Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Left chest pain and cough. Unchanged cardiomegaly and enlargement of central pulmonary vasculature. Coarse interstitial abnormality is chronic. No focal air space opacity. Osseous stigmata of sickle cell disease.

Output: No radiographic evidence of acute chest. No acute pulmonary abnormality. Cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: Determination if patient has acute respiratory infection History: Fever, prior PNA/aspiration, cough Small lung volumes with basilar atelectasis and elevation of right hemidiaphragm, not significantly changed.The findings are compatible with previously demonstrated pulmonary embolism.No specific evidence of pneumonia.

Output: Basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: fever, evaluate for infectious process History: as above Marked rotation with scoliosis and shift of the mediastinum to the right. Fragmented bullet projected over the lower spine, unchanged. No sign of pneumonia or other significant interval change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old. ET tube tip approximately 1 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery, slightly withdrawn compared to the previous radiograph.Pacemaker leads unchanged.Patchy bilateral air space opacity with partial atelectasis in the right upper lobe and pleural effusions, greater on the left.No new findings.

Output: Swan-Ganz catheter tip in the area of the proximal main pulmonary artery. No other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Eval ETT and OG tube after adjustment History: Resp failure.Additional history per EMR: Sarcoidosis, CHF (EF 36%), COPD. Endotracheal tube, AICD unchanged. Enteric tube terminates beyond the field-of-view.Bilateral airspace opacities continue to diffuse bilaterally.Small left pleural effusion.Stable cardiomegaly.

Output: Bilateral airspace opacities may reflect atypical edema, aspiration, hemorrhage, or infection.


Instruction: Generate impression based on medical findings.

Input: 64 year-old female metastatic CRC. Evaluate response to chemo. CHEST:LUNGS AND PLEURA: Tiny nodule at the left lung base (image 61; series 5) is stable and was present in retrospect. Second nodule in the superior segment of the right lower lobe as seen on image 40 is unchanged. No other new nodules seen. No effusions.MEDIASTINUM AND HILA: Small nodes not pathologic by size criteria, unchanged.CHEST WALL: Right chest port.ABDOMEN:LIVER, BILIARY TRACT: Multifocal liver lesions are again noted but somewhat more cystic appearing on the current exam compared to prior. The largest conglomerate lesion is seen coursing between segment 7 and 8 measures 10.5 x 7.0 cm (image 87; series 4). This is roughly stable. Other liver lesions also appear stable in size.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small peripancreatic lymph nodes are stable.BOWEL, MESENTERY: Possible tumor in the region of the ileocecal valve (image 140; series 4) and ascending colon appears to represent serosal spread of disease. It is difficult to characterize but stable in appearance since prior exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable exam. Liver lesions appear slightly more cystic on the current exam. There appears to be serosal tumor spread along the ileocecal valve and a sending colon. Tiny pulmonary nodules are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: 38F with upper abdominal pain History: burning abdominal pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Left PICC, tip in subclavian.Cholecystectomy clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: PTX? History: upright please - sudden L chest pain, sharp, pleuritic No evidence of pneumothorax. Borderline heart size.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with metastatic renal cell cancer. Evaluate disease status. CHEST:LUNGS AND PLEURA: Scarring at the lung apices bilaterally. Stable centrilobular subcentimeter nodules in the right lower lobe and right middle lobe. The etiology is more likely to be infectious, however, possible to metastatic disease cannot be entirely excluded. Postsurgical change in the right middle lobe is unchanged.MEDIASTINUM AND HILA: Reference subcarinal lymph node measures 13 x 13 mm at axial image number 36 on series number 4, unchanged. Reference anterior diaphragmatic lymph node is smaller measuring 6 x 5 mm on image number 70, series number 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted. Calcification compatible with old granulomatous disease. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measuring 11 x 13 mm is unchanged on image number 92/202, series number 4. KIDNEYS, URETERS: Right kidney is absent. Left kidney has multiple hypodensities which are unchanged from previous CT, likely representing simple cysts. Cortical scarring in the lower pole of the left kidney is also 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:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metastatic left pubic bone lesion, stable compared to previous CT. OTHER: No significant abnormality noted.

Output: Expansile metastatic lesion in the left pubic bone is stable. Adrenal lesion is unchanged.Stable to decreased subcentimeter nodules in the right lower lobe and the right middle lobe. The etiology of these nodules is not certain however their distribution suggests an infectious etiology, however, metastatic disease cannot be entirely excluded.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with wheezing, shortness of breath, and abnormal spirometry. Evaluate for asthma versus interstitial lung findings. Cardiomediastinal silhouette is unremarkable. No evidence of focal opacities or findings consistent with interstitial lung disease.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: swan in place History: as above Cardiomegaly with mild basilar edema and small pleural effusions, improved since yesterday.Right jugular Swan-Ganz catheter, tip in right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Improving CHF, with decreased edema and pleural effusions. Swan-Ganz catheter unchanged in position.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old. Abdominal pain in the LUQ and palpable nodule/mass upon palpation. No discrete fluid collection or abnormal solid mass lesion is identified. The area of reported palpable abnormality/mass corresponds with a lateral rib which is tender to palpation.

Output: No sonographic abnormality to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: infxn, pneumothorax History: new oxygen requirement Right IJ line unchanged. Mild pulmonary edema and patchy left basilar opacity again noted. Small pleural effusions, unchanged. Unchanged heart size. No pneumothorax.

Output: Mild pulmonary edema with pleural effusions and patchy left basilar opacity again noted. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 89 yearsGender: MaleReason for Study: Reason: eval for PNA, aspiration, ETT placement History: confusion, aspiration ET tube with its tip approximately 3 cm above the carina.NG tube with its tip beyond the margin of the image.Interstitial and patchy airspace opacities in both lungs consistent with aspiration, infection, or edema.This may represent acute changes superimposed on chronic lung disease.Cardiac size is normal with mild prominence of the central pulmonary vasculature.

Output: Bilateral interstitial and patchy airspace opacities compatible with aspiration, infection, or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Positive QF-TB History: Positive QF-TB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Hx of breast CA now with worsening SOB. Previously had PleurX on the right which was removed 3 months ago. Please eval for worsening pleural effusion vs other cause of SOB History: SOB Large right pleural effusion extending above the level of the hilum, markedly increased since the previous radiograph, with underlying atelectasis.Port catheter with its tip in the area of the SVC.Small left effusion.

Output: Large right pleural effusion, markedly increased compared to previous.


Instruction: Generate impression based on medical findings.

Input: Chest tube removal The 2 mediastinal chest tubes have been removed without associated complication. The inferior left basilar chest tube is otherwise unchanged along with the underlying cardiopulmonary appearance. Please see subsequent report

Output: Mediastinal chest tubes have been removed without complication


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: ct hx History: ct hx Right chest tubes removed with no pneumothorax.Nonspecific basilar atelectasis and small pleural effusions are unchanged.Heart mildly enlarged status post sternotomy.

Output: No pneumothorax following removal of right chest tubes.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male status post liver transplant febrile with altered mental status CHEST:LUNGS AND PLEURA: Blurring secondary to respiratory motion.Atelectasis/Consolidation of the right middle lobe and right lower lobe with increasing pleural effusion on the right. Interval improvement of left pleural effusion. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant with multiple surgical clips noted. Irregularity of the liver contour with pericapsular and subcapsular fluid collection compatible with expected post surgical pericapsular and subcapsular hematoma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left mid pole water density renal lesion compatible with a simple renal cyst and unchanged from prior (series 4 image 113). Right subcentimeter high-density renal lesion, unchanged from prior (series 4 image 110). No hydronephrosis or hydroureter defect.LYMPH NODES: No significant abnormality noted.VASCULATURE: Atherosclerotic calcifications involving the abdominal aorta and right iliac arteries.BOWEL, MESENTERY: Interval decrease in ascites. Incisional ventral hernia of small bowel and transverse colon. NG tube with its tip noted coiling in the stomach.SOFT TISSUES: Subcutaneous fluid collection adjacent to the right transverse surgical staples compatible with resolving hematoma. Multiple transverse mid abdomen surgical staples.Interval decrease in anasarca.PELVIS:REPRODUCTIVE TRACT: No significant abnormality noted. BLADDER: No significant abnormality noted. LYMPH NODES: See LYMPH NODES, above.VASCULATURE: See VASCULATURE, above.BOWEL, MESENTERY: See BOWEL, MESENTERY, above.SOFT TISSUES:See SOFT TISSUES, aboveBONES: No significant abnormality noted.

