouette is unremarkable.Numerous calcified granulomas compatible with prior granulomatous disease.No focal areas of consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 54 year-old man with metastatic melanoma. Restaging exam to evaluate disease status; please compare to previous. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary metastatic nodules are reidentified which are diffusely larger in size. No new pulmonary nodules are appreciated. The reference nodule in the superior segment of the left lower lobe as seen on image 40/104 now measures 1.3 x 1.1 cm (this in comparison to 1 x 0.9 cm on CT of 1/18/2008. The left lower lobe nodule now measures 1.0 x 0.9 centimeters as seen on image 69/104. Other metastatic nodules seen in the lungs have grossly increased in size. The large pleural-based metastatic mass within the right lower lobe appears stable.MEDIASTINUM AND HILA: Extensive mediastinal and hilar confluent lymphadenopathy has increased in size which causes compression of the esophagus with proximal dilatation.CHEST WALL: Bilateral axillary lymphadenopathy and posterior subcutaneous metastatic nodules are reidentified.ABDOMEN:LIVER, BILIARY TRACT: The large right lobe metastatic liver mass is larger in size and measures 9.2 x 8.1 cm as seen on image 93/229. Hepatic vessels are patent. There is no evidence of intrahepatic or extrahepatic ductal dilatation. The gallbladder is normal in appearance.SPLEEN: No significant abnormality notedPANCREAS: The mass in the uncinate process of the pancreas appears larger.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The exophytic right renal metastatic lesion as seen on image 105/229 has increased in size from prior study. A subcentimeter hypoattenuation in the right kidney is stable and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: Reference retrocaval lymph node measures 2.3 x 1.7 cm as seen on image 110/229.BOWEL, MESENTERY: Scattered mesenteric lymph nodes are reidentified.BONES, SOFT TISSUES: Lytic metastatic lesion involving the vertebral body and right pedicle of L5 is reidentified. Lytic lesion in the body of L2 vertebra is reidentified.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: The reference right external inguinal lymph node now measures 2.8 x 1.8 cm as seen on image 216/229.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Widespread metastatic disease with interval progression.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with large B-cell lymphoma CHEST:LUNGS AND PLEURA: Right lower lobe nodular densities, which may represent parenchymal disease versus consolidation. One of the nodules measure 11 x 7 mm, image number 32, series number 4. Minimal right-sided pleural effusion and pleural thickening. Right apical scarring. Small blebs in the right upper lobe.MEDIASTINUM AND HILA: Previously measured right retrocrural mass is very low density and measures 16 x 13 mm image number 67, series number 3. Enlarged left lobe of the thyroid with heterogeneous density is unchanged.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: Left pararenal mass has a very low density and measures 8.1 x 3.4-cm on image number 91, series number 3 the encases the left renal vessels. Benign renal cyst. Mild left hydronephrosis is unchanged.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:Limited examination of the pelvis to to extensive beam hardening artifact caused by bilateral total hip arthroplasties.UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval decrease in the size of the left pararenal mass. Right retrocrural mass is unchanged.Right lower lobe nodular densities in the lung, which may represent consolidation versus neoplasm. Further follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Preoperative evaluation. Cardiomediastinal silhouette within normal limits for age.Spiculated, approximately 2.5 cm nodule projected within the left upper lobe. No additional focal pulmonary opacities or pleural effusions.Calcified pleural plaque which may reflect sequela of prior complicated effusion or asbestos exposure.Chronic appearing deformities of lateral inferior ribs. Compression deformities of T5 and T6 and mild compression deformity of T12.

Output: Spiculated left upper lung nodule highly suspicious for pulmonary neoplasm. Recommend CT for further evaluation.Findings discussed with PLATT, ANDREW at 9:42 a.m. on 2/25/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: ro PNA History: cough x 2 weeks with SOB, hx of CLL Lungs clear.Heart size normal.Nipple shadow stimulating nodule right lower lobe.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: History of tongue cancer. Evaluate for recurrence status post surgery. Rule out lung metastases. LUNGS AND PLEURA: Mild scarring anteriorly in the right middle lobe.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Subcentimeter cyst in the left lobe of liver, unchanged.

Output: No evidence of metastases and no change.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: ?pna History: 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: 74-year-old male with left lower lobe lesion and cough. LUNGS AND PLEURA: Right lower lobe pleural based opacity with internal air is unchanged in size and appearance. Micronodule in the right major fissure is unchanged, and likely represents an intrapulmonary lymph node. No pleural effusions. No new suspicious pulmonary nodules. Minimal pleural thickening in the left may be postinflammatory.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Pleural-based opacity in the right lower lobe is unchanged in size and appearance. Follow-up in one year is recommended to confirm stability.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: PNA History: sob Low lung volumes with basilar atelectasis.Stable left pulmonary nodule which is previously judged to represent a hamartoma.Progression of left basilar airspace opacity which may represent a developing infection. Follow-up recommended.No pneumothorax. No pleural effusion.

Output: 1. Possible left basilar pneumonia. Follow-up recommended.2. Stable left pulmonary nodule, judged to represent hamartoma or a prior CT study.3. Basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Nontraumatic aortic valve disorder post removal of aortic mass. Interval removal of mediastinal drains with a small to moderate retrosternal air collection. Sternotomy hardware appears similar in alignment. Mild basal atelectasis with associated bronchial wall thickening suggesting aspirated secretions. No pneumothorax. Small nodular opacity in the projection of the left eighth rib may reflect summation artifact from nipple shadow or debris within an airway.

Output: Retrosternal air collection status post mediastinal drain removal.


Instruction: Generate impression based on medical findings.

Input: Reason: infection? fever unclear etiology. History: as above Unremarkable cardiac and mediastinal silhouette. No sign of pneumonia or other acute disease.Catheter tip in the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: RECURRENT MALIGNANT (CLL) PLEURAL EFFUSION History: worsening sob Small pleural effusions unchanged.No specific evidence of infection or edema.Heart size normal.Pectus excavatum deformity.

Output: Stable small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: pneumothoraces bilaterally History: as above Bilateral pleural vents with no pneumothorax.No significant pulmonary or pleural abnormality.Tracheostomy tube tip 8 cm above the carina.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval lung fields History: s/p AVR Small lung volumes with a mild interstitial edema pattern.Surgical drain overlies the right side of the chest.ET tube low, at the level of the right main bronchus, subsequently repositioned.Right jugular introducer, as well as a second right jugular Swan-Ganz catheter, terminating in the right pulmonary artery.Left subclavian pacemaker, leads unchanged in position.Status post aortic valve repair.

Output: Mild interstitial opacities. Low ET tube. A more recent radiograph has been interpreted.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: r/o PNA History: leukocytosis hx COPD s/p cystectomy No change in bibasilar and perihilar lung opacities which may represent aspiration, infection, or atelectasis. Ureteral stents partially visualized.

Output: No change in bibasilar and perihilar lung opacities which may represent aspiration, infection, or atelectasis.