Output: 1.Increase in right pleural effusion with atelectasis/consolidation of the right middle lobe and right lower lobe.2.Post liver transplant changes are expected pericapsular and subcapsular hepatic hematoma.3.Incisional ventral hernia of transverse colon.4.Interval decrease in ascites and anasarca.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Swan line placement History: none Possible small left pleural effusion. No other significant abnormality.Heart size normal status post sternotomy.Left subclavian ICD, leads unchanged in position.New right jugular Swan-Ganz catheter tip in right main pulmonary arteryStatus post valve replacement.

Output: Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Tachypnea Swan-Ganz redundant in the right atrium along with other support of hardware unchanged. Cardiopulmonary appearance is also similar, see subsequent report

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Cough. Shortness of breath. Low lung volumes. Mild bibasilar atelectasis similar to prior. No focal consolidation, pneumothorax or pleural effusion. Upper limits of normal cardiomediastinal silhouette. Reverse right total shoulder arthroplasty.

Output: Low lung volumes, with no acute interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Suicidal ideations. Medical clearance. The cardiac and mediastinal contours are within normal limits. Lung volumes are normal. No abnormal focal lung parenchymal opacities. The pleural spaces and visualized bones are within normal limits.

Output: Chest radiograph within normal limits.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: eval for infiltrate History: febrile neutropenia, shortness of breath Interval development of right upper lobe opacity compatible with pneumonia.Interval development of left basilar opacity which can represent infection or atelectasis. Low lung volumes.Heart size upper normal.No pleural effusion. No pneumothorax.

Output: Interval development of right upper lobe pneumonia. Left basilar opacity may be atelectasis secondary to low lung volumes.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with with dyspnea, history of DVT, INR of 1.5. Evaluate for PE. Study is limited by motion artifact.CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: Diffuse groundglass opacities with scattered centrilobular nodules. Mild bronchial wall thickening bilaterally.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Left thyroid nodule.Hiatal hernia.CHEST WALL: Degenerative changes of the lower thoracic spine. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Diffuse prominent is a ground glass opacities bilaterally with scattered centrilobular nodules. Differential considerations include noncardiogenic pulmonary edema versus diffuse alveolar hemorrhage. Viral infection is a less likely consideration. Favor edema.2. No evidence of pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: r/o pulm edema History: shortness of breath No acute cardiopulmonary abnormality. Small calcified granuloma on the left.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Acute dyspnea. Evaluate for edema versus new effusions. Interval increase in right basilar opacity and moderate right pleural effusion. No focal opacity or large effusion on the left. The heart size is normal.Mottled appearance and lucency of the right distal clavicle likely represents a metastatic lesion.

Output: 1. Right basilar opacity compatible with edema and moderate right pleural effusion. 2. Probable right clavicular metastatic lesion.


Instruction: Generate impression based on medical findings.

Input: 19 year old female, kicked to right rib cage one month ago, complaining of persistent pain. Evaluate for rib fracture or pneumothorax. Local chest No focal airspace opacities. No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.No displaced rib fractures.

Output: No evidence of displaced rib fracture or pneumothorax. No other acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: Lead placement History: rising pacing threshold No significant cardiopulmonary abnormality.Right subclavian biventricular dual-chamber pacemaker.

Output: No significant abnormality. Unchanged pacemaker.


Instruction: Generate impression based on medical findings.

Input: Reason: new trach placement. Also neutropenic fever, eval for new infection History: new trach, neutropenic fever The tracheostomy tube, venous catheter and NG tube unchanged.Bilateral diffuse airspace opacities, not significantly changed since the previous radiograph.No new findings.

Output: Diffuse airspace opacity compatible with infection without significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: FemaleReason for Study: Reason: eval lung fields History: s/p CABG ET tube has been removed.Chest/mediastinal tubes and right IJ Swan-Ganz unchanged.Stable cardiac enlargement.Pleural effusions and basilar atelectasis slightly increased from the prior exam.No evidence of a pneumothorax.Mild gaseous distention of the stomach.

Output: Interval extubation. Mild increasing left pleural effusion and left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 25 year-old female with right upper quadrant pain, history of gallstones. Evaluate for cholecystitis. CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. The gallbladder is mildly distended, but does not demonstrate wall thickening or pericholecystic inflammatory changes. There is no evidence of common or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A 1.7cm by 0.5cm soft tissue density is noted in the right lower quadrant colonic mesentery, likely representing a lymph node (Image 61, Series 3).BONES, SOFT TISSUES: Streak artifact from metallic ring at the level of the umbilicus limits detailed evaluation of adjacent structures. A right thoracolumbar curve is noted. OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: A homogeneous unilocular cystic structure arising from the left ovaryis present. It measures 4.6 cm x 4.6 cm and displaces the roof of the bladder to the right.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: A 1.7cm by 0.5cm soft tissue density is noted in the right lower quadrant colonic mesentery, likely representing a lymph node (Image 61, Series 3).BONES, SOFT TISSUES: Streak artifact from metallic ring at the level of the umbilicus limits detailed evaluation of adjacent structures. A right thoracolumbar curve is noted. OTHER: No other significant abnormality noted.

Output: 1. No evidence of cholecystitis.2. 4.6cm x 4.6cm simple appearing left ovarian cyst. Followup ultrasound in 3 months is recommended. 3. 1.7cm by 0.5cm soft tissue density in the right lower quadrant colonic mesentery likely represents a borderline enlarged lymph node.


Instruction: Generate impression based on medical findings.

Input: Reason: Worsening edema? History: Shortness of breath Mild cardiomegaly.Poorly defined nodular pulmonary opacities, unchanged or slightly improved compared to previous, better characterized on a previous CT scan.Catheter tip in the SVC.

Output: Mild cardiomegaly and nodular opacities compatible with infection, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: shortness of breath History: shortness of breath Interval mid to lower zone opacities with small right pleural effusion. Cardiomegaly with vascular redistribution. No pneumothorax.

Output: Cardiomegaly with mid to lower zone opacities favoring edema with right greater than left pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Unresponsive, evaluate for lung pathology Mild cardiomegaly.No pleural effusion or pneumothorax.Lungs hypoinflated, no focal airspace opacity.

Output: Lungs hypoinflated, otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old with history of cough Stable cardiomediastinal silhouette without evidence of infection or edema. No evidence of pneumothorax or free intraperitoneal air. Partially visualized distended bowel loops with multiple small bowel air-fluid levels.

Output: 1. Stable cardiomediastinal silhouette without evidence of acute cardiopulmonary abnormalities.2. Partially visualized small bowel dilatation with multiple air-fluid levels, please refer to abdominal pelvic CT dated 2/7/16 for additional findings.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Patient status post sternotomy and CABG. New small left pleural effusion versus thickening with possible loculation. Probable left basilar atelectasis. Right lung remains clear. Unchanged heart size.

Output: New small left pleural effusion versus thickening with possible loculation. Probable left basilar atelectasis.No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: GOH History: GOH ET tube tip approximately 3 cm above the carina.Mild right basilar opacity, confirmed on recent CT scan, compatible with aspiration and infection.NG tube coiled in the stomach.

Output: Mild residual right basilar airspace opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, correlate with V/Q scan History: shortness of breath Unremarkable cardiac and mediastinal silhouette. Moderate bilateral pleural effusions with underlying atelectasis, greater on the right.Large lung volumes consistent with COPD. A suspicious nodule in the right lung shown on a recent CT scan is not clearly visible on the radiograph.

Output: COPD with bilateral pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: 43M s/p PICC line for islet cell transplant. Now pulled back. Need reimaged History: PICC line pulled back, need to reimage Left PICC pulled back from the left jugular, terminating now in the subclavian vein.No cardiopulmonary abnormality.

Output: Left PICC repositioned.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: sob History: sob Chest and pleural drains unchanged with no pneumothorax.Status post sternotomy.Mild/moderate cardiomegaly.Mild retrocardiac subsegmental atelectasis postop.Status post extubation.Right jugular Swan-Ganz catheter tip directed towards the right pulmonary artery.

Output: Status post extubation. Chest tubes unchanged with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: rule out pneumonia History: asthma but now with subjective fevers and productive sputum Linear atelectasis or scarring left lower lobe.No specific evidence of infection.Heart size near upper normal.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Mitral valve replacement Mild COPD changes without additional cardiopulmonary acute abnormality

Output: COPD and emphysematous changes


Instruction: Generate impression based on medical findings.

Input: Reason: infectious w/u History: infectious w/u Normal heart size with pacemaker leads projected in the area of the upper right atrium and right ventricular apex.ECG electrodes projected over the upper lungs bilaterally.No sign of pneumonia or other acute disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: evaluate ETT History: see above Cardiomegaly with improving edema but persistent left lower lobe consolidation and left pleural effusion.IABP catheter tip within 2 cm of the top of the aortic arch.ET tube tip approximately 5 cm above the carina.Right jugular Swan-Ganz catheter directed towards the right interlobar pulmonary artery slightly pulled back.An NG tube terminates in the stomach.

Output: ET tube tip approximately 5 cm above the carina. Improved edema with persistent left lower lobe consolidation and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: eval for pneumonia History: cough, night sweats Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: new right chest tube inserted History: new right chest tube inserted Interval placement of a second right chest tube with its tip directed inferiorly. Small lung volumes with nonspecific basilar opacity compatible with edema and atelectasis.Extensive subcutaneous emphysema.No visible pneumothorax.

Output: New right chest tube with no visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Right-sided pleuritic chest pain for 3 days. History of unknown childhood aortic/cardiac surgeries,? coarctation. Normal heart size. Diminutive size of the aortic knob. Well-circumscribed right posterior paratracheal soft tissue opacity nonspecific and could be a vascular conduit in a patient with unknown surgical history or could reflect a dilated aberrant right subclavian artery however is of unclear etiology and a dilated vascular structure or other abnormality from a delayed postoperative complication cannot be entirely ruled out.Minimal scarring in the left lung. No pneumothorax or acute pulmonary abnormality. No pleural fluid.

Output: Mediastinal contour abnormality. Recommend CT angiogram of the thorax for further evaluation.


Instruction: Generate impression based on medical findings.

Input: HIV positive patient with tachypnea. Increased work of breathing Interval mixed interstitial airspace opacities observed largely in the upper lungs bilaterally and mildly greater on the right with minimal associated volume loss. Questionable small effusions and decreased lung volumes. Borderline cardiomegaly.Mild scoliosis

Output: Interval acute new mixed airspace and interstitial opacities concerning for acute infection, appearance can be associated with pneumocystis pneumonia in light of the patient's history. Serial imaging will be helpful


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: r/o infiltrate History: history HIV, altered mental status Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: evaluate lung fields History: s/p cardiac surgery Median sternotomy with cardiomegaly status post CABG.Unchanged pleural effusions, basilar consolidation and edema.

Output: No change in pulmonary opacities and pleural effusions with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: dialysis line placement History: dialysis line placement Chest/mediastinal tubes and right IJ venous catheter unchanged.Temporary pacemaker the has been removed.No evidence of pneumothorax.Stable cardiac enlargement.Small left pleural effusion mild pulmonary edema similar to the prior exam.

Output: Stable cardiopulmonary appearance with cardiomegaly, small effusions, and mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: Lung nodule/post-op History: Lung nodule/post-op 2 right chest tubes with no pneumothorax.Right pleural effusion larger than before.Left lung unremarkable.

Output: 2 right chest tubes with no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Screening for tuberculosis 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, 19 years old.Chest pain -- rule-out acute cardiopulmonary process. Soft tissues and bony structures appear normal. Cardiac and mediastinal silhouettes are normal. Pulmonary vascularity is normal. No evidence of focal airspace disease or parenchymal mass lesions. No pleural effusions.

Output: Normal chest examination.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval for pna History: cough, occasional blood streaked sputum Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Healed left-sided rib fractures. Tracheostomy in place.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tightness History: as above Heart size was upper normal with a calcified aorta, compatible with age.Large lung volumes with mild chronic reticular interstitial opacity at the lung bases compatible with fibrosis, unchanged from previous.No sign of CHF or pneumonia.

Output: Chronic interstitial disease with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: New RLL PNA History: New RLL PNA Enteric tube extends beyond the field-of-view of study. ET tube tip just below thoracic inlet, unchanged.Right lower lobe consolidation and pleural effusion, overall less dense, likely due to decrease in pleural effusion.

Output: Persistent right lower lobe consolidation though the area at the right base is less dense likely due to decrease in associated pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: post tPA placement History: chest pain Extensive opacity and volume loss in the right hemithorax, unchanged, compatible with hydropneumothorax with underlying consolidation and atelectasis.Pleural drain extending to the right apex, unchanged.No new findings.

Output: Right hydropneumothorax with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: sob History: sob Tracheostomy again noted.No focal pulmonary opacity, pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.Chronic elevation of the left hemidiaphragm is redemonstrated.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Index pretracheal lymph node is unchanged measuring 8 x 11 mm on image number 34, series number 4.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: Heterogeneous enhancing mass in the right kidney measures 4 x 2.5 cm on image number 137, series number 4, not significantly changed from previous study.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Soft tissue mass encasing the L3 vertebra now measures 7.8 x 6.2 cm on image number 133, series number 4, slightly smaller compared to previous study. The mass enters the spinal canal. Again noted, lytic destruction of L3 vertebral body. The lesion also extends into L4 transverse process and posterior elements.Right sacral asymmetric soft tissue density suspicious for metastatic disease.OTHER: No significant abnormality noted

Output: Interval decrease in the size of the bone metastasis.Right sacral metastatic disease is seen on today's study.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: r/o pna, edema, effusion History: chest pain Left subclavian AICD with position unchanged.No focal airspace opacity.No pleural effusion pneumothorax.Vascular redistribution and cardiomegaly similar to prior.

Output: Stable cardiomegaly, without specific evidence of pulmonary edema or significant interval change.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: ro pna History: leukocytosis of unknown source, weakness, esophageal carcinoma The cardiomediastinal silhouette is unremarkable. No large pleural effusions or pneumothorax. Small lung base nodules mentioned on prior abdominal CT scan is not well seen on this study.Right chest wall port tip in the SVC/atrial junction. Esophageal stent extends across the GE junction.

Output: No acute cardiopulmonary process. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: COPD exacerbation, History: see above No pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. Right infrahilar and left lower patchy airspace opacities are increased in comparison to prior examination.

Output: Right infrahilar and left lower lobe patchy airspace opacities, increased from prior examination are nonspecific but may represent infection/aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia, cardiomegaly, effusion History: fever, recent ablation for afib Mild cardiomegaly.No significant pulmonary abnormalities.The osseous pacemaker projected over the right ventricle.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: s/p L thora History: s/p L thora Status post thoracentesis with reduction in the volume of left pleural fluid with no pneumothorax.The right pleural effusion is larger and there is increased edema.Left basilar atelectasis has improved.A Dobbhoff tube terminates in the stomach.

Output: No pneumothorax following successful left thoracentesis. Enlarging right pleural effusion and increasing edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Re-evaluate pleural effusion History: sob Catheter and single lead pacemaker unchanged.Bilateral pleural effusions, greater on the left, also unchanged.Skeletal abnormalities consistent with multiple myeloma.

Output: Persistent pleural effusions without significant change.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: Eval for fluid overload, atelectasis History: mild dyspnea requiring O2, negative V/Q scan Low lung volumes.No cardiomegaly.Perihilar fullness as well as a stable left upper lobe opacity projecting over the lower anterior first rib.No significant pleural effusions or pneumothorax.

Output: No specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: determine interval improvement in pulmonary edema History: CHF with cardiogenic pulmonary edema Right internal jugular central venous catheter tip terminates the cavoatrial junction.Diffuse basilar predominant interstitial opacities compatible with edema/atelectasis slightly increased from the prior exam.Unchanged small bilateral pleural effusions.Cardiomegaly unchanged.

Output: Diffuse basilar predominant interstitial opacities compatible with edema/atelectasis and effusions stable to slightly increased.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: Eva ETT History: intubated ET tube tip approximately 4 cm above the carina.NG tube doubled back in the stomach.Bilateral catheters extending to the SVC.Bilateral basilar opacity compatible with atelectasis and consolidation, greater on the left.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: diaphoresis; SOB History: see above Loop recorder projects over the cardiac ventricles.Persistent low lung volumes with elevation of the right hemidiaphragm. Basilar opacities of subsegmental atelectasis are unchanged. Small pleural effusions. Heart size is enlarged. No interval pneumothorax.

Output: No significant change in basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with hypoxia. Cardiomediastinal silhouette is unchanged.Low lung volumes. Unchanged pulmonary nodules. No new focal lung opacity. No pneumothorax.Right central venous catheter with tip in the SVC, unchanged.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of non-small cell lung cancer status post chemotherapy CHEST:LUNGS AND PLEURA: Reference left upper lobe pulmonary nodule measures 23 x 20 mm (series 5; image 31), previously 23 x 22 mm when remeasured.No significant change in the size of the previously noted bilateral pulmonary nodules.Slight increase in bilateral pleural effusions, left greater than right. MEDIASTINUM AND HILA: 13 x 10 mm paratracheal lymph node (series 3; image 33), previously 15 x 9 mm. Reference left hilar lymph node is no longer measurable. Cardiomegaly. Vascular calcifications. CHEST WALL: Scattered metastases involving the ribs and thoracic spine, not significantly changed from 11/4/09. Pacer wires.ABDOMEN:LIVER, BILIARY TRACT: No gross change in the size or number of the hepatic metastases, suspected to be diffuse rather than scattered with underlying congestion. Reference lesion in segment 4 measures 16 x 16 mm, unchanged (series 3; image 95).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 10 x 9 mm left adrenal nodule (series 3; image 113), with this 11 x 11 mm.KIDNEYS, URETERS: Bilateral renal scarring and cysts remain.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Clips are seen throughout the retroperitoneum. Extensive vascular calcifications with mild dilatation of the proximal celiac artery, unchanged. Mild ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Numerous osseous metastases involving the lower lumbar spine and pelvic bones, not significantly changed in number, however a few have mildly increased in size compared to 4/29/09.OTHER: Mild ascites.

Output: No significant change in the pulmonary nodules. The previously described small left hilar node is no longer definitively measurable. No gross change in the hepatic metastases or thoracic osseous lesions. Slightly increased osseous metastases in the pelvis, though this is compared to 4/29/09.New mild ascites.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: evaluate lung fields, ETT History: s/p TECAB Bilateral chest tubes with no pneumothorax.Mild basilar postop subsegmental atelectasis and mild cardiomegaly.ET tube tip approximately 5 cm above the carina.Right jugular introducer unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval effusions History: known effusions, chest tubes to water seal Bilateral pigtail pleural drains, with no pneumothorax.Unchanged edema like opacities, small pleural effusions and basilar atelectasis.Support devices unchanged in position.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: chest pain in patient with sickle cell crisis History: chest pain Basilar volume loss with reticular opacities of atelectasis and possibly aspirated secretions. Mild cardiomegaly. No pneumothorax. Mild osseous changes reflecting known sickle cell disease.

Output: Basilar opacities compatible with atelectasis in the setting of acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: 55M follow-up flash pulm edema History: flash pulm edema Improving left lower lobe consolidation, with residual basilar subsegmental atelectasis.Heart size normal.No specific evidence of edema.

Output: Improving left lower lobe consolidation with no new findings.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: chest tube eval History: chest tube ET tube removed.Right IJ Swan-Ganz and chest/mediastinal tubes unchanged.Orphaned left-sided ICD redemonstrated.Decreased lung signs of stable cardiac mediastinal silhouette.Median sternotomy is intact.Mild gaseous distention of the stomach.

Output: Interval removal of an ET tube. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Previously observed shunt catheter projected over the right hemithorax appears unchanged yet incompletely visualized.No underlying cardiopulmonary abnormality, specifically the left small effusion and atelectasis has resolved

Output: Resolved small left effusion and atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Evaluate support devices. Left subclavian ICD and right PICC unchanged. Swan-Ganz catheter with its tip in the right descending pulmonary artery. IABP marker in the proximal descending aorta, unchanged.Moderate cardiomegaly with basilar opacities compatible with edema, atelectasis, effusions appearing similar to prior.

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


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: swan History: as above Swan-Ganz catheter has been pulled back slightly still terminating in the right pulmonary artery. Slight increase in left basilar opacity. Small left pleural effusion again noted. No pneumothorax. Unchanged cardiomegaly.

Output: Swan-Ganz catheter, as above. Increased left basilar opacity, likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with history of multiple lytic lesions found on CT of chest abdomen September 2011 This study is severely limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Bilateral large pleural effusions, increased in size compared to previous study.Bilateral patchy airspace opacities which may represent pneumonia. Bilateral lower lobe subsegmental atelectasis.MEDIASTINUM AND HILA: Calcified hilar and mediastinal granuloma. There is also noncalcified hyperdense adenopathy in the mediastinum. Index pretracheal lymph node measures 3 x 2.2 cm in image number 15, series number 3.CHEST WALL: Bilateral axillary adenopathy. Index left axillary lymph node measures 1.7-cm in image number 9, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Nodular contours of the liver, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mixed lytic and sclerotic lesions involving the left iliac bone, stable.OTHER: Generalized anasarca.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: Please see discussion aboveOTHER: No significant abnormality noted.

Output: Generalized anasarca. Extremely limited study due to lack of IV contrast.Extensive mediastinal calcified and noncalcified adenopathy, etiology unknown.Interval increase in the size of the bilateral pleural effusions.Bilateral patchy airspace opacities, suspicious for pneumonia.No significant change in the mixed lytic and sclerotic lesions involving the left iliac wing.


Instruction: Generate impression based on medical findings.

Input: Bilateral rhonchi evaluate for infection. 3.3 cm mass in the right upper lobe. Bilateral pulmonary nodules. Severe septal and bronchial wall thickening with mild thickening of the fissures, but no pleural fluid. Heart size is upper normal.

Output: Right upper lobe mass, pulmonary nodules and diffuse interstitial abnormality suspicious for metastatic disease, a subsequent CT will be reported separately. If patient is neutropenic, fungal pneumonia is within the differential diagnosis for the mass and nodules.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluation for pneumothorax History: diaphragmatic resection and repair Questionable small right apical pneumothorax, not confirmed however on a subsequent radiograph. NG tube tip in stomach and drain in the left upper quadrant of the abdomen. ET tube tip approximately 3 cm above the carina. Mild opacity in the right base which may be related to aspiration.

Output: No pneumothorax. Mild basilar opacity compatible with atelectasis and aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: 59 year old female with history of renal cell carcinoma and breast cancer. Evaluate disease status. Given the limitations of a noncontrast enhanced study, the following observations are made.CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules are reidentified. These nodules are stable in number and size. The reference right lobe nodule measures 2.8 x 2.4 cm as seen on image 64/108 of series 5, which is not significantly changed from prior study.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous stable hepatic cysts are reidentified. SPLEEN: No significant abnormality noted.PANCREAS: A hypodense lesion seen in the body of the pancreas is secondary to streak artifact.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Enlarged polycystic right kidney with numerous cysts replacing most of the renal parenchyma. The previously identified high attenuation nodule arising from the anterior aspect of the right kidney measures 2.0 x 2.5 cm as seen on image 106/214.RETROPERITONEUM, LYMPH NODES: Diffuse aortic calcifications that extend into the common iliac arteries. The infrarenal aorta fails to taper.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The previously identified mesenteric lymph node is stable in size from prior study and measures 2.5 x 1.3 cm as seen on image 116/214.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in the numerous bilateral pulmonary nodules or the high attenuation lesion arising from the polycystic right kidney. No new metastatic lesions are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: new aflutter, eval central line placement History: see above Cardiomegaly with moderate edema.Right jugular catheter, tip in SVC.NG tube removed.

Output: Cardiomegaly with moderate lower lung zone edema with CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess flow to LPA; s/p pulm homograft History: LPA stenosis by echocardiogram The comparison chest radiograph performed on 8/20/2015 demonstrates no focal pulmonary opacities or pleural fluid. Cardiomegaly noted compatible with patient's history of tetrology of fallot.The perfusion images show diffuse mild decreased perfusion of the left lung.Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 35.1 % (upper lung 9.2%; middle lung 19.3%; lower lung 6.5 %)Right lung: 64.9% (upper lung 10.3%; middle lung 34.6%; lower lung 20.0%)

Output: Diffuse mild decrease in left lung perfusion.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: ETT \T\ central line placement History: intubated Small lung volumes with basilar atelectasis and very small pleural effusions.No reliable evidence of edema.Median sternotomy, heart size normal.Tortuous calcified aorta, status post upper abdominal endograft.ET tube tip approximately 6 cm above the carina.Right jugular catheter, tip in SVC.

Output: Basilar subsegmental atelectasis, with small pleural effusions. ET tube tip approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.History shortness of breath. Bronchial wall thickening and left basilar scarring/atelectasis. Sharply marginated left lung nodule consistent with hamartoma is better characterized on prior CT. No superimposed focal airspace opacity or pneumothorax.Cardiac silhouette unchanged.

Output: Reactive airways disease/bronchitis without specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: preop History: SOB Large lungs consistent with COPD.Heart size normal.No specific evidence of infection or edema.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.PICC. Right PICC tip at the lateral aspect of the right subclavian vein projection.Right jugular Swan-Ganz catheter tip at the level of the right descending pulmonary artery.Left subclavian ICD unchanged in position.Visualized lungs appear clear.

Output: Right PICC projects over the lateral aspect of the right subclavian vein.


Instruction: Generate impression based on medical findings.

Input: Check ICD Interval placement of a single lead left subclavian ICD with lead tip projected in the expected location of the distal ventricular septum. No associated postprocedural complicationNo distinct additional cardiopulmonary acute abnormality given portable recovery room technique

Output: Left subclavian ICD placed


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with history of pancreatic cancer. Status post Whipple surgery CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple surgery. Residual pancreas is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: Index lymph node is unchanged, measuring 10 x 6 mm image number 99, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Acute respiratory failure ETT projects 5 cm above the carina. NG mildly under advanced with side port seen at the GE junction, interval retractionRight jugular catheter terminates in the upper SVCPersistent unchanged cardiopulmonary appearance significant for cardiomegaly with compression atelectasis and/or consolidation left lower lobe with bilateral moderate effusions

Output: NG repositioned, see above


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: 51 yo male with history of AML; post-allo research screening History: evaluate No focal lung opacity, pleural effusion, or pneumothorax. The heart size is normal.

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, 30 years old.History of asthma presenting with shortness of breath. No pleural effusion or pneumothorax. Mild bronchial wall thickening. The cardiac silhouette is not enlarged. No focal lung opacity.

Output: Mild bronchial wall thickening consistent with reactive airway disease or bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: eval ett History: ett Small lung volumes with unchanged pulmonary opacities.ET tube tip approximately 4 cm above the carina.Left jugular catheter, tip in SVC.Unchanged ECMO cannulae.A Dobbhoff tube terminates in the stomach.

Output: ET tube tip approximately 4 cm above the carina. Unchanged pulmonary opacities and other support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: dyspnea History: dyspnea Low lung volumes with basilar linear opacities likely representing atelectasis. Mid and upper lung zones are clear.Heart size normal.No pneumothorax

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: r/o acs/pna/cardiomegaly History: found down No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: 50M intubated in CCU with IABP and VA-ECMO, hypoxic respiratory failure, ?line placement, ? History: 50M intubated in CCU with IABP and VA-ECMO, hypoxic respiratory failure, ?line placement, ? Unchanged pulmonary opacities and pleural effusions.Stable support devices, including the IABP and ECMO cannula.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.IABP catheter tip 5 cm below the top of the aortic arch.

Output: Unchanged pleural effusions and pulmonary opacities, and stable support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Eval for edema, atelectasis, effusion History: LV dysfunction S/P CABG MAZE No change in basilar opacities and small effusions.

Output: No change in pleural effusions and edema.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Sarcoid Fever and Chills History: Fever/Chills left luing sarcoid imuran 100 prednisone 10 Fibrosis and scarring again noted in the left lung with left-sided pleural thickening. Right lung remains clear. Unchanged heart size. Unchanged cardiac leads. Mild disc degeneration.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: eval for PNA History: high fever, recent h/o flu A, increasing desats Patchy pulmonary opacities slightly increased from the prior exam.Stable cardiomediastinal silhouette.No pleural effusions.Sternotomy is intact.

Output: Patchy pulmonary opacities minimally increased on the left since the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: pneumonia History: wheezing Probable large right-sided hemidiaphragmatic eventration. No focal lung consolidation or evidence of overt left-sided heart failure. Stigmata of previous granulomatous disease. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: 45968 History: hypoxia, history of CHF and COPD Mild basilar interstitial opacities could be aspiration or edema.No specific evidence of infection.Heart size upper normal.

Output: Mild basilar opacities suggestive of edema, versus aspiration. No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: history of positive ppd test History: chronic cough, night sweats Mild apparent elevation of the right hemidiaphragm, likely positional. 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: Male, 31 years old.Reason: lung infiltrate History: SOB; acute resp distress; Cough Cardiomegaly with new airspace opacities suggestive of edema or infection.There may be a small right pleural effusion.

Output: Severe cardiomegaly, with airspace opacities suggestive of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male; 59 years. Reason: CRC IV restaging after 6 cycles of chemotherapy History: constipation and LGIB CHEST:LUNGS AND PLEURA: Linear atelectasis in the basesMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The right hepatic lobe is largely replaced by partially necrotic masses measuring approximately 16 x 14 cm, similar to prior. Degree of necrosis appears similar to 1/20/12. Smaller hypoattenuating lesions in the left hepatic lobe are also similar in appearance. Cholelithiasis.SPLEEN: Splenomegaly, measuring 18.5 cm.PANCREAS: Fatty infiltration.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions bilaterally are unchanged in size, likely representing benign cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild soft tissue stranding surrounds the mesenteric root/retroperitoneum.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: Stranding and engorged vessels surround the rectosigmoid which as thickened walls, similar to prior. No evidence of obstruction.Small fat-containing inguinal hernias bilaterally.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No significant interval change in hepatic metastases. No new findings.2. Stranding and wall thickening of the rectosigmoid may be related to neoplasm/treatment or inflammation.3. Splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: infiltrate? History: hbSS with VOC, now with O2 requirement Patchy pulmonary opacities seen throughout the lungs could represent edema related infection, but are partially artifactual of overlying skeletal sclerosis.Eventration both hemidiaphragms with overlying atelectasis.Mild cardiomegaly.

Output: Diffuse pulmonary opacities suggestive of edema or infection, partially artifact of overlying skeletal sclerosis from known sickle cell disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate ETT placement History: s/p ETT ET tube tip approximately 3 cm above the carina.Cardiomegaly with basilar opacity compatible with atelectasis and nonspecific consolidation, likely related to aspirated secretions, slightly increased.No other new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: chest tubes History: chest tubes Right-sided chest tubes again noted. No substantial change in right basilar opacity and small right pleural effusion. Right-sided subcutaneous emphysema again noted. New small to moderate size left pleural effusion and left basilar opacity. Unchanged heart size.

Output: New small to moderate sized left pleural effusion and left basilar opacity. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: s/p thoracentesis. Left upper extremity midline catheter overlying the left axilla.Cardiomediastinal silhouette within normal limits. Significant interval improvement of large left pleural effusion with residual small pleural effusion and atelectasis status post thoracentesis.No pneumothorax.

Output: Significant interval improvement of large left pleural effusion status post thoracentesis without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Sickle cell disease presenting with pain crisis. Left chest port tip at the superior cavoatrial junction. Slight improvement in lung volumes with bilateral parenchymal scarring no focal airspace opacities or specific signs of acute chest by plain film. Normal heart size.

Output: No radiographic signs of acute chest syndrome. Parenchymal scarring.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: confirm placement of centrally placed PICC History: picc line placement Right IJ venous catheter unchanged with its tip in the SVC.New left PICC line with its tip in the SVC.Decreased lung volumes with basilar opacities, right greater than left, compatible with pleural effusion and atelectasis.The current mediastinal silhouette is unremarkable.

Output: New left PICC line with its tip in the SVC. Basilar opacities again noted compatible with pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with lung cancer status post chemo radiation therapy. Evaluate progression of the disease. CHEST:LUNGS AND PLEURA: Reference spiculated nodule in the left upper lobe previously measuring 1.8 x 1.6 cm, now continues to be stable measuring 1.8 x 1.8 cm on image 22/79. Left apical nodule on image 11/79 appears to be at least stable or smaller as compared to the previous image. Other small left apical and lingular nodules remain unchanged. There is interval progression of the scar like consolidation in the left paramediastinal region medial to the index mass, consistent with radiation fibrosis.Scar like consolidation in the right apex remains unchanged. Right upper lobe ground glass nodule has decreased in size.MEDIASTINUM AND HILA: No significant lymphadenopathy.CHEST WALL: No significant abnormality noted. AABDOMEN:LIVER, BILIARY TRACT: Unchanged small round liver lucency consistent with hemangioma.SPLEEN: Unchanged hypodensities in the spleen.ADRENAL GLANDS: Enlarged lobulated bilateral adrenal glands, unchanged.KIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Stable or decreased bilateral lung nodules.2. Interval progression of the left upper and right apical lobe lung opacities, consistent with radiation fibrosis.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, 47 years old.Reason: Eval line/tubes/devices History: Eval lines/tubes/devices Heart transplant Persistent basilar atelectasis and scarring. No new opacity. Left PICC unchanged.

Output: Left PICC unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Pneumothorax Lines and tubes are unchanged. Diffuse pulmonary opacities, unchanged. Small pleural effusions, as before. Moderate right-sided loculated pneumothorax again noted. Unchanged heart size.

Output: Unchanged moderate sized right apical pneumothorax. Diffuse pulmonary opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Left arm pain and chest pain. No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits. Note is made of accentuated thoracic kyphosis.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: need for VQ History: need for VQ Cardiomegaly with enlargement of central pulmonary arteries. Translumbar port catheter. Focal atelectasis and probable mild bronchiectasis in both lower lobes unchanged.

Output: Cardiomegaly with enlargement of central pulmonary arteries. Focal atelectasis and probable mild bronchiectasis in both lower lobes unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: 1073 Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: POD 1 cardiac surg - eval lung fields History: POD 1 cardiac surg - eval lung fields Lines and tubes are unchanged. Low lung volumes, as before. Questionable mild interstitial pulmonary edema. Patchy bibasilar opacities, unchanged. Unchanged heart size. No pneumothorax.

Output: No substantial difference compared to last study.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: lung transplant History: lung transplant Unchanged pulmonary opacities and pleural effusions.No significant pneumothorax.Tracheostomy tube tip approximately 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.An NG tube terminates in the stomach.

Output: Unchanged pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: intubated History: as above Median sternotomy with small lung volumes and streaky atelectasis, unchanged.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. Stable streaky atelectasis with no new findings.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: s/p redo MVR History: SOB Left IJ venous catheter has been removed.Enteric tube with its tip in the margin of the image.Decreased lung volumes with basilar atelectasis/edema.Stable cardiomediastinal silhouette.Right pleural effusion similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with cardiomegaly and pleural effusions, right greater than left.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Cough and diaphoresis evaluate for pneumonia. No specific signs of pneumonia, pleural fluid or pneumothorax. Very small opacity in the anterior aspect of the right middle lobe new from previous and could reflect atelectatic lung and may be monitored to exclude development of infection patient's symptoms. Sternotomy hardware, superior mediastinal and upper abdominal clips unchanged. Left axillary stent.

Output: No specific signs of pneumonia, though a small opacity in the right middle lobe may be monitored by serial radiographs to assess for worsening if patient's symptoms continue.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: follow up after right nephroureterectomy for ureteral carcinoma History: none Mild cardiomegaly.No specific evidence of infection or edema.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: hypoxia, eval for pna History: hypoxia Dobbhoff tube with its tip in the stomach.Decreased lung volumes stable cardiomediastinal silhouette.Basilar opacities compatible with atelectasis/consolidation and pleural effusions improved from the prior exam.No new pulmonary opacities identified.

Output: Interval improvement in the basilar atelectasis/consolidation and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pna History: cough. syncope. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: r/o acute process History: cough, congestion for one week The lungs and pleural spaces are clear. There are several midthoracic compression fractures that were visualized 1/11/2015. There is a cavity noted in the anterior medial segment left lower lobe.

Output: No evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.History of hypoxemia status post intubation, evaluate ET tube position. ET tube tip approximately 2.5 cm above the carina. Right IJ catheter unchanged. Enteric tube tip below the field of view.Cardiomediastinal silhouette is normal and unchanged.Moderate right pleural effusion is stable. Extensive bilateral airspace opacities unchanged.

Output: Overall stable examination with moderate right pleural effusion and extensive bilateral airspace opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Transvenous pacemaker Single lead pacemaker from an IVC approach terminates in the expected location of the right ventricle. ETT terminates at the level of the clavicular heads. Worsening perihilar/peribronchial thickening and opacities on the right.

Output: Worsening pulmonary opacities on the right which appears somewhat atypical for edema and may reflect pulmonary hemorrhage in the appropriate clinical context. Aspiration is considered less likely.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of endotracheal tube adjustment. Endotracheal tube tip 5 cm above the carina. The remaining devices and lines are unchanged. Stable cardia mediastinal silhouette. Minimal bibasilar opacities likely representing aspiration/atelectasis.

Output: Endotracheal tube tip 5 cm above the carina, but otherwise stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Shortness of breath, history of pulmonary TB . Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.No focal airspace opacity. Mild volume loss of the right upper lobe.

Output: Progressive mild volume loss of the right upper lobe without focal airspace opacity. Findings may represent mucous plugging. Follow-up radiograph is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for infiltrates History: fever Unremarkable cardiac and mediastinal silhouette.Focal calcification or bone island projected over the right upper lobe.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old. The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Mild gaseous distention of multiple loops of bowel in the upper abdomen.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 72 years old Female. Reason: eval for interval change in IABP placement History: IABP. Balloon catheter marker in the proximal descending aorta and Swan-Ganz cathetertip in the right descending pulmonary artery.Multiple surgical clips in the right chest wall.No significant pulmonary abnormalities.There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is prominent.

Output: Balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: ? volume History: missed dialysis Cardiomegaly.Linear atelectasis or scarring left lung, the lungs otherwise unremarkable.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: PNA History: Fever Small lung volumes with evolving upper lobe opacities and left basilar atelectasis, which could be infection or aspiration.Right jugular catheter tip at SVC/junction level.Left subclavian ICD, leads unchanged in position.

Output: Possible evolving upper lobe opacities suggestive of infection or aspiration, or atypical edema.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: RIJ central line placement History: RIJ central line placement Interval placement right IJ central catheter terminating at the superior right atrium.Skin folds project over the chest; no pneumothorax is present. Persistent retrocardiac subsegmental atelectasis.

Output: No pneumothorax following central line placement.


Instruction: Generate impression based on medical findings.

Input: 60 years, Male. Reason: dobhoff History: dobhoff Dobbhoff with tip in the distribution of the gastric antrum. Gaseous distention of the large and small bowel may represent a generalized ileus. The inferior pelvis is excluded from the field-of-view.Interval improvement in the bibasilar interstitial and airspace opacities compared to the recent chest radiograph. Small residual right pleural effusion.

Output: Dobbhoff with tip in the distribution of the gastric antrum.


Instruction: Generate impression based on medical findings.

Input: 86 year old female with persistent cough with thick sputum production x1 month, evaluate for atypical pneumonia. Chronic blunting of the right costophrenic angle suggestive of pleural thickening/scarring. No new focal airspace opacity. No pneumothorax.Degenerative changes of the spine with compression deformity of T9 unchanged.

Output: No interval change in cardiopulmonary appearance. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: 49F ESRD on HD, missed HD yesterday, SOB with faint crackles History: SOB with faint crackles Cardiomegaly appears unchanged. Interstitial opacities and fluid within the right minor fissure may reflect mild edema. No pleural effusion or pneumothorax.

Output: Interstitial opacities and fluid within the right minor fissure may reflect mild edema.


Instruction: Generate impression based on medical findings.

Input: Hypoxia and pancreatitis Persistent small-to-moderate bilateral pleural effusions with underlying small lung volumes and atelectasis. Aspiration or even infection cannot entirely be excluded however again serial imaging will be important for clearance.Mild nonspecific cardiomegaly.Interval Dobbhoff placed, tip projects beyond inferior to the image. Right jugular catheter extends into the proximal SVC

Output: Dobbhoff tube placed


Instruction: Generate impression based on medical findings.

Input: 40 years old Male. Reason: chest pain History: sob. The cardiac silhouette is within normal limits. There is no evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: Unremarkable study. Please refer to the diagnostic CT report from 8/21/2016.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiopulmonary pathology History: sob, cp, back pain hx of chemoradiation for lung cancer Unremarkable cardiac and mediastinal silhouette. A right perihilar nodule described on the recent CT scan is not visible, likely due to its low opacity. No new findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 75 year old female with history of bladder cancer CHEST:LUNGS AND PLEURA: Left upper lobe pulmonary nodule measures 5 mm number 30, series number 6, stable. Right lower lobe nodule is increased in size and now measures 10 x 11 mm image number 67, series number 6. Left lower lobe nodule in image number 70, series number 6 has also significantly enlarged. Other scattered micronodules are relatively unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate hypodense foci in the liver and simple cyst in the right lobe are unchanged.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: Right lower quadrant ileal conduit and ileostomy is again noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Uterus, adnexa: No significant abnormality notedBLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Artifact from a left hip prosthesis limits optimal evaluation of the pelvis.OTHER: No significant abnormality noted

Output: Interval increase in the right and left lower lobe nodule suspicious for metastatic disease. No other significant change.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with squamous lung cancer CHEST:LUNGS AND PLEURA: Diffuse emphysema.Cavitary lesion in the posterior segment of the right lobe is smaller and does not demonstrate cavitation and now measures 16 by 17-mm image number 36, series number 4.There is new air space opacity in the apical segment of to right lower lobe associated with mild bronchiectasis best seen in image number 48, series number 4. Another new similar focal area of air space opacities in the left lower lobe on image number 67, series number 4. These areas may represent foci of organizing pneumonia, however, follow-up imaging is recommended to exclude neoplasm.Mild right-sided pleural effusion, unchanged.MEDIASTINUM AND HILA: Right hilar mass/adenopathy, now measures 3 x 1.9 cm image number 41, series number 3, not significantly changed from previous study.CHEST WALL: T3 sclerotic focusABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal mass measures 3.6 x 3.1 cm image number 95, series number 3, slightly enlarged compared to previous study. Right adrenal diffuse thickening is unchanged.KIDNEYS, URETERS: Subcentimeter renal lesions are unchanged.RETROPERITONEUM, LYMPH NODES: Index paraceliac lymph nodes is significantly enlarged in size and now measures 5 by 4.9-cm image number 88, series number 3. This lymph nodes compresses the main portal vein.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: Interval increase in the size of the retroperitoneal adenopathy and left adrenal metastatic lesion.Mediastinal adenopathy is unchanged.Index cavitary lesion in the right lung is smaller, however, there is new air space opacities in the right lower lobe, which may represent pneumonia versus less likely neoplasm. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: effusion v copd exacerbation v chf? History: copd, chf, malignancy with sob and poor air movement Stable cardiomediastinal silhouette in size and configuration.Mild biapical bullous changes. Slight increase in interstitial markings suggest an element of interstitial edema. No focal consolidation, sizable effusion or pneumothorax.Left apical pulmonary nodule is better demonstrated on this study and correlates with findings on prior CT chest 8/31/2016. Other previously identified pulmonary nodules are less evident.A few sclerotic lesions are identified in the ribs and thoracic spine suggesting osseous metastatic disease.

Output: 1.Interval increase in interstitial markings prominence suggests element of mild edema.2.Previously identified left apical pulmonary nodule is better demonstrated.3.Osseous metastatic disease likely progressed since prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: cardiopulm process History: cough, copd vs asthma exacerbation Cardiomegaly. Perihilar and basilar predominant interstitial and airspace opacities, compatible with mild pulmonary edema. Bilateral small pleural effusions or thickening. No evidence of pneumonia or edema. No pneumothorax. No specific evidence to suggest COPD or asthma exacerbation.

Output: Cardiomegaly. Perihilar and basilar predominant interstitial and airspace opacities, compatible with mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with metastatic prostate cancer CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the right middle lobe other subcentimeter nodules in the right lung are also stable.MEDIASTINUM AND HILA: Small mediastinal nodes are unchanged.CHEST WALL: Sclerotic rib metastases, several rib and sternum are stable.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small left adrenal myolipoma is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Well-defined 20 x 15 mm, hypodense lesion in the second portion of duodenum on image number 121, series number 21, unchanged from previous CT. This may represent a benign neoplasm in the wall of the duodenum such as gastrointestinal stromal tumor.Small mesenteric lymph nodes are stable.BONES, SOFT TISSUES: Multifocal osteosclerotic metastases are stable compared to prior exam.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy..BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic bone metastases are stable.OTHER: No significant abnormality noted

Output: Sclerotic bone metastases are stable.Well-defined, hypodense lesion in the wall of the second portion of duodenum is stable. This may represent a gist tumor. Further evaluation with endoscopy may be helpful.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: infxn, edema History: sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: incr WOB History: incr WOB Large lung volumes with moderate bilateral pleural effusions and underlying atelectasis.Catheter tip in the SVC.Skinfold over the left upper lobe but no pneumothorax or other acute change.Feeding tube traversing the esophagus and surgical drain in the upper abdomen.

Output: Pleural effusions with underlying atelectasis and no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: ILD, hypoxia Unremarkable cardiac and mediastinal silhouette. Small lung volumes with diffuse fine reticular opacities compatible with fibrosis, unchanged.Stimulator device in the spinal canal.

Output: Chronic interstitial disease with no acute change.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female with headache and abdominal pain SHUNT DEVICE: Again seen is an intracranial shunt catheter which exits the skull via a right parieto-occipital burr hole and courses down the right scalp, neck, anterior chest and enters the abdomen with tip projecting over the anterior right upper quadrant. Portions of the shunt catheter that overlie the skull are relatively radiolucent and difficult to evaluate but appear similar to prior exam, without specific findings to suggest discontinuity. The notch of the shunt valve points towards the 6 o'clock position. Orphaned shunt tubing is again noted within the neck.SKULL: No acute abnormality.CERVICAL SPINE: No acute abnormality.CHEST: Underinflated lungs which are otherwise clear.ABDOMEN: Nonobstructive bowel gas pattern. Surgical clips project over the right upper quadrant. Posterior element defects within the lower lumbar spine are again visualized.

Output: Shunt device as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval for edema, infiltrate; hx of Grave's s/p thyroid removal History: chest pain, SOB Vascular staples are present at the neck at midline. Lungs and pleural spaces are clear. Heart size is within limits of normal. No evidence of pulmonary edema

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.ICD extraction Interval removal of the left-sided ICD.A chest wall drain projects over the left hemithorax.No unexpected radiopaque foreign body is identified.Unremarkable cardiomediastinal silhouette.No evidence of pulmonary infection or edema.

Output: ICD removal, without radiopaque foreign body identified.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.History of HIV and nonproductive cough for 4 days question pneumonia. No focal airspace opacities, visible pulmonary nodules or masses. No pleural fluid or pneumothorax. Heart size is normal.

Output: No acute cardiopulmonary abnormality. If the patient has a low CD4 count, consider unenhanced thoracic CT to exclude atypical pneumonia.


Instruction: Generate impression based on medical findings.

Input: 33 years old Female. Reason: assess pneumonia History: dx and treated from pna on 3/25/15. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Nonspecific right lower lung interstitial change is noted. The cardiac silhouette is normal.

Output: Nonspecific right lung interstitial changes.


Instruction: Generate impression based on medical findings.

Input: Hypoxia and shortness of breath Marked limitation due to semiupright portable technique with rotation. Within this limitation, no definite interval change, however small effusions cannot be excluded. The previously described right midlung nodular opacity is questionably observed. Overall overlying structures obscure detail

Output: Limited exam without definite superimposed acute interval change. See detail provided


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz placement Swan-Ganz again projects into the right pulmonary outflow tract. IABP marker persists 4 cm beyond the aortic arch.Cardiopulmonary appearance is otherwise significant for decreasing perihilar changes and pulmonary edema. Vascular redistribution again observed and most likely due to semiupright positioning

Output: Swan-Ganz unchanged in improving and now mild pulmonary perihilar edema


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: ro pna History: upper abd pain, sepsis Chronic appearing basilar interstitial opacities again noted, not substantially changed. No pleural effusion or pneumothorax is evident. The heart and mediastinal contours are within normal limits for size.

Output: Stable findings consistent with mild basilar fibrosis, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old. Catheter tip in the SVC.Small lung volumes with a similar opacity consistent with atelectasis.

Output: Catheter tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: evidence of old TB infection? History: acute pain The cardiomediastinal silhouette is normal. No pulmonary opacity. Blunting of the posterior costophrenic angles on the lateral view may suggestive of small pleural effusions. No pneumothorax. Bibasilar subsegmental atelectasis. No radiographic evidence of tuberculosis.

Output: No acute cardiopulmonary disease. No radiographic evidence of tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: chest tube History: chest tube Dobbhoff tube with its tip in the stomach.Right-sided chest tube unchanged.No evidence of a significant pneumothorax.Stable cardiomediastinal silhouette.Opacities and pleural effusion similar in appearance prior exam.No new pulmonary opacities identified.TIPS is identified in the right upper abdomen.

Output: Stable cardiopulmonary appearance with pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: chest tube in place for effusion History: same Right chest tube, with a moderate size right pneumothorax slightly improved, right chest tube in place and considerable right sided consolidation.Extensive right chest wall soft tissue emphysema.

Output: Persistent but improved right pneumothorax


Instruction: Generate impression based on medical findings.

Input: Visualization of the thorax is limited by the field of view and length of scan, which excludes substantial areas of the lungs.CHEST:LUNGS AND PLEURA: Mild basilar scarring.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Right inferior pole renal cyst.

Output: No significant extra cardiovascular abnormalities in the visualized portion of the thorax.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Left-sided crackles and productive cough. Cardiomediastinal silhouette is within normal limits. No focal airspace opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: eval for pulmonary edema History: tachypnea Lines and tubes are unchanged. Bibasilar opacities and pleural effusions, not substantially different. Unchanged heart size. No pneumothorax.

Output: Bibasilar opacities and pleural effusions, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: eval lung fields History: weaning vent Support devices unchanged.Stable cardiomediastinal silhouette.No new pulmonary opacities identified.No evidence of a pneumothorax.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: effusion History: no Interval removal of one of two left chest tubes.Skin folds over the upper chest and a minimal left pneumothorax.Elevated left hemidiaphragm and left basilar opacity compatible with atelectasis and a small effusion.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.History: AML, status post stem cell transplant. Febrile neutropenia. Right central venous catheter tip in the SVC. Borderline cardiomegaly. Perihilar and basilar airspace opacities, compatible with edema although aspiration/infection cannot be excluded.No pleural effusions.

Output: Borderline cardiomegaly. Perihilar/basilar airspace opacities compatible with edema, aspiration/infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Evaluate lung fields status post right chest tube placement. History of right upper lobe neoplasm. Interval placement of right chest tube terminating medially. Large right pneumothorax with maximal pleural separation from the chest wall of around 6 cm. The remaining right lung is arch with collapsed. Suture lines consistent with resection. Volume of pleural fluid on the right difficult to assess given patient positioning but is at least moderate. Pleural plaques on the left. Right chest port unchanged in position.

Output: Persistent large right pneumothorax. The right lung has not reexpanded post tube placement.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out pneumonia History: 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: ro PNA History: shortness of breath Normal heart size with a moderately tortuous aorta. Diffuse bilateral streaky pulmonary opacities compatible with scarring and pleural calcification.Focal subsegmental atelectasis in the left lower lobe may be due to bronchial mucous plugging or mild aspiration. No specific evidence of pneumonia.

Output: Extensive chronic abnormalities with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female history of colon cancer status post resection on chemotherapy with sarcoidosis. CHEST:LUNGS AND PLEURA: Overall, the numerous bilateral pulmonary nodules have not significantly changed in size. The reference lesion in the right midlung measures 12 x 11 mm, unchanged (series 4; image 41).Multiple areas of mosaic perfusion have not significantly changed nor have scattered fibrotic changes.Scattered calcified pleural-based opacities remain.MEDIASTINUM AND HILA: Numerous enlarged bilateral hilar and mediastinal lymph nodes remain, not significantly changed, some calcified. The reference subcarinal lymph node is stable, measuring 4.3 x 2.6 cm.Moderate focal stenosis of the left brachiocephalic vein is unchanged (series 3; image 22). No collateral vessels are identified.CHEST WALL: The right-sided port terminates at the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver is identified.Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 15 x 15 mm portacaval lymph node, stable. The other upper abdominal lymph nodes are also grossly unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Partial colectomy.The previously described right lower quadrant mass is no longer visualized. Surgical clips are identified in the right lower quadrant.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post resection of the right lower quadrant peritoneal mass. Otherwise, stable pulmonary findings and thoracic/abdominal adenopathy


Instruction: Generate impression based on medical findings.

Input: Age: 19 yearsGender: FemaleReason for Study: Reason: r/o infiltrate History: cp, sob Bronchial wall thickening and mild bronchiectasis bilaterally unchanged from the prior exam.Lingular subsegmental atelectasis unchanged.No new pulmonary opacities identified.No pleural effusions.

Output: Bronchial wall thickening and mild bronchiectasis unchanged from the prior exam. No acute abnormality identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval port placement/edema/infiltrate History: port bleeding/leakage Mild to moderate cardiomegaly without edema.Right jugular catheter tip at cavoatrial junction. Left subclavian ICD, leads unchanged in position.Right PICC and Swan-Ganz catheter removed.

Output: New right jugular catheter terminating at the cavoatrial junction. Mild to moderate cardiomegaly without CHF.